Thank you for your query at DoctorSpring.com
You seem to be suffering from chronic prostatitis. Chronic prostatitis can reoccur even without sexual intercourse.
You should start yourself on T. Septrim ds twice daily and C. Flomax 0.4 mg once daily for 2 weeks and see how you do.
You shall settle with these medications and then you can follow up with urologist at a later date.
Feel free to discuss further,
Patient replied :
Dear Doctor Goel
Thank you for your reply.
I took the medication that you recommended. My symptoms improved noticeably by the second day after I started the new meds in the sense that going two hours without urinating didn't cause excruciating pain anymore and the urgency lessened but the dull pain has continued.
After finishing the Septrim a couple days ago, the sense of urgency is slowly starting to return though the excruciating pain has not (yet) returned.
Since the dull pain was continuing, I consulted another urologist at a larger hospital and he suggested a CT scan of my groin which I did. He said the only abnormality was that the scan indicated that my left spermatic cord may be slightly swollen and that if it was due to a bacterial infection, that the antibiotics I'm taking for the prostatitis should help to resolve that issue too.
I've read about the common symptoms of epididymitis and epididymo-orchitis and they don't seem to describe my symptoms at all. I have had no discomfort in my testes, nor any discharge,nor pain during ejaculation, etc.
My only pain away from my bladder and prostate is slight discomfort if I press on the left side of my pubic area where I think my vas deferens is, from where my pubic hair begins just above my scrotom to where my pubic hair ends at the top.
The local doctor I talked to about this recommended I try either doxycycline or cefuroxime axetil at the uncomplicated uti/prostatitis dosages of .1g bid or .25g bid respectively.
Q1: Do you think I should try again with one of these or some other antibiotic at the uncomplicated dosages?
Q2: At what point should I conclude that I have complicated prostatitis and what meds and dosages would be appropriate in that case?
Q3: Do you think a swollen left spermatic cord is just another symptom related to having prostatitis and is treatment for that therefore the same as for prostatitis without that symptom?
Q4: Assuming I need to do another course of antibiotics, do you recommend that I again have comprehensive cultures done on my urine and/or prostatic fluid after prostate massage either before or after another course of meds? If so, how long should I wait to do the tests after ending antibiotics?
Thank you in advance for any further suggestions you can offer that might help me finally resolve this ongoing problem.
You should start yourself on Doxycycline 100 mg twice daily for 4 weeks. Treat yourself at uncomplicated does only. Reassess at 4 weeks and if symptoms are still persisting then continue it for 12 weeks. There is no need for fresh cultures at this point of time.
Bulky epididymis may be because of prostatitis and nothing needs to be done for it as it is not troubling you. Continue flomax also in addition to doxycycline.