Acute Bacterial Prostatitis
Acute bacterial prostatitiis generally
affects younger men and is characterized by fever, chills,
painful urination, urinary frequency, urgency ( sudden, compelling urge
to urinate that brooks no delay), and extremely tender
prostate which may be boggy on examination. Vigorous Prostatic
massage which may produce purulent secretions (and therefore
aid in the diagnosis) should be avoided because this may
result in bacteremia (presence of bacteria in the blood stream).
The causative organisms can often be identified by simply
doing urinalysis, Gram's staining and urine culture. The
infections are commonly due to gram negative organisms such
as E.coli and Klebsiella.
Initially, patients are placed
on intravenous antibiotics such as trimethoprim-sulfamethaxazole,
cephalosporins or aminoglycosides. Patients often recover promptly,
but some cases of acute prostatitis may result in abscess formation,
vesiculitis or septicemia.
Chronic Bacterial Prostatitis
Chronic
bacterial prostatitis is the most common cause of recurrent
urinary tract infections in elderly men, and the diagnosis
is established by culturing prostatic secretions. The most
common organisms implicated are E.Coli, Proteus and
Klebsiella pneumoniae and Enterococcus species. Unlike acute
bacterial prostatitis, patients may not show any symptom and
the prostate may feel normal on exam. Sometimes, affected
individuals may present with obstructive symptoms, perineal
pain and infections may spread to the bladder causing
increase frequency of urinating, urgency and pain while
urinating. The diagnosis is often established by culturing
the prostate secretions. Patients are often treated with trimethoprim-sulfamethaxazole
or a quimolone antbiotics such as levofloxacin or
ciprofloxacin. Relapses are quite common even if the patient
is placed on prolonged treatment regimen. Sometimes,
treatment may require prostate resection.
Non Bacterial Prostatitis
Individuals who present with
sign and symptoms of prostatitis but with no bacterial
growth when the prostate secretion is cultured ( and has no history of
recurrent bacterial prostatitis) are classified as having
non bacterial prostatitis. The infectious agents are
unknown, but involvement of Chlamydia trachomatis
and Ureaplasma urealyticum have been postulated but not
conclusive. Most cases of non bacterial prostatitis occur in
young sexually active men. The effectiveness of
antimicrobial agents is questionable and uncertain, but some
patients do benefit from 4-6 weeks of Doxycycline and
symptomatic control, including sitz baths.
Prostatodynia
Some patients may have symptoms
and signs of prostatitis , but no evidence of prostatic
inflammation and cultures of the urine yield nothing. These
patients are said have Prostatodynia. These patients are not
given antimicrobial agents, because there is no infection. The management is purely symptomatic and supportive.
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