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Key Features

  • Most common of the prostatitis syndromes

  • May be caused by chlamydiae, mycoplasmas, ureaplasmas, and viruses but cause may remain unknown

  • May represent a noninfectious inflammatory or autoimmune disorder

Clinical Findings

Diagnosis

  • Usually one of exclusion

  • Increased numbers of leukocytes are seen on expressed prostatic secretions

  • All cultures are negative

  • Urinary cytologic examination and cystoscopy are warranted in older men with irritative voiding symptoms and negative cultures to rule out bladder cancer

Treatment

  • Antimicrobial therapy directed against Ureaplasma, Mycoplasma, or Chlamydia is warranted

  • Erythromycin (250 mg orally four times daily)

    • Can be initiated for 14 days

    • Should be continued for 3–6 weeks only if a favorable clinical response ensues

  • Nonsteroidal anti-inflammatory drugs or sitz baths may provide symptomatic relief

  • Dietary restrictions are not necessary unless the patient relates a history of symptom exacerbation by certain substances such as alcohol, caffeine, or particular foods

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