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Prostitis or STD?


On January 28, I had unprotected anal sex with a male. Didn't know who they were. I also am a male.  On Feb 1st I had dysuria.  Went to PCP and she did not see WBC or RBC in urine.  Culture revealed 1:10000(ten thousand) streprococcus agalactiae group b.  I am also a type 1 diabetic.  She placed me on cipro for 3 days and z-pack for 2 days. I was then put on amoxil 250mg TID for 7 days.  I had some relief of dysuria, but not total. After day 4 of being off amoxil, the pain started going to the rectum and bladder.  She repeated urine culture while on antibiotics and it came back negative.  Semen culture revealed few PMN's, but no organisms.  Was sent to urologist, after being off antibiotics for 4 days. He did DRE and said prostate was a little boggy and saw some WBC's in fluid.  Did not send fluid for culture even after I asked.  Urine was free from WBC and RBC, but he did not culture that either.  Completed 30 days of Levoquin 500mg once daily.  Still buring, bladder cramping is somewhat better, fullness in rectum is also somewhat better. PCP just started me on amoxil 500mg TID for 15 days.  Chlamydia and Gonorrhea tests were negative prior to any treatment being started on Feb 1st.  I get a full cramping feeling in my bladder and still burn.  The buring subsides if I drink lots of water.  Painful ejaculations off and on, fullness feeling in rectum off and on.  What tests should I have done, what procedure should I request, I go to the urologist again this tuesday.  Could they be treating me with the wrong antibiotic?  Could the group b strep be hiding in my prostate?  I read that penicillin was drug of choice for strep agalactiae.  Is amoxil a penicillin?
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To answer your questions:
1) I would consider further tests on the prostate, including a transrectal ultrasound - which can evaluate for abscesses that cannot be treated by antibiotics.  If all the tests for infection are negative, I would consider a cystoscopy to evaluate for any anatomical abnormalities (i.e. stricture or polyps) that can be causing the symptoms.

2) Testing the culture for antibacterial sensitivities can determine if the bacteria is resistant to the antibiotic you are taking.

3) Amoxil is an antibiotic in the penicillin class.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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