Chronic Prostatitis: Challenges in Antibiotic Treatment and PSA Levels - Urology

Acute or chronic prostatitis, with PSA levels above 12, shows poor sensitivity to oral antibiotics?

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Hello Dr.
Li,
I would like to describe my medical history as it has been quite distressing and painful for me.
I apologize for the lengthy details.

Urological History: I have a history of anxiety disorder and often engage in sexual activity (masturbation or intercourse) to alleviate my anxiety, which indicates a higher sex drive.
Occasionally, after excessive indulgence (3-5 times in a day), I take a few days to rest, but when I resume sexual activity, I sometimes experience perineal cramping and burning after ejaculation, making it difficult to sleep for a short period.
(This usually resolves after urinating several times or disappears within an hour).
I initially thought that resting for a few days caused the sperm to become too concentrated...
Additionally, during excessive indulgence, I occasionally experience urethral pain and itching (this symptom does not resolve within an hour and usually lasts one to three days).
These symptoms have occurred intermittently from the age of 14 to now at 29 (the incidence of urinary pain and itching is quite low, I recall it being no more than five times).
Since I have never experienced prolonged and significant discomfort, I did not seek medical attention for it.
In November 2020, I underwent a health check-up, and due to my work, I sometimes hold my urine for extended periods.
At that time, my PSA level was 8.3.
After researching online, I found that the likelihood of cancer in young individuals is almost zero, and since I had no symptoms, I did not pay much attention to it.
Acute Phase History: On February 6, 2020, I suddenly experienced urinary pain and a persistent sensation of a foreign body at the urethral opening after urination.
Pressing on the tip of my penis caused sharp pain.
The discomfort was significantly more intense than my previous experiences and lasted for two days without any signs of relief.
On the morning of February 9, I visited a urology clinic, where I was diagnosed with a urinary tract infection and prescribed Pipemidic Acid Trihydrate.
After two days of treatment, there was no improvement; instead, I began to experience perineal cramping, burning, and dull pain in the groin (there was no ejaculation during this period of urinary tract infection), which persisted throughout the day.
On the third day, the discomfort continued, and I was worried about acute prostatitis.
On the evening of February 12, I went to the emergency room, where blood and urine tests showed no signs of inflammation.
The doctor believed that the antibiotics were effective and advised me to complete the course.
By February 14, after finishing the antibiotics, my symptoms had not improved; instead, the perineal pain changed from cramping to a feeling of fullness, making it uncomfortable to sit or stand, with some relief only when lying down with my legs slightly apart.
I went to the emergency room again, where I had an ultrasound of the kidneys and bladder.
The bladder was somewhat swollen, but the kidneys were fine with no stones.
Another urine test and bacterial culture showed no signs of inflammation, and the doctor believed there was no issue, prescribing Ciprofloxacin for three days as a precaution.
After taking Ciprofloxacin for three days, there was a noticeable improvement in urinary pain, but the perineal fullness changed from continuous discomfort to intermittent episodes of varying severity.
On February 17, during my urology follow-up, no bacteria were found in the urine, and the doctor believed there was no issue, suggesting it might be a varicocele cramp rather than inflammation, or possibly hard-to-detect bacteria like Chlamydia or Mycoplasma.
However, I felt it was not a cramp and asked the doctor if there were any other tests available, to which the doctor replied there were none.
I informed the doctor about my previous PSA level of 8.3, and he said it was quite high and agreed to retest it.
The doctor prescribed Doxycycline for seven days.
On February 18, I suspected that the doctor was busy with many patients and only informed me that there were no other tests available.
I consulted another doctor, who reviewed the PSA report, which was now 12.342, and believed it indicated prostatitis, but since there was no fever, hospitalization was unnecessary.
He prescribed Cefuroxime instead.
From February 18 to 20, my symptoms slowly but noticeably worsened; the previously alleviated urinary pain returned with increased severity, accompanied by persistent itching.
I began to experience frequent urination, needing to urinate twice a day.
On February 20, I woke up with a feeling of bladder fullness but struggled to urinate, eventually needing to push like having a bowel movement to get it out.
After urinating, I still felt a sense of fullness and had the urge to go again.
Given the timeline, I reasonably suspected that the change in antibiotics was related, as it felt almost ineffective.
I quickly scheduled an appointment to inform the doctor, but he advised against using Ciprofloxacin again, gave me an injection, and told me to finish the Cefuroxime and observe.
After receiving a Ceftriaxone injection, I went home to rest, but during the day, I still felt the urge to urinate multiple times.
I had been drinking a lot of water while on antibiotics, but I intentionally reduced my fluid intake and still felt the urge to go.
That night, I could not bear the frequent trips to the bathroom, but each time I could only urinate a little, and even after finishing, I still felt the urge.
The injection did not seem effective, and when I went to the emergency room, the doctor stated that the urologist had diagnosed me multiple times with normal urine tests.
I felt hopeless and asked the doctor if further tests could be done.
The doctor replied that there were no tests available, and everything seemed normal.
Out of desperation, I asked the doctor to prescribe Ciprofloxacin again, which I felt had previously alleviated my symptoms.
On February 21, I took Ciprofloxacin but did not find relief from the bladder fullness and difficulty urinating.
On February 22, I switched to the infectious disease department in the afternoon.
The doctor listened to my medical history and suggested checking for sexually transmitted infections first, but based on his experience, he believed I had chronic prostatitis without an acute phase (the doctor mentioned that conditions requiring immediate hospitalization, like fever, were not present).
He stated that Ciprofloxacin is effective for chronic prostatitis, while Cefuroxime has difficulty penetrating the prostate.
However, I informed the doctor that after starting Ciprofloxacin, I felt joint swelling and muscle pain, which he said could be related side effects, but since there were no other medications available, the other antibiotic had a narrow spectrum and could cause severe allergies.
I initially thought I could tolerate the current joint and muscle pain, so the doctor prescribed a seven-day course and suggested a follow-up with new blood and urine tests.
That afternoon, I resumed work, as I had been on leave since February 10 due to illness.
After slight activity, I immediately felt strains and sprains, primarily in my hands and feet.
On February 23, after working all day, my right wrist was so painful I could not write, and my left wrist was similarly affected but less painful.
My knees and ankles also hurt, and a tendon connecting my heel to my calf experienced severe cramping.
Multiple muscle areas were noticeably tender.
On February 24, I took a sick leave and visited the clinic.
The doctor believed it was a side effect but mentioned there were no other medications available.
The doctor asked if my urological symptoms had improved, and I felt the most significant improvement was in urinary pain.
Urination was somewhat more normal, but not significantly, making it hard to assess.
The doctor said it would not improve so quickly, but since urinary pain had improved, he advised me to continue taking this type of medication.
However, continuing the medication made me feel incapacitated, so the doctor switched me to Nemonoxacin, stating that although it was similar, the structure was different and might avoid side effects.
He also reviewed the urine and blood test reports, confirming all sexually transmitted infections were negative, and the urine was normal with no bacteria cultured.
However, the doctor noted that antibiotics often do not yield cultures, but switching antibiotics could worsen the situation, indicating an ongoing infection.
Thank you, Dr.
Li, for patiently reviewing my medical history.
I have a few questions I would like to ask:
1.
After switching to Nemonoxacin for two days, on February 26, I started experiencing symptoms at the urethral opening again.
Previously, while on Ciprofloxacin, the improvement was most noticeable regarding discomfort at the urethral opening, while other symptoms fluctuated with minimal improvement, making it hard to assess.
Now, with Nemonoxacin, I have noticeable itching and occasional sharp pain at the urethral opening, which has persisted throughout the day.
I read online that switching antibiotics may take some time to show effects.
How many days should I take it to assess its effectiveness? If it is ineffective, can I switch back to Ciprofloxacin? (Regarding muscle-related side effects, I feel that while Nemonoxacin is better than Ciprofloxacin, I still experience muscle and joint weakness and susceptibility to injury).
2.
If the antibiotic effects remain poor in the future, what further tests can I undergo? Is it true, as the urologist from Hsinchu National Taiwan University said, that there are no tests available? If urine tests show no significant inflammation and no bacteria can be cultured, why do I still have a frequent urge to urinate with minimal output? Would imaging tests like MRI or ultrasound truly not help diagnose the issue?
3.
After experiencing acute pain and discomfort, I observed the color of my semen during masturbation on two occasions, February 17 and February 24.
It changed to a yellow-green color resembling mucus from a cold, which is different from before.
Although my clinic doctor said this is normal, I am concerned it could indicate a Pseudomonas infection.
4.
I read that diagnosing prostate infections may require a digital rectal exam to test prostatic fluid, but my doctor did not perform this test.
Can urine be tested in place of prostatic fluid for inflammation and bacteria?
5.
If oral medications are not suitable, are there alternative options for intravenous antibiotics?
Thank you, Doctor.

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Ku Tong Tai Duo, 20~29 year old female. Ask Date: 2021/02/26