Hi doctor,
I am a 27 year old sexually active male. I have been with the same girl for the past 10 years and we are loyal in the relationship. I am having a ton of issues and pain in my lower region. The symptoms are lower back pain, pain in my pubic region, pain and tingling in my testicles, burning with and without urination and pain within the penis. I have been to three different walk-in clinics and had three different antibiotics, including Levaquin, Bactrim and Cipro. I went to a urologist and was told to have pelvic pain syndrome. I have had similar issues in the past. I dealt with a prostate infection a few years ago and that was treated with antibiotics. But, this time nothing is working. Most urine cultures show no bacteria. My thoughts are possibly pudendal neuralgia or interstitial cystitis, as my mom has IC. Do you advise sonogram or endoscopy or medications?
Hi,
Welcome to icliniq.com.
Your symptoms do point towards chronic prostatitis. With negative culture and positive pus cells, it is likely that you are suffering from CPPS IIIA, which is non-bacterial inflammatory chronic prostatitis. Now, this is a difficult condition to manage and requires long-term therapy. I would suggest that you follow up with a urologist on a long term basis. Therapy takes some time and different medications work for different patients.
IC (interstitial cystitis- painful bladder) is also a possible condition, but CPPS is more common in males than IC. You do not meet all criteria for IC as per the classic definitions. So, I would keep CPPS as the first differential. I am mentioning some tests that you may want to get done to clarify the situation in a better way.
Recurrent infections.
Investigations to be done:Urine anti-proliferative factor, EPS Culture (expressed prostatic secretions) after prostatic massage, uroflowmetry with post-void residual urine assessment and cystoscopy.
Differential diagnosis:1. CPPS IIIA.
2. BPS (bladder pain syndrome) / IC.
I suggest combination of Amitriptyline, alpha blockers, NSAIDS (nonsteroidal anti-inflammatory drugs) and Gabapentin. Dietary modifications will be necessary. Consult your specialist doctor, discuss with him or her and take the medicine with consent.
Preventive measures:Stay away from spices, coffee and anything that you feel trigger the symptoms or aggravate them.
Regarding follow up:Revert back with the reports to a urologist online.---> https://www.icliniq.com/ask-a-doctor-online/urologist
Thank you doctor,
I really appreciate your answer and the extra information. I am going to follow up with a urologist. Is kidney stone or bladder stone a possible cause of this? Do you think getting a sonogram of my bladder, kidneys and scrotum would be beneficial in trying to rule out?
Hi,
Welcome back to icliniq.com.
Revert back with the reports to a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist
Was this answer helpful?
| Comprehensive Medical Second Opinion.Submit your Case
Can Aleve and Goody's powder cause stomach upset?
Query: Hi doctor, I recently had a migraine, so I took two tablets of Aleve. It did not work, so I took Goody's powder, but the pain was still there, so I took another one. The migraine pain has gone, but my stomach seems to be upset. Read Full »
Why am I getting recurrent kidney stones with stomach pain?
Query: Hello doctor, I have many health problems. My gallbladder was removed two years back and now I feel pain in the left as well as right side of the stomach below ribs. I am also suffering from repeated kidney stones at the left side and also in my both arms, I feel some bulges sort of thing. Please s... Read Full »