Chronic Bacterial Prostatitis Clinical Presentation
- Author: Sunil K Ahuja, MD; Chief Editor: Edward David Kim, MD, FACS more...
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.
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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