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Searing pain through urethea. Started at the end of

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urination and then can be...
Searing pain through urethea. Started at the end of urination and then can be there constantly. No fever, have enlarged prostate that has given me problems over the past 7 years. First time I had these new symptoms. Did 10 days of CIPRO, got better after wards for a few weeks. Back again, stated after a PT treatment. Now on Uribel, 3 days. A little better. Also have been taking Ibuprofen for 8 weeks in pretty high doses. In the past it would clear up prostatitis but not this time.
Having to wait before I can get back in to see my urologist. Also take Terazosin to improve flow.
Think I need to have an ultrasound and perhaps a CT scan. PSA is 2.4. Has stayed in the lower 2 range accept for on spike to 3.1 a few years back.
Submitted: 2 years ago.Category: Medical
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Answered in 21 minutes by:
6/30/2015
Doctor: Dr. D. Love, Doctor replied 2 years ago
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,548
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello from JustAnswer.
What evaluation was done?
Was a culture done prior to the prescription of the Cipro or the Uribel?
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Customer reply replied 2 years ago
No. Did culture a few days after starting Cipro which might have effected the finding of nothing but protein in my urine.Just started Uribel after symptoms came back.
Customer reply replied 2 years ago
I think I needed more than 10 days on Cipro for a prostate issue. A Dr friend told me he would have recommend 4 to 6 weeks.
Doctor: Dr. D. Love, Doctor replied 2 years ago
Thank you for the additional information.
You are correct that the presence of antibiotics in the system may interfere with the accuracy of a culture.
Since the Cipro helped, it certainly suggests that it is infectious, but the key next question is whether the Cipro adequately cleared the infection. The prostate can have an acute bacterial infection, but also can have a chronic bacterial infection. Treatment of the latter frequently needs a very long course of antibiotics. Cipro is one of the recommended antibiotics for this, but a much longer course would be needed for a chronic infection, usually 12 weeks.
A standard urine culture will usually not detect a bacterial prostatitis. The usual method for diagnosis of a chronic bacterial prostatitis is urine analysis and culture before and after prostate exam and massage. Ideally, these cultures would be done when not taking antibiotics. In some cases, if antibiotics seem to be helping and adequate cultures cannot be obtained, the doctor may decide to give 12 weeks of antibiotics empirically.
There are also some men that have symptoms similar to a chronic infection of the prostate, but do not have any positive cultures. The cause of these symptoms are not always clear, but may be due to inflammation in the prostate or irritation of the nerves that serve the prostate. In these patients, terazosin may help with relief of symptoms, but it may also need other medicines, such as medicines that suppress the nerves to the prostate, such as with gabapentin, pregabalin, amitriptyline or duloxetine.
So, ideally, it would be better to get cultures done off antibiotics, but if this cannot be obtained, it may be an option to use antibiotics empirically for 12 weeks. If cultures are negative or antibiotics are not successful, then adding medicines to suppress the nerves to the prostate may be reasonable.
If I can provide any further information, please let me know.
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