stillHurting

[dazed]

I appreciate your response yesterday greatly. I've been trying to get someone to respond, but have been unable to.

You say ureaplasm/myoplasm might be an issue...but I thought those were all things that zithromax would've cleared, since 1000mg is recommended for chlamydia and NGU, and those cause NGUs. Also, somewhere down the line, i took 7 days of Doxy, which would've cleared it as well. Plus I've had a couple of urineanalysis done...i'd assume this would pick up bacteria...no?

Why don't you think my urethra would get reinfected with gonn/chlam if that was causing my prostatitis? I mean, it's so easy to get infected with gonn/chlam, you would think reinfection would highly be possible if the bacteria was passing through my urethra.

Appreciate your help.

[stillHurting]

Well in most cases, the antibiotics you took would have cleared mycoplasma and ureaplasma.  However, that's no guarantee.  Some strains can have resistances to certain drugs, and there is really no way to know if that is the case with whatever you might have, short of doing a culture and an antibiotic susceptibility profile.  Very often, one short course of antibiotics will reduce the size of the infection, but not eliminate it.

For instance, in two studies I've read, doxycycline resistance for ureaplasma was nearly 50%.  It other studies, it's below 10%.  So it varies by time/region.  That's why it's hard to give a definitive answer.

The only reason I doubt you are reinfected with gonn/chlam is that they usually don't reoccur.  That's not to say that they couldn't. It's also not to say that a urine test might not be negative even if your prostate is infected.  That's why a prostate massage might be useful. But chances are, given the negative NAAT tests, which are quite accurate, you are not infected.

As for a urinalysis, if you just mean a dipstick urinalysis, it will definitely not show bacteria.  What it does show is leukocyte esterase, which is indicative of having white blood cells (leukocytes) in your urine, which often (but not always) indicates infection.  However, it's not often sensitive enough.  For instance, about 30% of men with NGU will show negative on a urinalysis.  Especially if you provide too much volume.  Using the absolute minimum to cover the stick will make the test more accurate.  You can buy urinalysis strips yourself to test, they are pretty cheap (about $30 for 100 of the 10 reagent strips).

If you mean a urine culture, that will not grow mycoplasma or ureaplasma unless it's a special culture. That is not what is typically used.

Now if you do find mycoplasma or ureaplasma if you test for it, that doesn't mean it's the cause of your problems.  Many people harbor these bacteria with no symptoms.  However, it might be worth checking out.  The exception is mycoplasma genitalium.  That is not present in a healthy person and definitely should be eradicated if found.

I'd like to know how you were diagnosed first.  Was it a gram stain?  Or a NAAT?  A swab with culture?  Or just a urinalysis positive for leukocytes?

[dazed]

I was initially diagnosed with gonorrhea via stain gram test. Doc took a swab from urethra and looked at it under a microscope and stained it and said I had gonorrhea. I'm not sure about the specifics, but it was a swab test.

As for prostatitis, I was diagnosed by the doc (urologist) massaging my prostate and taking the prostate fluid, looking at it under the microscope, and saying that it looks boggy. I initially went to the urologist thinking the pain was in my testicles, but he said it was my prostate.

What do you mean when you say it's not typical to get reinfected with gonorrhea and chlamydia? I've never heard that before. If I've had it once, I know I can get it again. So what do you mean by that? As far as gonorhea and chlamydia are concerned, the cdc website reports trials done with ceftriaxone, which show that it cured 98.9% of gonorrhea infections, and 1000mg zithromax cleared 97% of chlamydia infections. I'm really hoping I'm in the clear for that, so that i haven't given anything to my g/f.

As far as other bacteria, I'm not sure. I haven't had a urethra swab test since the first gonorrhea diagnoses...i've only tested for gonorrhea and chlamydia via urine amplification tests...i was really hoping that my prostatitis isn't caused by those bacteria and if they were, that the urine test would pick it up.

Also, my leg has been hurting for the past 2 months, but i'm not sure if it's related. Thanks.

[stillHurting]

I didn't mean for you to interpret what I said as meaning that you can't get gonorrhea /chlamydia again easily, what I meant is that nearly always (as you say), when they are treated they go away.  You can catch them again, reinfection, very easily.  But recurrent symptoms are not usually due to these organisms.  By recurrent, I mean the symptoms reoccur but there is no new infection.

The swab test you had with the gram stain is definitely enough evidence to say you had gonorrhea to start. You might also have had something else at the same time, that's much harder to say.

If the urologist examined your EPS and said you have prostatitis, then he's definitely right. If you want to be sure that it's not gonorrhea in your prostate, you should either culture your EPS or have a massage and then do a NAAT.  However, like I said, I'd bet it would come up negative. But it's possible the urine NAATs might miss an infection in your prostate otherwise.  Did the urologist do a gram stain of your EPS?

So, it seems like you've done everything correctly so far. After your last course of antibiotics, your EPS still was positive?  Via a microscope slide?

At this point, and it's up to you, I'd go ahead and get a PCR test or culture for mycoplasma/ureaplasma. PCR is more sensitive and faster. Mycoplasma genitalium can take 8 weeks to grow. If positive, you would at least have another interesting data point. If not, you'd eliminate a potential variable.

I am not going to rule out though, your test might come back negative and your symptoms continue. But by symptoms, you mean are still having discharge?  Or just pain?  I'd be really surprised that you could have discharge and a negative urinalysis.  However, prostatitis is a tricky ailment.

If you do run some tests, tell me what happens if you don't mind.  I'm really curious.

[dazed]

Thanks again for the response. It's just stressful for me b/c I keep thinking that gonorrhea is causing my prostatitis, otherwise it's a HUGE coincidence that I got this weeks after my diagnosis for gonorrhea. However, I think you're right. My treatment should've killed the gonorrhea, as long as my one beer didn't interfere with the treatment.

The doctor never did a culture of my EPS b/c he said it's hard to determine the bacteria in the prostate fluid. All he did was look at it under a microscope and said it looked boggy, as in it wasn't clear. I don't know if that's a correct diagnoses.

I NEVER had discharge to begin with. Even when I had gonorrhea, never once did I have discharge. By symptoms, I still mean that it burns when I urinate and I have a fullness feeling, and a dull pain behind my testicles, whcih is where the prostate is i guess. This is bothering me every single day.

I asked my doc to do a culture, but he said that since I was on antibiotics for so long, nothing would grow. I'm supposed to take 2 weeks of Flagyl now and go back, at which point he said that if it didn't go away, he would give me a prostate massage and make me pee in a cup and do a culture on the urine. (I somehow feel that he should've done that a while ago).

I still have pain in my leg, mostly stiffness on my left calf. I'm not sure if this is related or not, but it's not going away.

Thanks

[stillHurting]

I don't see how the leg pain could be related, unless it's reactive arthritis, which I have no first had experience with but it sounds like it would be more of a whole body thing than just a few joints.  So I doubt that. I bet it's just coincidence.

I agree the Flagyl is a good idea and 2 weeks would almost certainly eliminate Trich where it there.  Usually 1 week is enough.

You could still do a PCR for mycoplasma/ureaplasma even after the antibiotics. Of course at this point, it could come back positive even if the infection is gone because it usually takes about a week for the DNA to be cleared out of your system. However it seems it's been longer than that so I'd think the test would be accurate.  But, it would be better to wait longer to take it.  Lots of times antibiotics will knock down one of those infections but not clear it.

For instance, one study I read recently showed 73% of people with NGU due to ureaplasma test negative for ureaplasma 2 weeks after taking 1g azithromycin, but at 5 weeks past, only 52% tested negative.  So basically that extra 21% was still infected. The antibiotics had lowered the level of infection below where it was detectable, but only temporarily.  There are other studies with similar results.

From what I've read, 4 weeks after your last round of antibiotics should be long enough to see if there is any lingering infection.  I don't know when you finished your last course.  Although, once again, even if you test positive for mycoplasma/ureaplasma, that might not be your problem.  But it very well might, and in my opinion it's worth looking in to.

[Wear/a/Jimmy]

Sounds like I could join this crowd...  I have been fighting something now for about 10 weeks. Whaterver it is, it seems to have gone to the prostate.

Exposure: Protected vaginal, unprotected oral from a CSW (Thialand)  STUPID STUPID STUPID

Meds thus far (in chronological order)

1) 1.5 gram Zithromax (for possible chlamydia/gonorea)
2) 4 days of doxi        
3) 1.25 gram Zithro
4) Erythromycin 15 days
5) 6 days of Cravit
6) 1 dose of 250 mg of Rocephin (doctor says other meds not adequate for gon. so gives the shot)
7) 14 days 2 gram Rocephin       (for possible prostatis induced by gon)

Initial symptoms: slight burn in urethra, pain in right testi, bladder pain, no discharge, split urrine flow, burn during ejaculation

Symptoms: No discharge to speak of, slight constant burn in urethra, mild burn during voiding, throbbing senstation around cocyx (sp), burn