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Acute Prostatitis

Checked: 23-05-2022 by Sandi Littler Next Review: 23-05-2023

Overview

Acute bacterial prostatitis is a severe, potentially life-threatening bacterial infection of the prostate and infection of the urinary tract. [1]

Acute prostatitis should be suspected in a man who presents with signs and symptoms of:

A urinary tract infection (UTI) — dysuria, frequency, urgency.
Prostatitis – perineal, penile, or rectal pain; acute urinary retention, obstructive voiding symptoms; low back pain, pain on ejaculation; tender, swollen, warm prostate (on gentle rectal examination).
Bacteraemia – rigors, arthralgia, or myalgia; fever, tachycardia.

For advice on chronic prostatitis / chronic pelvic pain syndrome please see the Chronic Pelvic Pain in Men page.

Who to Refer

Acute prostatitis is rarely encountered in primary care and if it is suspected then a discussion with the on call urology team should be considered (see Referral section below)

Admission to hospital should be arranged if symptoms get worse or have not improved within 48 hours of starting antibiotic treatment. [2]

Following recovery, men should be referred to a urologist for investigation to exclude structural abnormality of the urinary tract.

Urgent referral to a genito-urinary medicine (GUM) clinic should be arranged if a sexually transmitted infection is identified.

Red Flags

Admission to hospital should be arranged if the man:

Is unable to take oral antibiotics.
Has severe symptoms.
Has signs or symptoms of a more serious condition (for example sepsis, acute urinary retention or prostatic abscess).

What To Do Before Referral

Mid-steam urine (MSU) sample to confirm UTI by dipstick, culture and sensitivity. [3]
Blood cultures (if available) and full blood count.
Physical examination – Including abdomen to detect a distended bladder and costovertebral angle tenderness, a genital examination, and a digital rectal examination (DRE).
Consider screening for sexually transmitted infection, particularly in men considered to be at risk.
Men suspected of having acute bacterial prostatitis should be prescribed an oral antibiotic. See BNSSG Primary Care Antimicrobial Guidelines v9.6. Please note interaction between NSAIDs and quinolone antibiotics - NSAIDs may increase the risk of seizures when given with quinolones. [4]
Men should be advised:
- To take paracetamol (with or without a low-dose weak opioid, such as codeine) for pain, or ibuprofen (if preferred and suitable).
- To drink enough fluids to avoid dehydration.
- About the usual course of acute prostatitis (several weeks).
- About possible adverse effects of the antibiotic.
- To seek medical help if symptoms worsen at any time, symptoms do not start to improve within 48 hours of taking the antibiotic, or they become systemically very unwell.
Follow up should be arranged after 48 hours to check response to treatment and the urine culture results.

Services

Same day advice

There should be a low threshold for discussion with the on call urology team if acute prostatitis is suspected and particularly if there are red flags.

Please see the Urgent Care and HOT Clinic page for details of the urgent urology advice line.

Referral to urology for further investigation

Patients not requiring admission should be referred to Urology via eRS. GP Care will be given as the default choice by the Referral Service (as long as there is no suspected cancer) or Secondary Care Urology if appropriate or specified in the referral.

Urology Advice & Guidance Service is also available at GP Care.

Referral to GUM clinic

Urgent referral to a genito-urinary medicine (GUM) clinic should be arranged if a sexually transmitted infection is identified.

Resources

Quick Reference Guide from Prostate Cancer UK

Acute Prostatitis (PDF) from Patient UK at http://www.patient.info

Prostatitis (URL) from NHS choices at www.nhs.uk

Chronic Prostatitis – NICE CKS

[1] NICE CKS Prostatitis - Acute - Definition

[2] NICE CKS Prostatitis - Acute: Summary

[3] NICE CKS How should I diagnose acute prostatitis?

[4] quinolones | Drug class | BNF content published by NICE

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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