An Overview of Acute Bacterial Prostatitis

The Prostate

Part of the male uro-reproductive system is a walnut sized and shaped prostate gland located at the back of the bladder and adjacent to the urethra. It produces part of the semen that is released during sexual climax.

Because of its location, the prostate can be infected by different bacteria coming from the urinary system, as a consequence of having sex with an infected partner, or as a complication from other diseases.

Causes of Acute Bacterial Prostatitis

An acute infection of the prostate by bacterial agents can affect young and old men alike, although the possible mechanisms and infecting agents may differ.

Young men around the age of 20 to 35 who are sexually active may be infected by a partner with STD, and common agents are:

  • Chlamydia
  • Gonorrhea
  • Trichomoniasis
  • Ureaplasma urealyticum

Older men may contract the disease by other means like urinary tract infection (UTI), urethritis and epididymitis, where the bacteria involved may be:

  • Enterococci
  • Escherichia coli
  • Klebsiella pneumonia
  • Proteus mirabilis
  • Pseudomonas aeruginosa
  • Staphylococcus aureus

Other possible causes of acute bacterial prostatitis are:

  • Trauma
  • Invasive procedures like prostate biopsy, surgery, catheterization and cystoscopy
  • Bladder outlet obstruction, which causes a urinary retention and backflow of urine
  • Phimosis, a condition where there is a small opening of the urethra
  • Anal intercourse

Symptoms of Acute Bacterial Prostatitis

This is a very painful condition and usually starts as soon as one is infected. The infection may also affect the testes and the epididymis (part of the reproductive system which also conducts semen), so pain may also be felt in these areas. Other symptoms include:

  • Fever and chills
  • Burning pain and difficulty in urination
  • Feeling of urgency in urination, increased frequency urination
  • Lower abdominal pain
  • Low back pain
  • Pain during ejaculation
  • Pain around the anus, and pain during bowel movement
  • Blood in the urine and/or semen
  • Foul smelling urine

Diagnosis of Acute Bacterial Prostatitis

After taking the patient’s history, a physical examination is done which includes a digital rectal exam to evaluate the size of the prostate. During this procedure a prostatic massage may be performed by the physician to obtain a semen sample with the urine. This is sent to the laboratory for microscopic examination.

To rule out other possible causes of disease like UTI, urinary stones, bladder infections, etc, other tests may be helpful required such as:

  • Urinalysis and urine culture
  • Blood tests
  • Ultrasound
  • Magnetic resonance imaging (MRI)
  • Biopsy

Treatment

Antibiotic therapy is the hallmark of treatment for bacterial infections of the prostate. For severe cases it may be necessary to hospitalize the patient for a few days to allow for hydration, monitoring and intravenous delivery of antibiotics such as ceftriaxone (for STDs). Other antibiotics may be given for a course of 2-4 weeks or longer for relapsing cases:

  • Doxycycline
  • Trimethoprim-sulfamethoxazole
  • Fluoroquinolones
  • Tetracycline

An increase in fluid intake is advised to make one urinate more often and flush out the bacteria. Stool softeners may be given to relieve difficulty in bowel movements. Spicy foods, acidic, caffeinated and alcoholic drinks are avoided to decrease bladder irritation.

Patients may respond immediately to treatment, but complications such as chronic prostatitis and prostatic abscess are possible. A prolonged course of antibiotic treatments may be necessary for these.

References

Medline Plus, “Prostatitis – bacterial acute” accessed 12/23/10

https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm

NIDDK, “Prostatitis: Disorders of the Prostate” accessed 12/23/10

https://kidney.niddk.nih.gov/kudiseases/pubs/prostatitis/