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Chronic urogenital issues including epididymitis prostatitis urethritis
Dear Dr. Hook,
Back in May of this year I was exposed to an STD and developed urethitis and epididymitis within a week of exposure. I had clear discharge, testicular pain and urethra pain but tested negative for all the regular STDs. I went to my GP and she diagnosed me with epididymitis (clean urine culture) and gave me a 250mg shot of rocephin and doxy 100mg 2x day for 2 weeks. These both helped but did not completely cure the issues so she gave me another week but this did not resolve the issues either. She then referred me to a urologist who did a urine culture (clean) and perfomred a DRE and said my prostrate was enlarged and boggy. He put me on Cipro 500mg 2x day for 4 weeks and uroxatral 10mg 1xday. This regimen did not help so I then went on septra DS for only 9 days (3 week prescription) because I didn't notice an improvement (hindsight probably stopped this one too early). He then put me on 10 weeks at 100mg 2x day. In the meantime I've taken several standard STD tests which have all come back negative however I've read that certain STD's have incubation periods and antibiotics can interfere with the results. I then went to another Urologist who suggested Trich so he put me on 2g flagyl, 1g Azithromycin and stared another Cipro round. Honestly I felt ok after the flagyl and zmax but as soon as I took the first day of Cipro the diarrhea set in for a week probably due to the multiple antibiotics. I stayed off the antibiotics for a month and went back to my original urologist who put me on levaquin 500mg 1x day for 4 weeks which I just finished to no avail and I'm now on to tindamax 1g/day for 7 days. I would really like to know what I have but I feel that I have not had the proper tests done other than normal STD tests (after antibiotics), urine cultures and DRE's. I've read that mycoplasma/ureaplasma (NGU) and Trich are hard to detect in men and are all difficult to treat. Any help/suggesions you could provide would be greatly appreciated.
Back in May of this year I was exposed to an STD and developed urethitis and epididymitis within a week of exposure. I had clear discharge, testicular pain and urethra pain but tested negative for all the regular STDs. I went to my GP and she diagnosed me with epididymitis (clean urine culture) and gave me a 250mg shot of rocephin and doxy 100mg 2x day for 2 weeks. These both helped but did not completely cure the issues so she gave me another week but this did not resolve the issues either. She then referred me to a urologist who did a urine culture (clean) and perfomred a DRE and said my prostrate was enlarged and boggy. He put me on Cipro 500mg 2x day for 4 weeks and uroxatral 10mg 1xday. This regimen did not help so I then went on septra DS for only 9 days (3 week prescription) because I didn't notice an improvement (hindsight probably stopped this one too early). He then put me on 10 weeks at 100mg 2x day. In the meantime I've taken several standard STD tests which have all come back negative however I've read that certain STD's have incubation periods and antibiotics can interfere with the results. I then went to another Urologist who suggested Trich so he put me on 2g flagyl, 1g Azithromycin and stared another Cipro round. Honestly I felt ok after the flagyl and zmax but as soon as I took the first day of Cipro the diarrhea set in for a week probably due to the multiple antibiotics. I stayed off the antibiotics for a month and went back to my original urologist who put me on levaquin 500mg 1x day for 4 weeks which I just finished to no avail and I'm now on to tindamax 1g/day for 7 days. I would really like to know what I have but I feel that I have not had the proper tests done other than normal STD tests (after antibiotics), urine cultures and DRE's. I've read that mycoplasma/ureaplasma (NGU) and Trich are hard to detect in men and are all difficult to treat. Any help/suggesions you could provide would be greatly appreciated.
MEDICAL PROFESSIONAL
Apparently what I just wrote didn't register. I think you should discuss this with a urologist that you trust and set out to find out what you really have. It may be prostatitis and if so, may require further, prolonged therapy. . testing for the sorts of organisim that you descirbe is, in my opinion, of little help. EWH
Dear Dr. Hook,
Thanks for your reply. My current symptoms are prostrate pain (can't sit comfortably at all due to burning and swelling), urethra/testicular pain after ejaculation and urination difficulties (still on uroxatral). I'm 38 and was in excellent health prior to the STD exposure (female worker). All antiobiotics have seemed to help in one way or another but when I done with them then the pain comes back full force and the urination issues intensify. The original course of doxy and rocephin seemed to have got me to 90% but whatever bacteria/parasite it is seems to have lodged itself in my prostrate and won't come out. I've never had a prostate massage for a 4 glass test or been asked to provide a morning urine or prostrate fluid sample to send off to culture or test. My morning urine has glass like beads and is frothy/cloudy which I've read is a sign of an infection. I feel that I just haven't had enough tests done to determine exactly was is causing my issues. Do you think I should wait 3-4 weeks after my current antibiotic treamtment to send off a morning urine sample for PCR tests for candida, ureaplasma/mycoplasma, trich and standard STD tests? What about an extended course of a macrolide (3-4 weeks?)? Should I try the Septra DS again for 6 weeks or another fluoroquinoline?
Thanks for your reply. My current symptoms are prostrate pain (can't sit comfortably at all due to burning and swelling), urethra/testicular pain after ejaculation and urination difficulties (still on uroxatral). I'm 38 and was in excellent health prior to the STD exposure (female worker). All antiobiotics have seemed to help in one way or another but when I done with them then the pain comes back full force and the urination issues intensify. The original course of doxy and rocephin seemed to have got me to 90% but whatever bacteria/parasite it is seems to have lodged itself in my prostrate and won't come out. I've never had a prostate massage for a 4 glass test or been asked to provide a morning urine or prostrate fluid sample to send off to culture or test. My morning urine has glass like beads and is frothy/cloudy which I've read is a sign of an infection. I feel that I just haven't had enough tests done to determine exactly was is causing my issues. Do you think I should wait 3-4 weeks after my current antibiotic treamtment to send off a morning urine sample for PCR tests for candida, ureaplasma/mycoplasma, trich and standard STD tests? What about an extended course of a macrolide (3-4 weeks?)? Should I try the Septra DS again for 6 weeks or another fluoroquinoline?
MEDICAL PROFESSIONAL
Welcome to our Forum. Unfortunately, your problem is not unique. In your detailed history, you did not mention what the symptoms are that continue to trouble you- perhaps you could describe then although I doubt that they will change the observations and suggestions I make below.
Several comments due occur to me related to these issues.
1. The therapy you have had is more than adequate therapy for typical STDs and epididymitis arising as a complication of these infections. I find it difficult to think that an STD is related to your ongoing symptoms.
2. Trich in men is difficult to diagnose. Nonetheless, carefully studies have never even suggested that they can be a cuase of chronic symptoms or complications in men.
3. Organisms like the genital mycoplasmas and ureaplasmas are the subject of much controversy and are not known to definitively cause chronic problems but, because they are part of the NORMAL bacterial flora of the genital tract are often suggested as pathogens for persons with chronic complaints. Had these been the cause of your problems, your therapy should have resolved them.
4. Chronic prostatitis is a possibility for you and if so is a challenging problem to deal with, often requiring repeated, prolonged courses of antibiotics with the sorts of drugs you have received- fluoroquinolone antibiotics such as Cipro or levofloxacin or trimethoprim-sulfamethoxazole. The best approach to this difficult to manage problem is to commit to work in ongoing fashion with a urologist who you have faith in.
5. Another, recently describe, non-STD syndrome, the Chronic Pelvic Pain Syndrome (CPPS- well described in Wikipedia) may be in play here as well. If so, again working with a trusted urologist is a good approach.
I hope these comments help. There is little reason for you to be worried about STD at this time and the onset of your original or continuing complaints may be more co-incidental than causal. EWH
Several comments due occur to me related to these issues.
1. The therapy you have had is more than adequate therapy for typical STDs and epididymitis arising as a complication of these infections. I find it difficult to think that an STD is related to your ongoing symptoms.
2. Trich in men is difficult to diagnose. Nonetheless, carefully studies have never even suggested that they can be a cuase of chronic symptoms or complications in men.
3. Organisms like the genital mycoplasmas and ureaplasmas are the subject of much controversy and are not known to definitively cause chronic problems but, because they are part of the NORMAL bacterial flora of the genital tract are often suggested as pathogens for persons with chronic complaints. Had these been the cause of your problems, your therapy should have resolved them.
4. Chronic prostatitis is a possibility for you and if so is a challenging problem to deal with, often requiring repeated, prolonged courses of antibiotics with the sorts of drugs you have received- fluoroquinolone antibiotics such as Cipro or levofloxacin or trimethoprim-sulfamethoxazole. The best approach to this difficult to manage problem is to commit to work in ongoing fashion with a urologist who you have faith in.
5. Another, recently describe, non-STD syndrome, the Chronic Pelvic Pain Syndrome (CPPS- well described in Wikipedia) may be in play here as well. If so, again working with a trusted urologist is a good approach.
I hope these comments help. There is little reason for you to be worried about STD at this time and the onset of your original or continuing complaints may be more co-incidental than causal. EWH
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