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Key Features

  • Irritative voiding symptoms

  • Perineal or suprapubic discomfort, often dull and poorly localized

  • Positive expressed prostatic secretions and culture

  • Although chronic bacterial prostatitis may evolve from acute bacterial prostatitis, many men have no history of acute infection

  • Most common: gram-negative rods

  • Less common: Enterococcus

Clinical Findings

  • Variable; some patients are asymptomatic; most have irritative voiding symptoms, low back and perineal pain

  • Many report a history of urinary tract infections

  • Physical examination often unremarkable; prostate may feel normal, boggy, or indurated

Diagnosis

  • Culture secretions or postprostatic massage urine specimen

  • Urinalysis: normal unless a secondary cystitis is present

    • Expressed prostatic secretions: > 10 leukocytes/hpf, especially lipid-laden macrophages; however, this finding is consistent with inflammation and is not diagnostic of bacterial prostatitis

  • Differential diagnosis

    • Chronic urethritis

    • Cystitis

    • Perianal disease

Treatment

  • Anti-inflammatory agents (indomethacin, ibuprofen)

  • Quinolones, cephalexin, erythromycin, and carbenicillin for 6–12 weeks

  • Regimens

    • Ciprofloxacin, 250–500 mg every 12 hours orally for 1–3 months

    • Ofloxacin, 200–400 mg every 12 hours orally for 1–3 months

    • Trimethoprim-sulfamethoxazole, 160/800 mg every 12 hours orally for 1–3 months (increasing resistance noted [up to 20%])

  • Hot sitz baths

  • Relax pelvic floor with micturition

  • Difficult to cure

  • Symptoms and recurrent urinary tract infections can be controlled by suppressive antibiotic therapy

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