Prostatitis; acute

Causes and Risks:
Acute prostatitis is caused by a bacterial infection of the prostate gland. Many bacteria are capable of causing prostatitis. Escherichia coli is one of the more common types of infection. E. coli typically is found in the colon. Some sexually-transmitted diseases can cause an acute prostatitis. These include gonorrhea , chlamydia , U. urealyticum, and trichomonas.

E. coli is more often a cause of prostatitis than sexually transmitted diseases. E. coli prostatitis may follow urinary tract infections , urethritis or epididymitis . Prostatitis from a sexually-transmitted disease typically follows sexual contact with an infected partner.

Acute prostatis may also develop as a result of urethral instrumentation (such as catheterization or cystoscope), trauma, bladder outlet obstruction , or an infection elsewhere in the body.

Acute prostatitis often begins with chills and fever associated with lower abdominal discomfort or perineal pain. The person may have burning with urination and, depending on the degree of prostate swelling, a diminished urine stream or difficulty urinating. Bowel movements may increase the abdominal pain and ejaculation may be painful. Prostatitis (especially a STD) may occur in conjunction with epididymitis and/or orchitis in which case symptoms of these conditions may also be present.

Prostatitis is found in approximately 2 out of 10,000 outpatient visits. Increased risk is associated with men age 20 to 35 years old, who have multiple sexual partners, and those who engage in high-risk sexual behaviors (such as lack of condom use or anal intercourse).

Prevention:
Not all types of prostatitis are preventable. Good hand washing after defecating (having a bowel movement) and prior to handling the penis may prevent potential transferral of E. coli organisms from the rectal area to the genito-urinary tract. Those infections that are associated with sexually transmitted diseases can be prevented by practicing safer sex behaviors .

Symptoms:

Additional symptoms that may be associated with this disease:



Signs and Tests:
A physical examination will reveal a prostate that is swollen, firm, warm, and very tender. The physical examination may reveal enlarged and/or tender inguinal lymph nodes (groin area), scrotal swelling and/or tenderness, and a urethral discharge.

Triple-void urine specimens may be collected for urinalysis and urine culture :

  • #1 initial stream
  • #2 mid-stream
  • #3 post (after) prostatic massage by examiner

Note: The health care provider may choose not to perform prostatic massage in an acute condition where the prostate is obviously swollen and tender because massage may potentially spread the infection and cause bacteremia or sepsis (generalized infection in which bacteria are present in the bloodstream, rather than localized to one specific part of the body).

Prostatitis may be present where urinalysis reveals increased WBCs and bacterial growth upon culture of urine #3, or where prostatic secretions contain increased levels of WBCs and more concentrated bacterial growth upon culture.

This disease may also alter the results of the following tests:



Treatment:
Mild cases of acute prostatitis may resolve completely with appropriate treatment.

MEDICATIONS:
Prostatitis is treated with antibiotics. Trimethoprim-sulfamethoxazole and tetracycline derivatives are commonly used. The course of antibiotic therapy is long, frequently 6 to 8 weeks and recurrence is common. In severe cases, broad spectrum intravenous (IV) antibiotics may be required while waiting for prostatic fluid culture results.

Stool softeners (such as colace) may be recommended to reduce the discomfort associated with bowel movements.

SURGERY:
Surgery or urethral instrumentation (urinary catheterization or cystoscopy ) are not recommended in the presence of an acute prostatitis.

OTHER THERAPY:
Frequent and complete urination is recommended to decrease the symptoms of urinary frequency and urgency. Urinary retention, requiring the placement of a suprapubic catheter , may occur as a result of the swollen prostate occluding the urethra.

Warm tub baths or sitz baths may provide some relief of the perineal and lower back pain associated with acute prostatitis.

Preventive measures may reduce symptoms and may prevent recurrence of infection. Cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. The genitals should be cleaned and wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.

DIET:
Increasing the intake of fluids (2000 to 4000 cc per day) may allow frequent urination to flush the bacteria from the bladder and decrease urinary symptoms. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, hot or spicy foods, and caffeine .

MONITORING:
Follow-up should include an examination at completion of antibiotic therapy to ensure that infection is no longer present.

Prognosis:
The outcome for acute prostatitis is usually better than for chronic prostatitis . The majority of men who are diagnosed accurately become symptom-free after treatment.

Complications:
Chronic prostatitis can develop. Urinary retention may occur as a result of the swollen prostate occluding the urethra.

Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms of prostatitis occur.


This is an internal view of the male reproductive system.



This is an illustration of the male urinary tract. The female and male urinary tract are relatively the same except for the length of the urethra. The positioning and relative size of the organs are also shown.