| Chronic bacterial
prostatitis (CBP) is another uncommon form of prostatitis, characterized by recurrent
infection of the prostate. It usually is associated with some underlying defect in the
prostate that serves as a focal point for persistent bacterial infection. Antibiotics may
not cure the infection; surgery may be required. CBP What are the causes and risks of the condition? increased alkalinity of
the prostatic fluid; there is some evidence that this condition leads to decreased
fertility, as sperm do not tolerate such an environment.
- What are the causes and risks of the condition?
As in cases of CBP, the initial bacterial
infection may be caused by bacteria traveling up the urethra and reflux of infected urine
into the prostatic ducts. This can be brought on by the use of a urinary catheter,
enlargement of the patient's prostate, a bladder infection or bacteria acquired by
engaging in anal intercourse.
What characterizes CBP from ABP, however, is the recurrent
nature of the infection. This usually results from an underlying defect in the prostate
which provides a host environment for the bacteria. This may be calculi -- stones caused
by hardened salts or prostatic secretions that block portions of the gland -- or minute
pools of stagnant, difficult-to-sterilize urine trapped in the bladder by
enlarged or inflamed portions of the prostate. Until the defect is fixed, the infection
will linger. The usual course of antibiotics prescribed for ABP may knock the infection
down for a time, only to have it rebound.
- What are the signs and symptoms of the condition?
- The symptoms of CBP are similar to those of
ABP: rapid onset, chills, fever, pain in the lower back and genital area, body aches,
burning or painful urination, increased urinary frequency and urgency, often at night, and
occasionally visible blood in the urine. The most distinguishing feature of CBP is its
high incidence of recurring bladder infections.
- How is this condition diagnosed?
- A diagnosis of CBP typically is made when the
patient returns frequently after treatment for ABP, complaining of renewed discomfort and
recurrent infection.
- What are the treatments?
- CBP requires a longer course of antibiotic treatment-typically
four to 12 weeks. Antibiotics prescribed include ciprofloxacin, trimethoprim,
sulfamethoxazole, carbenicillin, tetracycline, doxycycline and erythromycin. About 60% of
CBP cases respond to this treatment.
If this is unsuccessful, a 4 to 12-month, low-dose course of
antimicrobal treatment may be recommended. Alternative treatments involving direct
injection of antimicrobal agents into the prostate and low-dose suppressive antibacterial
therapy also have been tried, without conspicuous success.
The most persistent cases of CBP may require surgery to
correct the underlying prostate or urinary tract defect responsible for reinfection.
Transurethral resection of the prostate (TURP) may be necessary.
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