Welcome to the forum. Thanks for your question. We get lots of questions similar to yours. Wide awake in the early morning hours (I'm currently 9 time zones from my home), I'm taking the opportunity for a blog-like response that I can save to aid in responding to future questions as well.
There is more than one type of prostatitis: 1) Bacterial, caused by the same non-STD bacteria that cause other urinary tract infections. It's rare except in older men and following urinary tract instrumentation or surgery. Bacterial prostatitis can be acute (very painful, high fever) or, much more commonly, chronic, with relatively mild symptoms.
2) Nonbacterial prostatitis is less clear-cut. Some cases may be caused by undefined infections -- especially if there is evidence of inflammation, such as elevated white blood cells in prostate fluid; but others are non-inflammatory (no elevated WBC) and apparently not due to infection. A few years ago the American Urological Association re-defined chronic nonbacterial prostatitis as "chronic pelvic pain syndrome", although many doctors have stuck with the old terminogy. These cases typically do not respond to antibiotics, although such treatment often is tried. When antibiotics seem to work, they do so slowly -- and as often as not, the problem really has just gone away on its own.
You don't say the symptoms that led to your diagnosis of prostatitis, or the details of your doctor's diagnosis. Most men with CPPS (or nonbacterial prostatitis, whichever you call it) have various combinations of pain or other discomfort in the lower abdomen, testicles, anal area, perineum (between the scrotum and anus), and often somewhat frequent urination -- but not painful urination. This pain is believed to result from tension in the pelvic muscles -- i.e. there may be nothing actually wrong with the prostate.
You also don't describe the details of your past epididymitis -- but I have to wonder whether that was actually another episode of CPPS/prostatitis. If you had testicular pain but without actual swelling or tenderness of a single testicle, this may be a possibility. (Real epididymitis is almost always involves only one testicle; pain throughout the scrotum is rarely due to epididymitis.)
What are the causes? Not really known well. Over the years, STDs have been studied repeatedly as potential causes and nothing has panned out. Herpes was never a serious consideration among experts. Probably it's not an infection of any kind (which is why antibiotics don't work well). Some cases probably result from genitally focused anxiety, which in turn result in the pelvic muscle tension noted above. This probably explains why it often shows up after new sexual encounters, especially if such an event has caused worry, guilt or regret.
For more information, google CPPS (spell it out) and/or chronic prostaitis. The Wikiepedia article is excellent, and so is information provided by the Stanford University Dept of Urology.
I might be able to say more if you would like to describe your symptoms and more information about the basis of your doctor's diagnosis. But at this point, I would advise you to discuss these issues with your doctor (you could print out this thread as a framework for discussion); and in any case, to not worry about STDs. Those tests are highly reliable and at this point I see no need either for additional STD tests or further antibiotic treatment.
Finally, there is good news as well: CPPS/chronic prostatitis are not known to result in any long term harm, either for affected men or their sex partners; and over time, the symptoms generally improve or resolve entirely. In the long run, it seems to be more an inconvenience than a serious health problem.
I hope this has been helpful. Best regards-- HHH, MD
My prostatitis was diagnosed by my Dr after he felt my prostate and found it to be swollen. The symptoms that brought me to the Dr. was a low grade fever and difficulty urinating. Since that visit i have experienced all different kinds of sensations in my groin area. Most predominately was a feeling of very tight groin muscles, some pain in my testicles, and penis. This usually occurs in the evening or after sitting for long periods. The symptoms seem to get better for a day or so and then can come back stronger for a day or so. The symptoms are not what I would describe as severe, but more of an annoyance.
My epididymitis was 5 years ago. It was a pain focused mainly at the back of my testicles with some difficulty urinating. I was put on antibiotics and relatively pain free after a week or so.
You way well have had inflammatory prostatitis, but if so I'm still not convinced it was related to the sexual exposure except by coincidence. STDs, especially gonorrhea, chlamydia, or NGU have over the years been suspected of triggering true prostatitis, but as noted above, this has never been documented by objective analysis. Some experts would point out that nonchlamydial NGU in particular may at times involve the prostate. I'm still not clear exactly when your prostaitits symptoms began. NGU symptoms typically start 1-2 weeks after exposure.
Judging prostate enlargement or inflammation by digital examination is difficult and notoriously inaccurate. That's not a criticism of your doctor; digital-rectal exam is universally recognized to be inaccurate by uology experts. However, if the enlargement and tenderness were substantial, his assessment likely was valid. In any case, the lack of clear response to levofloxacin is itself strong evidence against infection (including STDs) as the cause in your case.
So I would still recommend you discuss these issues with your doctor, and continue to follow his advice; it seems he is on top of things. Good luck with it.
Thanks for your follow up response. My Dr. is a family friend so I am having difficulty asking the STD questions and have relied on independent testing to get my negative results. My prostate symptoms began about a week after my sexual encounter. I thought it was my epididymitis returning so I took some Cipro. It alleviated the difficulty i was having urinating almost immediately, but about 3 days later is when I had the slight fever and went to the Dr. where he diagnosed me with Prostatitis. I did not mention the sexual encounter to my Dr.
It is now 8 weeks post encounter. I have not had any symptoms I would associate with an STD. I guess the only questions I have remaining are...If I was treated, as a precautionary matter, for both Chlamydia & Gonorhea 2 days after my sexual encounter, should I assume if I did have an STD the treatments cured it or can the STD infection somehow retreat into the prostate and I could still be infectious? I know my 3 week STD test was also negative, but wanted to make sure my antibiotics (Levofloxacin) did not produce a false negative. I know that this is all conjecture since I have never been diagnosed with an STD, but just want to be 100% sure I do not have an STD for any future sexual partners. I appreciate you helping me with this problem.