For Dr. Handsfield preferably: I am a  married 64 year old male with chronic mild nocturia,  frequency and urgency, also mild right testicular discomfort, intermittently since vasectomy. I had an encounter with a massage provider in Vancouver BC 22 November 2018, with genital stimulation, I think just with hands, though I was face down for most of that.  I had some mild genital aching in the following days, attributed to some genital anxiety, which I know you are familiar with.  About 2 weeks ago, during an attempt at intercourse with my wife, entering from the back, my penis did not go in readily, and there was some discomfort on both our parts.  About a week ago, I started to experience more frequency, and urgency with some new burning with urination, urethral pruritic feeling, with possibly very minimal discharge, very scanty, if at all.  I went online and purchased some tests, done at LabCorps 4 days ago, urine negative for trichomonis, chlamydia and gonorrhea, HIV and herpes serology negative. A first voided urinalysis done without cleansing the glans first (I am circumcised) showed >30 wbc per high power field, 2+ wbc esterase, negative for bacteria. I went to see my primary doctor today, she was inclined to attribute my symptoms to low grade prostatitis.  Today, a  midstream urine after cleansing the outside was negative.  A first voided urine with glans cleansing, after a prostate exam/massage (not terribly tender, but uncomforable),  showed 1+leukocyte esterase.  She ordered a urethral swab for mycoplasma genitalium which I still need to collect and drop off at the lab.  She prescribed Cipro and Flomax feeling most likely that symptoms are due to bph and prostatitis rather than urethritis.  Wanted to get an opinion on that diagnosis/recommendation, also should my wife be tested for any of the above, or ureaplasm. I suggest you would feel the massage with hand genital stimulation has nothing to do with my current situation, if not, should I try to inform her 

Welcome to the Forum. Dr. Handsfield and I share the forum and answer questions based on our availability.  As it happens, I will be answering your question.  For better or worse, clients are not able to request a response from one or the other of us and once someone receives a response from one of us, the other will not chime in.  This approach allows us to assist more Forum  clients.  FYI, part of the basis for our partnership is that while our verbal styles may differ, Dr. Handsfield and I have worked together for more than 30 years and have never come to different conclusions in our advice to clients.

Thanks for your detailed description of your exposures, your symptoms and the events to date.  As I read this information, I find the scenario far, far more consistent with a prostatitis than with and STI.  The fact that you have a degree if nocturia, frequency and urgency are all far more suggestive of prostatitis than STI.  In fact I recently published a peer-reviewed paper which demonstrated the urinary frequency is almost never a symptom of urethritis in males.  In addition, the nature of your encounter and your negative tests for the most common STIs also make an STI most unlikely.  Based on what you have mentioned, I would not feel the need for further STI testing, nor for ureaplasma (which is not really an STI but is part of the normal genital flora).  I would suggest that it may be time to initiate a trial of antibiotics.

I hope this information is helpful.  EWH

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