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Am Fam Physician. 1999;59(2):439-440

Osteitis pubis is a disorder of the pubic symphysis. Andrews and Carek describe a case report and review the features and diagnosis of this disorder.

The differential diagnosis of pain in the pubic symphysis includes muscle strain, prostatitis, orchitis, arthritis, fracture and osteitis pubis. Other causes include ankylosing spondylitis, Reiter syndrome, urolithiasis and hyperparathyroidism. Osteitis pubis was first described in 1924 by a urologist who noted the condition in patients who had undergone suprapubic surgery. It has subsequently been diagnosed in athletes and in patients who have had urologic or gynecologic surgery.

There is some speculation that osteitis pubis may be caused by trauma or infection. However, radiographic evidence does not indicate avulsion or other trauma to the pubis. Some patients describe localized pain about one month after surgery, and these patients may be found to have infection with Pseudomonas aeruginosa (most commonly), Escherichia coli or Staphylococcus aureus. In some cases of infection the leukocyte count is normal, the erythrocyte sedimentation rate is only slightly increased and blood cultures are negative. Bone biopsy may be required to determine the organism involved.

Usually, osteitis pubis is considered to be an inflammatory condition. It is self-limited and occurs more often in men who are in their 20s or 30s. It may cause pain localized to the pubic, groin or abdominal areas. The patient may experience pain with activity. This pain may occur in the perineal, testicular, suprapubic or inguinal areas. Patients may also experience postejaculatory scrotal or perineal pain. Range of motion may be decreased in one or both hips.

Plain films of the pubis may be normal or may show sclerosis and irregular cortical margins. Radionuclide studies will show unilateral uptake of the pubic symphysis.

Osteitis pubis can be treated with rest, ice, physical therapy and nonsteroidal anti-inflammatory medications.After the initial treatment, efforts should be made to strengthen hip flexors and pelvic muscles. It generally takes about three to six months for patients to resume a premorbid functioning level. Osteitis pubis recurs in approximately 25 percent of patients.

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