From the Guidelines
Prostatitis symptoms include pain or discomfort in the pelvic area, painful urination, increased urinary frequency and urgency, difficulty starting urination, weak urine flow, and sometimes pain during ejaculation, and it is crucial to seek medical evaluation promptly to determine the appropriate management approach. Men may also experience flu-like symptoms such as fever, chills, and body aches, particularly with acute bacterial prostatitis 1. Chronic prostatitis can present with persistent dull pain in the lower back, perineum, or genitals, along with urinary problems that come and go over months. Some men report pain after sitting for long periods or experience sexual dysfunction. The severity of symptoms varies widely between individuals and depends on the type of prostatitis (acute bacterial, chronic bacterial, chronic pelvic pain syndrome, or asymptomatic inflammatory prostatitis) 1.
Diagnosis and Management
The diagnosis of bacterial prostatitis involves clinical presentation and laboratory tests, including midstream urine dipstick, midstream urine culture, blood culture, and total blood count 1. It is recommended to perform accurate microbiological evaluation for atypical pathogens such as Chlamydia trachomatis and Mycoplasma species in patients with chronic bacterial prostatitis (CBP) 1. The Meares and Stamey 2- or 4-glass test is also recommended for patients with CBP 1.
Key Recommendations
- Do not perform prostatic massage in acute bacterial prostatitis (ABP) 1
- Take a midstream urine dipstick to check nitrite and leukocytes in patients with clinical suspicion of ABP 1
- Take a midstream urine culture in patients with ABP symptoms to guide diagnosis and tailor antibiotic treatment 1
- Perform accurate microbiological evaluation for atypical pathogens such as Chlamydia trachomatis and Mycoplasma species in patients with CBP 1
These symptoms occur because of inflammation in the prostate gland, which can be caused by bacterial infection, immune system reactions, or nerve damage in the pelvic area 1. If experiencing these symptoms, it's essential to seek medical evaluation promptly, as acute bacterial prostatitis requires immediate antibiotic treatment, while other forms may need different management approaches 1.
From the Research
Prostatitis Symptoms
Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland 2. The symptoms of prostatitis can vary depending on the type and cause of the condition. Some common symptoms include:
- Pelvic pain
- Urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention
- Systemic symptoms, such as fevers, chills, nausea, emesis, and malaise 3
- Lower urinary tract symptoms, such as nocturia and dysuria 4
Types of Prostatitis
There are several types of prostatitis, including:
- Acute bacterial prostatitis: an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms 3
- Chronic bacterial prostatitis (CBP): a type of prostatitis that is characterized by recurrent urinary tract infections with the same organism identified on repeated cultures 4
- Chronic nonbacterial prostatitis (CNP)/chronic pelvic pain syndrome (CPPS): a type of prostatitis that is characterized by prostatic pain lasting at least three months without consistent culture results 4
- Asymptomatic inflammatory prostatitis: a type of prostatitis that is characterized by inflammation of the prostate gland without any symptoms 4
Diagnosis and Treatment
Diagnosis of prostatitis is typically made based on history and physical examination, and may be aided by urinalysis and urine cultures 3. Treatment for prostatitis depends on the type and cause of the condition, and may include:
- Antibiotics, such as fluoroquinolones, to treat bacterial infections 2, 3, 5, 6
- Alpha-blockers, such as doxazosin, to help relieve symptoms 4, 5
- Anti-inflammatory agents, such as pain medications, to help relieve symptoms 4
- Combination therapy, which may include antibiotics, alpha-blockers, and other medications, to help eradicate infecting organisms and relieve symptoms 6