Prostatitis - bacterial

Any bacteria that can cause a urinary tract infection can cause acute bacterial prostatitis.

Infections spread through sexual contact can cause prostatitis. These include chlamydia and gonorrhea. Sexually transmitted infections (STIs) 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 years, E coli and other common bacteria most often cause prostatitis. This type of prostatitis may begin in the:

• Epididymis, a small tube that sits on top of the testes.
• Urethra, the tube that carries urine from your bladder and out through the penis.

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

• Blockage that reduces or prevents the flow of urine out of the bladder
• 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 years or older who have an enlarged prostate have a higher risk for prostatitis. The prostate gland may become blocked. This makes it easier for bacteria to grow. Symptoms of chronic prostatitis can be similar to symptoms of an enlarged prostate gland.

Symptoms can start quickly, and can include:

• Chills
• Fever
• Flushing of the skin
• Lower stomach tenderness
• Body aches

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

Urinary symptoms include:

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

Other symptoms that may occur with this condition:

• Pain or aching 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.

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

Your provider may perform a digital rectal exam to examine your prostate. During this exam, your provider inserts a lubricated, gloved finger into your rectum. The exam should be done very gently to reduce the risk of spreading bacteria into the blood stream.

The exam may reveal that the prostate is:

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

Urine samples may be collected for urinalysis and urine culture.

Prostatitis may increase your level of the prostate-specific antigen (PSA), a blood test to screen for prostate cancer.

Antibiotics are often used to treat prostate infections.

• For acute prostatitis, you will take antibiotics for 2 to 6 weeks.
• For chronic prostatitis, you will take antibiotics for at least 2 to 6 weeks. Because the infection can come back, you may need to take medicine for up to 12 weeks.

Often, the infection will not go away, even after taking antibiotics for a long time. Your symptoms may come back when you stop the medicine.

If your swollen prostate gland makes it hard to empty your bladder, you may need a tube to empty it. The tube may be inserted through your abdomen (suprapubic catheter) or through your penis.

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 to 128 ounces or 2 to 4 liters per day) to urinate often and help flush bacteria out of your bladder.

Get checked by your provider after you finish taking your antibiotic treatment to make sure the infection is gone.

Acute prostatitis should go away with medicine and minor changes to your diet and behavior.

It may come back or turn into chronic prostatitis.

Complications may include:

• Abscess
• Inability to urinate (urinary retention)
• Spread of bacteria from the prostate to the bloodstream (sepsis)
• Chronic pain or discomfort
• Inability to have sex (sexual dysfunction)

Contact your provider if you have symptoms of prostatitis.

Not all types of prostatitis can be prevented. Practice safe sex behaviors.

Chronic prostatitis - bacterial; Acute prostatitis

McGowan CC. Prostatitis, epididymitis, and orchitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 110.

Pontari M. Inflammatory and pain conditions of the male genitourinary tract: prostatitis and related pain conditions, orchitis, and epididymitis. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 56.

US Department of Health and Human Services; National Institute of Diabetes and Digestive and Kidney Diseases. Prostatitis: inflammation of the prostate. www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate. Updated July 2014. Accessed July 14, 2023.

Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.