STDs Expert Forum
The nightmare continues!
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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The nightmare continues!

Hi Doc, I
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239123_tn?1267651214
I'll try to help, but your urologist probably knows more than I do; prostatitis isn't an STD and I'm not an expert in it.

The only actual STD problem you have had is the gonorrhea.  The only other slight possibility may be trichomoniasis, which commonly is acquired simultaneously with gonorrhea.  Trichomonas probably (??) can get into the prostate and/or might mimic prostatitis.  It's almost impossible to diagnose in men without special research tests, so the usual approach is to give treatment just to be safe.  Therefore, you should talk to the urologist about trying treatment with metronidazole (Flagyl); or even better, the newer drug tinidazole (Tindamax), which is more active against trichomonas.  Tell him you don't want to rely on the commonly used single-dose treatments; a proper trial should include treatment for a week or so.  You could also speak with the woman you caught your gonorrhea from, to see if by any chance she has had trichomoniasis; it's much easier to diagnose in women than men.

But don't get your hopes up about trich.  Most likely the diagnosis of prostatitis is correct.  Nonbacterial prostatitis is more common than bacterial, and is a mysterious condition.  Most cases are probably not due to infection at all, but some sort of non-infectious inflammation--generally not well understood.  However, if your urologist is certain you have a bacterial case (e.g., a positive culture for one of the typical bacteria that cause it), that probably is reliable.  Even for nonbacterial or uncertain cases, most urologists and other experts assume infection as a possibility and treatment with antibiotics is the norm.  However, antibiotics often make no difference in symptoms.  STDs might sometimes trigger such problems, but this also is a matter of uncertainty and some controversy.  However, prostatitis itself is not due to STD and is not acquired sexually.

This all sounds like bad news.  But it's important to know that nonbacterial prostatitis does not appear to be harmful, only uncomfortable.  There probably isn't any serious risk of anything really bad--no infertility, no cancer, and nothing you can transmit to a current or future sex partner, assuming trichomonas isn't an issue.  In the long run this whole business is likely to be an inconvenience for you more than a significant health threat.

To the specific questions from your follow-up comment below:

1,3) Although gonorrhea may have triggered your current problem, gonorrhea always responds to the treatments you had and you can be sure it's no longer an issue.  Ditto for chlamydia, if you happened to have it.

2) Most likely your prostatitis is nonbacterial, if only because it's more common than the bacterial variety.  Either way, there is no known risk of harm to your girlfriend.

4) Gonorrhea isn't an issue, so at this point the specific test doesn't matter.  NAAT is the test of choice, and can be done on either urine or a urethral swab.

5,8) No medical problem, for practical purposes, and no antibiotic, changes the reliability of HIV testing.  You really don't need further HIV testing, but if you do it, you can rely on the result.

6) Prostatiis does not commonly cause infertility, but this is a question for your urologist; not my area of expertise.

7) There are many options for antibiotic trials, and trimethoprim is reasonable.  If a culture has shown a specific kind of bacteria that is known to be responsive to trimethoprim, then you're definitely on the right track.  Also see above about trichomonas and possible treatment for it.

9) Most likely it wouldn't hurt to have sex at any time, but you should follow your urologist's advice.

As a cross-check, you might consider printing out your questions and this reply and taking it to your urologist.  Let me know if we disagree with each other.  I'll bet not.

I hope this helps. Best wishes--  HHH, MD
17 Comments
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I know I
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239123_tn?1267651214
See my replies above.
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Hi Doc, thanks for taking the time to look at my question and give me a detailed analysis.

1) Can I transmit trich to my gf by her giving me oral sex?

2) What are the long-term consequences of untreated trich?

3) You're contention was that the 3 negative naat urine tests for gonorrhea and chlamydia are 100% indicative that I no longer have those stds??

I'm not sure if you do answer follow up questions, but I would really appreciate it if you could. Thank you!
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239123_tn?1267651214
Trich is not known to be transmitted orally, but to my knowledge nobody has ever looked or studied it.  Trich causes little or no harm, except in women it might increase the risk of HIV if exposed.  After the treatment you had, even one such test would have been 100% reliable, let alone 3 of them.
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I had one last question before closing the thread Doc. Four days after my initial treatment with 250mg injection of ceftriaxone and 1000mg of zithromax, I drank ONE beer only. My doc emphasized for me not to drink for 7 days. I do drink quite often, but in the seven days following my medication I had only one beer on the 4th day. Would this have affected my treatment in any way? I've read that alcohol can work against the treatment.
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I feel sorry for you dazed cause Im going through the same thing  The docs I have had have all said that I was fine, but healh wise I fell terrible. I have red eyes, discharge, tiredness, head aches, and yes what ever you have (most likly constant and persistant NGU) is very contagious. To make a long story short.

#1. No Sex of any kind while your healing for a month

#2. No drinks or drugs for a month

#3. If you execise like my no squats for a month

#4. ! month of Doxy 100mg cap 2 a day

#5. Work eat and sleep for a month, this is the only way
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UnluckySoul

I'm sorry to hear about your situation, but I don't think i have what you have. I don't have any discharge. I just have pain in my prostate and doc said my prostate fluid was infected, and gave me another antibiotic and said its ok to have sex after 7 days. I'll trust my doc.

Doc HHH,

As to my last question above, would the alcohol have affected my gonorrhea/chlamydia treatment?

Also, I'm assuming I have bacterial prostatitits since doc said my prostate fluid was infected. I don't understand why an otherwise healthy male my age would have prostatitits.
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Trusting your Doc has you surfing the net looking for ansswers. Your ou living up to your name dazed. Your initial thoughts were challenged by your doc and you folded, not totally your fault. I wish you the best.
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79258_tn?1190634010
Grace posted this link on the STD support board, and I'm going to post it here 'cause I think it might fit.

http://www.pelvicpainhelp.com/excerpts.html

I used to be a massage therapist in a medically-oriented practice, and what they're saying about chronic tension/trigger points is dead-on. My experience is that most people carry an enormous amount of tension in their pelvises--not just the pc muscle, but the piriformis, psoas, glutes, etc.--and are often inactive to boot. I think it would be worthwhile to check it out...
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Unluckysoul,

Again I appreciate your input. I was treated with antibiotics for gonn/chlam/ngu, and doc said that those antibiotics would have killed the bacteria in my urethra. I've consistently tested negative for gonn/chlam since that time. My urologist's diagnosis is what I'm going to trust...not my own instinct and not you (no offense). If I go searching the internet or listening to people like you, then I'd drive myself crazy. I just wanted to get another doc's feedback and Dr. HHH is really good at exactly that. I've done a lot of research on bacterial prostatitis and it seems that I'm on the right track as far as antibiotics are concerned.

Monkeyflower,

Thanks for the link...I'll check it out. However, a person with a chronic pelvic pain would not have an infection in his prostate fluid, as I do.
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79258_tn?1190634010
Sorry, I was intending it more for unluckysoul, as well as other readers. This comes up ALL THE TIME...
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Let me start by saying alot is unknown to doctors about everything that has to do with PRACTICING their field. By saying that Im saying you could have been a doctor with the proper training because they like you are human, and all humans are not all knowing as GOD. Ive had your condition so it would be wise to listen to me I stated that youe condition was constant and persistant which means that you would need to treat it as such. Thanks Monkey flowr you always give great adviceI hope Mr Dazed wakes up and stops thinking doctors are GODS..
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First and foremost, I never said that I thought doctors were God, nor did I ever ask for your opinion. That's why I posted my question on the doc's thread and not the patient-to-patient forum.

Until you go through 4 years of medschool and then do a specialty, like Dr. HHH has done, I don't need any advice from you. Doctors aren't gods, but they know what they're talking about, unlike you. You have persistent NGU? SOrry to hear that. But I was tested negative for gonorrhea and chlamydia numerous times after my treatment, and had a negative urine analysis. What does that mean? It means that my problem is not in my urethra. Obviously my doc found an infeciton in my prostate, which means I have prostatitis. I've read several articles which say that prostatitis isn't a health risk to sexual partners.

Thanks but no thanks "Dr." Unluckysoul
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Did you know that NGU hardly ever picked up on a swab, and absolutly never detected in a urine sample. Did your God tell you that?
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1) I've had NGU in the past...and it was detected via swab test.

2) NGU can be detected via urine analysis, b/c NGU usually means there is bacteria in your urine.

3) NGU has never been proven to be a health hazard for men nor women.

4) You're an idiot!

5) Read my comment above regarding my "God"
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Is that STD infecting your brain. You've just stated that you keep getting STDs cause you had NGU before, like your proud of it or something. You probibly got this STD from the same place that you got your NGU from,  YOUR MAMA idiot.
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