How to Distinguish Between Bacterial and Non-Bacterial Prostatitis?

Prostatitis is a common disease among adult males and significantly impacts patients' quality of life. Bacterial and non-bacterial prostatitis are the two main categories among the prostatitis types. However, due to similarities in some of their symptoms, many patients find it challenging to differentiate between them.

So, how can one accurately distinguish between bacterial and non-bacterial prostatitis?

Firstly, different causes:

Bacterial prostatitis, as the name implies, is caused by infection with pathogens such as bacteria, mycoplasma, chlamydia, fungi, and trichomonas. These pathogens can enter the prostate through retrograde infection via the urethra, hematogenous infection, or lymphatic infection, causing an inflammatory response. Common pathogens include Escherichia coli, Staphylococcus aureus, and Streptococcus.

The causes of non-bacterial prostatitis are more complex and not yet fully understood. They may be related to factors such as irregular sexual activity, frequent masturbation, excessive sexual activity, or prolonged abstinence; long-term sitting, cycling, and other activities that lead to prolonged pressure on the prostate; and poor blood circulation.

Secondly, different symptoms:

Bacterial prostatitis and non-bacterial prostatitis share some similar symptoms, such as frequent urination, urgency, pain during urination, incomplete urination, discomfort or pain in the perineum and lower abdomen, and sexual dysfunction. However, there are also some subtle differences.

Bacterial prostatitis usually has an acute onset with relatively noticeable systemic symptoms such as fever, chills, and fatigue. Local pain symptoms are more severe, accompanied by significant urinary tract irritation symptoms such as urgency, pain, and frequency, with possible purulent discharge from the urethral orifice.

Non-bacterial prostatitis has a relatively slow onset and generally no noticeable systemic symptoms. Pain is usually mild or a dull ache with a relatively lighter degree. Urinary tract irritation symptoms are also less severe than those in bacterial prostatitis, and there is typically no discharge from the urethral orifice.

Additionally, different examination results:

Prostate fluid examination is crucial to differentiate between bacterial and non-bacterial prostatitis. For bacterial prostatitis, the number of white blood cells in the prostate fluid increases, exceeding 10 per high-power field, and the number of lecithin bodies decreases. Pathogenic bacteria can be detected through bacterial culture. In non-bacterial prostatitis, the number of white blood cells in the prostate fluid is average or slightly increased, generally less than 10 per high-power field, and the number of lecithin bodies may also be somewhat reduced, but the bacterial culture results are negative.

Urinalysis of bacterial prostatitis patients may reveal abnormalities such as white and red blood cells. Urinalysis of non-bacterial prostatitis patients usually shows no significant abnormalities.

Ultrasound can observe the prostate's shape, size, and structure. In bacterial prostatitis patients, the prostate may show congestion and swelling; in non-bacterial prostatitis patients, the prostate's shape and size may be standard or only slightly uneven.

Additionally, blood tests, semen analysis, CT, or MRI can assist in diagnosing bacterial and non-bacterial prostatitis.

Lastly, different treatments:

Both conditions can be treated with α-blockers to relieve urinary obstruction symptoms and nonsteroidal anti-inflammatory drugs to relieve pain.

However, antibiotic therapy to combat infection is the primary treatment for bacterial prostatitis. Sensitive antibiotics, such as levofloxacin and ceftriaxone sodium, are chosen based on bacterial culture and drug sensitivity test results.

Non-bacterial prostatitis, which does not involve bacterial infection, generally does not use antibiotics. Symptomatic treatment is the primary approach. Physical therapies, such as prostate massage, thermotherapy, and biofeedback therapy, are often used. Traditional Chinese Medicine, such as Diuretics and Anti-inflammatory Pill, also has certain efficacy for non-bacterial prostatitis.

In summary, differentiating between bacterial and non-bacterial prostatitis requires a comprehensive consideration of causes, symptoms, and examination results. If prostatitis symptoms appear, visiting the hospital promptly for relevant examinations is essential to ensure an accurate diagnosis and targeted treatment measures. Early diagnosis and treatment are crucial for improving prostatitis prognosis and enhancing patients' quality of life.

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