Prostatitis

exp date isn't null, but text field is

Prostatitis is an infection or inflammation of the prostate gland. Prostatitis is categorized as follows:

Category

 

Characteristics

Signs and Symptoms

 

 

Pain

Bacteria

WBCs

I

Acute prostatitis

-        Bacterial infection of the               prostate gland

-        Requires urgent medical               treatment.

Yes

Yes

Yes

II

Chronic bacterial prostatitis

-        Rare

-        Intermittent  urinary tract             infections

±

Yes

Yes

IIIa

Inflammatory

-        Chronic prostate                         inflammation

-        Chronic pain

-        90%-95% of prostatitis                diagnoses

Yes

No

Yes

IIIb

Non-inflammatory

Yes

No

No

IV

Asymptomatic inflammatory prostatitis

-        Asymptomatic

-        No history of genitourinary           pain complaints

-        Leukocytosis is present

No

No

Yes

Causes

UTI and STI pathogens

Signs and symptoms

  • Fever
  • Acute pain in the pelvis and perineum
  • Dysuria and frequency
  • Urinary retention or difficulty to void
  • Acutely tender prostate on rectal examination
  • Painful ejaculation
  • Blood in the semen

Complications

  • Bladder outlet obstruction
  • Urinary retention
  • Abscess formation
  • Infertility
  • Recurrent cystitis
  • Pyelonephritis
  • Renal damage
  • Sepsis

Investigations

  • Full blood count
  • Blood cultures
  • Urine analysis
  • Urine microscopy, culture and sensitivity

Treatment objectives

  • Alleviate symptoms
  • Eradicate causative microorganisms
  • Prevent recurrence

Non-pharmacological treatment

  • Sitz baths may provide symptomatic improvement
  • Increase fluid intake to 3 to 4 litres per day

Pharmacological treatment

Acute bacterial prostatitis

Four to eight weeks of prostate-penetrating antibiotic therapy is typically required

If there are features of associated urethritis (STI regimen):

Ceftriaxone IV

1gm twice daily stat

THEN

Ciprofloxacin oral 

500mg twice daily for three to six weeks

OR

Ciprofloxacin IV

200mg every 12 hours until pain and fever subside

THEN

Ciprofloxacin oral

500 mg orally every 12 hours for 3-6 weeks

Chronic/relapse/persistent infection:

Ciprofloxacin oral

500 mg orally every 12 hours

Referral

Refer to a urologist if:

  • There is no response to treatment
  • Urinary retention present
  • Prostatitis is chronic or relapsing