[Question #6652] Prostatitis caused by an STI?

13 months ago
Dear Drs:
I’m a 47 year old male. On Jan 18th I had a protected vaginal intercourse with a CSW in India. I can confirm that the condom was properly used and it not rupture. I flew back to the US on Jan 19th. From Jan 20 th late afternoon I have been experiencing pain and burning sensation in my urethra, increased urinary frequency and general feeling of malaise. After two days I started experiencing pain and burning sensation in my prostate, especially after I urinate. Please note that I’m not seeing any discharge coming from my penis. On the 24 th I went to a urgent care where they first tested my urine (no WBCs were found) and then sent it for Chlamydia and Gonorrhea testing. The physician in the urgent care suspected prostatitis and prescribed 10 days of Doxycycline. I took the meds and symptoms I was experiencing were almost gone within 5 days. I finished talking Doxycycline and felt I was back to normal. Also my tests for chlamydia and Gonorrhea came back negative. A day after completing the regimen all the symptoms came back! I took Naproxen for 3 days but the symptoms did not improve much. I visited a urologist on the 4 th day. He conducted a DRE and told me that my prostate was not swollen but it was tender. Since my symptoms responded to doxycycline he prescribed it again for 1 month. I’ve been taking it for about 10 days now and my symptoms are getting better but not completely gone. Here are my questions:

1. What STIs can be transmitted through a  condom that could potentially cause prostatitis?  Is this NGU?
2. How long does it typically take for an STI to cause prostatitis?  Is NGU causing prostatitis in my case? Can it happen with couple days?
3. I’ve read on the internet that HIV can cause prostatitis. Is this correct? Should I get tested for HIV? Please note I don’t have any ARS type symptoms.
4. Since my symptoms responded ( at least during the first regimen) to Doxycycline can we assume there was a bacterial infection, potentially a bacterial STI?
5. What

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Welcome to the forum. Thanks for your confidence in our services.

The quick response to the question as you posed it in the title, is no:  STIs rarely if ever cause prostatitis. In the pre-antibiotic era, when gonorrhea went untreated for weeks at a time, some cases involved the prostate. But never as the sole problem:  the main gonorrhea symptoms (painful urination, pus dripping from the penis) always were present as well.

Now having read the details, I am sure your prostate problem is not due to any STI. First, you couldn't have acquired an STD involving your genital tract from sex with a properly used condom that did not rupture. Second, I'm not completely convinced you have (or had) prostatitis. If you google "chronic pelvic pain syndrome" and read the available information, you'll probably see many parallels with your symptims. (The Wikipedia article is good, and there is great information from the Stanford University Department of Urology.) CPPS overlaps with chronic prostatitis and is easily confused with it.

The atypical part is the initial response of your symptoms to doxycycline. That tends to confirm an infection, i.e. perhaps bacterial prostatitis. On the other hand, your relapse of symptoms has not responded completely.

To your specific questions:

1. No STIs can be transmitted through an intact condom. Neither can NGU. And for sure you don't describe any symptoms that suggest NGU; the main symptom is discharge, without the internal pain that suggests prostatitis or CPPS.

2. Since no STI is possible, this is irrelevant.

3. Don't believe everything you can find online. HIV is not known to cause prostatitis. In any case, you were not at risk of HIV, given the proper condom use. You're free to be tested forr HIV if you would be reassured by a negative result. But there is ntohing in your symptoms to suggest HIV.

4. Discussed above. In addition, doxycycline has anti-inflammatory properties, in addition to being an antibiotic. Improved symptoms might be from lessened inflammation, not from an anti-bacterial effect.

Although CPPS includes the term "chronic", it has to start sometimes, and sometimes such symptoms begin soon after an anxiety-producing, regretted sexual exposure. That has to be a consideration for you. But most important, all the evidence suggests nothing bad will happen. There are no known complications of non-infectious prostatitis or CPPS, either for affected men or their sex partners. You shoud look at this whole situation as one of comfort and pain control, not a serious or ultimately important health problem beyond the discomfort itself.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
13 months ago
Dr. Handsfield,
Thanks a ton for your detailed response.  Below are some additional questions I have:

The atypical part is the initial response of your symptoms to doxycycline. That tends to confirm an infection, i.e. perhaps bacterial prostatitis. On the other hand, your relapse of symptoms has not responded completely.

Can you please clarify this a bit more?  Do I have bacterial prostatitis or CPPS?

Given that my symptoms came back just one day after completing the initial doxycycline regimen, is it more likely that it was solely working as an anti-inflammatory or do you see this behavior with antibiotics also?

Is Doxcycline a better anti-inflammatory compared to Naproxen since I’m seeing a much better response to my symptoms when I take it as opposed to Naproxen?

Since taking doxycycline now is not being as effective as the first time, do you think I developed resistance to it?

Should I continue to take doxycycline for another 20 days or should I switch to a anti-inflammatory? 

Thanks you very much for your help!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
I would think naproxen has more potent anti-inflammatory effect than doxycycline, but I can't say whether your initial improvement on doxy was due to its anti-infective or anti-inflammatory properties. Pain and other sorts of discomfort are subjective -- you're the best judge of which drug helps your symptoms most effectively.

All things considered, these details don't help very much in distinguishing prostatitis from CPPS, and I don't know which of these terms best explains your symptoms. There is so much overlap between CPPS and nonbacterial prostatitis that many experts consider them the same (see the Wikipedia CPPS article).

All this is really outside the scope of this forum:  we deal with STDs, and do not attempt to sort out non-STD genital symptoms, and for sure no STD is responsible for what you are experiencing. You should discuss your treatment with your doctor, who is in a much better position to advise you than I am, or any other distant online expert. 
---
---
13 months ago
Dear Dr. HHH,
I forgot to mention in my original post that the corona of my penis is also swollen. I wonder if your opinion about it not being an STI will change due to this symptom. Can prostatitis also cause this symptom?

What’s the best way to diagnose bacterial prostatitis so that the right antibiotic can be prescribed?

Typically how long does CPPS take to resolve? Or will it be there forever?

I realize this is my last post on this topic. Thanks a ton for answering all questions!


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
I'm not sure what to make of the swelling, but it doesn't change the fact that no STI is likely from sex with an intact condom, and no STI causes prostatitis. Although penile swelling can occur with gonorrhea, chlamydia, or herpes, there is no evidence nor serious suspicion you have any of these.

As I said above, this is a non-STD problem so off topic for this forum. Suffice to say diagnosis of prostatitis can be quite complex; if your symptoms continue or you otherwise remain concerned, see a urologist, who will know how to go about it.

The C stands for chronic. That means long lasting, and CPPS often doesn't respond to treatment. Each case is different -- I've seen cases that clear up in a month, others that never do. The psychological factors may be important. (Presumably you have read the online resources I recommended, right?) CPPS symptoms often resolve once someone becomes convinced -- emotionally as well as intellectually -- that it's nothing serious.

I hope the discussion has been helpful. Best wishes and stay safe.
---