What is the cause and treatment for prostatic infection?

Q: I am suffering from sensation of passing urine, penile pain and slight burning sensation when semen comes out after a long time. I went to a urologist, but couldn't get any relief. I did a cystoscopy, midstream test and a PSA. All the reports were clear and no infection was found. Right now I feel slightly better. I pass urine at least 8-9 times in a day and experience discomfort between the root of the penis and the scrotum. I have taken all antibiotics prescribed by the doctor, but to no avail. I was prescribed Ciprofloxacin. What test do I need to undergo to cure the root cause? I am suffering from this problem for almost 2 years. Now it is affecting my sexual life. Please advise.

A:Chronic prolonged course of two years, pelvic and penile pain, urinary frequency, painful ejaculation and lately the killed sex - all these indicate the possibility of chronic prostatitis. Differential diagnoses include a bladder or lower ureteric stone, genitourinary tuberculosis and some rare form of bladder cancer (carcinoma in situ) which, I suppose, have already been excluded by your attending Urologist. The ailment was called chronic prostatitis in the past, as it was presumed to be a result of chronic prostatic infection, and no wonder, was being treated with antibiotics. Accumulating evidence has disproved the infective hypothesis, and hence the disease has been renamed Chronic Pelvic Pain Syndrome (CPPS). The patients who improve with antibiotics are, in fact, thought to be the responding to the anti-inflammatory property of antibiotics. There is very little known of the etiology of the disease, and thus the possible treatment list is very long, from antibiotics to anti-inflammatory drugs to vitamins to calcium supplements; each proving to be as ineffective as others. Some medications, which may work in certain patients, are alpha-blockers, antihistaminic, anti-inflammatory drugs and anti androgens. Fortunately, the disease has waxing and waning course, and symptoms may disappear the way these started. Another consolation is that there is no proof that CPPS grows into anything sinister over a long period. Attempt with surgery is usually reserved for older patients for associated bladder outlet obstruction, after the same has been documented with a urodynamic study.