Chronic Prostatitis

Chronic prostatitis is a low-grade bacterial infection of the prostate gland. It can last a long time and cause recurrent urinary tract infections.

What is going on in the body?

The prostate gland in males makes fluids that are part of the semen. Normally, the contents of the prostate are sterile, that is, free of bacteria and other organisms. The prostate can become infected in acute bacterial prostatitis. If it is not treated completely, some bacteria can remain in the prostate. This causes chronic bacterial prostatitis. The bacteria can be extremely difficult to kill with medications once the acute infection is over. They can infect the urine over and over again. This is what brings on the episodes of symptoms. The chronic disease usually evolves from the acute form. But often there is no history of the acute infection.

What are the causes and risks of the infection?

Bacteria are thought to get into the prostate by way of a backwash into the urethra. So avoiding urinary tract infections should reduce the risk of chronic bacterial prostatitis.

What are the signs and symptoms of the infection?

The symptoms of chronic bacterial prostatitis are variable, and often come and go. They include:

How is the infection diagnosed?

Unlike the acute form of bacterial prostatitis, the chronic form has no characteristic symptoms. If prostatitis is diagnosed and there are no acute symptoms, the prostatitis is assumed to be chronic.

Secretions from the prostate are examined to aid in the diagnosis. The healthcare provider inserts a gloved finger into the rectum and massages the prostate. The gland produces a drop of prostatic fluid that can be milked out of the urethra. The fluid is then examined under a microscope. If more white blood cells than normal are seen, the diagnosis of prostatitis is made. The diagnosis is also made if bacteria are cultured from this specimen, or from the urine voided right after prostate massage.

What can be done to prevent the infection?

Any bladder outlet obstructions should be treated. This will reduce the amount of urine retained in the bladder after voiding. Urinary tract infections are then less likely to occur.

What are the long-term effects of the infection?

Prostatitis can certainly affect the person's quality of life. Otherwise, there are no serious long-term effects.

What are the risks to others?

Prostatitis is not a communicable disease, so sexual partners are not at risk.

What are the treatments for the infection?

After an acute infection has gone away, it's very hard for antibiotics to get into the prostate. So antibiotics, such as trimethoprim-sulfamethoxazole or one of the fluoroquinolones, are often taken for 2 to 3 months. This long-term treatment is the only way to get rid of the persistent bacteria.

If antibiotics don't completely eliminate the infection, they may be given for an even longer time at low doses. The goal is to prevent the infection of the urine by the chronically infected prostatic fluid.

A hot sitz bath, or bath with warm water, may also help to reduce symptoms. Bedrest may also be necessary when discomfort and swelling is severe.

For very stubborn infections, surgery known as a simple prostatectomy is sometimes done. An instrument is threaded through the urethra and most of the prostate is removed. This removes the infected tissue and decreases the number of bacteria so that antibiotics can work.

What are the side effects of the treatments?

Many antibiotics have side effects like stomach upset and allergic reactions. Prostate surgery carries a risk of bleeding, infection, retrograde ejaculation, and allergic reaction to anesthesia.

What happens after treatment for the infection?

A male with retrograde ejaculation passes semen into the bladder instead of out the end of the penis. This can result in infertility.

How is the infection monitored?

Since symptoms can continue for many months, a person may need to be reevaluated as treatment is in progress.

Author:Stuart Wolf, MD
Date Written:
Editor:Duff, Ellen, BA
Edit Date:05/12/00
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:06/06/01