Patient: Good evening, how are you? My 32 year old boyfriend has a mystery condition and I would appreciate your help. He has had constant daily pain in his urethra for 11 weeks now. He had no problem urinating, no dysuria, and no discharge. For the last two weeks, he now has a new symptom that he feels like he has to urinate more frequently, but cannot. We have both had urinalysis and they both came back negative for chlamydia, gonorrhea and no bacterial growth. He had a prostate exam that was WNL. He has been on doxy, bactrim and cipro with no results. He has seen two urologists, one at Cleveland Clinic, and they were not able to provide him with a diagnosis. Last Fri he was given an injection of Rocephin and out on augmentin. We are starting to lose hope and would like to know what it is that he has so we can prevent him from getting it again. It started out as a differential dx of urethritis which has now been changed to prostatitis, however, his EPS has not been tested or cultured, and he has not had a PSA screening or flow rate done. Please help if you can, it has really disrupted his life. Thank you for taking the time to read this.
Doctor: Your boyfriend’s frustration is understandable. From the history you have provided it seems that he has Nonbacterial Pro statitis, for which he is being treated. Though the name suggest that bacteria is not the cause of inflammation in the prostate, this is not the case. Rather, the organism cause the infection cannot be easily identified via the usual methods such as urine cultures or prostate secretion cultures. Treatment consist of 2-4 weeks of antibiotics followed by a patient review to assess severity of symptoms. If symptoms have improved then antibiotics are continued for another 2-4 weeks. If there is no improvement in symptoms then an alternate diagnosis must be sought. Other conditions which can explain his symptoms include bladder neck dysfunction, urethral stricture or even cancer of the urinary bladder. If the current course of antibiotics fail to relieve his symptoms then these conditions must be ruled out.