[Question #748] See Q 694 - NOT REPETITIVE Please read severe symptoms prostate

52 months ago
Dear Dr,

I was experiencing sever pain in my genital and anal area and went to see my MD. Urine came back normal as did tests for Ghonorrhea and Chlamydia. HIV and Syphillis still pending but as you said I have nothing to worry about. He diagnosed me with Prostatitis. I am in extreme pain. Most of the pain is actuall in the lower back and anal area with occasional pain/burning in the genital area as well. Is it truly coincidental that I would develop prostatitis shortly after several protected blowjobs? With different strippers (always with new condoms.) Additionally, the DR mentioned it is a different treatment if prostatitis is caused by an STI or just normal prostatitis. Could the fact that I took amoxicillin recently have impacted my chlamydia/ghon urine test? It was at least 3-4 days passed, but perhaps more. Should I be re checkd for chla/gono in a few days just to be certain or can I have confidence that the Cipro 500mg BID will help? Any suggestions? I am sorry for bothering you and am hopeful you will have some suggestions for me. All the best wishes. 
52 months ago
I just can't believe that this is not related. Any suggestions for prostatitis? Am I stuck with this for a long time? Is it serious? I am only 25. Is it common at my age? How could it not be related. I have never had such a thing before. 
52 months ago
And if I could get some infection from a blowjob with condom couldn't I get any of them? I am sorry. Just looking for some answer and advice. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Sigh. You just don't get it. You could not have acquired any STD from the exposures described. Therefore, any symptoms or health problems you may have -- prostatitis or anything else -- are not due to an STD from that event. Period, full stop.

Prostatitis is never an STD, regardless of what some physicians (even urologists) believe and in some cases have been taught. (Gonorrhea can cause it, but so rarely that in 40+ years I have never seen a case -- and in any case, not with symptoms like yours.) And for sure prostatitis has never been linked with an infection acquired by oral sex.

Neverthless, symptoms like yours are common when people are anxious about sexual decisions they regret or that make them nervous. In other words, I agree that your symptoms probably are indeed connected to the oral sex exposures, but through a psychological mechanism, not infectious. I recommend you reserach "chronic pelvic pain syndrome". The Wikipedia article is quite good, and there also is excellent information from the Stanford Unviersity dept of Urology. In your case, I would drop "chronic" from the name and would classify your problem as genitally focused anxiety. Whatever you call it, the pain has a physiologic explanation:  just as tension headaches are caused by increased tone or spasm in scalp muscles, so pelvic pain is believed to be the result of increased pelvic muscle tension. In any case, your symptoms are absolutely typical.

And no, taking amoxicillin cannot turn STD tests negative and yet still have those infections cause these or any other symptoms. There is no such thing as antibiotics masking infections in that fashion. If they turn tests negative, they do so because the infection has been cured.

HHH, MD
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52 months ago
Hi Dr,

I am sure you are correct. I hope you can see from my perspective how insane it is that as I am worried about this I develop a prostate infection? I am in so much pain its insane and keeping me up at night. Do you really believe this is all psychosomatic? That I do not need the antibiotics? Is Prostatitis a serious long term condition? The article confused me more than it helped :( How long can I expect to be in this pain. 
52 months ago
You do not think it is possible I have acute bacterial prostatitis? I can not imagine that such a pain althought getting better now with antibiotics could not be from some infection. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
I did not use the term "psychomatic"; I don't believe in it. Your pain has a physiological explanation, as I described above. Just as tention headache causes real pain and not psychogenic. But anxiety and worry certainly can greatly magnify trivial pain or even normal body sexnations that otherwise would not be bothersome or even noticed. 

I have not examined you, and cannot say for sure you do not have bacterial prostatitis. However, bacterial prostatitis is far less common than non-infectious prostatitis or CPPS, especially at your age. That said, cften a course of antibiotic (such as cipro) is tried. I cannot say whether your initial improvement is because of an infection being treated or placebo effect. Your doctor should have done a urine culture; if you have bacterial prostatitis, it would be positive for the causative bacteria. But as long as your symptoms are improving, you should continue the cipro unless your doctor suggests otherwise.  If you do have prostatitis, it is not due to any STD.  

And no, non-infectious prostatitis or CPPS have no no known long term complicaitons. It's an issue primarily of comfort.

We're once again coming up on the forum limit of two follow-up comments and replies, so carefully consider any additional comments or concerns. But the bottom line (well, one of the bottom lines) is tnat this isn't a debate. You've had my advice as a respected STD specialist. The rest is up to you.

Best wishes--  HHH, MD



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52 months ago
Dear Dr. the urinalysis came back normal. I am concerned that this is causing me some sexual disfunction. I am unable to ejaculate easily. Will this get better with time? Or should I see a urologist?
52 months ago
I feel pain when i get close to ejaculation and was not able to ejaculate although I "felt" it inside. 
52 months ago
Its really possible that this pain and inability to ejaculate can be caused only by an emotional response? Im trying to accept it but its really difficult. Do you think I should see a urologist?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Yes, it is "really possible". The normal urinalysis adds to the evidence against bacterial prostatitis.

You came to the forum for expert advice. You have had it. We do not provide direct medical care and can do nothing more; this isn't a debate. The rest is up to you.

We're back to the same forum policy against repetative posts from individual users on topics/questions already addressed. Any future questions from you WILL be deleted without reply or refund of the posting fee.

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