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QUESTION: Symptoms: Pain in the base, where the penis meets the groin. This area is easily aggravated and itches and burns, in fact, the whole pubic region seems to itch and burn. Occasional pain in the testicle, and at the tip of the penis. All symptoms are localized to the left side. Sometimes I have a discharge throughout the day, other times I don't. This discharge is normally fairly thin, but sticky. The amount is not usually that much. Symptoms seem to vary in severity, and come and go. I always have a discomfort in the base of the penis. I also had thrush (balanitis) for the first 2.5 months, but this has cleared up. (This whole ordeal has lasted 4 months) It also seems that the pain is aggravated by touching any affected area, and the pain in the base of the penis seems to be right below the skin.
Negative for chlamydia, ghonorrhea. Urine sample after prostatic massage normal (during a time when there were little symptoms.) No pain on urination or ejaculation.
Treatment: doxycycline, metronidazole, levoflaxin, azithromycin, fluconazole.
Now the doctor wants to do a cystoscopy, but I want to be sure it is necessary before I go through with it. Would it be worth trying another urine culture (after prostatic massage), or maybe a semen or discharge culture? If it is non-bacterial, what could be the possible causes? Could it be fungal?

Possibly related side-effects: burning in the left side of abdomen and back, discomfort in rear of left thigh, increased frequency of defecation.

Thanks for any help

ANSWER: Josh:

I can't diagnose your problem from here, especially when your local physicians are having a hard time.  Prostatitis is one possibility, but the definitive test for this is usually a 2 glass or a 4 glass urine test.  Ask your urologist about considering that before doing the cystoscopy.  A cystoscopy is not unreasonable especially since it appears your problem has been resistant to standard therapy.

Fungal infections are unlikely causes of prostatitis, but often no bacteria are found either.

---------- FOLLOW-UP ----------

QUESTION: Hi again, thank you for your response.

I was diagnosed with chronic prostatitis by my urologist. It is not yet known whether it is bacterial or not, but I know it is probably non-bacterial. I just want to ask a couple of follow up questions;

Are there any symptoms that distinguish bacterial (or fungal) and non-bacterial prostatitis, or do both conditions have identical symptoms?

If it is non-bacterial, what are common solutions? My uro gave me celecoxib for 10 days and told me to try not to get an erection or aroused during the course. Are there any further things I can do to help?

What is the long-term prognosis? I am only 23. Is the condition likely to worsen as I age, or will it likely become better with time?

Josh

Answer
Josh:
There are no specific symptoms that distinguish bacterial from non-bacterial prostatitis.

Future course is hard to predict, especially when we don't even have the final diagnosis yet.  However, typically it may heal up fine or continue to recur periodically.

Other treatments for prostatitis include anti-inflammatories, antibiotics, avoidance of caffeine-smoking-alcohol, use of hot sitz baths 1-2 times daily.  There is some controversy regarding supplements, but there is pretty good evidence that quercetin can help.  You'll have to try to find that in your local pharmacy or health food store.

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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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