Prostatitis

Overview

Prostatitis refers to inflammation of the prostate gland, most commonly caused by bacterial infections but also due to non-infective chronic inflammatory conditions. It can present acutely with urinary and systemic symptoms or manifest as a chronic and recurrent condition with pelvic discomfort. It is a common cause of male genitourinary complaints, especially in younger and middle-aged men.

Definition

Prostatitis is the inflammation of the prostate gland, classified into acute, chronic bacterial, chronic non-bacterial (non-specific), and granulomatous forms.

Aetiology

Infective (Bacterial)

• Most common cause of acute forms
• Typical organisms:
  • Escherichia coli (most common)
  • Staphylococcus aureus (rare)
  • Neisseria gonorrhoeae (occasionally, in STIs)

Non-Infective Causes

• Chronic non-specific prostatitis: often idiopathic or following recurrent bacterial prostatitis
• Granulomatous prostatitis:
  • Post-BPH infarction or post-TURP
  • Tuberculosis
  • Allergic (eosinophilic)
  • Idiopathic

Pathogenesis

• Acute suppurative prostatitis: infection ascends from the urethra or bladder, leading to pus-forming inflammation
• Chronic non-specific prostatitis: repeated minor infections or inflammation → fibrosis and lymphoplasmacytic infiltrates
• Granulomatous prostatitis: granuloma formation from varied causes (infection, infarction, or allergic responses)

Clinical Features

Symptoms

• Lower urinary tract symptoms (LUTS), similar to benign prostatic hyperplasia (BPH):
  • Dysuria
  • Urinary frequency and urgency
  • Hesitancy or poor stream
• Rectal/perineal pain
• Fever and malaise (in acute bacterial types)
• Painful ejaculation and pelvic discomfort in chronic forms

Signs

• Tender, swollen prostate on digital rectal examination (DRE)
• Avoid vigorous DRE in acute cases to reduce risk of bacteraemia

Investigations

• Urinalysis and urine culture
• Full blood count and inflammatory markers (↑WCC, ↑CRP)
• Prostate-specific antigen (PSA) may be elevated in acute inflammation
• Transrectal ultrasound (TRUS) if abscess or chronic infection is suspected

Management

Acute Bacterial Cases

• Antibiotics:
  • Fluoroquinolones (e.g. ciprofloxacin) are first-line
  • Intravenous antibiotics if septic
• NSAIDs: for pain relief
• Alpha-blockers: to relieve bladder outlet obstruction and dysuria

Chronic/Non-Specific Cases

• Longer antibiotic courses (4–6 weeks)
• Alpha-blockers for symptomatic relief
• Psychological support and physiotherapy for chronic pelvic pain syndrome

Complications

• Prostatic abscess
• Chronic bacterial prostatitis
• Urinary retention
• Bacteraemia/sepsis in untreated acute cases

Summary

Prostatitis is a clinical syndrome of prostatic inflammation, typically due to E. coli or other pathogens, and presents with urinary symptoms, rectal pain, and systemic features like fever. Chronic and granulomatous forms may occur and require tailored management. Early recognition and treatment with antibiotics and symptomatic relief measures are crucial. For a broader context, see our Reproductive Health Overview page.