The answer is D. Prostatitis
Prostatitis, particularly chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is the most likely diagnosis for this patient, given the chronicity of his symptoms, including dysuria, urinary frequency, urgency, and perineal pain. The mild tenderness upon prostate palpation further supports this diagnosis. CP/CPPS is a common urological diagnosis in men and can present with a wide range of symptoms, including those related to urinary and pelvic discomfort without evidence of a urinary tract infection.
Explanation for Incorrect Answers:
A. Cystitis – While cystitis can cause dysuria, frequency, and urgency, it is less likely to cause chronic perineal pain and is more common in females. Males with cystitis may have underlying issues such as bladder outlet obstruction or an anatomical abnormality.
B. Gonococcal urethritis – This condition typically presents with acute symptoms, including purulent urethral discharge, which was not reported by the patient. It is also associated with recent sexual contacts, which the patient denies.
C. Epididymitis – Epididymitis usually presents with acute scrotal pain, swelling, and often fever, which are not described in this vignette. The patient’s symptoms are more consistent with prostatitis.
E. Urolithiasis – While urolithiasis (kidney stones) can cause dysuria and frequency, it is more commonly associated with acute, severe flank pain that may radiate to the groin, not chronic perineal pain.
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