feel your pain!

about 8 weeks ago i developed a sudden urge to urinate.  it was consistent and always felt as if i wasn't completely relieved.  about 1 week into this feeling i noticed a stream of blood towards the end of urinating.  a little puss followed the blood as well.  this only occured once and i immediately went to my gp.  upon telling him the story he quickly diagnosed me with acute prostatitis and said the blood was due to an infection.  he said prostatits is often caused by chlamydia or gonorrhea.  he gave me 2 gram azithromycin (oral susspension) and a 30 day course of ofloxacin.  after reading up on this site i decided to not screw around and set up an appointment with a urologist. (gp did not perform prostate exam, only went by symptoms) urologist performed a rectal and said he firmly believes it is not prostatitis.  he said my prostate is normal, not tender and felt as if the entire feeling was in my head.  he pushed in on my prostate to extract fluid but none came out.  "he said if you had an infection you would have had fluid."  i also shared with him my experience with the gp.  the urologist laughed!  in the mean time i continued taking a 30 day course of ofloxacin, due to the possiblity of prostatitis (in my head),  also took week supply of vantin(cefpodoxime) becasue symptoms have not gotten any better.  

FACTS: NO PENIS DISCHARGE, WITH THE EXCEPTION OF THE FIRST TIME WITH BLOOD AND A LITTLE PUSS AT THE END OF URINATING. NO PAIN, NO IRRITATION, NO SORES, NO SCABIES, NO PUSS LIKE PIMPLES.  NOTHING OTHER THAN A FEELING OF HAVING TO TAKE A **** ALL DAY.. SIMPLE URINE TEST SHOWED NO BACTERIA OR WHITE BLOOD CELLS.. HOWEVER, A URINE CULTURE WAS NOT PERFORMED!  sexual deseases are highly unlikely.  not many partners, condoms always!

1. IF MY SYMPTOMS WERE DUE TO CHLAMYDIA, GONORRHEA, NGU (UREAPLASMA or MYCROPLASMA) WOULD THE ABOVE REGIMINE OF ANITBIOTICS CURE THESE BACTERIA?  2 gram azithro (oral susspension), 30 days ofloxacin 300 mgs bid) and 1 week vantin 200 mg bid --- curious about resistance?  
2. DOES THIS SYMPTOM SOUND ANYTHING LIKE SYPHILIS, HERPES? WHY NOT?
3. DOES PROSTATITIS ALWAYS HAVE INFLAMATION (inflammation)? OR TENDER? EVEN IF IT IS CONSIDERED NON BACTERIAL,CHRONIC?  WOULD PUSHING IN ON THE PROSTATE PRODUCE FLUID?
4. WHAT COULD BE CASUING THIS CONSTANT FEELING OF URINATION?
5. COULD I BE CONFIDENT I DO NOT HAVE ANY OF THE ABOVE MENTIONED DESEASES AFTER TAKING THE MEDS?

[Kevin Pho, MD]

To answer your questions:
1) Yes, if the symptoms are caused by chlamydia or gonorrhea, the antibiotic course should treat these organisms.  There is always the chance of resistance - if this is the case, one can consider modifying the antibiotics.  The best way would be to culture the urine or any prostatic secretions.

2) Although possible, this would be an uncommon presentation of herpes or syphillis (syphilis).

3) In most cases, prostatitis would have a tender prostate on DRE.  In some cases, pushing on the prostate (prostatic massage) would generate fluid.  There is the possibility of an abscess, which can be evaluated via a transrectal ultrasound.  

4) Infection remains a possibility.  Since you mentioned blood, a cystoscopy can be considered to further evaluate the lower GU system.

5) I would consider a transrectal ultrasound and cystoscopy for further evaluation to completely rule out the diseases you have mentioned.

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_