For a male patient experiencing recurrent UTIs with pain during ejaculation, which treatment is likely appropriate?

In cases of recurrent urinary tract infections (UTIs) accompanied by pain during ejaculation, it is essential to consider a possible underlying urological issue, such as prostatitis. Fluoroquinolones, such as ciprofloxacin or levofloxacin, are commonly used to treat prostatitis due to their excellent penetration into the prostate tissue and effectiveness against a broad range of bacteria, including common pathogens involved in UTIs.

A 6-week course of fluoroquinolones is indicated particularly when prostatitis is suspected, as it allows for adequate duration of therapy to target the bacteria residing within the prostate and helps address inflammation. The use of longer antibiotic courses is often necessary because the infection might not clear quickly due to the bacterial reservoir in the prostate.

Short courses of trimethoprim typically address uncomplicated UTIs but may not be sufficient for prostatitis or recurrent cases where more aggressive treatment is warranted. Long-term prophylactic antibiotics can be considered in recurrent infections but are generally not the first-line treatment when active infection or prostatitis is indicated. An immediate surgical consult would not be the first step in the management of recurrent UTIs unless there are specific signs of urinary obstruction or other surgical conditions present, which is typically addressed after conservative medical management fails