[Question #12520] Prostatitis
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7 months ago
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Hi doctors,
To cut to the chase, in September of 2024 I received oral sex from a friend. I had some mild dysuria about a week later, but it went away if I was well hydrated. 2 months went by and the friend told me she tested positive for oral gonorrhea. I was tested and was positive as well (she was my only contact for 8 months). I was given cefixime (800 mg as I am scared of needles). I took it and any mild dysuria went away in 24 hours. However, 10 days later I began feeling symptoms of prostatitis - pain in the perineum, split urine stream, pressure in the rectum. Could this be gonococcal prostatitis?
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Edward W. Hook M.D.
7 months ago
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Welcome to the Forum. Thanks for your questions. This is a rather unusual situation. Did all of this take place several months ago (i.e. Sept/Oct) or are your symptoms current? STIs following receipt of oral sex are relatively uncommon although when they occur, gonorrhea is most common. Prostatitis is rarely caused by gonorrhea- most of it is caused by non-STI organisms. Cefixime in the dose you received while no longer a recommended therapy, would still be expected to cure about 90% of uncomplicated gonorrhea. Finally while some of your symptoms may be due to prostatitis, others such as a split urinary screen are not.
Given all of the unusual characteristics of this situation, I would suggest the following-
1. I would get a repeat test for gonorrhea. In addition, I would suggest a urinalysis looking for white blood cells which may be present if prostatitis is present, no matter what is causing it.
2. Have you started therapy at this time, other than the cefixime? If you have not, I would wait for test results or at the very least, until tests have been performed.
3. I think you would be well served to be seen by a urologist. Prostatitis can be challenging to treat and given the unusual nature of your problem, I think it best taken care of by a urologist, not someone in ad ED or urgent care center. Evaluation for prostatitis should more likely than not, include a rectal exam to evaluation for prostate tenderness.
I hope this perspective is helpful. If there are further questions or you wish to provide more detail, please use your up to 2 follow-ups for clarification. EWH
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7 months ago
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Thank you for your reply, Dr. Hook. The symptoms started in mid-November. I went to my PCP and they said that since there is no evidence of urethritis, the cefixime worked. They believe that I have CPPS, though no diagnostic tests have been done.
Currently, the symptoms are intermittent. If I am standing or sitting for long periods, the symptoms can be mild to moderate (mostly pain in the left groin which "pulls" in the shaft of my penis). However, stretching seems to relieve a lot of the symptoms. I have no discharge or dysuria since the medication. I should mention that I was on 500mg/day azithromycin from Dec. 20 to 25 for a stubborn case of bacterial sinusitis. While not the recommended medication or dose for gonorrhea, I know some strains are susceptible to azithromycin and the drug had no impact on my prostate symptoms at all.
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Edward W. Hook M.D.
7 months ago
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Thanks for the additional information. I too agree that the cefixime worked and doubt that what you are experiencing is prostatitis. The symptoms of prostatitis are not intermittent while that is classic for CPPS.
It is not clear to me whether you have been re-tested for gonorrhea or not. If you not been, then perhaps another test would help to address your apparent continuing concern that your gonorrhea was not fully treated. If your cefixime had failed, the test would be positive. I am confident, should you choose to re-test (again, I emphasize that I suggest re-testing not because I am concerned that you have failed therapy but to address your continuing concern)
I hope that this comment is helpful. I really don't have much more to add. EWH
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7 months ago
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Thank you again! I will take your advice and get a test. May I ask a couple of general knowledge questions?
1) Would a simple urine NAAT test be sufficient? Or would I need post prostate massage to be sure?
2) I have read on this site and in some medical journals from the early 20th century that gonorrhea is a self-limiting disease. Is there any data about time to clearance? I know Dr. Handsfield has mentioned often less than a year for a man, does that mean that prolonged, chronic infections are unheard of?
3) Finally, you mentioned cefixime would cure around 90% of uncomplicated infections, does this mean oral cephalosporins are not useful anymore? Or would it be more accurate to say that single doses of them may not be reliable, but multi-dose treatments would still work?
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7 months ago
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Sorry, I had one last question:
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Edward W. Hook M.D.
7 months ago
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Thanks for the additional information. As you know, this will be my final reply.
1. I think a urine NAAT test for gonorrhea will be sufficient.
2. You are correct that a portion of gonorrhea infections will clear themselves over time. Two weeks after infection, 10-15% of infections which were not treated at the time of testing will have cleared. There is no evidence that is the case in your situation. There is no reason for you to think that this is a chronic infection. I hope that when your test for gonorrhea is negative you will accept that there is no evidence of persisting gonorrhea.
3. A 90% cure rate is a conservative estimate. Further a 90% cure rate is acceptable.
The more you describe your situation, the more likely it is that you have CPPS. I hope that the information I have provided is helpful. This will complete this thread. EWH
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