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QUESTION: 6 weeks ago slight pain urethra/penis on and off after sex. Got swab for STD negative. No bacteria on several urine samples. Prostate 25 grams (I'm 65), doc put me on Cipro and Doxycycline, got poor reaction after 5 days. Second opinion: Urine negative. Ultrasound prostate slightly enlarged, 5mm kidney stone left kidney, no symptoms. Ultrasound prostate now at 54grams, PSA 2.2. Pain on and off continues. Semen culture done "coagulase negative staphylococcus species, moderate growth". Put me back on Cipro, now five days, some nausea (haven't had an aspirin in 20 years so quite sensitive to drugs). Says can change to levoquin or septra. Did urine culture "rare urothelial and squamous cells with scattered neutrophils and blood. scant cellular specimen. I'm confused. Says likely prostatis causing urethra symptoms. May want to do cystostophy. I'm confused. Do I have prostate infection?

ANSWER: Steve:

I suspect you probably do have prostatitis which means inflammation and not necessarily a bacterial infection.  This is because prostatitis is by far the most common cause of persistent pain in the areas you mentioned.  I do not know what cystostophy is but I suspect you meant cystoscopy which would be reasonable.

They should probably use a different antibiotic rather than cipro which seems to bother you.  Typical treatment for prostatitis takes 4-6 weeks so 5 days is hardly sufficient.

Diagnosis is usually by history and/or physical examination.  A rectal exam showing a tender or soft "boggy" prostate is considered sufficient, but a "2 glass" or "4 glass" urine test is considered the most definitive.  It is too complex to explain here, but if you are interested you can find it on the internet.

Other prostatitis treatments involve hot sitz baths, avoidance of caffeine and hot spices, and the use of flow enhancing meds like tamsulosin.

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

QUESTION: Thanks very much for this advice. I do have a follow-up. Yes I did mean cystoscopy, sorry. First question is 1) Do you happen to know if that coagulase negative staph specie" from the semen culture means I have a bacterial infection? If yes, then I understand the need for antibiotic. If not (as you mention), then why take one? They are hard on me. 2) Is there another perhaps less potent but still effective antibiotic that doesn't have such side effects? 3) Isn't a cystoscopy for to see the bladder, rather then the prostate? If so, is it just done to look for some other type of irritation? Thanks so much for your help!

ANSWER: Steve:

Staph is a common skin organism so it's presence does not necessarily mean a staph infection as it could just mean contamination.

We give antibiotics regardless of the cultures because they often work even in negative cultures.

Antibiotics are not classified as "potent"; just broad spectrum and limited.  In the case of prostatitis, only a limited number of antibiotics cover the usual bacteria, can penetrate into the prostatic ducts and operate at alkaline pH which is found there.  Something other than cipro is available to you.

Cystoscopy looks through the prostate into the bladder.  In this case, it's mainly the prostate that is being viewed.  

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

QUESTION: Okay, thank you! I guess what I'm asking is if "coagulase negative staphylococcus species, moderate growth" is an infection that needs treatment with antibiotics? The manifestations for me are slightly enlarged prostate; on and off irritation in penis. And a kidney stone. When I say "potent" I mean Cipro after 5 days caused me dizzyness, lots of stomach upset, etc. I was just taken off it and told could switch to Doxy; Bactrim; or Erythromycin. I don't really want to take any antibiotics unless there is a goal (like killing a bacteria) as so far hard on me. But I don't know that this 'bug' is what is causing the on/off pain. Can that 'bug' cause an infection? I don't seem to have any other symptoms. THanks very much!

Answer
Steve:

The decision about whether or not the staph found in the culture needs to be treated is up to your physician.  It's a judgement call.  The kidney stone has nothing to do with your other symptoms.  Doxycycline, bactrim and erythromycin are reasonable choices for most prostatitis infections.  

Please review the other treatment options listed earlier.

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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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