Patient's question:
Dear Teacher Guo,I am 40 years old. Two months ago, I experienced frequent urination, urgency, a sense of fullness and burning pain in the urethra, along with itching. At times, I also felt testicular swelling and pain. After receiving two days of Ceftriaxone and one day of Azithromycin plus Ofloxacin, my symptoms improved. Subsequently, I had an ultrasound, which showed slightly enlarged prostate and seminal vesicles. The doctor diagnosed me with prostatitis and prescribed 14 days of Azithromycin plus Levofloxacin, along with oral Unflavored Roxithromycin. My symptoms largely disappeared, but they returned after sexual activity. Later, I had a prostate fluid test at a major hospital, which showed: milky, thin fluid, 3+ leukocyte esterase, RBC 0/HP, WBC few/HP, no squamous epithelial cells, no sperm, and negative for pus cells.
Doctor's answer:
Hello, I think you have aseptic prostatitis. The treatment of aseptic prostatitis is relatively difficult, and a comprehensive therapy can be adopted. The patient should first eliminate unnecessary worries and enhance their confidence in overcoming the disease. Most patients with prostatic hypersecretion have symptoms of neurasthenia, with a relatively tense mentality. It is important to help such patients understand that the white discharge from the urethral orifice is prostatic fluid, not leakage of semen, which is crucial for correcting their neurasthenia. The patient should establish a healthy and regular lifestyle, avoid excessive sexual desire, frequent sexual activity, and abnormal sexual behavior. Participate actively in physical exercise, abstain from smoking and alcohol, and avoid spicy foods. Antibiotics are ineffective for treating aseptic prostatitis. However, if mycoplasma and chlamydia infections cannot be ruled out, trying tetracycline, erythromycin, or ofloxacin may sometimes yield unexpected therapeutic effects. Prostatic massage is an important means of treating aseptic prostatitis, especially for unmarried or married couples living apart. Regular massage of the prostate to drain accumulated prostatic fluid is very beneficial for eliminating local inflammation and alleviating symptoms, which can be done once a week for 4–8 weeks of continuous treatment. Additionally, spasmolytic drugs such as probenecid (15 mg, three times daily) can be taken orally. For patients with significant pain, prednisone or short-term hormone therapy can be added, but medication must be under the guidance of a doctor. Chinese medicine and physical therapy methods can also be used. As long as confidence is established and treatment is adhered to, most patients can significantly improve or recover.