In the entire cohort of 4,758,039 male users of the VA health care system during 2003, 6,379 (0.13%) men had diagnosis of infectious/acute prostatitis and 126,731 (2.7%) men had a diagnosis of urinary tract infection. The 131,818 men with either a diagnosis of infectious/acute prostatitis or a diagnosis of a urinary tract infection were excluded from all of the other results leaving 4,626,221 men as the denominator. In 2003, 23,037 (0.50%) had a diagnosis consistent with chronic pelvic pain syndrome meaning they had a diagnosis of prostatitis with no corresponding diagnosis of either urinary tract infection or infectious/acute prostatitis (). Distributions of diagnoses were similar in each of the four prior years (data not shown).
Study Patient Flow Chart for FY2003. A similar process of inclusion and exclusion was conducted for the years 1999, 2000, and 2001 and 2002.
Chronic pelvic pain syndrome prevalence varied by age, number of comorbidities, and race/ethnicity. Men with chronic pelvic pain syndrome were substantially more likely to be prescribed an antibiotic, particularly a fluoroquinolone, during the same year as their diagnosis than men without chronic pelvic pain syndrome. Among men with a diagnosis of chronic pelvic pain syndrome in 2003, 49% received a prescription for a fluoroquinolone within the same year as compared to only 5% of men without chronic pelvic pain syndrome despite the exclusion of men with infectious/acute prostatitis or urinary tract infection (). These associations were similar in each of the four prior years (data not shown).
Fiscal Year 2003 Cohort Characteristics of Male VA Users Excluding Men with a Diagnosis of Infectious/Acute Prostatitis or Urinary Tract Infection
In unadjusted models, men with chronic pelvic pain syndrome had a ten-fold higher prevalence of fluoroquinolone use (PR=10.3; 95% CI 10.1 to 10.4) in 2003. This association was only modestly attenuated by adjustment for age group, race/ethnicity and number of comorbidities (PR=7.9; 95% CI 7.8 to 8.0). From 1999 through 2003, an estimated 32,562 men with a diagnosis of chronic pelvic pain syndrome received a fluoroquinolone, attributable to their chronic pelvic pain syndrome diagnosis, even though they lacked a diagnosis of infectious/acute prostatitis or urinary tract infection during the corresponding year (). While the adjusted percentage attributable risk for all fluoroquinolone use remained stable over time ranging from 3.54% to 3.30% per year the total number of men who were estimated to have been prescribed a fluoroquinolone to treat their chronic pelvic pain syndrome increased 50% from 5,091 in 1999 to 7,635 in 2003 due to the larger number of men receiving care at VHA and the increased use of fluoroquinolones.
Association between Chronic Pelvic Pain Syndrome and Fluoroquinolone Use among VA Users Excluding Men with a Diagnosis of Infectious/Acute Prostatitis or Urinary Tract Infection
Men with a diagnosis of chronic pelvic pain syndrome were also more likely to have been prescribed other classes of antibiotics (PR=3.57 95% CI; 3.51, 3.63) independent of age, race/ethnicity and number of comorbid conditions (). Over the five year period, we estimated 14,153 men were prescribed an antibiotic other than a fluoroquinolone to treat their chronic pelvic pain syndrome.
Association between Chronic Pelvic Pain Syndrome and Antibiotic Prescriptions among VA Users Excluding Men with a Diagnosis of Infectious/Acute Prostatitis or Urinary Tract Infection and Excluding Men with a Fluoroquinolone Prescription
Secondary Analysis Comparing Infectious/Acute Prostatitis to Chronic Pelvic pain Syndrome
When we included all FY2003 male VHA users with a diagnosis of prostatitis (n=34,003), regardless of whether or not it was infectious/acute, we found 28,124 men (0.6% of all VHA users who did not have a diagnosis of urinary tract infection) had at least one diagnosis of prostatitis during FY2003. Nearly 82% (n=23,037) of these men with prostatitis met our diagnostic criteria for chronic pelvic pain syndrome. The multivariable-adjusted prevalence ratios for fluoroquinolone prescriptions were similar in men with infectious/acute prostatitis and men with chronic pelvic pain syndrome (PR of 8.60 and 8.66, respectively) compared to men with no prostatitis diagnosis. The observation was similar for all of the years (data not shown).