Asymtomatic prostatitis keeps returning


Q: Hello, I'm 21 years old, male, studying engineering. I eat very healthy food, do excersise and have no previous history of serious illness. I'm having problems with prostatitis. It all started 2 years ago. I only felt a small pressure around my left testicle. I did a lot of tests and went to a lot of doctors and they found out that I have a very small varicocele and most of them said surgery is not necessary. I did urethral swab 6 times for chlamydia, plasmids etc., I gave urine and semen countless times during these 2 years and had rectal scope. Everything was fine except E. Colli and Enterococcus spp. in my semen. I was taking variety antibiotics for months. After my semen was tested negative for bacteria I was fine for a short period of time but E. Colli returned. I cured it again by taking antibiotics for almost half a year with pauses after every month. Now I have enterococcus spp. again in my semen and I'm very nervous about it. This time the only difference was I had to go to toilet 2 times per night (which I never did before) and that happened for a few nights and stopped (now I'm back to normal without having to wake up). Thats what made me go to doctor to get me tested again. I never felt any symptoms except small pressure around my left testicle that is supposed to be varicocele. I never had fever, pain, weird smell in urine or anything. My semen tests also show low count of white blood cells (one urologist told me that I don't have a real infection according to white blood cells). I have an appointment with my urologist next week but I'm worried to take antibiotics again and why do the bacteria keep returning when I really watch over myself. What can I do? Thank you in advance for your time and understanding. Nino


A:   I do understand your concern, chronic or non-bacterial prostatitis is a difficult entity to treat. Chronic nonbacterial prostatitis may cause long-term pain and urinary symptoms. The possible causes of chronic prostatitis are infection by bacteria, fungi, viruses, irritation caused by the backflow of unine into the bladder and urethral strictures.
Treatment involves trial of antibiotics like trimethoprim-sulfamethoxazole, levofloxacin or ciprofloxacin. Bladder neck dysfunction may be treated with alpha-blockers such as terazosin or doxazocin. A urethral stricture can be surgically repaired. Some patients have had improvement of prostatitis symptoms after transurethral microwave thermotherapy (TUMT).
Avoiding food that might cause irritation like alcohol, lemon, carbonated drinks, spicy food, coffee, acidic food and chocolate may help reduce the urinary irritation symptoms. frequent ejaculations may also help to improve the symptoms by allowing the natural drainage of secretions from the prostate. If symptoms do not resolve, I would advise periodic reevaluation by your urologist.

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