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

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:

• Bladder outlet obstruction
• Catheterization or cystoscopy
• Prostate biopsy
• Trauma

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.

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

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:

1. Initial stream
2. Mid-stream
3. 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

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.

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.

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

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

Not all types of prostatitis are preventable.

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

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.