Prostatitis - nonbacterial

Alternative names
NBP; Prostatodynia; Pelvic pain syndrome

Definition
Nonbacterial prostatitis is an inflammation of the prostate gland with no known cause.

Causes, incidence, and risk factors

There are many theories about the cause of nonbacterial prostatitis: fungi, viruses, trichomonads, and obligate anaerobic bacteria have been suspected. Irritation caused by a reflux of urine flowing into the prostate may also be a cause.

Up to 65% of patients with chronic prostatitis have the nonbacterial form. The disorder is seen in 5 of every 10,000 outpatient visits by men.

Symptoms
The common symptoms associated with nonbacterial prostatitis include:

     
  • Pain       o Perineal       o Suprapubic       o Scrotal       o Low back       o Urethral       o Tip of penis  
  • Frequent urination  
  • Pain or burning with urination  
  • Decreased urinary stream  
  • Pain with ejaculation  
  • Pain with bowel movements  
  • Blood in the urine  
  • Blood in the semen

The symptoms of nonbacterial prostatitis are the same as those of chronic bacterial prostatitis.

Signs and tests

A physical examination usually will not reveal anything unusual, although the prostate may be swollen, firm, warm, and tender.

Triple-void urine specimens may be collected for urinalysis and urine culture:

     
  • #1 - initial stream  
  • #2 - mid-stream  
  • #3 - after prostatic massage by examiner

A urinalysis reveals increased white blood cells, but no bacterial growth, upon culture of urine #3. Blood may be detected in the urine. Prostatic secretions also contain increased levels of white blood cells and no bacteria.

A semen culture will not demonstrate bacterial infection but may demonstrate increased numbers of white blood cells and decreased numbers of sperm, with poor motility.

Treatment

Treatment for nonbacterial prostatitis is difficult and is aimed at treating the symptoms.

MEDICATIONS:
Many patients are treated with long-term antibiotics to assure that bacteria is not the cause of their prostatitis. Common antibiotics used for chronic bacterial prostatitis include the following:

     
  • Trimethoprim-sulfamethoxazole (Bactrim)  
  • Ciprofloxacin (Cipro)  
  • Tetracycline  
  • Penicillin

Other medications used to relieve prostatic urinary obstruction, including doxazosin, terazosin, and tamsulosin, are successful in many patients. Anti-inflammatory agents such as aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve the symptoms in some patients.

Some people have had limited success with pollen extract (Cernitin) and allopurinol. Stool softeners may be recommended to reduce the discomfort associated with bowel movements.

SURGERY:
Transurethral resection of the prostate may be done if medical therapy is unsuccessful. This surgical treatment is usually not performed on younger men because it carries potential risks for sterility, impotence, and incontinence.

OTHER THERAPY:
Warm baths may provide some relief of the perineal and lower back pain associated with prostatitis.

Expectations (prognosis)

Many patients respond to treatment while others are not relieved despite multiple treatment attempts. Symptoms often recur after treatment and may eventually not be treatable.

Complications

Unresolved symptoms of nonbacterial prostatitis may cause significant changes in lifestyle and emotional well-being related to sexual and urinary problems.

Calling your health care provider

Call your health care provider if symptoms of prostatitis occur.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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