February 28th 1997
I am 24 years old and have been experiencing symptoms of prostatitis for about nine months now.  I've been to four different doctors and I am becoming quite frustrated with the results I've had. I was hoping you may have some insight on my situation.

My story begins in July of 1996.  My girlfriend and I had been broken up for about 6 months but we had reconciled by July.  We had not had unprotected sex for about nine months.  She swears up and down that she did not have relations with other men and I believe her to be telling the truth. Four days after our first unprotected sexual encounter I developed a burning sensation upon urination and three sores on the shaft of my penis.  The burning was only present at the very terminus of the penis.  I promptly went to a physician who tested me for herpes simplex 1 and herpes simplex 2. The test came back negative.  He said that since I had no discharge there was probably not a bacterial infection and advised me to drink copious amounts of cranberry juice. I am now of the opinion that he should have tested me for other pathogens and/or treated me empirically for the usual suspects but there is not much I can do about that now.  My symptoms went away after about 7 days and I thought nothing more of it, being advised that I was OK by the doctor I had seen.  I should note that at the same time as these first symptoms occurred my girlfriend developed a "very bad yeast infection" complete with a little blood and discharge.  Her symptoms cleared up upon treatment with Monistat 7 or one of the other over the counter products used to treat such problems.  She and I resumed normal sexual activity and since we have been together for 4 years (aside from the aforementioned break-up) we were only using oral contraceptives to prevent pregnancy.  On September 30, 1996 I awoke with a whitish, runny discharge and dysuria.  I went to see a different physician who swab-tested me for Chlamydia and the other usual causes of urethritis.  He found no pathogenic cause and said I had prostatodynia and would have to take anti-inflammatory drugs from time to time, but other than that there was no treatment.  At this point I went to a urologist who empirically treated me for Chlamydia/nonspecific urethritis with Doxycycline (200mg, 2 times daily)  for 15 days.  My discharge went away but the underlying burning was only slightly relieved.  After 2 weeks off of antibiotics I relapsed and was treated with another 15 day course of Doxycycline (200mg, 2 times daily).  Three weeks after completion another recurrence.  This time my urologist found pus cells in my urine.  He treated me with olfloxacin (300mg, 2 times daily, 15 days).  Again my discharge went away but the dysuria was not completely alleviated and my urine flow had become difficult.  Three weeks after the course was finished, relapse. At this point I went to a different urologist who placed me on olfloxacin (200mg, twice daily) for two months.  At present I have three weeks of medication left.  Again my only real relief is lack of discharge.

Urination is difficult. I experience start/stop symptoms, burning, and difficulty getting flow started.  Also occasionally upon finally "breaking the seal" I will experience intense urethral pain at the point were the muscles which fill with blood upon erection seem to end and the glans begins.  I am also experiencing assorted other lower abdominal pains. Last Friday I had a cystoscopy performed which turned up a "congested prostate", no visible urethral strictures.  When driving I have the sensation of sitting on a lump.  This occurs in the perineum.

I know you can't really offer up a diagnosis without really seeing me and assessing the situation, but I was hoping you may have some insights on my condition.  I'm also considering your methodology for treating prostatitis.  I've only recently graduated college (with a B.S. in Microbiology, in 1994) and I'm very financially burdened with loan payments and such so traveling to The Philippines is not really an option for me. I was wondering if you knew of any Washington, D.C./Baltimore, MD area urologists who are familiar with your techniques and if not could you
send me a detailed explanation of them so that I can consult with my urologist about them and see if he might be willing to give them a try.

I realize you are a very busy fellow so I appreciate your reading this very much.  Thank you in advance for any insights, advice or information you are able to give.