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Prostatitis

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Topic updated on 09/26/16 3:20pm

Snapshot
  • pyuriaA 27-year-old African American presents with fever, chills, lower back pain, dysuria, and urinary frequency. Rectal exam reveals a tender prostate, the prostate message specimen contains Escherichia Coli (>100,000).
Introduction
  • Inflammation of the prostate gland
  • May be acute or chronic
    • acute prostatitis
      • infectious process
        • < 35 years most commonly C.trachomatis, N.gonorrhoeae
        • > 35 years most commonly E.coli, P.aeruginosa, K.pneumoniae
    • chronic prostatitis
      • can be non infectious (bicycle riding)
        • most common
      • can involve recurrent infections
Presentation
  • Symptoms
    • fever
    • chills
    • low back pain
    • urinary frequency
  • Physical exam
    • possible fluctuant and swollen prostate
    • acute - very painful on DRE
    • chronic - less painful on DRE
Evaluation
  • Serology
    • leukocytosis
  • Urinalysis
    • pyuria
    • hematuria
    • bacteruria
      • especially during the end of micturition which is the prostate component
      • may also collect urine following a prostate massage
        • contraindicated in acute prostatitis
Treatment
  •  Acute (<35)
    • treat STDs
      • ceftriaxone with doxycycline
  • Acute (>35)
    • ciprofloxacin with TMP-SMX
  • Chronic
    • ciprofloxacin and alpha blockers 




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