Chronic bacterial prostatitis

Alternative names
Prostatitis - chronic

Definition
Chronic prostatitis is an inflammation of the prostate gland that develops gradually, continues for a prolonged period, and typically has subtle symptoms.

Causes, incidence, and risk factors

Chronic prostatitis is usually caused by a bacterial infection. It may be associated with or follow urinary tract infection, urethritis, epididymitis, or acute prostatitis. The most common causes are Escherichia coli and proteus, enterobacter, and klebsiella bacteria.

The disorder is diagnosed in 5 of every 1,000 outpatient visits. It is estimated that as many as 35% of men older than 50 may have chronic prostatitis.

Increased risk is associated with men over age 30. Certain factors may predispose a man to develop chronic prostatitis, such as excessive alcohol intake, perineal injury, and certain sexual practices (particularly anal sex without a condom). These factors may cause congestion of the prostate gland, which produces an excellent breeding ground for various bacteria.

Symptoms

     
  • History of recurrent urinary tract infections  
  • Low-grade or subtle symptoms may include:       o Low back pain       o Perineal or pelvic floor pain       o Testicular pain       o Pain and burning with urination       o Pain with ejaculation       o Pain with bowel movement  
  • Recurrent low-grade fever  
  • Pain on urination  
  • Decreased urinary stream  
  • Urinary hesitancy (delayed start of urination)  
  • Frequent urination  
  • Blood in the urine  
  • Incontinence

Note: There may be no symptoms.

Signs and tests

A physical examination may reveal an enlarged, mildly tender prostate. The examination may reveal enlarged or tender lymph nodes in the groin area, scrotal swelling and tenderness, and a urethral discharge.

Triple-void urine specimens may be collected for urinalysis and urine culture:

     
  • #1 - initial stream  
  • #2 - midstream  
  • #3 - after prostatic massage by examiner

A urinalysis reveals increased white blood cells (WBCs) and bacterial growth upon culture of urine #3. Culture of prostatic secretions shows in increased levels of WBCs and more concentrated bacterial growth.

A semen analysis may also show increased numbers of white blood cells and decreased numbers of sperm, with poor motility.

Treatment

Treatment options for chronic prostatitis include a combination of medication, surgery, and lifestyle changes.

MEDICATIONS:
Chronic prostatitis is treated with an extensive course of antibiotics. Trimethoprim-sulfamethoxazole (Bactrim) and ciprofloxacin (Cipro) are commonly used. Other antibiotics that may be used include:

     
  • Tetracycline  
  • Carbenicillin  
  • Erythromycin  
  • Nitrofurantoin

The course of antibiotic therapy is long - frequently 6 to 8 weeks - but may be continued much longer. Most antibiotics are not able to adequately penetrate the prostate tissue. Often, infectious organisms persist despite long periods of treatment.

After antibiotic treatment has ended, recurrence of symptoms is common.

Stool softeners may be recommended to reduce the discomfort associated with bowel movements.

SURGERY:
Transurethral resection of the prostate may be necessary if antibiotic therapy is unsuccessful or recurrence occurs frequently. This surgical treatment is usually not performed on younger men because it carries potential risks of sterility, impotence, and incontinence.

OTHER THERAPY:
Frequent and complete urination is recommended to decrease the symptoms of urinary urgency. If the swollen prostate restricts the urethra, the bladder may not empty. Insertion of a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary.

DIET:
Avoid substances that irritate the bladder, such as alcohol, caffeinated food and beverages, citrus juices, and hot or spicy foods.

Increasing the intake of fluids (64 to 128 ounces per day) encourages frequent urination that will help flush the bacteria from the bladder.

MONITORING:
Follow-up should include an examination at completion of antibiotic therapy to ensure that infection is no longer present.

Expectations (prognosis)
Recurrence of symptoms is common.

Complications
If the enlarged prostate restricts the flow of urine through the urethra, urinary retention may cause kidney damage.

Calling your health care provider

Call your health care provider if symptoms of chronic prostatitis occur.

Prevention

Prevention includes avoiding urinary tract infections and sexually transmitted diseases. Completion of the full course of antibiotic treatment decreases chance of recurrence.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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