What is Acute Bacterial Prostatitis?
Bacterial prostatitis, or BP, is a bacterial infection that affects the prostate gland. This condition can happen in both younger and older men. There are two types: acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). If not treated correctly, it can lead to serious health problems, so it’s vital for healthcare providers to understand the causes, how it happens, symptoms, evaluation and treatment procedures, whether in emergency rooms or regular check-up clinics.
It’s worth noting that acute bacterial prostatitis is quite rare. However, when it does occur, it’s usually linked to issues with bladder obstruction or a weakened immune system.
What Causes Acute Bacterial Prostatitis?
Bacterial prostatitis, or BP, is usually caused by an infection from bacteria in the Enterobacteriaceae family. However, different types of bacteria can cause the condition, especially in people with certain risk factors. The most common bacteria found in people with BP are Escherichia coli, making up about 50% to 90% of cases. Other bacteria that can cause BP include Proteus, Klebsiella, Enterobacter, Serratia, and Pseudomonas.
Some other bacteria, such as Enterococcus species, Staphylococcus species, and sexually transmitted bacteria such as Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, can also cause BP. Activities that involve touching the prostate, like certain medical procedures and tests, can increase the risk of getting BP from certain bacteria, including pseudomonas and staphylococcal.
People with weakened immune systems require special attention because they have a higher risk of getting BP from atypical bacteria like Salmonella species, Mycobacterium species, and Staphylococcus species. Doctors should also consider the possibility of causes other than bacteria in these cases, such as fungi or viruses.
Although bacteria in the Enterobacteriaceae family are the most common cause of both acute and chronic bacterial prostatitis (ABP and CBP), gram-positive bacteria and atypical bacteria are more likely to be found in people with CBP. However, not all doctors agree on this point.
The risk factors for bacterial prostatitis can include various conditions and activities, such as having phimosis (a tight foreskin), intraprostatic ductal reflux (backflow of urine into the prostate), unprotected vaginal or anal sex, a urinary tract infection, a urinary catheter, a prostate biopsy, a transurethral surgery (surgery performed through the urethra), a birth defect of the ureter, or a history of sexual abuse.
Risk Factors and Frequency for Acute Bacterial Prostatitis
Prostatitis affects around 8% to 16% of men, mainly those who are young to middle-aged and older. It’s interesting to note that only 5% to 10% of prostatitis cases are caused by bacteria. This relatively uncommon type of prostatitis has led experts to establish different classifications
- Acute Bacterial Prostatitis (ABP)
- Chronic Bacterial Prostatitis (CBP)
- Chronic Prostatitis/Chronic Pelvic Pain Syndrome
- Asymptomatic Inflammatory Prostatitis
Men who experience one case of bacterial prostatitis often face repeat occurrences and might even progress to chronic bacterial or nonbacterial prostatitis. Certain health conditions and practices increase the risk for bacterial prostatitis such as manipulating the prostate, a urethral stricture, benign prostatic hyperplasia, phimosis, urethritis, diabetes, other immune-compromising conditions, and a history of sexually transmitted infections (STIs), among others. Prostatitis also increases the likelihood of developing benign prostatic hyperplasia and potentially, prostate cancer.
Signs and Symptoms of Acute Bacterial Prostatitis
Acute bacterial prostatitis (ABP) is a condition with sudden onset and symptoms of infection, whereas chronic bacterial prostatitis (CBP) develops more gradually and subtly. People with ABP usually report feeling feverish, tired, muscular pain, trouble with urination, a higher urge to urinate, an uneasy feeling while urinating, and pelvic pain. During a physical check, the prostate might appear bigger than normal and will be extremely sensitive to touch. Extremely thorough examination of the prostate gland should be avoided in ABP situations as it can make the condition worse. Additional indicators like urinary retention could exist, showing up as tenderness and a feeling of fullness above the pubic area. ABP suspects should also be checked for sensitivity in the area between the ribs and hip (CVA), since kidney infection might also be a consideration.
On the other hand, the signs of CBP are long-term and recurrent. The intensity of the symptoms is often less severe than ABP but can still significantly affect the patient’s quality of life. Like ABP, CBP may exhibit signs and symptoms of a urinary tract infection, trouble with urination, and discomfort in the pelvic region. However, men with CBP typically do not appear severely unwell, and some might not exhibit any symptoms, but simply have a lingering, symptom-less bacteria presence in their urine. During the examination, the prostate might not show inflammation but may be sensitive to touch. Men with CBP could also experience sexual dysfunction.
Testing for Acute Bacterial Prostatitis
If someone is suspected of having acute bacterial prostatitis (ABP), which is an infection of the prostate, doctors usually consider the patient’s individual characteristics and possible complications. For chronic bacterial prostatitis (CBP), it is best evaluated by a specialist, such as a urologist. Once ABP is suspected, the patient should have a midstream urinalysis and urine culture. These are tests which examine urine samples. If the patient shows signs of sepsis or has other major health issues, additional tests like blood cultures, lactic acid tests, a full metabolic panel, and a complete blood count would be needed.
While imaging tests aren’t always necessary, they can be highly recommended in certain situations. Computed tomography (CT) scanning or transrectal ultrasound (TRUS) can be used to search for a prostatic abscess, which is a puss-filled cavity in the prostate, particularly if the patient’s immune system is compromised or they’re predisposed to having bacterial infections in their blood (bacteremia) or bacterial clots in their bloodstream (embolic bacterial seeding). These imaging tests might also be needed if the patient’s condition is getting worse despite treatment.
Doctors who specialize in conditions of the urinary tract and male reproductive organs—urologists—should be called in if a patient with ABP can’t urinate and needs a suprapubic catheter, which is a tube inserted into the bladder to drain urine. Transurethral urinary catheters, which pass through the urethra, can make the patient’s condition worse. Prostate-specific antigen (PSA) and inflammatory markers like C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) aren’t highly useful in diagnosing ABP, because they lack specificity. If a sexually transmitted infection is suspected, tests for Neisseria gonorrhea and Chlamydia trachomatis should be performed.
Chronic prostatitis is best diagnosed by a specialist using the Meares and Stamey four-glass test or the two-glass pre-massage and post-massage test, possibly alongside a semen sample culture and urodynamic studies. The four-glass test involves the collection and examination of four different samples: urine initially voided, mid-stream urine, prostate secretions, and urine after a prostate massage. The two-glass test involves taking urine samples before and after a prostate massage. The four-glass test isn’t performed often as it is difficult for both the patient and provider, and lacks strong supporting evidence.
One thing to note is that a prostate biopsy, a procedure where a small sample of prostate tissue is removed for examination, should not be done if there’s an acute infection. This is because it might spread the infection to nearby organs and also because the biopsy can be very painful.
Treatment Options for Acute Bacterial Prostatitis
Acute bacterial prostatitis (ABP) is treated by using appropriate antibiotics that effectively reach the prostate tissue and by managing any associated complications. The prostate is unique in its structure and biochemistry, making certain antibiotics less effective. Its high alkaline levels and less permeable blood vessels mean that antibiotics that are highly potent and fat-soluble are the best at reaching higher tissue concentrations. This includes antibiotics like fluoroquinolones, tetracyclines, macrolides, and trimethoprim.
Overall, the most acutely inflamed prostate tissue can be penetrated by most antibiotics, excluding nitrofurantoin, providing doctors with multiple options to treat ABP. However, the treatment of chronic bacterial prostatitis (CBP), should be based on the patient’s specific culture results and waited until they are available, as antibiotics can be chosen that will effectively reach the prostate. The treatment usually lasts for two to six weeks. Enterobacteriaceae bacteria are the most common cause, so the initial treatment should aim to target these organisms.
For those with ABP who are not severely ill, and who don’t present a high risk for treatment failure, they can be sent home with a prescription of oral fluoroquinolones or Bactrim for 2 to 4 weeks, with a follow-up culture test to ensure the infection has cleared. If the infection is suspected to be sexually transmitted, a single dose of intramuscular ceftriaxone with a two-week course of doxycycline will be prescribed. Severe cases that show signs of sepsis, urinary retention, or high risk for treatment failure will be admitted to the hospital for intensive care and will receive antibiotics as an injection or an IV drip.
In such serious illness, the initial treatment may include a fluoroquinolone combined with either an aminoglycoside, anti-pseudomonal penicillin, or cephalosporin. Doctors may also use imaging techniques, like the transrectal ultrasound (TRUS) or CT scans, to check for any prostate abscess, which might need surgery to be drained. Urologists may be consulted if the patient cannot urinate, the treatment for which can include the placement of suprapubic catheter to ease the urine flow.
Upon discharge from the hospital, they will continue taking oral antibiotics tailored to their specific infection and with favorable properties that can effectively treat it. Some patients may also be given alpha-blocker drugs, such as Terazosin, usually over several months, to reduce urine flow obstruction. If a patient’s condition doesn’t improve with antibiotic therapy and an abscess has developed, surgical drainage may be required.
What else can Acute Bacterial Prostatitis be?
When a doctor is trying to diagnose bacterial acute prostatitis, there are other conditions that can have similar symptoms and must be considered:
- Inflammation of the urethra (Urethritis)
- Prostate cancer
- Urinary tract infection (UTI)
These possibilities should be ruled out with appropriate testing to reach the correct diagnosis.
What to expect with Acute Bacterial Prostatitis
Patients who respond well to antibiotics generally have good outcomes. However, those who don’t respond to antibiotics often need to undergo surgery to treat an abscess. Infertility can also occur when the prostate is significantly exposed to bacteria. Although rare, a prostatic abscess may form in patients who have catheters. Other complications may include the development of chronic prostatitis, epididymitis, or pyelonephritis. It’s also important to note that at least 10% of patients may experience chronic pelvic pain.
Possible Complications When Diagnosed with Acute Bacterial Prostatitis
There are several possible complications, which include:
- Sepsis (a severe, body-wide infection)
- Epididymitis (inflammation of a tube at the back of the testicles)
- Abscess (collection of pus)
- Chronic prostatitis (long-term inflammation of the prostate)
- Chronic pelvic pain (persistent pain in the lower abdominal area)
