Chronic bacterial prostatitis

Causes

Ascending urethral infection

Undertreated acute bacterial prostatitis

Recurrent urinary tract infection with prostatic reflux.

Causative  organism

Gram-negative rods

Mycobacterium, Ureaplasma urealyticum

Chlamydia trachomatis

Trichomonas vaginalis

Escherichia coli

Clinical features

The patient may be asymptomatic

Lower back pain

Dysuria

Perianal pain

Low-grade fever

Often the physical examination, including prostate examination, is normal.

The prostate examination should be performed to document any abnormalities such as prostatic calculi, which can serve as a reservoir of infection.

Investigation

Pre- and post-prostatic massage urine samples for analysis and culture may be useful and can guide antibiotic therapy.

Urine MCS

Chlamydia and gonorhea PCR

Transrectal ultrasound

Management

First-line treatment

Norfloxacin 400 mg orally every 12 hours for 4 weeks

or

Trimethoprim 300 mg orally daily for 4 weeks

If chlamydia or ureaplasma noted

Doxycycline 100 mg orally every 12 hours for 2–4 weeks

Patients should be warned about the common side effects of extended duration of antibiotic use, such as Achilles tendon rupture with fluoroquinolones.

NSAIDs may alleviate pain symptoms.

Alpha-blockers may diminish urinary obstruction and reduce future occurrences.

Daily sitz baths

Perianal massage and frequent ejaculation may also help to clear prostatic secretions and lessen discomfort.