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Persistant penile irritation
First of all many thanks for a very valuable and informative service. Apologies for lengthy case history but grateufl for any views you may have.
Brief details 32 year old male, married, no prior medical history.
In early Oct. '05 I had protected oral sex, condom used (correctly so I though), no other sexual contact, with CSW. Over the next 5-7 days I developed penile, irritation, slight discharge and then severe testicular pain. I visted a local ER (a urine sample provide positive for Chamydia) and was treated with injection of Rocephine (?) and a 14 day course of doxcyline.
Penile irritation and pain in perineum persisted. I visited urologist at the local clinic for follow up test of cure (a blood test (in beginning Dec. 05) which was negative for C. - from archives I see you cast some dout on serolgical testing for C. in clincal situation) and was diagnosed with prostatitis (treatment 3 day course 500mg azithromycince, 30 day course ciproxine). No change in symptoms.
As symptoms persisted I consulted a GP in early January who performed swab tests for C and Gonn plus full STD panel (HIV, syph, HSV) all negative. However, a urine test was postive for enteroccus (for which I was treated with amoxcillian).
He also referred me to a new urologist at a major academic hospital in Brussels (currently living in Belgium), where I had repeated urethral swab tests, urine, culture of semen, culture of expressed prostatic secretions, transrectal ultrasound. The EPS showed evidence of bacteria (couldn't be cultured) and inflammation). Uro diagnosed chronic bacterial infection of unknown etiology however, he did not recommend further abx treatment beliving that infection is localised in prostate and will not be responsive to further abx treatment.
I am concerned as:
(1) irriation and pain in perineum persist (definately not magnifying ordinary sensations; and
(2) more importantly for wife's health. I avoided all sexual contact with my wife until after initial treatment (doxy, recephine, azth and cipro)and then only mutual masturbation until first uro gave all clear (on basis of blodd test for C.). However, shortly after first occasion we had unprotected sex she complained of pain (a first) and severe thrush (again a first). She visited GP and had a urine test for UTIs (neg)
My questions are:
(1) Could an undetected chlamydial infection persist in prostate?
(2)Could mine and my wife's symptoms be due to enteroccus infection going back and forth between us?
(2) Does my wife need to be tested for STDs (there is no possibility that she was the one to infect me and I have had no other sexual partners in past 7 years)
(3) Do you have recommendation for further treatment / investigation?
Brief details 32 year old male, married, no prior medical history.
In early Oct. '05 I had protected oral sex, condom used (correctly so I though), no other sexual contact, with CSW. Over the next 5-7 days I developed penile, irritation, slight discharge and then severe testicular pain. I visted a local ER (a urine sample provide positive for Chamydia) and was treated with injection of Rocephine (?) and a 14 day course of doxcyline.
Penile irritation and pain in perineum persisted. I visited urologist at the local clinic for follow up test of cure (a blood test (in beginning Dec. 05) which was negative for C. - from archives I see you cast some dout on serolgical testing for C. in clincal situation) and was diagnosed with prostatitis (treatment 3 day course 500mg azithromycince, 30 day course ciproxine). No change in symptoms.
As symptoms persisted I consulted a GP in early January who performed swab tests for C and Gonn plus full STD panel (HIV, syph, HSV) all negative. However, a urine test was postive for enteroccus (for which I was treated with amoxcillian).
He also referred me to a new urologist at a major academic hospital in Brussels (currently living in Belgium), where I had repeated urethral swab tests, urine, culture of semen, culture of expressed prostatic secretions, transrectal ultrasound. The EPS showed evidence of bacteria (couldn't be cultured) and inflammation). Uro diagnosed chronic bacterial infection of unknown etiology however, he did not recommend further abx treatment beliving that infection is localised in prostate and will not be responsive to further abx treatment.
I am concerned as:
(1) irriation and pain in perineum persist (definately not magnifying ordinary sensations; and
(2) more importantly for wife's health. I avoided all sexual contact with my wife until after initial treatment (doxy, recephine, azth and cipro)and then only mutual masturbation until first uro gave all clear (on basis of blodd test for C.). However, shortly after first occasion we had unprotected sex she complained of pain (a first) and severe thrush (again a first). She visited GP and had a urine test for UTIs (neg)
My questions are:
(1) Could an undetected chlamydial infection persist in prostate?
(2)Could mine and my wife's symptoms be due to enteroccus infection going back and forth between us?
(2) Does my wife need to be tested for STDs (there is no possibility that she was the one to infect me and I have had no other sexual partners in past 7 years)
(3) Do you have recommendation for further treatment / investigation?
1) Can the irritation show up the next day after exposure
2) What else can mimic the symptoms.
3) Does liquid Z-max provide the same benefit as a Z-pack of azithromycin.
4) HIV exposure doesn't produce these symptoms , does it
5) After taking the azithromycin, diarrhea developed, does this interfere with its absorbtion.
2) What else can mimic the symptoms.
3) Does liquid Z-max provide the same benefit as a Z-pack of azithromycin.
4) HIV exposure doesn't produce these symptoms , does it
5) After taking the azithromycin, diarrhea developed, does this interfere with its absorbtion.
Dr., Thank you for a prompt and comprehensive reply.
My urologists
My urologists
MEDICAL PROFESSIONAL
Most likely you have chronic prostatitis. The causes are unknown; many (most?) cases probably are due to inflammation, not infection--which goes along with the lack of response to the antibiotics you mention. For sure you do not have any kind of persistent STD.
Your chlamydial infection is puzzling. Chlamydial urethritis has never been proved to be acquired by oral sex (chlamydia rarely infects the throat) and it is impossible to acquire chlamydia through an intact condom. So I have to wonder about other exposures, including the possibility that your wife is infected; or that you were carrying the infection prior to the oral sex event you describe. I take you at your word that she is unlikely to have had other partners, and you can predict her behavior with much greater accuracy than I can. But from my perspective as an STD specialist, I have to raise the possibility. It also is possible your test was falsely positive, but that seems unlikely in view of your symptoms at the time, which were quite classical.
1) Although a few reports have suggested that chlamydia might cause prostate infections, this has never been proved and most chlamydia experts believe it doesn't happen. It is conceivable, but also unproved, that an initial case of urethritis due to any cause (including chlamydia) might set up an inflammatory reaction that persists long after the infection itself is gone. In any case, chlamydia cannot hide undetected in the prostate; if you had it, your tests would still be positive.
2) Enterococcus is not sexually transmitted. Thrush is a yeast infection (also not sexually acquired or transmitted). Most likely your wife's symptoms have no connection with yours.
3) If you had sex with your wife at all following the date you think you caught chlamydia, or if otherwise there is the slightest doubt about her risks, then she should be tested and treated for it. This may be especially important in view of my concerns above about the source of your infection.
4) Just to follow your own providers' advice. Many men with the persistent symptoms you have just have to learn to live with them. In most cases, they fade with time, with no long term damage or harm.
Good luck-- HHH, MD
Your chlamydial infection is puzzling. Chlamydial urethritis has never been proved to be acquired by oral sex (chlamydia rarely infects the throat) and it is impossible to acquire chlamydia through an intact condom. So I have to wonder about other exposures, including the possibility that your wife is infected; or that you were carrying the infection prior to the oral sex event you describe. I take you at your word that she is unlikely to have had other partners, and you can predict her behavior with much greater accuracy than I can. But from my perspective as an STD specialist, I have to raise the possibility. It also is possible your test was falsely positive, but that seems unlikely in view of your symptoms at the time, which were quite classical.
1) Although a few reports have suggested that chlamydia might cause prostate infections, this has never been proved and most chlamydia experts believe it doesn't happen. It is conceivable, but also unproved, that an initial case of urethritis due to any cause (including chlamydia) might set up an inflammatory reaction that persists long after the infection itself is gone. In any case, chlamydia cannot hide undetected in the prostate; if you had it, your tests would still be positive.
2) Enterococcus is not sexually transmitted. Thrush is a yeast infection (also not sexually acquired or transmitted). Most likely your wife's symptoms have no connection with yours.
3) If you had sex with your wife at all following the date you think you caught chlamydia, or if otherwise there is the slightest doubt about her risks, then she should be tested and treated for it. This may be especially important in view of my concerns above about the source of your infection.
4) Just to follow your own providers' advice. Many men with the persistent symptoms you have just have to learn to live with them. In most cases, they fade with time, with no long term damage or harm.
Good luck-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
