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Dr. D. Love
Dr. D. Love, Doctor
Category: Urology
Satisfied Customers: 18531
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a 28 year old male. Last week I came down with what I

Customer Question

I am a 28 year old male. Last week I came down with what I thought was a UTI. I went to the clinic and was tested for and came back negative for STDs. Strangely, the urine test came back normal with no white blood cells or sign of infection. I was diagnosed with non-gonoccal urethritis. The first course of action was a 250mg shot of Rocephin and 1000mg Azithromycin. This was Friday. There was mild relief from symptoms, dysuria and pain upon ejaculation. Sunday I went back to the clinic for a follow up and reported I still had symptoms. Again, tests came back negative for infection and I was given Bactrim, 160mg to be taken twice daily for 3 days. It is now Monday, 3.5 days since the initial visit, 5 days since original symptoms started and they still persist.
Is it normal to still have symptoms of UTI at this stage? I have been otherwise healthy up to this point but I cannot rule out complicated UTI, prostatitis, or cystitis.
Please let me know if this is a normal timeline for symptoms or if I need to further investigate this issue.
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

The primary concern at this point would be a prostatitis.

A UTI is commonly used to describe a bladder infection or cystitis, and would virtually always be detected by the urinalysis, so a normal urine test excludes the possibility of a UTI/cystitis, including a complicated UTI. It is also worth noting that young adults only rarely get a UTI/cystitis.

Urethritis is more common in young men, but they would usually respond well to the antibiotics that you have already taken. A prostatitis is also fairly common in young men, and it is more common for a prostatitis to respond poorly or slowly to antibiotics. The Bactrim may help a prostatitis, but it may be slow to respond.

So, in this situation, a prostatitis would be the primary concern.

There also are some non-infectious conditions that can mimic a UTI, such as interstitial cystitis, but this is much less common and would usually only be considered once infectious causes have been excluded.

Since your symptoms are persistent, then it would be appropriate to pursue further evaluation, particularly for a prostatitis.

If I can provide any additional information, please let me know.

Customer: replied 1 year ago.

Thank you for your reply.

I should have also put down the fact that I started intensely training for long distance running the week prior, running 6-9 miles every other day. The symptoms of burning while urinating are reduced but still pronounced. Tomorrow will be my last day of a 3 day cycle of Bactrim. How long should I expect it to take for symptoms to reduce in order to rule out infectious prostatitis?

Also, are their any blood tests that can confirm or rule out prostatitis? Unfortunately I work overseas and our hospital on project does not possess the ability to do cultures. Is their anything I should ask them to look into further?

Expert:  Dr. D. Love replied 1 year ago.

I am sorry for the delay, but I was away from the computer when you responded.

Long distance running is not associated with urinary or pelvic symptoms. However, long distance bicycling can cause some atypical pelvic symptoms due to pressure on a nerve by sitting on a narrow bicycle seat.

Some cases of prostatitis will respond within a week or so, but there are some cases that require 4-6 weeks of antibiotics for resolution.

There is no blood test that can detect prostatitis. The PSA, a test used to screen for prostate cancer in older men, may be elevated in men with prostatitis, but it is not a consistent finding, so a normal result does not exclude the possibility of prostatitis. There is n lab test that is perfect for prostatitis, but the lab test that is most sensitive at detecting prostatitis is a urinalysis of fluid expressed after a prostate exam. A standard urinalysis is usually normal during cases of prostatitis, but after pressure on the prostate after a rectal exam, if the first fluid expressed is separately collected and examined, it reflects the prostate much better than a standard urinalysis.

Customer: replied 1 year ago.

Thanks again for your reply. I have seen improvement in the dysuria, however the immediate skin around the urethral opening is very slightly inflamed. Is this a typical reaction to an antibiotic treatment of a UTI? I feel better urinating so is that a sign of the potential infection making its way out?

Expert:  Dr. D. Love replied 1 year ago.

Inflammation around the urethral opening is more often a reaction to any germ that is present, but it could also occur as a reaction to the antibiotic.

Yes, improvement in symptoms is usually a sign that the infection is improving.