Acute Bacterial Prostatitis
By Julie Chacko, M.D.
• Definition: Bacterial infection of the prostate gland.
• Overview:
· Tends to be diagnosed in younger men.
• Types:
· Acute bacterial prostatitis is one of a number of inflammatory conditions that can affect the prostate. See Chronic Bacterial Prostatitis and Non-bacterial prostatitis as well.
• Symptoms:
· Usually presents with fever, urinary frequency or urgency, pain with ejaculation, discomfort in the perineum (the area between the back of the scrotum and anus), and may have associated general fatigue.
· There may be associated difficulty emptying the bladder which may be perceived due the the irritative symptoms or actual due to obstruction of urinary flow due to the swollen gland.
• Complications:
· Bacteremia (infection spreading into the bloodstream) is a possible complication which, if not treated promptly, can result in sepsis.
· Prostatic abscess can form even when treated with appropriate antibiotics.
• Clinical Findings/signs:
· Fever is generally present.
· The prostate is warm and tender on examination.
· Bloodwork reveals an elevation in the white blood cell count as well as the PSA if it is checked during infection.
· The most common organism is E. Coli and the organism can be cultured from the seminal fluid and usually from the urine as well.
· When the infection has spread to the bloodstream blood cultures will also be positive.
· Imaging is usually not necessary to make the diagnosis though a CT or prostate ultrasound may be ordered if the clinical course warrants further evaluation.
• Treatment:
· Lifestyle: There is no lifestyle modification that can treat acute bacterial prostatitis though using a barrier method during anal intercourse may help reduce infection rates.
· Medication: Antibiotics are the mainstay of treatment. Depending on the severity of infection, admission to the hospital to start IV antibiotics may initially be indicated. The antibiotics are generally taken for at least four to six weeks to ensure complete eradication of the infection. Anti-inflammatories and fever reducing agents such as Tylenol* may alleviate symptoms. Stool softeners may be helpful as well.
· Surgery: If the patient is unable to urinate, a tube may be placed through the abdomen directly into the bladder (called a suprapubic tube). Otherwise, surgical intervention in rarely indicated unless a prostatic abscess forms.
• Prognosis: Prognosis tends to be good if caught early.
Posted on April 16, 2009
