Chronic Prostatitis: Symptoms, Diagnosis, and Treatment Options - Urology

Chronic prostatitis

---

Hello Doctor,
I would like to share 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 activities (either 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 off, but when I resume sexual activity, I sometimes experience perineal cramping and burning after ejaculation, making it difficult to fall asleep 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 led to overly concentrated sperm, which caused this...
Additionally, during periods of 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, not exceeding five times in my memory).
Since I have never experienced prolonged and significant discomfort, I did not seek medical attention for these issues.
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 people 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 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 the 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 (during the urinary tract infection period, I did not experience any orgasms), which persisted throughout the day.
On the third day, the discomfort continued, and concerned about acute prostatitis, I went to the emergency room on the evening of February 12.
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, there was still no improvement; instead, the perineal pain transitioned 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 returned to the emergency room, where they performed an ultrasound of the kidneys and bladder, revealing some bladder swelling, but the kidneys were fine with no stones.
Another urine test and bacterial culture showed no signs of inflammation, and the doctor concluded that there was no issue, prescribing Ciprofloxacin for three days as a precaution, with a follow-up appointment in urology after the Chinese New Year.
(After taking Ciprofloxacin for three days, there was a noticeable improvement in urinary pain, but the perineal fullness persisted intermittently.) On February 17, during my urology appointment, no bacteria were found in the urine, and the doctor believed there was no issue, suggesting it might be a case of spermatic cord cramping rather than inflammation, or possibly difficult-to-detect bacteria like Chlamydia or Mycoplasma.
However, I felt it was not cramping 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 noted it was quite high and ordered another test.
The doctor prescribed Doxycycline for seven days.
On February 18, I suspected the doctor was busy with many patients and told me there were no other tests available.
I consulted another doctor who reviewed my PSA report of 12.342 and believed it was still 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 intensified, accompanied by persistent itching, and I began to feel dull pain in the lower abdomen, indicating bladder fullness.
I started urinating frequently, needing to go twice a day.
On February 20, I woke up with a feeling of bladder fullness but struggled to urinate, eventually having to squat and push like having a bowel movement to get it out.
However, I still felt a sense of fullness after urination and continued to feel the urge to go.
Given the timeline, I reasonably suspected it was related to the change in antibiotics, feeling almost ineffective.
I quickly returned to the clinic 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 my nap, I got up to use the bathroom twice.
I had been drinking plenty of water while on antibiotics, but I intentionally reduced my fluid intake and still felt the urge to urinate.
That night, I was overwhelmed by the constant need to go, but each time, I could only produce a small amount, and even after urinating, I still felt the urge.
The injection did not seem effective, and when I returned to the emergency room, the doctor stated that the urology specialist had diagnosed me multiple times with normal urine tests.
I felt hopeless, not knowing how to treat my condition (despair).
I asked the doctor if further tests could be done, but he 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 my bladder fullness and difficulty urinating did not improve.
On February 22, in the afternoon, I switched to the infectious disease department.
The doctor listened to my medical history and suggested checking for STDs first, but based on his experience, he believed I had chronic prostatitis without an acute phase (the doctor mentioned that conditions requiring immediate hospitalization would involve fever).
He stated that chronic prostatitis indeed responds better to Ciprofloxacin, as Cefuroxime has difficulty penetrating the prostate.
However, I informed the doctor that after starting Ciprofloxacin, I began to feel joint swelling and muscle pain.
The doctor mentioned this could be a related side effect, but since there were no other medications available, he prescribed a seven-day course and planned to check my blood and urine tests again.
That afternoon, I resumed work, as I had been on leave since February 10 due to illness.
After minimal activity, I immediately felt strains and sprains, mainly in my hands and feet.
On February 23, after working a full day, my right wrist was so painful I couldn't write, and my left wrist was also painful but more tolerable.
My knees and ankles hurt, and I experienced severe cramping in the tendons connecting my heels to my calves.
Multiple muscle areas were noticeably tender.
On February 24, I took a day off to visit the clinic, informing the doctor of my condition.
He believed it was a side effect but reiterated that there were no other medications available.
The doctor asked if my urological symptoms had improved, and I felt the most noticeable improvement was in urinary pain.
While urination seemed somewhat more normal, it was still inconsistent, making it difficult to assess accurately.
The doctor said it wouldn't improve so quickly, but since urinary pain had improved, he suggested I continue taking this type of medication.
However, continuing the medication made me feel almost disabled, so the doctor switched me to Nemonoxacin, stating that while it was similar, its structure was different and might avoid side effects.
He also reviewed my urine and blood test reports, confirming all STDs were negative, and urine showed no bacteria growth.
However, the doctor noted that antibiotics often do not yield growth in cultures, but switching antibiotics could worsen the situation, indicating an ongoing infection.
Thank you, doctor, for patiently reviewing my medical history.
I have a few questions I would like to ask:
1.
After switching to Nemonoxacin for two days, as of today, February 26, I have 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 without significant improvement, making it difficult 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 proves ineffective, can I switch back to Ciprofloxacin? (Regarding the muscle-related side effects, I feel that while Nemonoxacin is better than Ciprofloxacin, I still experience muscle and joint weakness and increased susceptibility to injury.)
2.
If the antibiotic effects remain poor in the future, what further tests can I undergo? Is it true, as the urology doctor at Hsinchu National Taiwan University said, that there are no tests available? If urine tests show no significant inflammation and cultures do not yield any bacteria, why do I still feel the urge to urinate with minimal output? Would imaging tests like MRI or ultrasound truly not assist in diagnosing 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 appeared different from before, resembling yellow-green mucus, similar to nasal discharge during a cold.
Although my clinic doctor said this is normal, I am concerned it might indicate a Pseudomonas aeruginosa infection.
4.
I read that diagnosing prostate infections may require a digital rectal examination to analyze prostatic fluid, but my doctor has not performed such tests.
Can urine be tested as a substitute for prostatic fluid to check for inflammation and bacteria?
5.
If oral medications are unsuitable, are there other options for intravenous antibiotics?
Thank you, doctor.

---

Ku Tong Tai Duo, 20~29 year old female. Ask Date: 2021/03/02