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Burning Sensation and UTI
Hello, Having burning sensations in urinary trac and anal opening whole day for last couple of months. 3 culture reports done and following species detected.1. Pseudominas arg 2. Citrobactor 3.E coli at interval of 15 days 14x7 mm prostate calcification detected in sonography else no other findings On antibiotic bactrim ds for last 1 month but still issue persist Please advise
Answers (30)
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You symptoms and reports are suggestive of chronic prostatitis with recurrent UTI , a male having recurrent UTI needs to be evaluated properly with organisms mostly suggestive of drug resistant organisms, so more history with detailed urinary profile needs to with done with renal scarring scans also
Next Steps
consult me in practo for a detailed plan
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Void often. Every 1 hour. Slowly the burning sensation will decrease. Continue medication.
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The symptoms are suggestive of urinary tract infection. Require proper history to treat the condition.
Book an online appointment to discuss further.
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You may have chronic prostatitis and recurrent UTI.The bacteria isolated from the culture could be resistant to the antibiotic you are using.Repeat the culture on stopping antibiotic, check for the sensitivity and appropriate antibiotic selection.It may need a long time to treat chronic prostatitis
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Your symptoms and repeated urine cultures showing Pseudomonas, Citrobacter and E. coli suggest a persistent urinary tract infection, and the presence of prostate calcification on ultrasound increases the possibility of chronic prostatitis. When the prostate is involved, infections often become recurrent and difficult to clear with routine antibiotics. Burning in the urinary tract and at the anal opening throughout the day is a common presentation of chronic prostatitis.
Next Steps
Since the infection has continued despite taking Bactrim DS for almost a month, it is likely that the bacteria are either not fully sensitive to this antibiotic or the prostate involvement requires longer, targeted therapy. At this stage, the next step is to repeat a urine culture with sensitivity, and ideally a semen culture, to identify which antibiotic the organism is best treated with. Sometimes, infections like Pseudomonas require drugs such as ciprofloxacin, levofloxacin, or piperacillin–tazobactam, depending on sensitivity.
Health Tips
In addition to antibiotics, a few measures can help reduce symptoms: drink plenty of fluids, avoid caffeine, alcohol and spicy food, empty the bladder regularly, and use warm sitz baths for relief. If prostatitis is confirmed, treatment usually requires 4–6 weeks of the right antibiotic along with an alpha-blocker (like tamsulosin) to reduce prostate irritation. I would strongly recommend consulting a urologist for proper evaluation and culture-guided treatment, as persistent infections should not be ignored.
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• Persistent burning in the urinary tract and anal region for months
• Repeated urine cultures showing Pseudomonas, Citrobacter, and E. coli
• 14 × 7 mm prostate calcification (prostatic stone) on ultrasound
• Incomplete response to 1 month of Bactrim DS
This picture is most consistent with chronic bacterial prostatitis associated with a prostatic (calculous) nidus, leading to recurrent colonization and persistent symptoms.
Bactrim (TMP-SMX) is not ideal for Pseudomonas or prostatitis with calculi
• Pseudomonas is usually resistant to TMP-SMX
• Prostatic stones act as a biofilm reservoir → bacteria persist despite antibiotics
• Therefore symptoms continue even after long antibiotic courses
Next Steps
Most Likely Diagnosis
Chronic Bacterial Prostatitis with Prostatic Calcification (Prostatic Stone)
This causes:
• Burning urethral sensation
• Burning at anal opening/perineum
• Discomfort after urination
• Recurrent bacterial growth
• Chronic pelvic inflammation
Health Tips
Recommended Work-Up
1. Repeat Urine Culture + Sensitivity (mid-stream sample)
Aim: identify the current dominant organism and antibiotic sensitivity.
2. Expressed Prostatic Secretion (EPS) / Semen Culture (if available)
More accurate for prostatitis organisms.
3. PSA (optional)
To rule out any chronic inflammatory elevation.
4. HbA1c
Diabetes predisposes to chronic prostatitis and persistent gram-negative infections.
Treatment Plan (Evidence-Based)
1. Change Antibiotic – must target prostate tissue + Pseudomonas
Most effective options (based on sensitivity):
A. Ciprofloxacin 500 mg twice daily
– 4 to 6 weeks
Excellent penetration into prostate.
Covers E. coli, Citrobacter, some Pseudomonas.
B. Levofloxacin 500 mg once daily
– 4 to 6 weeks
Better tolerance.
C. If resistant → Amikacin, Piperacillin-Tazobactam, or Ceftazidime (IV course)
— Only if severe/resistant infection.
Choice must be based on culture sensitivity.
Important: Chronic prostatitis requires 4–6 weeks of uninterrupted therapy.
2. Alpha-Blocker for symptom relief
• Tamsulosin 0.4 mg at bedtime for 4–6 weeks
Helps with:
• Perineal discomfort
• Urinary burning
• Pelvic floor spasm
3. Anti-inflammatory
• NSAIDs (e.g., Diclofenac/Etoshine) for 5–10 days
Reduces chronic pelvic inflammation.
4. Sitz Bath
Warm water sitz bath twice daily
→ reduces anal burning and pelvic congestion.
5. Prostatic Stone (Calcification) Management
A 14 × 7 mm prostatic stone is significant.
Stones act as persistent bacterial reservoirs.
If symptoms persist despite 6–8 weeks of targeted antibiotics, refer to Urology for:
→ Prostatic calculi clearance
Conservative options first, but if large or symptomatic:
• Transurethral resection of the prostate (TURP)
or
• Endoscopic calculi removal
Removing the stone often results in complete cure of the chronic infection.
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Share your reports.
You need to share your history and symtomatology for proper evaluation of your problem
Consult online
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Step 1. Get pre and post void bladder scan to check if your urine bladder is emptying completely after you have passed urine. We call it chronic urinary retention. This is a reason why the urine test shows different types of bacteria.
If the above test is okay then proceed to next step by
2. MRI scan of pelvis and prostate to check there is no signs of collection of pus around the urine tube (urethra) and prostate gland. We called it a Peri-urethral and prostatic abscess. If it turns out to be an abscess then please consult a Urologist.
All the best.
J G S R
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Since your cultures have shown different organisms over time and the symptoms have been going on for months, this looks less like a simple UTI and more like a chronic prostatitis/prostate-related infection. That’s why Bactrim for a month hasn’t given full relief — the prostate needs a different approach, sometimes with drugs that penetrate it better (like fluoroquinolones or nitrofurantoin in selected cases, depending on the exact sensitivity report).
Next Steps
safely, I’ll need to review your culture reports and the ultrasound findings once, because chronic symptoms really need a tailored plan — not broad antibiotics again.
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Tab nitrofurantin 100mg bd
Tab cefexime bd bd 299 mg
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Likely this is chronic bacterial prostatitis, especially since
• symptoms > 6 weeks
• different bacteria on cultures
• prostate calcification
• no response to 1 month of Bactrim
What to do now (short):
✅ See a urologist – Bactrim usually works only if bacteria are sensitive.
✅ Get urine + semen culture with sensitivity (preferably after prostatic massage).
✅ Treatment usually needs 4–6 weeks of a sensitive antibiotic (commonly fluoroquinolone like levofloxacin/ciprofloxacin, only if sensitivity supports and doctor approves).
✅ Ask your doctor about adding:
• Alpha-blocker (tamsulosin) for burning/urgency
• NSAID short-term if pain
✅ Sitz bath with warm water 2× daily
✅ Avoid caffeine, spicy food, alcohol, prolonged sitting, cycling.
Red flags – seek urgent care if:
• fever/chills
• inability to pass urine
• blood in urine
• severe worsening pain
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Tab .Ciprofloxacin 4-6 days p/o intake
Tamsulosin 0.4 mg once daily at night
Warm sitz baths 1â2 times daily
Pelvic floor stretching
Avoid long sitting, cycling, constipation
Next Steps
Eat more fiber: fruits (papaya), vegetables, oats Avoid straining during stool Avoid spicy, oily foods for 3â4 days Donât sit long on the toilet
Health Tips
Must consult with urologist
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Dr. Tejasree
Consult Now
Ayurvedic Endocrinologist & Internal Medicine Specialist
4 yrs exp
Tirupati
The report you mentioned gives species identified, In the same report antibiotics sensitivity is also mentioned, please share that report
Then I can prescribe based on that, Use SYP CITRALKA 5ml in 100ml water, that eases ur burning micturition
Next Steps
Consult me on practo online, with above reports for further prescription on antibiotics
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Start nitrofurantoin 100mg 1tab bd for 7 days
Followed by 1tab odhs for 6 months.
Take plenty of water
Maintain hygiene
Next Steps
you can contact me on practo.
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You can consult me directly on Practo, or reach out via WhatsApp:
Eight Seven Six Two Seven Four Nine Nine Seven Four
I’ll guide you step-by-step with easy-to-follow treatment plans.
Early consultation helps avoid complications — feel free to connect.
Only whatsapp message no calls
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Need more details..can connect with me on practo
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Please share results of drug sensitivity of culture report and what meds you have taken so far? Then I can suggest suitable meds for cure.
Drink more water, take syp citralka 5m.l. three times a day.
For calcified prostate, consult a gen surgeon or urologist physically.
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Need few more details for proper understanding of your issue.
You can consult with me online on Practo or whatsapp on eight three one eight four six nine eight eight six for proper diagnosis, conclusion and management
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You need a superspecialist like urologist
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Urologist
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Dr. Shivam Mishra
General Physician
5 yrs exp
Mumbai
Hello,
Your symptoms and reports together point toward chronic prostatitis / chronic pelvic pain syndrome (CPPS) rather than a simple UTI.
This is why:
1. Recurrent organisms (Pseudomonas, Citrobacter, E. coli) appearing in cycles
These bacteria commonly hide deep inside the prostate ducts.
Regular short-course antibiotics rarely reach those pockets properly, which leads to persistent burning in the urinary tract and anal area.
2. Ongoing burning despite 1 month of Bactrim DS
If symptoms continue despite prolonged antibiotics, it usually means the issue is not just infection.
There is often a combination of:
Low-grade bacterial presence
Prostate inflammation
Pelvic floor tightness
Sometimes nerve sensitization
3. Prostate calcification (14×7 mm)
Calcifications act like bacterial reservoirs.
They don’t go away with routine treatment and can keep causing recurrent discomfort.
4. Anal burning + whole-day symptoms
This pattern is classic for prostatitis-related nerve irritation, not a typical UTI.
What should be done next
Before deciding treatment, 3 things must be assessed:
1. Full urinary symptom profile
(flow, frequency, urgency, pain pattern, night-time symptoms)
2. Pelvic floor evaluation
A tight pelvic floor can worsen burning even when cultures improve.
3. Review of all three culture reports
It’s important to look at sensitivity patterns to understand why the response has been incomplete.
Based on that, the plan usually includes:
Correct duration + correct antibiotic group (varies depending on sensitivities)
Anti-inflammatory strategies (non-medicinal initially)
Pelvic relaxation techniques
Lifestyle modifications to reduce nerve irritation
Without reviewing your reports properly, giving treatment steps here wouldn't be appropriate.
You don’t need to continue suffering like this
Your case is clearly not a superficial UTI.
It needs structured management, not random antibiotics.
If you want a proper step-by-step personalised plan after reviewing your reports, you can message me privately on:
w.h.a.t.s.a.p.p – nine three two six zero two zero five three six
I’ll help you sort this out in a systematic way.
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Dr. Anuj Mothsra
General Physician
6 yrs exp
Jhunjhunu
Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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Dr. Pawan Kumar Tiwari
General Physician
5 yrs exp
Varanasi
Persistent burning despite antibiotics = chronic bacterial prostatitis with 14×7 mm prostate stone harbouring bacteria (E. coli, Citrobacter, Pseudomonas).
Stones/biofilms protect bacteria; normal antibiotics (even Bactrim) fail to reach inside.
You need a dedicated urologist experienced in chronic prostatitis/prostatic calculi.
Next steps: semen/EPS culture, prolonged culture-specific antibiotics (4–12 weeks) or fluoroquinolone + alpha-blocker; large stone may need TURP/endoscopic removal.
Do not keep changing antibiotics without proper localisation studies; see specialist urgently.
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Dr. Davra Kaushalkumar Dilipbhai
General Physician
6 yrs exp
Ahmedabad
Its complicated uti
Need further investigation
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Dr. Vetsa Sri Krishna Chaitanya
General Physician
6 yrs exp
Rajahmundry
UTI is serious complication if you neglect...go for physical consultation with the nearest hospital for further evaluation
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Dr. Ravi Kumar Nadella
General Physician
18 yrs exp
Hyderabad
Urine culture needed
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Dr. Shaikh Huzaif
General Physician
18 yrs exp
Aurangabad
Please consult
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Dr. Gaurav Jaiswal
General Physician
6 yrs exp
Jhansi
Do connect and consult
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