Prostatitis - bacterial acute

Definition

Acute prostatitis is swelling and irritation (inflammation or infection) of the prostate gland that develops rapidly.

Causes, incidence, and risk factors

Acute prostatitis is usually caused by a bacterial infection of the prostate gland. Any bacteria that can cause a urinary tract infection can cause acute bacterial prostatitis, including:

• Enterococci
• Escherichia coli
• Klebsiella pneumonia
• Proteus mirabilis
• Pseudomonas aeruginosa
• Staphylococcus aureus

Some sexually transmitted diseases (STDs) can cause acute prostatitis, typically in men younger than age 35. These STDs include:

• Chlamydia
• Gonorrhea
• Trichomonas
• Ureaplasma urealyticum

Prostatitis from an STD usually comes soon after sexual contact with an infected partner.

In men older than age 35, E. coli and other common bacteria typically cause prostatitis. E. coli prostatitis may occur spontaneously or after:

• Epididymitis
• Urethritis
• Urinary tract infections

Acute prostatitis may also develop from problems involving the urethra or prostate, such as:

• Bladder outlet obstruction
• Catheterization or cystoscopy
• Prostate biopsy
• Trauma
• Phimosis
• Anal (rectal) intercourse
• Transurethral surgeries

Prostatitis is rare in young boys. Men ages 20 - 35 who have multiple sexual partners are at an increased risk. Also at high risk are those who engage in anal intercourse, especially without using condoms.

Men age 50 or older who have an enlarged prostate (benign prostatic hyperplasia) are at increased risk for prostatitis due to their risk of urinary tract infection.

Symptoms

Prostatitis may occur with an infection in or around the testicles (epididymitis or orchitis), especially if it was caused by an STD. In this case, there will also be symptoms of the other condition.

Symptoms of acute prostatitis are more likely to start quickly and cause greater discomfort. They may include the following:

• Abdominal pain (usually right above the pubic bone)
• Burning with urination (dysuria)
• Fever, chills, flush
• Inability to completely empty the bladder (urinary retention)
• Low back pain
• Pain with urination (dysuria)
• Pain with bowel movement
• Pain with ejaculation
• Pain in the area between the genitals and anus (perineal pain)

Other symptoms that may occur with this condition:

• Blood in the semen
• Blood in the urine
• Decreased force of urinary stream
• Difficulty urinating
• Foul-smelling urine
• Increased urinary frequency or urgency
• Testicle pain

Signs and tests

During a physical examination, your health care provider may find the following signs:

• Discharge from your urethra
• Enlarged or tender lymph nodes in your groin
• Swollen or tender scrotum
• Warm, soft, swollen, or tender prostate

Urine specimens may be collected for urinalysis and urine culture.

Examination of the discharge from the prostate may show increased white blood cells and bacteria.

Note: Your health care provider may choose not to perform a prostate massage if the prostate is obviously swollen and tender. Massage may spread the infection and cause bacteremia or sepsis. These are potentially life-threatening infections in which bacteria are in the bloodstream, rather than in just one part of the body.

Acute prostatitis may also affect the results of the following tests:

• Complete blood count (CBC)
• Prostate-specific antigen (PSA)
• Semen analysis

Treatment

Most cases of acute prostatitis clear up completely with medication and slight changes to the diet and behavior.

MEDICATIONS:

• Antibiotics, most often trimethoprim-sulfamethoxazole (Bactrim or Septra), fluoroquinolones (Floxin or Cipro), tetracycline or a tetracycline derivative such as doxycycline -- for at least 4 weeks
• A shot of ceftriaxone followed by a 7-day course of doxycycline (for men with prostatitis caused by an STD)
• A hospital stay and antibiotics given through a vein (IV) (for severe cases)

Because it is possible for the infection to relapse, some health care providers recommend even longer courses of medication -- 6 to 8 weeks -- to get rid of the infection.

Stool softeners may reduce the discomfort that occurs with bowel movements.

SURGERY:

Surgery, urinary catheterization, or cystoscopy are not recommended for patients with acute prostatitis.

OTHER THERAPY:

• Urinate often and completely to decrease the symptoms of urinary frequency and urgency.
• A suprapubic catheter (a drain that empties the bladder through the abdomen) may be needed if the swollen prostate makes it diffcult to empty your bladder.
• Warm baths may relieve some of your perineal and lower back pain.

DIET:

• Avoid substances that irritate your bladder, such as alcohol, caffeinated food and beverages, citrus juices, and hot or spicy foods.
• Increase fluid intake (64 - 128 ounces per day) to urinate often and help flush bacteria from your bladder.

MONITORING:

After you finish antibiotic treatment, get examined by your health care provider to make sure the infection is gone.

Expectations (prognosis)

Most men who are accurately diagnosed with acute prostatitis become symptom-free after treatment.

Patients who have had acute prostatitis may have the infection come back or develop chronic prostatitis.

Complications

Chronic prostatitis or prostatic abscess can develop. Urinary retention may occur as the swollen prostate presses on (compresses) the urethra.

Calling your health care provider

Call your health care provider if you have symptoms of prostatitis.

Prevention

Not all types of prostatitis are preventable.

You can prevent infections caused by STDs by practicing safer-sex behaviors.

References

Nickel JC. Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 9.

Barry MJ, McNaughton-Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 130.