Acute Prostatitis

🔍 When to Suspect

Urinary symptoms (dysuria, frequency, urgency) with fever and perineal, groin, or suprapubic pain, especially with risk factors like recent UTI or urological procedure

From the full topic in The Ocean Library: Acute Prostatitis

🧭 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 lower urinary tract symptoms (dysuria, frequency, urgency, or acute retention) together with systemic features – fever, rigors, or feeling unwell – and 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), and 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 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 / 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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