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Patient's Query
Hi doctor,
I am a 48-year-old male. I had gross hematuria with dysuria one month ago. I was prescribed Bactrim twice a day for ten days. The first culture was negative despite heavy bleeding. After two weeks, I once again had gross hematuria with dysuria. A culture test was taken, and I was prescribed Cephalexin 500 mg four times a day for seven days. I still have mild burning pain in the penis and an urge to urinate. Please help.
Hi,
Welcome to icliniq.com.
I understand your concern.
This might be due to inflammation. Urinary infection in man is rare and always have an internal cause. Ultrasound KUB (kidney, ureter, and bladder) is mandatory as an initial investigation with post-void volume. There might be a stone or obstruction at any level. Another thing is that the culture should show antibiotic sensitivity for the course of antibiotics for at least two weeks. Usually, a day's course will not work. Please follow up with the ultrasound results, and I will guide you further. And if possible, share the culture result so I can choose the antibiotic.
If you have any further questions, please let me know.
Regards.
Patient's Query
Hi doctor,
Thank you for the reply. I will get the ultrasound as requested. I do understand that UTIs in males are very rare. Could this be a case of chronic prostatitis?
Hi,
Welcome back to icliniq.com.
I understand your query and concern.
Yes, it can be, but urine culture usually is negative for chronic prostatitis, while semen culture is positive. Chronic prostatitis diagnosis is mainly based on symptoms and clinical examination. If your prostate is painful on examinations, then yes, it is chronic prostatitis. But we have a positive culture, so you should get proper treatment. Yes, I checked your ultrasound results (attachments are hidden to protect the patient's identity), and hopefully no issues.
If you have any questions, please let me know.
Regards.
Patient's Query
Hi doctor,
Thank you for the reply,
I had pain in the pelvic area for the first time, and it was just before the bleeding started. The first culture was negative, but I was given antibiotics. After a 10-day course of Bactrim, I was feeling good. After the 10-day course, I was fine for another 10 days, and again, I had sudden pain below the bladder, and bleeding with dysuria started. Both times, the blood came toward the end of the urine. The second time, the culture was positive. I have attached the result. I have completed the 7-day course of Cephalexin 500 mg four times per day. What shall I do next?
Hi,
Welcome back to icliniq.com.
I understand your concern.
According to your reports (attachments are hidden to protect the patient's identity), Cephalosporins have good sensitivity. If you are good with the current antibiotic, continue it for two weeks. You need to take culture after completion of two weeks, and you need an ultrasound as well.
If you have any other questions, please let me know.
Regards.
Patient's Query
Hi doctor,
Thank you for the reply,
The doctor had prescribed a seven-day course only. What shall I do? I only have extra Bactrim.
Hi,
Welcome back to icliniq.com.
I understand your concern.
On the last day of the current antibiotic course, start Bactrim (Sulfamethoxazole and Trimethoprim) for another seven days. Your UTI (urinary tract infection) is complicated. You need at least two weeks of antibiotics.
Hope this helps.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply,
I have completed 24 days of antibiotics course today. However, I still have mild discomfort in the penis, and it is a bit sore. There is no burning pain yet, but I feel twirls. At the end, there is a bit of mild burning. Is this common even after a 24-day course?
Hi,
Welcome back to icliniq.com.
I understand your query and concern.
This also should improve at this time. You should add Celecoxib 200 mg twice daily for a month. This is not an antibiotic, but it is anti-inflammatory. After 48 hours of completing the antibiotic, please repeat the urine culture. Please follow up with the culture result for further advice.
If you have any more questions, please let me know.
Kind regards.
Patient's Query
Hi doctor,
Thank you for the reply,
I had a PSA blood test and CT scan under contrast. I have attached the CT scan results. The blood test for PSA was 3.6 ng/mL. Three years ago, it was at 0.86 ng/mL. Could you kindly read through the attached CT results, which show that there is some issue with the enlarged prostate? After medication, I still have some symptoms of mild pain and discomfort or soreness in my penis. I also have some burning and pain on the tip of my penis after passing urine. I generally do not feel well. Please help.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Well, CT (computed tomography) reports (attachments are hidden to protect the patient's identity) showed inflammation in the prostate, and rising PSA (prostate-specific antigen) is a sign. For that, I hope you will do a test for urine culture and also semen culture after 48 hours of the last dose of antibiotics. As you have taken 24 days, it is enough. Just stop antibiotics and do cultures for urine and semen after two days and follow up with results to assess you further.
Revert in case of queries.
Kind regards.
Patient's Query
Hi doctor,
Thank you.
The urine culture is negative. I do not have laboratories here that offer semen culture. The urologist here mentioned it could be chronic bacterial prostatitis. I have mild discomfort and pain in the penis. What do you recommend? The urologist here is saying we need six weeks of antibiotics. Kindly advise if Bactrim 1 tablet twice a day for six weeks with Flomax once a day is enough.
Hi,
Welcome back to icliniq.com.
I understand your query.
Yes, Bactrim and Flomax (Tamsulosin) are the correct treatment. Prostatitis will need two to six weeks of treatment. Ideally, we give Bactrim for four weeks. Flomax also is good for treating prostatitis. Please carry on using them.
If you have any more questions, please let me know.
Kind regards.
Patient's Query
Hi doctor,
Thank you for the reply.
I was concerned about the dosage. He gave me Bactrim (400 mg/80 mg) one tablet twice a day. However, I have noted that normally it is prescribed two tablets twice a day (800 mg/160 mg). So my question is, is it fine to take a tablet twice a day for six weeks, or should I swift to 2 tablets twice a day?
Hi,
Welcome back to icliniq.com.
I understand your query
There are two preparations. One is Bactrim 480 mg twice daily, and the other one is Bactrim DS 980 mg once daily. So yours is Bactrim 480 mg, and it should be twice daily.
Hope this answers your query.
Kind regards.
Patient's Query
Hi doctor,
Thank you
However, I have noted that many doctors prescribe Bactrim DS 980 mg twice daily, not once. I am worried that if I am given Bactrim 480 mg twice instead of the Bactrim DS twice, the infection will not clear up. Is the 480 mg tablet to be taken 1 tablet twice, or is it 980 mg twice a day?
Hi,
Welcome back to icliniq.com.
I understand your concern.
As per guidelines for prostatitis, 480 mg twice daily is enough, or double strength 980 mg once daily is also sufficient. I am prescribing it regularly for my patients.
Revert in case of queries.
Kind regards.
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