prostatitis/epidymitis question

[sam5935]

I am a 32 year-old, otherwise very healthy male.In Jan. I was in the Dominican Republic, where I received unprotected oral sex and very very briefly gave unprotected oral sex with a prostitute. About a week later, I developed a very slight pain on the right side directly above the penis, radiating into my testicle. Blood work and urine cultures came up negative for organisms. My doctor put me on NSAID's for 8-10 weeks with little improvement. I then underwent a scrotal ultrasound, which revealed a small right hydrocele. My doctor diagnosed epidymitis and gave me 10 days of Cipro. My symptoms disappeared within 2-3 days. I stopped taking the NSAID's and, towards the end of the course of Cipro, the pain came back, along with urinary frequency, tingling at the tip of the penis, and pain at the base of the penis. I was refered to a urologist who did a DRE and diagnosed prostatitis. He started me on Septra. Again, my symptoms quickly went away, only to return again about 7 days into the treatment, this time with constipation. I once passed some mucous through my anus. The urologist then switched me to 2 weeks of doxycycline. Again, after 2-3 days, my symptoms were much,much better,only to return again 7 days into the course. He has told me to continue the anti-biotics and call him when finished. I now have testicular and scrotal pain, along with slight urethral burning and just a vague feeling of discomfort in my groin region. My urine stream has improved, which has made me realize that I have had urinary frequency and urgency for at least 7-8 years!! I can't remember a time that I didn't urinate frequently with little output so there seems to be something going on even before this more acute cluster of symptoms.

I have been online researching and have come across all the horror stories about never-ending prostatitis. I am terrified that this is where I'm headed. My sex drive has dissapeared and I'm very depressed. Is it common for symptoms to come and go like this, even when on anti-biotics? Does my urologist seem to be on track with his treatment protocal? I guess my real question is whether or not my current case warrants the poor prognosis I'm leading myself to believe? I realize he will next want to put me on a longer course of anti-biotics, as that seems to be the norm. When people are on a longer course, does it take several weeks for an improvement in symptoms or does the fact that my symptoms are not resolving trend towards intractable prostatitis?

I am in nursing school if that has any bearing on the nature or technical level of your answer. Thank you!

[Kevin Pho, MD]

Prostatitis can require extended periods of antibiotics - sometimes 4 to 12 weeks.  To ensure that the bacteria is susceptible to the antibiotics given, you may want to inquire about a prostatic massage.  Any prostatic fluid that is expressed can be sent off to the lab for analysis and culture.  That being said, the antibiotics that have already been prescribed are a reasonable initial start.

Improvement with prostatitis sometimes can take a slow course.  A transrectal ultrasound can be considered to image the prostate for any abscesses as well.

These options can be discussed with your urologist or 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_

[senthil75]

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