CPPS symptoms after unprotected sex

[sopalegumens]

If you can please keep me posted on how the forget the infection is going. I'm having a hard time letting go of that.

[Avyar]

Me too. I’m always thinking about the possibility that maybe with the next test something will show up again, because the symptoms are still there, not that much but still it’s not normal.

[webslave]

The problem that a lot of guys have is that they associate pain around the sexual organs with infection.

It's counter-intuitive to think that the pain may originate from nerves, muscles and brain. Doesn't seem to make sense.

So I like to use the example of cats. Some cats experience bladder inflammation and pain when placed under stress, when the central stress response system (SRS) is activated, and researchers have commented on the similarity to humans. In cats, a lot of things can activate the SRS:

External environmental events that activate the SRS are termed stressors. Examples of these events include sudden movements, unknown or loud noises, novel and unfamiliar places and objects, and the approach of strangers. Inadequate perception of control and predictability also can activate the SRS in animals because of interference with attempts to cope with their environments. Depending on the frequency, intensity, and duration, chronic activation of the SRS can overtax homeostatic regulatory systems, resulting in diminished welfare, abnormal conduct, and sickness behaviors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760680/

And once the stress system is activated, all hell can break lose ("linking changes in the activity of the SRS to a bewildering array of cellular responses via cell surface receptors"):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC149934/

For humans, we have more complex stressors, like work stress, relationship stress, worry about any number of issues. But they can all activate the SRS. And people with CPPS/IC have a greater tendency to experience stress (i.e. hypervigilance):

The acoustic startle response in cats with feline IC (FIC) is greatest and most different from that of healthy cats during stressful situations, but is still greater in cats with FIC than in healthy cats even when adapted to enriched housing conditions. Exaggerated acoustic startle responses also have been reported in women with IC.

Now once the SRS has been activated, the lining of the bladder, urethra and lower urinary tract becomes more permeable and easier to inflame:

Activation of the SRS also can increase epithelial permeability by neural mechanisms, permitting environmental agents greater access to sensory neurons, which could result both in increased afferent firing and local inflammation. Thus, the effects of the emotional state of the animal may modulate perceived sensations from peripheral organs, completing a loop that may be modulated by both central and peripheral neural activity.

The "neural mechanisms" are explained here:
https://ucpps.men/chro ... condition/

Does lowering stress help? Well, with cats, it does:

.... a darkened, low stress environment that did not house any dogs resulted in resolution of urethral obstruction, defined as spontaneous urination within 72 hours and subsequent discharge from the hospital, without the need for urethral catheterization in 11/15 (73%) of male cats with urethral obstruction.

So take the stress out of their lives, and cats suddenly lose their obstructed urethras. Amazing, isn't it?

Continuing on the cat theme —because it's interesting— this study also noted that exposing cats to unusual events can cause bladder problems:

These results suggest that some of the most commonly observed abnormalities in client-owned cats occurred after unusual external events...

So for humans, an "unusual external event" is something out of left field that we are not used to coping with. Such events can act as triggers for pelvic pain.

The study also talks about looking at the cat's history:

Additional supportive data might include evidence of early adverse experience (orphaned, abandoned, etc.), presence of related signs in family members, waxing and waning of signs related to environmental threat, and the absence of evidence for an alternative cause.

This exactly parallels human pelvic pain syndromes, where early abuse or neglect can set someone up for CPPS/IC (see studies in the Research subforum).

What about the prognosis for cats with pelvic pain syndrome?

The prognosis for recovery of cats with LUT-predominant “Pandora” syndrome appears to depend on the commitment of the owner, the modifiability of the environment, and the severity of the disorder in the cat. Additionally, cats seem to retain the underlying vulnerability, however, even after long periods of time without expressing clinical signs, if exposed to sufficiently severe stressors.

1. You must be committed to getting well if you want to succeed
2. I have long advocated changing your environment to a lower stress lifestyle to combat pelvic pain
3. Just like us, cats retain the vulnerability to pelvic pain if exposed to stress.

[amnesia]

If you can please keep me posted on how the forget the infection is going. I'm having a hard time letting go of that.

Me too. I’m always thinking about the possibility that maybe with the next test something will show up again, because the symptoms are still there, not that much but still it’s not normal.

Not sure if I’m the right person to help here. I decided to move on and accept it’s not an infection. Whether I’ll achieve that or not is a different story. The doctor says everything is normal but I can see that this is not me. Last night again I had to pee 3 times before going to bed, then 1 time during the night and again in the morning. I think that’s excessive; it’s definitely not the normal me.

However, there are now four PCR tests, one MDX test, and several cultures and urinalyses saying there’s no infection. There are several doctors providing alternative explanations. It would be irrational to instead insisting to believing some idea that isn’t backed by any such credentials. It’s a bit like someone who has chronic diarrhea because of IBS insisting it’s HIV, despite all tests saying it’s not.

Again, that all is easier said than done. But what’s the point of chasing a unicorn instead?

[amnesia]

The problem that a lot of guys have is that they associate pain around the sexual organs with infection.

I have to disagree here. If you read one of my earlier posts, I told that some three or so years ago I went to a urologist because I’d have to get up during the night to pee and my testicles would have a dull aching during the day. That time I was being told it’s a normal thing guys have, especially during cold winter, because of the prostate getting bigger. The doctor said it would go away and I was fine with that. I didn’t do extensive tests like this time; I understand he did a urine culture and an ultra sound of my balls. Eventually it went away by it’s own.

The difference at that time was that: 1) it wasn’t related to unprotected sex, and 2) there was no discharge. These are the two things that make me worry the most. In fact, any urologist you go to with discharge after unprotected sex will assume an infection and give antibiotics based on that assumption, before carrying out any tests. Frankly, would the discharge go away it would make it much easier for me to accept and move on.

[webslave]

Most men looking down the urethra will see the same "discharge" that you are seeing, to a greater or lesser extent. The urethra is lubricated with mucous, there can be a little residual urine in there (normal), and sometimes secretions of prostate, cowper's glands and SVs. It's not like a rifle barrel.

A discharge is so called because it exits the penis. You'll find it on your underwear. You keep misusing the word.

[amnesia]

Most men looking down the urethra will see the same "discharge" that you are seeing, to a greater or lesser extent.

I know my penis quite well. When you have a lot of (unprotected) sex and an UTI every now and then you start to observe these things. I’ve only ever saw anything inside when I had an infection.

A discharge is so called because it exits the penis. You'll find it on your underwear. You keep misusing the word.

Two comments:
1) It actually exits sometimes. Then it’s clear and watery. Can’t say if it’s just urine leakage though.
2) I had the exact discharge symptoms before: Clear sticky discharge that I can see inside but that hardly comes up or out. And clear watery discharge that sometimes would leak. In all those cases I went to the urologist, would be diagnosed NSU, get a course of Doxycycline and after a week it would be gone.

That being said, maybe you understand why it’s difficult for me to convince myself that it’s nothing. There’s this crazy idea in my head that I have a low-level infection that just doesn’t show up on any of the tests because the bacterial load is just too small. Everytime I see discharge (whether it’s the one inside or the one that leaks) I have this idea. I understand that even those highly accurate PCR tests only detect an infection when a certain threshold is met.

[amnesia]

What are the recommended tests to do, especially after infection has been ruled out?

I'm still having symptoms of urethritis / lower urinary tract symptoms: discharge (clear sticky or watery, mainly in the morning after getting up); frequent urge to pee or feeling of itch/pressure in the tip (incl. having to get up during the night). The pain around anus and testicles fortunately disappeared mostly.

The only thing that seems to help with the remaining symptoms is camomile tea. I can drink without having to pee extensively and it even seems to make the discharge go away for some hours. Cardio/Soccer helps with providing some hours of no urge/itch to pee.

I don't have pain, and normally have a strong urine stream when going to pee, before I have to press out the remaining urine in split streams.

The urologist told me it's all just irritation or residual symptoms from the initial infection and that it will go away. However, it's almost four months now after the last round of antibiotics (which supposedly killed any infection). I want to give it another maybe two months of sit-and-wait and then go for additional steps (if any).

(1) Antibiotics taken:

- Doxycycline
- Azithromyzin
- Metronidazole (though taken for something else, should have cured any Trich infection if there was)

(2) Common tests for bacterial infections:

- Multiplex PCR STI tests: done several times with negative results
- Urine culture: done several times with negative results
- Semen culture: done once with negative result
- Swab culture: done several times with negative results
- Standard urinalysis: done several times, only once slightly higher WBC and mucus
- MicrogenDX urine: done once with negative result
- Prostate secretion? Not done yet

(3) Other tests for infections:

- HIV: done several times with negative results
- Syphilis: done two times with negative results
- Hep B: done once with negative result (and showed my vaccination is still active)

(4) Tests for viral urethritis causes:

- HSV? not done yet; though unlikely, there are some cases of urethritis caused by HSV
- Adenovirus? not done yet; though unlikely, there are some cases of urethritis caused by adenovirus
- Genital Tuberculosis? not done yet; though unlikely, there are some cases of urethritis caused by this
- Epstein-Barr-Virus: I read there is a connection between EBV and IC. I had EBV some years ago (though not urethritis at that time), and given all the stress and anxiety this time I'm wondering whether it could have come back

(5) Other tests/diagnosis:

- Diabetes test: done with negative result (only slightly higher blood sugar explained by my high carb diet)
- Ultrasound of bladder/kidneys/prostate: done with no findings (“perfect kidneys”)
- DRE: done without any pain (though carried out by ID doc, not urologist)
- Residual urine ultrasound: done which found residual urine of c. 70cc (ID doc found it significant, urologist thought it's normal)
- Bladder diary: Only done based on estimates, wanna get a measurement cup and do it properly. Recommended by webslave and the diabetes doc (to rule out Diabetes Insipidus)
- Cystoscopy? not done yet. Are there less intrusive ways of checking for strictures, such as MRT or X-ray?
- Uroflow? not done yet
- Colonoscopy? at the same time when I got the initial STI, I started to develop chronic diarrhea without any infection found (several extensive stool exams). Even though the diarrhea got away, my stool still is different (lighter color and much more crumbly)


Anything else before I have to accept to just live with it?

[webslave]

Your symptoms as per your signature do not in any way denote an infection. You have mild IBS and mild IC, is my best guess.

In your shoes, I would "accept to just live with it" as you put it, for at least a year. These pain and irritation syndromes simply fade away in many men, especially mild cases, and especially if you decide to ignore it.

[amnesia]

Thanks. Encouraging words like this are extremely helpful. There are days when I just accept and move on and tell myself it’ll all just fade away. Then I have fallbacks into old thinking, triggered by symptoms getting worse or by reading stuff about certain infections online or by seeing the discharge.

Do you think there’s risk of a stricture which (especially if not diagnosed and treated promptly) could get worse?

[webslave]

No. Watchful waiting for a couple if years will not make a stricture, if you have one, worse.

[webslave]

The most appropriate treatment depends on how severe the stricture is. When the risk of complications is low, watchful waiting may be the best option. In more severe cases, a surgical approach is the best option.

https://www.umassmemorialhealthcare.org ... re-disease

[amnesia]

It seems I’ve been using the wrong terms here. Apparently there’s a difference between urgency and frequency, and urgency refers to the “sudden urge to pee”. I guess my situation is better describe by frequency; I have an almost constant feeling of having to pee a little bit. It’s driving me crazy.

Camomile tea seems to be the only thing that’s helping so far. According to the NHS, it’s antiseptic and helping against cystitis (which is describes as an inflammation of the bladder). Not sure if that is what I have.

[webslave]

Well, no, chamomile is not antiseptic in the urinary tract, it's mildly antiseptic in the throat for instance, where there is direct contact with bugs. Evidence that is has antiseptic effects in the urinary tract is thin.

In fact chamomile is similar to benzodiazepines, which is probably why it is helping you:

The sedative effects of chamomile may be due to a benzodiazepine-like compound in the flower head.... Some animal trials suggest that it is efficacious as a mild sedative and anxiolytic. (From Therapy in Sleep Medicine, 2012)

Chamomile also has sedative, anticonvulsant, carminative (anti-gas), antispasmodic, analgesic and anti-inflammatory properties.

[amnesia]

Is there anything similar but stronger? This constant feeling of pressure and itch and having to pee is eating me alive; it’s sucking all energy from me. Before the hope of it going away kept me feeling ok, but I feel like this I never going to end../