By Telder D. Depaynos, MD
The patient has been working abroad for quite some time when he suddenly had chills and fever associated with difficulty and “burning” sensation upon urination. He was diagnosed to have a “severe urinary tract infection” and was given antibiotics for 10 days. Because of relief and the heavy schedule of his work, he never returned for follow up.
After two or three weeks after his antibiotics, he felt a slight fever from time to time and although his dysuria returned it was however, slight and very tolerable. He did not seek any MD consultation anymore because he was scheduled to go home for vacation.
At home, he just bought “over the counter” antibiotics and continued his treatment on his own. He was surprised that when he had sexual contact with his girlfriend he experienced pain during ejaculation. This made him worry and it forced him to seek consultation. Because his condition made him shy and he wanted privacy, he sought the MD who circumcised him when he was a kid.
He denied any sexual contact abroad and any history of “sexual diseases”. Because of the history of “painful ejaculation, the old MD from his various patient experience entertained the possibility of “prostatitis” or inflammation of the prostate.
The prostate is a small gland about the size and shape of a chestnut. It is located just below the bladder and surrounds the canal called “urethra” which carries the urine from the bladder through the penis during urination. Obviously, females do not have a prostate.
The prostate secretes fluid which forms part of the semen in which the sperms are transported. During sexual activity and sudden orgasm, the semen enters the urethra and passes along it through the penis to the outside. This is what is called “ejaculation”.
In general the basic prostatic problems are its enlargement due usually to “old age” called Benign Prostatic Hyperplasia or BPH which was the topic of our previous column, prostatic cancer and bacterial infection or “Prostatitis”.
Infection of the prostate could either be acute or chronic. Acute Prostatitis is sudden in appearance and just like any infection it is accompanied by chills and fever. The sudden initial manifestation of the patient must be Acute Prostatitis. Chronic Prostatitis may also be accompanied by occasional chills and fever but less severe. It may be due to untreated or incompletely treated Acute Prostatitis. This may have also happened to the patient and he was manifesting it when he consulted his old MD.
Most of the time the bacteria that infects the prostate comes from the urethra by the backward flow of infected urine. Insertion of a urinary catheter or any instrument into the urethra may contribute to the infection. Those with urinary tract abnormality may be prone to this infection and of course those with urethra (urethritis) and urinary bladder infection.
Since the prostate is just outside the bladder and surrounds the urethra, enlargement or inflammation may cause symptoms similar to the symptoms caused by the other causes of prostatic enlargement like urinary frequency, frequent urination at night and urinating with effort. Because of the infection, aside from chills and fever, severe burning sensation when attempting to urinate and inability to empty the bladder are common. Perineal, testicular and even bladder pains maybe experienced by patients with chronic infection. They may even radiate to the back. In some cases, ejaculation may also be painful and this made the consulted MD entertain the condition.
The MD did a digital rectal examination and upon palpation of the prostate, there was severe pain. He then referred the patient to a young urologist for further work-up.
Although, cancer or BPH are usually painless upon palpation, the urologist requested aside from routine blood tests, a test (prostate specific antigen or PSA) for the possibility of a concomitant prostatic Ca especially so that the father of the patient died of this Ca. Despite the pain, the prostate was massaged to obtain prostatic fluid which confirmed the diagnosis. It was negative for sexually transmitted bacteria like gonorrhea and even for tuberculosis. He was prescribed antibiotics for at least 6 weeks and was advised to return for follow-up because Chronic Prostatitis may take even 12 weeks of antibiotics. Although, the old textbooks would say that this kind of infection is non-transferrable thru sexual contact, the urologist advised him to refrain from it in the mean time. He plans to marry his girlfriend after treatment because she was getting suspicious when he started following the advice of the urologist. Because he was supposed to return abroad for work, he decided to file a “permanent sick leave”. He preferred finding another job than losing his loved one. **