Prostate/Sexual Dysfunction for NGU

[Worrier88]

I have had chlamydia in the past and  2 weeks ago received unprotected oral. Symptoms:
-intermittent pain in left side of groin
-moist tip of penis in mornings, though no discharge
-stringiness of two sides of urethrea. When I separate them, they are stuck together at one point in a stringy way.
-a limp, soft left testicle that felt weak and not firm like my right testicle. my penis was tiny and could get aroused.

My urologist identified small enlarged lymph nodes and gave me 7 days doxycycline. My testicle has gone back to normal. I can get aroused but only through physical stimulation (and even then not like before) not mentional stimulation.

I am going to get fully tested for urine/swab/blood. In the meantime:

Question 1: I don't think my problem is only psychological. Can STDs infections cause erectile dysfunction? Does this mean I have to have my prostate examined? (cause of lack of blood flow) Or can there be other explanations?

Question 2: After 1 week of doxy, some signs of improvement, but not full improvement, would you suggest 1 more week of doxy, 2 weeks of azithromycin, and then another drug? What regime would you recommend for someone who wants to make sure I kill it?

Many thanks!

[Edward W Hook, MD]

I woul work with my doctor.  It souns like he is being thoughtful.  I am sure that if you look around enough you can find someone who will prescribe antibiotics but they (and you) would not know what is being treated - that is nto in your best interest.

I will sign off now- you need to work this through with your doctor.  EWH  

[Worrier88]

Thanks again! I am working with my urologist and have taken a course, 7 days, of doxycyclin. It seems as though my urethritis is under control thus far. However my prostate still feels a little funny. Arousal is not normal. I have done a urine test and waiting for results. Doctor wants to see results before even contemplating a rectal exam (no idea if this is standard?). I am feeling much better and seem to be responding to doxy. However, I read online that many people make the mistake of not killing the chlamydia fully in their prostate or wherever else and then it reappears with greater resistance and more prostate problems and I don't want to make this mistake. Given my long history with chlamydia (got it in 2008, took lne week doxy and symptoms went away, got it again 2 months ago when I also got conjunctivitis and did 3 weeks total doxy, 2 weeks tetracycline ointmentnand appeared fully cured), it seems to me to be a good idea to push for a longer course of doxycycline, perhaps 4 weeks total, and 1 azithromycin antibiotics with metronidazole just to be safe to cover other ngus. I realize antibiotics are not great for the body and I ideally wouldnt take them, but it seems to me like a good strategy where the benefits outweigh the costs. I feel, though, the doc is likely to disapprove and i may have to get a second opinion/find a doc to proscribe the antibiotics? What do you think? What would you do if you were 31, experiencing erectile dysfunction for first time and trying to do the best thing for oneself?

[Edward W Hook, MD]

If your tests are negative an your exam is normal, you need not worry about infection by "hidden" bacteria.  As I said before, I suggest you work through this with your octor. EWH

[Worrier88]

Thanks, doctor.

As a follow up question, is it true that bacteria can "hide out" in your prostate and not show up on tests but continue to cause problems? I am worried that my urologist will find nothing during my prostate exam, proscribe nothing, my prostate deteriorate into prostatitis and worse, when I could have done more to try to kill it, like take more antibiotics at an early stage.

I have felt a bit of pain in my anal area and during masturbation I cannot will an erection with my mind, only use physical stimulation. Amount of ejaculate produced seems small and worst of all i don't have a full sense of orgasm but a tightness in what I imagine to be my prostate area. This scares me since I'm only 31 and I want to have my normal life back.

[Edward W Hook, MD]

Welcome to the Forum.  Your initial symptoms could well have been NGU caused by chlamydia or some other bacteria.  Doxycycline is good, recommended therapy and it sounds like it is working for you.  Typically 7 days of therapy should be plenty.

Erectile dysfunction is not a recognized complication of any STD so I suspect that you will need to find another explanation. You are seeing the right doctor to address this- a urologist.  ED can be caused by psychological issues or physical problems.  The urologist should be able to help an I would include a prostate exam (including examining the prostate through a rectal exam as part of that).  

At this time, unless there are abnormal lab tests or you are found to have prostatitis, there is little indication for further therapy.  I would not suggest additional therapy unless there is some more objective reason to o so.

Hope these comments are helpful.  I would suggest you stick with your urologist.  EWH