Chronic Bacterial Prostatitis Guidelines

Updated: May 18, 2023
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Guidelines Summary

The urologic infection guidelines of the European Association of Urology includes the following key recommendations for the diagnosis of chronic bacterial prostatitis (CBP) [68] :

  • Microbiologic evaluation should be performed to identify atypical pathogens such as  Chlamydia trachomatis or Mycoplasmata
  • Meares and Stamey 2- or 4-glass test should be administered
  • To rule out the presence of prostatic abscess in selected patients, transrectal ultrasound may be performed. However, it is unreliable for the diagnosis of CBP.
  • Ejaculate alone should not be routinely used for diagnosis because semen culture sensitivity is estimated to be 50%.

For the treatment of CBP, the guidelines offer the following recommendations and dosing regimens [68] :

  • First-line treatment: A fluoroquinolone (eg, ciprofloxacin, levofloxacin) for 4-6 weeks at an optimal oral daily dose.
  • For  C trachomatis infections: Either 500 mg once daily of azithromycin for 3 weeks or 100 mg twice daily of doxycycline for 10 days.
  • For Mycoplasma infections: Doxycycline, 100 mg twice daily for 10 days.
  • For  Trichomonas vaginalis infections: Metronidazole, 500 mg three times daily for 14 days