Q. Can testicle pain and difficulty in reaching ejaculation be prostatitis?

Answered by
Dr. Karthik Rajan
and medically reviewed by iCliniq medical review team.
Published on Jun 27, 2018 and last reviewed on: Oct 09, 2018

Hello doctor,

I am a 30-year-old married man and this is my story. Three months back testicle pain and difficulty reaching ejaculation for a few days. Also, a mild pain near the rectum or anus for a few days. A month later received unprotected oral sex from a woman. The very next month started to feel intense burning sensation in the penis (not when urinating, in fact, urinating relieved it). Also, intense pain located in glans to the right, between the corona and the meatus. No discharge. Took 1.0 g of Azithromycin and 1.0 g of Ciprofloxacin, just in case. Gonorrhea. chlamydia, mycoplasma, etc, and urine culture and stain grams all were negative. Two days later I had a lot of urinary urgencies. CT scan revealed inflamed bladder walls, small urine retention, and urinalysis shows WBC count of 2 to 4. I was started on Levofloxacin. Two weeks later the symptoms continued. Urine turned very thick. Urologist says it is urethritis (which I do not think so, because the burning is not when urinating, but mostly all the time) orders another CT scan and MRI. Everything comes out normal, except WBC count in urine 8 to 10. Culture and STD negative again.

Two days later the doctor orders four weeks of Levofloxacin, Tamsulosin, and Solifenacin. Also, something for a fungal infection and a pill for if the penis pain was neurological. A week later another urine sample was taken. Everything was normal this time, including WBC count. STD panel negative. Three weeks later the doctor had diagnosed prostatitis and insists on continuing treatment. Symptoms persisted like frequent urination, constant intense burning in penis or bladder, painful ejaculation and a small amount of semen, thick urine, occasional testicle pain. No rash on the penis, no discharge, no lesions, no fever, no joint pain.

Could this be really prostatitis? If it is, could it be bacterial from the oral sex episode? Is constant burning in pain more consistent with non-chlamydial NGU (or NSU) or prostatitis? Could it be related to the bladder more than the prostate? Please help.

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome to icliniq.com.

I have gone through your query. I would like to know a few more details to answer your query better.

  1. Do you strain to pass urine?
  2. How frequently do you have the sensation to urinate?
  3. Do you pass a good amount of urine everytime you have the urge or is it only a few drops?
  4. Did your urologist do a rectal exam, was it painful when he felt your prostate gland?

Let me answer your questions one by one.

  1. From your symptoms and findings on urine analysis and CT, it is highly likely to be prostatitis.
  2. Any unprotected intercourse can lead to urinary tract infections, but as you have specifically mentioned oral, it is less likely, it is more common after anal intercourse.
  3. Constant pain is a feature of prostatic inflammation, your other symptoms like frequency, pain during ejaculation, pain near the anus corroborate with prostatitis than with a bladder infection although it is common to have both and untreated prostatic infection will cause repeated UTI's (urinary tract infection).
  4. If I were your treating physician, I would ask you to do a uroflowmetry to check your flow, then start you on antibiotics for at least 4 to 6 weeks as it takes prolonged therapy to clear a prostatic infection. I concur with the treatment prescribed by your urologist.
  5. If your symptoms are not improving in 4 to 6 weeks then you might require a cystoscopy to examine your urethra, prostate, and bladder to rule out any structural abnormalities.

For more information consult an urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

Thank you doctor,

  1. I have not felt the strain, but sometimes urine takes a little while to come out.
  2. Very variable. I have days where my urination is pretty much normal, but when my symptoms of burning are acute, I feel the need to urinate more often. Two nights ago, I urinated four or five times during night sleep.
  3. Also variable. Sometimes it is normal quantity, sometimes it is just a little bit. I have noticed that when it is a low amount of urine, it is usually sticky urine and some dribbling drops stick to the toilet as if they were mucous.

The only consistent symptom throughout the whole event has been burning sensation in my penis. Sometimes the burning sensation feels like upper (in the bladder) but it is mostly in the penis. The pain in right side of glans has gotten better.

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome back to icliniq.com.

I have gone through your symptoms and they are typical of an attack of prostatitis. As I suggested, you will require a prolonged course of antibiotics. I agree with the drugs you have been prescribed. In addition, I would like to assess whether there is any narrowing in your urethra with a uroflowmetry.

For more information consult an urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

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