Prostatitis after Chlamydia infection cleared

[NYC-man]

It all started in May (2005). I had a red rash on the head of my penis which didn't hurt or itch. It went away on its own in a few days but at that point I developed urethritis. I tested positive for Chlamidya (urine PCR test). Got 1g of Zythromax and a 7-day course of Cipro (this was before the test results were back to cover for both Chlamidya and Gonorrhea). About 10 days later the symptoms came back. At the beginning of June the doctor tested me again and gave me another 1g of Zythromax and a 7-day course of Doxycycline. I got the result after I finished the Doxy: negative.

During the Doxy course however the symptoms worsened a LOT. I got pain on the tip of my penis and generalized burning on scrotum, perineum and anus. Pain and burning was unbearable. Thinking that it could be a yeast infection from the Doxy the doctor gave me an antifungal cream that seemed to help. However pain on tip of penis and generalized burning and disconfort continued. Also I had a clear and very sticky liquid inside urethra which does not leak on its own but comes out if I milk it. No other symptom beyond the pain and the fluid: urination is fine, ejaculation is not painful. However amount of ejaculate was very small and very yellow.

Went to see a urologist who performed 2 urineanalysis both negative. He said that the it could not be an infection so he told me to take hot baths and ibuprofen (I took 600 or 800mg twice a day for 3 weeks). No improvement.

Went to the STD clinic where I was given 1g Zythromax and an IM injection of 125mg of Rocephin. Felt good for 2 days then bad again. Tests for all STDs negative.

Went to see another urologist who massaged my prostate and looked at the EPS: no white cells and negative for Chlamydia (both culture and PCR). Ultrasound (from belly not rectal) showed a normal prostate. He thinks it's just an inflammatory response that will go away in time. Complete blood work also normal.

At this point (beginning of July) symptoms were VERY slowly improving. Pain was bearable, ejaculate was back to normal in quantity and aspect. Still some feeling of heat in perineum and urethra and the sticky fluid still there. I had been taking a combination of quercetin and sting nettle and also cernilton flower pollen.

Last weekend symptoms suddenly worsened: two things could have triggered this. I drank 1-2 glasses of wine every night of the weekend (have been abstaining from alcohol). Also I had receptive anal sex (I am gay) for the first time since this whole thing started.

Questions:
1) Could the Doxy have generated all of this?
2) Are there any other tests that I should have performed? Semen culture? EPS culture for other stuff (we only tested Chlamydia)
3) could receptive anal sex have triggered the symptoms back?
4) I am an avid cyclist and runner: have been off biking since early June. When should I be able to safely go back cycling?
5) Can there be a hidden infection in the prostate?

thanks

[Kevin Pho, MD]

To answer your questions:
1) It is unlikely that the doxycycline is the cause of the symptoms.
2) You can consider a transrectal ultrasound to evaluate for any evidence of abscess.
3) It is possible that anal sex could be contributed to the symptoms.
4) The determination of whether you can cycle should be discussed with your urologist - I cannot make any recommendations without a physical exam.
5) Infections of the prostate can be difficult to diagnose - it is certainly possible an untreated abscess may be present.  The transrectal ultrasound can be considered for further evaluation.

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.
http://www.straightfromthedoc.com

[NYC-man]

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[Bobo_]

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