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NSU or Prostatitis??

Now 48 yr old male. In 2013 I was diagnosed with Prostatitis, non bacterial, as no WBC’s were found in urinalysis. Antibiotics (Bactrim) was prescribed for 2 weeks but the symptoms did not go away for a few months.  Symptoms included pereneum pain, abdominal discomfort and penis pain.  Never had any noticeable discharge or skin changes.  I was also tested for 10 std panel and all was negative.
Skip ahead to Nov 2019.  New female partner and we had unprotected oral and vaginal sex on only a few occasions as the relationship was brief.  We both had recent negative tests for all common STDs.  However, a week or so after sex I noticed a small bit of discharge in my underwear. Only once did I see it and not again after that. I was tested for Gonorrhoea and Chlamydia at that point and all were negative.  Symptoms similar to previous bout of diagnosed Prostatitis began to occur as well at this time.  A month later I was tested for Trichomonas and that was negative as well.  Went back to GP In January 2020 and he diagnosed it as non bacterial Prostatitis again as no WBCs found in urine and a culture also showed no bacteria growth.  Was put back on Bactrim even though it wasn’t bacterial.  Antibiotics seem to help at times (maybe placebo?) but I ended up being on them for 3 weeks and still wasn’t back to normal, still with penis discomfort and perineum and sometimes lower back pain. In a worry, in February 2020 I took a new 10std panel and all was negative again as I expected.  Symptoms seemed to wane and became mostly unnoticeable for a few months.
Then in late June, I had unprotected oral sex and protected intercourse at a party.  Not long after - like a day or two - symptoms similar to previously diagnosed Prostatitis began again. Perineum pain, penis tip discomfort, but again no noticeable discharge.  Again in a worry, I was tested for Gonorrhea and Chlamydia and was negative. So it appears that:
1.  Timing of these exposures and Prostatitis symptoms recurring are coincidental??
2.  Maybe the anxiety of not knowing and dwelling on it has induced Prostatitis symptoms??
3.  Could this have been an undiagnosed NSU that is causing these problems and is still causing ongoing problems?  Would lack of discharge and WBC’s in urine and culture rule out an NSU?

Thanks for reading and your thoughts.
1 Responses
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207091 tn?1337709493
So between 2013 and 2019, were you sexually active? I ask because if you were, and just had 2 instances of sex that caused symptoms 6 years apart, that's one narrative. If you weren't, and both times you had sex in 6 years you got symptoms, that's a different narrative.

The lack of WBCs in your urine rules out NSU, but when you do these urine tests, are you waiting an hour since you had last urinated, and are you giving the first part of your urine stream for testing?

So assuming the above is true:

1.  Timing of these exposures and Prostatitis symptoms recurring are coincidental??

Yes, I would think so. What kind of diagnostics have you had this time? Given your age this time around, the cause could be something different, too. It might be BPH vs a non-bacterial prostatitis. A urologist can help determine that.

2.  Maybe the anxiety of not knowing and dwelling on it has induced Prostatitis symptoms??

I'm sorry, but I'm not sure what you're anxious about? You don't have an STD - that's been ruled out. Are you concerned that every time you have sex, you'll get prostatitis? If these are your only 2 encounters in 6 years, that's a fair question, but without knowing that, it's hard to answer. Also, the cause could be different, and this could be a really, really unfortunate coincidence.

3.  Could this have been an undiagnosed NSU that is causing these problems and is still causing ongoing problems?  Would lack of discharge and WBC’s in urine and culture rule out an NSU?

The lack of WBCs rules out NSU. Not every man with NSU will get discharge, but the diagnosis is made on WBCs in the absence of other symptoms.

Have you seen a urologist? If you haven't, you definitely should.





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6 Comments
Thanks for your reply.  I have been sexually active in between these episodes, so my guess is that this is coincidental.  To your specific questions regarding my questions:
1. Only diagnostics for the recent on ongoing occurrence have been Gonorrhea and Chlamydia testing which was negative.  I have an appt with urologist this week and would expect to have a urine test and culture for wbcs and bacteria.
2. Anxiety is about having an undiagnosed STD
3.  I see a urologist Thursday.  The absence of wbcs again will reassure me that it’s not NSU from recent one time oral exposure
1. Only diagnostics for the recent on ongoing occurrence have been Gonorrhea and Chlamydia testing which was negative.  I have an appt with urologist this week and would expect to have a urine test and culture for wbcs and bacteria.

Ask about other types of prostatitis, and if you need an ultrasound or other imaging. (I'd think yes, but I'm not a urologist.)

2. Anxiety is about having an undiagnosed STD

Oh this makes sense. I'm sorry I missed that. No, you have tested for everything, and are negative. You don't have any WBCs, which you'd likely have with gonorrhea or chlamydia, so it's safe to say you don't.

3.  I see a urologist Thursday.  The absence of wbcs again will reassure me that it’s not NSU from recent one time oral exposure

Yes, I'm sure they'll take another urine sample. Get used to this lol. Make sure it's been at least an hour since your last urination, and follow their instructions for collection. (It will probably be the first part of your urine stream, but follow whatever they ask for.)

Let us know what happens.
Appointment with urologist.  He agreed symptoms were consistent with Prostatitis.  Urine sample showed no WBC’ and was what he called “clean”.  He wants to do an ultrasound in the near future and I’ll make an appt to do that.  Looks like it is not NSU or anything potentially sexually acquired based on this visit. Agree?
Absolutely agree. I also think an ultrasound is a great idea.

Glad it went well, and keep us posted. I'm going to move this to urology now, but I check in there, too. :)
Good advice, auntiejessi!
Quick update for anybody reading the post. A few more tests came back today and my PSA level was 0.6. Urologist called and thinks it is not an enlarged prostate but an infection in the prostate that is hard to penetrate. He is prescribing Levaquin for two weeks and expects that to clear The infection. I am also scheduled for an ultrasound in two weeks in a follow up. I will post results then.
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