F/U to 2-15-05 Post

[justincase]

I had a complete STD workup and all negative, except mixed gram + for enterococus faecalis - moderate on GC. The clinic presribed tequin 7 day and zithro while waiting for results. No change for 4 or 5 days on the antibotics. Day 4 to 5 pain sensation seemed to subside, then returned day six. F/U with other dr at clinic and he didn't feel what I was given was sufficient, feeling that there was bacteria that was fighting back, that I probably had a false (-)test for something and prescribed levequin 500 mg for like 28 days, indicating symtoms pointed to prostatitis. Do all four types of prostatitis infections show up on a culture? Three or four days and pain seems to go away and everything feels "right". Have had intercourse two times with wife, and coincidence or not seems that I get the pain/pressure/infection coming on feeling again, some pain in  L testicle, no apparent swelling next day. She gets w/u and all neg.  I insist we are passing something back  and forth, she, a med prof. disagrees as has no symtoms. Urologist yesterday says now that major symtoms pr prostatitis are over pain probably from impact of intercourse, suggest wear condom  for month, see if all goes away, them resume uncovered if comes back, both come back, indicating wear briefs, elevate testicles.  I totally disagreed.  He felt no need to do anything else, ie. ultrasound, jt anti-biotic course saying come back in 3 months.  See another Urologist?  Isn't it logical to beleive that the gc swab shows that  bact being above normal level levels and coming back into me each time we have sex?  Please comment above things that wouldn't show on our test that might be going back and forth.  THanks.

[Kevin Pho, MD]

One way to further evaluate for bacteria in the prostate would be to consider a prostatic massage and send the prostatic fluid out to the lab for analysis and culture.  This can determine whether the bacteria is resistant to the antibiotics that you are being prescribed.  

No, not all prostatitis shows up on culture.  There are cases of chronic prostatitis that are culture negative.  If this is the case, some studies have shown that medications like alpha-blockers or finasteride may help.  

I would still consider an ultrasound to rule out an abcess (abscess) - you can discuss this option with a second urological opinion.
Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b