A man with acute bacterial prostatitis should stay on antibiotics for six weeks, even if his symptoms get better right away. Bacterial prostatitis could be compared to another stealthy infection too easily harbored by the body— tuberculosis—in that if it’s not obliterated right away, it becomes much more difficult to cure. Somehow, over time, the bacteria become tougher to eliminate. Eradicating acute bacterial prostatitis the first time around, by relentless treatment with antibiotics, is the best way to avoid developing chronic bacterial prostatitis.
The same holds true for patients with chronic bacterial prostatitis. Again, says the University of Maryland urologist, “Any treatment with antibiotics will help somebody initially; a week to ten days’ worth will get you through the first episode. Then a few months later, the infection might come back.” In many cases, the infection goes away every time with treatment; if, a few months later, it returns, it will vanish again after another round of antibiotics.
For men with nonbacterial prostatitis, the anti-UTI antibiotics are useless: If there’s no infection, and thus no bacteria, why take bacteria-killing drugs? No reason. (However, some doctors try fourteen days’ worth of drugs, such as erythromycin and tetracycline, commonly used to treat other kinds of pathogens, as a first step. There is no real information on whether this is effective.) For the most part, all doctors can do currently for this kind of prostatitis is try to give relief from the symptoms.
Sometimes there’s a clear cause-and-effect relationship at work in prostatitis— the insertion of a urinary catheter, for example, during a medical procedure. This causes more trauma in the urinary tract for some men than for others.
Other risk factors include a recent bladder or kidney infection; an enlarged prostate (BPH, in which the prostate grows to constrict the urethra and can have a harmful effect on the urinary tract); and rectal intercourse, also associated with trauma to the urinary tract.
In bacterial prostatitis, the question is, how did the bacteria get into the urinary tract? In the instances mentioned above, bacteria may be able to invade the prostate from the urethra when infected urine “backs up” into the prostate ducts. (During unprotected rectal intercourse, too, rectal bacteria can be picked up by the penis and drawn into the urethra, and then can make their way into the urinary tract.)
But for nonbacterial prostatitis, and prostatodynia, the basic answer is that nobody knows. There have been severe cases in which men have had their prostates removed—and yet the symptoms failed to go away. Which leads to the question of whether nonbacterial prostatitis and prostatodynia are really happening in the prostate at all? “Prostatitis is a catch-all term,” says the University of Maryland urologist. “Too often, any time a patient comes in with pelvic pain, rectal pain, lower back pain—the doctor says, ‘You’ve probably got a touch of prostatitis.’ But a lot of men are told they have prostatitis when they’ve really got something else.”
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