About three months ago I was diagnosed with a case of acute bacterial prostatitis. I was put on a four week course of ofloxacin. My urine samples were negative for bacteria but from what i understand, this is common for prostatitis sufferers. I have recently been experiencing some discharge after urination. No real burning, or blood in urine, but a weak stream and the same lower back pain that I experienced the first time around. Should I go back to get examined even though I have my appt with a urologist in about a week and a half? I would like to be antibiotic free in case the uro wants a sample of prostatic fluid for culture. I’m afraid just because of the history they’ll stick my on another long course of quinolones (which by the way caused major pain in my hips after long term use) Are there other anti-microbials that are as effective as quinolones. I’m worried if I leave it to long it will spread to my bladder or my urethra. Suggestions would be greatly appreciated.

From your symptoms, it sounds as if you are suffering from chronic prostatitis but your urine cultures have been negative. This can either indicate that you have either a chronic bacterial prostatitis or a chronic abacterial prostatitis. To distinguish between the two, you will need to have your expressed prostatic secretions cultured (not just urine samples).

Chronic bacterial prostatitis is the diagnosis if the expressed prostatic secretions are positive for bacteria. It has a reputation among urologists as being difficult to treat because of the persistence of bacteria within the prostate either because of poor drainage of prostatic fluids or reflux of urine into the prostate. The standard treatments for bacterial prostatitis are fluoroquinolones like you mentioned such as Ciprofloxacin, Oxfloxacin, or Levofloxacin. As an alternative Trimethoprim/Sulfamethoxazole (Bactrim) is also prescribed twice a day for a four week course and may be especially effective in patients who experience side effects from the fluoroquinolones.

Chronic abacterial prostatitis mimics the symptoms of chronic bacterial prostatitis except the expressed prostatic secretions are negative for bacteria. In fact, the majority of chronic prostatitis – up to 90% of treated patients – are abacterial. It is important to note a negative culture does not necessarily mean there are no organisms infecting the prostate but could indicate infection by a non-culturable organism such as chlamydia, trichomonas, gonorrhea, viruses, fungi, or other rare bacteria. Autoimmune diseases and conditions can also cause abacterial prostatitis. The initial treatment is either with a two week trial of trimethoprim/sulfamethoxazole (Bactrim) or with a quinolone. However, your urologist might add other drugs such as Flomax or finasteride to your treatment regimen.

In your case, the proper algorithm to follow four weeks of unsuccessful antibiotics is a repeat expressed prostatic secretion analysis. At this time, your urologist might elect to either perform more tests, put you on a full course of antibiotics, or put you on additional drugs if he determines that you have abacterial prostatitis. I would keep the appointment with your urologist and if you are concerned about antibiotics, give him/her a call to ask for advice.