What are chronic pelvic pain syndrome symptoms at 27?

Question

Hi doctor,

I am a 27-year-old sexually active male. I have been with the same girl for the past 10 years, and we are loyal in the relationship. I am having a ton of issues and pain in my lower region. The symptoms are lower back pain, pain in my pubic region, pain and tingling in my testicles, burning with and without urination and pain within the penis.

I have been to three different walk-in clinics and had three different antibiotics, including Levaquin, Bactrim and Cipro. I went to a urologist and was told to have pelvic pain syndrome.

I have had similar issues in the past. I dealt with a prostate infection a few years ago and that was treated with antibiotics. But, this time nothing is working. Most urine cultures show no bacteria. My thoughts are possibly pudendal neuralgia or interstitial cystitis, as my mom has IC. Do you advise sonogram or endoscopy or medications?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

Your symptoms do point towards chronic prostatitis. With negative culture and positive pus cells, it is likely that you are suffering from CPPS IIIA, which is non-bacterial inflammatory chronic prostatitis. Now, this is a difficult condition to manage and requires long-term therapy. I would suggest that you follow up with a urologist on a long term basis.

Therapy takes some time and different medications work for different patients. IC (interstitial cystitis- painful bladder) is also a possible condition, but CPPS is more common in males than IC. You do not meet all criteria for IC as per the classic definitions. So, I would keep CPPS as the first differential. I am mentioning some tests that you may want to get done to clarify the situation in a better way.

I hope this helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Bladder stones are a possibility, but less likely. Kidney stones are very unlikely to cause such symptoms. You may do well by getting an ultrasound done and I do recommend it. The post-void residual assessment that I mentioned is done by sonography only and it may be a good chance to assess bladder stone. It is likely that your sonography may show the changes of cystitis. I will appreciate if you can send over the reports to me so that I can help you further. The therapy would obviously be best under the guidance of urologist.

I hope this helps you.

Thank you.