Q: I am a 26 years old man suffering from pain and inflammation in the urethra region of penis and the pain gets worst after ejaculation. The doctor did the HIV, VDRL and urine culture test; HIV and VDRL test reports were negative and culture shows Escherichia coli (E. coli) infection. I was taking antibiotics for the last 3 months - ofloxacin (7 days), doxycycline (14 days), cefixime and Augmentin (7 days.), amikacin (3 days). These antibiotics increased the irritation and inflammation in the affected region. I have no symptoms of STD infection except the pain. There was no discharge of liquid from the shaft or any ulcer, clusters or blisters on genitals. I do not feel pain or inflammation while urinating but I feel some pain in prostate region and feel very tired and fatigue. Ultrasound report was normal except the calculi (6 to 7 mm) in cortex of both kidneys but I have no pain like a kidney stone patient. The urologist gave me Rolitren, Libotryp, capsule for mecobalamin and lipic acid and Neeri, but these too gave no relief. Then he gave me Fludac for 10 days but the problem still persists. This problem is affecting my sexual and married life. Do I have STD or prostatitis? Please advise.

A:The most common cause of the described complaints is inflammation of the prostate gland, called prostatitis. Symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip, aching in the penis, testicles, and discomfort in the lower abdomen, low back or perineum. Prostatic discomfort is often referred into the testicles.
Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, aggressive bike or horseback riding, and excessive spicy foods, alcohol, and caffeine in the diet may predispose to the discomfort. Sitting for long periods of time, as by computer professionals, or driving can aggravate the condition. It is best not to sit for more than 2-3 hours at a time, and take a short walk and empty the bladder intermittently. Eliminating all the factors that apply to you may help keep symptoms at bay, and are as important as medication. A daily warm bath for 10-15 minutes twice daily also lessens the discomfort.
Prostatitis may have a bacterial aetiology, or may be abacterial. A 4 to 6 weeks course of an antibiotic (fluoroquinolones, trimethoprim or tetracycline) would benefit bacterial prostatitis. Abacterial prostatitis has several varieties. In one, the prostatic fluid demonstrates pus cells but no bacteria. In the other, called prostadynia, there are neither pus cells nor bacteria in the fluid, just the symptoms.
Abacterial prostatitis usually responds to the general measures mentioned above. Medications that sometimes help include alpha-blockers and anticholinergics. Some ayurvedic and other herbal preparations available over the counter may help too. As mentioned earlier, changes in lifestyle are equally important to take care of symptoms. Your urologist would be able to guide you further, and investigate you to exclude other conditions that mimic this condition.