Chronic Prostatitis

An inflammation of the prostate gland, prostatitis may be acute or chronic. Acute prostatitis most often results from gram-negative bacteria and is easy to recognize and treat. However, chronic
prostatitis, the most common cause of recurrent urinary tract infection (UTI) in men, is less easy to recognize. As many as 35% of men over age 50 have chronic prostatitis.

Prostatitis can appear in several forms. The acute form is the least common, but is also the most severe and may require hospitalization. Symptoms of chronic prostatitis tend to develop more slowly and aren't as severe as those of acute prostatitis.

It's not always possible to cure prostatitis, but in many cases symptoms can be controlled. A variety of treatments as well as self-care measures can provide relief.

Causes

Prostatitis is an infection that likely occurs due to bacteria that have entered the prostatic ducts from the rectum and/or as a result of a backward flow of infected urine.

Prostatitis is not a contagious condition and is not considered a sexually transmitted disease. It can result, however, from several different sexually transmitted diseases.

Signs and symptoms

You might experience no symptoms, or symptoms so sudden and severe that you seek emergency medical care.

When present, symptoms include:

• Frequent urge to urinate
• Difficulty urinating
• Pain or burning during urination
• Chills and fever

Other symptoms might include pain that comes and goes low in the abdomen, around the anus, in the groin, or in the back. In some cases, bacteria can get into the vas deferens (the tube that carries sperm from the testicles to the urethra), causing groin pain or an infection of the epididymis (area near the testicles where sperm mature and are stored). The prostate might swell, causing a less forceful urine stream. Sometimes blood in the urine and painful ejaculation are other symptoms of prostatitis.

Men might also complain of pelvic pain, pain during ejaculation, and pain with sexual intercourse.

Chronic bacterial prostatitis some­times produces no symptoms but usually elicits the same urinary symptoms as the acute form but to a lesser degree. UTI is a common complication. Other possible signs include painful ejaculation, hemospermia, persistent urethral discharge, and sexual dysfunction.

Diagnosis

Although a urine culture can often identify the causative infectious organism and characteristic rectal examination findings suggest prostatitis, firm diagnosis depends on a comparison of urine cultures of specimens obtained by the Meares and Stamey technique. This test requires four specimens:

• one collected when the patient starts voiding (voided bladder one- VB1)
• another specimen collected midstream (VB2)
• another specimen collected after the patient stops voiding and the doctor massages the prostate to produce secretions (expressed prostate secretions; EPS)
• a final voided specimen (VB3).

A significant increase in colony count in the prostatic specimens confirms prostatitis.

Treatment

Appropriate treatment includes drug therapy and support measures. Surgery may be necessary if drug therapy is unsuccessful.

Drug therapy

Systemic antibiotic therapy is the treatment of choice for acute prostatitis. Cotrimoxazole is given orally and, if the pathogen is sensitive to it, continued for about 30 days. If sepsis is likely, I.V. cotrimoxazole or I.V. gentamicin plus ampicillin may be given until sensitivity test results are known.

If test results and clinical response are favorable, parenteral therapy continues for 48 hours to 1 week; then an oral agent is substituted for 30 more days. In chronic prostatitis due to E. coli, cotrimoxazole is usually given for at least 6 weeks.

Support measures

Supportive therapy includes bed rest, adequate hydration, and administration of analgesics, antipyretics, sitz baths, and stool softeners as necessary. In symptomatic chronic prostatitis, regular massage of the prostate is most effective. Regular ejaculation may help promote drainage of prostatic secretions. Anticholinergics and analgesics may help relieve nonbacterial prostatitis symptoms. Alphaadrenergic blockers and muscle relaxants may relieve prostatodynia.

Surgery

Your doctor may recommend surgery to open blocked ducts if you have a bacterial form of the disease and antibiotics don't improve your symptoms or your fertility is severely affected. Surgery is not a treatment for nonbacterial prostatitis.

Prevention

Potential sources of infection should be avoided. Good perineal hygiene should be maintained and sex should be avoided when one's partner has an active bacterial vaginal infection. If the kidneys, bladder, or other genitourinary organs are infected, prompt treatment may prevent the development of prostatitis. By far the best way of preventing chronic prostatitis is to treat an initial acute episode promptly and effectively.