Health Encyclopedia

Prostatitis - acute

Definition

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

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 (UTI) 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 after:

Epididymitis
Urethritis
Urinary tract infections

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

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 together with 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 include the following:

Abdominal pain (above the pubic bone)
Burning with urination
Chills
Fever
Inability to completely empty the bladder (urinary retention)
Low back pain
Pain and burning with urination (dysuria)
Pain with bowel movement
Pain with ejaculation
Pain in the area between the genitals and the 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 the urethra
Enlarged or tender lymph nodes in the groin
Swollen or tender scrotum
Warm, soft, swollen, or tender prostate

Triple-void urine specimens may be collected for urinalysis and urine culture. Specimins will be taken:

Initial stream
Mid-stream
After a prostate massage by the health care provider

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.

Urinalysis and examination of discharge from the prostate may show increased white blood cells (WBCs) and bacteria.

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), fluoroquinolones (Floxin or Cipro), or tetracycline derivatives 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 common for the infection to return, 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 tightens the urethra and makes it diffcult to empty the bladder.
Warm baths may relieve some of the perineal and lower back pain.

DIET:

Avoid substances that irritate the 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 the 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 are likely to have the infection come back, and to develop chronic prostatitis.

Complications

Chronic prostatitis or prostatic abscess can develop. Urinary retention may occur as the swollen prostate tightens 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

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.

Review Date:9/7/2008
Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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