Urinary Tract Infection Followed by Burning Sensation on Scrotum and Testicular Pain

[TomS2008]

Approx. 1 week after receiving one-off unprotected oral sex from a woman I developed mild burning/stinging sensation at tip of penis and need to urinate frequently (every hour). Very mild burning sensation when passing urine. No discharge noticed and no spots/warts. A urine test showed bacteria: doctor prescribes antibiotics (Nitrofurantoin) to treat "bladder infection" (their description).

After 1 week and end of antibiotic course, no change noticed. Very slight pain/irritation in left testicle area. Doctor prescribes different antibiotics (Amoxicillin/Clavadanic acid). Urine test negative for bacteria, positive for blood (though no blood visible to naked eye). Urine and culture tests for gonnorhea and chlamydia are negative.

After 1 week the testicular pain is much more pronounced (a bit like somebody has given me a nasty kick in the nuts), gets worse during the day after initially being undetectable early in the morning. Testicle feels slightly swollen and left side has burning sensation on outside, especially in upper region. Although the testicle feels sore/sensitive, actually touching or handling it doesn't cause any significant discomfort. Sitting down at my PC is unbearable after a while, but walking seems to reduce pain slightly. Burning sensation at tip of penis/need to urinate frequently are gone. No abdominal, back or flank pains.

The doctor has said my urine is blood and bacteria-free, that my testicles are not swollen (although they do feel a little swollen) and that there are no hard lumps present.

The diagnosis is that its simply a groin strain and I've been prescribed mild anti-inflammatories to cope with the pain. Now I can't believe this, I play a lot of soccer and I know exactly what a groin strain is and how it feels. This isn't it !

My question is what is going on ? My doctor seems puzzled ! From what I've read on this forum the pain isn't bad enough to be epididymitis and the urine/culture tests indicate I've got healthy urine.

Is this a case of a urinary tract infection going straight to chronic epididymitis ?

Should I try a few more different antibiotic combinations ?

[Vanessa Lacuesta]

Hi,

Was a prostatic evaluation done? A digital rectal exam done to evaluate the prostate? During urination was the prostate milked for a culture?

Chronic epididymitis may still be a differential .Another thing to consider is urethral syndrome and prostatodynia. Urethral syndrome may present with urinary frequency and pain in urination without signs of bacteria in the urine. Prostatodynia may present with testicular or groin pain but there is absence of bacteria in prostatic samples.In the absence of lumps, swelling , redness in the scrotum , an acute epididymitis may not be likely.However, it is important to note any changes in sexual response such as pain in ejaculation and blood in the semen. The urine culture should be able to guide treatment.  

[TomS2008]

Thanks for the reply ! I had and still have no pain in the area between the rectum and testicles, a second doctor has diagnosed epididymitis and prescribed Levofloxacin.

The effect was almost immediate, reducing swelling, pain and burning considerably within 10 hours, after 2 days the condition was down to minor discomfort and by 3 days I would describe the condition as merely an irritation. Yesterday I was almost euphoric but today, half-way through my antibiotic course, things seem to have quickly regressed considerably, I'm back to the same levels of discomfort just 24-36h after starting the antibiotic course. What does this indicate ? Is this normal for antibiotics ?

My urine culture results are not due until the end of the week. I can't comment on the sexual response changes as my girlfriend won't let me anywhere near her for the time being !

[TomS2008]

I forgot to add, the dosage of Levofloxacin is 250 mg, once per day.

[Vanessa Lacuesta]

Hi,

Continue to comply with your medications.It is best to complete this to ascertain if you are really responding well or not.Your physician initiated an empirical therapy of antibiotics to manage your condition.The results of your urine culture will guide treatment and given your response to the medication, your physician may change it to another set of antibiotics.

For the meantime, refrain from any sexual activities. Let us wait for the urine culture results and see if the antibiotic is the right one for you.

[TomS2008]

It takes a long time for tests here ! The urine culture tests have been negative. No antibiotics have been taken for a while because the urologist sees little point in administering antibiotics when the bacterial cause is not known.

The epididymitis (EP) pain has decreased from a level of 7/10 before the Levofloxacin to levels of 1/10 to 3/10 - improvement is noticed but very slow, its now nearly 4 weeks since the EP started. An ultrasound scan revealed healthy testicles with good homogeneity, except for a minor accumulation of fluid.

The urinary tract infection doesn't want to go away however, I'm no in the middle of my third infection, it comes and goes in 10 day cycles.

Erection and ejaculation causes throbbing/burning in the left testicle region where the EP is, even now.

Would it be fair to say that the EP is a complication of an underlying chronic UTI ? Or could prostitis be an issue ? I've felt occasional perineal and groin pains, but nothing too serious, these could be caused by bad posture on my office chair.

What sort of a timeframe are we talking about complete recovery from EP ? 1-3 months ? Longer ?

At present I'm waiting for urine culture results for possible Staph. aureus and Candida albicans infection, perhaps urologist is clutching at straws already.