AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question age 47, male, Septra 800/160 2x / day. Newark, NJ
On 6/15 my penis stared to burn and ache, I have urine frequency, painful urination, went to a MD, gave me cipro (500mg x 2 per day for 10 days), did not help, went to another MD. gave me 1 gram of azithromycian, no change, went back to him 12 days later, he gave me another 1g, no change. 2 days after that I went and got teated for syphillus, chlymdia, gonnorea, and herpes, all negitive execpt herpes 1 and 2. Could these be false negitives due to antibotic use (dna-pcr for gonorra and chlymdoa and rpr monitor w/titer for syphillis) went to a urogolist did a scope and found an inflamed uretah and prostate, blatter was good, all urine tests in MD offices came out no lukacites, no nitrates, no nitrates, no bacteria (no cultures were ever done). Urogolist gave me the septra 3 weeks ago, still have burnibg in penis, not so much on the tip, but in the middle. Uro is treating for prostitus. Is someting else up. 15 days before the problem started, I had a lap dance at a bar, I and the girl were fully clothed. I could not see this as a risky behavior, but it is the only thing I can think of is that I picked up an STD.
Please help.
Thanks
Answer John, the most common cause of these complaints is an inflammation of the prostate gland, so called prostatitis. Symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip unrelated to voiding, sexual dysfunction (such as difficulty with erection), aching in the penis, testicles, and discomfort in the lower abdomen, low back, groin, rectum or perineum (the area between the scrotum and rectum – betwixt the “wind and the rain”). The passage of blood at the initiation or termination of urination or in the semen can also be noted. During sexual arousal the prostate gland manufactures fluid that accounts for about 2/3 of the volume of ejaculate. The seminal vesicles are paired structures located behind the prostate gland that also manufacture fluid. Sperm from the testicles (which account for only 1-2% of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts. These structures empty into the prostatic portion of the urethra. At the time of ejaculation, prostatic fluid is discharged into the urethra (urinary canal) where it mixes with discharge from the ejaculatory ducts forming the semen. The semen volume is in the 2-6 cc range. It is not uncommon for inflammation and/or infection to spread in a retrograde manner into the vas and epididymis. Even without such spread, prostatic discomfort is
often referred into the testicle. Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, aggressive bike or horse back riding, and excessive spicy foods, alcohol, and caffeine in the diet can predispose you to this. Sitting for long periods of time, especially in an automotive vehicle, can put undo pressure on the prostate and aggravate the condition. For the latter, it is best not to sit more than 2-3 hours at a time. Stop the vehicle periodically, take a short walk and go to the bathroom to urinate. A thick pad or piece of sponge rubber on your seat will also help to cushion the prostate. One should avoid any of the above that apply. Eliminating all of the factors that apply to you are just as important, if not more so, than taking medication! Ejaculation beyond the tolerance of the prostate to fill and empty may also cause discomfort. Likewise if one does so infrequently, fluid still builds up from thoughts, dreams, fantasies, etc. and has to be released periodically to decompress the gland and relieve the symptoms. For most men, ejaculation in moderation, perhaps 1-2 times a week, is reasonable. A daily warm bath for 10-15 minutes 1-2 times daily also lessens the discomfort. Attention to sexual activity and warm bathes should be utilized regardless of the type of prostatitis and whether or not medications are prescribed!
There are several types of prostatitis. Sometimes prostatitis can be due to an infection of the gland with bacteria. This usually requires an initial 4 week course of an appropriate antibiotic (the commonest prescribed are the fluoroquinolones, but tetracyclines, sulfas and other agents can also work). Typically, pus cells and bacteria are found in the prostatic fluid. Since your problem is somewhat refractory to treatment, culture of the semen or prostatic fluid will be helpful. Bacterial prostatitis is the only type of prostatitis that responds to antibiotics. Since you are still having symptoms while on antibiotics, very careful attention to the predisposing factors mentioned above are very important.
Abacterial prostatitis has several varieties. In one, the prostatic fluid demonstrates pus cells but no bacteria. In the other, called prostadynia, there are neither pus cells nor bacteria in the fluid, just the symptoms. In all types of prostatitis, the urinalysis generally is normal unless the infection spreads into the bladder. Abacterial prostatitis usually responds to the general measures mentioned above. Medications that sometimes help include the over-the-counter natural supplement saw palmetto 320 mgm daily and alpha-blockers (such as Flomax, Hytrin, Cardura & Uroxatral). The latter require a prescription from you physician if he thinks it is indicate
Prostatitis may also be classified as acute (severe), subacute (mild), or asymptomatic. It may also occur as a single episode, be recurrent or chronic. A man should learn to listen to his body.
Antibiotic use can produce false negatives for bacterial infections. If still concerned, repeat them after being off of antibiotics for several weeks. If the only sexual activity you had was a lap dance, you cannot get an STD from this while clothed. Good luck!
