prostate concerns

[radio_13]

I posted before about having symptoms involving urine retention, dribbling and a general uncomfortable feeling after I urinate, like there was some left in my penis. I was worried that it may have been some std,Chlam or ghon,because I had been with two pro's once unprotected oral , and one unprotected oral and protected(always)vaginal.You informed me of the very low risk of these activities, but went to the doctor anyway and explained my condition. She didn't run any tests , but did do a Digital rectal exam and found my prostate to be inflamed or enlarged. She prescribed 7 days of Cipro xr 1000mg and Avodart.I'm only 40 and thought it strange to have a prostate problem at my age but she said that it does happen, more often than I would think. My question is this, would that medication effectivly treat Chlam and Ghonn if it were indeed that? And I've done some reading on the Cipro treatment, do I need more than 7 days? High anxiety with the prospect of std. Thanks for all your help.

[H. Hunter Handsfield, M.D.]

As you say, the sexual exposures you describe would not have given you gonorrhea or chlamydial infection; and neither gonorrhea nor chlamydia causes prostate infection or other prostate problems.  However, if you had one of those infections, ciprofloxacin would cure it.  (Cipro isn't an ideal drug for chlamydia, but in the high dose you are taking, it would be effective.)

Is your doctor a urologist?  I am not, but from my somewhat limited knowledge, there are some peculiarities in your care.  Are you aware that dutasteride (Avodart) is a testosterone inhibitor?  It and related drugs are intended and normally used as lifelong care in older men with prostate enlargement; and to my understanding are not indicated for a short term problem, such as infection causing prostate inflammation or enlargement.  It takes many weeks or months for such drugs to significantly shrink the prostate.

Further, I do not believe most urologists would rely on a single digital rectal exam to diagnose significant prostate enlargement; confirmation with an imaging procedure (ultrasound, usually) is the norm.  Finally, digital exam is virtually worthless in diagnosing prostate gland infection.  The usual approach involve the "3 glass" urine test:  urinalysis on the first 15-30 ml (0.5-1 oz) voided urine; a midstream urine; and another urine sample after vigorous massage of the prostate.  Comparing the number of white blood cells in each sample and culture for bacteria really are required to localize inflammation to the prostate.

You can put the STD fear behind you, but I fear the main effect of all this may be to transfer your anxieties in another direction.  The treatment you are getting is unlikely to cause any harm, at least not with a week of treatment.  But I also doubt it will help.

As I say, I am not a urologist, and perhaps your doctor is up to speed on new developments that I am not.  But I am skeptical.  You might consider a second opinion with a urologist; or post your question (and perhaps my response) on the Med Help Urology Forum.

HHH, MD

[HHH,MD]

It's also very peculiar for any physician to do no urine tests at all when an infection is suspected.  But I didn't think to ask where you are, maybe a developing country?  Depending on local medical standards and access to standard laboratory tests, you may be getting excellent care.  But perhaps not, if you in the US or other industrialized country.

HHH, MD

[radio_13]

thank you Dr
I am in the states, and no she isn't a urologist. I am scheduled to undergo a full physical on WED. After reading up on prostate treatment, I've seen where the avodart would take weeks if not months to be effective on the prostate, also it takes more than a week of cipro to effectively treat a prostate infection.She didn't schedule a follow up but did allow for three refills on the cipro as well as the avodart. the avodart is a thirty day script. I've refilled the cipro and continued another week. While the symptoms seem to be better I wonder if I'm just getting used to the feeling. Is it just bad timing that these symptoms have come up now. Also, what risk am I for HIV? thank you DR.

[radio_13]

was hoping you could comment on my last post

[H. Hunter Handsfield, M.D.]

As may have seen in very many other threads on this forum, you are at essentially no risk for HIV from the exposures you describe.  I think the timing of onset of your symptoms is coincidental with those exposures.

HHH, MD

[radio_13]

Went to a different doctor with more experience in the area as well as being experienced with STD's. I gave urine and he said it came back with no bacteria(no surprise because of the Cipro) but did draw blood for cbc,hiv,syphilis,and chlamydia. He said in theory it could have originally been chlamydia even though my main exposure was unprotected oral and protected vaginal.Is there a real risk for syphilis. That never really entered my mind. Tests not due for a couple of days and very worried. Thanks for all of your advisement. P.S. rechecked my prostate and found it to be fairly normal. He thinks it was just a mild prostatis and recommended discontinuing Avodart.Thank you for all your help.

[mike1759]

i though i had protected oral sex. her giving me oral sex. two days later my tip of my penis became tender.so i started taking penicillin v. did not work. So i went on cipro and dox just in case it was a std.i have taken 500 mg of cipro for two days and dox for two days my urethra still seems to burn at times. do you think i might have gotten an std.have i givin the cipro and dox enough time?how long should i give it? should i change meds
            thank you

[mike1759]

to answer last post.not dr.s sorry

[mike1759]

was hopeing you would comment on my question