[Question #10566] Sore Testicles

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21 months ago
26 yr. old male here, and have unprotected sex with only females. Been experiencing sore/swollen testicles, and penile discharge for the past 7 months. STD Testing for common STIs have concluded negative results. 

Primary assumed it was prostatitus and prescribed bactrum. Completed 30 day dosage, yet symptoms are still prevalent. 

Any ideas?
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H. Hunter Handsfield, MD
21 months ago
Welcome back. I reviewed our discussion of a few weeks ago. I'm afraid these additional comments do not significantly change my evaluation and advice. I'll try to help, but it remains very unlikely that any STD, or any infection from the sexual exposures you have mentioned.

Your symptoms continue to present a mixed picture about an STD versus non STD problem. Urethral discharge indeed is most consistent with an STD, but testicular pain of the sort you describe is not. During our last discussion, I asked for more detail about the discharge but you didn't follow-up with additional information. Please let me know:   Is it continuous (present most of hte time every day) or intermittent? If intermittent, how often? Does it occur primarily when moving your bowels? Did your doctor test the discharge (or a urethral swab) for increased white blood cells? Did your negative STD tests include Trichomonas vaginalis and Mycoplasma genitalium?

The only STD cause of testicular pain is acute epididymitis due to gonorrhea or chlamydia, and there always is marked enlargement and tenderness, almost always of a single testicle, not both; the standard gonorrhea or chlamydia test always is positive; and failure of your pain to improve after the initial treatment (the "bum shot", i.e. ceftriaxone, and oral doxycycline) are 100% effective against gonorrhea and chlamydia, respectively. Non sexually transmitted UTI also can cause acute epididymitis, but the nature of your testicular pain doesn't fit. Bilateral testicular pain, without signfiicant tenderness or enlargement, indeed can result from prostatitis, but urethral discharge usually is not present. Prostatitis is rarely due to any known STD. Most cases are not due to infection at all, but to non-infectious inflammation of unknown cause. It is common practice to attempt treatment with a broad-spectrum antibiotic like sulfamethoxazole-trimethoprim (Bactrim), but usually is doesn't work -- i.e. prostatitis continues.

This forum and our expertise are limited to STDs, and the weight of evidence continues to argue for prostatitis or a related condition, such as the male chronic pelvic pain syndrome (CPPS); you can google it (spell it out) for lots of information -- the Wikipedia article is good, and I also recommend the information provided by the Stanford University Department of Urology -- which also should pop up on a google search.

I look forward to more information about your discharge and the STD tests done. It also would perhaps be helpful to know where you are (I'm thinking UK or Western Europe?) and what specialist(s) you might have seen -- urologist or genitourinary medicine specialist for example?

HHH, MD
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21 months ago
Apologies for the delayed response. Wanted to provide most up to date info as I’ve just left the doctors office. 

To answer your question, urethral discharge was present almost always before Bactrim. Since completion discharge is more intermittent, bowel movements are not impacted by discharge. Bactrim did cure sore testes whilst taking it and has since returned. Doctor prescribed Cipro today and also completed another round of STD testing, urine and blood, including mycoplasma. Doctor did not swab discharge, urology appointment has been set for the end of the month. I’m located in the US and have only visited urgent cares and my Primary. I’m just worried it’s HIV or something permanent. 

Thank you again for the extensive feedback, I sincerely appreciate it greatly. 
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H. Hunter Handsfield, MD
21 months ago
Thanks for the additional informatoin. 

HIV doesn't do anything like this. Let me know your test results when available. Does testing for mycoplasma mean M. genitalium? It would be pointless to test for other mycopasmas. What about Trichomonas vaginalis, as I suggested above? If not included in your current round of tests, I suggest you contact your doctor and ask that they be added; or arrange for an additional urine specimen for these tests.

I'm skeptical about ciprofloxacin but perhaps worth a try.
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