Nonbacterial prostatitis is swelling and irritation (inflammation) of the prostate gland with no known cause.

There are many theories about the cause of nonbacterial prostatitis, including:

• Bacteria
• Fungi
• Irritation caused by a backup of urine flowing into the prostate
• Parasites (trichomonads)
• Viruses

Life stresses and some psychological factors may also contribute.

Most patients with chronic prostatitis have the nonbacterial form.

• Blood in the semen
• Blood in the urine
• Decreased urinary stream
• Frequent urination
• Pain
  • Above the pubic bone (suprapubic)
  • Between the genitals and anus (perineal)
  • Low back
  • Scrotum
  • Tip of penis
  • Urethra
• Pain or burning with urination
• Pain with bowel movements
• Pain with ejaculation

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

A physical examination usually will not show anything unusual. However, the prostate may be swollen, soft or firm, warm, and tender.

Triple-void urine specimens may be collected for urinalysis and urine culture. For these tests, the urine is collected in the:

1. Initial stream
2. Mid-stream
3. After prostate massage by health care provider

Urine tests may show white blood cells, blood, and bacteria in the urine. A semen culture may show increased white blood cells and low sperm count with poor movement (motility).

Treatment for nonbacterial prostatitis is difficult. Its goal is to control the symptoms.

MEDICATIONS:

Many patients are treated with long-term antibiotics to make sure that bacteria is not causing their prostatitis. Common antibiotics used for chronic bacterial prostatitis include the following:

• Ciprofloxacin (Cipro)
• Penicillin derivatives such as amoxicillin or carbenicillin
• Tetracycline
• Trimethoprim-sulfamethoxazole (Bactrim)

Other medications are used to relieve prostatic urinary obstruction in patients with nonbacterial prostatitis, including:

• Doxazosin
• Tamsulosin
• Terazosin

Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve symptoms in some patients.

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

SURGERY:

Transurethral resection of the prostate may be done if medical therapy is not successful. This surgical treatment is usually not performed on younger men because it carries risks such as sterility, impotence, and incontinence.

OTHER THERAPY:

Warm baths may help relieve some of the perineal and lower back pain.

Many patients respond to treatment. However, others do not get relief even after many attempts at treatment. Symptoms often come back after treatment, and may eventually not be treatable.

Untreated symptoms of nonbacterial prostatitis may lead to sexual and urinary problems, which can affect your lifestyle and emotional well-being.

Call your health care provider if you have symptoms of prostatitis.

Barry MJ, McNaughton-Collins M. Benign Prostate Disease and Prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 130.