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Anyway it really seems to me like an infection is present as my underwear always feels wet and I was having ED symptoms today and I haven't been having morning wood, when in April I was and in april my symptoms were not present. So that makes me think maybe the infection is in my prostate? My doctor also seemed very sure that this is indeed an infection.
The way we are trained and the way I have trained is that when reading a gram stain or any stain for that matter of fluid or tissue that when you see many white cells one always looks harder for bacteria. We also have a special protocol with surgery when orthopedic surgeons send joint fluid during surgery that we must report out the cell counts as fast as we can and get on the phone and call the results, WBC, so they can determine the extent of the surgery to take place if the white count is elevated. That is how important the white cell count is.
Every wound culture will have a gram stain performed in order to evaluate the presence of inflammation and the predominant cause of acute inflammation is infection. It also helps in determining if an infection is present in the first place. White blood cells are there to fight the infection. The reporting of few, moderate and many white blood cells aids in defining if an infection is present and aids in evaluating bacteria that are not invasive and thus commensal or if they are causing damage and initiating an immune response.
With regards to urine bacterial cultures,
"Quantitative colony counts should not be used to guide therapy in asymptomatic patients (6).In symptomatic females, colony counts of >10 to the 2 cfu/mL are usually clinically meaningful. In symptomatic males, colony counts >10 to the 2 cfu/mL are usually clinically relevant for diagnosis of UTI or prostatitis"
One can not use wound cultures performed on urine samples to determine a UTI because there is no quantification taking place other than noting few, moderate or many bacteria on a swab. It isn't colonies per unit volume of urine. Your urine cultures are negative I presume.
The significance of wound cultures are the visual open wound damage seen on visual inspection and then comes the interpretation of a laboratory objective of seeing many white cells and a predominant organism seen under the microscope doing the damage.
That brings into question the pathology of the organisms being isolated. It might also explain the lack of a sustained response to various antibiotics. It also should be treated empirically. There are apps now that state what antibiotics to use for first line, second line and even third line regiments for urethritis.
I would defer to the urologist for further consultation.
OP, sorry not much help from me, but since you said you have swollen lymph node, do you have mild grade fever or fever at all?
btw, since you get all those tests done, might as well get an HIV test just in case. You did say you had 'unprotected' sex with a woman, just to be on the safe side you know.
And did you said your Gonorrhea test came out negative?
Ive had all STD tests come back negative including for Hiv 4th gen and the RNA test at 100 days. Tests for chlamydia and gonnorhea are negative at least 8 times. I’ve also had no fevers at all throughout this entire episode.
The way we are trained and the way I have trained is that when reading a gram stain or any stain for that matter of fluid or tissue that when you see many white cells one always looks harder for bacteria. We also have a special protocol with surgery when orthopedic surgeons send joint fluid during surgery that we must report out the cell counts as fast as we can and get on the phone and call the results, WBC, so they can determine the extent of the surgery to take place if the white count is elevated. That is how important the white cell count is.
Every wound culture will have a gram stain performed in order to evaluate the presence of inflammation and the predominant cause of acute inflammation is infection. It also helps in determining if an infection is present in the first place. White blood cells are there to fight the infection. The reporting of few, moderate and many white blood cells aids in defining if an infection is present and aids in evaluating bacteria that are not invasive and thus commensal or if they are causing damage and initiating an immune response.
With regards to urine bacterial cultures,
"Quantitative colony counts should not be used to guide therapy in asymptomatic patients (6).In symptomatic females, colony counts of >10 to the 2 cfu/mL are usually clinically meaningful. In symptomatic males, colony counts >10 to the 2 cfu/mL are usually clinically relevant for diagnosis of UTI or prostatitis"
One can not use wound cultures performed on urine samples to determine a UTI because there is no quantification taking place other than noting few, moderate or many bacteria on a swab. It isn't colonies per unit volume of urine. Your urine cultures are negative I presume.
The significance of wound cultures are the visual open wound damage seen on visual inspection and then comes the interpretation of a laboratory objective of seeing many white cells and a predominant organism seen under the microscope doing the damage.
That brings into question the pathology of the organisms being isolated. It might also explain the lack of a sustained response to various antibiotics. It also should be treated empirically. There are apps now that state what antibiotics to use for first line, second line and even third line regiments for urethritis.
I would defer to the urologist for further consultation.
Thank you again. all of my urinalyses appear fine, even under microscopic examination which was done by Lapcorp from a sample i gave on 5/7. And again all std tests are negative repeatedly. My urologist didn’t seem very concerned when I saw him last Wednesday. And my CT scan on 2/22 came back fine so it doesn’t appear to be anything structural. I’m just having a hard time trusting my Mgen results because it seems incredibly difficult to diagnose but i folllowed all the instructions when I gave my sample, first void and first part of stream on 5/7.
and when i took 1g of Zpak on 5/7 i didn’t alleviate the symptoms at all so it probably isn’t anything to do with the mycoplasmas no?
I’m also very afraid of going on the penicillin again and having it come back like it did before as penicillin doesn’t penetrate into the prostate. I don’t know if I should ask my doctor to give a different antibiotic as it only seems they tested those two. Thank you for all the input this is just incredibly confusing and i’m not sure how i’m going to get better.
Thank you again. all of my urinalyses appear fine, even under microscopic examination which was done by Lapcorp from a sample i gave on 5/7. And again all std tests are negative repeatedly. My urologist didn’t seem very concerned when I saw him last Wednesday. And my CT scan on 2/22 came back fine so it doesn’t appear to be anything structural. I’m just having a hard time trusting my Mgen results because it seems incredibly difficult to diagnose but i folllowed all the instructions when I gave my sample, first void and first part of stream on 5/7.
and when i took 1g of Zpak on 5/7 i didn’t alleviate the symptoms at all so it probably isn’t anything to do with the mycoplasmas no?
I’m also very afraid of going on the penicillin again and having it come back like it did before as penicillin doesn’t penetrate into the prostate. I don’t know if I should ask my doctor to give a different antibiotic as it only seems they tested those two. Thank you for all the input this is just incredibly confusing and i’m not sure how i’m going to get better.
I think you're at the point where you need fresh eyes to check into the prostate since you did state that your urologist thinks you're too young to have prostate issues. Do you have a university hospital near you or within an hour or so drive? That's my suggestion, finding a university hospital urologist who probably sees more cases of "younger people" having prostate issues.
My hub had tonsil cancer back in August 2009. He had gone to Tennessee to visit our old neighbors, when he came home he had a golf ball sized tumor protruding over his right carotid. We spent almost a month with the local ENT who knew it had to be cancer but the needle biopsies were not getting the cancer in them. It was the 3rd needle biopsy that finally did it.
We then went a few weeks wondering where this cancer started because the type doesn't start in lymph nodes. Did a PET scan, which took 10 days for the report. It actually finished just in time for me to drive to get it then we drove to Philly for the ENT. The Philly ENT did a quick look at my hubs ears, nose and throat, told him he has cancer in his right tonsil. I'm still floored that the local ENT couldn't tell there was cancer in that tonsil, but the Philly ENT sees lots of different oral cancers every day where our local ENT may not have seen another case until 10 years. I will say that his previous dentist who also had no experience with oral cancer patients, started advertising they can check for oral cancers in the mouth.
Anyway, as I said, a university urologist is what you need at this point because they will have more experience with people hard to diagnose like you. You're way past being able to get diagnosed locally. All you've been doing is wasting money and making yourself more stressed out.
I give you a lot of credit for keeping such detailed history. I wonder if having sex brought this on or not. It does seem like that's when it started for some reason.
You're also very lucky the MedicalLabGuy recently retired and found CD. I've been seeing your thread suggested in the active thread box but never clicked it until today. Hopefully my little bit of advice will be what answers your issue. I think you should give up the pot. Valiums would do you a lot better to relax.
I think you're at the point where you need fresh eyes to check into the prostate since you did state that your urologist thinks you're too young to have prostate issues. Do you have a university hospital near you or within an hour or so drive? That's my suggestion, finding a university hospital urologist who probably sees more cases of "younger people" having prostate issues.
My hub had tonsil cancer back in August 2009. He had gone to Tennessee to visit our old neighbors, when he came home he had a golf ball sized tumor protruding over his right carotid. We spent almost a month with the local ENT who knew it had to be cancer but the needle biopsies were not getting the cancer in them. It was the 3rd needle biopsy that finally did it.
We then went a few weeks wondering where this cancer started because the type doesn't start in lymph nodes. Did a PET scan, which took 10 days for the report. It actually finished just in time for me to drive to get it then we drove to Philly for the ENT. The Philly ENT did a quick look at my hubs ears, nose and throat, told him he has cancer in his right tonsil. I'm still floored that the local ENT couldn't tell there was cancer in that tonsil, but the Philly ENT sees lots of different oral cancers every day where our local ENT may not have seen another case until 10 years. I will say that his previous dentist who also had no experience with oral cancer patients, started advertising they can check for oral cancers in the mouth.
Anyway, as I said, a university urologist is what you need at this point because they will have more experience with people hard to diagnose like you. You're way past being able to get diagnosed locally. All you've been doing is wasting money and making yourself more stressed out.
I give you a lot of credit for keeping such detailed history. I wonder if having sex brought this on or not. It does seem like that's when it started for some reason.
You're also very lucky the MedicalLabGuy recently retired and found CD. I've been seeing your thread suggested in the active thread box but never clicked it until today. Hopefully my little bit of advice will be what answers your issue. I think you should give up the pot. Valiums would do you a lot better to relax.
Thank you for the response. I do feel frustrated as my urologist doesn’t seem at all concerned and he does seem like a younger guy, but he basically waved off my symptoms as anxiety. Unfortunately i live in a semi-rural part of NY state and while there are several universities around, i can’t seem to find any info on urologists affiliated with them. Maybe i’ll try seeing if I could see a new urologist in general.
As an update though, my doctor put me back on penicillin and also Flagyl for the p. loescheii. If you see this Mr MedLabGuy, could you offer any insight into what would bring that + the e. faecalis on? And do I need to worry about them becoming embedded in my bladder or prostate or anything? When I saw my primary dr yesterday , she also said I shouldn’t be having prostate issues and that if I did have prostatitis I would have pelvic pain and wouldn’t be able to be sitting down due to pain. I’ve had no pain at all, no pain while urinating or ejaculating. Ejaculating at this point feels a little uncomfortable and my sex drive is extremely low, this is what happened back in March right before my culture diagnosed the EF. I also have no morning wood and have to urinate frequently at this point. This all went away in April for a little while when I was on the second 10-day penicillin course and stayed gone until early this month. My morning wood had been returning and it seemed like my body was healing.
one thing is that I was taking the meds very haphazardly in regards to timing. It was every 6 or 10 hours instead of 8 and my dr said accuracy can really effect things. So now my current course is 4 times a day so i’m taking it very strictly every 6 hours. I hope it helps. I’m also trying to think that i don’t have Mgen as my symptoms have come and gone and I haven’t had any increasing pain or anything. And I read penicillin doesn’t act again Mgen. So hopefully that’s not it? I’m fixating I know. Anyway I did make an appt with my urologist for thursday and i’ll see if I can convince him to do a prostate test or something, I don’t know how soon I could see a different urologist. But i’ll keep digging. Open to any other input, thanks all.
Thank you for the response. I do feel frustrated as my urologist doesn’t seem at all concerned and he does seem like a younger guy, but he basically waved off my symptoms as anxiety. Unfortunately i live in a semi-rural part of NY state and while there are several universities around, i can’t seem to find any info on urologists affiliated with them. Maybe i’ll try seeing if I could see a new urologist in general.
When I saw my primary dr yesterday , she also said I shouldn’t be having prostate issues and that if I did have prostatitis I would have pelvic pain and wouldn’t be able to be sitting down due to pain. I’ve had no pain at all, no pain while urinating or ejaculating.
Anyway I did make an appt with my urologist for thursday and i’ll see if I can convince him to do a prostate test or something, I don’t know how soon I could see a different urologist. But i’ll keep digging. Open to any other input, thanks all.
You can try as the other poster said to get a second opinion from a larger University center which I think is a good idea considering the alternative will be a chronic condition with limited options.
Just to reiterate why the urologist questioned the some findings and the difference between "prostatitis" and "prostatodynia" and the use of the suffix "itis" in general. In infections like meningitis, appendicitis, tonsillitis and urethritis there is inflammation because of the immune response that is comprised of fluid accumulation and white cells in the area. It is analogous to pus. Two things that go against infection are the lack of white blood cells present along with the finding of mixed flora on the culture in an area where there can be commensal flora. That is why the urologist is not concerned about the culture results. The other reason is that enterococcus can cause cystitis and any cystitis for that matter can irritate the urethra but they don't just cause urethritis by itself. There are organisms that cause urethritis that don't cause cystitis indeed urine cultures are not intended to detect gonorrhea. Clinically urethritis is really quite different from cystitis. It is questionable whether you had a discharge (pus) or whether it is urine or prostate secretions.
Just to reiterate the importance of the "itis" in areas where there a tons of bacteria present and none sterile sites like the colon and stool. The presence of bacterial enterocolitis will cause white blood cells to be present in the stool. Doctors would order fecal leukocyte examinations in order to determine which diarrhea cases require antibiotic use and which do not (viral) based on invasive bacteria generating a white cel response.
Clinically a lack of white cell response on the part of the prostate we have this which is why the itis is not part of the word. The same applies to vaginosis vs vaginitis. There's an altered microbial flora that causes smell but it isn't invasive thus not causing a leukocyte response.
"Prostatodynia is a clinical entity associated with voiding symptoms and pelvic pain suggestive of prostatitis but with a normal prostate examination and without evidence of inflammation or infection in expressed prostatic secretions. The problem tends to be chronic and is vexing in its management."
You did state you have had testicular discomfort, dysuria, and ED without inflammation and it is chronic after months and it is "vexing in its management".
The antibiotics might work in an apparent remission and hope it never comes back but if it is the above then it will come back if it goes away at all with the antibiotics. Again a second opinion from another urologist for your own minds sake appears to be an option. They can take a fresh look at all of the information to see if they missed something or tried something.
You can try as the other poster said to get a second opinion from a larger University center which I think is a good idea considering the alternative will be a chronic condition with limited options.
Just to reiterate why the urologist questioned the some findings and the difference between "prostatitis" and "prostatodynia" and the use of the suffix "itis" in general. In infections like meningitis, appendicitis, tonsillitis and urethritis there is inflammation because of the immune response that is comprised of fluid accumulation and white cells in the area. It is analogous to pus. Two things that go against infection are the lack of white blood cells present along with the finding of mixed flora on the culture in an area where there can be commensal flora. That is why the urologist is not concerned about the culture results. The other reason is that enterococcus can cause cystitis and any cystitis for that matter can irritate the urethra but they don't just cause urethritis by itself. There are organisms that cause urethritis that don't cause cystitis indeed urine cultures are not intended to detect gonorrhea. Clinically urethritis is really quite different from cystitis. It is questionable whether you had a discharge (pus) or whether it is urine or prostate secretions.
Just to reiterate the importance of the "itis" in areas where there a tons of bacteria present and none sterile sites like the colon and stool. The presence of bacterial enterocolitis will cause white blood cells to be present in the stool. Doctors would order fecal leukocyte examinations in order to determine which diarrhea cases require antibiotic use and which do not (viral) based on invasive bacteria generating a white cel response.
Clinically a lack of white cell response on the part of the prostate we have this which is why the itis is not part of the word. The same applies to vaginosis vs vaginitis. There's an altered microbial flora that causes smell but it isn't invasive thus not causing a leukocyte response.
"Prostatodynia is a clinical entity associated with voiding symptoms and pelvic pain suggestive of prostatitis but with a normal prostate examination and without evidence of inflammation or infection in expressed prostatic secretions. The problem tends to be chronic and is vexing in its management."
You did state you have had testicular discomfort, dysuria, and ED without inflammation and it is chronic after months and it is "vexing in its management".
The antibiotics might work in an apparent remission and hope it never comes back but if it is the above then it will come back if it goes away at all with the antibiotics. Again a second opinion from another urologist for your own minds sake appears to be an option. They can take a fresh look at all of the information to see if they missed something or tried something.
Well i’m really hoping the antibiotics work now. Why they only have worked for that moment in April because of anti inflammatory properties? And I guess I was really thinking/hoping it was just some uti thing that recurred because on February 2/27, I had a couple days of balanitis. Starting on the 27th and lasting a couple days my penis had some red-blotchy rash on it and there was itching of my foreskin. it was very irritating. It went down a bit after a shower and lasted a few days after but stopped after i went on the penicillin. I assumed it was the e. faecalis irritating my penis. Also, again back in Feb this seemed to occur after I stopped smoking, but I basically had wet dreams several nights in a row. I would wake up to ejaculate very often for a few days, and it even happened during the day during a nap on 3/31. Could that be pelvic floor dysfunction or prostatitis? It hasn’t happened since. But i’ll be seeing my urologist on thursday, unfortunately I can’t see anyone else but i really want consultation on this ASAP. I was really wanting to rule out pelvic dysfunction and prostatitis as again I have no pain, no pelvic pain or pain while sitting or urinating or ejaculating. Just having to pee often. A urologist I consulted with on Just Answer seems to think this is a UTI situation. I’ll see if a phone call might be illuminating
Thank you for the response. I do feel frustrated as my urologist doesn’t seem at all concerned and he does seem like a younger guy, but he basically waved off my symptoms as anxiety. Unfortunately i live in a semi-rural part of NY state and while there are several universities around, i can’t seem to find any info on urologists affiliated with them. Maybe i’ll try seeing if I could see a new urologist in general.
As an update though, my doctor put me back on penicillin and also Flagyl for the p. loescheii. If you see this Mr MedLabGuy, could you offer any insight into what would bring that + the e. faecalis on? And do I need to worry about them becoming embedded in my bladder or prostate or anything? When I saw my primary dr yesterday , she also said I shouldn’t be having prostate issues and that if I did have prostatitis I would have pelvic pain and wouldn’t be able to be sitting down due to pain. I’ve had no pain at all, no pain while urinating or ejaculating. Ejaculating at this point feels a little uncomfortable and my sex drive is extremely low, this is what happened back in March right before my culture diagnosed the EF. I also have no morning wood and have to urinate frequently at this point. This all went away in April for a little while when I was on the second 10-day penicillin course and stayed gone until early this month. My morning wood had been returning and it seemed like my body was healing.
one thing is that I was taking the meds very haphazardly in regards to timing. It was every 6 or 10 hours instead of 8 and my dr said accuracy can really effect things. So now my current course is 4 times a day so i’m taking it very strictly every 6 hours. I hope it helps. I’m also trying to think that i don’t have Mgen as my symptoms have come and gone and I haven’t had any increasing pain or anything. And I read penicillin doesn’t act again Mgen. So hopefully that’s not it? I’m fixating I know. Anyway I did make an appt with my urologist for thursday and i’ll see if I can convince him to do a prostate test or something, I don’t know how soon I could see a different urologist. But i’ll keep digging. Open to any other input, thanks all.
IMO, you're just wasting money seeing your urologist.
How far are you from the big names in NYC? That's what you need. I brought my hub to Thomas Jefferson in Philly. We could have also gone to Penn, Fox Chase or another. Jefferson fast tracked him in, he liked the ENT so we stayed. It was the right choice because he's clean since then, no recurrence, plus he has minimal damage. Some saliva issues and his thyroid is finally on it's way out but both are mild considering some never eat or swallow again after being treated locally. Some lost their life.
Telemed is popular now, you should be able to get a new patient video consult appointment, you can fax them what ever they would need or have your urologist do it. Then he would probably want to actually examine you for the next appointment, so you commute there and plan to see them in person. It will be time and money well spent because they are your best bet if you really want to get this figured out. They may even have newer testing they're doing or some sort of clinical trial for people like you.
Big name medicine is the best for a reason. Local doctors just don't have the network of brain power and patients like these places do. You'll never get your life back if you stay local.
In your above post you said you can't see anyone else. Why not? Do you not want a solution or do you like trying to figure it out on your own?
Go back over this thread, you keep adding new information you forgot. Copy and paste it into an email draft or word document so you can send it to the NYC physician so he has the detailed history. He will love that, coming straight from you, easy to read. I think I would break it up into months, then add what happened that month. Watch long paragraphs.
Thank you. After reading that post I immediately booked an appointment with Dr Samadi in NYC. I realize I didn’t actually tell my own urologist about my infection with the swans and whatnot so I’ll see what he thinks tomorrow. And then I see Dr Samadi next thursday.
Meanwhile, Im now past 3 days into my meds. The leaky crawling feeling isn’t happening AS much but I do still have some discharge. ED is still present and I do have to pee quite a bit but I don’t know if it’s as much as the past couple days. No stinging or pain anywhere. I did have to defacate quite a bit throughout the day but no pain or real discomfort. A little less hesitancy when starting a urine stream. Other than that no real changes but it’s hard to wonder if a lot is just my imagination.
Thank you. After reading that post I immediately booked an appointment with Dr Samadi in NYC. I realize I didn’t actually tell my own urologist about my infection with the swans and whatnot so I’ll see what he thinks tomorrow. And then I see Dr Samadi next thursday.
Meanwhile, Im now past 3 days into my meds. The leaky crawling feeling isn’t happening AS much but I do still have some discharge. ED is still present and I do have to pee quite a bit but I don’t know if it’s as much as the past couple days. No stinging or pain anywhere. I did have to defacate quite a bit throughout the day but no pain or real discomfort. A little less hesitancy when starting a urine stream. Other than that no real changes but it’s hard to wonder if a lot is just my imagination.
That's the thing about staying local, they aren't finding your issue. It could be because they have no experience with someone your age having prostate issues if it turns out to be the reason, the NYC doctor may have many patients like you, will know or have a good idea of what to do next. Until you try it, you don't know.
With the local doctors not finding a reason it's hard to know if it's just you fixating on it or if you have a true medical issue. If I remember right, they're the ones that suggested it's in your head.
Will you be doing telemed or driving in?
I think it's a great decision. Hopefully they do have answers for you. If anyone does, it would be in NYC. You're very fortunate to be able to do that.
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