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Need help with urology diagnosis or treatment options

Hello bright minds, I am a med student on my uro clinical and had this difficult Dx, any ideas?

30/m complaining of progressive urethral pain, no other major health problems, pain started 4 years ago as sporadic pain and progressed over time into constant “extremely painful” burning pain. 14 visits to clinic for same reason with no relief. Complains new joint pain in knees with burning throbbing pain their as well, itching and burning in penis, around penis, around anus, and newly attributed neurological pain in his fingers and hands. Patient claims pain started after unprotected sex with female 4 years ago and insists symptoms resemble or mimic exact symptoms of late stage syphilis.

Tx/Dx thusfar:
- for STDs, - for 2 cystoscopies, - for Hep A, B, C, HIV, urine test normal xray for kidney stones negative..
- Treatment included rocephin shot, deoxy antib, cipro antib, given different times to eliminate variables (no + results, pain progressed).

Dx of attending thusfar
Chronic pros. as hunch, but really just out of process of elimination. Attending asked me for other Dx, causes of symptoms, and ideas for treatment.
All I can think of for causes Trauma to the urinary tract; PID, STDs, Chronic/acute bac or non bac prost., cancer, autoimmune disorders?
And for Tx:
I don’t know, seems like patient tried every antib with no positive change. Should I recommend trial of penicillin since every other STI seemed to be treated eventhough no + result shown? Other tests I really don’t know. Patient seems in extreme pain and to be honest I don’t think the Attending really knows what the exact Dx is and what the exact Tx should go from here.
Any ideas?
1 Responses
489228 tn?1291535054
Have you considered IC/PBS.  Men with symptoms like above often have Interstital Cytitis and it is not diagnosed or diagnosed as Chronic Prostitis.  The symptoms to me sound very much like IC especially in men.  This might be something to consider?
With my IC I have a lot of urethra pain.  My compounding pharmacist can make urethral suppositories of lidocaine and valium.  These help a lot with the pain.

HI, I have IC and am an IC support group leader. A good way to get an idea is to go to the Elmiron website allaboutic.com.  Here they have a Patient pain and frequency scale that you can give him that will help them determine if he might have IC.  Though  there is no cure for IC their are many treatments that can help your pain!  I have pretty severe IC pain because of some additional issues, but have great coping tools and treatments that my physician and I have found help me.

There are several great sites/organizations that can help you learn more about IC, especially in men.  If you can not find what you need feel free to contact me.  Though i am not physician I would be glad to help you any way I can!
the ICA which is ichlep.org
the ICN which is ic-network.com

Our support group is set up mainly to network patients and medical practitioners throughout Missouri and Arkansas, but I have tried to put a lot of articles on the board to help any patient as well.

we are
moarkic.com  it stands for mo for Missouri and Ark for Arkansas and of course IC

One suggestions I would make is to find a good Pelvic Pain Physical Therapist, often they can rule out alot of other issues that might be going on along with  IC or by themselves.!

I hope that gives you some hope and direction!  

Shelly Matthewson
Private Researcher
IC Support Group Leader
Director of MOARK Interstitial Cystitis
"And we know that all things work together for
good to them that love God, to them who are the
called according to His purpose."Romans8:28
Shelly Matthewson
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