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Dr.Sumanth, Doctor (MD)
Category: Urology
Satisfied Customers: 20058
Experience:  Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
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I'm 38 year old male, I have been struggling with

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Good morningI'm 38 year old male, I have been struggling with prostatitis symptoms for a bout 2 months now, started with frequent urination, poor urine stream, pain after ejaculation and burning sensation in the urethra. I still have these symptoms with mainly burning sensation especially early morning.I did urine test twice which did not show any bacteria. No other tests done.I took a Doxycycline for 3 weeks and did not help.I do regular stretch exercise and regular cardio workout with no much help.I live in the UK and I would like to book initial consultation with you either virtually or I could come in person between 22nd-26August if you are available.I am struggling with my symptoms and I would appreciate your help.Kind regards
JA: How long have you been dealing with the burning? Are you experiencing any other discomfort?
Customer: it has been going on for 2 months
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Doctor should know?
Customer: No

Hi...Welcome to Just Answer. I am Dr. Sumanth Amperayani. I have 17 years of experience in the field of Medicine at a tertiary care referral hospital. I am currently reviewing your question.
Kind regards ***** ***** Sumanth Amperayani

Customer: replied 4 days ago.
Thank you Dr. Amperayani

  1. How long have these symptoms been going on?
  2. Are you having any pain or burning sensation while urinating?
  3. Is there any difficulty in urinating or hesitation or dribbling or frequent urination?
  4. Are you feeling urgent need to urinate?
  5. Is there any blood in the urine or is the urine cloudy?
  6. Any pain in the lower abdomen or are in the perineum?
  7. Any pain during ejaculation or pain and discomfort in the penis and testicles as such?
  8. Are you having any fever or flu like symptoms?

Customer: replied 4 days ago.
1. Two months (main symptoms are burning sensation after urination in urethra, perineum and rectum
2.mainly after urination
3.these symptoms were present but are getting better urgency blood or cloudiness
6.onlybpainnin perineum
7.pain occur after ejaculating, no pain in penis or testicles. fever or flu like symptoms

Hello...I understand your concern.
From you symptom analysis and correlating it with the medical history that I have gathered from you I feel that this might be Prostatitis....a chronic prostatitis at that and it needs antibiotic for 4 - 12 weeks.

Prostatitis is an infection or inflammation of the prostate gland. The prostate gland is present only in men. Its job is to make some of the fluid that men release during sex. The prostate gland forms a ring around the urethra, the tube that carries urine from the bladder to the end of the penis.
Prostatitis can be "acute" or "chronic." Acute prostatitis is usually caused by bacteria. Chronic prostatitis is sometimes caused by a bacteria. But chronic prostatitis can sometimes happen even when there is no bacterial infection.
It can be acute or chronic
Men with acute prostatitis can have:

  • Fever
  • Chills
  • Flu-like symptoms
  • Muscle pain
  • Pain when they urinate
  • Pain in or near the groin or genitals
  • Cloudy urine

Men with chronic prostatitis sometimes have no symptoms. When they do have symptoms, they can:
  • Have pain when they urinate
  • Feel like they have to urinate a lot more often than normal
  • Have the sudden need to urinate in a hurry
  • Have pain in or near the groin or genitals
  • Have a low-grade fever

Your doctor and nurse can check your urine and the fluid that comes out of your prostate gland for signs of infection. But these tests do not always find the problem.
In general, the treatment for prostatitis is antibiotics. The right antibiotics for you will depend on the type of prostatitis you have and the type of bacteria (if any) that show up on your tests. If antibiotics do not help, you might have chronic prostatitis that is not caused by a bacterial infection.
For chronic bacterial prostatitis, you'll need to take antibiotics longer, most often for 4 to 12 weeks. About three in four of chronic bacterial prostatitis cases clear up with this treatment. Sometimes the symptoms return and antibiotics are needed again.In this case, your doctor might give you other medicines to help with your symptoms.
If you have problems urinating, you might also get medicines to help make it easier to urinate.
There are a number of conditions that could cause this:
Ureaplasma parvum infection: this is a bacteria is transmitted sexually, it is of little consequence in males and therefore not routinely tested in males but infection with this can cause burning urination and other symptoms of urine infection.
Abacterial prostatitis or Non specific Prostatitis: This is when the prostate is inflamed, no bacteria are found in the urine but white blood cells are found. This can cause burning during urination. In mild cases there may be pain only in the urethra or tip of penis while in more severe cases there is pain in the prostate.
Prostadynia: In this, the prostate is inflamed but neither bacteria nor white blood cells are found in urine.
Interstitial cystitis: In this there is pain along the urinary tract without any infection. In mild cases there may be pain only in the tip of the penis while in more severe cases there is pain in the bladder region.
Urethral Syndrome: This is a condition which presents with the features of pain due to a urinary tract infection but with sterile urine. The exact cause is not known. Treatment is with a prolonged course of antibiotics, oral contraceptive pills in females, muscle relaxants, tricyclic antidepressants, behavioural therapy, etc.
For now, you can take the following steps:
  1. Plenty water at least 3 - 4 liters per day.
  2. Cranberry juice
  3. Urine alkalisers - Bicitra, Citrolith,Oracit,Polycitra-K, Uristat tablet - you can get this OTC at pharmacies.
  4. Avoid tight under garments
  5. Minimize outdoor activities like cycling, jogging, heavy exercise, weight lifting etc
  6. Avoid rough sex and prolonged sex
  7. Reduce coffee, alcohol, smoking.
  8. Good healthy diet and sleep hygiene
  9. Iron, Vit. C and Zinc supplements

May I suggest you discuss these with your primary care physician and get yourself appropriately evaluated and managed please.
I sincerely ***** ***** I have helped you today!
Is there anything else where I can be of assistance to you in this regard please. We can continue here until you are satisfied, simply use the reply box and let me know.
Kind regards ***** ***** Sumanth Amperayani

Customer: replied 4 days ago.
I'm very thankful for your comprehensive answer.
I've had a urine and semen analysis and both came back normal. I took doxycycline for 3 weeks with no improvement. I understand from what you said that prostatitis can be non- bacterial, do antibiotics still have a role in treatment?

Yes and in your case I would suggest antibiotics for 6 weeks and then decide further.

Customer: replied 4 days ago.
I see. Which antibiotics would you suggest?
Ciprofloxacin as it is broad spectrum.
Customer: replied 4 days ago.
what would be the dose and frequency please?
500mg twice a day please.

Customer: replied 4 days ago.
Thank you. Is there any place for
Low oxalate diet? Or any dietary restrictions?
I've been told that my symptoms could be due to chronic pelvic pain syndrome/ non-bacterial prostatitis , so I've been avoiding many vegetables and fruits that are acidic or high in oxalate.

What do you mean by place?

Customer: replied 4 days ago.
I meant is there a role for low oxalate diet as part of treatment? Would that be helpful?

Diet restrictions may not be that helpful. But if you drink three to four litres of water per day oxalste diet should not be a problem.

Dr.Sumanth and 2 other Urology Specialists are ready to help you

I wish you an early recovery!
I am happy that my interaction was helpful for you and put your mind at ease.
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Kind regards ***** ***** Sumanth Amperayani