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gonorrhea or prostititis?

Jul 22, 2010

Dr Bob:

I am an HIV+, 39 yo male (undetectable,835 CD4). About 5 wks ago I started having a dull ache in my rectum, above my pubic area, and in my lower back/pelvic bone, about 4 or 5 after unprotected receptive intercourse. I went to the ER, they did urine and rectal cultures for gono/chlamydia and sent me home. The next day they called said rectal culture came back positive for both. I was precribed one oral dose each of Suprax 400mg and 1g (2, 500mg pills) Arithromycin. A week later I had my 3 month HIV check-up,at which time I only had pain in hip joint (dr said was probably bursitis) and dull rectal ache (could be due to my IBS/persistent small internal rectal fissure). He said prostate felt normal upon digital rectal exam. He then gave me a 7 day course of Doxicyclin, 100 mg, twice a day to make sure. The rectal pain never went away. Within 7-10 days after this treatment, I started having the dull ache above my pubic area again as well as a slight burning sensation after I urinate, but there is NO discharge or burning during urination. 5 days ago I went to the same ER again, they did no tests (even though I requested a rectal culture to make sure gono was gone) and sent me home with 14 day treatment for prostatitis (doxycyclin, 100 mg , twice a day.) The symptoms have not gotten any better and now I have a slight burning sensation in the tip of my penis (again no burning when I urinate and no discharge). During this whole process I also noticed when I first wake up in the morning the inside of my urethra is really puffy/swollen (I have a larger than normal meatus) for the first 30 mins or so then it goes back to normal (not sure if thats related to a bacteria accumulating overnight in my urethra) . I am not sure if I am dealing with Gono still or prostatitis? Was I prescribed the best treatments for both? I have to pay a $50 copay every time I Go to the ER, I cant afford to go again. My doc only has clinic hours Tuesday mornings and even when its an urgent need, it can take 2-3 weeks to be seen. In addition, he doesnt have the proper culture to do a rectal culture (which is why I went to the ER to begin with). I know you cant diagnose over the internet, but any feedback would be greatly appreciated.

Response from Dr. Frascino


You are correct: I cannot diagnose the cause of your persistent/ recurrent recto-genital discomfort over the Internet. Certainly a partially treated prostatitis or STD would top the list of my differential diagnosis. If your HIV specialist can't help resolve this problem definitively and completely, I would recommend that you see an HIV-knowledgeable urologist for a more complete evaluation.

Good luck.

Dr. Bob

Dang just get tested

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