Prostatitis, or...?

[Brian H.]

Hello, I am 27 and having a number of symptoms that I believe are related to prostatitis. However, I am not positive of this diagnosis and am looking for feedback. My symptoms include:

1) discomfort during ejaculation; a slight burning pain. Sometimes I have very little ejaculate. Never any blood.

2) Very occasionally, after ejaculating, my next urination is extremely painful, and the urine, especially towards the end of the stream, is very cloudy. This symptom is what sent me to the doctor. The pain lingers, and I feel a strong urge to urinate though nothing comes out, but the occasional few drops. I usually drink a big glass of water and take a shower and by the time I urinate again, the pain is gone. I have had this symptom once every couple of months for at least 5 years, and only recently was the pain so unbearable that I thought there might be something wrong.

3) Urinary symptoms: hesitancy, reduced stream, split stream, urgency, and frequency. All classic prostate symptoms. I usually have to get up once after about 6 hours of sleep to urinate.

4) general pains: lower back, hips (either, and infrequently) testicular (very infrequently), general 'bloated' feeling not related to gas. Occasional 'tickly' or sometimes slightly painful itch at the tip of the penis.

I went to my doctor with only symptom number 2 at first as it was the only one I noticed. I had been living with the others for so long I came to think they were normal, as they only slowly increased in severity and I never associated them. The doctor indicated that due to correlation with ejaculation I should keep a journal. In keeping the journal and researching prostate issues I realized the range of symptoms I was having. A urine test was clean. The DRE felt normal, according to the Doc, and I did not have any signs of acute infection.

My first treatment was 4 weeks of Cipro. At the end I felt absolutely fantastic. The doctor asked what percentage of 100 I felt, and I said  95%. All urinary symptoms were gone, orgasms felt better than they had in years, and other than the tendon pain I was having in my knees, and the tinnitis, (both Cipro side effects) all of my pain was gone. 3 weeks after the Cipro I started noticing urinary symptoms again. It started while traveling, spending 11 hours sitting in airports / on planes, I noticed the urgency and reduced stream were noticeable. By the time I got back, I knew there was still something wrong. The doctor wanted to send me to the urologist but I can't really afford it right now; we compromised and decided to do 6 weeks of Bactrim (due to the Cipro side effects and the length of my infection, if that's the case).

I'm currently 3 weeks into the Bactrim and feeling worse than I have yet. My stream quality is very poor (although it may very well still be better than what it was when I first went to the doctor; without paying attention to the symptoms before, I can't say just how bad they were). Ejaculation decreases my stream quality considerably further. The pain is not too bad, but I'm feeling intense anxiety and I think the tension in my muscles isn't helping. Hot baths provide mild relief, but not for long.

My question is mostly this: Why did the ciprofloxacin help, but the sulfamethoxazole is not? These are my own conjectures, and I'd love if others would chime in:

1) Cipro is more strongly anti-inflammatory than bactrim, and hence whatever non-bacterial issues I have were better treated by the anti-inflammatory properties of the cipro. (non-bacterial CP)

2) the bactrim is simply not effective on the organisms that are in my prostate, but the cipro was.

I have a slight worry of cancer, as I think all men with prostatitis probably go through, but my symptoms started around age 20-21 (as best as I can remember), and I'm 27 .... prostate cancers in men my age are usually more aggressive so the odds are very against this option, aren't they? 

I should say lastly that my wife has a history of yeast infections, and has been treated for a cervical infection once about 5 years ago. I believe I did a short term of general antibiotics at the time. Her recent tests came up clean.

[Rick Hall]

Hi Dennis.  Pain on massage is most common according to the medical field. 

[Brian H.]

My understanding is that pain on massage is more common in acute bacterial prostatitis but not necessarily on chronic cases.

I have just finished a 2nd run of antibiotics.... again, I had almost 100% improvement while on the pills and it's coming back once I'm off of them. First run was Cipro, 2nd was Bactrim. Urologist said if it came back he would put me on doxycycline to cover more of the gram positive bacteria. Not sure I want to go on antibiotics again as I've been on them for 10 weeks already.

[Hunter G]

Brian,

I've had prostatitis for almost 20 years now & I've probably had at least 50 individual prostate massages. The massages hurt like hell every time for me. The first series of drainages were done in Tucson, Az about 10 years ago & they hurt really bad but they also gave me some relief from the pain and symptoms, although none have really seemed to help after the first 2 or 3. I'm not really sure why but I believe that the infection/inflammation is just too deep inside my prostate for any more relief/penetration & thus the reason they don't help me anymore. I've asked several urologists if everyone should have pain with a prostate massage/drainage & none seem to know.

It appears that most people with prostatitis have considerably more pain with a massage than someone without prostatitis. I believe this is a fairly good diagnosis technique (one way) I also have several calcifications that show up on ultrasound. I've also had enough antibiotics to sink a ship & it essentially ruined my system & gave me candida, so be careful when taking them for a long time. It's very common for a doctor to just prescribe 6 months worth of antibitoics just to get you out of their office for a while & because they don't have a clue as to what's going on.

[mr park]

I was going to answer your question independently but its important to read the other comments as it is a forum  and once again Blake is spot on if antibiotics are anti inflammatory in my opionion its because they are killing something!