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Irritative voiding symptoms
Perineal or suprapubic discomfort, often dull and poorly localized
Abnormal expressed prostatic secretions and positive culture
Although chronic bacterial prostatitis may evolve from acute bacterial prostatitis, over half of affected men have no history of acute infection
Most common: gram-negative rods
Less common: Enterococcus
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Variable; most have varying degrees of irritative voiding symptoms, urethral pain, and obstructive urinary symptoms
Low back and perineal pain
Many patients (25–43%) report a history of urinary tract infections
Physical examination is often unremarkable; prostate may feel normal, boggy, or indurated
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Urinalysis is normal unless a secondary cystitis is present
A postvoid residual urine volume should be measured to evaluate for urinary retention
Expressed prostatic secretions and/or a postprostatic massage voided urine demonstrate increased numbers of leukocytes (> 5–10 per high-power field) and bacterial growth when cultured
Culture of the secretions and/or the postprostatic massage urine specimen is necessary to make the diagnosis
Leukocyte and bacterial counts from expressed prostatic secretions do not correlate with severity of symptoms
Differential diagnosis
Nonbacterial prostatitis
Chronic pelvic pain
Interstitial cystitis
Chronic urethritis
Perianal disease
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Symptomatic relief may be provided by
Anti-inflammatory agents (indomethacin, ibuprofen)
Hot sitz baths
Alpha-blockers (tamsulosin, alfuzosin, silodosin)
If patients are febrile or systemically ill, they may require admission and initial intravenous therapy with broad-spectrum antibiotics such as ampicillin plus gentamicin, a third-generation cephalosporin, or a fluoroquinolone
Ampicillin, 1 g every 6 hours, plus gentamicin, 1 mg/kg every 8 hours, intravenously for 14 days
Ceftriaxone, 1 g daily intravenously for 14 days
Ciprofloxacin, 400 mg every 12 hours intravenously for 14 days
Therapy would then continue with oral trimethoprim-sulfamethoxazole, fluoroquinolones, or an extended spectrum beta-lactamase antibiotic based on culture and sensitivities of expressed prostatic secretion or postprostatic massage urine
Trimethoprim-sulfamethoxazole, 160/800 mg every 12 hours orally for 14 days (increasing resistance noted [up to 20%])
Ciprofloxacin, 500 mg every 12 hours orally for 7 days (increasing resistance has been noted)
Levofloxacin, 750 mg daily orally for 5 days
The optimal duration of therapy remains controversial, ranging from 4 to 6 weeks