[Question #5959] Regarding HHH view on Prostate infection

18 months ago
I am dealing with what I am confident is a debilitating case of CPPS or Prostatitis. Pain in penis tip, urination problems, etc... I have read on what appear to be legitimate sites, such as Mayo clinic for example, that Chlamydia, if left untreated can move to the prostate and cause this illness. I am wondering if myself and my SO could have always been carrying C, not realize it bouncing it back and forth and now it is causing this illness.

1. Despite the numerous sources stating this is possible, do you believe this is dated information and stand by your position?

2. Assuming I did have a Chlamydia infection (prostate or otherwise) would 100mg of doxycycline a day for 20+ days cure it? I realize the standard treatment is 2x a day for 7-10 days.

3. I have read that anal sex can be another cause (E.coli) Would the Doxy have cured that?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your question and your confidence in our services. This is an important issue for many men, so I'm taking the opportunity to write a blog-like reply that can be used in response to future questions as well as your own.

A little bit of medical history to start; bear with me:  In the distant past -- before effective antibiotics were available -- gonorrhea was an occasional cause of prostatitis, almost always in men who had prolonged untreated urethritis. GC prostatitis is extremely rare today, because almost all men with obvious gonorrhea get treated pretty soon. Flash forward to the chlamydia era (chlamydia was first known to be sexually transmitted and cause urethritis etc around 1970), when it became obvious that chlamydia causes pretty much the same kinds of infections and health problems as gonorrhea. As a result, it became assumed or suspected that pretty much anything caused by gonorrhea could also be caused by chlamydia. That's the origin of many beliefs about chlamydia, including the possibility of causing prostatitis.

However, numerous studies have found no association of chlamydia with prostatitis or chronic pelvic pain syndrome (CPPS). Testing for chlamydia in men with these problems is almost always negative. (An occsional positive result of course is expected:  both CPPS/prostatiis and garden-variety chlamydial infections are common, so of course there are a few persons who have both simultaneously. But finding chlamydia in CPPS and prostatitis is rare, and no more common than in other men.) In addition, treatment of prostatits with antibiotics active against chlamydia, especially doxycycline or other tetracycline, typically has no effect. But rumors persist, partly because the basic causes of prostatitis and CPPS remain uncertain:  whenever a proved cause can't be found, of course it increases speculation about all sorts of possibliities. But that's all it is, speculation without scientific evidence.

Those comments pretty well cover your specific questions, but to be explicit:

1) Indeed I stand by all I have said before on this topic. So do virtually all STD experts.

2) Yes:  if chlamydia were the cause, I would expect doxycycline to clear it up. The tetracyclines in general, and doxy in particular, achieve excellent levels in prostate tissue and would eradicate chlamydia if it were there.

3) A small proportion of prostatitis (but not CPPS) is caused by bacteria that cause non-STD urinary tract infections. E. coli is one of many that cause UTI and prostatits and that can be acquired by anal sex (although most men with bacterial prostatitis have not performed anal sex). However, in bacterial prostatitis, stendard urine culture easily detects the infection. Assuming that somewhere along the line you had a negative urine culture to check for non-STD UTI, that result was reliable. If you have not had a routine urine culture, you should discuss this with your doctor. In the very unlikely chance you in fact have bacterial prostatits, whether due to E. coli or other, doxycycline may or may not be effective:  the antibiotic sensitivity of E. coli and others is highly variable. If such bacteria show up on culture, it is standard practice to test which antibiotics are active against it, so it usually isn't necessary to guess which treatment is best.

The bottom line is that you can rest assured chlamydia isn't the problem, and I doubt E. coli or other non-STD bacteria are involved. But all this should be discussed with the doctor treating this problem. You could print out this thread as a framework for discussion. I'm betting your doctor will agree with all I have said.

I hope these comments are helpful. Let me know if anything isn't clear. Good luck with your prostatitis/CPPS problem.

HHH, MD

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18 months ago
Thank you for that informative reply. I do realize I am diving down rabbit holes, but wanted to cover all possibilities. I have had a standard culture which did not show anything so Ecoli is out I suppose. 
I am sure it's probably non bacterial, but the penile pain is so prominent and relentless it is hard to grasp my body is doing this itself and my brain goes to bacteria infections.
In any case thanks again for the help and thank you and congratulations for your dedication and achievements.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
We don't get into the weeds for genital symptoms/problems once STDs are out of the picture. But I would advise that a second opinion often makes sense in this situation, e.g. from (another?) urologist or maybe infectious diseases specialist.

Thanks for the thanks and your kind words. That's why we're here.
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