🔑 Key Learning

  • Acute prostatitis is a bacterial infection of the prostate, often caused by E. coli
  • Presents with lower urinary tract symptoms, perineal pain, and systemic upset
  • 1st line treatment: Ciprofloxacin or ofloxacin for 14 days

🧬 Pathophysiology

  • Acute infection of the prostate and lower urinary tract
  • Caused by ascending urethral infection or reflux of infected urine into the prostatic ducts
  • Common pathogens:
    • E. coli (most common)
    • Pseudomonas
    • Klebsiella
    • Enterococcus
    • Rarely: Neisseria gonorrhoeae, Chlamydia trachomatis

👀 Clinical Features

  • Urinary symptoms - frequency, urgency, dysuria, fever
  • Perineal pain 
  • Bladder outflow obstruction due to swelling - urinary retention, voiding symptoms (poor stream, hesitancy, intermittency, straining etc.)
  • Pain on ejaculation
  • Lower back pain
  • Systemic upset, fever, rigours
  • Examination findings (DRE):
    • Tender, swollen, boggy prostate
    • Warm on palpation
    • Avoid prostate massage – risk of bacteraemia or abscess rupture

🧪 Investigations

  • Urine dipstick and midstream sample for MCS
  • If acutely unwell: FBC, CRP, blood cultures

💊 Management

  • Admit if severely unwell/septic/abscess etc.
  • Consider urgent referral if immunocompromised/diabetic/urological condition
  • Antibiotics (14-day course):
    • 1st line: Ciprofloxacin 500 mg BD
    • Alternative: Ofloxacin 200 mg BD
    • If contraindicated: Trimethoprim 200 mg BD

📝 Exam Clues & Clinchers

  • Man with fever, dysuria, perineal pain, tender boggy prostate on DRE
    • 1st line treatment: Ciprofloxacin 500 mg BD for 14 days