Causes

Prostatitis is usually caused by a bacterial infection of the prostate gland. Any bacteria that can cause a urinary tract infection can cause acute bacterial prostatitis.

Some sexually transmitted diseases (STDs) can cause bacterial prostatitis, including chlamydia and gonorrhea. STDs are more likely to occur from:

• Certain sexual practices, such as having anal sex without wearing a condom
• Having many sexual partners

In men over age 35, E. coli and other common bacteria usually cause prostatitis. This type of prostatitis may occur after:

• Epididymitis
• Urethritis
• Urinary tract infections

Acute prostatitis may also be caused by problems with the urethra or prostate, such as:

• Bladder outlet obstruction
• Foreskin of the penis that cannot be pulled back (phimosis)
• Injury to the area between the scrotum and anus (perineum)
• Urinary catheter, cystoscopy, or prostate biopsy (removing a piece of tissue to look for cancer)

Men age 50 or older who have an enlarged prostate (benign prostatic hyperplasia) are at increased risk for prostatitis. The prostate gland may become blocked, making it easier for bacteria to grow. Symptoms of chronic prostatitis can be very similar to symptoms of an enlarged prostate gland.

Symptoms

Symptoms of acute prostatitis can start quickly, and can include:

• Chills
• Fever
• Flushing of the skin

Symptoms of chronic prostatitis are similar, but not as severe. They usually begin more slowly. Some people have no symptoms between episodes of prostatitis.

Urinary symptoms include:

• Blood in the urine
• Burning or pain with urination (dysuria)
• Difficulty starting to urinate or emptying the bladder
• Foul-smelling urine
• Weak urine stream

Other symptoms that may occur with this condition:

• Pain or achiness in the abdomen above the pubic bone, in the lower back, in the area between the genitals and anus, or in the testicles
• Pain with ejaculation or blood in the semen
• Pain with bowel movements

If prostatitis occurs with an infection in or around the testicles (epididymitis or orchitis), you may also have symptoms of that condition.

Exams and Tests

During a physical exam, your health care provider may find:

• Enlarged or tender lymph nodes in your groin
• Fluid released from your urethra
• Swollen or tender scrotum

To examine your prostate, the health care provider will perform a digital rectal exam. During this exam, the provider will insert a lubricated, gloved finger into your rectum.

The prostate may feel:

• Large and soft (with a chronic prostate infection)
• Warm, soft, swollen, or tender (with an acute prostate infection)

Your doctor may do a prostatic massage to see whether you have an infection:

• The health care provider will rub a gloved finger over the prostate gland a few times to release fluid from the urethra
• The fluid will be examined for white blood cells and bacteria -- signs of an infection

Urine samples may be collected for urinalysis and urine culture.

Prostatitis may affect the results of the prostate-specific antigen (PSA), a blood test used to screen for prosate cancer.

Treatment

Antibiotics are often used to treat prostate infections.

• For acute prostatitis, you take antibiotics for 4 to 6 weeks.
• For chronic prostatitis, you take antibiotics for at least 4 to 6 weeks. Because the infection can come back, you may need to take medicine for even longer -- up to 12 weeks -- to get rid of the infection.

Often, the infection will not go away, even if you've been taking antibiotics for a long time. After you stop taking antibiotics, your symptoms may return.

If your swollen prostate gland makes it hard to empty your bladder, you may need a tube to empty it through your abdomen (suprapubic catheter), or from inside your body (indwelling catheter).

To care for prostatitis at home:

• Urinate often and completely.
• Take warm baths to relieve pain.
• Take stool softeners to make bowel movements more comfortable.
• Avoid substances that irritate your bladder, such as alcohol, caffeinated foods and drinks, citrus juices, and hot or spicy foods.
• Drink more fluid (64 - 128 ounces per day) to urinate often and help flush bacteria out of your bladder.

After you finish antibiotic treatment, get examined by your health care provider to make sure the infection is gone.

Outlook (Prognosis)

Acute prostatitis should clear up completely with medicine and minor changes to your diet and behavior.

Acute prostatitis may come back or turn into chronic prostatitis.

Possible Complications

• Abscess
• Inability to urinate (urinary retention)
• Spread of bacteria from the prostate to the bloodstream (sepsis)

When to Contact a Medical Professional

Call your health care provider if you have symptoms of prostatitis.

Prevention

Not all types of prostatitis are preventable.

You can prevent infections caused by STDs by practicing safe sex behaviors.

Alternative Names

Chronic prostatitis - bacterial; Acute prostatitis

References

Nickel JC. Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 9.

Barry MJ, McNaughton-Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 130.

Updated: 4/19/2012

Reviewed by: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.