Last updated: October 12, 2023

Summarytoggle arrow icon

Prostatitis is an inflammation of the prostate gland that is of either infectious (acute bacterial prostatitis and chronic bacterial prostatitis) or noninfectious (chronic pelvic pain syndrome) origin. Bacterial prostatitis is most often caused by Escherichia coli. Patients with acute bacterial prostatitis typically present with spiking fevers, chills, perineal pain, and symptoms of bladder irritation. The presentation of chronic bacterial prostatitis is more subtle, including symptoms of urinary tract infections such as dysuria and increased urinary frequency and urgency. The prostate is typically tender and boggy in acute bacterial prostatitis and mildly tender or normal in chronic bacterial prostatitis. For bacterial prostatitis, diagnosis aims to identify the causative organism via urine culture, and empirical antibiotic treatment is the primary approach. Acute prostatitis can lead to life-threatening complications (e.g., acute urinary retention, prostatic abscess formation, sepsis) that may require additional treatment, such as suprapubic catheterization or ultrasound-guided abscess drainage. Chronic pelvic pain syndrome (CPPS) is characterized by chronic urogenital pain without evidence of urinary tract infection. Affected individuals may also experience lower urinary tract symptoms and erectile dysfunction. The etiology is unknown. A multimodal treatment approach with a symptomatic focus is recommended.

Epidemiologytoggle arrow icon

  • Common urologic diagnosis in men < 50 years of age [1][2]
  • In men, there is an ∼ 8% lifetime risk of developing prostatitis.
  • Bacterial prostatitis (2–5% of cases): most commonly men between 20 and 50 years of age
  • Chronic pelvic pain syndrome (90–95% of cases): primarily men between 40 and 60 years of age

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Acute prostatitis [3]

Chronic prostatitis

Other causes for acute or chronic bacterial prostatitis

Clinical featurestoggle arrow icon

Overview of clinical features of bacterial prostatitis and chronic pelvic pain syndrome [2][4][5][6]
Acute bacterial prostatitis Chronic bacterial prostatitis Chronic pelvic pain syndrome (CPPS)

Constitutional symptoms

  • Commonly absent
  • Low-grade fever in some patients
  • Commonly absent

Genitourinary tract symptoms

  • Acute bladder irritation
    • Acute dysuria
    • Frequency
    • Urgency
  • Cloudy urine

Genitourinary pain

  • Severe
    • Lower back
    • Perineal
    • Pelvic
    • With defecation
  • Mild


  • Tender, boggy
  • Warm, swollen
  • Often normal
  • May be enlarged and tender
  • Usually normal
  • May be slightly tender

Subtypes and variantstoggle arrow icon

Chronic pelvic pain syndrome (CPPS) [7][8][9]

Diagnosticstoggle arrow icon

Approach [3][10]

Exercise special caution when performing DRE in patients with suspected acute bacterial prostatitis to avoid causing bacteremia. When in doubt, consult a urologist.

Urine studies [3][10]

STI testing [10][11]

Additional evaluation

Prostate-specific antigen may be significantly elevated in patients with acute prostatitis but should not be used for diagnostic purposes. Perform an evaluation for prostate cancer if PSA remains elevated 8 weeks after treatment. [3]

Treatmenttoggle arrow icon

Empiric antibiotics for prostatitis [3][8][10]

Initiate empiric therapy as soon as possible based on suspected etiology, duration, severity, and local resistance patterns (consult local antibiogram if available).

Mild acute and chronic infections

Severe acute infections [10][12]

Further management

  • Adjust antibiotics to culture results.
  • Repeat urine culture ≥ 1 week after the end of treatment to ensure resolution. [3]
  • Evaluate for prostatic abscess if no improvement in 36 hours and arrange drainage if present. [13]

Supportive care [10]

Disposition [3][10]

  • Consider inpatient management for patients with any of the following:
  • Consider urology consult for all patients, especially those with chronic or severe acute prostatitis.

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Collins MM, Stafford RS, O'leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998; 159 (4): p.1224-1228.
  2. Lipsky BA, Byren I, Hoey CT. Treatment of bacterial prostatitis. Clin Infect Dis. 2010; 50 (12): p.1641-1652.doi: 10.1086/652861 . | Open in Read by QxMD
  3. Schaeffer AJ. Chronic Prostatitis and the Chronic Pelvic Pain Syndrome. N Engl J Med. 2006; 355 (16): p.1690-1698.doi: 10.1056/nejmcp060423 . | Open in Read by QxMD
  4. Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment.. Am Fam Physician. 2010; 82 (4): p.397-406.
  5. Rees J, Abrahams M, Doble A, Cooper A, Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015; 116 (4): p.509-525.doi: 10.1111/bju.13101 . | Open in Read by QxMD
  6. Coker TJ, Dierfeldt DM. Acute bacterial prostatitis: diagnosis and management. Am Fam Physician. 2016; 93 (2): p.114-120.
  7. Müller A, Mulhall JP. Sexual dysfunction in the patient with prostatitis. Curr Opin Urol. 2005; 15 (6): p.404-409.
  8. Sönmez NC, Kiremit MC, Güney S, Arisan S, Akça O, Dalkılıç A. Sexual dysfunction in type III chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) observed in Turkish patients. Int Urol Nephrol. 2010; 43 (2): p.309-314.doi: 10.1007/s11255-010-9809-5 . | Open in Read by QxMD
  9. D'amico AV, Smith MR. Clinical decisions: Screening for prostate cancer. N Engl J Med. 2012; 367 (7): p.e11.doi: 10.1056/NEJMclde1209426 . | Open in Read by QxMD
  10. Brede CM, Shoskes DA. The etiology and management of acute prostatitis. Nat Rev Urol. 2011; 8 (4): p.207-212.doi: 10.1038/nrurol.2011.22 . | Open in Read by QxMD
  11. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70 (4): p.1-187.doi: 10.15585/mmwr.rr7004a1 . | Open in Read by QxMD
  12. Schaeffer AJ, Nicolle LE. Urinary Tract Infections in Older Men. N Engl J Med. 2016; 374 (6): p.562-571.doi: 10.1056/nejmcp1503950 . | Open in Read by QxMD
  13. Xiong S, Liu X, Deng W, et al. Pharmacological Interventions for Bacterial Prostatitis. Front Pharmacol. 2020; 11.doi: 10.3389/fphar.2020.00504 . | Open in Read by QxMD

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