Prostatitis

Prostatitis is the inflammation of the prostate gland, an organ of the male reproductive system located just below the bladder.

The prostate gland is a walnut-sized structure. It produces a fluid that together with sperm cells and other fluids makes up semen.

Prostatitis is often caused by a bacterial infection (bacterial prostatitis). In many cases, it is associated with STD (Sexually Transmitted Diseases) such as gonorrhea, chlamydia and trichomonas.

Sometimes, prostatitis is secondary to other causes (including surgical procedures) like:

• Urinary catheter
• Cystoscopy
• Trauma
• Bladder obstruction due to calculi or bladder stones

Prostatitis can be classified as:

• Bacterial prostatitis
  • Acute bacterial prostatitis: Happens suddenly and develops quickly.
  • Chronic bacterial prostatitis: Develops slowly and gradually and can last for years.
• Nonbacterial prostatitis: Inflammation not caused by bacterial infection in which there is a recurrent pain in the prostate area.

The first symptoms of acute prostatitis are:

• Pain in the lower stomach or the low back
• Pain in the perineum (the area between the scrotum and the anus)
• Discomfort or burning with urination (dysuria)
• Fever and chills

If the inflammation persists, and the prostate gland increases in size, there may be trouble with the flow of urine with weak urine stream, and difficulty starting urination. As the area may be affected, there is usually painful ejaculation or defecation.

Sometimes, if the underlying cause is a STD (Sexually Transmitted Disease) prostatitis is present along with epididymitis and orchitis (inflammation of the testicles).

Therefore, other symptoms are usually common, such as:

• Blood in urine (hematuria)
• To feel the need to urinate more often than usual, often urgently
• Pain in one or both testicles
• Blood in the semen (hematospermia)

Prostatitis is a very common disorder with an incidence over 1 case per 10.000 people in medical practice.

It is more common in males under 35 years of age.

People with benign prostatic hyperplasia (BPH), which usually affect older people, are at a higher risk to develop prostatitis.

Most often, the symptoms and physical findings are enough to form a diagnosis of prostatitis. When the examiner inserts a finger in the rectum, the swollen prostate can be felt; the doctor may detect the prostate enlarged, warm, firm, and the possible presence of tender lymph nodes. An examination of the testicles is also performed to assess tenderness, possible swelling of the scrotum, and urethral discharge.

It is also advisable to perform a urine test with the collection of three samples:

• Initial voided urine (urethral urine)
• Mid-stream urine (bladder urine)
• A third one at the end following a prostatic massage to force the output of prostatic secretions.

The urine sample in case of prostatitis typically contains a large number of white blood cells (leukocytes) and bacteria. A bacterial culture and an antiobiogram can help to know the response to the antibiotics.

Prostatitis may alter the results of other studies such as the PSA test for detection of prostate cancer or the spermiogram.

Prostatitis treatment is based on antibiotics to fight the specific germ causing the infection.

The most common treatments include the following antibiotics:

• Combination of the antibiotics trimethoprim and sulfamethoxazole (Bactrim)
• Fluoroquinolones (ciprofloxacin)
• Tetracyclines

Oral antibiotics should be given for 4 weeks. If necessary, the treatment is prolonged up to 8 weeks.

If prostatitis is related to STD (Sexually Transmitted Disease), it should be treated with a single dose of intramuscular ceftriaxone followed by 10 days of doxycycline or a quinolone.

Treatment is effective, but recurrence is quite common in people who experienced an episode of acute prostatitis. Exposing the perineum to warm water for 20 minutes or longer often relieves pain (sitz baths).

In addition, it is recommended to drink plenty of water and fruit juices.