Dear Dr Leslie
I would be very grateful for your opinion on my problem.
In the middle of last year I was diagnosed with acute prostatitis (on the right-side), which manifested itself for around 10 days as pain of a very old testicular cyst on the right testicle (no swelling) and then everywhere. There was and has been no discharge or pain/problems during urination. I visited a urologist, after treatment with Tavanic antibiotic (7days, 2x500mg + 5days, 2x250mg) everything seemed OK. I don't know how (no sexual contact) or why I got this infection. I am normally in excellent health. Ultrasounds showed nothing unusual.
Then in September the right testicle pain started again. I was treated with Cipro (7days, 2x500mg) at the general practitioner. The pain returned in December (as in September no testicle swelling just very sore/painful) again Cipro (18days,2x500mg) from general practitioner. At the end of this treatment the testicle was still sore. I revisited the urologist who tested the urine after taking urethral swabs. The swabs showed the presence of only corynebacterium (I don't know which type) and urethritis, urine was OK. An antibioticogram showed that Cirpo was ineffective against this bacteria but that Doxycline was effective. I was prescribed 10days,200mg. Thereafter everything felt really really good and for a few weeks thereafter. Now, although a have no pain, I feel that the testicular soreness is returning.
During the second visit to the urologist I had a urine flow test/ultrasound which showed that there was no urine remaining in the bladder after passing water, but that the flow was rather slow. Have been taking Tamsulsin since that visit. Recently while showering a noticed that on right-side of the penis head, under the foreskin, there is a small (25mm2) area that is slightly more red than the surrounding area. Additionally this area seems smooth and wet compared to the surrounding dry and matt looking area.
Do you think this wet-looking area may have something to do with these repeated infections? What is your opinion on how I could have got this infection. If on the next visit to the urologist if the same bacteria is found, would its resistance to Doxycyline indicate that the December infection was not fully cleared? Is it possible to determine if the current returning soreness is a recurrent infection (i.e. the previous antibiotic coarse was not long enough) or that it is a new infection from an unknown source?
Is it possible that the bacteria is somewhere else within the body and causing genitourinary problems. Is it possible to perform a blood test specifically for this bacteria type? I ask because a blood test on my first visit to the doctor in the middle of last year showed no sign of infection, only signs of inflammation.
Could you suggest any further advise?
With very many thanks for your help.
I cannot determine from the available information if the red spot on the head of the penis is related or not to your other problem.
It is also impossible to determine how the infection was found. Often, sexual contact is involved or chronic prostatitis. If prostatitis is present, then your antibiotic treatments may have not been of sufficient duration to completely eradicate it.
Likewise, it is not always possible to determine if this is a recurrent or relapsing problem unless we can get duplicate cultures. If the organism is the same, then it is probably relapsing; if different, then it is recurrent.
While another infection elsewhere in the body is possible, this would be quite unlikely.
A blood culture is possible but given your symptoms it is virtually certain to be negative.
You may want to consider a consultation with another urologist for a second opinion or infectious disease.