New Member with questions!! (Tascam's Case)

[tascam]

Here is my story:

I presented 8/10/08 with groin pain (more pronounced when bladder ful)l, more frequent urination (usually sleep through the night or up to urinate early, woken up from the pressure), constant pelvic burning, and painful post ejaculation symptoms. Immediately after the first symptoms, I received a urine test (8/10/08), negative for STDs (chlamydia and gonorrhea). HIV test (9/17/08), negative.

Received 2 courses of Rocephin 250 mg (8/10 and 8/21) and 12 days of Cipro 500 mg BID. Urinary retention via 2 ultrasound studies was unremarkable (complete or near complete emptying), 2 DRE\'s. 1 was pronounced normal, the other slightly enlarged. 10 days of Augmentin 875 BID. PSA 12/27/07 = .8. ……..PSA August 28 08 = 1.6.
Then I tried (3rd week of Sept 2008 of September) 2 weeks of Doxycycline 500 mg bid and 1 week of Flagyl and an additional 500 mg injection of Rocephin. The fairly content burning in my urethra continued with transient discomfort in my groin, more pronounced upon a full bladder.

I had a pelvic CT scan which was read as normal except for a "mild" prostate enlargement. Prostate measured 2.8 x 4.7 x 3.7 cm. The CT scan showed no evidence of calculi but the later TRUS did.

I am 52 years old, and otherwise healthy. Just prior to the first episode, I had a number of sexual partners (I am heterosexual). I almost always used condoms, but received unprotected oral sex from multiple partners. Could I have received an infection in my prostate while my urine is normal (no signs of bacteria, blood, protein, or sugar)?

I started a course of oral Levaquin 500 mg , 10/27/08, Urine Velocity somewhat diminished. Post ejaculatory discomfort, pelvic discomfort, especially when bladder is full, and transient urethral burning continued. Took last dose (7) on 11/2 after no improvement. PSA test results on 10/30/2008, 1.7. Started taking PEENUTS and any accredited quercetin product at the same time.

I presented at the ER at West Boca Medical center 11/1/08 with severe UTI symptoms, extreme weakness, mild fever. Contrast CT Abdomen and Pelvic scan was read as normal. Received 2 gm of IV Rocephin. Severe UTI symptoms on 11/2. Received results of TRUS scan on Nov 3. The TRUS showed 2 non specific hypoechoic lesions and same calcifications which 1 urologist said were most likely related to BPH or Prostatitis. 11/12/08- urine test shows no bacteria, PSA-F test result is 50%, PSA is now 1.3. The fairly constant groin burning continues, with continued frequent urination, but no nocturia. The burning gets worse in response to stress, especially while driving, which I hate doing.

I am waiting for the results of a semen culture. Why no one has done an EPS culture is a concern, as this particular urologist said a semen culture is just as good and he stated if my infection was caused by an STD, it would have shown up in the urine. Any feedback would be appreciated. This has been a nightmare.

[Jay]

Hi tascam,

Welcome to the boards. Sorry to hear of all you've been through. Stories like yours are not uncommon here, and while I am by no means a medical professional, I'd hazard to guess that you're in the right place.

You look to have been run through a very thorough gauntlet of scanning/testing, which is a good thing. That weeds out many possibilities. Don't know enough to comment on the significance of the hypoechoic lesions detected in your TRUS, except that they are typically benign.

In men your age, calcifications and calculi are extremely common, whether they have chronic prostatitis / chronic pelvic pain syndrome or not. In fact, guys quite a bit younger than yourself often have them, too. There's not much to show that these are significant in causing CPPS, and methods of breaking them up have met with little success in terms of resolution.

Regarding your concerns about infection: most guys come here fearing these, and very few end up having them. Now, there are some who report an actual infection as the trigger, with chronic prostatitis / chronic pelvic pain syndrome symptoms persisting once said infection is gone. My layman's opinion is that, having been on such potent antibiotics as quinolones and IV Rocephin, any infection that might have been in your body has been obliterated.

Often, our members have found that the cause of symptoms like yours is tension and spasm in the pelvic floor muscles. You can find a more detailed explanation on the main site, as well as in the book "A Headache In The Pelvis", which I highly recommend.

I noticed that you mentioned West Boca. I happen to live in Port Saint Lucie, so we're rather close! I've been receiving treatment from a very skilled physical therapist in Coral Gables, Pamela Downey, who teaches at the University of Miami and specializes in pelvic floor dysfunction. You might consider giving her a call to discuss your symptoms and see whether she thinks an evaluation might be revealing. Her number is: 305-666-3232

- Jay

[webslave]

Firstly, please fill in your signature:
viewtopic.php?f=37&t=4198

.. groin pain ... frequent urination ... constant pelvic burning ... painful post ejaculation symptoms

Par for the course.

Could I have received an infection in my prostate while my urine is normal

No, very unlikely.

severe UTI symptoms, extreme weakness, mild fever

This is the clincher. You have CP/CPPS, almost certainly. Those are not symptoms of a real UTI, and if it was acute prostatitis you'd be admitted to hospital.

The burning gets worse in response to stress

No surprises there.

Welcome to the site and happy reading. You will get better.

[tascam]

Jay, thanks for your response. I will definitely call the therapist. I have read that in infection can "hide" in the prostate which antibiotics can't penetrate. Is this possible? I thought I might have received this condition from unprotected oral sex because it flared up right after an extremely "active" period in my life where I was with a number of women in that capacity. Urine tests were negative for STDs. And then I thought I might have created an "overuse prostatitis" by having as many as 3 orgasms a night on those busier nights with those women. In several cases there were multiple women at the same time; I am not joking. Resting things for as long as 10 days at a time has done nothing to improve my condition. If the semen culture is negative, should I still demand an eps culture? I have been doing 30-40 minute hot baths at night. The burning feels similar to a UTI. It's hard to believe it's not caused by an infection. what do you think?

[tascam]

Webslave, thank you. The generalized groin burning is relentless and depressing, sometimes worse than others. The reason I thought this was sexually related is because of the timing. There has never been any urethral discharge. Do you think it's possible that this could be chronic bacterial prostatitis whereas the infection is still "hiding" in the prostate? Would a negative semen culture satisfy that?

[Jay]

Hi,

The concept of "stealth bacteria" is unproven, and to my knowledge, there is little to no scientific evidence to support it.

If you have the funds, I would encourage you to get whatever testing you must in order to feel comfortable. However, statistically speaking, something like 95% of chronic prostatitis / chronic pelvic pain syndrome cases are non-bacterial. Chronic bacterial prostatitis is actually quite rare by comparison, and the colonizing bacteria would be detectable. It's usually caused by something like a structural defect causing backwash of urine, etc.

[BrettP]

Tascam what's your secret with ladies? Anyways, my symptoms started like you, only I had an infection after a long night of bumping and grinding with a stripper. This caused a nasty UTI which led to me freaking out which led me here. My problems started as UTI but when that was gone I was left with CPPS. Doubtful that you have infection, but overtime you will get better.

[tascam]

Brettp, I have to be honest here. I met a really cute Chinese girl and we went to a swingers club 5-6 times (stupid thing to do, but I was thinking with the wrong head). At the club, I always used latex condoms for screwing, however, I received a number of "unprotected" BJs from some very hot women. The other stupid thing I did was trying to be "super-stud" The way I did that was by using Viagra so I could last all night, and in some cases trying to "force" a 3rd orgasm within a 4 or 5 hour period even though my body didn't want to. How stupid was that? That's why I thought this could be related to an overuse condition or an STD. Also, my pain started immediately after the 3rd orgasm on my last night that I went to that place in August. The next day I received urine tests for Chlamydia and Gon and was negative for both but was treated anyway (twice). Other than telling me how dumb this was, can anyone give me any additional suggestions? Thanks.

[tascam]

If you have the funds, I would encourage you to get whatever testing you must in order to feel comfortable.

So what is the best way to test for bacteria in the prostate. Is it a semen culture, EPS culture, or something else?

[pminturn]

I have read that in infection can "hide" in the prostate which antibiotics can't penetrate. Is this possible?

I was told the same thing by my general practitioner when I first started having my urinary symptoms just over a year ago. I was on a month of Cipro 3 times and a month of Bactrim once. This was without there being any sign of an infection. I had pelvic and abdominal CTs with contrast. The only thing found at any point was a slightly inflamed prostate.

Like the others said, you have come to the right place. Just researching what is really wrong with me and hearing stories of so many other guys that have gone through what I have has given me a great piece of mind. This relief of the stress and anxiety of not knowing what is wrong has actually improved my condition immensely.

[tascam]

pminturn, I am still concerned about the the 2 hypoechoic lesions on my prostate. If they are indeed a response to inflammation, I need to make sure they are not abscesses. I might have an MRI to check this out. Has anyone else here been told they had hypoechoic lesions show up on a TRUS?

My CT scans with contrast produced the same result as yours. Only the TRUS showed the hypoechoic lesions. I wonder if it really is chronic prostatitis / chronic pelvic pain syndrome or CNBP in the presence of those lesions. I also wish I could feel good again and get rid of these damn urinary symptoms. Would it make sense for me to get a PCR test or is it safe to say that all of the antibiotics would have killed any chlamydia if I had it to begin with (I did test negative in initial urine test)? I still wonder if my prostatitis was caused by receiving oral sex from a partner with bacteria in her mouth!?

[webslave]

Hypoechoic areas in the prostate are far more likely to be caused by prostate cancer than by abscesses.

With an abscess, you will have the following symptoms:

• pain on urination
• fever
• Painful digital examination

Most likely of all is prostatic calculi or corpora amylace.

[webslave]

I have read that in infection can "hide" in the prostate which antibiotics can't penetrate. Is this possible?

No. There are plenty of studies showing that selected antibiotics penetrate the prostate well.

[tascam]

Hypoechoic areas in the prostate are far more likely to be caused by prostate cancer than by abscesses.

With an abscess, you will have the following symptoms:

• pain on urination
• fever
• Painful digital examination

Most likely of all is prostatic calculi or corpora amylace.

I have none of those symptoms. Urination actually feels good during and after, no fever, and the DREs have been a little uncomfortable but not painful at all. No nodules were felt upon palpation, but the last DRE described the prostate as "slightly boggy" with no mention of it being warm. Since my PSA is now 1.3, PSA Free = 50% and a normal DRE, I didn't see the point in doing a biopsy. Does that make sense? Would an MRI offer any benefit? Thank you so much for your help!!!!!

[tascam]

I have read that in infection can "hide" in the prostate which antibiotics can't penetrate. Is this possible?

No. There are plenty of studies showing that selected antibiotics penetrate the prostate well.

My introduction shows the stew of Antibiotics I was on. However, I never stayed on any particular 1 for more than 2 weeks. Was that a mistake even though it didn't seem to be helping. Should I have stayed on Cipro or Levaquin for a full month before giving up? Maybe I was mistaken when I thought I would notice an improvement in just a week or two on an antibiotic. Thanks for your feedback on this!