Asymptomatic prostatitis keeps returning

[Nino Kan]

Hello,

 I'm 21 years old, male, studying engineering. I eat very healthy food, do excersise and have no previous history of serious illness. I'm having problems with prostatitis. It all started 2 years ago. I only felt a small pressure around my left testicle. I did a lot of tests and went to a lot of doctors and they found out that I have a very small varicocele and most of them said surgery is not necessary. I did urethral swab 6 times for chlamydia, plasmids etc., I gave urine and semen countless times during these 2 years and had rectal scope. Everything was fine except E. Colli and Enterococcus spp. in my semen. I was taking variety antibiotics for months. After my semen was tested negative for bacteria I was fine for a short period of time but E. Colli returned. I cured it again by taking antibiotics for almost half a year with pauses after every month. Now I have enterococcus spp. again in my semen and I'm very nervous about it. This time the only difference was I had to go to toilet 2 times per night (which I never did before) and that happened for a few nights and stopped (now I'm back to normal without having to wake up). Thats what made me go to doctor to get me tested again. I never felt any symptoms except small pressure around my left testicle that is supposed to be varicocele. I never had fever, pain, weird smell in urine or anything. My semen tests also show low count of white blood cells (one urologist told me that I don't have a real infection according to white blood cells). I'm not even sure what type of prostatitis I have. First they told me its acute now it might be chronic bacterial. Once I was even told its non-bacterial chornic. I suppose I have chornic bacterial prostatitis but I'm not sure . I have an appointment with my urologist next week to see what to do but I'm afraid I'll get prostatitis again after stopping to use antibiotics.

What can I do about this? I read that chronic prostatitis is very hard to treat, is this true and what long term damage can I expect?

Thank you in advance for your time and understanding.

Nino

[Arnon Krongrad, MD]

Nino,

Are you not actually describing asymptomatic urethral colonization?
What is the basis for diagnosing you with chronic prostatitis, which is associated with symptoms?

Have you done the CPSI? What is your score?

[Nino Kan]

Dear Dr. Amon

Thank you for your reply. Unfortunately I'm not a medical expert (I'm studying engineering) so I'm not familiar with urethral colonization. The only reason I mentioned chronic prostatitis is because my urologist  mentioned that I might be suffering from chronic prostatitis. Thats what really confuses me becase I'm getting different diagnoses from each doctor. The fact is that I have no symptoms except small, barely noticable tension or discomfort in my left testicle and I was told that it is a small varicocele. On the other hand last week I gave my semen for analysis they came positive with bacteria (at the moment Enterococcus spp.). I also did a swab and it came positive with the same bacteria. Previously, I had E Colli and Enterococcus spp. (roughly half a year ago) and the first time I was tested I only had E Colli (Year and a half ago).

I always end up on antibiotics for months (once I was taking them almost half a year) and then I get cured. Shortly after, when I do a check up,  I get bacteria in my semen again. Its starting to make me nervous and a little bit concerned to take antibiotics for this long period of time.

My score on CPSI is: Pain: 4, Urinary symptoms: 3 I must say last week is the first time I expirienced urinary symptoms and after a few days they passed (maybe I cought a cold or something), previously when I had prostatitis I never had any problems with my bladder or urinating, Quality of Life Impact: 7 

Now I'm wondering what exact illness do I have and if its prostatitis which one and how can I try to cure it? Also is there any danger looking long term?

[Arnon Krongrad, MD]

So CPSI = 14. More to the point, you're not really describing prostatitis. Keep in mind that our bodies are covered by bacteria. So to find them in a specimen is either sign of infection or just normal flora/colonization that has no clinical meaning; it's also possible that they are merely contaminants from you, the staff, or the lab personnel. So finding infectious agents, such as enterococcus, is not in itself sufficient criterion for treatment. The finding has to be correlated to the clinical symptoms, which in your case are principally testicular and mild. Your doctor(s) can help with this.

 

Yes. There is danger, including from long-term antibiotic use.

[Nino Kan]

So I guess I shouldn't be worrying about having bacteria in semen as long as I don't have any symptoms. I hope my urologist won't give me antibiotics again if there is no need for them.

Thank you for your time and making my situation clearer to me. You were of great help.

[Arnon Krongrad, MD]

Nino, I am not your doctor and am not in any position to tell you what to worry about and what not to worry about. This is just some things you can think about and discuss with your doctor(s).

[Nino Kan]

I know, I just wanted to get myself better informed by talking with other professionals or people who expirience similar problems so I can understand my situtation better and maybe have more things to talk about with my urologist. I have an appointment next week and I can discuss this matter with him in detail.

Thank you for helping me.