🧠 Acute Bacterial Prostatitis – an acute infection of the prostate, usually due to ascending urinary pathogens. On digital rectal examination, the prostate is tender, enlarged, and “boggy”. ⚠️ Do NOT massage the prostate – risk of bacteraemia and sepsis.

📘 About

Acute inflammation of the prostate caused by bacterial infection.
Most commonly due to ascending infection from the urethra or bladder (e.g. E. coli).
In younger men (<35) or those with risk factors → consider sexually transmitted pathogens (e.g. Chlamydia trachomatis, Neisseria gonorrhoeae).

🩺 Clinical Features

💧 Lower UTI symptoms: Dysuria, frequency, urgency, cloudy or malodorous urine.
🧍‍♂️ Prostatic symptoms: Perineal, rectal, or penile pain; painful ejaculation; acute urinary retention; weak stream or hesitancy.
🔥 Systemic features: Fever, chills, rigors, malaise, myalgia → may progress to urosepsis.
🩹 DRE: Tender, warm, swollen “boggy” prostate – examine gently.

🧪 Investigations

💧 Urinalysis: Leucocytes, nitrites, blood → send MSU for culture.
🩸 Bloods: FBC (↑WCC), CRP (↑), U&E (AKI risk), blood cultures if febrile/systemically unwell.
📸 Imaging: Renal/bladder ultrasound if urinary retention or suspicion of prostatic abscess.
🧬 STI testing: If risk factors → refer to GUM clinic.
🚫 PSA: Avoid during acute infection (falsely elevated).

🧭 Differentials

🧓 BPH: LUTS without systemic illness.
♻️ Chronic prostatitis: Symptoms >3 months, milder, recurrent.
🦠 UTI / cystitis: No prostate tenderness.
🧫 Epididymo-orchitis: Scrotal pain/swelling.
🎗️ Prostate / bladder cancer: Haematuria, weight loss.
🧻 Colorectal pathology: Change in bowel habit, rectal bleeding.

💊 Management (NICE-aligned)

🧴 General: Rest, hydration, analgesia (paracetamol ± NSAID if appropriate), avoid alcohol/caffeine.
🏥 Admit urgently if:
- Systemically unwell / sepsis ⚡
- Unable to tolerate oral antibiotics
- Acute urinary retention
- Suspected prostatic abscess
- Failure to improve with oral therapy
⚠️ Early urology input if:
- Immunocompromised or diabetic
- Indwelling catheter
- Known urological abnormality

💉 Antibiotic Therapy

Empirical treatment should cover Gram-negative uropathogens. Adjust according to culture results.

Setting	Recommended Treatment
Outpatient (oral)	• Ciprofloxacin 500 mg BD OR Ofloxacin 200 mg BD (first-line) • Trimethoprim 200 mg BD ONLY if low risk of resistance 📅 Treat for 14 days → review → extend to 28 days if needed ⚠️ Stop fluoroquinolone if tendon pain, neuropathy, or CNS effects
Second-line / culture-guided	• Levofloxacin 500 mg OD (specialist advice) • Co-trimoxazole 960 mg BD (ONLY if sensitivity confirmed)
Inpatient / severe	• Ceftriaxone OR IV ciprofloxacin • ± Gentamicin (monitor renal function)

🧾 Review at 14 days → stop or extend depending on response.
🧪 If STI suspected → urgent GUM referral + contact tracing.
🩺 After recovery → consider urological assessment (e.g. obstruction, residual urine).
🚫 Avoid urethral catheterisation if possible – consider suprapubic catheter if retention.

⚡ Red flags: Hypotension, confusion, severe pain, urinary retention → suspect urosepsis → urgent admission.

💡 Teaching tip: The prostate is a poorly penetrated gland → requires antibiotics with high tissue penetration (e.g. fluoroquinolones, trimethoprim). This explains prolonged treatment duration (2–4 weeks) and risk of relapse if undertreated.

📚 Reference

NICE CKS – Prostatitis (acute)

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Acute Bacterial Prostatitis ✅