One of the most common aspects of infectious disease is that you don’t always get cured forever.
It happens with influenza and other respiratory diseases. It also occurs with pharyngitis or a urinary tract infection. But what about prostatitis?
Prostatitis is the inflammation of the prostate. It can be acute or chronic, bacterial or nonbacterial. Acute prostatitis features sudden and typically more severe urinary symptoms. Chronic prostatitis is usually prolonged for some time and may not be relieved by the usual treatment.
In most cases, prostatitis is caused by bacteria infecting the prostate gland. They cause an inflammatory condition and trigger urinary symptoms. But other cases are triggered by nonbacterial agents. For example, it can be an immune problem or a dysregulation of inflammatory substances in the body.
The question is, what happens in a recurrent prostate infection? When is it considered recurrent, and how is it treated?
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What is a recurrent prostate infection?
Defining recurrent prostate infection is going beyond the official terms used in medical language. We have different categories of prostatitis considered above. They are (1):
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic prostatitis and chronic pelvic pain syndrome (CPPS)
- Asymptomatic inflammatory prostatitis
Recurring prostatitis or recurrent prostate infection is not officially listed here. Then, we need to define “recurrence,” which is not as easy as it seems. In simple words, when you get influenza once again after one year, is it considered a recurrent disease? Not really, because it is likely a different strain of influenza. Plus, a considerable time passed between one episode and the other. Then, this is considered a new infection.
But what if we’re talking about prostate cancer or breast cancer? Time is independent in these cases. Once cured of cancer, any new malignant tumor in the same spot would be considered cancer recurrence. Something similar happens with prostatitis. Recurrence does not depend on the time or type of prostatitis. You have recurring prostatitis if you had prostatitis symptoms, improved with therapy, and now the disease is back.
Also, independent from any other factor, when prostatitis comes back, it is chronic prostatitis. It doesn’t matter if your first episode was acute prostatitis. If your symptoms come back, it will be chronic prostatitis.
What causes recurring prostatitis
As noted above, recurring prostatitis is a case of chronic prostatitis. There are different causes of chronic prostatitis, including:
Antibiotic treatment failure
This is the most likely cause of a recurring case of prostatitis. The antibiotics may not be working as they should. The bacteria in question may be resistant to the antibiotics administered by your doctor. You may not have completed the treatment appropriately and contributed to antibiotic resistance. There is antibiotic treatment failure in all of these cases, and the prostate infection comes back after a while.
A secretory dysfunction of the prostate
The prostate is a gland, and prostatic fluid is very important for immunity. It has a substance with an antibacterial effect known as the prostatic antibacterial factor. If your prostate is not synthesizing the right proportion of substances, you may fail to counter bacterial infection. Moreover, this secretory dysfunction also compromises the pH in prostate secretions. It becomes alkaline instead of acid. When this happens, antibiotics can’t reach the prostate due to a chemical gradient problem that blocks their way. They do not reach the gland and do not cure the disease. This is an additional cause of antibiotic treatment failure (3).
Intraprostatic ductal reflux
The prostate is not made to circulate its secretions to the blood, they are mostly secreted during ejaculation. Thus, prostate fluid is usually stagnant, especially in an enlarged prostate. But it is designed to be like that in a healthy prostate, too. However, patients with chronic prostatitis experience urine reflux from the urethra into the prostatic ducts. This urine was in contact with the urethra and came with added bacteria.
The urine also becomes stagnant, and minerals in the urine start to deposit and create prostate stones. These prostatic calculi and the static nature of the secretions create a suitable environment for bacterial growth. This causes recurrent prostate infections because antibiotics do not solve the root cause. Urine will continue entering prostatic ducts. Calculi will continue creating a protected environment for bacteria. And bacteria will continue to thrive, causing a new case of chronic bacterial prostatitis every once in a while (4).
A complication of acute bacterial prostatitis
In some cases, the treatment fails because it does not contemplate certain bacterial prostatitis complications. For example, your prostate could be forming a prostatic abscess. This is a collection of pus in an attempt to enclose the infection and prevent any spread. But a prostatic abscess has a different treatment, and it heals slowly. If you’re not taking the right meds, it won’t heal properly. Moreover, it needs a more prolonged treatment and sometimes surgical drainage. This complication is more common in older adults and immunosuppressed patients (5).
An infection by fungi, protozoans, or viruses
These agents are commonly in chronic nonbacterial prostatitis. They are handled differently and will sometimes be difficult to detect. Some of them trigger recurrent disease. For example, we all know that the herpes virus can be apparently cured on the outside. But then a stressful situation activates the dormant virus, and the disease comes back. Herpes virus, cytomegalovirus, and papillomavirus can infect the prostate and lead to chronic nonbacterial prostatitis. Other agents include mycoplasma or chlamydia trachomatis. In these cases, patients may fall in the category of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) (4).
A neurologic problem or cytokine dysregulation
Another possibility is that you don’t actually have an infection. Instead, you can have a dysregulation of cytokines or a neurologic problem. For example, in autoimmune diseases such as rheumatoid arthritis, your own immune system attacks your joints. Something similar can happen in your prostate, except that it is not as aggressive. You only get an inflamed prostate without an infection. A neurologic problem can also make you feel prostate pain when there’s no reason for it. That’s why all of these causes fall in the category of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) (4).
Patient adherence to the treatment is extremely important in this case. Prostatitis treatment takes a very long time, and some patients are reluctant to continue antibiotics after so long, especially if they stop experiencing symptoms.
We’re familiar with 7 days of antibiotics maximum. Then, we may feel a bit shocked when the doctor prescribes 28 days instead of one week. Treatment started, we feel better after a while and the effects of listening to the doctor’s recommendations and adhering to treatment fade away. Your doctor’s agenda is 28 days of antibiotic therapy, but your plans start to change. You don’t realize that regardless of feeling better, not complying with the treatment leads to treatment failure. That is a recurrent prostate infection.
Worse still, if you were diagnosed with chronic bacterial prostatitis or come back with a recurrent prostate infection, your doctor may recommend a more extended treatment. You could stay up to 6 weeks taking antibiotics. But in week 3 or 5, when the doctor’s office effect fades away and you’re tempted to quit antibiotic treatment; remember the possibility of a recurrent prostate infection if you fail to follow recommendations.
What are the treatment options for a recurrent prostate infection?
When doctors deal with a recurrent prostate infection, they follow treatment protocols of chronic bacterial prostatitis. Even if you were formerly treated as acute bacterial prostatitis, this time, everything changes.
It is a prostate infection, so you also treat it with antibiotics. Depending on how long did you stay asymptomatic, doctors may choose to stay with the last antibiotic or try a new one. They will more likely try with a different antibiotic, mostly if you didn’t stay asymptomatic for long.
In some cases, they might need to try different antibiotics simultaneously. As noted above, your prostate pH changes if you have a prostate fluid abnormality. The same antibiotics won’t work in a prostate with normal fluids as compared to another with fluid abnormalities.
It is also very likely that you will need to keep taking antibiotics for a longer time. 6 weeks is a lot, but you may need more time in some cases. This is because the prostate tissue is particularly difficult to infiltrate with antibiotics.
Reaching a therapeutic level of antibiotics in your prostate can be very challenging and requires full compliance with the treatment. In some cases, intravenous antibiotics will be recommended instead of their oral counterparts. This is because intravenous administration makes treatment easier to monitor.
Another possibility is that you need other medications besides antibiotics. Take proton pump inhibitors, for example, which are very useful to protect your stomach during antibiotic therapy. Nonsteroidal anti-inflammatory drugs will help you relieve pain symptoms and reduce inflammation in your prostate. Your doctor may also consider alpha-blockers, a group of meds that relax your urethra. They are very useful to relieve urinary symptoms (5).
As you can see, there are many options and not a unique path to follow. Your doctor will decide what to do next based on your symptoms, how did you respond to antibiotics last time, your previous compliance with antibiotic therapy, and other variables. He might need additional information about your prostate, especially a prostate fluid sample.
You might need to undergo a prostatic massage for this. This will give your doctor information about your prostate pH and the bacteria causing the problem. With this information, they will know precisely what bacteria they are against and what antibiotics to use.
Ruling out other health issues
Doctors might initially think that your problem was a prostate infection but then find out that you’re a case of nonbacterial prostatitis. Sometimes we need complex studies to rule out this possibility, such as a CT scan to evaluate your nerves and urinary bladder. A cystoscopy may also be performed to evaluate your urinary tract. In some cases, patients require a prostate biopsy. The exams will depend on your particular case, and you can ask your doctor why each one of them is needed (5).
Recurring prostate infections such as recurring prostatitis are difficult to handle. Make sure that you’re seeing a specialized doctor. Only an experienced urologist will determine what to do in your case and the next step to follow.
An infected prostate usually causes prostatitis. It features similar symptoms to benign prostatic hyperplasia. That is a reduction in urine flow and other obstructive symptoms. Additionally, these patients typically report painful urination.
After completing antibiotic treatment, the symptoms may come back. In this case, you will have a recurrent prostate infection, or recurring prostatitis. In a practical way, doctors handle it as chronic bacterial prostatitis. You may need more prolonged treatment, changing your antibiotics, considering additional drugs to control your symptoms, and evaluating your condition with a few tests to guide your treatment.
Patients with recurrent prostate infection (recurring prostatitis) sometimes have repeated urinary tract infections as well. But keep in mind that this type of infection is not as common in males. Thus, you might need studies to assess your prostate problem.
This recurrence is the result of a treatment failure. Not choosing the right antibiotic could be one cause. But you can also contribute to treatment failure if you don’t take antibiotics as prescribed. You may also have a condition that doctors can’t solve with antibiotics or any other treatment. In these cases, symptomatic treatment will be appropriate to find some relief.
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