> Granted the urine culture was negative (it was done shortly
> after a week of Cipro, though)

Well, there you have it. Mine was negative 3 weeks after Cipro, but 7 weeks after it was positive, and a urine culture was positive too. The good thing is what may be causing my symptoms has a name; the bad thing is it is now in my bladder AND balls. So happy new year!

> If 2 weeks isn't nearly long enough, how do you convince your
> doctor? Mine REFUSED to give me antibiotics for any more than
> 2 weeks

There is a chance that bacteria is not your problem -- even if you were temporarily better while on antibiotics. Some antibiotics have an anti-inflammatory effect apart from bacteria-fighting, and it's not uncommon to feel good while on antibiotics, but back to the starting line after a week or so off of them.

Septra, Doxycycline and Cipro did nothing for me, but Levaquin made a lasting improvement, so in my case on that basis alone I have reason to hope that an infection is my problem. I only did Levaqin about 5 or so weeks -- I wish I had done it longer.

Dr. Kaufman gave me a script for Levaquin and said "if I show improvement, we'll know we're on the right tract". Two weeks is probably not enough, although you might want to find someone who will prescribe Levaquin (it's as nasty as Cipro in terms of potential side-effects from long term use; but it has some activity against the anerobic bacteria that some docs think is at the root of chronic cases).

> how do I convince my doctor to go for a longer course of drugs?

The hard answer is: you may have to see another doctor.

You can find things on the net that say for chronic cases (people who've had symptoms more than 3 months) MANY months of antibiotics may be needed. Possibly such things will enlighten your urologist. But more likely he will not appreciate the education, and he may be part of the movement that is worried about overprescribing antibiotics (and goes too far the other way).

I've had this problem for over 10 months now, and I wound up seeing MANY doctors. 20 maybe, including 11 urologists (I lost track). Some were covered by insurance, and some I paid for. What's crazy is each one has a different point of view. Some are of the school "if 2 weeks of Cipro didn't work, give up". Some will prescribe Cipro until your joints ache. Some will prescribe randomly Septra or whatever, just to get you out of their office. One told me to learn to meditate (I already know, thanks).

But it took 8 months before I got a semen culture, and more than another month before I stubbornly managed to get tested again. Maybe that should be a goal -- getting another urine culture and a semen culture, after being off all antibiotics for at least 5 weeks.

The thing that probably is not smart is ordering drugs over the Internet. One of the things I prescribed myself is Flagyl, which can cause PERMANENT neurological damage. Usually you have to take it longer than I did to be at risk, but my left arm is still numb from the elbow to my fingers, and it may not repair entirely.

One thing you can try is something I'm not very good at: looking your uro in the eyeballs, and stare steadily, and talk in a really quiet voice, saying: "Doc. Maybe you don't understand. I am in serious, disabling pain. I cannot walk around like this hoping it will go away". Of course, if you do that really well you are more likely to get thorazine and a week of observation than antibiotics.

Sorry I can't be more helpful, but I guess the short answer is:

[1] try to educate your doctor (see below). You'll probably piss him off, but it's worth a shot.

[2] if that doesn't work, find another doctor.

[3] If that doesn't work, find another doctor.

- Charles

===============================
TRY EDUCATION

- see if he's following the guidelines. This will make him nervous because not following them might be malpractice. So good: make him nervous.
http://epididymitisfoundation.org/cdcguidelines.php

- places that say 2 weeks of Cipro is not enough, in part because a major cause of testicular pain in young men is Chlamydia, which Cipro can make persistent... so Cipro is a kinda dumb place to start if you're treating "empirically" (without reliance on a test that proves what you're fighting)

http://aac.asm.org/cgi/content/abstract/44/12/3288
Cipro makes chlamydia persistant

http://jama.ama-assn.org/cgi/content/abstract/264/11/1418
Cipro makes chlamydia persistant (a different article)

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224083&Ausgabe=225688&ArtikelNr=19784
The ***minimum*** duration of antibiotic treatment should be 2-4 weeks. If there is no improvement in symptoms, treatment should be stopped and reconsidered. However, if there is improvement, it should be continued for at least a further 2-4 weeks to achieve clinical cure and, hopefully, eradication of the causative pathogen

http://www.medreviews.com/pdfs/articles/RIU_13_160.pdf
If the response to antibiotics is positive, they can be contin-
ued according to the management strategy for category II prostatitis. If this approach is unsuccessful, repeti-
tive prostate massage plus antibiotics for a further 6 weeks may be attempted.

http://www.springerlink.com/index/VWA22N3B6LBLCEAP.pdf
an oral fluoroquinolone should be given for at least 4–6 weeks