What do you think this could be???

[fufsky]

Hopefully Dr Handsfield can answer for me.         About November 2007 I had received unprotected oral sex and about 3 weeks later developed a UTI(urine analyses confirmed at urgent care) - The main symptoms were burning, pain in the tip of penis(no discharge) and right testicle pain that was pretty intense.   They never could figure out what the bacteria was by culture or just never told me.......Went to numerous doctors who said it could be something with the prostate.   Doctors Put me on Doxycycline for a month or so and symptoms never really went away for about 6 agonizing months.    Finally, in about July of 2008 my symptoms had subsided greatly.     It is now Nov 2010 and symptoms come and go every once in a while but it is very manageable and almost a nonfactor until lately.    I had unprotected sex on Nov 19th with a girl I had met and immediately after sex(within 5 minutes) I took doxycycline(it ended up to be 3 pills in a days time) as what I considered to be a prophylactic just in case since I came to my senses after the fact and figured it was probably a good idea just in case.    I did this to kill any possible UTI(if there even was one...)    Problem is I am experiencing the same old symptoms again - Tip of Penis is tingling,mild burning, .......No discharge.   Doesnt hurt to pee, masterbate, etc - I just pee a bit more than normal.     I sleep fine and it only really starts shortly after I wake up in the morning.

Questions are:

1)    Do you think the Doxy would have eliminated any possible STD with good probability??   I did afterall take this within minutes of intercourse ending so even if there was infection it would have never had a chance right?
2)    How long can I expect this to last???  -  Is it out of anxiety??   The symptoms sure feel real.    
3)    Is this something I could possibly pass on to another partner accidently in future.   Or should I just relax....
4)    Should I go get Urine tested for bacteria?

[Edward W Hook, MD]

Normal flora is the laboratory term for the absence of known pathogens such as gonorrhea and describes the sort of bacterial one might expect to find in a specimen.  It ruyles of STDs. On the other hand, prostatitis could still be associated with a test showing normal flora  EWH

[fufsky]

Culture came back  -  (Normal Flora).     Done with the 1 week course of cipro now.

Please reflect what Normal Flora is and why it may have happened..........

Thanks.

[Edward W Hook, MD]

As I said before, your situation is complex.  From a distance (which is not really worth too much) however,your test results are less suggestive of STD than of some other urinary tract problem (such as recurrent prostatitis).  My advice would be to discuss your situation with your urologist.  EWH

[fufsky]

Retested today.    Came back positive for RBC, WBC, Bacteria.     Would I have been infectious while on doxycycline for the time period I gave of the one day????  

Do you think it is STD?    I am extremely ashamed and nervous I may have given something to my girlfriend on that night.....

This will be my last question.

Thank you.

[Edward W Hook, MD]

Yes, I think re-testing at this time would be helpful after 3 days.  EWH

[fufsky]

Thanks for the prompt reply.

If Friday the 20th was last day on the Doxy, would it be okay to get evaluated for urine analyses today considering that I took the pills and they might have given a false negative a couple of days ago??

I am asking - Would they(antibiotics) be out of my system by now and if I did have an infection would it show by now(today)? - The 23rd with 3 days off of them???

They wouldn't skewer the results at this point would they???

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Prostatitis is a challenging problem to manage.  It typically requires prolonged and sometimes repeated courses of antibiotics to control signs and symptoms and even following successful treatment can have a tendency to recur.   In persons who have had prostatitis, distinguishing the difference between a recently acquired STD and a recurrence of prostatitis can be quite challenging and typically required urine testing for white blood cells and bacteria (including the bacteria which cause STDs) and carefully physical examination including a rectal exam to evaluate the prostate.  While I will comment on your specific questions, my advice is to discuss these symptoms with your urologist:

1.  Doxycycline in the doses you took would markedly reduce your risk for NGU, chlamydia and some but not all gonorrhea making your overall risk of STD low.  On the other hand these antibiotics may not cure all of the bacterial associated with prostatitis.

2.  Until we know about test results, this is a difficult question to answer.  Symptoms of the sort you describe can be due to anxiety so if the tests and exam are negative, anxiety could be the cause.  On the other hand, if the tests are positive, there should be concern for prostatitis or, less likely, an STD.

3 and 4.  See above. Given your history I would suggest evaluation.

As I read your post, I suspect there is a good chance that your symptoms are anxiety related but I would still suggest a visit to your urologist to be sure.  If this were a flare up of prostatitis, the longer it is present the more difficult it becomes to treat.  EWH