Chronic Bacterial Prostatitis Clinical Presentation

  • Author: Sunil K Ahuja, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Oct 4, 2011
 

History

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. A symptom index for CBP appears below.

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

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

Joe D Mobley III, MD, MPH  Fellow, Department of Female Urology and Voiding Dysfunction, Cleveland Clinic Florida

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, and 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: Medscape Salary Employment

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

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, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

References

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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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