Follow up question to previous post

[sam5935]

I have a follow up question to a post by myself, sam5935 that was posted on 5/10/06. I will summarize below but more detail about previous aspects of my case are available there.

32 year-old, previously very healthy male.

I was initially misdiagnosed with a muscle strain and given NSAIDS for a couple of months before, after an ultrasound, being told that I had epidymitis. Blood and urine cultures were negative. I took 10 days of Cipro. Symptoms(right testicular pain,sometimes left testicular pain, starting to have pain above pubic bone, weak urinary stream, lower abdominal pain.) disappeared initially, then 5-6 days into the Cipro came back. I was referred to a urologist who did a DRE and diagnosed prostatitis. He prescribed 6 weeks of Septra. Symptoms went away initially, then came back after a week or so. By now, I was getting more classic signs of prostatitis: Pain in tip of penis, pain upon sitting, difficulty urinating, along with right testicular pain and,at times,left testicular pain. Doctor took me off Septra and placed me on 10 days of Doxycyline. Symptoms got better for a few days, then came back. Doctor then put me back on Septra but after 10 days, I developed a rash. He then prescribed 6 weeks of Trimethoprim.

Initially there was no response but, about one week into the Trimethoprim, I started getting better and, over 4-5 days, symptoms almost completely disappeared. However, over the past two days, they've come back almost as severe as before. Sitting down seems to make things worse.

Is it normal for symptoms to fluctuate this rapidly during an extended course on anti-biotics? Does this mean that I'm responding and just need to give it time or that I'm not responding and need to try something else? I don't understand why the doctor hasn't done a prostatic culture and, from my reading, trimethoprim doesn't seem like the most effective anit-biotic.

I am really starting to get depressed about this. I am considering leaving my HMO and going to a private urologist, which is absolutely going to bankrupt me. However, I can't continue living like this!!

So, I guess I have 2 main questions that I really need answered.

1. Is the pattern I'm experiencing of symptoms coming back and going away normal and indicative that I'm progressing and just need to be patient? Does my pattern suggest bacterial or non-bacterial prostatitis?

2. In your opinion, is it time to pressure my HMO to do more and/or get a second opinion?

I understand that this often takes an extended course of anti-biotics. What I don't know is if my pattern of symptoms re-emerging is in line with successful treatment or not.

I'm really at wit's end and just need to know if I should be patient or if this seems like one of the intractable cases of prostatitis I keep reading about.

Thank you!

[Kevin Pho, MD]

To answer your questions:
1) I would re-assess your symptoms after completing the course of antibiotics.  It may be possible for infection to persist and symptoms fluctuate during the extended course of treatment.  

I cannot say whether this is bacterial or non-bacterial prostatitis based on this description.  Sending any urine tests for culture as well as prostatic fluid would help cement the diagnosis.  

2) If the symptoms don't improve, I always recommend another opinion.  Perhaps finding another urologist within your HMO can be considered before seeing a private urologist.  

These options can be discussed with your personal physician.

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.
kevinmd_

[jakesma]

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