Chronic Bacterial Prostatitis

Chronic bacterial prostatitis is a prostate infection, one of the most challenging urological diseases to diagnose. Recently, this problem has become increasingly relevant as its frequency begins to gradually increase due to various medical, social, and particularly environmental reasons. Globally, according to various data, this disease affects 3% to 16% of the male population aged 20 to 40 years. For instance, in the USA, there are 3 million cases annually.

In terms of prevalence, chronic bacterial prostatitis can be compared to diabetes mellitus, and in terms of the impact on quality of life, it is comparable to myocardial infarction or pancreatic cancer. The pathology is of particular social importance due to the relatively young age of patients, severe symptoms, frequent relapses, and subsequent impairment of reproductive function.

The cause of the disorder is the penetration of pathogenic microorganisms into the secretion of the prostate gland. The Enterobacteriaceae family is most often identified:

• Escherichia coli strains – the most frequently cultured;
• Pseudomonas aeruginosa – a type of gram-negative aerobic motile rod-shaped bacteria, often the cause of hospital-acquired infections;
• Serratia species – rod-shaped gram-negative conditionally pathogenic bacteria, with infections more likely in individuals with weakened immune systems;
• Klebsiella species – straight gram-negative rods, can cause prostatitis after anal intercourse;
• Enterobacter aerogenes – a genus of gram-negative facultatively anaerobic conditionally pathogenic bacteria, can cause infectious diseases of the kidneys and urinary tract;
• Acinetobacter spp – rod-shaped gram-negative bacteria, causative agents of many hospital-acquired infections.

Some studies also note the role of Staphylococcus and Streptococcus, but it is questionable. Many experts believe they are an uncommon cause of bacterial chronic prostatitis, but the absence of associated cystitis questions their pathogenicity.

Infection of the prostate secretion by bacteria can be a consequence of the following risk factors:

• Frequent, unprotected sexual intercourse, constant change of partners;
• Delayed consultation with a specialist, incorrect or irregular medication intake;
• Self-medication;
• Reduced immunity and local defensive mechanisms;
• Urinary reflux;
• Anatomical features of the urethra and penis (e.g., phimosis);
• Inflammatory and infectious processes of nearby organs;
• Recent pelvic surgeries;
• Previous antibiotic therapy;
• Stagnation of prostate secretion due to prolonged abstinence.

The disease's manifestations may develop and increase gradually, over at least three months. As a result of the prolonged course, symptoms can be subtle and vague, so men are advised to consult a doctor with any discomfort:

• Pain or discomfort in the pelvic area;
• Discomfort in the perineum, groin area;
• Pain in the lumbar or sacral area;
• Discomfort in the genital organs;
• Sometimes – discomfort in the rectum;
• Increased urination frequency, especially at night;
• Feeling of incomplete bladder emptying;
• Urinary dribbling, uneven stream;
• Burning, pain during or immediately after urination;
• Erectile dysfunction – inability to maintain an erection;
• Discomfort during ejaculation or intercourse;
• Small semen volume.

Symptoms of chronic bacterial prostatitis lead to a significant reduction in quality of life. Constant pain and discomfort can also cause psychological disorders, fear of sexual intercourse, or going to the toilet.

During the initial consultation, special tests for chronic bacterial prostatitis – NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) and IPSS (International Prostate Symptom Score) may also be used. These are available in both paper and online forms, so they can also be used for self-diagnosis.

The treatment of CBP currently presents a challenging task – as evidenced by the high number of relapses even after adequate treatment. The disease tends to persist, and eradicating bacteria from the prostate secretion is quite difficult. There are many treatment options for chronic bacterial prostatitis, and the doctor must consider the patient's condition and his positive or negative response to previous therapy.

General recommendations that are most effective include:

• Maintaining a stable sex life – avoiding abstinence but also not frequently changing sexual partners;
• Excluding spicy, smoked dishes from the diet;
• Abstaining from alcohol and smoking;
• Avoiding hypothermia.

During therapy for chronic bacterial prostatitis, antibiotics are always prescribed. The choice of medication may vary depending on the pathogen identified in the patient and its sensitivity to various agents, so several laboratory tests are necessary before prescribing.

In addition to antibiotics, alpha-blockers are used in the treatment of chronic bacterial prostatitis. They help reduce pelvic pain, increase urine flow speed through the urethral canal, and generally improve the quality of life for patients.