Urethritis - Prostatitis - Antibiotics and symptoms

[aktraveler]

Early 30's married heterosexual male, multiple partner history both with and without condoms, isolated childhood bladder infection(s) and UTI's likely chemical (soap / bath / etc) and nothing again until ~5 years ago.  



~5 years ago had unprotected sex (a few times all within a few days) with 'partner B'.  Subsequently (1 week later?) had unprotected sex with 'partner A'.  ~2 weeks after 'partner B', mostly clear but occasionally cloudy (white) penile discharge began and continued for several days.  Discomfort slowly increased but was overall mild.  Was concered about my regular partner ('partner A'), saw a doctor, was diagnosed with NGU and given a round of antibiotics (Augmentin maybe?).  Symptoms resolved - nothing reported by 'partner A'.  



~2 months ago, had several unprotected sex encounters with 'partner C'.  1 1/2 weeks later, had unprotected sex with 'partner A'.  1 week later, symptoms similar to 5 years ago began.  The symptoms are occasional light colored stains on underware (yellowish - sometimes lint sticks to tip of penis); clear non-urine fluid discharge; mornings or after long periods without urination produces slightly cloudy white discharge; dicomfort includes mild stinging / burning during urination and, during ejaculation, reduced quantity of discharge during and mild burning.  Also possibly related sore throat (?).



I visited a doctor, described the symptoms, gave an incomplete sexual history (don't like that stuff in writing associated with me).  He performed a prostate exam, diagnosed prostatitis, and prescribed 10 days of Levoquin.  I asked about transmission to partners and he indicated no concern.  No tests were performed.



After 2 days of Levoquin the discharge, and discomfort resolved (also the sore throat).  1~2 weeks later I received unprotected oral sex from 'partner C' and had unprotected sex with 'partner A' several times.  'Partner A' subsequently reported mild UTI symptoms (did not see a doc) which resolved with a short run of Bactrim.  Subsequently my symptoms returned.



I saw a different doctor who did not examine me but indicated prostatitis is typically difficult to resolve and prescribed 30 days of Levoquin.  A basic urine test was normal.  The symptoms didn't resolve like they did previously.  They began to get better, then I had unprotected sex with 'partner D'.  The symptoms got worse, and now are getting better again (still on Levoquin).  The biggest remaining symptom is during ejaculation lower quantity discharge and burning.  Here are the questions:



1: Does the prostatitis diagnosis sound reasonable?

2: Based on the above, does 30 days of Levoquin still sound best?

3: Is it likely that this began with recent sexual transmission, or much earlier?

4: What is the risk of transmission?

5: Should a different antibiotic be considered?  If so, which one?  Is there a test to determine what would be best?

6: Should any other testing be done?

7: If symptoms don't resolve, should I just go on with life?

[Kevin Pho, MD]

To answer your questions:

1) Prostatitis is certainly a possible cause if the symptoms are continuing despite short courses of antibiotics.



2) If prostatitis is in fact causing your symptoms, extended courses of antibiotics are necessary - sometimes lasting 4 to 12 weeks.



3) The infection can certainly be caused by both recent and previous transmission.



4) Again - depends on the cause.  If the prostatitis is caused by gonorrhea or chlamydia, there is certainly a risk of transmission.



5) Levaquin is appropriate for prostatitis.  A culture of the urine or prostatic fluid can be considered to determine if there is any bacterial resistance to the antibiotics.



6) I would consider a prostatic massage and send off any prostatic fluid for culture and analysis.  A transrectal ultrasound can be done to image the prostate for abscess.



7) If the symptoms continue, I would consider another urology opinion - preferably at a major academic medical center.



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_b

[Michael MRM]

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[youngone1]

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