Acute Bacterial Prostatitis: Clinical Presentation
Acute bacterial prostatitis presents with a combination of systemic inflammatory symptoms (fever, chills, malaise) and lower urinary tract symptoms (dysuria, frequency, urgency), often accompanied by pelvic or perineal pain. 1, 2
Systemic Symptoms
The hallmark systemic manifestations include:
- Fever and chills are characteristic presenting features, reflecting the acute infectious nature of the condition 1, 2, 3
- Malaise, lethargy, and generalized weakness commonly accompany the febrile response 3
- Nausea and emesis may occur, particularly in more severe cases 3
- Risk of progression to sepsis exists in approximately 7.3% of cases, making recognition of systemic toxicity critical 1
Lower Urinary Tract Symptoms
Bladder-related symptoms are prominent:
- Dysuria (painful urination) is a frequent complaint 2, 3
- Urinary frequency and urgency develop as the inflamed prostate affects bladder function 2, 3
- Urinary retention can occur when the acutely inflamed prostate obstructs urinary flow, requiring bladder drainage 4, 3
- Difficulty voiding or inability to voluntarily urinate indicates more severe obstruction requiring hospitalization 3
Pelvic and Genitourinary Pain
Pain localization helps distinguish this condition:
- Pelvic pain or discomfort is a defining feature of acute bacterial prostatitis 2, 3
- Perineal pain (between the scrotum and rectum) is characteristic 3
- Painful ejaculation may be reported 4
- Suprapubic pain or tenderness can accompany bladder involvement 5
Physical Examination Findings
Digital rectal examination reveals a tender, enlarged, or boggy prostate gland, though this examination must be performed gently to avoid precipitating bacteremia 1, 3. Vigorous prostatic massage is absolutely contraindicated in acute bacterial prostatitis due to the risk of inducing sepsis 1.
Important Clinical Pitfalls
Up to 20% of patients with acute pyelonephritis lack bladder symptoms, and a similar pattern can occur with acute bacterial prostatitis, making the diagnosis more challenging in the absence of classic lower urinary tract complaints 5. Maintain high clinical suspicion in older adults, diabetic patients, or immunosuppressed individuals, as symptoms may be diminished or atypical in these populations 6.
The combination of fever with flank pain or tenderness, with or without voiding symptoms, and with urinalysis showing pyuria and/or bacteriuria, should prompt consideration of upper urinary tract infection including possible prostatic involvement in men 5.