Sections

Prostatitis

Presentation

History

Patients with acute bacterial prostatitis may present with the following^[2]:

Fever
Chills
Malaise
Arthralgias
Myalgias
Perineal/prostatic pain
Dysuria
Obstructive urinary tract symptoms, including frequency, urgency, dysuria, nocturia, hesitancy, weak stream, and incomplete voiding
Low back pain
Low abdominal pain
Spontaneous urethral discharge
History of sclerotherapy for rectal prolapse

Patients with chronic bacterial prostatitis typically have no systemic symptoms. Instead, these patients may present with the following^[31]:

Intermittent dysuria
Intermittent obstructive urinary tract symptoms
Recurrent urinary tract infections^[21]

Patients with chronic prostatitis and chronic pelvic pain syndrome may present with the following^[32]:

Pelvic pain or discomfort, including perineal, suprapubic, coccygeal, rectal, urethral, and testicular/scrotal pain for more than 3 of the previous 6 months without documented urinary tract infections from uropathogens^[21]
Obstructive urinary tract symptoms, including frequency, dysuria, and incomplete voiding
Ejaculatory pain
Erectile dysfunction

Asymptomatic inflammatory prostatitis by definition produces no symptoms.

Consider a diagnosis of sexually transmitted prostatitis in sexually active adolescents.

Do not overlook the prostate gland when searching for a source of sepsis in patients with diabetes mellitus, patients on dialysis for chronic renal failure, patients who are immunocompromised, and postsurgical patients who have had urethral instrumentation. In all those settings, prostatitis can lead to urosepsis.

Physical Examination

Of importance, the physical examination findings, especially the rectal examination, are not specific for each diagnostic category of prostatitis. However, the examination in patients with acute bacterial prostatitis may reveal the following:

Tender, nodular, hot, boggy, or normal-feeling gland on digital rectal examination
Suprapubic abdominal tenderness
Enlarged tender bladder due to urinary retention

Avoid prostatic massage in patients with acute bacterial prostatitis.

Physical examination in patients with chronic bacterial prostatitis may reveal the following:

Normal examination findings between acute episodes
Tender, nodular, or normal gland on digital rectal examination
Suprapubic tenderness during acute episodes

Physical examination in patients with chronic prostatitis and chronic pelvic pain syndrome may reveal the following:

Mildly tender or normal prostate on digital rectal examination
Tight anal sphincter on digital rectal examination

Digital rectal examination in patients with asymptomatic inflammatory prostatitis may reveal a normal prostate.

Complications

Potential complications of prostatitis include the following:

Bladder outlet obstruction/urinary retention
Abscess - Typically in immunocompromised patients
Infertility due to scarring of the urethra or ejaculatory ducts
Recurrent cystitis
Pyelonephritis
Renal damage
Sepsis

Differential Diagnoses

Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999. 282:236-7. [QxMD MEDLINE Link].
Davis NG, Silberman M. Bacterial Acute Prostatitis. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Motrich RD, Salazar FC, Breser ML, Mackern-Oberti JP, Godoy GJ, Olivera C, et al. Implications of prostate inflammation on male fertility. Andrologia. 2018 Dec. 50 (11):e13093. [QxMD MEDLINE Link].
Berghuis JP, Heiman JR, Rothman I, Berger RE. Psychological and physical factors involved in chronic idiopathic prostatitis. J Psychosom Res. 1996 Oct. 41(4):313-25. [QxMD MEDLINE Link].
Aaron LA, Herrell R, Ashton S, Belcourt M, Schmaling K, Goldberg J, et al. Comorbid clinical conditions in chronic fatigue: a co-twin control study. J Gen Intern Med. 2001 Jan. 16 (1):24-31. [QxMD MEDLINE Link].
Khan FU, Ihsan AU, Khan HU, Jana R, Wazir J, Khongorzul P, et al. Comprehensive overview of prostatitis. Biomed Pharmacother. 2017 Oct. 94:1064-1076. [QxMD MEDLINE Link].
Fu W, Zhou Z, Liu S, Li Q, Yao J, Li W, et al. The effect of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) on semen parameters in human males: a systematic review and meta-analysis. PLoS One. 2014. 9 (4):e94991. [QxMD MEDLINE Link].
Rivero VE, Motrich RD, Maccioni M, Riera CM. Autoimmune etiology in chronic prostatitis syndrome: an advance in the understanding of this pathology. Crit Rev Immunol. 2007. 27 (1):33-46. [QxMD MEDLINE Link].
Lampiao F, du Plessis SS. TNF-alpha and IL-6 affect human sperm function by elevating nitric oxide production. Reprod Biomed Online. 2008 Nov. 17 (5):628-31. [QxMD MEDLINE Link].
Motrich RD, Salazar FC, Breser ML, Mackern-Oberti JP, Godoy GJ, Olivera C, et al. Implications of prostate inflammation on male fertility. Andrologia. 2018 Dec. 50 (11):e13093. [QxMD MEDLINE Link].
Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006. 57:195-206. [QxMD MEDLINE Link].
Taoka R, Kakehi Y. The influence of asymptomatic inflammatory prostatitis on the onset and progression of lower urinary tract symptoms in men with histologic benign prostatic hyperplasia. Asian J Urol. 2017 Jul. 4 (3):158-163. [QxMD MEDLINE Link].
Nickel JC. Prostatitis. Can Urol Assoc J. 2011 Oct. 5 (5):306-15. [QxMD MEDLINE Link].
Stancik I, Lüftenegger W, Klimpfinger M, Müller MM, Hoeltl W. Effect of NIH-IV prostatitis on free and free-to-total PSA. Eur Urol. 2004 Dec. 46 (6):760-4. [QxMD MEDLINE Link].
Mastroianni A, Coronado O, Manfredi R, Chiodo F, Scarani P. Acute cytomegalovirus prostatitis in AIDS. Genitourin Med. 1996 Dec. 72(6):447-8. [QxMD MEDLINE Link].
Gebo KA. Prostatic tuberculosis in an HIV infected male. Sex Transm Infect. 2002 Apr. 78(2):147-8. [QxMD MEDLINE Link].
Krieger JN, Dobrindt U, Riley DE, Oswald E. Acute Escherichia coli prostatitis in previously health young men: bacterial virulence factors, antimicrobial resistance, and clinical outcomes. Urology. 2011 Jun. 77(6):1420-5. [QxMD MEDLINE Link].
Brede CM, Shoskes DA. The etiology and management of acute prostatitis. Nat Rev Urol. 2011 Apr. 8(4):207-12. [QxMD MEDLINE Link].
Barash A, Stern E, Hoelle R. A Case Report of Acute Prostatitis Secondary to Use of P-valve Condom Catheter During Cave Diving. Clin Pract Cases Emerg Med. 2021 Nov. 5 (4):436-439. [QxMD MEDLINE Link].
Feneley M, Kirby RS, Parkinson C. Clinico-pathological findings simulating prostatic malignancy following sclerotherapy: a diagnostic pitfall. Br J Urol. 1996 Jan. 77(1):157-8. [QxMD MEDLINE Link].
Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009. 69(1):71-84. [QxMD MEDLINE Link].
Rees J, Abrahams M, Doble A, Cooper A, Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015 Oct. 116 (4):509-25. [QxMD MEDLINE Link].
Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998 Apr. 159(4):1224-8. [QxMD MEDLINE Link].
Nickel JC, Downey J, Hunter D, Clark J. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol. 2001 Mar. 165(3):842-5. [QxMD MEDLINE Link].
Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006 Oct 19. 355(16):1690-8. [QxMD MEDLINE Link].
Ku JH, Kim SW, Paick JS. Epidemiologic risk factors for chronic prostatitis. Int J Androl. 2005 Dec. 28 (6):317-27. [QxMD MEDLINE Link].
Awadh B, Watson K, Abdou NI. Wegener prostatitis presenting with acute urinary retention. J Clin Rheumatol. 2006 Feb. 12(1):50-1. [QxMD MEDLINE Link].
Huong DL, Papo T, Piette JC, Wechsler B, Bletry O, Richard F, et al. Urogenital manifestations of Wegener granulomatosis. Medicine (Baltimore). 1995 May. 74(3):152-61. [QxMD MEDLINE Link].
Middleton G, Karp D, Lee E, Cush J. Wegener's granulomatosis presenting as lower back pain with prostatitis and ureteral obstruction. J Rheumatol. 1994 Mar. 21(3):566-9. [QxMD MEDLINE Link].
Davis NG, Silberman M. Bacterial Acute Prostatitis. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Perletti G, Trinchieri A, Stamatiou K, Magri V. Safety considerations with new antibacterial approaches for chronic bacterial prostatitis. Expert Opin Drug Saf. 2022 Feb. 21 (2):171-182. [QxMD MEDLINE Link].
Khattak AS, Raison N, Hawazie A, Khan A, Brunckhorst O, Ahmed K. Contemporary Management of Chronic Prostatitis. Cureus. 2021 Dec. 13 (12):e20243. [QxMD MEDLINE Link].
Donovan DA, Nicholas PK. Prostatitis: diagnosis and treatment in primary care. Nurse Pract. 1997 Apr. 22(4):144-6, 149-56. [QxMD MEDLINE Link].
[Guideline] Grabe M, Bishop MC, Bjerklund-Johansen TE, et al. Prostatitis and chronic pelvic pain syndrome. Guidelines on the management of urinary and male genital tract infections. Arnhem, The Netherlands: European Association of Urology (EAU). 2008 Mar. 79-88. [Full Text].
McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Ann Intern Med. 2000 Sep 5. 133(5):367-81. [QxMD MEDLINE Link]. [Full Text].
Loeb S, Gashti SN, Catalona WJ. Exclusion of inflammation in the differential diagnosis of an elevated prostate-specific antigen (PSA). Urol Oncol. 2009 Jan-Feb. 27(1):64-6. [QxMD MEDLINE Link].
de la Rosette JJ, Giesen RJ, Huynen AL, Aarnink RG, van Iersel MP, Debruyne FM, et al. Automated analysis and interpretation of transrectal ultrasonography images in patients with prostatitis. Eur Urol. 1995. 27(1):47-53. [QxMD MEDLINE Link].
[Guideline] Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, et al. General treatment of chronic pelvic pain. Guidelines on chronic pelvic pain. Arnhem, The Netherlands: European Association of Urology (EAU). 2008 Mar. 84-97. [Full Text].
Coker TJ, Dierfeldt DM. Acute Bacterial Prostatitis: Diagnosis and Management. Am Fam Physician. 2016 Jan 15. 93 (2):114-20. [QxMD MEDLINE Link].
Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, et al. Pharmacological Interventions for Bacterial Prostatitis. Front Pharmacol. 2020. 11:504. [QxMD MEDLINE Link].
Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007 Apr 13. 56(14):332-6. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59:1-110. [QxMD MEDLINE Link]. [Full Text].
Yoon BI, Han DS, Ha US, Lee SJ, Sohn DW, Kim HW. Clinical courses following acute bacterial prostatitis. Prostate Int. 2013. 1(2):89-93. [QxMD MEDLINE Link].
Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev. 2013 Aug 12. CD009071. [QxMD MEDLINE Link].
Le BV, Schaeffer AJ. Genitourinary pain syndromes, prostatitis, and lower urinary tract symptoms. Urol Clin North Am. 2009 Nov. 36(4):527-36, vii. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Nickel JC. alpha-Blockers for Treatment of the Prostatitis Syndromes. Rev Urol. 2005. 7 Suppl 8:S18-25. [QxMD MEDLINE Link]. [Full Text].
DeWitt-Foy ME, Nickel JC, Shoskes DA. Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Eur Urol Focus. 2018 Sep 8. [QxMD MEDLINE Link].
Sindhwani P, Wilson CM. Prostatitis and serum prostate-specific antigen. Curr Urol Rep. 2005 Jul. 6(4):307-12. [QxMD MEDLINE Link].
Zhang ZC, Jin FS, Liu DM, Shen ZJ, Sun YH, Guo YL. Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. Asian J Androl. 2012 Nov. 14 (6):870-4. [QxMD MEDLINE Link].
Mehik A, Hellström P, Sarpola A, Lukkarinen O, Järvelin MR. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int. 2001 Jul. 88(1):35-8. [QxMD MEDLINE Link].
Wise GJ, Shteynshlyuger A. How to diagnose and treat fungal infections in chronic prostatitis. Curr Urol Rep. 2006. 7(4):320-8. [QxMD MEDLINE Link].
Kim JW, Oh MM, Bae JH, Kang SH, Park HS, Moon du G. Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: Is transrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category?. J Infect Chemother. 2015 Jun. 21 (6):434-7. [QxMD MEDLINE Link].
Etienne M, Pestel-Caron M, Chapuzet C, Bourgeois I, Chavanet P, Caron F. Should blood cultures be performed for patients with acute prostatitis?. J Clin Microbiol. 2010 May. 48 (5):1935-8. [QxMD MEDLINE Link].
Gill BC, Shoskes DA. Bacterial prostatitis. Curr Opin Infect Dis. 2016 Feb. 29 (1):86-91. [QxMD MEDLINE Link].
Breyer BN, Van den Eeden SK, Horberg MA, Eisenberg ML, Deng DY, Smith JF, et al. HIV status is an independent risk factor for reporting lower urinary tract symptoms. J Urol. 2011 May. 185 (5):1710-5. [QxMD MEDLINE Link].

Media Gallery

Bacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.
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.
Treatment algorithm for chronic bacterial prostatitis. Courtesy of Frontiers Media [Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, et al. Pharmacological Interventions for Bacterial Prostatitis. Front Pharmacol. 2020. 11:504. Online at https://www.frontiersin.org/articles/10.3389/fphar.2020.00504/full].
Treatment algorithm for acute bacterial prostatitis. Courtesy of Frontiers Media [Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, et al. Pharmacological Interventions for Bacterial Prostatitis. Front Pharmacol. 2020. 11:504. Online at https://www.frontiersin.org/articles/10.3389/fphar.2020.00504/full].

of 5

Author

Robert Ledbetter, MD Resident Physician, Department of Emergency Medicine, Florida Atlantic University Charles E Schmidt College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Joshua J Solano, MD, FAAEM, FACEP Associate Professor of Emergency Medicine, Emergency Medicine Medical Student Clerkship Director, Florida Atlantic University

Joshua J Solano, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Florida 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.

Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Canadian Association of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section of Emergency Medicine, University of Chicago, University of Chicago, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Tarlan Hedayati, MD Assistant Professor of Emergency Medicine, Rush Medical College, John H Stroger Hospital of Cook County

Tarlan Hedayati, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Christine R Stehman, MD Visiting Clinical Associate Professor, University of Illinois College of Medicine-Peoria

Disclosure: Nothing to disclose.

Paul J Turek, MD Director, The Turek Clinic; Former Professor-in-Residence, Academy of Medical Educators Endowed Chair, Department of Urology, Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine

Paul J Turek, MD is a member of the following medical societies: American Association of Clinical Urologists, American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Western Section of the American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: BioQuiddity, Inc; Contraline, Inc; Future Family, Inc; DxNow, Inc; Mandalmed, Inc; CellArts, Inc; GiveLegacy, Inc; Doximity, Inc; Progyny, Inc. Inherent Biosciences, Inc.; Arex Biosciences, Inc.<br/>Have a 5% or greater equity interest in: AlphaSperm, Inc.; CellArts, Inc.<br/>Received income in an amount equal to or greater than $250 from: Progyny, Inc.

Prostatitis Clinical Presentation

History

Physical Examination

Complications

References

Tables

Contributor Information and Disclosures

What would you like to print?