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Medicine (MD/DO)
First Aid
First Aid for the USMLE Step 1 (2023)
Page 674 -
Chronic Prostatitis

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Chronic Prostatitis

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Chronic Prostatitis

Crone Plum-on-fire
Onset > 3 Months
On-switch Greater than (3) Tree Month-moon

Chronic prostatitis is characterized by an onset of more than three months.


Bacteria can infect the prostate through ascending urethral infection, rectal bacteria spread through lymphogen, systemic spread of bacteria, recurrent UTI with prostatic reflux, or inadequate management of acute bacterial prostatitis. Etiologies may include gram-negative rods, Escherichia coli, fungi, Chlamydia trachomatis, Trichomonas vaginalis, Ureoplasma urealyticum, and Mycobacterium.

Nun Bacteria-guy

Non-bacteria etiologies, such as nerve problems, previous secondary infection, and chemical irritation, can cause chronic prostatitis. It can show without positive bacterial cultures from prostatic secretions.

Secondary Previous Infection
(2) Tutu Infectious-bacteria

Chronic prostatitis can occur as an inflammation of the prostate due to a secondary previous infection.

Nerve Problems
Broken Nerve-guy

Nerve problems are suggested to contribute as a cause of chronic prostatitis due to neurogenic inflammation. This inflammation may cause nerves to secrete mediators, which can induce local inflammation and/or hyperalgesia. Nerve damage can also cause neuromuscular dysfunction, resulting in bladder-neck spasms. As a result, intraprostatic urinary reflux will occur.

Chemical Irritation
Chemical-sign Irritated

Chemical irritation can cause chronic prostatitis due to urine reflux, even if it's sterile. An example of this chemical is urate, one of the metabolites of urine.

Urinary Frequency and Urgency
Urinating Frequency-wave and Urgently squeezing knees

Patients may experience urinary frequency (frequent urinates: around every 1-2 hours, especially at night) and urgency (patient has the urge to urinate). Inflammation causes these symptoms to occur.


Dysuria is a pain or burning sensation when the patient urinates. This symptom can occur in any source of inflammation in the urinary tract, especially the prostate, bladder, or urethra.

Low Back Pain
Low Back Pain-bolts

Patients can experience pain. This pain can occur in the lower back, suprapubic, penis, testes, or scrotum. Patients can also experience painful ejaculation.

Warm, Tender, Enlarged Prostate
Warm-fire, Tenderizer, Enlarged Prostate-Plum

Digital rectal examination in patients can show a warm, tender, and enlarged prostate.

Treat Underlying Cause
Treating Underlying Attacker

Treatment may include underlying causes such as antibiotics, alpha-blockers such as tamsulosin, which helps lower urinary tract symptoms, cognitive behavioral therapy, and physiotherapy to reduce symptoms. The antibiotic is chosen empirically based on local resistance patterns: uropathogenic treatment with trimethoprim and sulfamethoxazole or fluoroquinolone, and sexually transmitted pathogens are treated with ceftriaxone and azithromycin.


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