Chronic Prostatitis: Symptoms, Diagnosis, and Treatment Options

Prostate infection (Prostatitis)

Hello, doctor.
Recently, I visited for sudden pain during urination.
I took Dolcol for five days without improvement, and the symptoms worsened with perineal swelling and pain, making it difficult to ride a motorcycle, along with burning sensation and frequent urination.
Upon follow-up, a urinalysis was performed, but no bacteria were detected.
Seven days prior to the onset of symptoms, I had visited a hotel (but did not engage in sexual intercourse, only physical contact).
The doctor suspected a possible infection of the prostate by Chlamydia or Ureaplasma, so I was prescribed Ciprofloxacin and received an injection of Ceftriaxone.
I was also given four Azithromycin tablets to take at once.
A PSA blood test was conducted.
After seven days of medication, there was slight improvement, but the PSA result was 12.845.
Since there was no fever, the doctor diagnosed me with chronic prostatitis and informed me that antibiotics would need to be taken for at least one month to be effective.
However, Ciprofloxacin caused widespread muscle and joint pain, making normal activities difficult, so the doctor switched me to another fluoroquinolone antibiotic, Nemonoxacin.
I have been taking Nemonoxacin for 14 days, in addition to the 7 days of Ciprofloxacin, with symptoms fluctuating, particularly itching in the urethra and anus, along with perineal swelling and pain.
The improvement has been unclear.
After 14 days of the new medication, a blood test showed PSA around 11, indicating a slight decrease.
The doctor suggested continuing for another 14 days.
I have a few questions for the doctor:
1.
If this is not a new infection but a chronic one (the PSA was 8.4 during a health check last November), and I did not seek medical attention due to the absence of symptoms, can chronic prostatitis, due to the unique nature of the prostate, be effectively treated with limited medications? Are the single-dose injections and medications effective for prostate infections caused by Chlamydia, such as Azithromycin and Ceftriaxone?
2.
Are the current medications effective for chronic prostatitis caused by Chlamydia? (Nemonoxacin).
The doctor mentioned that sulfonamides might be more effective, but due to severe side effects, they are not recommended.
However, there are no other medications available, and Nemonoxacin is the only option.
I have had adverse reactions to Ciprofloxacin.
3.
Although urinalysis did not detect bacteria and white blood cell counts were normal, the antibiotics have alleviated symptoms (I stopped the medication for two days due to unclear effects, and symptoms worsened significantly).
Should a prostate fluid analysis for bacteria and white blood cells be more accurate? The doctor believes that the PSA, along with the recent yellow-green color of the semen, indicates inflammation, even though no white blood cells were detected.

Ku Tong Tai Duo, 20~29 year old female. Ask Date: 2021/03/08

Dr. Fu Shizhang reply Urology

1.
If the pathogen is not resistant to antibiotics, they will be effective.

2.
The answer is the same as above.

3.
In theory, online consultations cannot replace in-person evaluations and physical examinations by a physician.
It is still recommended to seek medical care at healthcare facilities when there is a disease.

Reply Date: 2021/03/08

More Info

Chronic prostatitis is a complex condition that can significantly impact a patient's quality of life. It is characterized by pelvic pain and urinary symptoms, and it can be challenging to diagnose and treat effectively. Based on the information provided, it appears that you are experiencing symptoms consistent with chronic prostatitis, possibly of the non-bacterial type, given the negative cultures and the prolonged nature of your symptoms.

Symptoms
The symptoms of chronic prostatitis can vary widely but often include:
- Pelvic pain or discomfort, particularly in the perineum, lower abdomen, or lower back.

- Urinary symptoms such as frequency, urgency, and pain during urination.

- Sexual dysfunction, including pain during ejaculation or changes in semen quality.

- Pain that may radiate to the thighs or lower back.

In your case, the presence of pain in the perineum, burning sensations, and urinary frequency aligns with these symptoms. The fact that you have experienced these symptoms intermittently over a prolonged period suggests a chronic condition.

Diagnosis
Diagnosing chronic prostatitis typically involves:
- A thorough medical history and physical examination, including a digital rectal exam (DRE) to assess the prostate.

- Urinalysis and urine cultures to rule out bacterial infections.

- Blood tests, including PSA (prostate-specific antigen) levels, which can indicate prostate inflammation or other issues.

- In some cases, a prostate massage may be performed to obtain prostatic secretions for analysis, although this is less common.

Your elevated PSA levels (12.845) are concerning and warrant further investigation, as they can indicate inflammation or other prostate issues. However, elevated PSA does not definitively indicate cancer, especially in the absence of other symptoms.

Treatment Options
Treatment for chronic prostatitis can be multifaceted and may include:
1. Antibiotics: While you have been prescribed various antibiotics, including Ciprofloxacin and Nemonoxacin, the effectiveness can vary. Non-bacterial prostatitis may not respond to antibiotics, and prolonged use can lead to side effects, as you have experienced.

2. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and inflammation. However, you should be cautious with their use, especially if you have experienced adverse effects.

3. Alpha-blockers: These medications can help relax the muscles around the bladder and prostate, potentially easing urinary symptoms.

4. Physical Therapy: Pelvic floor physical therapy can be beneficial for managing pelvic pain and improving muscle function.

5. Lifestyle Modifications: Avoiding irritants such as caffeine, alcohol, and spicy foods, along with practicing stress management techniques, can help reduce symptoms.

6. Alternative Therapies: Some patients find relief through acupuncture, biofeedback, or dietary supplements, although evidence for these treatments varies.

Addressing Your Questions
1. Effectiveness of Current Medications: Azithromycin and Ceftriaxone may not be the most effective treatments for chronic prostatitis, especially if the infection is not bacterial. Nemonoxacin is a reasonable choice, but if you are experiencing significant side effects, discussing alternative options with your physician is crucial.

2. Testing Prostatic Secretions: Testing prostatic secretions can provide more definitive information regarding inflammation and infection. If your symptoms persist despite treatment, this may be a valuable next step.

3. Long-term Management: Chronic prostatitis can be a long-term condition requiring ongoing management. Regular follow-ups with your urologist are essential to monitor your symptoms and adjust treatment as necessary.

4. Potential Complications: While chronic prostatitis itself is not typically life-threatening, it can lead to complications such as chronic pelvic pain syndrome, sexual dysfunction, and psychological distress. Therefore, addressing your symptoms and finding effective management strategies is important.

In conclusion, chronic prostatitis can be a challenging condition to manage, but with a comprehensive approach that includes medication, lifestyle changes, and possibly physical therapy, many patients can find relief. It is essential to maintain open communication with your healthcare provider to tailor the treatment plan to your specific needs and experiences.

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