persistent symptoms, negative tests

[urolhelp]

Hi, about three weeks ago, I saw a GP with pain in my groin region that felt like epididymitis, which I had had one year prior.  I had had prolonged pain after urinating, and a persistent need to urinate, which transformed into pain in my testicles and in the surrounding area.  I was prescribed azithromycin.  This did not help, so a week later I was tested for chlamydiae, gonorrhea, and a UTI, and prescribed doxycycline, twice daily.  The doxycycline also did not help.  All the test results came back negative.  I was scheduled for an ultrasound tomorrow.  By yesterday, the pain had become almost constant and focused in my groin area -- in my inner thigh, under my testicles, with shooting pain reaching my testicles themselves.  Nothing hurt (or presently hurts) to touch.  Because I am scheduled to travel to the United States this Friday, I decided to go to an Emergency Room.  They took blood and urine and examined me at the ER.  I don't know exactly what I was tested for, but all the tests came back negative.  They said that there was no indication that my body was fighting an infection.  Today, I am back to having a strong urge to urinate, even when I can't, with burning pain, and radiating groin pain.  I have had symptoms for about 3 weeks.

Additional information: I take Sybicort for asthma and Finasteride.  Also, I have had one problem since childhood that might be relevant.  Often, though not invariably, after I ejaculate, I have symptoms like some of those described above for between 10 minutes and 1 hour.  In particular, I feel burning pain and a persistent need to urinate, even if I cannot.  I have never had the matter looked at.

1. What remaining diseases do you think it would be worth looking into?  Does anything serious jump out at you?
2. Is there any reason that I should not travel to the United States next week in my condition (I do not seem to be otherwise ill -- normal energy, etc.)?
3. Anything else I should know?

[Rajiv Goel, MD]

Dear urolhelp,

Good to hear that your ultrasound is normal and hence you can travel to US.

I sincerely believe that you should stop finasteride to avoid its side effects and look at other alternatives to manage hair loss.

Treatment for chemical epididymitis involves scrotal elevation with scrotal supporter and antiinflammatory agents. In addition, I usually put my patients on alpha blockers to make them void better and thus prevent reflux of urine into ejaculatory ducts.

You can discuss these treatment options with your doctor.

Hope that this information helps and hope that you will get better soon.

Best Regards
Dr. Rajiv Goel.

[urolhelp]

Thanks very much for the helpful response.  

I had an ultrasound today, and the person who performed it said that it looked completely normal -- not even any inflammation.  I am on finasteride for hair loss.  I have been on it for 5 years or more without any significant side effects.  I am 28.  What is the treatment for chemical epididymitis?

Thanks again.

[Rajiv Goel, MD]

Dear urolhelp,

You could be having Epididymitis in spite of negative tests. Epididymitis can be chemical or infective. If during normal course of things you had difficulty in passing urine you could be having chemical epididymitis. All your tests would come negative in such a case. I am interested in knowing why you are on finasteride and what is your age.

All your symptoms after ejaculation are normal and don't have any relation to your present condition.

You should certainly get an ultrasound scan of the abdomen and pelvis region done and rule out stone disease. Once stone disease is ruled out and you are started on treatment for your epididymitis, I don't see any reason why you cannot travel to United States.


Hope that this information helps and hope that you will get better soon.

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Best Regards,
Dr. Rajiv Goel