[Question #3824] NGU/Prostatitis Treatment

32 months ago
Hi Doc, I'll be brief. I went to a urologist to assess my pain in the perineum, anus, penis and tailbone. I described the events and he gave me an exam, including a prostate exam. He decided on prostatitis as a diagnosis, but my guess is that is a bit of a fall back when nothing else is really apparent. Questions: 

1) He prescribed Cipro for 30 days. Even if I had NGU, would this treatment rectify it? I've read that Azithro and Doxy are the choices, but would this long of a course of Cipro work? 

2) Can prostitits be caused by oral sex/NGU from bacteria going into the reproductive system? (I tested negative for chlamydia and gon) Or, can prostitits be caused simply by immense stress and regret only? 

3) Finally, Even if NGU, could it potentially cause symptoms in the entire pelvic/genital region, or is that a strong sign that NGU isn't the issue as you have suggested? 

4) Is it safe to have sex with my partner with prostaitits, with antibiotics, even if the possibility of a NGU cause were to blame? 

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Welcome to the Forum.  I'll be glad to comment.  I happened to come on-line soon after your post arrived so you are receiving a response more quickly that is typical for our Forum.  Symptoms of genito-urinary and pelvic pain in men are more compatible with prostatitis than with NGU which typically is mildly uncomfortable at most.  the distinction is an important one as NGU is most often sexually acquired as and STI and prostatitis is rarely, if even and STI.  Your symptoms do sound more like prostatitis than and STI.  This is important because the not only are the causes different but so are the treatments.  In answer to your specific questions:

1) He prescribed Cipro for 30 days. Even if I had NGU, would this treatment rectify it? I've read that Azithro and Doxy are the choices, but would this long of a course of Cipro work? 
Cipro is a widely used treatment for prostatitis.  Its activity against the causes of NGU is marginal and treatment failures sometimes occur. 

2) Can prostitits be caused by oral sex/NGU from bacteria going into the reproductive system? (I tested negative for chlamydia and gon) Or, can prostitits be caused simply by immense stress and regret only? 
Prostatitis is typically a bacterial infection.  there is no known relationship to receipt of oral sex.  Prostatitis symptoms can be brought on by stress however.  I would suggest checking out the description of the Chronic Pelvic Pain Syndrome on Wikipedia for an excellent description of stress-related prostate symptoms. 

3) Finally, Even if NGU, could it potentially cause symptoms in the entire pelvic/genital region, or is that a strong sign that NGU isn't the issue as you have suggested? 
See above, your symptoms really do not suggest NGU.

4) Is it safe to have sex with my partner with prostaitits, with antibiotics, even if the possibility of a NGU cause were to blame?
Sexual intercourse can be uncomfortable for persons with prostatitis but it is not contraindicated and is not a danger to your partner.

I hope these comments are helpful.  Please feel free to use your up to 2 follow-up questions if anything here is not clear.  EWH

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32 months ago
Thank you for the reply. I have been really convinced that NGU was the cause of my genital area discomfort, as my penis tip, and what feels like my urethra are really uncomfortable, however no discharge or dysuria. I was somewhat relieved when the doctor indicated prostatitis, but I have some reservations about it. I had a chance to read about CPPS and the symptoms seem similar to what I am experiencing. My challenge is, there was no evidence of bacteria infection in my visit, and my urine test was normal. I feel like the doctor prescribed the Cipro as it was my 2nd visit with him, and of course he wants to provide a solution. In fact, from what I've read, the most popular form of prostatitis isn't from bacteria at all. And if I indeed am suffering from CPPS, which is not bacteria related, the antibiotics which I was prescribed would do nothing. The reason for my concern is that I have taken one dose of the Cipro and the side effects of being dizzy, lightheaded, spaced out, and anxious are really troubling. I don't even want to take one more dose, let alone a 30-day trial. Some questions, although I am fully aware that your advice would not be intended to overrule a local physician: 

- NGU: I have had 3 urinalysis, all clean, but i know they aren't the perfect test.  It's been 10.5 weeks post-exposure, no discharge and no pain on urination. But I have had symptoms of something: Pain in penis, pain at penis tip, burning pain in perineum and anus, tailbone and pelvic bone, and at times on the inner thighs. This all started around 2.5 weeks after the oral sex event, at times intermittent. This is my main concern. I want to be sure I don't have NGU, yet there is no specific test to prove that to me. I was hopeful the Cipro would kill it if so, but you say it would be somewhat ineffective. Can I exclude NGU from my fears? I can't seem to get past it. 

-Prostatitis: If indeed I have prostatitis (prostate exam was normal, urine was normal) my personal assumption is that it was from the IMMENSE amount of stress, regret, and anxiety I have had over this event. I can't begin to explain the level of anxiety I have experienced. Knowing that the Cipro side effects may be too much, how do you recommend I proceed? Shall I work towards removing all NGU fears and expect the symptoms to fade over time, especially since there is no proof of a prostate bacterial infection? Or would I have to consult with the Urologist yet again and ask for a different prescription? I'm concerned about the trail of prescriptions viewed by my family which would appear to be STI related. And all of this is from a fear of orally acquired NGU. Perhaps you could help me understand the ramifications of this infection, if I were to have it. 

Thanks for the advice. I'm terribly conflicted





Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Thanks for the additional information.  Having read it, I still find nothing to suggest that NGU is the problem.   Further, we try not to interfere with the medical care our clients get from their health care providers. 

My suggestions are:
1.  Sometimes the best we can do as health care providers is embark on a therapeutic trial and see how things work.  The side effects you describe are amongst those that Cipro can cause, although they are infrequent.  There are alternate antibiotics as well.  It sounds like the urologist you saw was thorough and made a reasonable assessment.  My advice would be to tell him of your side effects and explore the alternate antibiotics- one dose or even a few days of antibiotics is not enough to know if they are going to help of not.
2.  Address your anxiety.  You can be confident that what is going here is not NGU and is not an infection related to receipt of oral sex more than two months ago.

Hope this helps. EWH
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32 months ago
Thank you, that is very encouraging. For my last available post, I’d like to ask, just for final clarity:

1) Can NGU just cause irritation, redness, pain, and a burning sensation in the urethra and penis tip as the only symptom? (no discharge or pain when urinating)

2) If so, could it come and go in severity? And how long would it last?

3) Could NGU cause other pain in the area as described above similar to prostatitis, or simply stay local to the urethra?

4) If NGU presented itself late, do I have to inform my partner and have her treated? (Oral sex was the only exposure)

5) If I did acquire it, would it ping pong back and forth with my partner? (Discovery in this instance would be catastrophic) 

6) Is penis pain from prostatitis similar to the description in question 1? I can’t imagine this pain lasting so long. 
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Final Responses:

1) Can NGU just cause irritation, redness, pain, and a burning sensation in the urethra and penis tip as the only symptom? (no discharge or pain when urinating)
Yes, but not the perineal pain you describe.

2) If so, could it come and go in severity? And how long would it last?
No, it would not come and go.

3) Could NGU cause other pain in the area as described above similar to prostatitis, or simply stay local to the urethra?
See above

4) If NGU presented itself late, do I have to inform my partner and have her treated? (Oral sex was the only exposure
Repetitive, see my original answer.  Your partner does not need to be informed of STI exposure and should not be at risk. 

5) If I did acquire it, would it ping pong back and forth with my partner? (Discovery in this instance would be catastrophic)
A baseless "what if question".  Ping-pong infections occur in persons with STIs.  There is nothing to suggest you have an STI but your guilt. 

6) Is penis pain from prostatitis similar to the description in question 1? I can’t imagine this pain lasting so long
Prostatitis can linger, thus so can the symptoms. 

I hope my comments have been helpful.  I think you have a prostate problem which occurred coincidentally with your dalliance.  That however does not mean you have an STI.  I suggest you address your guilt and move forward.  Work with your doctor to address the prostate problem.

This completes this thread which will be closed in a few hours without further responses from me.  Take care.  EWH
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