Note: Griffin Guice has graciously shared his AMR presentation on Acute Bacterial Prostatitis.  The words are his, I only added formatting and pictures. If you are interested in sharing your work on I Hate Rashes, please let me know.  We will make it happen!  ES

Acute Bacterial Prostatitis

• Epidemiology
  • Affects men of all ages. Up to 10% of men will have had prostatitis by age 70.
  • Incidence peaks between 20-40 years of age and then peaks again after 60 years
• Symptoms
  • The pain may be located in the back, rectum, perineum, testicles, penis, and/or suprapubic region. Pain can be difficult for patient to localize.
  • Urinary symptoms may be irritative (urgency, dysuria) or obstructive (hesitancy, straining, incomplete emptying).
• Physical Exam
  • Prostate should be gently palpated. It may be warm, firm, swollen/boggy, and tender. Massaging the prostate is not helpful
• Workup
  • Urinalysis, urine culture should be done. More than 10 WBCs per high-power field suggests the diagnosis
  • PSA likely to be elevated in acute prostatitis, but has little clinical utility
• Microbiology
  • Usually a gram negative bacilli like E. coli, Klebsiella, or Proteus. It can be part of an STD caused by gonorrhoeae or C. trachomatis.
• Treatment
  • Best initial, empiric treatment is a fluoroquinolone (Ciprofloxacin 500mg PO BID x 4-6 weeks)
  • Alternative options for susceptible bacteria include Bactrim DS and Doxycycline

References:

• Lipsky BA. Prostatis and urinary tract infection in men: what’s new; what’s true? AM J Med 1999; 106: 327-334.
• Lipsky BA, Byren I, Hoey CT. Treatment of bacterial prostatitis. Clin Infect Dis 2010; 50: 1641-1652
• Sharp, V., Takacs, E., & Powel, C. Prostatitis: Diagnosis and Treatment. American Family Physician, 82, 397-406