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recurrent epididymytis and possibly ngu
good afternoon,
first, i am a 29 year old male. This may be slightly complicated. Hopefully this wont be too long. and the question is two part. first part is dealing with epididtymitis and the second deals with urethritis.
1.) For a long while now (off and on for over a year plus), i have had recurrent epididymytis. my right testicle would swell and eventually goes down. i would have, what im guessing is referred pain that goes down my leg. Earlier this year, i went to ER with a swollen testicle and was given doxy. i was then sent to a urologist and everything came back normal beside a large hydrocele. i was prescribed levaquin for 14 days, that seemed to work. now the second part of the question.
2.) i'm not sure of the cause but was diagnosed with NGU - chlamydia and gonnoreah were negative. i felt like these symptoms came on after about 3 days after an encounter with a woman without a condom, i was treated with doxy and cipro. ive had encounters with same woman again with unprotected oral and have similar symptoms of ngu. It was oral only. At this point I still had a bit of swelling in the testicle and spoke with my urologist and was prescribed another course of levaquin. ive taken it for 7 days now and see that i am still having the clear discharge and have some discomfort.
also, i was also treated for a mycoplasma pnemonia infection about 3 weeks prior and was given clarithomycin for 10 days.
i went to a new doctor, because I just moved out of state, and am waiting the results of a urinalysis. he mentioned that because i had just finished clarithomycin and am taking levaquin not much can be done yet.
so with all that said, any thoughts on the recurrent nature of the epididiyitis and urethritis? how long until the levaquin kicks in? how long generally until symptoms subside with urethritis? NGU from Oral only?
first, i am a 29 year old male. This may be slightly complicated. Hopefully this wont be too long. and the question is two part. first part is dealing with epididtymitis and the second deals with urethritis.
1.) For a long while now (off and on for over a year plus), i have had recurrent epididymytis. my right testicle would swell and eventually goes down. i would have, what im guessing is referred pain that goes down my leg. Earlier this year, i went to ER with a swollen testicle and was given doxy. i was then sent to a urologist and everything came back normal beside a large hydrocele. i was prescribed levaquin for 14 days, that seemed to work. now the second part of the question.
2.) i'm not sure of the cause but was diagnosed with NGU - chlamydia and gonnoreah were negative. i felt like these symptoms came on after about 3 days after an encounter with a woman without a condom, i was treated with doxy and cipro. ive had encounters with same woman again with unprotected oral and have similar symptoms of ngu. It was oral only. At this point I still had a bit of swelling in the testicle and spoke with my urologist and was prescribed another course of levaquin. ive taken it for 7 days now and see that i am still having the clear discharge and have some discomfort.
also, i was also treated for a mycoplasma pnemonia infection about 3 weeks prior and was given clarithomycin for 10 days.
i went to a new doctor, because I just moved out of state, and am waiting the results of a urinalysis. he mentioned that because i had just finished clarithomycin and am taking levaquin not much can be done yet.
so with all that said, any thoughts on the recurrent nature of the epididiyitis and urethritis? how long until the levaquin kicks in? how long generally until symptoms subside with urethritis? NGU from Oral only?
MEDICAL PROFESSIONAL
Welcome to the Forum. I'll try to help in the way of guidance but you are right, this is complicated. Obviously, this appears to be a recurring problem and as such it is best addressed through repeated evaluation/examination by the same doctor so that they can be aware of changes in your examination and how they correlate with your symptoms. Hydroceles are sometimes symptomatic and can increase and decrease in size in some persons. Whether your epididymitis is, in fact epididymitis or simply related to your hydrocele is hard to say. Having recently moved, you have the opportunity to establish a relationship with a new urologist and go forward from here- that is what I would recommend.
The second issue, which may or may not be related to the first is the question of non-chlamydial, recurring NGU. NGU is best diagnosed with a swab specimen taken from the penis at least an hour after last urination. On occasion microscopic evaluation of urine collected just as a person begins to urinate can serve the same purpose but the swab is the preferred approach. With either method, one is not looking for bacteria but for white blood cells which are a sign of inflammation. It is the signs of inflammation, manifest as increased numbers of white blood cells, which are the basis for the diagnosis of NGU. Much NGU is caused by bacteria of which the association with chlamydia is most certain. Other micro organisms cause it less often (trichomonas, some ureaplasmas, Mycoplasma genitalium, oral bacteria introduced into the urethra during receipt of oral sex, etc.) but are not typically tested for and despite optimal microbiological evaluation, in about 30% or more of cases there is no clear cause. We also DO know that there are non-STD causes of urethritis (NGU) as well. In most men NGU responds well to recommended treatment with doxycycline or azithromycin irrespective of cause. While not recommended therapy, both the levofloxacin (levoquin) and clarithromycin you have taken recently would be expected to cure most NGU.
Recurrent NGU is sometimes a tough clinical problem to deal with if that is what you have. When person fail therapy for NGU the typical approach is to then treat persons with the alternate antibiotic, often (but not always, depending on the sort of exposure) with a single 2.0 gram dose of metronidazole in case the NGU is due to trichamonas. If this fails and both partners have been treated and not re-exposed either to each other or to an untreated partner, aproportion simply have a recurring problem that can be more of a nuisance than anything else. At that time, it is also appropriate to ask if the person had NGU to start with. Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned. This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times. Perhaps this was a contributor to your situation. Alternatively, there may be something other than NGU going on here such as a urinary tract infection (rare in men), prostatitis (more common) or a recently recognized problem called the chronic pelvic pain syndrome (well )defined and described on Wikipedia). Perhaps one of these is going on.
Perhaps some of these comments will be helpful. If you reply, please be patient, I will be traveling and it may be a while before I am able to reply. EWH
The second issue, which may or may not be related to the first is the question of non-chlamydial, recurring NGU. NGU is best diagnosed with a swab specimen taken from the penis at least an hour after last urination. On occasion microscopic evaluation of urine collected just as a person begins to urinate can serve the same purpose but the swab is the preferred approach. With either method, one is not looking for bacteria but for white blood cells which are a sign of inflammation. It is the signs of inflammation, manifest as increased numbers of white blood cells, which are the basis for the diagnosis of NGU. Much NGU is caused by bacteria of which the association with chlamydia is most certain. Other micro organisms cause it less often (trichomonas, some ureaplasmas, Mycoplasma genitalium, oral bacteria introduced into the urethra during receipt of oral sex, etc.) but are not typically tested for and despite optimal microbiological evaluation, in about 30% or more of cases there is no clear cause. We also DO know that there are non-STD causes of urethritis (NGU) as well. In most men NGU responds well to recommended treatment with doxycycline or azithromycin irrespective of cause. While not recommended therapy, both the levofloxacin (levoquin) and clarithromycin you have taken recently would be expected to cure most NGU.
Recurrent NGU is sometimes a tough clinical problem to deal with if that is what you have. When person fail therapy for NGU the typical approach is to then treat persons with the alternate antibiotic, often (but not always, depending on the sort of exposure) with a single 2.0 gram dose of metronidazole in case the NGU is due to trichamonas. If this fails and both partners have been treated and not re-exposed either to each other or to an untreated partner, aproportion simply have a recurring problem that can be more of a nuisance than anything else. At that time, it is also appropriate to ask if the person had NGU to start with. Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned. This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times. Perhaps this was a contributor to your situation. Alternatively, there may be something other than NGU going on here such as a urinary tract infection (rare in men), prostatitis (more common) or a recently recognized problem called the chronic pelvic pain syndrome (well )defined and described on Wikipedia). Perhaps one of these is going on.
Perhaps some of these comments will be helpful. If you reply, please be patient, I will be traveling and it may be a while before I am able to reply. EWH
MEDICAL PROFESSIONAL
1. How long generally does it take the levaquin to clear symptoms? I have taken the full 7 days. Took the last pill today.
For NGU, the sypmtoms should have cleared several days ago. For prostatitis, there should at least be improvement by now but it may take longer (and more therapy).
2. I have taken the levaquin previously for the the epididimytis. Does it become less effective after multiple usage?
Sometimes.- if it is not working the question comes up as to what exactly is going on. discuss it with the doctor.
3. The onsite urinalysis I took a few days back at the doctors office showed trace amounts of leukocyte esterase and WBC 1-5. Is this significant?
Borderline but probably not. EWH
For NGU, the sypmtoms should have cleared several days ago. For prostatitis, there should at least be improvement by now but it may take longer (and more therapy).
2. I have taken the levaquin previously for the the epididimytis. Does it become less effective after multiple usage?
Sometimes.- if it is not working the question comes up as to what exactly is going on. discuss it with the doctor.
3. The onsite urinalysis I took a few days back at the doctors office showed trace amounts of leukocyte esterase and WBC 1-5. Is this significant?
Borderline but probably not. EWH
Thanks for your response. This was helpful. A few follow up questions.
1. How long generally does it take the levaquin to clear symptoms? I have taken the full 7 days. Took the last pill today.
2. I have taken the levaquin previously for the the epididimytis. Does it become less effective after multiple usage?
3. The onsite urinalysis I took a few days back at the doctors office showed trace amounts of leukocyte esterase and WBC 1-5. Is this significant?
Thanks.
1. How long generally does it take the levaquin to clear symptoms? I have taken the full 7 days. Took the last pill today.
2. I have taken the levaquin previously for the the epididimytis. Does it become less effective after multiple usage?
3. The onsite urinalysis I took a few days back at the doctors office showed trace amounts of leukocyte esterase and WBC 1-5. Is this significant?
Thanks.
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