Resolved question:
Hello.
I've been having severe bladder pain and prostate discomfort for the last two weeks that started slowIy with frequent urination at night a few weeks before that. I took .4g moxifloxacin(Avelox) once daily for 6 days starting on January 6th with no improvement so on Jan 13th I changed to .75g levofloxacin once daily on the advice of a local urologist.
Still there is no improvement in my bladder and prostate pain and I am now experiencing significant stomach discomfort, muscle weakness and general tiredness which may be side effects from the antibiotics in addition to being unable to sleep well at night recently. I don't have any discharge nor additional pain during urination but my bladder is always painful and more so as it fills with urine.
If I avoid sitting and lying down and urinate every 2 hours or more, the pain is just a constant ache and constant dull burning sensation in my bladder. If I sleep or otherwise go for more than 2 hours the sense of urgency becomes excruciating and just after urinating the burning sensation becomes even more severe and continues for a half an hour or more.
Between the recent moxifloxacin and the levofloxacin doses I went one day with no antibiotics and submitted a urine sample for culture but that test came back negative at a local lab. An ultrasound was also done which also didn't reveal any specific problems. My symptoms worsened noticeably after not taking any antibiotics for that one day and have remained about the same for the five days on levofloxacin since then.
Almost exactly a year ago I had a similar onset of symptoms when traveling in the US. I submitted a urine sample to a large US lab and they found 50-100,000 colony forming units of "mixed urogenital flora"but they didn't further identify the organisms found. My one and only sexual partner during these infections had a comprehensive urine culture done at the same time and she was found to have 5-10,000 cfu's of mixed urogenital flora and a yeast infection as well.
The next day both of us began a 10 day course of .4g daily moxifloxacin. I felt significant relief after the 2nd dose and felt fine for most of the last year after those 10 doses until my symptoms starting returning over the last month. We haven't had any sexual contact at all since March of 2014 and she has never had any symptoms at all of a uti.
I have had problems with prostatitis and uti's for a few years that seemed to correlate with what were likely std's but whatever offending organism is causing the pain this time seems to have been in my prostate and/or bladder for most of the last year or longer since I haven't had any recent exposure to cause a new infection.
On two occasions in the last couple of years I've had my prostatic fluid tested after prostate massage. On one occasion the urologist said he thought it was mycoplasma genitalium and gave me a 10 day course of cipro. On the other occasion, the test was negative but a (different) urologist suggested I take moxifloxacin for 6 days. In both cases my symptoms were the same as now before treatment and improved after treatment. I inquired about a single dose treatment of azithromycin but was told it wasn't available locally.
All of my previous bladder/prostate problems seemed to have been treated successfully with either Septrim DS, ciprofloxacin, cefuroxime axetil, moxifloxacin, ofloxacin or doxycycline in about that order of use. I only took ofloxacin and doxycycline for one course each many years ago and inquired about them with a local urologist this time before starting the levofloxacin but apparently neither of them are readily available locally.
I am 54 years old, don't smoke or drink at all, exercise regularly, am not overweight, don't take any other meds or supplements except saw palmetto and fish oil occasionally, don't have any known allergies and am otherwise in generally good health. I'm currently in a small to mid-sized city in Southeast Asia so I can imagine that testing protocols, lab results and treatments here may not be the same as in larger/more modern facilities elsewhere.
Do you have any specific suggestions as to how to proceed such as other diagnostics to try or different oral or IV antibiotic(s) and/or dosage(s)? I could travel to a large metro area such as Bangkok, Hong Kong or Singapore that would have Western doctors and facilities available if I'm risking serious and/or long-term damage from continuing to only guess here at what is an appropriate treatment for this problem but if there's any way to solve this without extensive travel that would be greatly preferable for me.
Thank you in advance for your suggestions.
Al
Submitted:
4 Days
Category:
Urologist
Hello,
Thank you for your query at DoctorSpring.com
You seem to be suffering from chronic prostatitis. Chronic prostatitis can reoccur even without sexual intercourse.
You should start yourself on T. Septrim ds twice daily and C. Flomax 0.4 mg once daily for 2 weeks and see how you do.
You shall settle with these medications and then you can follow up with urologist at a later date.
Feel free to discuss further,
Take care
Sincerely
Rajiv Goel
Dear Doctor Goel
Thank you for your reply.
I took the medication that you recommended. My symptoms improved noticeably by the second day after I started the new meds in the sense that going two hours without urinating didn't cause excruciating pain anymore and the urgency lessened but the dull pain has continued.
After finishing the Septrim a couple days ago, the sense of urgency is slowly starting to return though the excruciating pain has not (yet) returned.
Since the dull pain was continuing, I consulted another urologist at a larger hospital and he suggested a CT scan of my groin which I did. He said the only abnormality was that the scan indicated that my left spermatic cord may be slightly swollen and that if it was due to a bacterial infection, that the antibiotics I'm taking for the prostatitis should help to resolve that issue too.
I've read about the common symptoms of epididymitis and epididymo-orchitis and they don't seem to describe my symptoms at all. I have had no discomfort in my testes, nor any discharge,nor pain during ejaculation, etc.
My only pain away from my bladder and prostate is slight discomfort if I press on the left side of my pubic area where I think my vas deferens is, from where my pubic hair begins just above my scrotom to where my pubic hair ends at the top.
The local doctor I talked to about this recommended I try either doxycycline or cefuroxime axetil at the uncomplicated uti/prostatitis dosages of .1g bid or .25g bid respectively.
Q1: Do you think I should try again with one of these or some other antibiotic at the uncomplicated dosages?
Q2: At what point should I conclude that I have complicated prostatitis and what meds and dosages would be appropriate in that case?
Q3: Do you think a swollen left spermatic cord is just another symptom related to having prostatitis and is treatment for that therefore the same as for prostatitis without that symptom?
Q4: Assuming I need to do another course of antibiotics, do you recommend that I again have comprehensive cultures done on my urine and/or prostatic fluid after prostate massage either before or after another course of meds? If so, how long should I wait to do the tests after ending antibiotics?
Thank you in advance for any further suggestions you can offer that might help me finally resolve this ongoing problem.
Best regards
Al
Dear sir,
You should start yourself on Doxycycline 100 mg twice daily for 4 weeks. Treat yourself at uncomplicated does only. Reassess at 4 weeks and if symptoms are still persisting then continue it for 12 weeks. There is no need for fresh cultures at this point of time.
Bulky epididymis may be because of prostatitis and nothing needs to be done for it as it is not troubling you. Continue flomax also in addition to doxycycline.
Take care
Sincerely
Rajiv Goel