Diagnostic Considerations

The differential diagnosis of prostatitis is based on the history, physical examination findings, and, frequently, analysis of expressed prostatic secretions.^[33]Absence of systemic symptoms and persistence of pain for at least 3 months indicate chronic prostatitis rather than acute disease.^[34]In addition to prostatitis, other conditions to consider include the following:

Benign prostatic hyperplasia
Chronic pain syndromes (ie, inflammatory bowel disease)
Cystitis
Erectile dysfunction
Prostate cancer
Radiculopathies
Testicular cancer
Urolithiasis

See the following for more information:

Differential Diagnoses

Anal Fistulas and Fissures
Hemorrhagic Cystitis, Noninfectious
Inflammatory Bowel Disease
Male Urethritis
Mechanical Back Pain
Rectal Foreign Bodies
Urinary Incontinence
Urinary Tract Obstruction Management in the ED
Urinary Tract Infection (UTI) in Males

Workup

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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].

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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 Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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