🧠 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.
| Setting |
First-line / Comments |
| Outpatient (oral) — 14 days |
• Ciprofloxacin 500 mg BD or Ofloxacin 200 mg BD
• If unsuitable → Trimethoprim 200 mg BD
⚠️ Stop fluoroquinolone if tendon pain, weakness, neuropathy, or CNS effects; report immediately.
|
| Second-line (if resistant or culture-guided) |
• Levofloxacin 500 mg OD
• Co-trimoxazole 960 mg BD (only if culture-confirmed sensitivity)
|
| Inpatient / IV route (severe, sepsis) |
• Ceftriaxone 1–2 g OD
• Ciprofloxacin 400 mg BD
• ± Gentamicin (check renal function)
|
- 🧾 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
