Persistent Prostatis?

[DukeLit11]

I am a 26 year old male. About 18 months ago, I woke up with intense pressure in my bladder area and a constant urge to urinate (often I could only squeeze out drops). No pain, no fever, just pressure and the urge to urinate. Unfortunately, since I was traveling, it took two weeks to get back home to a urologist who could diagnose the problem (prostatitis, he said), and find an antibiotic that worked--doxycycline. I had gone to an ER while traveling but was given Levaquin which had no effect.
The urologist put me on a 12-day course of doxycycline, and with the first dose the acute infection symptoms went away--i.e., the constant bladder pressure. However, and here is the complicated part, as soon as I took the doxycycline my infection died down but new symptoms arose: a weak stream, frequent urination, feeling like I couldn't empty my bladder, nocturia, weak ejaculations, and discomfort (but not pain) in my penis. Alcohol and caffeine exacerbated these symptoms. There has never been any pain. The urologist, during a subsequent examination, said my prostate felt normal but during a cystoscopy said that it felt like my prostate was very tight.
My symptoms have not shown any sign of disappearing during the past 18 months. I'm wondering, however, if my initial course of doxycycline was too short (and therefore only partially effective)? If I went on a 3-4 week course now, without clear signs of infection, might there be a positive effect (i.e., maybe there is bacteria somewhere in the prostate, which as I've read can be hard to treat)? Or, since this problem initially went untreated for nearly two weeks (before I took doxycycline for the infection), have I suffered permanent damage? And why might the doxycycline have helped some symptoms and changed others?
I sometimes think this is all in my head, but since there was a very real infection at first, I'm hoping there is some other explanation.
Thank you very much for any advice you may have.

[Stephen Liroff, MD]

You are right, it is time to get to the botton of this. At this point, 18 months into it, the problem could be anxiety related, due to a neurological problem or chronic pelvic pain syndrome. It sounds as though you need a full work-up with a urodynamic evaluation (measuring your bladder function by filling your bladder with a liquid and observing bladder sensation, pressures) to rule out a neurological cause, a renal ultrasound or ivp (x-ray of your kidneys), and a full history and physical. I doubt that the length of the antibiotic treatment caused you any harm nor do I see any problem with a month of an antibiotic. But, if you and your urologist choose the antibiotic plan first, and your symptoms do not resolve completely, then you need to pursue the full work-up and not drag things out further.
S.A.Liroff, M.D.



"This information is provided for general medical educational purposes only. It
does not  necessarily reflect the opinions of Henry Ford  Hospital  or the
Vattikuti Urologic Institute.  Please consult your physician for diagnostic
and treatment options pertaining to your specific medical  condition.”

[kanu67]

I have prostatitis since one year ago. Tee semen culture showed a staphylococcus infection (about 1milion/ml) and the echography of prostate showed also a calcification. The doctor prescript me Ceforuxime for 12 days but there is no amelioration and the same symptoms especially after each ejaculation persist (pains in the rectum and urethra, pains in lower abdomen just above the pubic bone, and sometimes pains in the epididymis especially in the left testicle, a loss of the libido, and very early (premature) ejaculation). Additionaly I have always signs of the flu (common cold) such as fever (headache, blocked noses, sweating after making a little work), a permanent feeling of fatigue after the slightest effort, and the envy to sleep always). My problem is that the urologist does not want to give me another antibiotic or drug and he says me to wait until the pains disappear?  3 months and the pains somhaw increase day after day? My questions are:
1) What to do with this infection?
2) Why the doctor did not want to prescript me another antibiotic?
3) What are the origins of this infection?
4) are there a very good antibiotic particularly for staphylococcus  infection?
Thank you for help me
Best regards

[Stephen Liroff, MD]

The physician who is able to examine you and decide what lab you need and evaluate you first hand is in the best position to figure out what is happening to you. I cannot speak for your urologist. I do not know his logic. He may feel that you are not truly infected but just have symptoms as though you are.  You could seek the care of another urologist and get that person's opinion. Septra in high doses may be the best drug for you if an antibiotic is needed.
S.A.Liroff, M.D.

"This information is provided for general medical educational purposes only. It
does not  necessarily reflect the opinions of Henry Ford  Hospital  or the
Vattikuti Urologic Institute.  Please consult your physician for diagnostic
and treatment options pertaining to your specific medical  condition.”

[Shimuk]

I live in India.I had the first bout of prostatitis infection two years ago. There was profuse amount of Klebsiella in my semen and had a pus discharge from urethra. After one and a half years, it is back....this time no urethral discharge or itching but intense rectal pain. Transrectal scan has not found any abnormality in prostate but heavy growth of Pseudomonas has been found in semen. Have been treated with one week of Cefuroxime, three weeks of Doxycline, three weeks of Gatifloxacin+Cephalexin.The symptoms had improved by 20-30% but now I am taking only 200 mg of Gati and the pain is getting bad again to the point of being really debilitating. It goes away with sleep and is temporarily relieved with sitz bath or a five minute meditation.

And the biggest trigger that invariably brings it back within minutes is "standing" or walking. The sonologist was able to insert the probe only with great difficulty and I find the rectum to be tight and tender even when I gently try to stretch it by pulling on my buttocks. Why is the pain still there after weeks of antibiotics ? Why do I get the pain on standing ? The infection is resistant to Amox, Ceftizoxime, Cotrimaxazole, Cafaclor and Cefoperazone. What should I do now ? Please help me regain my quality of life.