Urology/Epididymitis ...at a loss
I've been diagnosed with bacterial epididymitis and have now been suffering for 6 weeks. It all started after a sexual episode so im quite certain the bacterial diagnosis is correct.
I started with significant swelling in my scrotum, mostly on the left side but also on the right. Day 1 I was prescribed azithromyicn and told it should clear up. Day 5 I went back to doctor with no improvement and they prescribed levofloxacin for 14 days.
About 5 days into the levo the swelling subsided, but I was left with quite an obvious mass on the back of my left teste and could feel the enlarged epidymis like a huge vein along the back of the teste. When I touch that area I felt quite nauseous (like after being kicked in the nuts). At this point I started getting frequent tingling throughout the day in the left teste and a fairly regular dull ache.
Unfortunately 10 days into the levo the swelling came back, so I went back to the doctor and they gave me a shot of rocephin and 10 days of doxycycline to rule out gonorreah.
After the rocephin the swelling subsided but I was left with the mass and tingling and aching mentioned above. At this point I noticed my left teste is hanging a good inch or more lower than my right - way lower than normal - and probably due to the inflammation mass weighing heavily on the back of the teste.
Back to the doctors now my antibiotics had run out - he put me on another 2 weeks of levo. Said it might take up to a month of levo to kill non-claumydia and non-gonorreah bacterial such as ecoli or staph.
About a week into the second course of levo I had the best improvement - 2 full days without pain, tingling or swelling, but it was short lived.
I finished the 2nd course of levo, now on 5 straight weeks of antibiotics, and still have the mass of enlarged epidymis in the left teste, as well as tingling and dull ache throughout the day.
I went back to the doctor after the 2nd course finished. Note that up until now I had 2 urine tests and 2 blood tests and all came back negative for any stds - but I was advised that was probably because of all the antibiotics I had been on.
At this point my doctor got me an ultrasound which confirmed a slightly enlarged left epidymis but 'unremarkable' and a varicocele on the left teste. I have no idea how the epidymis came up as unremarkable as I can practically see the swollen thing through the scrotum, but that was the result.
My doctor asked for a semen sample after 48 hrs of no antibiotics. He wants to try to sample the culture and find what bacteria is there - note this was never done before I got on antibiotics so I never knew. I took the sample and got the metrics back - significantly high WBC of 15HPF which apparently shows I am fighting some infection in my sperm delivery system. RBC of zero but im not sure what that means. I am still waiting for the culture results next week, but doctor said dont get too hopeful you may need to be off antibiotics for 10 days to get a successful culture.
He put me on a strong dose of augmentin for 4 days - 2g a day - but admitted at this point it's a guessing game until we get the bacteria culture. I'm into day 4 of the augmentin with no improvement.
Now I'm really worried. The constant swelling, aching, tingling throughout the day is making me completely useless at work and even disrupting my sleep. I am fearful of losing my job and fear I am falling into a depression over this. The doctor said I've been through all the right antibiotics to rule out claumydia and gonorreah and that this is likely some weird Ecoli or staph bacteria, and he can't confirm that we will even know what antibiotic will work. Also he suggests part of the problem is the epidymis is so hard to get to that even with the right antibiotic I may not see improvement!
I have so many questions....I can't imagine living with this as I am otherwise a fit and super health freak 30 yo... This has prevented me from doing any exercise over the past 6 weeks and otherwise killing my life.
Does anyone have any advice on what to do next? Anyone experienced the same thing? I read about horror stories of epididymitis but most of them are the non-bacterial type. Given mine is bacterial is there a certain cure or possibly not? Am I at risk of infertility? Would I transfer the infection to my future wife If I can't get rid of it? Is it something that can just 'burn out' over time as some websites suggest?
I am at the end of my line here and would love to hear some advice - I would love success stories and direction for a cure, I am not ready to give up and give in to this yet. All of your input is greatly appreciated.
I can't give you specific treatment advice but I can answer some of your questions. Immediate treatment of painful scrotal swelling tends to minimize the chances of a long term problem such as yours has been. Once it is established, the swelling can take weeks or even months to get better although the pain is usually gone by then. Since your problem appears to be bacterial, it is theoretically treatable with antibiotics but if the prostate is involved the course takes much longer.
Infertility is not usually an issue as long as only one testicle is involved. This type of infection is usually not transferable to your future partner.
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QUESTION: Hi doctor, in response to your answer:
> Since your problem appears to be bacterial, it is theoretically treatable
> with antibiotics but if the prostate is involved the course takes much
How would I know if my prostate is also infected? What symptoms would this create? I have noticed smaller than usual volume of ejaculation, but I can pass urine 100% and have no other noticable symptoms such as abdominal
How much longer is "longer"? How long can I safely take antibiotics?pain or frequency urinating.
The doctors unfortunately could not culture any bacteria from my sperm sample however they did say this was probably because I was on so many antibiotics. I am back on levofloxacin for 2 more weeks as the doctor says sometimes it takes 3 months of levo to clear an infection! Does this sound right?
I know you cannot give me specific treatment advice, but would would the theoretical next steps be here? Stay on antibiotics for another month or 2 and see what happens? Get off antibiotics entirely and see if we can culture some bacteria from another 'antibiotic free' sperm sample? What are the risks of the latter? Could the infection (which may now be localized), now without taking antibiotics, start spreading to my other teste and prostate if it has not already? Is it worth that risk just to get the culture and understand what bacteria is in there?
Would knowing what bacteria is in there always lead to a successful antibiotic treatment anyway? Or is there a chance there is some antibiotic resistant bacteria in there or hard to get to and I will have to live with this?
Sorry for all the questions but your answers are very much appreciated.
There are no symptoms that specifically indicate bacterial infection of the prostate.
Treatment courses for prostatitis can take months and sometimes years.
Three months of levo is not unusual in treatment of chronic bacterial prostatitis.
Knowing the bacteria involved is helpful, but we usually treat without this information and just go by clinical response.
We do not usually recommend stopping antibiotics just to get a culture; only when we think the need for the antibiotics has passed.
A prostatic infection can theoretically travel to either testicle, the bladder and either kidney.
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QUESTION: Doctor, I've had a flare up in swelling once again - the entire left epidymis is swollen and what I believe is the vans deferens. If i touch it is is tender and painful and i feel nauseas like being kicked in the nuts. If i dont touch it i get a constant dull ache throughout the day that makes me nauseas.
i am still on the augmentin (2g per day) and levo (500mg per day).
Is this a sign the antibiotics are not working?
I've been through levo (6 weeks), augmentin (2 weeks), doxy (2 weeks), rocephin shot IM.
My WBC count in semen sample is 15 HPF - is this moderate or high? Does it look like this is an antibiotic resistant strain of bacteria? What course should I follow now? I have been on close to 8 weeks of antibiotics and have no idea what to do now.
I am on edge here and almost ready to throw it all in given the constant pain and mental anguish of not knowing what I have. Your replies are so very greatly appreciated doctor..
The exacerbation while on antibiotics suggests a lack of efficacy. The WBC from the semen is a little high but a culture would be more helpful.
Your course should be to consult with your urologist.
If antibiotics continue to be ineffective and the pain continues, a surgical exploration or excision may be needed.