[Question #9977] Testicular pain: STI, Prostatitis, something else?

27 months ago

Thank you the service you offer here. I have reviewed past posts on the board and would welcome your advice.

Situation: 46 yo het male, long term monog relationship + 1 mut-masturbation outside relationship 11 wks ago, recent flair up of long standing testicular pain.

B’ground: Treated for NSU c.12 yrs and 8 yrs ago (Azith + Doxy). Neg tests for Gon/Chlam/HIV/Syph. Acute symptoms disappeared each time but testicular sensitivity remained.

Current: 1x mutual masturbation exposure (I fingered her then masturbated myself) @ beginning March (regret, guilt, never again). In wk following noticed scant clear gel in meatus following erections only. Tested for Gon/Chlam @ 3 wks (neg) & HSV1/2 + Syph at 6 wks (neg). @10 wks: 2x severe bouts of left testic. pain (relieved by urination + rehydration). Intermittent scant urine-like moisture under foreskin. Nil urethral pain, nil burning during urination or ejaculation in last 11wks.

Have now seen doc at med clinic (STI a focus for practice). Urine sample (Gon, Chlam, MGen, Trich) + bloods (Prostatis). Rectal exam - poss prostrate involvement (Dr unsure). Dip test apparently clear of UTI. Awaiting urine/blood results. Doxy prescribed to manage symptoms.

Please advise:

- likelihood of recent STI acquisition?

- likelihood of persistent MGen/Trich from 8 yrs ago?

- likelihood of Prostatis / other cause?

- alternative explanations?

Thanks for any help you can offer!

Edward W. Hook M.D.

27 months ago

Welcome to the Forum. Thanks for your questions. Thanks as well for looking at past threads on the Forum; we leave them up so clients can review and learn from them. The event you describe, mutual masturbation and possible transfer of genital secretion's from a partner to yourself by masturbation are no risk activities for STIs. The evaluation you have had, which is quite thorough, proves that no STI is present. Was a urinalysis performed? What did it show? I do have some alternative thoughts. I'll provide them by addressing your specific questions:

- likelihood of recent STI acquisition?

Zero chance, an assessment verified by your test results.

- likelihood of persistent MGen/Trich from 8 yrs ago?

Zero. Persistent infection would still result in positive tests if causing your symptoms.

- likelihood of Prostatis / other cause?

Possible. You are of an age when prostatitis starts to become more common. Other possibilities include kidney stones which can present this way, are more likely when a person has reduced fluid intake, and can improve with hydration. Stones can be tough to diagnose- after the acute attack they may pass leaving no evidence they were there and may not show up on X-ray or ultrasound. A more challenging possibility (which I would put lower on the list) is the CPPS (Chronic Pelvic Pain Syndrome) which has many possible presentations and while rarely if ever associated with complications can be challenging to get rid of.

- alternative explanations?

I've mentioned alternate explanations above. Further comments have to do with whether or not antibiotics (doxycycline) seem to be helping or not. If so, this somewhat increases the likelyhood that this is prostatitis which sometimes may need prolonged (4, 6 or even 8 weeks of) therapy. If not, this could well be stones. The evaluation for kidney stones involves urine analysis and, sometimes urinary tract ultrasounds. In the interim, in addition to the antibiotics you are already taking, I would be sure to stay hydrated.

I hope this helps. This is not an STI related to the encounter you describe, nor a lingering infection acquired years ago. EWH

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27 months ago

Thank you for your quick reply, Dr Hook. Your comments are much as I anticipated (and hoped) and are consistent with those of the Dr I saw. Her evaluation was indeed very thorough. I should note too that the scrotal exam had noticeable pain when left testicle was squeezed plus the doctor mentioned some lymph inflammation (?) on the right, which is unsurprising as I’ve had sensitivity on both sides (left always more so than right) for years. Unsure if that’s significant though.

To your specific points:

- Tests: to clarify, I am still waiting for my MGen & Trich results and have never tested for them before. Gon/Chlam have always tested negative including in March this year. Anxiety notwithstanding, my reading of your advice is that I should expect these results to be negative due to (a) time since NSU outbreaks (if that’s even what they were) in early 2010s and (b) no-risk nature of March exposure. Is that correct?

- Urinalysis: on the spot dipstick test (No apparent UTI). Urine test in lab atm is an STI one. No lab-based urinalysis as such.

- Kidney stones / Prostatitis: Roger all of that, will follow up with my regular doctor on my return from abroad.

- Response to Doxy: Probably too soon to say (1st dose last night, 2nd dose this morning). Cautiously optimistic as no pain today.

- From here: Will use my second follow up to report test results (hopefully negative) and ask any final questions should they arise. Until then I’ll stay hydrated and keep on top of the anxious “What if…” thoughts.

Thank you again!

Edward W. Hook M.D.

27 months ago

Thanks for your summary - I agree with it. I anticipate that your tests will be negative.

I agree with your plan and thoughts. I appreciate your awareness of the "what if" "rabbit hole" - this awareness will help you to avoid it.

I look forward to hearing of your negative tests. EWH

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27 months ago

Hello again Dr Hook,

Update - test results are back:

- Gon/Chlam/MGen/Trich urine test - all negative;

- Prostatitis blood test - clear.

Test results are as you anticipated. I presume that I can therefore be confident that I’m STI-free.

From here, the doctor doubted kidney stones on basis of location of pain (and absence of pain in other diagnostic areas). She recommended seeing a urologist to continue narrowing down the root cause of my testicular pain (she referred to it as “possibly a little bit of epididymo-orchitis”). I’ve also been instructed to continue the doxy, which does seem to be having an overall pain reduction effect.

One final question: the doxy did seem to correlate with some dysuria last night, which hadn’t been a symptom previously and now seems to have settled down again … is that normal with doxy and should I expect that to come and go throughout the course?).

That one question aside, those are my next steps. Thanks to you and your colleagues for this service, and thanks to you personally for your reassurance while I was waiting for my results!

Cheers

Edward W. Hook M.D.

27 months ago

Thanks for your follow-up. Yes, you can now be confident you are STI free. While I doubt that this is epididymo-orchitis, particularly given your test results, seeing a urologist is reasonable, as is finishing up the doxycycline.

Not sure about why the doxy should cause dysuria, particularly if it is transient. Doxycycline blood levels are around for an entire day, reaching steady state after three doses so I think the "correlation" may be by chance and not directly related.

Thanks for your thanks. As you know, since this is my 3rd response, this will complete this thread which will be closed shortly without further responses. Be confident that this is not an STI. Take care. EWH

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