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For further information, see CMDT Part 23-03: Genitourinary Tract Infections

Key Features

Essentials of Diagnosis

  • Fever

  • Irritative voiding symptoms

  • Perineal or suprapubic pain

  • Exquisite tenderness on rectal examination

  • Positive urine culture

General Considerations

  • Usual causative organisms: Escherichia coli and Pseudomonas

  • Less common: Enterococcus

Clinical Findings

Symptoms and Signs

  • Perineal, sacral, or suprapubic pain

  • Fever

  • Irritative voiding complaints

  • Obstructive symptoms

  • Urinary retention

  • Exquisitely tender prostate

Differential Diagnosis

  • Epididymitis

  • Diverticulitis

  • Urinary retention from benign or malignant prostatic enlargement

  • Chronic bacterial prostatitis

  • Nonbacterial prostatitis

  • Chronic pelvic pain syndrome

Diagnosis

Laboratory Tests

  • Complete blood count: leukocytosis and a left shift

  • Urinalysis: pyuria, bacteriuria, hematuria

  • Urine culture: positive

Imaging

  • Pelvic CT or transrectal ultrasound is indicated in patients who do not respond to antibiotics in 24–48 hours

Treatment

Medications

  • Intravenous ampicillin and an aminoglycoside until afebrile for 24–48 hours, then oral quinolone for 4–6 weeks

  • Ampicillin, 1 g intravenously every 6 hours, and gentamicin, 1 mg/kg intravenously every 8 hours for 21 days

  • Ciprofloxacin, 750 mg orally every 12 hours for 21 days

  • Ofloxacin, 200–300 mg orally every 12 hours for 21 days

  • Trimethoprim-sulfamethoxazole, 160/800 mg orally every 12 hours for 21 days (increasing resistance noted [up to 20%])

Therapeutic Procedures

  • If urinary retention develops, an in-and-out catheterization to relieve the initial obstruction or short-term (12 hours) small indwelling urinary catheter is appropriate

Outcome

Follow-Up

  • Posttreatment urine culture

  • Posttreatment examination of expressed prostatic secretions after completion of therapy

Prognosis

  • Appropriate antibiotic therapy eradicates bacteria causing acute bacterial prostatitis

  • Progression to chronic bacterial prostatitis is rare

When to Refer

  • Evidence of urinary retention

  • Evidence of chronic prostatitis

When to Admit

  • Signs of sepsis

  • Need for surgical drainage of bladder or prostatic abscess

References

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Kwan  ACF  et al. Fosfomycin for bacterial prostatitis: a review. Int J Antimicrob Agents. 2020;56:106106.
[PubMed: 32721595]  
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Lupo  F  et al. Is bacterial prostatitis a urinary tract infection? Nat Rev Urol. 2019;16:203.
[PubMed: 30700862]
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Xiong  S  et al. Pharmacological interventions for bacterial prostatitis. Front Pharmacol. 2020;11:504.
[PubMed: 32425775]  

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