Prostatitis?

I had been having symptoms similar to that of a UTI for a week or so before seeing a doctor.  The first time I noticed the onset was after ejaculation...only a couple of minutes afterwords I felt "pressure" and some leakage working it's way up.  I got a sudden urge to ejaculate again that would not go away.  I masturbated and felt some pressure near my tip.  The next morning, I noticed some dysuria, as well as minor dull pain at the tip of my penis.  

This went on for a week, with the major symptoms being dull bladder discomfort (just above my penis), leakage during the day, minor pain with erection, and inability to fully urinate.  No real pain though, mainly discomfort.  I saw a doc and he gave me antibiotics for urethritis, which didn't work.  I mostly abstained from sexual activity, but noticed the symptoms worsened a bit afterwards the couple times I had an orgasm.

I went to a urologist who gave me 4 weeks of levaquin for prostatitis.  My urine samples came back negative again as well.  The first 2 weeks didn't have much improvement and I started taking Saw Palmetto in addition to the antibiotic.  This past week was great and everything seemed on its way back to normal.  Near the end of my 4 week treatment, I noticed that the tip of my penis was resting on the toilet seat for a few seconds, near the inside.  At first I thought I was being paranoid, but surely enough, about 2 hrs later the symptoms came back a bit for the first time in almost a week.  The last few days have been fairly uncomfortable, with the only symptoms I have are the dull bladder feeling, minimal urination but frequent urge and some leakage after peeing.  Also, during ejaculation I only get a dribble, rather than my normal orgasm.  This time there is no minimal pain with erection or orgasm though, just the dysuria symtoms (symptoms).

I just really want to get back to normal, as I believe I am in good health and this is causing much stress.  I am seeing the urologist again tomorrow, but want to know if there is anything else I should be thinking about, such as the possibility of cancer, or the effect of a varicocele, which I've had for 2 years.  I'm still taking Saw Palmetto, and I'm wondering if, like the varicocele, this could be a problem that will get better on its own and only flare up on occasion after that.  What should I do?

[Kevin Pho, MD]

Prostatitis can be difficult to detect and treat.  You can consider a prostatic massage, where the prostatic fluid can be sent to the lab and cultured.  There is a possibility that the prostatic bacteria is resistant to the antibiotics, and a different one can be chosen.  

Another consideration would be a prostatic abscess - which can be determined via a transrectal ultrasound.  

Regarding the possibility of cancer - if this is a concern, you can consider PSA testing looking for prostate cancer or a scrotal ultrasound looking for testicular cancer.  

You can consider these options 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.
Medical Weblog:
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