What is prostatitis?

Prostatitis is a common inflammation or infection of the prostate gland. The prostate is a doughnut-shaped gland that sits in a man's pelvis in the small space between the base of the penis and the bladder. The prostate gland completely surrounds the urethra, the tube through which urine and semen pass. The prostate produces several components of semen, including nutrients for sperm.

How does it occur?

Many cases of prostatitis are caused by bacteria. Usually the infection-causing bacteria are transmitted to the prostate from other areas of the urinary tract, such as the bladder or kidneys. The other common route of infection is through the urethra after sexual contact. Much less frequently bacteria are spread to the prostate by the bloodstream.

The cause of cases of prostatitis that do not appear to be caused by bacteria is unclear. They may result from an infection caused by microorganisms that have not yet been identified, or perhaps such cases are a noninfectious inflammation of the prostate.

What are the symptoms?

There are three general types of prostatitis: acute bacterial prostatitis, chronic prostatitis, and nonbacterial prostatitis. The symptoms of these different types vary somewhat.

If you have acute bacterial prostatitis, you have clear signs of illness and you need to get treatment promptly. The symptoms most often are fever, chills, sweating, and lower back pain. You may have pain behind the scrotum, including pain or difficulty when you urinate or pain when you have a bowel movement.

The symptoms of chronic (also called subacute) prostatitis and nonbacterial prostatitis are much more subtle, develop more gradually, and are not as severe. Typical symptoms include vague discomfort when you urinate and a mild lower backache. You may have an aching sensation in the penis, scrotum, or middle to lower abdomen. You may feel pain during or after ejaculation. Sometimes there are small amounts of blood in the semen.

How is it diagnosed?

Acute bacterial prostatitis is diagnosed from the symptoms of illness. Your health care provider will examine your abdomen and scrotum to rule out other possible diagnoses. A rectal exam may be performed. A sample of your urine may be cultured in the lab to find out what type of bacteria is causing the prostatitis. After the acute infection symptoms have been treated, x-rays or sonograms of the urinary tract may be necessary. These images of your pelvic area help rule out underlying causes or complications of prostatitis, such as kidney infection or an abscess of the prostate gland.

It can sometimes be difficult to determine whether chronic bacterial prostatitis or an infection of the urinary tract is causing milder symptoms. For this reason a special series of urine samples and prostate secretions are obtained for lab tests. Your health care provider will ask you to provide a urine sample before a rectal exam of the prostate. During the rectal exam, your provider will press on the prostate, causing secretions from the prostate to enter your urinary tract. After the rectal exam you will provide an additional sample of urine. If white blood cells and bacteria are present in the last urine specimen, but not in the first specimen, your provider will conclude that the prostate gland is infected.

Your provider may conclude that you have nonbacterial prostatitis if you have symptoms but neither the urine culture nor the prostate secretions show evidence of infection.

What is the treatment?

Acute bacterial prostatitis and chronic bacterial prostatitis are treated with antibiotics. If you have acute prostatitis and your symptoms are severe, you may need to spend some time in the hospital for intravenous (IV) antibiotics.

Sometimes it is helpful to treat nonbacterial prostatitis with antibiotics. Some men find that certain foods, such as foods that contain caffeine or are spicy, seem to cause prostate symptoms.

How long will the symptoms last?

The symptoms of bacterial prostatitis usually respond to antibiotic therapy within a few days. Sometimes the symptoms will persist for 1 to 2 weeks after you start taking the medicine.

The symptoms may recur if not all of the bacteria in the prostate gland are killed by the antibiotic. Symptoms may also return if bacteria from the urinary tract or from sexual contact reinfect the prostate. In such cases, another treatment with antibiotics is necessary.

What can be done to help prevent prostatitis?

• Prevent infection with sexually transmitted diseases (for example, by using a condom during sexual intercourse) to decrease the risk of prostatitis.

• Practice good genital hygiene, especially if you are uncircumcised, to prevent urinary tract infections, which can lead to prostatitis.

• Get prompt treatment of any urinary tract problems to lessen the likelihood of prostate infection.