Bowie W R
Department of Medicine, University of British Columbia, Vancouver, Canada.
Med Clin North Am. 1990 Nov;74(6):1543-57. doi: 10.1016/s0025-7125(16)30494-1.
The most important causes of urethritis, and epididymitis in younger men, are C. trachomatis and N. gonorrhoeae. Management of these syndromes requires a thorough sexual history, genital examination, evaluation for objective and laboratory evidence of infection, antimicrobial therapy directed toward the major etiologies, and evaluation and treatment of sexual partners. Treatment of N. gonorrhoeae requires use of a single-dose regimen active against this organism, plus a 7- to 10-day tetracycline regime active against C. trachomatis and nongonococcal urethritis. With recommended regimens, microbiologic failure is infrequent in compliant patients. Recurrent urethritis is frequent, however. The management of patients with persistent or recurrent symptoms requires careful reevaluation of the patient, documentation of urethritis, and re-treatment with antimicrobials if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leukocytes in urethral secretions. Additional treatment beyond this point usually is not indicated, even though a proportion of men will remain symptomatic and some of these will have increased numbers of polymorphonuclear leukocytes in urethral secretions. The most important causes of prostatitis, and epididymitis in older men or men with urethral structural abnormalities, are classical urinary tract pathogens rather than sexually transmitted pathogens. Management of these infections includes documentation of the infection and treatment directed toward the specific pathogen. Men with symptoms of "prostatitis" must be evaluated using both urine and prostatic secretions to document infection and inflammation. The majority of men with such symptoms do not have an infection that can be documented. These men respond poorly to medications. Men with documented chronic bacterial prostatitis require long courses of antimicrobials to effect cure. In some cases, however, the disease is intractable, and chronic suppression with antimicrobials may be necessary.
在年轻男性中，尿道炎和附睾炎的最重要病因是沙眼衣原体和淋病奈瑟菌。这些综合征的管理需要全面的性病史、生殖器检查、评估感染的客观和实验室证据、针对主要病因的抗菌治疗以及性伴侣的评估和治疗。淋病奈瑟菌的治疗需要使用针对该病原体的单剂量方案，外加一个针对沙眼衣原体和非淋菌性尿道炎的7至10天四环素方案。采用推荐方案时，依从性好的患者微生物学治疗失败情况很少见。然而，复发性尿道炎很常见。对持续或复发症状患者的管理需要对患者进行仔细的重新评估、记录尿道炎情况，如果尿道分泌物中培养阳性或多形核白细胞数量增加证明存在尿道炎，则需再次使用抗菌药物治疗。在此之后通常无需进一步治疗，尽管一部分男性仍会有症状，其中一些人尿道分泌物中的多形核白细胞数量会增加。在老年男性或有尿道结构异常的男性中，前列腺炎和附睾炎的最重要病因是典型的尿路病原体而非性传播病原体。这些感染的管理包括记录感染情况并针对特定病原体进行治疗。有“前列腺炎”症状的男性必须同时使用尿液和前列腺分泌物进行评估，以记录感染和炎症情况。大多数有此类症状的男性并无可记录的感染。这些男性对药物反应不佳。有记录的慢性细菌性前列腺炎患者需要长期使用抗菌药物才能治愈。然而，在某些情况下，该病难以治疗，可能需要长期使用抗菌药物进行抑制治疗。
