Chronic bacterial prostatitis
Chronic bacterial prostatitis is a persistent bacterial infection of the prostate lasting more than 3 months that presents with recurrent lower urinary tract infections caused by the same organism, confirmed by a positive expressed-prostatic-secretion or post-massage urine culture, and treated with a 6 to 8 week course of a culture-directed, prostate-penetrating oral antibiotic.
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What this article covers
- Overview
Persistent prostate infection with the same organism: chronic bacterial prostatitis is bacterial infection of the prostate that persists or recurs for longer than 3 months, most commonly manifesting…
- Epidemiology
Prostatitis overall is common: the estimated prevalence of prostatitis syndromes is approximately 9.7% of men.
- Risk factors
Prior acute bacterial prostatitis: incompletely treated or recurrent acute infection is the leading antecedent.
- Pathophysiology
Bacterial reflux into prostatic ducts: infected urine refluxes into prostatic ducts, seeding the gland with uropathogenic bacteria, most often Escherichia coli.
- Clinical features
Recurrent urinary tract infection with the same organism: repeated episodes of dysuria, frequency, and urgency between which the patient may be entirely asymptomatic, with the same organism recovered on repeated urine cultures.
- Differential diagnosis
Chronic prostatitis/chronic pelvic pain syndrome: the culture-negative counterpart, accounting for over 90% of chronic prostatitis presentations; distinguished by a negative urine and…
- Diagnosis
Diagnosis is established by expressed-prostatic-secretion or post-massage urine culture growing the same uropathogen that has caused recurrent UTIs, in a man with symptoms persisting or recurring…
- Management
First, start empiric oral antibiotic therapy with a prostate-penetrating agent, then narrow to culture results once they return: trimethoprim-sulfamethoxazole, one double-strength tablet…
- Complications
Prostatic abscess: suspected with antibiotic failure or persistent fever; confirmed by CT or transrectal ultrasound and requires drainage plus antibiotics.
- Prognosis
Treatment is often difficult, with frequent UTI recurrence: even with an adequate 6-8 week culture-directed course, relapse is common because the intraprostatic focus is hard to fully eradicate.
- Prevention
Complete the full course for every episode of acute bacterial prostatitis: treat acute bacterial prostatitis with 2-4 weeks of an appropriate agent (up to 6 weeks in some experts' practice) to reduce…
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