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Is it Chronic Bacterial Prostatitis or Chronic Prostatitis/ Chronic Pelvic Pain Syndrome

User
Posted 07 Oct 2020 at 15:07

Hi 

Sorry for the long post. I am a 61, of Asian ethnicity not living in UK.

My initial indication that something was wrong was four months ago (third week of June) when I felt a slight groin pain when pushing myself against the bedhead and drawing my feet towards me when watching TV from the bed. The sort of pain you get after stretching your groin playing cricket. As I had not played sports for a long period, I was a bit puzzled. A week or so later the pain was more pronounced and was felt when shaving and pushing the groin area against the vanity counter to get near the mirror. I then felt pain in my testicles and the top of the penis.

I saw my GP who did a DRE and examination of the testicles for epididymitis. He said there was nothing wrong with either the prostrate or the testicles. He asked me to take a urine test. It came positive with pus cells 8-10/H.P.F. However, unfortunately no culture was done.

I then consulted a STD specialist as I was concerned about a possible exposure to a female towards end of February 2020 (before Covid). He ordered several tests for STD’s. Urine and blood and all were negative. Before the test results came, he gave me a two-week course of Doxycycline. I was also given 2 tablets to be taken once. Although initially the symptoms eased by the second week the testicle, groin and top of the penis pain was back.

I then consulted a urologist who also did a DRE, testicle and groin / pelvic examination and then a prostate massage for an immediate urine test. He prescribed a 2-week course of Levofloxacin 250mg once a day and urimax once a day.

The urine culture post prostate massage came back with Leukocytes(pus cells) > 10 cells/mm3 with a comment “ significant pyuria”. However, no bacterial growth presumably as I was still on Doxy.

Once again initially the symptoms subsided but towards the second week the testicle, groin and top of penis was still there. Saw the urologist again before the end of Levofloxacin and he decided to continue antibiotic treatment for an other week but put me on Trifix 200mg (cefixime) once a day  as I had surgery 2 years ago for insertional tendinitis.  

About a week after finishing the course of antibiotics the groin, testicle and top of the penis along with pelvic pain for the first came back with a vengeance. I was in real distress and worried that the infection could go septic.

I consulted another urologist as the other guy was not available and he decided to put me back on Levofloxacin but increased to 500mg once a day for one month. Within a couple of days, the pain subsided and gradually all symptoms subsided.

I saw my urologist a few days back and told him that I would like to continue Levo (250 mg once a day) for an other 2 weeks ( 6 weeks altogether) as on certain days the pain on the top of the penis and the groin pain still comes on. My orthopedic surgeon told me to get the infection cured and not to worry too much about tendinitis.

I feel I am not totally cured. I take 2 paracetamols in the morning and 2 in the evening.

The last time I consulted the urologist he felt that I have chronic prostatitis / chronic pelvic pain. However, I told him that when I am on antibiotics the symptoms significantly ease off. He told me once I finish the course of antibiotics and if the pain comes back to take a urine test and culture immediately.

All tests done in the last 3 months other than the initial urine test and then the post prostate massage have been negative for STD’s. The KUB ultrasound scan, scrotum ultrasound scan indicating nothing wrong. The PSA is 1.56. Uroflow too was ok.

I understand chronic bacterial prostatitis and CPP are long term issues.

On several occasions I enquired from my GP and Urologists whether there is any risk of cancer (prostate, testicle, bladder) and all of them have said NO. However, I am concerned about the groin / upper thigh pain.

I welcome suggestions from anyone who has undergone similar issues like me and what is the prognosis for the future and in particular someone who has been cured.

 

User
Posted 07 Oct 2020 at 15:38

Tip of penis is a common site for referred pain from urology organs such as prostate which your brain doesn't have in its body map, so can't associate pain from the prostate with the prostate.

You need to find a specialist in prostatitus - the one that did the prostate massage to try and obtain a culture might have been. No one should be giving you any antibiotic without having cultured a baterium and checked it's not resistant to it first, unless you are in imminent risk of sepsis or death which justifies a shot in the dark. Taking the wrong antibiotics which don't work just makes your infection more resistant to future treatment, and increases the chances of ending up with sepsis.

Many antibiotics also have some anti-inflammatory properties, and this can be misinterpreted as the antibiotic working, when in fact it hasn't, it's just some anti-inflammatory action while you're taking them, and that might explain some of the temporary relief you got followed by immediate relapse.

User
Posted 07 Oct 2020 at 17:37

Hi Andy

thanks for your input. I was told by the urologist what you had said about the prostate pain mimicking top of the penis pain precisely due to what you had attributed. The initial mistake was made by the STD specialist who did not ask for a culture before prescribing Doxy. I will see how it goes once I complete the course I am on currently and if symptoms return. However, I have read and the urologist has confirmed that Levo is the best antibiotic for chronic bacterial prostatitis  due as it ability to penetrates the prostate. I feel the first time the urologist prescribed Levo he should have given me 500mg once a day as opposed to 250mg. 

User
Posted 08 Oct 2020 at 00:44

I also think prostate fluid culture or semen culture would be a good idea. I'm having semen culture done soon. Do you have pain on ejaculation and reduced ejaculate?

I've had prostatitis on and off for 4 years, have not taken antibiotics for it yet as, until now, it's gone by itself after a few weeks. If it's not  bacterial, I'm told stress is a big factor.

User
Posted 08 Oct 2020 at 15:33

Hi Trionic

I did ask the Urologist about a semen culture. He did not prescribe one I presume because I am antibiotics.

I don't have pain on ejaculation although I do suffer from top of the penis pain about 24 to 48 hours subsequently. I did observe reduced ejaculate although it might be due to Urimax that I taking. I did read that as a consequence. To be honest in the last six weeks I have refrained from ejaculation either from sex or masturbation because this damn condition is seriously bothering me. I also read that it is best to avoid ejaculation when the prostate is infected. I believe there is contrary view as well.   

Once I finish this course I hope to keep away from antibiotics although I have read various posts where even a 3 month course of antibiotics is prescribed. The distressed that I felt due to the pelvic, groin and top of the penis was so severe that I am not sure avoidance is an option. Hope I will be ok at least for a two week period so that a urine and semen culture can be done with no impact due to the antibiotics. 

User
Posted 08 Oct 2020 at 16:32

Hi 

Yes if Urimax is like Tamsulosin then ejaculate will mostly end up in your bladder. I'm refraining too as my waterworks seem to suffer for about a week afterwards.

Like you, I've done a lot of reading as you just want to rid yourself of the discomfort. 

The cultures you plan are worth it to try to determine which bacteria, if any, are causing the symptoms. 

I'm having a MP MRI scan on Monday to see if that shows anything up. 

Prior to your discomfort, were you stressed?  I take it you are avoiding alcohol  and spicy, fatty foods and red meat? Something has annoyed your prostate...bacteria, food/drink or stress. Need to tick each one off and see what's left. Unfortunately, it's a long and winding road.

Take care.

 

Edited by member 08 Oct 2020 at 16:33  | Reason: Not specified

User
Posted 08 Oct 2020 at 16:58

Hi Trionic

Yes Urimax is quite similar to Tamsulosin. 

One of the Urologists did give me at my request a note to do a MP MRI scan as I am concerned about cancer. However the the other urologist said not to do it as invariably there might be a shadow or so on the scan and then we will  be searching for something else without truly identifying the actual problem. I hope he is correct.

Yes leading up to the onset of the initial pain issues I was under significant stress due to an unexpected loss of a person very close to me. I have read about stress related CPP. That’s a possibility. However, I did have an infection as the very first urine test did indicate pus cells although no culture was done. 

Yes I am off alcohol, red meat, fatty foods. Usually our curries do have spice but by our standards it is no too spicy. Being off sex and alcohol is bad enough!.  

It is crazy that despite all the advances made on the medical front there has been no real progress on prostatitis in the last two decades. 

Hope your MRI will be ok and there is nothing wrong.

 

Wishing you a full recovery.

User
Posted 08 Oct 2020 at 21:56

Pockets of infection in the prostate often end up in blocked off ducts, and don't show up in semen or urine samples. This is why the culture needs to be grown from expressed prostatic fluid, using prostate massage by a urologist.

Many antibiotics also can't get in to the prostate ducts, and the consultant urologist we have at The FOPS support group said he will often do prostate massage a few times while on antibiotics, I presume to get them in to the infected areas so they can work.

These are the reasons persistent prostatitis is difficult to fix - many doctors and even urologists don't appreciate how difficult it is to get antibiotics in there, nor try to culture and cross-match against a sensitive antibiotic first.

User
Posted 09 Oct 2020 at 15:49

Hi Andy

I have read elsewhere that some urologists avoid prostate massages on a regular basis to avoid spreading the infection. However, I do understand the logic of what the consultant taking part in the FOPS has said. Maybe at the next meeting you could raise the issue and let me know. The next time I consult my urologist I will ask him about this. 

The other issue is the pain that I feel in the upper thigh area. Is that normal for prostatitis? 

 

User
Posted 09 Oct 2020 at 17:07

Thanks kumardavid. Hope all works out for you too. I guess there's a complicated network of nerves in that area so I guess it's feasible you could encounter pain in the upper thigh.

Mine is penile, rectum, sometimes ejaculation pain and discomfort urinating when the prostate is annoyed. Usually brought on by heavy weights and ejaculating having drunk alcohol...so I don't do much of either now!

Edited by member 09 Oct 2020 at 17:15  | Reason: Not specified

 
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