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Chronic Bacterial Prostatitis Clinical Presentation

  • Author: Sunil K Ahuja, MD; Chief Editor: Edward David Kim, MD, FACS  more...
Updated: Feb 29, 2016


Patients with chronic bacterial prostatitis (CBP) often present with myriad subjective complaints. Only a few of these complaints offer diagnostic clues for CBP because the complaints are often not of an unusual nature and are not specific for CBP.

Genitourinary pain occurs in the perineal area, penile tip, testicles, rectum, lower abdomen, and back. Fevers and chills are uncommon.

Relapsing urinary tract infections, interspersed with asymptomatic periods, are common in persons with CBP. Patients can also have irritative or obstructive urologic symptoms, such as frequency, urgency, dysuria, decreased force of the urinary stream, nocturia, and postvoid dribbling.

Other symptoms include a clear to milky urethral discharge, ejaculatory pain, hematospermia, and sexual dysfunction.[14] A symptom index for CBP appears below.

Chronic Bacterial Prostatitis. US National Institu Chronic Bacterial Prostatitis. US National Institutes of Health chronic prostatitis symptom index.

Physical Examination

While chronic bacterial prostatitis (CBP) may be associated with symptoms of perineal, scrotal, and low back discomfort, the physical examination findings are typically normal. The classic presentation in a symptomatic patient is an enlarged, soft, or boggy gland that is moderately to severely tender upon palpation.

In contrast, acute bacterial prostatitis is characterized by a very tender, warm, swollen, firm gland. When acute bacterial prostatitis is suspected, prostate massage should be avoided because of the risk of causing bacteremia.

In some cases of CBP, an examiner is able to palpate prostatic stones. Because stones can be a nidus for recurrent infections, they may offer a significant clue to the cause of the recurrences. However, prostatic calculi are rarely palpable on prostate examination because of their location, which is typically deep within the prostate gland.

Contributor Information and Disclosures

Sunil K Ahuja, MD Department of Urology, Kaiser Permanente San Jose Medical Center

Sunil K Ahuja, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.


Joe D Mobley, III, MD, MPH Urologist, Kentucky Lake Urology Clinic

Joe D Mobley, III, MD, MPH is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Endourological Society, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

  1. Hung SC, Lai SW, Tsai PY, Chen PC, Wu HC, Lin WH, et al. Synergistic interaction of benign prostatic hyperplasia and prostatitis on prostate cancer risk. Br J Cancer. 2013 Mar 14. 108(9):1778-83. [Medline]. [Full Text].

  2. Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006. 57:195-206. [Medline].

  3. Dennis LK, Lynch CF, Torner JC. Epidemiologic association between prostatitis and prostate cancer. Urology. 2002 Jul. 60(1):78-83. [Medline].

  4. Roberts RO, Bergstralh EJ, Bass SE, Lieber MM, Jacobsen SJ. Prostatitis as a risk factor for prostate cancer. Epidemiology. 2004 Jan. 15(1):93-9. [Medline].

  5. NIH Summary Statement. NIDDK Workshop on Chronic Prostatitis, Bethesda, Md. December 1995.

  6. Wagenlehner FM, Naber KG. Fluoroquinolone antimicrobial agents in the treatment of prostatitis and recurrent urinary tract infections in men. Curr Urol Rep. 2004 Aug. 5(4):309-16. [Medline].

  7. Pontari MA. Etiology of chronic prostatitis/chronic pelvic pain syndrome: psychoimmunoneurendocrine dysfunction (PINE syndrome) or just a really bad infection?. World J Urol. 2013 Apr 12. [Medline].

  8. Weidner W, Diemer T, Huwe P, Rainer H, Ludwig M. The role of Chlamydia trachomatis in prostatitis. Int J Antimicrob Agents. 2002 Jun. 19(6):466-70. [Medline].

  9. Wiygul RD. Prostatitis: epidemiology of inflammation. Curr Urol Rep. 2005 Jul. 6(4):282-9. [Medline].

  10. McNaughton Collins M, Pontari MA, O'Leary MP, Calhoun EA, Santanna J, Landis JR, et al. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med. Oct/2001. 16(10):656-62. [Medline].

  11. Magri V, Perletti G, Montanari E, Marras E, Chiaffarino F, Parazzini F. Chronic prostatitis and erectile dysfunction: results from a cross-sectional study. Arch Ital Urol Androl. 2008 Dec. 80(4):172-5. [Medline].

  12. Cai T, Pisano F, Magri V, Verze P, Mondaini N, D'Elia C, et al. Chlamydia trachomatis Infection Is Related to Premature Ejaculation in Chronic Prostatitis Patients: Results from a Cross-Sectional Study. J Sex Med. 2014 Sep 25. [Medline].

  13. Vicari LO, Castiglione R, Salemi M, Vicari BO, Mazzarino MC, Vicari E. Effect of levofloxacin treatment on semen hyperviscosity in chronic bacterial prostatitis patients. Andrologia. 2015 Aug 10. [Medline].

  14. Tran CN, Shoskes DA. Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome. World J Urol. 2013 Apr 12. [Medline].

  15. Budía A, Luis Palmero J, Broseta E, Tejadillos S, Benedicto A, Queipo JA, et al. Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method. Scand J Urol Nephrol. 2006. 40(4):326-31. [Medline].

  16. Nickel JC, Shoskes D, Wang Y, Alexander RB, Fowler JE Jr, Zeitlin S, et al. How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?. J Urol. 2006 Jul. 176(1):119-24. [Medline].

  17. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. 1968 Mar. 5(5):492-518. [Medline].

  18. Magri V, Wagenlehner FM, Montanari E, Marras E, Orlandi V, Restelli A, et al. Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications. Asian J Androl. 2009 Jul. 11(4):461-77. [Medline].

  19. Gill BC, Shoskes DA. Bacterial prostatitis. Curr Opin Infect Dis. 2016 Feb. 29 (1):86-91. [Medline].

  20. Herati AS, Moldwin RM. Alternative therapies in the management of chronic prostatitis/chronic pelvic pain syndrome. World J Urol. 2013 Jun 6. [Medline].

  21. Grayson ML, Macesic N, Trevillyan J, Ellis AG, Zeglinski PT, Hewitt NH, et al. Fosfomycin for Treatment of Prostatitis: New Tricks for Old Dogs. Clin Infect Dis. 2015 Oct 1. 61 (7):1141-3. [Medline].

  22. Cunha BA, Gran A, Raza M. Persistent extended-spectrum β-lactamase-positive Escherichia coli chronic prostatitis successfully treated with a combination of fosfomycin and doxycycline. Int J Antimicrob Agents. 2015 Apr. 45 (4):427-9. [Medline].

  23. Los-Arcos I, Pigrau C, Rodríguez-Pardo D, Fernández-Hidalgo N, Andreu A, Larrosa N, et al. Fosfomycin-tromethamine long-term oral therapy for difficult-to-treat chronic bacterial prostatitis. Antimicrob Agents Chemother. 2015 Dec 14. [Medline].

  24. Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA. 2011 Jan 5. 305(1):78-86. [Medline].

  25. Shoskes DA, Thomas KD, Gomez E. Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience. J Urol. 2005 Feb. 173(2):474-7. [Medline].

  26. Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. 2004 Jan. 171(1):284-8. [Medline].

  27. Falahatkar S, Shahab E, Gholamjani Moghaddam K, Kazemnezhad E. Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results of a Prospective Pilot Double-Blind and Randomized Placebo-Controlled study. BJU Int. 2014 Oct 13. [Medline].

  28. Meares ET. Chronic bacterial prostatitis: role of transurethral prostatectomy (TURP) in therapy. Schmiedt E, Alken JE, Bauer HW. Therapy of prostatitis. Munich, Germany: Zuckerschwerdt Verlag; 1986. 193-197.

  29. Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009. 69(1):71-84. [Medline].

  30. Chung SD, Lin HC. Association between Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Anxiety Disorder: A Population-Based Study. PLoS One. 2013. 8(5):e64630. [Medline]. [Full Text].

Bacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.
Chronic Bacterial Prostatitis. US National Institutes of Health chronic prostatitis symptom index.
A nonspecific, mixed inflammatory infiltrate that consists of lymphocytes, plasma cells, and histiocytes is typical in chronic bacterial prostatitis.
Urine culture with greater than 100,000 colony-forming units (CFU) of Escherichia coli, the most common pathogen in acute and chronic prostatitis. Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture.
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