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Urology/Puzzling Prostatitis?

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Question
Hi Stephen. I'm a 62 year old male, in excellent health with a high level(elite) of fitness. Swimming,cycling and sailing. The diet is high in fruit and vegetables. I drink alcohol sparingly. For the past 2 months, I've experienced discomfort bordering on burning sensation at the end of my penis and along the shaft. Especially evident after urinating but can be there continually.  There is no change in frequency, no blood in my urine or ejaculate. All is normal otherwise. 20 years ago I was treated  successfully for what was a bacterial prostate infection with Noroxin for about 2 months. I think I have of the same symptoms over the years but lately, more frequently. My local doctor tested my urine - result clear; my PSA
-result 0.72 but did not do a digital exam.I explained to him what had transpired 20 years ago and since.  He prescribed ALPRIM for 2 weeks. I responded well and quickly with the symptoms disappearing. 3 weeks later, the same symptoms returned. I returned to the doctor and he prescribed another 2 weeks of ALPRIM which I have just begun. In the last few years I have taken cranberry tablets daily to ward off the symptoms with varying success and this is the first time I have onto antibiotics.
Can you indicate what the difference is between Noroxin and Alprim
in clinical terms and would Noroxin be an effective next step or other strategy please.
I had a vasectomy about 6 years ago without complication. Would there be any connection there with what I experience at present.
In the past, I have noticed that the discomfort happens when I have been sitting for long periods.

Answer
Richard:

Noroxin is a fluroquinolone antibiotic and alprim is trimethoprim which is another class of antibiotic.  While both work, we tend to think of the fluroquinolones as the "gold standard" antibiotics for prostatitis.  I suspect that if the alprim doesn't work, Noroxin or something similar will be prescribed.

It is unlikely that your current problem has anything to do with your vasectomy.

Try sitting in a hot tub for 5-10 minutes and avoiding caffeine.  These steps alone often offer some significant symptoms relief and help healing.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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