Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Young Adult Male

Case at a Glance

A 31-year-old male presents with recurrent lower urinary tract symptoms including frequency, pelvic discomfort, and intermittent genital pain, with negative urinalysis and STI screening.

Patient's Story

The patient reports a one-month history of urinary frequency that worsens with physical activity and improves when resting in seated or supine positions. He describes lower abdominal discomfort that triggers urinary urgency when palpated, intermittent penile tip irritation, and episodic dull testicular pain. He denies urethral discharge, genital lesions, or significant nocturia. Post-void dribbling is present, but he maintains normal urinary stream without incontinence. The patient experienced similar symptoms three years prior that resolved with a 14-day course of ciprofloxacin.

Initial Assessment

Physical examination revealed suprapubic tenderness on palpation. Urinalysis showed no abnormalities including absence of leukocytes, nitrites, or bacteria. Urine culture was negative. STI screening for gonorrhea and chlamydia returned negative results.

The Diagnostic Journey

Given the constellation of symptoms - urinary frequency, pelvic pain, and negative infectious workup - along with the history of similar episodes, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) was considered as the primary diagnosis. The previous response to antibiotic therapy suggested possible bacterial involvement in prior episodes.

Final Diagnosis

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS), Category IIIA (inflammatory) vs Category IIIB (non-inflammatory)

Treatment Plan

Initial management included alpha-blocker therapy, anti-inflammatory medications, and pelvic floor physiotherapy. Given the previous positive response to antibiotics, a trial of fluoroquinolone therapy was considered for potential bacterial involvement.

Outcome and Follow-up

Patient was scheduled for follow-up in 4-6 weeks to assess treatment response. Long-term management strategies including stress reduction, dietary modifications, and potential multimodal therapy were discussed for symptom control and prevention of recurrence.