STI or Prostatitis

[Saveen]

Dear Dr. Hunter,

I have read many posts on this forum on this topic.Here is my case history and need your help

3 months back I had a massage where the masseuse may have touched my urethra with her vaginal fluid on her hand.2 days after the exposure I had burning sensation in the urinary track with urge to urinate frequently. GP did a UTI dip stick test and was told that I MAY have mild bacterial infection.He gave me 5 days of Cipro (250mg x 2 a day) and the infection was treated by day 4,atleast the symptoms were gone by day 5.

Exactly 4 weeks later, same symptoms of burning sensation and urge to urinate came back but with more severity. Urologist tested me for the following with Urine and blood tests:

-White blood cells,Urine culture (all negative with no bacteria or WBC)
-STI tests, VD,PSA,HSV,HIV,PCR (all negative and non-reactive)

He gave me 20 day of Levofloxycin (250mg x 2 for 10 days, followed by once 10 days once a day) with Celebrex,anitinflamatory 200mg twice a day.

2 months from the first symptoms ,he gave Vesicare 5mg (once a day) for OAB along with Celebrex for 10 days.I tried this for 6 days with no change to the symptoms

Again tested Urine - negative for bactria etc

7 weeks from the first symptoms,we tried  Lyrica 0.4mg (twice a day) along with Tamsulosin (Alphablocker,once in night) and continue Celebrex 200 mg twice a day.
  
I changed my Urologist, he did an ultrasound and DRE and bladder,kidney and prostate are in good shape with no inflammation or abnormalities.

He gave me the following medicines for 2 weeks, (in week 2 now)

-Zithromycin: 1g followed on day one by 0.5g on day two
-Ciprofloxycin 250mg twice a day for 15 days
-Urogesic & Genurin 200mg 3 times a day
-I am also continuing Tamsulosin 0.4mg once in night.
-I am also taking Saw Palmetto extract supplement and probiotics

The symptoms are still on. There is no pain or any erectile dysfunction.

My questions are

[Saveen]

Dear Dr.Edward,

Thank you for your prompt response,really appreciated.I saw my urologist again and he suggested to go for Cystoscopy.I am reluctant to go for the procedure as we are not sure yet if there is anything related to bladder,urethra or kidney and it is invasive.

I have couple of follow-on questions:
-Can STI ever cause CPPS, my concern is that it was too coincidental that the symptoms and the massage happened at the same time. Is there any bacteria that is resistant to Azithromycin,Levofloxycin and Ciprofloxycin which we might not have covered in the diagnosis or treatment.
-Do I test for Bacterial Prostatitis also thru PPMT and do a prostate scope instead of cystoscope as we have not ruled out Bacterial postatitis yet
-Any other advise on IC or CPPS will be helpful

Just to recap, my constant symptom is burning/discomfort in urethra with 30 mins to 1 hr of urine collection in the bladder with urge to urinate.There is no other pain at all or erectile dysfunction.

Thanks once again.


-

[Edward W Hook, MD]

Thanks for restating your questions.

I suspect that your symptoms are more of a coincidence than anything else and are not an STD related to the exposure that you mention, of this I am confident.  From having read other posts, you will know that neither of us has ever encountered a patient who acquired a urethral STD through transfer of infectious material such as vaginal fluid from a partner on either their hands or their partners’ hands.  Further, besides your multiple negative tests for STD, among the treatments you have received in the past several months, are a number of medications which have been given in sufficient strength and duration to cure STDs, had one been present.  Finally with respect to your symptoms, urinary frequency is not a symptom suggestive of STD.

With respect to prostatitis, prostatitis is rarely, if ever an STD, despite the misperception by even some health care providers that this is the case.  Neither of us is a urologist so your questions about prostatitis may be better addressed on the MedHelp Urology Community site, although given your test results and the fact that you have been evaluated directly by two urologists who appear to have come to similar conclusions, I suspect that this is not prostatitis either.  My suspicion is that your current difficulties fall into the realm of interstitial cystitis or  the chronic pelvic pain syndrome (CPPS), a relatively recently describe urological problem for many men which causes these symptoms,  The CPPS is well describe on Wikepedia, I suggest you read about it there.

I see no reason for further STD tests. As for urologic tests, this should be discussed with your own doctor.  The same is true regarding your use of the alpha blockers although I should point out that alpha blockers are more for symptomatic relief or urological difficulties than therapy.

I hope these comments are helpful.  There is no reason to worry that your ongoing symptoms are due to any STD acquired through your interaction with the masseuse several months ago.   EWH

[Saveen]

3 months back I had a massage where the masseuse may have touched my urethra with her vaginal fluid on her hand.
2 days after the exposure I had burning sensation in the urinary track with urge to urinate frequently. GP did a UTI dip stick test and gave me 5 days of Cipro (250mg x 2 a day), infection was treated atleast the symptoms were gone
4 weeks later, same symptoms came back. Urologist tested me for the following:

-White blood cells,Urine culture (all negative with no bacteria or WBC)
-STI tests, VD,PSA,HSV,HIV,PCR (all negative and non-reactive)

He gave me 20 day of Levn (250mg x 2 for 10 days, then 10 days once daily) with Celebrex 200mg twice a day.

2 months later he gave Vesicare 5mg daily with Celebrex.I tried this for 6 days with no change.Again tested Urine - negative for bactria etc

7 weeks from the first symptoms,tried  Lyrica 0.4mg (twice a day) with Tamsulosin Alphablocker and Celebrex twice a day.
  
I changed Urologist, he did an ultrasound and DRE and bladder,kidney and prostate are in good shape with no inflammation or abnormalities.

He gave me the following medicines for 2 weeks, (in week 2 now)

-Zithromycin: 1g followed on day one by 0.5g day 2
-Ciprofloxycin 250mg x2 for 15 days
-Urogesic & Genurin 200mg x 3 daily
-Also continuing Tamsulosin 0.4mg once in night.
-Also taking Saw Palmetto extract,probiotics

The symptoms are still on. There is no pain or any erectile dysfunction.

My questions are:
-Are there any other tests that I do to cover any STI
-I have read many posts that STIs in rare cases cause Prostatitis and does not cause Non-bacterial Prostatitis but the timing of the symptoms immediately 2 days after the exposure and Cipro treating it atleast for first 4 weeks suspect STI as cause
-Can Prostatitis happen in 4 weeks of first exposure,I am in ealry 40's with good health
-If we go Prostatitis way,do I need to test for bacterial prostatitis (PPMT) If so,how many days after stopping antibiotics should I take the test
-Any other advise on non-bacterial prostatitis, there is no pain,no inflammation and it is too co-incidental to have the start after 2 days of the exposure.
-Do I continue the alpha blocker or stop them as it is causing retro-ejaculation.
-Anxiety could be other reason but cannot be determined


Pls help,thanks.

[Edward W Hook, MD]

You have not observed the 2000 character limit specifed by our Forum.  I'll be happy to address your concerns but you must follow the Forum's rules.  Please re-state your history and questions within out character limit.  If you cannot do this, your question is too complex to be answered on this site.  EWH

[Saveen]

My questions are:
-Are there any other tests that I ask my urologist to do to cover any STI
-I have read many posts that STIs in rare cases cause Prostatitis and does not cause Non-bacterial Prostatitis but the timing of the symptoms immediately 2 days after the exposure and Cipro treating it atleast for first 4 weeks suspect STI
-Can Prostatitis happen in 4 weeks of first exposure,I am in ealry 40's and have good health
-If we go the route of Prostatitis,do I need to test for bacterial prostatitis (PPMT) If so,how many days after stopping antibiotics should I take the PPMT test
-Any other advise on non-bacterial prostatitis, there is no pain,no inflammation and it is too co-incidental to have the start after 2 days of the exposure.
-Do I continue the alpha blocker or stop them as it is causing retro-ejaculation.
-Anxiety could be other reason but cannot be determined
-Is there anything else I can do as it is very frustrating.

Pls help,thanks