Sexual Health

Prostatitis

Prostatitis ranges from acute bacterial infection with systemic illness and urinary symptoms to chronic bacterial prostatitis and chronic pelvic pain syndrome; the first priorities are to recognise sepsis or retention, obtain cultures without delaying treatment, and avoid confusing non-bacterial pain with an infection that needs antibiotics.

Definition

Prostatitis is inflammation of the prostate and includes acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis. Acute bacterial prostatitis is a potentially systemic urinary infection of the prostate; chronic pelvic pain syndrome is a chronic pain syndrome without demonstrable infection.

First principles

Classify acute bacterial disease before chasing chronic symptoms

Acute bacterial prostatitis usually begins abruptly with voiding symptoms, perineal or pelvic pain, fever and malaise. Chronic bacterial prostatitis causes symptoms for at least 3 months with recurrent or persistent microbiological evidence. Chronic pelvic pain syndrome can produce similar pain and urinary symptoms without demonstrable infection, so it should not be treated as bacterial prostatitis by default.

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