Clinical prevention and comprehensive treatment plan for acute and chronic prostatitis and trichomonal infection

Once you have chronic prostatitis, it is unrealistic to expect to be cured by some magic cure. Instead, you should adhere to comprehensive prevention and treatment. (1) Strengthen prevention: Even if you have spent a lot of effort on treatment, if you ignore the prevention of the cause, all the treatment measures will be in vain. Therefore, while treating, you should strengthen personal hygiene, pay attention to the hygiene of sexual organs, restrain your desires, avoid drinking alcohol, eat less or no spicy food, treat the infection foci in other parts of the body in time, keep warm and dry and participate in physical exercise. These are measures that cannot be ignored. (2) Prostate massage: The purpose is to relieve the stagnation of prostatic fluid and let the prostatic fluid with bacteria be discharged from the body in time, which helps to reduce the inflammation of the prostate. At the same time, prostatic fluid can be taken for testing to observe the effect. Generally, massage once a week for 4 to 8 consecutive times. (3) Hot water sitz bath: Sitz bath in hot water at 42℃~43℃ for 10 to 15 minutes each time, 1 to 2 times a day, can accelerate the blood circulation of the prostate and help the inflammation subside. You should empty your bladder and bowels before sitz bath. Note that the water should not be too hot and the sitz bath time should not be too long. (4) Physical therapy: including ultrasound therapy and magnetic acupoint therapy. One or two types can be used depending on the hospital. (5) Drug therapy: There are not many bactericidal drugs that can penetrate the prostate. According to literature reports, the most effective drugs are erythromycin and compound sulfamethoxazole. Compound sulfamethoxazole, 2 tablets each time, twice a day, orally. Erythromycin, 0.3 grams each time, four times a day, orally. In addition, chloramphenicol, cephalosporin, doxycycline, ampicillin, kanamycin, tetracycline and other drugs can also treat chronic prostatitis. (6) Traditional Chinese medicine treatment: The treatment principle is to clear heat and detoxify and promote blood circulation and remove blood stasis. Commonly used prescription: 12 grams of danshen, 12 grams of red peony root, 15 grams of safflower, 15 grams of peach kernel, 15 grams of eupatorium, 15 grams of patrinia. Decocted in water and taken twice a day, 1 dose per day. Use for 10 to 14 days.

Trichomonal prostatitis is transmitted sexually from a woman with trichomonal vaginitis. Its clinical symptoms are largely the same as bacterial prostatitis, making differential diagnosis very difficult. Common clinical symptoms include terminal urinary pain, dull perineal pain, and rectal discomfort. Acute attacks may also present with urinary tract irritation symptoms such as urinary frequency, urgency, and dysuria, as well as systemic symptoms such as chills and fever. A milky discharge may be observed at the urethral opening. Detection of trichomonas is generally difficult; even with microscopic examination of fresh urine or prostatic fluid samples collected in an outpatient setting, multiple examinations are often required to detect the worms. Furthermore, prostatic massage for fluid collection often causes varying degrees of pain and discomfort for patients, making repeated procedures difficult. Based on clinical experience, when encountering patients with prostatitis symptoms who do not respond well to antibiotic treatment, inquiring about their partner's history of vaginal trichomoniasis is very helpful for diagnosis. This is because almost all male trichomonas infections are transmitted from their partners, while vaginal trichomoniasis testing is both convenient and accurate for women. Because trichomoniasis can be transmitted sexually, it often leads to prolonged and difficult-to-cure infections. Therefore, whether the man is diagnosed with trichomoniasis directly or his partner has trichomonal vaginitis, both partners should take metronidazole (Flagyl) orally for treatment. If used correctly under the guidance of a doctor, significant therapeutic effects can be achieved. Finally, patients with trichomonal prostatitis often have concurrent bacterial infections, and this factor should not be overlooked during treatment. After the trichomoniasis is cured, antibiotic treatment should continue for a period of time. Ideally, effective antibiotics should be selected based on prostate fluid bacterial culture and drug sensitivity testing, which will ensure a more certain outcome. Other types of prostatitis, such as fungal, viral, and chlamydial infections, require specific diagnostic methods. For example, in chlamydial infection, a large number of chlamydia lesions can be found attached to the surface of the prostate gland.

Acute prostatitis is an acute inflammation of the prostate gland and ducts caused by bacteria, viruses, and other pathogens or their toxins. It can resolve spontaneously, heal with treatment, or become chronic. It is often accompanied by seminal vesiculitis or acute epididymitis. Fatigue, colds, excessive alcohol consumption, excessive sexual activity, perineal injury, and hemorrhoid injections can all induce acute bacterial prostatitis. Gram-negative bacilli are the most common pathogens. Coccal infections often originate from purulent lesions of the skin, or infections of the tonsils, teeth, and respiratory system. Inflammatory lesions of the prostate can be localized or diffuse, with congestion, edema, and serous, fibrinous, bloody, or purulent exudate in the gland; in severe cases, localized or multiple prostatic abscesses may form. Clinical features include sudden fever, chills, back and perineal pain, accompanied by urinary frequency, urgency, dysuria, and difficulty urinating; nocturia, general malaise, and joint and muscle pain. Not all of the above symptoms will appear; some cases initially present only with fever and urethral burning sensation, which may be mistaken for a cold. If the infection is hemorrhagic, systemic symptoms will occur first; if it is a direct spread, local symptoms will appear first. Severe congestion and edema, or abscess formation, can lead to acute urinary retention. Digital rectal examination may reveal a swollen and tender prostate, but the surface is smooth and regular. Redness and tenderness in the perineum often indicate severe prostatitis or abscess formation. Treatment for acute prostatitis includes systemic and local treatment. Systemic treatment requires bed rest, stool softening, urine alkalization, and the use of antispasmodics, sulfonamides, and antibiotics. Sulfamethoxazole with a sulfonamide potentiator achieves high concentrations in prostate tissue and secretions and is often the first-line drug. If body temperature is high and white blood cell count is elevated, intravenous administration is preferred. For example, 8 million units of penicillin can be administered intravenously twice daily; ampicillin or cephalosporins can also be administered intravenously until the body temperature returns to normal, then switched to intramuscular injections for one week. Local treatment involves early use of hot sitz baths or diathermy, both of which help dissipate inflammation and prevent abscess formation. If acute urinary retention occurs, a small catheter may be left in place for a short period. If an abscess forms, it should be incised and drained.