[Question #5389] Prostatitis/MGen

22 months ago
Hello Dr's
I am back and very frustrated as I can't get to the bottom of my issues.  I have been diagnosed with prostatitis and have tried many different antibiotics without success.  Currently taking Bactrim again.  My symptoms are as follows lower back pain, pelvic pain, testicle pain, very thick semen and low volume, very slight yellow tinge to semen.  I also get random muscle and joint aches throughout my body.  I have been tested for most STDs except Mycoplasma Genitalium.  I never experienced discharge or pain urinating.  Also my wife has been having a problem with a fishy odor.  This has never been an issue until I experienced these symptoms.  I've read that MG can lead to Bacterial Vaginosis and cause muscle pain and joint aches in males.  I was with a lady  a few times and she recently told me she was diagnosed with BV.  That is why I am wondering if MG is the source of all these problems.  I've had standard urine tests also and everything has been right on....no signs of any infection.  In your opinion do you feel this could be the source and recommend that I get tested for it? Any other recommendations will be greatly appreciated!  Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Welcome back to the Forum although I'm sorry that you found it necessary.  I'm sorry you are continuing to have difficulties.  The questions you ask today were addressed, in part in our earlier exchange.  At that time I indicated that treatment of prostatitis is often challenging and my take 4-6 weeks and repeated courses of therapy.  Did you experience any improvement with your prior antibiotic therapy?  Also, I should point out that some prostatitis is non-bacterial and does not response well to antibiotics- none bacterial prostatitis overlaps with the CPP syndrome which I also mentioned in our prior exchange and belongs on your list of possibilities.  Unfortunately, this is not an STI either and responds poorly to most therapy.

In our prior exchange I also acknowledged that possibility of Mycoplasma genitalium as an outside possibility and indicated that if your chose to test and were positive, I would then treat you with moxifloxacin.  

Finally, in our past exchange, we also discussed BV and I told you that while your wife's symptoms may suggest BV and that BV may be the cause of her symptoms, there are no data that you would need to be treated for it.

I hope that my repeat of this information is helpful to you.  EWH
---
22 months ago
Is it true MG is a common cause of prostatitis?  I've been experiencing pain in my elbow, muscles by my neck etc.   Like I said I've never experienced any discharge, pain with urination or frequent urination.   If I did have MG wouldn't my urine test detect white blood cells?  I have my good days and then I have some really bad days.  The antibiotics don't seem to be doing much.  If in fact that is what's causing my prostatitis would it still show up on a test specifically for mycoplasma genitalium?
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
As I have also already mentioned, I am skeptical that M. genitalium is behind your symptoms but given your concerns about STIs and my commitment to being thorough, I brought it up.  M. genitalium can be present without WBCs in the urine.  If you have M. genitalium (question 1), then it should be treated to see if your symptoms improve (question 2), i.e. you could have M. genitalium but it might not be causing your problem.  The odds are that you do not have M. genitalium and that it is not related to your symptoms but the approach I have outlined is a logical one.  You need the answer to question 1 first.  

If you do not have M. genitalium or if you have it and treatment does not improve your symptoms, then you have ruled out STIs as the cause of your problems and need to consider the other possibilities I have suggested.  EWH
---
22 months ago
So if I get tested for mycoplasma genitalium would I still get a positive reading if it's secluded to my prostate?  Would it still show up on a urine sample?  Also is it common for this bacteria to cause aches to the muscles and joints throughout one's body?  If so what are the most common places?  I understand this is my final reply thank you again for any information you can provide me with.
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
If you have M. genitalium in your urogenital tract, including your prostate, it would show up upon testing.  Urine specimens are the preferred specimens for testing for M. genitalium which if it is a pathogen at all (see earlier comments) is primarily a urogenital tract pathogen.  As I already told you, I am skeptical that you have any STI and I doubt that your muscle and joint aches are due to an STI.  

As you point out, as this is my 3rd reply, this thread has now concluded and will be closed shortly without further responses.  Take care.  EWH
---