Prostatitis: Symptoms, Diagnosis, and Treatment Options

Prostatitis

Hello, doctor.
A while ago, I went to a clinic because I was experiencing pain during urination.
The physician, after listening to my symptoms, asked me to undergo a urinalysis.
Later, the doctor mentioned that I showed signs of inflammation and suggested that I might have gonorrhea or chlamydia urethritis.
When I asked if those were the only two possibilities, he confirmed that they were.
He then inquired if I wanted to undergo testing or start treatment directly, stating that the cost for both testing and treatment would be the same.
If the test came back positive, I would still have to pay for the treatment.
I have already received an injection and taken medication, but my condition has not improved.
I still notice a clear discharge from my urethra, and in the morning, there are dried remnants of discharge.
After researching online, I learned that gonorrhea and chlamydia urethritis typically do not occur without sexual activity.
Now, I suspect that I may have been persuaded to pay for unnecessary medication.
Based on my online research, my symptoms seem most consistent with prostatitis; however, I do not experience pain during erection or ejaculation, and my semen has been yellow-green for the past two days.
I still occasionally have a clear discharge (which does not flow out).
I understand that online consultations can easily lead to misdiagnosis, and most doctors are reluctant to provide direct answers.
However, I would like to confirm whether my current symptoms are indicative of prostatitis.
If these symptoms do not align with prostatitis, I will finish the gonorrhea and chlamydia medication and then reassess.
But if they are consistent and likely indicate prostatitis, I think it would be better to take a leave from work and seek a diagnosis at another hospital to avoid delaying treatment.
Thank you for your assistance.

Ka Bu, 30~39 year old female. Ask Date: 2023/12/21

Dr. Li Xinyi reply Urology

I apologize for my late response.
If there has been no risky sexual behavior, then there is no need to consider sexually transmitted infections.
However, some patients may deceive their physicians, which is why some doctors may recommend starting empirical therapy directly.
This should not be a tactic to make you pay out of pocket for medication, unless the medication is very expensive, but it should not be the case.
For prostatitis, blood tests should be considered, and approximately one month of oral antibiotics is necessary.
It is important to communicate well with a urologist in the outpatient clinic.

Reply Date: 2023/12/21

More Info

Prostatitis, an inflammation of the prostate gland, can present a complex clinical picture, often leading to confusion regarding its diagnosis and treatment. Based on the symptoms you've described, it is essential to understand the various forms of prostatitis, their symptoms, diagnostic approaches, and treatment options.

Symptoms of Prostatitis
Prostatitis can manifest in several ways, and its symptoms can vary significantly among individuals. The most common symptoms include:
1. Painful Urination (Dysuria): This is often the first symptom noticed, and it can range from mild discomfort to severe pain.

2. Frequent Urination: Increased urgency and frequency, especially at night (nocturia), are common.

3. Pelvic Pain: This can include pain in the lower abdomen, perineum, and lower back. Some patients also report pain during ejaculation.

4. Changes in Urine Flow: This may include a weak stream or difficulty starting urination.

5. Discharge: Some men may notice a discharge from the penis, which can be clear or cloudy.

In your case, the presence of yellow-green discharge and persistent pain could indicate a form of prostatitis, particularly if these symptoms have not improved with initial treatment.

Diagnosis
Diagnosing prostatitis typically involves a combination of medical history, physical examination, and laboratory tests. Key diagnostic steps include:
1. Medical History: A thorough history of symptoms, sexual history, and any previous urinary tract infections (UTIs) is crucial.

2. Physical Examination: A digital rectal exam (DRE) can help assess the prostate's size, tenderness, and any abnormalities.

3. Urinalysis and Culture: Testing urine for signs of infection and performing a culture can help identify bacterial causes.

4. Prostate Secretions: In some cases, examining prostatic secretions can provide additional information, although this is not always necessary.

Given your symptoms, it would be prudent to seek a second opinion from a urologist who can perform a comprehensive evaluation, including a DRE and possibly testing prostate secretions if indicated.

Treatment Options
Treatment for prostatitis varies depending on the underlying cause:
1. Bacterial Prostatitis: If a bacterial infection is confirmed, antibiotics are the primary treatment. The choice of antibiotic may depend on the specific bacteria identified.

2. Chronic Pelvic Pain Syndrome (CPPS): This non-bacterial form of prostatitis can be more challenging to treat. Management may include:
- Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain.

- Alpha Blockers: These medications can help relax the bladder neck and prostate, improving urinary symptoms.

- Physical Therapy: Pelvic floor physical therapy may be beneficial for some patients.

- Lifestyle Modifications: Avoiding irritants such as caffeine, alcohol, and spicy foods can help reduce symptoms.

3. Alternative Therapies: Some patients find relief through complementary therapies, including acupuncture, heat therapy, or dietary supplements like saw palmetto or quercetin.

Conclusion
Based on your symptoms, it is possible that you are experiencing prostatitis, particularly if your symptoms align with those typically associated with this condition. However, it is crucial to undergo a thorough evaluation by a qualified healthcare provider to confirm the diagnosis and rule out other potential causes of your symptoms. If your current treatment is not effective, do not hesitate to seek a second opinion or further diagnostic testing. Early and appropriate management can significantly improve your quality of life and prevent complications.

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