PROSTATITIS

PROSTATITIS

In both acute and chronic prostatitis, the seminal vesicles and posterior urethra are usually also involved. Aetiology Acute prostatitis is common, but underdiagnosed. The usual organism responsible is Escherichia coli , but Staphylococcus aureus Staphylococcus albus , Streptococcus faecalis , Neisseria gonorrhoeae or Chlamydia may be responsible. The infection may be haematogenous from a distant focus or it may be secondary to acute urinary infection. Clinical features General manifestations overshadow the local: the patient feels ill, shivers, may have a rigor, has ‘aches’ all over, especially in the back, and may easily be diagnosed as having influenza. The temperature may be up to 39°C. Pain on micturition is usual, but not invariable. The urine contains threads in the initial voided sample, which should be cultured. Perineal heaviness, rectal irritation and pain on defecation can occur; a urethral discharge is rare. Frequency occurs when the infection involves the bladder. Rectal examination reveals a tender prostate; one lobe may be swollen more than the other, and the seminal vesi cles may be involved. A frankly fluctuant abscess is uncommon. Treatment Treatment must be rigorous and prolonged or the infection will not be eradicated and recurrent attacks may ensue. Spread of infection to the epididymides and testes may occur. Prolonged treatment with an antibiotic that penetrates the prostate wall is indicated (trimethoprim, ciprofloxacin or aminoglycoside).