GPAtlas🧭 When to suspect
Acute bacterial prostatitis is an acute infection of the prostate gland, usually caused by uropathogens – most commonly Escherichia coli – ascending from the urinary tract.
It is uncommon in primary care but is potentially serious and life-threatening, and can progress rapidly to sepsis.
Suspect it in a man with these together:
• Lower urinary tract symptoms: dysuria, frequency, urgency, or acute retention
• Systemic features: fever, rigors, or feeling unwell
• Pelvic pain: classically in the perineum but also the suprapubic area, penis, groin, lower back, or rectum
Pain on ejaculation or defecation is common.
Raise suspicion particularly:
• After a recent UTI or urological instrumentation (especially transrectal prostate biopsy or catheterisation)
• In men with structural urinary tract abnormalities or who are immunocompromised
In younger, sexually active men, always consider a sexually transmitted infection as the underlying cause.
Because the prostate is a deep-seated site that most antibiotics penetrate poorly, the two key skills are to start an antibiotic that reaches the prostate promptly and to never miss sepsis or acute retention.
| NIH category | Type | Key features |
|---|---|---|
| I | Acute bacterial prostatitis | Sudden onset, systemically unwell, positive midstream urine (MSU) – the focus of this article |
| II | Chronic bacterial prostatitis | Recurrent UTIs or pelvic symptoms over 3 months with the same organism |
| III | Chronic prostatitis or chronic pelvic pain syndrome (CPPS) | • Most common type • Pelvic pain over 3 months with no proven infection (IIIa inflammatory, IIIb non-inflammatory) |
| IV | Asymptomatic inflammatory prostatitis | • Found incidentally (e.g. on biopsy or semen analysis) • No symptoms, no treatment needed |
Source: NICE NG110
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