acute bacterial prostatitis
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Acute ProstatitisAn uncommon (2/10,000/year) condition characterised by abrupt onset of prostate inflammation linked to coliform bacterial infection—e.g., Escherichia coli—as well as STD pathogens—e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, Trichomonas vaginalis.
Aetiology/risk factors Age 20 to 35, multiple sexual partners, high-risk sexual activity—e.g., non-use of condom, anal intercourse, bacterial migration up urethra; cystitis; kidney stones; prostate surgery; haematogenous spread of infection; urethral instrumentation—e.g., catheterisation, cystoscopy—trauma, bladder outlet obstruction, epididymitis, orchitis, systemic infection.
Clinical findings Pain at the base of the penis, perineal and perianal, urgency, burning with urination, fever, malaise, penile discharge; other findings include chills, painful defecation and ejaculation.
Management Symptomatic; 4-week course of antibiotics.
prostatitis syndromeUrology Any inflammatory condition defined by the Intl Prostatitis Collaborative Network under the aegis of the NIH. See Prostate.
Acute bacterial prostatitis Pts present with acute Sx of UTI–eg urinary frequency and dysuria, as well as malaise, fever, myalgia; bacteria and pus are usually present in the urine and due to uropathic bacteria–eg, E coli
Chronic bacterial prostatitis Pts have recurrent UTIs, usually due to the same organisms–eg, E coli , another GNR or an enterococcus; between symptomatic bouts, Pts continue to be carriers in cultures from the lower urinary tract
Chronic prostatitis/chronic pelvic pain syndrome The most common of the prostatitis syndromes, CP/CPPS recognizes the limited understanding of the cause of this condition and implies that other organs beside the prostate may be involved and is a diagnosis of exclusion, after active urethritis, urogenital cancer, GU disease, functionally significant urethral and neurological disease have been completely excluded; it is divided into an inflammatory subtype with leukocytes in the urine and a noninflammatory subtype which has no manifestation of inflammation
Asymptomatic inflammatory prostatitis A condition which is diagnosed in Pts who lack a Hx of GU complaints who have ↑ PSA or infertility
acute bacterial prostatitis
Inflammation of the prostate, commonly associated with urinary tract infections caused by enterococci, staphylococci, or gram-negative bacteria such as Escherichia coli. It often is caused by reflux of urine resulting from an anatomical abnormality. Patients present with fever, chills, urethral discharge, pain on urination, difficulty voiding, malaise, myalgias, and discomfort in the perineal area; the prostate is soft, swollen, and tender on examination.
The causative organism is identified through a culture of prostatic secretions and is treated with an extended course of antibiotics. Narcotics and antispasmodics may be needed to relieve pain.
See also: prostatitis