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Chronic Prostatitis.

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Following a short lived relationship over a year ago, I developed several std type symptoms. Burning urination, frequency, then urethritis and testicle pain. I had several tests done for Chlamydia, Gonherrea, herpes, trich, hiv, and UTI. All std tests were negative. Six months later it turned into painful prostatitis. I have taken prescriptions of doxy, azithromycin, rocephin, 30 day Cipro. The antibiotics helped but then symptoms returned after treatment. Finally the prostatitis subsided after 21 day sentence of Levaquin and Flagyl but then I got oral thrush. I took nystatin and probiotics to kill the thrush in about 3 weeks. Had a CT scan done (to look at prostate) in that time and found an enlarged spleen at 900ml(16.2x14.6cm). Spleen turned very painful but I never felt sick or fever. Had 3 CBCs done and told they were normal. More blood work done with a Hematologists, no concerns were expressed. They seem reluctant to share their findings with me. 3 weeks later an ultrasound revealed spleen had reduced to 600 ml. Then they prescribed me with 6 weeks of wait-n-see. Meanwhile, Im in pain and worried sick. I think Im dying. Now the Urethritis and testes pain are returning too. Ive read and researched these topics for months now.
My questions would be... Could Candida have caused all these issues and leading to the splenomegaly. How can I test for candida in blood and/or urine. Or what bacteria or virus would not be detectable? Such as mycoplasma, how do I test for that. ive seen 3 family doctors, 3 urologists, and 1 hematologists and left them all scratching their heads. Would an infectious disease doctor be able to do more in depth testing? Any other recommendations? Please help and Thank You.

Category: Infectious Disease Specialist

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Category: HIV- AIDS Specialist
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Thank you for choosing DoctorSpring.

May I know what are your current symptoms ?
Do you have fever ?
What was the CT finding ? (other than the splenomegaly)

You can reply as a followup
Thank you

Patient replied :

The CT scan showed everything normal except the enlarged spleen. My current symptoms are pain in spleen area and urethritis and testicular pain. I don't have fever or vomiting or any other sickness. I've been told that the splenomegaly is not related to the recent prostatitis. But that's the only sickness I've had. I haven't had any medication in two months since the Levaquin/flagyl. Could the oral thrush cause splenomegaly? How can I test for fungal infection? My doctors are not helping to figure it out. They are looking for an easy answer, but then snicker when I ask about Candida. Does the blood work look normal to you? What further testing should I request? The splenomegaly must be caused by infection, but they can't find any. The splenomegaly occured immediately after the oral thrush and prostatitis episodes in January. I know you can't diagnose me on here, but I need some ideas for further testing. My doctors have tried all the standard methods. There must be other tests? Could an infectious disease doctor find infections that other doctors would miss?


Thank you for the replies. You had a 'normally' enlarged spleen in the CT. This means your immune system is working perfectly normal. The enlargement could be due to the prostatitis or candidiasis. In that scenario when there is an infection in the body it is the spleens function to filter the red blood cells and also provide humoral and cell mediated immunity. No wonder the spleen enlarged to carry out the function. This just means your immune system is normal. And this is why the spleen enlargement is "normal". A pathological enlargement of spleen (the one that indicates a disease ) is usually more than 20 cm, and it should be palpable at least the tip - over abdomen. So you need not worry about the enlarged spleen.

Diagnosing Candidia infection is easy if you have a lesion. If not then blood culture is the way to go. You need to do repeated blood culture since the yield is very low. Unless you have immune supressing condition I would not really recommend testing for a fungal infection.

You had several antibiotics course. The current symptom set you have is called - LUTS - Lower urinary tract symptoms. This is possibly due a chemical epididymo orchitis or a non infectious inflammation. At this stage I would recommend a cooling period _ A resting time for 4-6 weeks. No antibiotics, No medications. Most likely the symptoms will resolve.

Hope this helps
Feel free to ask followups
Thank you

Patient replied :

Thank you Doc, I respect your opinion. I does make sense to me. I have not had any antibiotics for 2 months now. I have been taking some supplements in hopes it will help with my spleen pain.

Right now I am taking:
Milk Thistle
A Chinese Ginseng formula called Spleen Activator
A tincture called Lymphatonic which contains Echinacea, Burdock, Dandelion, and yellow dock roots.
Garlic 1000mg
Fish Oil
and a high potency multivitamin

Would you recommend me stopping these too? Or have you found any of these helpful for my situation? Is there any other vitamins or supplements that you would recommend that would boost my immunity and disease fighting ability and increase my overall health.

I do have a healthy diet with lean meats and many vegetables, I don't eat or drink much sugary or starchy foods. I have noticed that coffee seems to irritate the urethritis so I don't drink it much anymore either. I've been drinking green tea daily instead.

Thanks for your advice.

As per scientific evidence - only green tea and Fish oil is going to help you. There just not enough evidence that other supplements will help. They might even do some harm. My recommendation would be avoid those. Since you are eating healthy you do not require any supplement - Mega dose vitamins are MUST avoid as B complex vitamins excreted in urine can again worse the inflammation.

The 'spleen pain' is unlikely to be from spleen. Because most of the spleen is cannot sense pain. (no pain nerves). Even when there is 3 times enlargement of spleen patients never complaints of pain. So your pain could be from a gastritis. You can take an OTC anti ulcer medication like Prilosec once a day without food (in the night just before sleep) for 14 days. This should take care of the pain.

Hope this helps
Feel free to ask followups
Thank you

Patient replied :

Thank you so much for your insight. It has helped me understand my problem. I will definitely avoid the B vitamins. The "spleen pain" I am having is more of a pressure in the ribcage or cramping sensation in the side and left back. Its more prominent when I'm sitting. I have been taking Prilosec for years due to acid reflux. But you're not the first doc to assume gastro pains. I do have one final follow up question....In your own experience with splenomegaly caused by infection, what is the percentage of spleens that return to normal size versus spleens that remain enlarged or need to be removed?.....

Most of the spleens regress to normal size after the infection is treated. In old times - pre antibiotic era the spleens would remain enlarged if infection was not treated. But that is not the case.

Now a days all most all case of splenic enlargement due to systemic infection regress. Splenectomy is not done in cases of Splenomegaly from infective causes.

Hope this helps
Thank you

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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