In chronic prostatitis antibiotic therapy is given for how many weeks?
Chronic prostatitis Many urologists find the diagnosis of chronic prostatitis and 'prostatodynia' very difficult, for many men present with perigenital pain, testicular pain, prostatic pain exacerbated by sexual intercourse or pain that apparently renders sexual intercourse out of the question. Psychosexual dysfunction in such patients may be the underlying problem. The diagnosis of chronic prostatitis has to be based on: * persistent threads in voided urine; * prostatic massage showing pus cells with or without bacte ria in the absence of urinary infection. Aetiology This is thought to be the sequela of inadequately treated acute prostatitis. While pus is present in the prostatic secretion, the responsible organism is often difficult to find. Other organisms such as Chlamydia species may be responsible for chronic abacterial prostatitis. Clinical features The clinical features are extremely varied. Only men with symptoms of posterior urethritis, prostatic pain and perigen ital pain accompanied by intermittent fever and pus cells or bacteria in the post-prostatic massage specimen should be diagnosed as having chronic prostatitis. Diagnosis The three-glass urine test is valuable. If the first glass with the initial voided sample shows urine containing prostatic threads, prostatitis is present. Rectal examination of the prostate may be normal or may show a soft, boggy and tender prostate. Examination of the prostatic fluid obtained by prostatic massage should show pus cells and bacteria. Urethroscopy may reveal inflammation of the prostatic urethra, and pus may be seen exuding from the prostatic ducts. The verumontanum is likely to be enlarged and oedematous. In many men with the symptoms described above, all investi gations are normal. Treatment Antibiotic therapy should be administered only in accordance with bacteriological sensitivity tests. Trimethoprim or ciprofloxacin penetrate well into the prostate. If Trichomonas or anaerobes are the responsible agent, a rapid response is obtained from administration of metronidazole (200mg t.d.s. for 7 days to both paners). Treatment is continued upto 10-12 weeks. If Chlamydia is suspected, doxycycline is the antibiotic treatment of choice. There is little evidence that prostatic massage helps in eradicating the infection. Ref: Bailey and love 27th edition Pgno : 1475
4-6 weeks
6-10 weeks
10-12 weeks
12-16 weeks
Urology