Prostatitis is inflammation of the prostate and includes acute bacterial infection, chronic bacterial infection and the far more common chronic pelvic pain syndrome without a clear infection. Acute bacterial prostatitis is a serious infection, usually from gut bacteria such as E. coli, that can lead to sepsis.
Key symptoms
- Acute type: fever, chills and body aches
- Burning urination, urgency, frequency or a weak stream
- Pain in the perineum, lower back, rectum or with ejaculation
- Chronic type: pelvic or genital pain for 3 months or more with urinary symptoms
What you find on exam
- Temperature, heart rate and blood pressure to look for sepsis
- Gentle rectal exam: tender, warm, swollen prostate in acute cases; no vigorous massage
- Suprapubic tenderness or a palpable bladder from retention
- Check the testes and epididymis for tenderness
Tests
- Urinalysis and urine culture before antibiotics
- Blood count and blood cultures if febrile or ill
- Gonorrhea and chlamydia testing in sexually active men under 35
- Post-void residual; ultrasound or CT if an abscess is suspected
Treatment basics
- Acute, well enough for home: ciprofloxacin, levofloxacin or trimethoprim-sulfamethoxazole for 2 to 4 weeks
- Septic or very ill: admit and give IV antibiotics such as ceftriaxone or piperacillin-tazobactam
- Retention: suprapubic catheter or a careful small urethral catheter
- Chronic bacterial: 4 to 6 weeks of antibiotics
- Chronic pelvic pain: alpha blocker such as tamsulosin, NSAIDs and pelvic floor physical therapy
Red flags
- Fever with low blood pressure or confusion (sepsis)
- Inability to urinate
- Fever that persists after 48 hours of antibiotics, suggesting an abscess
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.