[Question #109] Chlamydia/Prostatitis-CPPS - Dr. Handsfield

38 months ago

Dr. I posted in the medhelp forum and not sure if I can link to some of the posts I found in that forum regarding this subject.

Here is my scenario:

I had a risky encounter in late april (unprotected vaginal sex for 1 minute, no ejaculation), started feeling symptoms in mid-late may (slight clear discharge, urethra itching, frequent urination). In June I felt pain in the perenium/rectum and I finally went to see a dr. I had taken flagyl thinking I probably had trich......but when I didn't get better, I went in to see the dr. I had a swab done that day and got a shot of rocephin and prescribed cipro. I started taking them but didn't feel too much better. This was on Saturday june 6th. Finally Thursday june 11th my lab results came back as positive for chlamydia and I was given 1 gram azithromycin. I instantly started feeling better within the next day or two. 2 weeks after this, I felt that rectum fullness/pain, but no discharge or urethra itching. I went back to the dr. and was put on doxy for 10 days. After this course of doxy, I felt good. No rectal pain, no more symptoms. I thought I was in the clear. 2 weeks after finishing my doxy....had to return to the dr. because I started feeling that pain down there. Its hard to pinpoint if its the perenium or rectum. Both times before the dr. had said my prostate felt a bit inflamed but basically told me that the medicines should clear that up. The final time I went to see him he told me it still felt a bit inflamed (prostatitis) and prescribed me cipro for a month which I finished. 

A few days after seeing my GP the final time, I went in to see a urologist, had urine analysis done, prostate exam, and told him my story. He said my urine was clean, the prostate felt normal (DRE) and he didn't think there was any infection. He said that we could treat it, or stop thinking about it and keep busy and that my "symptoms" (mostly discomfort/fullness in rectum) would go away. He then said, lets just keep you on your dr's prescription of cipro for a month and next month we can do doxy for a month. (Finished cipro and now on doxy) I have read horror stories about doxy and being out in the sun and I sometimes have to be out in the sun so I was reluctant to start the doxy but have.

I will feel good for a few days and then suddenly feel that fullness, as well as some tingle on the penis, itchy scrotum and itcy around the buttocks. Guys who I know that had chlamydia tell me its just the healing process, it could take a few months but that everyday you wake up and don't see discharge and your penis looks good again, not sick, you will get confidence. I agree with that but what about the rectal fullness, the perineum dull ache? This has got to be an infection in the prostate.

Is it possible for Chlamydia to get into the prostate and will these medicines kill it? I am wondering if my symptoms are psychosomatic as is with Chronic Pelvic Pain Syndrome? I have read some horrible stuff where people claim they got info somewhere that sometimes chlamydia gets into the prostate and you are a carrier of chlamydia for life. Is this possible? I have also read tons of postings from you doc where you always state that there has never been any proof that chlamydia is a cause of prostatitis. Some of those were old posts and some fairly recent. Is this still the case? I did not request a 3 glass study to culture for bacteria at the urologist, is this something that would work to find chlamydia if it is capable of getting to the prostate? I feel as If I waited too long to get to the dr. and this bacteria did make it to my prostate. But then again, why don't Asymptomatic carriers get sick if they could have it longer than I did and not even know it?

Do you honestly believe after 1 shot of rocephin and 5 days cipro, 1 gram azithromycin, 10 days doxycycline, 30 days ciproflaxcin, and now day 8 of 30 of doxycycline, that any chlamydia could still exist in me? I am married and I want to believe myself that I am clear of infection and that so is my wife (she took 1.5grams azithromycin as well as 7 days doxycycline). Do you think this is a case of CPPS, where I had a regrettable encounter that lead to infection and it's been cleared but now I am scared of something hiding in my prostate and causing me to infect my wife? I read where some guys were in my exact situation and you told them to resume having unprotected sex with their wives and that once you see that their partners don't get infected, the symptoms (chronic pelvic pain/prostatitis) would slowly fade away. Do you believe this to be the case with me?

Thank you Doc.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question. Apologies for the longer than usual delay in responding.

I'm somewhat surprised by the positive chlamydia test, but the tests are highly reliable so there's little doubt about it, and your initial symptoms (discharge, urethral itching) were typical, although onset was longer than average after the apparent exposure. (That assumes no sex with anyone else after the April event, such as a regular partner you haven't mentioned.) However, chlamydia cannot persist with the antibiotic treatments you have had, in the prostate or anywhere else. There has never been a proved case of chlamydia resistance or persistence after doxycycline for 7+ days, and rarely after azithromycin.

So I'm pretty sure your problem is the prostatitis/CPPS realm, more likely CPPS. The symptoms of CPPS are not psychosomatic, i.e. they do not have a direct psychological or emotional origin. The pain is real, believed to result from pelvic muscle tension. That in turn may be psychogenic, but the pain itself is physiologic. It's the same mechanism by which tension headaches are painful, due to increased tension in scalp and neck muscles -- and nobody doubt the pain of tension headaches is real and physiologic.

But the evidence is very strong that you have no ongoing infection or inflammatory process that is responsible for any of your symptoms. Bacterial prostatitis likely would have responded to one or more of you many antibiotics, so I don't think a 3 glass urine evaluation is necessary. Your comments about your urologist suggest he is pretty knowledgeable, and I think you can take his reassurance at face value. You mentioned trichomonas, but it almost never causes symptoms of any kind in infected men -- almost always asymptomatic.

And for sure nothing that can infect or harm your wife. That includes any bacteria that sometimes cause prostatitis, which are entirely normal in the female genital tract. (Of course, if you DID have sex with her after the April exposure, then your wife needs treatment for chlamydia, if not done -- but I suspect you know that and it isn't an issue.)

So my advice is what you have seen in similar discussions on MedHelp:  Continue to work with your urologist if symptoms continue; double check with him whether you really need the current 30 day course of doxycycline, which I am inclined to doubt (and would not take myself if somehow in your situation); accept his reassurance; and resume normal sexual relations with your wife, without worry. You may have to just live with the discomfort, but not necessarily. As you suggest yourself, such symptoms often fade when men become confident -- at an emotional as well as intellectual level -- that nothing serious is wrong. Many humans live with chronic, unexplaind pain:  the ankle that still hurts long after the sprain has healed, back pain, abdominal discomfort, etc, etc. For many people, the genitals have a special place in the human psyche, but the principle is no different: not all pain, discomfort, or other symptoms mean disease. In your case, you can be quite confident about it.

I hope this has helped, but let me know if anything isn't clear. Best wishes--

HHH, MD



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38 months ago
Doc,

Thanks for your re-assuring reply. I am going to evaluate some things and talk to my urologist and i will probably have some follow up questions. Can you keep my thread open? 

Thanks again!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
In general, threads stay open until there have been two follow-up comments and replies. I'll be happy to comment after you have seen a urologist.---
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
John, as noted above, we have been keeping this open for possible follow-up questions. If you have any, please ask in the next 24 hours, at which time this thread will be closed. Thanks.


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37 months ago

Doc,

I continued to take the doxy, just in case, and finished the whole course. All the while taking probiotics and fiber. I did well for a while, while on the doxy, then about 2 weeks before the end I was almost perfect! However, On my last day of the doxy started feeling some discomfort In the rectum/anus area. I moved my urologist appointment up to discuss this with him and I honestly don't believe he knows how to deal with this CPPS. He told me for sure I should not have any more bacteria, if there ever was any, especially not chlamydia because of the 30 days worth of doxy. I told him my only real symptom is rectal pressure/feeling of fullness or like if you need to go, but its not the actual feeling like when you actually have to go sit on the toilet and do it. He said its probably just pelvic tension. He did provide me with samples of RAPAFLO, which is an alpha blocker. He said this would help with swelling, and increase my stream, etc.. But I've never had problems with urinating a weak stream, urinating frequently, or trouble starting to urinate or anything like that. He told me to take them anyways and  he also mentioned the side effects of RAPAFLO and I have yet to take it because of this. The side effects being drop in blood pressure and retrograde ejaculation, or no ejaculation. He said I would feel the sensation of ejaculation but nothing would come out. He then said I would probably urinate the semen out. This is a bit scary. He said that if anything is in my prostate/semen producing organs, urinating it out would help. What do you think about this? Should I take this? I also told him since this whole onset happened I have been dealing with premature ejaculation. I never used to finish before my wife and now I have to stop and calm down and start again so I don't prematurely ejaculate. He told me it all has to do with the same pelvic tension. Not sure what your opinion is on this and what I can do to remedy this. He said the rapaflo would help with that as well. But like I said, the rapaflo sounds nasty.


Since finishing the doxy and a few days after seeing the urologist, I started to feel much better. Maybe the anxiety of no longer being on doxy and thinking what if chalmydia still persists got me. I know you said that it can't survive so I took that as re-assurance and forgot about that. My only symptom now that I would say is a tiny discomfort in my rectum. Like if I didn't finish getting everything out. I explained this to the urologist and he said I might try seeing a gastro dr. I have no bloating, diarrhea, any stomach conditions like that. In fact I've never felt healthier since I stopped drinking sodas and drinking mostly water and stopped eating spicy foods, thinking it could be infact something with my prostate. I am still not 100% certain this ever had anything to do with my prostate. After reading and researching so much stuff, I believe what happened to me is I did infact catch chlamydia and the guilt, anxiety of me giving something to my wife and my infidelity being discovered caused me to become tense in the pelvic/genital region. I went and got tested for every standard std, except trich. And after receiving my results and being re-assured I had nothing by the results and dr's visits and your responses here, and continuing to have unprotected sex with my wife, I feel I am ALMOST back to 100% healthy. The only thing is the little bit of discomfort I still feel. No urinary symptoms, no painful ejaculations, no problems getting erections, as is sometimes obtained from true prostatitis. Not sure what you can tell me doc to help me get over this last hump. I have read that a physical therapist who knows about pelvic floor dysfunction could be of some help. Or do you believe that in due time, continuing to live a normal life, the way before all this happened to me,  I will release that tension that I probably still have.

Is it possible that so much antibiotics (rocephin shot, 5 days cipro, 1 gram zithro, 10 days doxy, 30 days cipro, and 30 days doxy) could have opened the door to another type of infection in my rectum/colon/stomach? I have been taking Florastor probiotic the entire time to prevent this, but not sure how much that helped.

Do you think I need to be retested at the end of the month, would this give me enough time for medicines to clear my system? There should be no risk of re-infection as my wife took 1.5grams zitrho and 7 days doxycycline the same time I took my 10 day course of doxy. There has been no other risky encounters.

I am sure you have seen patients with similar stories to me, I know you have read their stuff on forums, but can you tell me if you've ever seen or heard of men making full recoveries from this chronic pelvic pain syndrome?

Thanks Doc!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
A lot of information there, but the bottom line, it seems to me, is that your symptoms are largely gone, if not completely. And it is clear your urolgist believes you have no currently active infection. I agree. Even though your problem likely started as garden variety NGU, most of your more recent symptoms probably were not due to any infection, and your improvement may have nothing to do with the antibiotics you had.

Those antibiotics are not likely to directly result in an antibiotic-resistant infection. However, you could now be colonized with potentially resistant strains of bacteria in your colon, body orifices, skin, etc. However, contrary to all the news about antibiotic resistance, infections with entirely untreatable bacteria remain rare. In the event you develop some other infection in the next few weeks or months, make sure your doctor knows about your recent antibiotic therapy. Otherwise no need to worry about it.

I see no need for you to be retested for anything, especially if your symptoms remain improved. You never had a positive test for anything, so even with relapsed symptoms, I wouldn't expect more cultures to reveal anything.

Finally, yes: many men have full recoveries from CPPS. They tend to be under-represented on websites; those who get better are much less likely to post that fact than are all the men with persistent symptoms that concern them.

I'm glad things are going well. You can put all this behind you and for sure no more worry or concern about STDs. Best wishes and stay safe!


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