Prostatitis - acute Health Article

Signs and tests

Your health care provider may perform a physical examination to assess the prostate (warm, soft, swollen, or tender), the groin lymph nodes (enlarged or tender), the scrotum (swollen or tender), and the urethra (discharge).

Triple-void urine specimens may be collected for urinalysis and urine culture:

• #1 initial stream
• #2 mid-stream
• #3 after prostatic massage by examiner

Note: Your health care provider may choose not to perform prostatic massage if the prostate is obviously swollen and tender, because massage may potentially spread the infection and cause bacteremia or sepsis. These are potentially life-threatening infections in which bacteria are present in the bloodstream, rather than localized to one part of the body.

Urinalysis may reveal increased white blood cells (WBCs) and bacterial growth. Examination of prostatic secretions may also show increased levels of WBCs and concentrated bacterial growth upon culture.

Acute prostatitis may also alter the results of the following tests:

• CBC
• Urine analysis
• PSA
• Semen analysis

Treatment

Most cases of acute prostatitis clear up completely with medication and slight modification of diet and behavior.

MEDICATIONS:

Prostatitis is treated with antibiotics, most often trimethoprim-sulfamethoxazole (Bactrim), fluoroquinolones (Floxin or Cipro), and tetracycline derivatives.

For men with prostatitis caused by an STD, a 250 mg shot of ceftriaxone followed by a 10-day course of doxycycline or ofloxacin. For other bacterial causes, a standard course of treatment consists of Bactrim, Cipro, or Floxin for at least 4 weeks.

Because recurrence is common, some health care providers recommend even longer therapies -- 6 to 8 weeks -- to eliminate the infection. In severe cases, hospitalization and intravenous (IV) antibiotics may be required .

Stool softeners may reduce the discomfort associated with bowel movements.

SURGERY:

Surgery or urethral instrumentation (urinary catheterization or cystoscopy) are not recommended for patients with acute prostatitis.

OTHER THERAPY:

Frequent and complete urination is recommended to decrease the symptoms of urinary frequency and urgency.

If the swollen prostate restricts the urethra, it may be difficult to completely empty the bladder, and insertion of a suprapubic catheter (a drain that empties the bladder through the abdomen) may be necessary.

Warm baths may provide some relief of the perineal and lower back pain associated with acute prostatitis.

DIET:

Avoid substances that irritate the bladder, such as alcohol, caffeinated food and beverages, and citrus juices, and hot or spicy foods.

Increasing the intake of fluids (64 to 128 ounces per day) encourages frequent urination that will help flush the bacteria from the bladder.

MONITORING:

Follow-up should include an examination at completion of antibiotic therapy to ensure that infection is no longer present.