Chlamydia Infection in Chronic Prostatitis: Treatment Options and Concerns

Clostridium infection

Hello Doctor, I have been diagnosed with acute or chronic prostatitis (different doctors have differing opinions; some say it doesn't seem chronic, while others say it is chronic).
Although I only recently started experiencing symptoms and sought medical attention, the inflammation may have been present for some time.
Currently, my PSA level is 12.845, compared to 8.4 during a health check last November.
However, I did not seek medical attention earlier due to the absence of symptoms, even though my urine showed normal white blood cells and no bacteria.
Initially, I experienced urinary pain, urethral itching, and after three days, anal itching, perineal swelling, burning, frequent urination, and difficulty urinating (symptoms began on February 9 of this year).
In the first 14 days, the symptoms were severe, leading me to the emergency room four times, with over 25 bathroom visits a day, but only able to urinate a small amount each time, still feeling the urge to go but unable to.
There was no fever.
After taking antibiotics for 14 days, there was some improvement, but stopping the medication led to a worsening of symptoms.
I have been on medication for a month now, with only slight improvement; the situation is not severe enough to require another emergency visit, but the symptoms persist.
Yesterday, I had my PSA rechecked, which was around 11.
I asked the doctor if the absence of bacteria in my urine could indicate other issues, such as cancer, but the doctor believes that given my age, there is no need for concern, and it could be a chronic infection from hard-to-detect bacteria, such as Chlamydia.

I would like to ask the doctor:
1.
Regarding chronic Chlamydia prostatitis, the doctor mentioned that due to the characteristics of the prostate, many medications are ineffective.
Is it possible to use a single-dose injection and medication treatment (such as azithromycin)? The doctor prescribed this medication for me to take once and administered an injection of Ceftriaxone.
Can these medications penetrate the prostate?
2.
I have been prescribed long-term antibiotics and am currently taking Nemonoxacin.
I previously took Ciprofloxacin for seven days but experienced severe muscle and joint side effects, so I switched to Nemonoxacin.
The doctor mentioned that sulfonamides might be more effective against Chlamydia infections and can penetrate the prostate, but due to severe side effects, I was advised to continue with Nemonoxacin.
Is Nemonoxacin ineffective against Chlamydia? Should I consider combining it with other antibiotics like doxycycline? Can doxycycline penetrate the prostate? (Doxycycline was prescribed by another doctor after hearing my symptoms, but my primary physician believes fluoroquinolone antibiotics are the first choice for chronic prostatitis.) I apologize for asking about medication-related issues, but since my urine tests have been normal and no bacteria were cultured, I feel like I am just being trialed on various antibiotics, and I was eventually referred to an infectious disease specialist.
The repeated outpatient visits have consumed a lot of medical resources, and I have been switched to several antibiotics, each prescribed for seven days, but after three days of no effect, I was switched again.

3.
Since three urine tests showed no white blood cells, is there really no risk of inflammation or infection? I am concerned about cancer and whether I need a CT scan.

Ku Tong Tai Duo, 20~29 year old female. Ask Date: 2021/03/08

Dr. Sun Hongshun reply Urology

Hello, regarding your concerns, prostatitis is highly suspected.
Have you undergone any semen analysis? If it is indeed a chronic inflammation, a two-week or one-month course of medication may not be sufficient.
In addition to antibiotic treatment, prostate massage and low-energy shockwave therapy (which is out-of-pocket but currently shows very good results) are also recommended.
At 29 years old, your risk of cancer is low, but it cannot be completely ruled out.
You are welcome to visit the hospital anytime for inquiries so we can arrange for examinations and treatment.

Reply Date: 2021/03/08

More Info

Chlamydia infection in the context of chronic prostatitis presents a complex challenge for both diagnosis and treatment. Chronic prostatitis, particularly the non-bacterial type, can be frustrating for patients due to its persistent symptoms and the difficulty in identifying a definitive cause. Your situation, characterized by elevated PSA levels and ongoing urinary symptoms, raises several important considerations.

1. Understanding Chlamydia and Prostatitis: Chlamydia trachomatis is a common sexually transmitted infection that can affect the urogenital tract. In men, it can lead to urethritis and potentially contribute to prostatitis. The prostate gland's unique anatomy makes it challenging for certain antibiotics to penetrate effectively, which can complicate treatment. Your physician's suggestion that you may have a chronic Chlamydia infection is plausible, especially if standard cultures have not identified other pathogens.

2. Treatment Options: The use of azithromycin and ceftriaxone is a common approach for treating Chlamydia due to their effectiveness against this organism. Azithromycin is a single-dose treatment that can penetrate well into tissues, including the prostate. Ceftriaxone, administered as an injection, is also effective against a broad range of bacteria. However, the effectiveness of these treatments can vary based on the individual’s specific circumstances, including the presence of other underlying conditions or infections.

3. Long-term Antibiotic Use: Your current regimen of Nemonoxacin, a fluoroquinolone, is often prescribed for chronic prostatitis due to its ability to penetrate prostate tissue effectively. However, if you are experiencing adverse effects from ciprofloxacin, it is understandable that your physician would switch you to a different antibiotic. The concern regarding the effectiveness of Nemonoxacin against Chlamydia is valid; while fluoroquinolones are generally effective against a wide range of bacteria, including some strains of Chlamydia, they may not be the first-line treatment for this specific infection. Doxycycline is another option that is often used for Chlamydia and can penetrate the prostate, but your physician's preference for fluoroquinolones may be based on their broader spectrum of activity against potential pathogens in prostatitis.

4. Concerns about Cancer and Further Testing: Your anxiety regarding cancer, particularly given the elevated PSA levels, is understandable. While elevated PSA can be associated with prostatitis, it can also indicate other conditions, including prostate cancer. The absence of white blood cells in your urine suggests that there may not be an active infection, but it does not entirely rule out the possibility of malignancy. If your symptoms persist and PSA levels remain elevated, further imaging studies, such as a CT scan or MRI, may be warranted to rule out any serious underlying conditions.

5. Next Steps: Given the complexity of your case, it may be beneficial to continue working closely with your healthcare providers, including a urologist and possibly an infectious disease specialist. They can help tailor your treatment plan based on your response to medications and any new symptoms that may arise. Regular follow-ups and monitoring of your PSA levels, along with any necessary imaging studies, will be crucial in managing your health.

In summary, managing chronic prostatitis, especially with a suspected Chlamydia infection, requires a multifaceted approach. It is essential to communicate openly with your healthcare team about your symptoms, treatment responses, and any concerns you may have regarding your health. This collaborative approach will help ensure that you receive the most appropriate care tailored to your specific needs.

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