Chronic Prostatitis and the Chronic Pelvic Pain Syndrome

A 38-year-old man reports pelvic pain, dysuria, and urinary urgency for the past 4 weeks. He has had several similar episodes over the past 2 years; urine cultures were not performed. He is sexually active and notes frequent discomfort after ejacula-tion. He is otherwise healthy and takes no medication. He does not have fever, chills, or flank pain. How should he be evaluated and treated? The Cl inic a l Probl em Prostatitis accounts for approximately 2 million outpatient visits per year in the United States, including 8 % of all visits to urologists and 1 % of those to primary care phy-sicians.1 The direct costs of care approach $4,000 per patient per year.2 A classifica-tion system for the prostatitis syndromes has been developed by the National Insti-tutes of Health (NIH) (Table 1).3 About 5 to 10 % of men with symptoms of prostatitis have acute or chronic bacte-rial prostatitis,4 conditions that are well defined according to clinical and microbio-logic measures and that usually respond to antimicrobial therapy. Acute bacterial prostatitis is a life-threatening systemic infection, and its diagnosis and treatmen