[Question #4639] Very Concerned!

26 months ago
Doctors please help as I need to get my symptoms figured out.  I have been seeing a lady for the last year about once a month.  When I first started seeing her she assured me she had no STDs but did state that she has HSV-1.  She even showed me her most recent STD test from when we first met.  She did mention at one time that she had some type of bacterial infection and I just assumed it was BV.  My symptoms are as follows: testicle pain, jelly like clumps in my semen, lower back pain, pelvic pain, abdominal pain and a general feeling of malaise.  I have not noticed any discharge but I have had minor irritation at my uretha opening.  I have taken two separate STD tests and both of them came back negative.  The first test I took too soon to detect HIV and Hepatitis.  It was a 10 panel test and everything was negative.  The second test I took I only tested for chlamydia gonorrhea and trichomoniasis and all three came back negative.  I made an appointment with my doctor and he suspected prostatitis.  I've tried Cipro dioxy and Bactrim.  I no longer have the testicle pain but my pelvic and lower back pain is a daily issue.  I am very concerned that I may have passed something onto my wife.  She also complains daily of back pain and this has never been an issue with her before.  We are both fairly physically fit.  I have also noticed a fishy odor with her during sex.  And it seems like my pain gets worse a couple days after having sex with my wife.  I feel terrible that I may have passed something onto her from my stupidity!  Do you feel that I require further testing such as mycoplasma genitaliam or ureaplasma?  I was not tested for either of them or do you recommend retesting for HIV and Hepatitis? Do my symptoms sound like it could be either of them?  Thanks in advance for your advice I really need to put an end to all this!
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome to the Forum.  I'll do my best to help. Your explanation is quite detailed and I appreciate it.  Because of the detail and complexity of the situation my several comments will focus on different aspects of what you report as it is difficult to tie everything together.

1.  The symptoms you describe in line 4 sound very much like prostatitis.  Like your doctor, I would have tried Bactrim and/or ciprofloxacin. - How long did you take these for and while you took them did they help, even partially?  Not all prostatitis is bacterial in origin and you may have non-bacterial prostatitis which is a problem better addressed by a urologist than an infectious diseases doctor.  
2.  Your STD tests rule out the most common STIs which might be associated with some of your symptoms and should be believed.  I am not troubled by the fact that you tested too quickly for valid HIV or hepatitis tests as your symptoms in no way suggest either of these problems. 
3. The fishy odor you describe with sex is a classical finding for bacterial vaginosis and she may have that.  FYI, BV is not a classical STI as there is no specific partner therapy and when partner therapy is given, it does not help.  If it is not troubling your wife, there may be no need to address this. There are no STIs which would account for the smelly odor symptoms.
4.  Mycoplasma genitalium is still being studied to try to sort out what it causes.  The investigators who study it are convinced it can cause just about anything (We're not so sure about this).  If you test and have it, I would probably treat you with moxifloxacin as a clinical trial.   OTOH, PLEASE DO NOT test for ureaplasma.  It is not a pathogen and is commonly present in the genital tract.  Finding it would not help your circumstance.  
5.  Finally, and as a diagnosis of exclusion, there is an all too common, non-STI syndrome called the chronic pelvic pain syndrome (CPPS) which may cause problems such as this. Again, there are no data to suggest that this is an STI and antibiotic treatment does not help.  I would suggest you check out the description in Wikipedia which has a pretty good description.  (This is the only part of your difficulties I would suggest going to the intent to find out about- otherwise I suggest you stay off it as so much of what is there is misleading.

I hope these comments are helpful. EWH
---
26 months ago
Thank you doctor for your prompt response.  I was first prescribed Cipro and they took that for two weeks.  It did seem to help towards the end but as soon as I stopped taking it symptoms came back.  I then took dioxy for 10 days and then Bactrim for two weeks.  Each time I was on the antibiotics they did seem to help a little....they basically just took the edge off.  There has to be something that are causing these symptoms.  And the vaginal odor and back pain associated with my wife.  So in your opinion you don't feel it's necessary to get retested?
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Thanks for the additional information:
1.  Sometimes bacterial prostatitis requires 4-6 weeks of therapy.  You might benefit from further evaluation for prostatitis by a urologist.  Typically this would involve a rectal examination of your prostate, additional urine tests for white blood cells and bacteria and possible an prostate ultrasound.  While I do not want to 2nd guess your doctors, I would discuss this with them and if you have not seen a urologist, that might be useful.   BTW, bacterial prostatitis is not an STI.
2.   Regarding the bacterial vaginosis, this is not an STI either.  Treatment may help with the odor but unfortunately, this syndrome, which is the most common cause of vaginal discharge in women, tends to recur requiring additional treatment.
3.  The relationship of your, or your wife's back pain to all of this is unclear.

Hope this helps. EWH
---
26 months ago
Doctor I'm just very curious what I could have passed on to my wife to cause the BV or whatever it is that she may have.  I'm 100% sure I caused it she has never had this issue until I slept with this other woman.  She has not said anything about discharge but has made a comment about spotting between periods.  She does not complain of any itchiness or pain during intercourse.  Do you recommend that I go in for further testing?  I am currently having the same symptoms as when my doctor diagnosed me with prostatitis.  I need to get this figured out before I go crazy! Thanks Doctor
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
As I said above, BV is not an STI.  BV is a disruption of the bacteria normally present in the vagina but as you have noted, it can occur due to changes in sexual partners.  There is no evidence that treatment of male sexual partners of women with BV changes the course fo infection or stops recurrences.  Further, as an FYI, BV does not cause spotting between periods.

I ee no need for further STI testing.  I mentioned several courses of actions to you above and that remains my advice.  Further, I would add that changing doctors is NOT a good next step since whomever you would see would not have the benefit of having seen you before and would need to start again.  

I hope this information helps.  As you know, we provide up to three responses to each question.  Thus this thread will be closed later today without further responses.  Take care.  EWH
---