URINARY TRACT INFECTION(S)-CHRONIC BACTERIAL PROSTATITIS

Question 1

May evolve from

Answer 1

acute bacterial prostatitis

Question 2

the most common etiologic agents

Answer 2

Gram-negative rods

Question 3

Only one gram-positive organism is associated with chronic infection.

Answer 3

Enterococcus

Question 4

Routes of infection

Answer 4

the same as discussed for acute infection

Question 5

Signs and Symptoms

Answer 5

(a) Variable degree of irritative voiding symptoms
(b) Low back and perineal pain
(c) Suprapubic discomfort
(d) History of urinary tract infections
(e) Physical exam often unremarkable

Question 6

Differential Diagnosis

Answer 6

(a) Chronic urethritis
(b) Cystitis
(c) Anal disease

Question 7

Laboratory orders

Answer 7

(a) Urinalysis
(b) Expressed prostatic secretions
(c) Culture of prostatic secretions

Question 8

Laboratory findings

Answer 8

(a) Urinalysis
1) Normal unless secondary cystitis is presen
(b) Expressed prostatic secretions
1) Increased number of leukocytes
(c) Culture of prostatic secretions
1) Demonstrate the offending pathogen

Question 9

Imaging

Answer 9

Not necessary

Question 10

Treatment

Answer 10

(a) Antimicrobials
1) Trimethoprim-sulfamethoxazole (Bactrim DS)
a) Associated with the best cure rates
2) Ciprofloxacin (Cipro)
3) Levofloxacin (Levaquin)
4) Optimal duration of therapy is controversial, ranging from 6-12 week

(b) Symptomatic relief
1) NSAIDS
2) Sitz baths

Question 11

Follow up

Answer 11

(a) Referral to Urology when suspected

(b) Chronic bacterial prostatitis is difficult to cure