Possible to Have Bacterial AND Nonbacterial Prostatitis?

[critthinker]

Hi All,

Am writing to get your thoughts on my situation. I understand most posters on this board are not doctors, so I will certainly not take whatever you have to offer as medical advice. However, given that I feel I have gained such a background knowledge in this area in the past few months, I'm guessing many of you have as well. To this end, I'd appreciate your thoughts as I consider next steps.

I had a Botox injection into my sphincter for treatment of anal fissure in August. Two days later, I developed all sorts of symptoms (fever, chills, nausea, burning on urination, malodorous urine, discharge, etc.). After going to the ER six days later, I was diagnosed with both a UTI and Epididymo-Orchitis (swelling of testicle and epididymis). It was later determined this this was likely an iatrogenic infection (one acquired from contamination during the procedure). I was given Doxycycline (one week) and Rocephin (injection), which seemed to improve most of the symptoms. On meeting a urologist for follow-up the next week, I was given a weeklong course of Cipro. Apparently this did not do the trick, as a week later my original symptoms came back (urgency, pelvic pain, frequency, etc.). Then I saw an infectious disease doctor when my urologist cultured my urine and found an extended-spectrum beta lactamase (a highly resistant) form of bacteria that was only truly responsive to IV antibiotics. The ID doctor did not want to put me on IV antibiotics, so he just gave me Nitrofurantoin. Many of the symptoms stopped, but I still had suprapubic pain. This is when I started going to physical therapy and noticed I was slowly getting better with trigger point release and stretching.

Now, nearly four months after the original procedure, I recently had a pretty severe flare-up. My urologist palpated my prostate and found significant tenderness (it was quite painful). Though the culture came back negative, he has me on Levaquin for a month. His belief is that the original infection is still in the prostate and simply needs to be bombarded with Levaquin for a month (with frequent ejaculation to get it out of the prostate).

So my question is the following: Is it possible to have both chronic prostatitis / chronic pelvic pain syndrome (the physical therapy obviously helped me and reduced my pain) while at the same time have a chronic bacterial prostatitis condition? Would appreciate anyone's thoughts on this. At the moment, my plan is to finish off the course of Levaquin (three more weeks) and then immediately begin taking Quercetin.

Current symptoms:
--Diffuse pelvic pain (very little to no anorectal pain)
--Tremendous fatigue/lethargy

[moxsum]

I wonder.. its certainly possible. I've read that you can get chronic prostatitis / chronic pelvic pain syndrome after a bout of acute bacterial prostatitis. I dont think every single case of prostate inflammation is caused by anxiety/muscle tension.

[webslave]

Though the culture came back negative, he has me on Levaquin for a month. His belief is that the original infection is still in the prostate and simply needs to be bombarded with Levaquin for a month (with frequent ejaculation to get it out of the prostate).

Unfortunately, many medicos make this error, especially when the original precipitating factor for UCPPS was an infection. The temptation to say the infection is back, even when (for some strange reason) this time it cannot be found or cultured, is overwhelming, especially since the truth is so complex (neuronal windup due to original problem, and allodynia).

[critthinker]

Do you know if an EPS is any more reliable than a VB3 (post-prostatic massage urine sample)? I've had two VB3s done and neither has indicated the presence of white cells. So that means that either:

1) I have Category IIIb chronic prostatitis / chronic pelvic pain syndrome and I need to be tested for cytokines as well as WBCs.
2) The WBCs (and potentially bacteria) are lodged in the clogged acini and it won't be until a few prostate massages that they come out.

I just saw Dr. Weiss earlier today for some more trigger point injections -- will see whether that helps w/ symptoms.

Thoughts?

[webslave]

There is no such thing as "clogged acini". It's an urban myth generated by the idiots at another website.

[critthinker]

So when you mention inspissated fluids, where in the prostate are these fluids inspissated?

[Jay]

I have been here for two or so years now. In that time, I've met tons of people who've had all kinds of testing. I can't recall even one person discovering that they had this sort of 'stealth' bacterial prostatitis.

Prostate massage is a treatment method now largely considered to be outdated, and I really doubt it's going to uncover anything hidden. Just having an orgasm clears out the acini quite well. Yes, chronic bacterial prostatitis does exist, but it's rare and often has a mechanical cause (i.e. structural defect causing urine backwash).

[webslave]

So when you mention inspissated fluids, where in the prostate are these fluids inspissated?

In the extensive prostatic ductal system. The acini are tiny glands at the ends/sides of the ducts.

[critthinker]

Thanks for all of your thoughts. They are appreciated.