Acute Prostatitis

Comments from Expert Advisory Group

• Acute prostatitis is a rare potentially serious bacterial infection of the prostate.
• It usually presents abruptly and most commonly affects men 20-40 years and >60 years of age.
• It is usually caused by bacteria from the urinary tract i.e. E. coli, Proteus, Klebsiella.
• Less commonly, it can be caused by sexually transmitted infections such as chlamydia or gonorrhoea.

Diagnosis

• Consider acute prostatitis diagnosis in a man presenting with:
  • Perineal/suprapubic pain (or may have penile, low back pain, pain on opening bowels or pain with ejaculation)
  • Tender, swollen prostate on rectal examination.
  • Urinary symptoms including dysuria, frequency, urgency or acute urinary retention.
  • Constitutional signs and symptoms e.g. fever, chills, malaise, myalgia/arthralgia, nausea and/ or vomiting.
  • Recent transrectal prostate biopsy or other urological procedure.

• The most important investigation in the evaluation of a patient with acute bacterial prostatitis is mid-stream urine culture.
• Imaging of the urinary tract is also advisable in men with acute prostatitis because of high prevalence of structural abnormalities.
• Due to increasing resistance, it is essential to send an MSU so culture can guide antibiotic treatment if no clinical response to first choice antibiotics.
• Review after 14 days and either stop antibiotics if symptoms have resolved or continue for a further 14 days if necessary based on assessment of history, symptoms, clinical examination and MSU result.
• 4 week treatment may prevent chronic infection i.e. chronic prostatitis, but it is difficult to predict those at risk.
• A full STI screen should be considered to rule out other aetiologies. Further information on STI Consultations in Primary Care is available.
• Refer to emergency department if patient does not respond to antibiotics, is in urinary retention or becomes systemically unwell. These symptoms could be due to a prostate abscess.
• Those with immunocompromise or diabetes mellitus are at higher risk of severe infection.
• Specialist urological management is required in men with acute prostatitis whose symptoms fail to settle as one must consider risk of prostatic abscess.
• Specialist urological management may be required for those with pre-existing urological condition (such as benign prostatic hypertrophy or an indwelling catheter)

Treatment

• Paracetamol with/ without codeine (and/ or ibuprofen if appropriate) should be advised for pain relief
• Advise patients about drinking enough fluids to avoid dehydration.

Patient Information

Visit https://www.nhs.uk/conditions/prostatitis/ for patient information on prostatitis

Safe Prescribing Visit the safe prescribing page

• Doses are oral and for adults unless otherwise stated
• Dosing in children quick reference dosage/weight guide
• Fluoroquinolone warning
• Renal impairment dosing table
• Drug interactions table.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed June 2024