ID
Chronic Bacterial Prostatitis
search
Chronic Bacterial Prostatitis
, Chronic Prostatitis
See Also
Prostatitis
Acute Bacterial Prostatitis
Chronic
Nonbacterial Prostatitis
Pathophysiology
Slow, indolent infection persisting more than 3 months
Retrograde infection from distal
Urethra
to
Prostate
Associated factors
See Risk Factors below
Recurrent Urinary Tract Infection
Asymptomatic bacteruria despite antibiotics
Causative organisms are the same as in
Acute Prostatitis
Enterobacteriaceae
, especially
Escherichia coli
(80%)
Enterococcus
(15%)
Pseudomonas
aeruginosa
Burkholderia pseudomallei
Risk Factors
Urethritis
due to
Sexually Transmitted Infection
(STI)
Urethral Stricture
Benign Prostatic Hyperplasia
Urethra
l instrumentation (including
Urethral Catheterization
)
Uncircumsized men (intact foreskin)
Retrograde ejaculation
Symptoms (sudden onset)
Irritative urinary symptoms (Mild to Moderate)
Dysuria
Urinary Frequency
Urinary urgency
Ejaculatory pain
Hematospermia
Referred pain
Low pack pain
Perineal pain
Lower
Abdominal Pain
Scrotal Pain
Pain in penis
Pain in inner thighs
Absent Symptoms (Contrast with
Acute Prostatitis
)
Systemic symptoms rare
Obstructive urinary symptoms uncommon
Exam
Abdominal exam including
Pelvis
and flank
Genitourinary exam (scrotal exam and penis exam)
Digital Rectal Exam
Avoid
Prostatic Massage
in suspected
Acute Bacterial Prostatitis
Obtain
Urinalysis
and
Urine Culture
before and after
Prostatic Massage
Findings in Chronic Prostatitis
Prostate
often normal on exam
Prostate
may be tender to palpation, boggy or indurated
Prostatic calculi or crepitation may be present
Labs
Urinalysis
Urine White Blood Cell
s >10/hpf
Urine Culture
Segmented Urine Culture
before and after
Prostatic Massage
(rarely done)
See
Prostatic Massage
Request lab to report all growth on cultures
STD Screening
(if risk factors or in men under age 35 years old)
Neisseria gonorrhoeae
PCR
Chlamydia Trachomatis PCR
Consider
Prostate Specific Antigen
(PSA)
See
Prostate Specific Antigen
for caveats to testing
Consider if significant
Prostate Cancer
risk factors (e.g.
Family History
at younger age)
Avoid performing after
Prostatic Massage
(falsely elevated)
Differential Diagnosis
Genitourinary
Acute Bacterial Prostatitis
Prostate
Abscess
Sexually Transmitted Infection
Chronic Noninfectious Prostatitis
Benign Prostatic Hyperplasia
Urinary Tract Stone (e.g.
Prostate
calculus,
Nephrolithiasis
)
Bladder Cancer
Urinary tract foreign body
Enterovesical fistula
Gastrointestinal
Irritable Bowel Syndrome
Musculoskeletal
Pelvic Floor Dysfunction
Pelvic injury or
Trauma
Neurologic
Neurogenic
Bladder
Pudendal neuralgia
Management
See
Prostatitis General Measures
Gene
ral
Antibiotics penetrate Chronic Prostatitis poorly
Prolonged antibiotic regimens are required (however, avoid chronic antibiotic use)
Antibiotics until
Segmented Urine Culture
sterile
Urine Culture
sensitivity may best direct antibiotic therapy
Expect 6 point decrease after treatment in
International Prostate Symptom Score
Course
Treat for 4-6 weeks
May require a second 4-6 week course (total of 8-12 weeks)
Add Selective
Alpha Adrenergic Antagonist
(e.g.
Tamsulosin
,
Alfuzosin
)
Antibiotics: First-Line (caution regarding prolonged
Fluoroquinolone
use)
Levofloxacin
750 mg orally daily (best efficacy)
Ciprofloxacin
500 orally twice daily
Norfloxacin
400 mg twice daily
Trimethoprim-sulfamethoxazole (
Bactrim
,
Septra
) DS 160 mg/800 mg one tablet orally twice daily
Antibiotics: Alternative agents (esp.
Chlamydia
)
Doxycycline
100 mg twice daily
Azithromycin
500 mg daily
Clarithromycin
500 mg twice daily
Refractory Cases
Consider
Chronic Noninfectious Prostatitis
Urology Referral Indications
Severe or atypical symptoms (severe
Dysuria
,
Hematuria
)
Pre-
Prostatic Massage
Urine Culture
Suspected
Prostate Cancer
(e.g.
Prostate
Nodule
, increased PSA)
Refractory course despite two courses of antibiotics and
Alpha Adrenergic Antagonist
References
Cooner (1994)
Prostate
Disease, AAFP, p. 9-15
(2018) Sanford Guide, accessed on IOS, 10/16/2019
Krieger (Summer, 1998) Patient Care Suppl.:
Prostatitis
Holt (2016) Am Fam Physician 93(4):290-6 [PubMed]
Pontari (2007) J Urol 177(6): 2050-7 [PubMed]
Schwager (1991) Am Fam Physician, 44(6): 2137-41 [PubMed]
Sharp (2010) Am Fam Physician 82(4): 397-406 [PubMed]
Type your search phrase here