[Question #4297] Chlamydia & Epididimytis

83 months ago

Hello Doctor(s)...my apologies in advance for asking my second and final question over 6 months so closely together. This is a piggyback thread to Question #4274 submitted last week. Here is a summary:

I am a 31 year old heterosexual male. Had unprotected vaginal sex with a female on 8/2.

8/9 - Tested positive for Chlamydia, nothing else. Took 1g of Azithromycin

8/16 - Prescribed 100mg of Doxy for 7 days due to lingering symptoms (sore testicles, soreness at head of penis)

8/27 - Prescribed 100mg of Doxy (again) for 7 days due to lingering symptoms (sore testicles, soreness at head of penis)

9/19 - Took follow up urine and blood test--negative for all STIs, negative for Chlamydia, Trichomoniosis (NAAT), etc. Also had full urine sample run to test for WBC in urine. Came back normal, with no abnormalities detected.

9/20 - Due to lingering symptoms again, went to a clinic. Clinician diagnosed me with Epididymitis due to one swollen testicle, red scrotum, soreness, very tender to touch, etc. I received 1 injection of Ceftriaxone (250 mg IM) and another 7 day course of 100mg Doxycycline.

I am confused about this diagnosis. If there are no bacterial infections in my system (chlamydia, gonnerea, trich, etc) how could I have Epididymitis? Further...even if I did have Micoplasma Genetallia...wouldn't my 1 usage of Azithromycin, coupled with my previous 2 doses of Doxycycline, have killed it off?

1. Can Epydidymitis occur despite there being no active bacteria that would cause NGU? That is...could my Chlamydia infection have caused Epididymitis, then been killed off, but the Epididymitis remained?

2. Is it safe to resume unprotected sexual intercourse, despite having Epididymitis? I am assuming that it is not infectious, only the bacteria that cause it? And, it appears as if there are no infectious bacteria within me currently. Does there have to be active bacteria in my system in order to Epididymitis to exist?

3. After the treatment I was prescribed on 9/20...when should I expect my symptoms to go away?

4. Also—my “negative’ Trich test was due to an NAAT test, per the testing center. It was NOT looked at under a microscope. Could Trich still be in my system, and causing all of this trouble?

I would appreciate your recommendations here, and I would also appreciate you keeping this thread open so I can update with my treatment results later this week. Thank you in advance!

Edward W. Hook M.D.

83 months ago

Welcome back to the Forum. In preparing to answer your questions it is not clear if you saw a urologist or tested for Mycoplasma genitalium. I recommended this because, as I told you, your symptoms really do not match up well with epididymitis and because about half of Mycoplasma genitalium infections are not successfully treated with either azithromycin or doxycycline. These are still my recommendations. with regard to your additional questions:

See my comment above. Your problem is not clearly prostatitis. Further, not all epididymitis is due to STIs. Further, even after the bacteria which cause epididymitis have been killed, inflammation and discomfort related to scarring may persist.

Most people who have epididymitis are sufficiently uncomfortable that they do not want to have intercourse. That said, with your negative tests for STIs and the absence of WBCs in the urine, it is safe to assume that you are not infectious for sex partners.

3. After the treatment I was prescribed on 9/20...when should I expect my symptoms to go away?

Following treatment for epididymitis, if that is what you have, symptoms may resolve gradually, depending on the severity of infection BUT they should certainly be improving.

4. Also—my “negative’ Trich test was due to an NAAT test, per the testing center. It was NOT looked at under a microscope. Could Trich still be in my system, and causing all of this trouble?

NAATS are far more accurate for detection of trichomoniasis and are the most accurate tests for this infection. Further, your symptoms are not suggestive of trichomoniasis.

I hope this information is helpful to you. EWH

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83 months ago

Thanks for the information Dr. Hook.

1. Primarily, I have not been seen by a urologist, nor been tested for Mycoplasma Genitailum to date. I have an appointment set for early October...the earliest I could get in.

2. In the meantime, the injection of Ceftriaxone and Doxycycline prescription given to me 5 days ago has yielded minimal results. Pain, tenderness, and redness still persist at my right testicle. Therefore, I was prescribed 500 mg Levofloxacin for 10 days. I have not started that medication yet due to the reviews I have read online. It does not appear to be safe...could you provide some color on this drug and what I could expect given my symptoms?

My question is this: As referenced above, all of my 'STI' bacteria have been cleared. There is nothing in the urine sample and I have been cleared of all STIs. Therefore...what would the Levofloxacin do? Is there any benefit to taking it, considering all of the STI bacteria are out of my system?

3. As far as Mycoplasma goes...as mentioned, I have no tenderness in the tip of the penis, no discharge, and no pain while urinating. The pain/tenderness is exclusively in the testicle(s). Does this sound like Mycoplasma, or based on my symptoms and lack of WBC in my urine, should I assume that I don't have this either?

At this point, I just don't understand what could be causing the pain, swelling, and redness in my testicle. I am scared (whether merited or not) that I will have this chronic pain. And perhaps may even suffer further health consequences because of it.

If all of the bacteria that could have caused it are gone...what will make it go away?

Thank you!

Edward W. Hook M.D.

83 months ago

2. Not sure who prescribed this for you and I worry that without being seen, neither you nor they know what you are being treated for. Levofloxacin is a fluroquinone antibiotic and this class of antibiotics has recently gotten some bad press due to an associate with tendinitis and occasional tendon rupture. This does not mean that the drug should not be used but means that the drug should be used judiciously when one knows what they are being treated for. In your case, this is a chronic problem which is not changing rapidly. Unless the urologist is the one who prescribed it, I would call the urologist office and ask if you should take it .

3. Please re-read my earlier reply - my assessment and advice is unchanged. Your problem does not sound like any typical STI and your treatment should have taken care of it. That is the reason I suggested additional follow-up. What can and cannot be caused by M. genitalium is still a topic of research but it is the main STI associated with symptoms like your that has not been tested or optimally treated.

EWH

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