Prostate Infections (Prostatitis)

Prostate Infection Facts

Prostate infections comprise only small percentage of all men with prostatitis. This small percentage is comprised of acute and chronic prostatic infections.

E. coli and other Gram-negative bacteria cause most acute and chronic prostatic infections.

  • Prostatic infection symptoms include groin pain, dysuria, pain with ejaculation, reduced urine output; and may include fever, malaise, and periodic recurrence of symptoms even after treatment.
  • Seek medical care if symptoms develop, emergency care if fever or inability to urinate occurs.
  • Diagnosis of prostate infections or prostatitis is made by identifying the agent (vast majority are bacteria) infecting the prostate.
  • Treatment of prostate infections or prostatitis is usually antibiotics; chronic infectious prostatitis may require long-term antibiotic treatment, and severe infections may require hospitalization with IV antibiotics.
  • Home care is limited to pain reduction. Men with a prostate infection or prostatitis need medical care.
  • Follow-up is important to confirm adequate treatment results or to plan additional treatment if the infection reoccurs.
  • Some prostate infections cannot be prevented, but reducing the risk of groin trauma or injury, avoiding sexually transmitted diseases, and staying well hydrated are ways to reduce the chance of getting infectious prostatitis.
  • The prognosis of acute infectious prostatitis is usually good, but chronic infectious prostatitis is only fair because it is difficult to cure.

Prostate Infections and Prostatitis Overview

The prostate gland is a part of a man's reproductive system, secreting fluids that help transport sperm. The gland lies just below the bladder and surrounds the urethra (the tube that drains the bladder).

Prostate infections may irritate the prostate and cause inflammation and swelling of the gland. Prostate infections occur most often in men aged 30-50 years but can occur in older men. Unfortunately, many people equate the terms prostate infection and prostatitis, but prostate infections comprise only two of the four major classifications of the term "prostatitis," and infectious types comprise only a few of the total number of prostatitis diagnosed patients.

Inclusion Criteria

pain or discomfort in the pelvic area (penis, scrotum, perineum, or thereabouts) for at least 3 months

male, at least age 18

Exclusion Criteria

  • the presence of cancer of the genitourinary tract
  • active urinary stone disease
  • herpes of the genitourinary system
  • bacteriuria (100,000 colonies in a midstream urine) within the past 3 months
  • antibiotic therapy within the past 3 months
  • perirectal inflammatory disorders
  • inflammatory bowel disease
  • history of pelvic radiation or systemic chemotherapy
  • history of intravesical chemotherapy
  • documented gonorrhea, chlamydia, mycoplasma, or trichomonas infection of the urinary tract within the past 3 months
  • clinical epididymitis within the past 3 months
  • urethral stricture of 12 French or smaller
  • neurological disease or disorder affecting the bladder
  • prostate surgery (not including cystoscopy) within the past 3 months

This classification system is important to understand because about 90% of men with prostatitis symptoms are diagnosed with chronic pelvic pain syndrome and, by definition, do not have infectious prostatitis.

The fourth category, asymptomatic inflammatory prostatitis, by definition, does not have an identified infectious cause, nor do the affected men have pain like chronic pelvic pain syndrome diagnosed patients. These patients are discovered when the prostate is biopsied for other situations such as a reason (possible cancer) for elevated PSA (prostate specific antigen) tests, or infertility. However, if the biopsy shows only inflammatory tissue changes and no cancer or other likely cause (infectious agents) for the asymptomatic inflammatory changes, then the patient is diagnosed with asymptomatic inflammatory prostatitis. Chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis are undergoing research to better define their causes and treatments.

Consequently, a diagnosis of prostatitis should be further defined by describing the classification that fits the patient. Clearly, infectious prostatitis fits only the acute or chronic classifications. The aim of this article is to describe prostate infections and not all four prostatitis classifications.

Prostate Infections Causes

Bacterial infections cause only a small percentage of cases of prostatitis. In the remaining percent, due to chronic pelvic pain syndrome or asymptomatic inflammatory prostatitis described above, the cause is not known. Prostate infectious agents are as follows for both acute and chronic infectious prostatitis:

  • Escherichia coli (E coli) is the bacterium most often the cause of prostate infections and approximately 80% of the bacterial pathogens are gram-negative organisms (for example, Escherichia coli, Enterobacter, Serratia, Pseudomonas, Enterococcus, and Proteus species).
  • Sexually transmitted disease-causing organisms also may cause infectious prostatitis especially in sexually active men under 35 years of age; the most usually identified organisms are Chlamydia, Neisseria, Trichomonas, and Ureaplasma.
  • Rarely staphylococcal and streptococcal organisms have been found to be the cause, and infrequently different organisms such as fungi, genital viruses, and parasites have been implicated.
  • The infectious agent (usually bacteria) may invade the prostate in two main ways.
    • The bacteria from a previous urethral infection move through prostatic ducts into the prostate (occasionally termed retrograde infection).
    • Movement of infected urine into the glandular prostate tissue can infect via ejaculatory ducts (occasionally termed antegrade infection).

Infectious organisms, as previously stated, cause two of the four main types of prostatitis; acute infectious prostatitis and chronic infectious prostatitis.