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Pain, burning during micturition with CHRONIC PROSTATITIS. Treatment.

Resolved Question:

Dear Doctor,

I am suffering from a long-standing (approx one year) urinary/prostate problem. I am a British expat working in China. I have good health insurance.

I have been to see two English-speaking urologists at highly regarded hospitals here in Beijing, with limited success.

I was sexually active with other people when I was first diagnosed, but have been in a monogamous relationship since the beginning of 2014 with a steady girlfriend.
She has also been to be checked for infection, and has none.

In order to help you with your answer, I will attempt to provide the full history of the condition, which is somewhat long:


November 2013:

Symptoms: Sudden on set of sharp pain during urination. After a few days of this, fearing an STD, I went to a clinic for STD checks.

Tests: Urine/blood

Diagnosis: No STDs (such as chlamedia or Gonhorrea) detected, diagnosed with non-specific urethritis

Treatment: doxycycline

Treatment Impact: Sharp pain subsides. Mild burning remains.


January 2014:

Symptoms: Although sharp pain has subsided, intermittent burning/irritation during urination and/or sex continues.

Tried to 'wait it out'


March 2014:

Symptoms: Irritation during sex has now reached significant levels of discomfort (burning, pain at the head of the penis)
particularly the day after sex.

Went to a different STD clinic back in the UK

Tests: Urine/blood/swab

Diagnosis: No STDs, swab test showed evidence of non-specific urethritis

Treatment: Azithromycin

Treatment Impact: none

-----------------------

waited two weeks (as recommended), then went back to the clinic where 2nd swab test revealed no evidence of NSU.

contacted an online doctor and described my experience.

Diagnosis: NSU

Treatment: Ofloxacin

Treatment Impact: none

----------------------

April / May 2014: pain during sex worsening. General discomfort in head of penis. Frequent urination.

went to see urologist

Tests: urine, ultrasound on bladder and prostate.

Remarks: ultrasound showed nothing unusal on bladder or prostate

Diagnosis: Chronic Prostatitis

Remarks: pain in head of penis is 'phantom' pain from prostate swelling

Treatment: Levofloxacin - six week course

Treatment Impact: return back to 90% health. Still need to urinate more frequently than before
but pain completely gone. Sex life back to normal.

---------------------

September 2014:

After holding in urine for an unusally long period of time (business meeting) - felt a strange spasm underneath my groin
(prostate area). Symptoms from before gradually start to return. In particular, needing to urinate more frequently,
even more than before (once very 30-45 minutes). Mild burning in head of penis/urethra.

Returned to urologist (different urologist)

Tests: urine and prostate ejaculate (manual prostate stimulation - joy)

Diagnosis: lower urinary tract irritation

Remarks: No evidence of infection found in prostate ejaculate - so reluctant to prescribe anti-biotics.

Treatment: alpha-blockers to reduce prostate swelling - one month course.

Treatment impact: none. Urinary frequency remains high.

------------------

Now (Nov 2014) - Continue to need to urinate very frequently, and often only a few drops result and/or it is somewhat difficult to pass urine.

The sensation comes and goes, sometimes it vanishes for a couple of hours. Mostly though, I am in mild discomfort, sometimes rising to more severe itch/burning in the head of my penis. But never enough so that I'm like 'I must go to a doctor now'. I also occasionally feel pressure around the prostate area.

The problem is slowly dragging me down and depressing me.


So there you have it, that's the full saga. You can see my confusion, particularly given that the two urologists offered different diagnoses. Key questions:

1) What do you think is wrong?
2) What are my options? Are there any other tests I have not yet had which could shed light on what is going on with me?
3) My next course of action would be to go back to urologist 1 and repeat the anti-biotic treatment, since this actually worked before. However, I'm hesitant to do so given urologist 2's diagnosis that I actually had no bacterial infection! Good idea?
4) Any other thoughts.

Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
 22 Doctors Online

Hello,
Thank you for your query at DoctorSpring.com

From your description and symptoms you seem to be having chronic prostatitis. Chronic prostatitis typically has a waxing and waning course. You shall be fine for few months and then to be treated again with antibiotics for long duration.

You don't need to have any more tests and should see urologist
Also start yourself on antibiotics and continue alpha blockers.

Feel free to discuss further,

Sincerely
Rajiv Goel


Patient replied :

Dear Doctor Goel,
Thank you for your response. Certainly the waxing and waning pattern you mention is what I have been experiencing.
Could you tell me a little more about the rationale for taking antibiotics to treat chronic prostatitis?
My (admitedly fairly limited) understanding of antibiotics is that they are used to treat bacterial infection. Yet as mentioned above, the second urologist I saw concluded that there was no infection following a prostate ejaculate test. I am also concerned about treating the problem frequently with antibiotics in case they stop having any effect.
Kind regards,
Chris


Dear sir
Chronic prostatitis is usually non bacterial inflammation. Hence you shall not isolate any bacteria.
Yet it has been found that inspite of no bacterial growth, antibiotics help in quelling the inflammation and hence provide relief to patient.
Your fear that antibiotics may stop working is not unwarranted. However as we are not attacking any bacteria so the chances of developing resistance are minimal. Hence you should start yourself on antibiotics and get relief in symptoms.
Take care
Sincerely
Rajiv Goel


Patient replied :

Dear Doctor Goel,
Thank you, one final follow-up question. What duration of anti-biotic course is recommended for chronic prostatitits? I've heard that in order to reach the prostate, unusually long courses may be required. Your thoughts on this issue would be appreciated.
Kind regards,
Chris


Hello,
You should be on antibiotics for at least 4-6 weeks along with alpha blockers. You should continue yourself on alpha blockers indefinitely.
Regards.


Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
DNB - NBE
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
Dr. Rajiv Goel and 4 other Medical Specialists are ready to help you

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