Prostatitis

Basics

Acute (bacterial) prostatitis:
- Acute febrile illness
- Systemic symptoms may appear days before localizing urinary symptoms appear
- Patients may appear toxic and usually have a concurrent cystitis
Chronic bacterial prostatitis:
- ∼10% of cases of prostatitis
- Most common cause of recurrent UTI in men
- WBC and bacteria may be present in expressed prostatic secretions (EPS)
Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS):
- Same symptoms as chronic bacterial prostatitis but unable to culture organisms from urine or EPS
- White cells may or may not be present
Asymptomatic inflammatory prostatitis:
- No subjective symptoms on presentation
- Inflammation present on prostate biopsy or evaluation for infertility or other disorders
Prostatic abscess:
- Once common after acute prostatitis, now rare except in immunocompromised patients
- Fever, rectal pain, and leukocytosis despite treatment
- Fluctuant mass on rectal exam

Usually a single-organism bacterial infection of the prostate
Acute prostatitis:
- Age <35 yr:
  - Neisseria gonorrhoeae and Chlamydia trachomatis are usual etiologies
- Age ≥35 yr:
  - Enterobacteriaceae or Escherichia coli (usual), Klebsiella, Pseudomonas, Enterococcus, and Proteus also seen
- Rarely may be caused by Salmonella, Clostridia, tuberculosis, or fungi
- Cryptococcus neoformans in AIDS patients
Chronic bacterial prostatitis:
- Enterobacteriaceae (80%), Enterococcus (15%), and Pseudomonas aeruginosa
Chronic l prostatitis:
- Possible role for Chlamydia, Ureaplasma urealyticum, Trichomonas vaginalis, and Mycoplasma hominis

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