[Question #11277] Hypotheticals
 |
15 months ago
|
I know STIs rarely cause prostatitis, but I have a few questions about what would happen if one did.
1)If say gonorrhea was left untreated and infected the prostate, is it possible that this would then lead to recurrent urethritis?
2)Since most antibiotics are not good at penetrating the prostate, and the ones that are aren't recommended as treatment for most STIs, would this lead to an ongoing issue?
3)I know the immune system is pretty good at clearing bacterial infection of the urethra, would this also apply to the prostate?
4) Would a gonococcal or chlamydial infection cause only acute prostatitis, or could it be a chronic infection?
Thanks in advance for the information.
 |
Edward W. Hook M.D.
15 months ago
|
Welcome to our Forum. Thanks for your questions. I'll be glad to comment but let me state clearly that proven gonococcal prostatitis is so rare that there are no good scientific data to answer your questions.
1)If say gonorrhea was left untreated and infected the prostate, is it possible that this would then lead to recurrent urethritis?
Unlikely
2)Since most antibiotics are not good at penetrating the prostate, and the ones that are aren't recommended as treatment for most STIs, would this lead to an ongoing issue?
This is unknown as well but unlikely
3)I know the immune system is pretty good at clearing bacterial infection of the urethra, would this also apply to the prostate?
There are no data to answer this question.
4) Would a gonococcal or chlamydial infection cause only acute prostatitis, or could it be a chronic infection?
Again, there are no data to answer this question.
The nature of your questions suggests that your "hypothetical" questions are a reflection of concerns which are more than hypothetical. If so, please don't play games but provide me with a description of your risk and concerns. EWH
--- |
15 months ago
|
Well spotted. I apologize for trying to stick handle around the issue.
Back in November, I received very brief oral sex from a friend. It lasted less than a minute before guilt made me end it (I am married with kids. My wife and I have been going through a lot, and haven't been intimate since October and we had been fighting the day of this incident).
5 days later, I experienced some slight burning at the top of my penis during urination. This lasted about 2 weeks before I went to my PCP. There was no discharge, and given the symptoms he said it was probably NGU. We took a urine sample and he gave me azithromycin to take.
After taking the antibiotics, the symptoms went away about a week later. I did not hear from the doctor so usually "no news is good news" and I assumed everything was fine.
At the end of January I came down with a bad case of sinusitis and went back to the doctor who gave me 7 days of doxycycline. I asked about the urine results and he looked - the results never were returned. Apparently the sample got lost. However, given no symptoms anymore I thought it was best to let it be.
|
15 months ago
|
Fast forward to April, I started feeling pain in my groin near the left hip. This lasted 2 weeks and now I sometimes feel pressure in my rectum and dysuria occasionally plus now, after bowel movements some clear discharge comes from my penis (I assume this is prostate fluid as it has the exact consistency and transparency of pre-ejaculate). I panicked thinking it could be gonorrhea in my prostate and took 4g of cefixime over 30 hours - doses of 1×1600mg and 2×1200mg. But after a week the symptoms are still there during the day (they don't interrupt sleep at all).
So, my question is could this have been gonorrhea the whole time, but my urethritis was resolved naturally in the 3 weeks coincidencing with the azithromycin and the infection has invaded the prostate and cefixime was unable to penetrate the gland.
|
Edward W. Hook M.D.
15 months ago
|
Thanks for the detailed account. It is very helpful. Gonorrhea is a vanishingly rare cause of prostatitis. I agree that your symptoms are suggestive of prostatitis but I suspect the brief episode of oral sex you mention is unrelated. Far more likely that this is "typical" prostatitis. These sorts of problems have a tendency to linger and be challenging to sort out. Taking antibiotics before there has been a more thorough assessment will only confuse things. I'd suggest that you see a urologist. Based on your symptoms it would not surprise me if he/she choose to treat you but letting them determine a baseline before embarking on a course of therapy would likely serve you well. EWH---
|
15 months ago
|
Thank you doctor. Since I am allowed three replies, can I pick your brain a little?
If this was gonorrhea (I am concentrating on that for two reasons: 1) it is possible to be transmitted orally and could infect the prostate; and 2) any other bacteria from the mouth should have been treated by either the azithromycin or doxycycline) would the amount of cefixime I took treat a prostate infection? I read the AAFP guidelines from 2016 that said either 250mg of ceftriaxone or 400mg of cefixime is the treatment. I realize that it was for acute prostatitis and the prostate is more permeable in this state.
My chief concern is that I would have to notify my wife about a diagnosis even though she hasn't been exposed. I deeply regret what I did and am terrified to lose my family. As the exposure was from oral sex nearly 6 months ago, it is probable the contact has spontaneously cleared the infection. The rules say I would then notify the next recent partner which was my wife, but she isn't the source.
Finally, I know that the natural history of gonorrhea is spontaneous clearance after many months, and that doctor Handsfield often states that in males resolution is weeks to a few months, would that be for all sites? Or is it possible an infection of the prostate could linger for longer, even years?
(I appreciate that this is more speculation than science).
|
Edward W. Hook M.D.
15 months ago
|
Final responses. There should be no need for further follow ups.
1. This is NOT gonorrhea. If it were your symptoms would be more severe. That said, treatment of prostatitis takes at least 7-14 days and often more. The drugs you took would not be expected to cure prostatitis.
2. GET OVER IT. Address your guilt. You do not have gonorrhea
3. This is a "what if", a guilt and anxiety-driven question. If you had gonococcal prostatitis it would be an acute, highly symptomatic infection which could be easily diagnosed.
One follow up remaining
EWH
--- |
15 months ago
|
Thank you for your input and reassurance. May I ask a few questions generally about STIs?
1) if symptoms resolve naturally, is it reasonable to assume microbiological clearance will follow in time? Or would these people be asymptomatic spreaders?
2) In your career, have you actually seen someone with a prostate infection from an STI? Or is this almost unheard of?
3) Why is it that people infected with bacterial STIs are more likely to be HIV positive? Is it just unsafe sex practices or is there some underlying immune system cause?
4) Given rising rates of AMR in these bacteria, is there any research into the use of bacteriophage treatment being done?
Thanks for answering. Keep up the good work.
|
Edward W. Hook M.D.
15 months ago
|
I'm disappointed that you are having so much trouble moving forward. I hope it will not keep you from pursing your diagnosis of non-STI prostate infection with a urologist.
1) if symptoms resolve naturally, is it reasonable to assume microbiological clearance will follow in time? Or would these people be asymptomatic spreaders?
Available data indicate that in most instances when gonorrhea or other STIs resolve without treatment, they are no longer infectious to others.
2) In your career, have you actually seen someone with a prostate infection from an STI? Or is this almost unheard of?
Never, in nearly 50 years of STI-focused practice and research
3) Why is it that people infected with bacterial STIs are more likely to be HIV positive? Is it just unsafe sex practices or is there some underlying immune system cause?
Both are likely contributors. Certainly the behaviors lead to overlapping risk for acquistion of STIs and other STIs but for some STIs (the data are best for syphilis and herpes) the infections also appear to confer increased susceptibility to HIV infection through a variety of complex mechanisms.
4) Given rising rates of AMR in these bacteria, is there any research into the use of bacteriophage treatment being done?
Little or none for STIs
This completes this thread. There should be no need for further questions. EWH
---