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Hello Dr Leslie.
I am a healthy 52 yr old man- very active physically. No regular medications except Ambien to sleep. In October I had unprotected sex with a new partner. Soon after those encounters I developed a pain in tip of my penis and frequent urination symptoms. I went to a doctor who did a DRE and noted asymmetry and a firmness in one small area of my prostate. My PSA is normal- 1.16. Prostate is small, not enlarged. The doctor gave me a scrip for Levaquin. (5 days x 500 mg) The symptoms progressed to pain in the scrotum, testicles and burning after urination. I saw a urologist in late October. He prescribed ampicillin because he did not think that the issues were related to a bacteria transferred during sex as the first doctor had suspected. The pain persisted. Went back to the urologist in November. He did a prostate massage and got a gland secretion which was cultured. It was found that I had a medium growth of enterococcus faecelis present. He treated it a round of Levaquin (14 days x 500 mg). The symptoms got better but then returned (though not as painful as before the Levaquin) The last culture showed no enterococcus but it did show some coag negative staphylococcus bacteria. The urologist said that he did not want to prescribe more antibiotics as the staph bacteria in the semen sample probably came from a skin contaminant. He thinks the prostatitis will burn out eventually.

My question is: should I seek a 2nd opinion now as its been 3.5 months since my symptoms appeared. I still experience a burning feeling in the penis most of the day especially after urination. Also some minor dull aching in testicles and underneath scrotum. Since the enteroccous was found would this be considered a bacterial prostatis? Could a firm spot in prostate be causing these symptoms? Is it possible that these symptoms are related to bacteria transferred during sex? How long do the symptoms usually last? As you can tell I am really at a loss of what to do next and why this aliment occurred in the first place. Could the symptoms be related to some other urinary issue besides prostatis?

THANKS!!!

Answer
Michael:

A second opinion at this point would seem reasonable as you are not progressing.  The enterococcus would suggest a bacterial type of prostatitis, but this is not conclusive as enterococcus is also a frequent contaminant.

A firm spot in the prostate could be anything from scar tissue or something more serious and should be rechecked regularly but is probably not causing your symptoms.  It is unlikely any prostatitis bacteria are transferred during sex.  It's impossible to determine length of symptoms as it varies considerably.

Typical Treatments for Prostatitis Include:

Avoid caffeine which irritates the prostate and bladder.
Hot sitz baths.  Sitting in a very hot tub for 10 minutes really seems to reduce pelvic pain, inflammation and discomfort.  We recommend twice or even three times a day for severe cases or flare-ups, but at least once a day for most prostatitis patients.
Avoid hot spices which tend to irritate the prostate.
Avoid sitting on hard surface; use an inflatable donut to spread the pressure away from the prostate.
Use NSAIDs like ibuprofen (Motrin, Advil) or naprosyn (Aleve) to help reduce discomfort and inflammation.
Antibiotics as prescribed by your physician.
Alpha blocker medications such as tamsulosin and alfuzosin will help relax muscle tension in the prostate.
Avoid high potassium foods that some people are sensitive to and which can be irritating.
Less alcohol and smoking.
Use quercetin which is a natural anti-inflammatory herbal supplement that has been shown to help reduce inflammation in the prostate.

Good luck.

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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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