Makindo Medical Notes

🧠 Acute Bacterial Prostatitis — an acute bacterial infection of the prostate gland, often arising from a lower urinary tract infection (UTI). On rectal examination, the prostate feels tender, enlarged, or boggy. ⚠️ Do NOT massage the prostate — this can precipitate bacteraemia or sepsis.

📘 About

• Inflammation of the prostate caused by bacterial infection.
• Usually results from ascending infection from the urethra or bladder.
• In sexually active men, consider sexually transmitted pathogens (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae).

🩺 Clinical Features

• 💧 Lower UTI symptoms: Dysuria, frequency, urgency, cloudy or malodorous urine.
• 🧍‍♂️ Prostatitis-specific symptoms: Perineal, rectal, or penile pain; painful ejaculation; acute urinary retention; weak stream or hesitancy.
• 🔥 Systemic features: Fever, chills, rigors, malaise, myalgia — may progress to urosepsis.
• 🩹 Rectal exam: Tender, warm, swollen “boggy” prostate — examine gently.

🧪 Investigations

• 💧 Urinalysis: Leucocytes, nitrites, and blood; send MSU for culture.
• 🩸 Bloods: FBC (↑WCC), CRP (↑), U&E (for AKI), blood cultures if hospitalised or septic.
• 📸 Imaging: Renal/bladder ultrasound if suspect retention or abscess.
• 🧬 STI screen: If sexually active → refer to GUM clinic for Chlamydia/Gonorrhoea testing.

🧭 Differentials

• 🧓 BPH: Hesitancy, nocturia, retention (but no systemic illness).
• ♻️ Chronic prostatitis: Symptoms >3 months, milder, recurrent.
• 🦠 UTI / cystitis: Dysuria, frequency, but no prostate tenderness.
• 🧫 Epididymo-orchitis: Scrotal pain/swelling, may coexist.
• 🎗️ Prostate or bladder cancer: Haematuria, weight loss, LUTS.
• 🧻 Colorectal cancer: Change in bowel habit, rectal bleeding.

💊 Management (NICE-aligned)

• 🧴 General advice: Rest, analgesia (paracetamol ± ibuprofen), good hydration, avoid alcohol/caffeine. Explain recovery may take several weeks.
• 🏥 Admit urgently if:
  • Unable to take oral medication or dehydrated.
  • Systemically unwell / septic.
  • Acute urinary retention or suspected prostatic abscess.
• ⚠️ Consider early urology input for men who are:
  • Immunocompromised or diabetic.
  • Have indwelling catheter or known urological abnormality.

💉 Antibiotic Therapy

Empirical therapy should cover Gram-negative uropathogens (e.g., E. coli). Adjust according to culture and sensitivity results.

• 🧾 Review at 14 days → stop or continue up to 28 days depending on clinical progress and lab results.
• 🧪 If STI suspected → urgent GUM referral for testing & contact tracing.
• 🩺 Following recovery → urological review to exclude structural abnormality (e.g., residual urine, stricture, BPH).

💡 Teaching tip: In prostatitis, infection within a closed glandular structure explains the need for prolonged therapy and poor penetration of some antibiotics. Always ensure antibiotics achieve high prostatic concentrations (e.g., fluoroquinolones, trimethoprim). Avoid catheterization unless absolutely necessary — consider suprapubic approach if retention develops.

📚 Reference

• NICE CKS — Prostatitis (acute), last revised Nov 2020