Chronic Prostatitis: Symptoms, Causes, and Treatment Options

Chronic prostatitis

About a year ago, I had unprotected oral sex with a sex worker.
Initially, 2 to 3 days later, I developed a fever, pain on the surface of the glans, and transparent discharge.
I also experienced anal fissures, and that month, every time I wiped after using the bathroom, there was blood.
After a period of treatment, I now have chronic prostatitis, along with symptoms of ear fullness, lower abdominal discomfort, and testicular numbness, with occasional numbness in my face and nose that comes and goes.
I would like to ask if there are similar patients with the same symptoms, as I have taken quite a bit of antibiotics.
I am unsure about the type of bacterial or viral infection I might have.
Do I need to get blood tests again? About three months after the incident, I had blood tests done, which were all negative.
My prostate index was normal but slightly elevated.
My previous doctor prescribed doxycycline for two weeks after hearing about the blood in my stool, but the testicular numbness, ear fullness, and lower abdominal discomfort have not improved.

Liu Xiansheng, 30~39 year old female. Ask Date: 2022/02/14

Dr. Chen Jiansheng reply Urology

Please visit the urology department for examination and treatment.

Reply Date: 2022/02/14

More Info

Chronic prostatitis, particularly nonbacterial prostatitis, can be a challenging condition to manage, especially when symptoms persist despite various treatments. Your symptoms, which include persistent pain in the lower abdomen, testicular numbness, and episodes of ear fullness, suggest a complex interplay of factors that may not solely be attributed to a bacterial infection.

Symptoms of Chronic Prostatitis
Chronic prostatitis can manifest in various ways, including:
1. Pelvic Pain: This is often the most debilitating symptom, which can include pain in the lower abdomen, perineum, and even the lower back. Some patients report discomfort in the testicles or groin area.

2. Urinary Symptoms: These may include frequent urination, urgency, and pain during urination. In some cases, blood in the urine can occur, which you have experienced.

3. Sexual Dysfunction: Many men report issues such as erectile dysfunction or painful ejaculation.

4. Systemic Symptoms: Fatigue, malaise, and even psychological symptoms like anxiety or depression can accompany chronic prostatitis.

Causes
The exact cause of chronic prostatitis is often elusive. While bacterial infections can lead to acute prostatitis, chronic prostatitis can occur without any identifiable bacterial infection. Possible contributing factors include:
- Pelvic Floor Dysfunction: Tension or spasms in the pelvic floor muscles can lead to pain and discomfort.

- Nerve Damage or Irritation: Conditions affecting the nerves in the pelvic region can lead to chronic pain.

- Inflammation: Chronic inflammation of the prostate can occur without a clear infectious cause.

- Psychosomatic Factors: Stress and anxiety can exacerbate symptoms, creating a cycle of pain and discomfort.

Diagnosis
Diagnosis typically involves a combination of medical history, physical examination (including a digital rectal exam), and various tests such as:
- Urinalysis: To check for signs of infection or blood.

- Prostate Secretions: Analyzing fluid from the prostate can help identify inflammation or infection.

- Imaging: Ultrasound or MRI may be used to rule out other conditions.

Given your history of symptoms and the fact that you have undergone multiple tests with negative results for bacterial infections, it may be beneficial to explore other avenues for diagnosis, such as pelvic floor assessments or consultations with specialists in pain management.

Treatment Options
Managing chronic prostatitis often requires a multifaceted approach:
1. Medications: While antibiotics are commonly prescribed, they may not be effective if no bacterial infection is present. Other medications that may help include:
- Alpha-blockers: These can help relax the bladder neck and prostate, reducing urinary symptoms.

- Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain.

- Muscle relaxants: These may help if pelvic floor tension is contributing to your symptoms.

2. Physical Therapy: Pelvic floor physical therapy can be beneficial for addressing muscle tension and improving pelvic floor function.

3. Lifestyle Modifications: Dietary changes (avoiding caffeine, alcohol, and spicy foods), regular exercise, and stress management techniques can also play a significant role in symptom management.

4. Alternative Therapies: Some patients find relief through acupuncture, biofeedback, or other complementary therapies.

5. Psychological Support: Given the chronic nature of your symptoms, psychological support or counseling may help address any anxiety or depression that may be exacerbating your condition.

Conclusion
Your symptoms and history suggest a complex case of chronic prostatitis that may not respond to standard antibiotic treatment. It is crucial to work closely with a healthcare provider who understands the nuances of chronic pelvic pain syndromes. Further evaluation, including potential referrals to specialists in urology or pain management, may provide additional insights and treatment options. Regular follow-ups and open communication with your healthcare team will be essential in managing your condition effectively.

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