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Prostatitis - acute
DefinitionAcute prostatitis is an inflammation of the prostate gland that develops suddenly.
Causes, incidence, and risk factors
Acute prostatitis is usually caused by a bacterial infection of the prostate gland. Any organism capable of causing an urinary tract infection (UTI) is also capable of causing acute bacterial prostatitis, including enterococci, Escherichia coli , Klebsiella pneumonia , Proteus mirabilis , Pseudomonas aeruginosa , and Staphylococcus aureus .
Some sexually transmitted diseases (STDs) can cause acute prostatitis, typically seen in men younger than 35. These include gonorrhea , chlamydia , urealyticum, and trichomonas. Prostatitis from an STD typically closely follows sexual contact with an infected partner.
In men older than 35,
and other common bacteria are more often the cause of prostatitis.
prostatitis may follow urinary tract infections , urethritis , or epididymitis .
Prostatitis is diagnosed in approximately 2 of every 10,000 outpatient visits. Men between the ages of 20 and 35 who have multiple sexual partners are at an increased risk, as are those who engage in high-risk sexual behaviors such as lack of condom use, particularly for anal intercourse.
Men age 50 or older who have an enlarged prostate ( benign prostatic hyperplasia ), are at increased risk for prostatitis due to their risk of urinary tract infection.
Acute prostatitis often begins with chills and fever, lower abdominal discomfort, perineal pain, and burning with urination. Symptoms of more advanced prostatitis include a diminished urine stream and difficulty urinating.
Prostatitis may occur in conjunction with epididymitis or orchitis, especially if caused by an STD, in which case symptoms of the accompanying condition may also be present.
Symptoms of acute prostatitis include the following:
Signs and tests
Your health care provider may perform a physical examination to assess the prostate (warm, soft, swollen, or tender), the inguinal (groin) lymph nodes (enlarged or tender), the scrotum ( swollen or tender), and the urethra (discharge).
Triple-void urine specimens may be collected for urinalysis and urine culture :
Note: Your health care provider may choose not to perform prostatic massage if the prostate is obviously swollen and tender, because massage may potentially spread the infection and cause bacteremia or sepsis . These are potentially life-threatening infections in which bacteria are present in the bloodstream, rather than localized to one part of the body.
Most cases of acute prostatitis clear up completely with medication and slight modification of diet and behaviors.
For men with prostatitis caused by an STD, a 250 mg shot of ceftriaxone followed by a 10-day course of doxycycline or ofloxacin. For other bacterial causes, a standard course of treatment consists of Bactrim, Cipro, or Floxin for at least 4 weeks.
Because recurrence is common, some health care providers recommend even longer therapies -- 6 to 8 weeks -- to eliminate the infection. In severe cases, hospitalization and intravenous (IV) antibiotics may be required .
If the swollen prostate restricts the urethra, the bladder may be unable to empty and insertion of a suprapubic catheter , which allows the bladder to drain through the abdomen, may be necessary.
Increasing the intake of fluids (64 to 128 ounces per day) encourages frequent urination that will help flush the bacteria from the bladder.
The majority of men who are accurately diagnosed with acute prostatitis become symptom-free after treatment.
Patients who have had acute prostatitis are prone to recurrence and are likely to develop chronic prostatitis .
Chronic prostatitis can develop. Urinary retention may occur as a result of the swollen prostate occluding the urethra. Scarring of the prostate and urethra may result in permanent strictures (narrowing) of the urethra.
Calling your health care provider
Call your health care provider if symptoms of prostatitis occur.
Not all types of prostatitis are preventable. Good hand washing after a bowel movement and prior to handling the penis may prevent the transfer of bacteria from the rectal area to the genitourinary tract.
Infections that are associated with STDs can be prevented by practicing safer sex behaviors.
Update Date: 5/25/2002Young Kang, M.D., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT