Acute Bacterial Prostatitis

Note

Important to consider prostatitis in the DDx of any male UTI as it generally requires four weeks of therapy and undertreatment may lead to chronic prostatitis

Suspect when systemic symptoms including fever, pelvic pain, symptoms of prostatic obstruction, or tender prostate on gentle DRE

Appropriate investigations

Urine culture & urinalysis.

Blood cultures if systemic symptoms.

Urine testing for STIs (gonorrhea, chlamydia).

Imaging (US/CT) not generally required unless suspicion of prostatic abscess (i.e. failure to improve despite appropriate therapy).

PSA may be elevated.

If patient develops urinary obstruction with acute prostatitis, suprapubic catheter required (foley contraindicated).

Most Likely Pathogens

Organisms are similar to other UTI (Enterobacteriaceae and other gram negatives including Pseudomonas).

Gram positive (enterococci, S. aureus) also occur but less common.

S. aureus should raise suspicion of bacteremic spread and deeper seated S. aureus infection.

N. gonorrhea and C. trachomatis can also involve the prostate.

Initial therapy should reflect illness acuity and other factors as outlined in related sections within the UTI pathway - i.e. patient requires ICU admission, nursing home resident, or male UTI.

Gentamicin should be avoided as monotherapy due to poor prostatic penetration.

The preferred treatment oral therapy for acute bacterial prostatitis is a fluoroquinolone or TMP-SMX if susceptible for ~4 weeks

Chronic often requires longer duration