Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 23-03: Genitourinary Tract Infections + Key Features Download Section PDF Listen +++ ++ Irritative voiding symptoms Perineal or suprapubic discomfort, often dull and poorly localized Abnormal expressed prostatic secretions and positive culture Although chronic bacterial prostatitis may evolve from acute bacterial prostatitis, over half of affected men have no history of acute infection Most common: gram-negative rods Less common: Enterococcus + Clinical Findings Download Section PDF Listen +++ ++ Variable; most have varying degrees of irritative voiding symptoms, urethral pain, and obstructive urinary symptoms Low back and perineal pain Many patients (25–43%) report a history of urinary tract infections Physical examination is often unremarkable; prostate may feel normal, boggy, or indurated + Diagnosis Download Section PDF Listen +++ ++ Urinalysis is normal unless a secondary cystitis is present A postvoid residual urine volume should be measured to evaluate for urinary retention Expressed prostatic secretions and/or a postprostatic massage voided urine demonstrate increased numbers of leukocytes (> 5–10 per high-power field) and bacterial growth when cultured Culture of the secretions and/or the postprostatic massage urine specimen is necessary to make the diagnosis Leukocyte and bacterial counts from expressed prostatic secretions do not correlate with severity of symptoms Differential diagnosis Nonbacterial prostatitis Chronic pelvic pain Interstitial cystitis Chronic urethritis Perianal disease + Treatment Download Section PDF Listen +++ ++ Symptomatic relief may be provided by Anti-inflammatory agents (indomethacin, ibuprofen) Hot sitz baths Alpha-blockers (tamsulosin, alfuzosin, silodosin) If patients are febrile or systemically ill, they may require admission and initial intravenous therapy with broad-spectrum antibiotics such as ampicillin plus gentamicin, a third-generation cephalosporin, or a fluoroquinolone Ampicillin, 1 g every 6 hours, plus gentamicin, 1 mg/kg every 8 hours, intravenously for 14 days Ceftriaxone, 1 g daily intravenously for 14 days Ciprofloxacin, 400 mg every 12 hours intravenously for 14 days Therapy would then continue with oral trimethoprim-sulfamethoxazole, fluoroquinolones, or an extended spectrum beta-lactamase antibiotic based on culture and sensitivities of expressed prostatic secretion or postprostatic massage urine Trimethoprim-sulfamethoxazole, 160/800 mg every 12 hours orally for 14 days (increasing resistance noted [up to 20%]) Ciprofloxacin, 500 mg every 12 hours orally for 7 days (increasing resistance has been noted) Levofloxacin, 750 mg daily orally for 5 days The optimal duration of therapy remains controversial, ranging from 4 to 6 weeks