Acute prostatitis

Lore & Background

Acute prostatitis presents with chills, fever, lower back or perineal pain, urinary frequency and urgency, and burning urination. The prostate gland is often very tender to palpation through the rectum. Diagnosis is relatively easy due to symptoms suggesting infection, and the causative organism may be found in blood or urine. A complete blood count reveals increased white blood cells, and C-reactive protein is elevated in most cases. Prostate massage should never be performed in suspected acute prostatitis, as it may induce sepsis.

Reader's Guide

Acute prostatitis is significant as a medical emergency that requires prompt diagnosis and treatment to prevent complications such as sepsis, particularly in immunocompromised patients. Antibiotics are the first line of treatment, with bactericidal antibiotics like fluoroquinolones preferred over bacteriostatic agents due to the potentially life-threatening nature of the infection. Hospitalization with intravenous antibiotics may be required for severely ill patients, while nontoxic patients can be treated at home with bed rest, analgesics, stool softeners, and hydration. Lack of clinical response to antibiotics should raise suspicion of an abscess and prompt imaging such as transrectal ultrasound. The condition is easily diagnosed through symptoms and urine analysis, and appropriate antibiotic therapy typically resolves the infection in a short time, though a minimum of two to four weeks of therapy is recommended.

Did You Know?

• Acute prostatitis is a medical emergency and should be distinguished from chronic bacterial prostatitis and chronic pelvic pain syndrome.
• Prostate massage should never be performed in suspected acute prostatitis because it may induce sepsis.
• Common bacteria causing acute prostatitis include Escherichia coli, Klebsiella, Proteus, Pseudomonas, and Staphylococcus aureus.
• Lack of clinical response to antibiotics should prompt an imaging study such as a transrectal ultrasound to check for an abscess.