Bacterial prostatitis

About bacterial prostatitis

Your prostate is a gland that produces the liquid part of semen. It's about the size of a walnut and lies at the base of your bladder. The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis.

For most men with prostatitis, there is no obvious cause for the inflammation but for some, it’s caused by a bacterial infection in the prostate. Bacterial prostatitis can be classed as an acute or chronic infection. The terms ‘acute’ and ‘chronic’ refer to how long you have had the infection, not how serious the condition is. An acute infection is typically over quickly whereas a chronic infection can last a long time and may come and go.

It's estimated that half of all men have prostatitis at least once during their lifetime. However, bacterial prostatitis is rare, and accounts for less than one in 10 men diagnosed. Most men with bacterial prostatitis have a chronic infection and are usually aged between 30 and 50.

Symptoms of bacterial prostatitis

Symptoms of bacterial prostatitis may include: 

  • a fever with shivers
  • muscle and joint pain
  • pain or stinging when you pass urine, if you ejaculate or during a bowel movement
  • a frequent or urgent need to pass urine
  • pain in your lower abdomen (tummy), lower back and/or the area between your scrotum and anus (perineum), at the tip of your penis, testicles and rectum (back passage)
  • feeling generally unwell
  • blood in your urine and semen

The symptoms of acute bacterial prostatitis tend to be very severe. They usually come on suddenly and you may need to go to hospital for treatment, such as intravenous antibiotics. A thin, flexible tube will be put into a vein to deliver the antibiotics directly into your bloodstream.

Symptoms of chronic bacterial prostatitis are less severe and usually last a long time (at least three months). You may find that your symptoms get better and then worse again, and there may be periods when you have no symptoms at all.

These symptoms may be caused by problems other than bacterial prostatitis. If you have any of these symptoms, see your GP for advice.

Complications of bacterial prostatitis

Complications of acute bacterial prostatitis can include:

  • being unable to pass urine (urinary retention) due to swelling in your prostate
  • a bladder infection (cystitis)
  • inflammation of the epididymis – a long, narrow tube at the back of your testicles where sperm is stored – because the infection can spread from your prostate to here
  • blood poisoning (septicaemia)
  • an abscess developing in your prostate
  • problems with fertility

If you have a weakened immune system, such as if you have HIV/AIDS, or take medicines that suppress your immune system, you’re more likely to develop some of these complications, such as an abscess.

There is also a risk of acute bacterial prostatitis developing into chronic bacterial prostatitis.

Causes of bacterial prostatitis

The exact reasons why you may develop prostatitis aren't fully understood at present. However, bacterial prostatitis is thought to be caused by an infection of your prostate with the same kinds of bacteria that cause urinary tract infections. These include:

  • Escherichia coli
  • Proteus species
  • Klebsiella
  • Pseudomonas
  • Staphylococcus aureus

Rarely, infections can spread from elsewhere in your body, such as your blood or lymphatic system, which is the tissues and organs that produce and store cells that fight infection and disease.

Prostatitis can also be caused by an injury to your pelvic area or if you have recently had a catheter inserted into your bladder to drain urine.

Diagnosis of bacterial prostatitis

Bacterial prostatitis may be diagnosed by your GP or he or she may refer you to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system). If you have severe symptoms and are seriously ill, your GP may admit you to hospital for emergency treatment.

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history.

You may have the following tests.

  • Your doctor may ask you for a sample of your urine, which he or she will test with a 'dipstick'. Alternatively, he or she may send the sample to a laboratory for testing to see if you have an infection.
  • Your doctor may do a digital rectal examination (DRE) to examine your prostate. Your doctor will feel your prostate through the wall of your rectum (back passage). If you have prostatitis, this examination may cause pain or discomfort but this will soon go away.
  • Your urologist may do a prostatic massage. He or she will insert a gloved finger into your rectum (back passage) to manually massage your prostate. Your urologist will also take a sample of fluids from the tip of your penis and will send this to a laboratory for testing. You may also be asked to give urine samples immediately before and after the massage. As well as diagnosing bacterial prostatitis, a prostatic massage may even alleviate your symptoms.

Chronic bacterial prostatitis can be harder to diagnose than acute bacterial prostatitis because the infection comes and goes so the bacteria may not always be present in your urine. Your doctor may ask you to have further tests to help rule out other conditions that may be causing your symptoms.

Treatment of bacterial prostatitis

It’s important to rest and drink enough fluids. The type of treatment you have will depend on whether you have acute or chronic bacterial prostatitis.

Medicines

Your doctor may try several different types of medicines to manage your symptoms. Some of these are listed below.

  • Antibiotics. You will usually be prescribed a four to six-week course of antibiotics, such as ciprofloxacin or ofloxacin. If you have acute prostatitis and your symptoms are severe or you don't respond to treatment, you may be admitted to hospital so that you can have antibiotics via a drip. If you have chronic bacterial prostatitis and don’t respond to treatment initially, you may need to try different types of antibiotics or take them for a longer period of time.
  • Alpha-blockers. These include alfuzosin and tamsulosin. Your doctor may prescribe these if you have chronic bacterial prostatitis. They work by relaxing the muscle fibres controlling tension in your prostate, which helps to relieve internal pressure and allows your bladder to empty more easily.
  • If you have pain during bowel movements, your doctor may prescribe a laxative (eg lactulose) to help make your faeces softer and easier to pass.
  • If you need pain relief, you can take over-the-counter painkillers, such as ibuprofen.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Surgery

Most men with prostatitis are treated with medicines but if you have a chronic infection that hasn’t responded to treatment with medicines, your doctor may suggest surgical treatment. It’s usually only recommended if you have a specific problem, for example an obstruction such as scar tissue in your urethra or prostate stones (prostatic calculi), that may be causing prostatitis.

Surgical options include:

  • a transurethral resection of the prostate (TURP) operation to remove part of your prostate
  • heat therapy (minimally invasive transurethral microwave thermotherapy) to destroy part of your prostate

However, the evidence for these treatments isn’t conclusive and more research needs to be done to prove that they are effective in treating chronic bacterial prostatitis.

Living with chronic bacterial prostatitis

Chronic bacterial prostatitis can be difficult to treat and it's possible the infection in your prostate may linger, and result in recurrent infections. This is because it’s sometimes difficult for antibiotics to clear the infection completely. However, your doctor will advise that you take antibiotics for four to six-weeks in an effort to do this. It can mean that your symptoms may come back every now and then, and you need treatment periodically in the long term. Your doctor will give you help and advice on coping with chronic bacterial prostatitis. There are also support groups that you can contact for further help.

Can bacterial prostatitis be passed on to sexual partners?

Answer

No, it's not possible to pass on bacterial prostatitis through sexual contact.

Explanation

You can't pass on bacterial prostatitis to sexual partners. There is no need to tell your sexual partners that you have the condition, unless you choose to.

However, some of the symptoms of bacterial prostatitis can be similar to those you get with several sexually transmitted infections (STIs). When you see your GP about your symptoms, he or she may carry out tests to rule out any STIs, or you may be referred to a sexual health clinic for tests. It's important to wait for the results of these tests before having sex to prevent the risk of spreading possible STIs.

If you have any questions or concerns about bacterial prostatitis or STIs, talk to your doctor.

How long does it take to recover from bacterial prostatitis?

Answer

The length of time it takes to recover from bacterial prostatitis depends on whether your condition is acute or chronic. Recovery from a bout of acute bacterial prostatitis usually takes about two weeks, but you may feel tired and have some discomfort for longer. Chronic bacterial prostatitis can be more difficult to treat and symptoms may come and go over a long period of time.

Explanation

If you have acute bacterial prostatitis, your symptoms should improve within two weeks of starting your course of antibiotics but you will usually need to continue to take them for four to six weeks. It’s important to take the full course of antibiotics. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Chronic bacterial prostatitis can be difficult to treat. Your doctor may need to prescribe a longer course of antibiotics (usually for three months). However, it's possible for the infection to linger and your symptoms can occasionally come back. This may continue long-term. Your doctor will work with you and may use a variety of different treatments to try and make your symptoms more manageable.

For more advice, talk to your doctor or urologist.

Will I need to be admitted to hospital if I have acute bacterial prostatitis?

Answer

You will only be admitted to hospital for acute bacterial prostatitis if your symptoms are very severe, if your immune system is already weakened or if you’re unable to pass urine.

Explanation

For most men, the symptoms of acute bacterial prostatitis can be treated effectively with a course of antibiotics, painkillers, drinking enough water and getting plenty of rest. However, in some situations, your GP may feel that you should be admitted to hospital for treatment.

You will need hospital treatment if you have any of the following.

  • Your symptoms have come on suddenly and are very severe.
  • You have difficulty taking antibiotic tablets or can’t keep them down.
  • You started your antibiotics but your symptoms have got worse.
  • Your prostate is so inflamed that you’re no longer able to pass urine (acute urinary retention).
  • You have a weakened immune system, such as HIV/AIDS, or take medicines that suppress your immune system, which means you’re more likely to develop complications, such as an abscess.

At the hospital, you may have a drip inserted into the back of your hand to give you medicines (painkillers and antibiotics) directly into your bloodstream.

If you have acute urinary retention, this can be extremely uncomfortable and painful. A doctor or nurse will insert a catheter (a thin, flexible tube) into your bladder to allow it to empty. He or she will usually insert the catheter though the opening at the end of your penis (urethra) and into your bladder. However, if you have an inflamed prostate, this type of catheter could be very painful, difficult to insert and may cause further damage. An alternative is to use a suprapubic catheter. This procedure involves inserting a catheter directly into your bladder through a small cut in your abdomen. The procedure is usually done under local anaesthetic and will often mean you need to stay in hospital overnight.

Talk to your GP or urologist if you need any advice.