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.
- Common urologic diagnosis in men < 50 years of age 
- 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.
Acute prostatitis 
- E. coli (most common)
- Sexually transmitted infections (e.g., C. trachomatis and N. gonorrhoeae)
- Rarer pathogens: , , ,
Other causes for acute or chronic bacterial prostatitis
|Overview of clinical features of bacterial prostatitis and chronic pelvic pain syndrome |
|Acute bacterial prostatitis||Chronic bacterial prostatitis||Chronic pelvic pain syndrome (CPPS)|
| || |
Genitourinary tract symptoms
| || |
| || || |
Subtypes and variants
Chronic pelvic pain syndrome (CPPS) 
- Definition: chronic urogenital pain with no evidence of urinary tract infection
- Epidemiology: 90–95% of prostatitis cases
- Exact etiology unknown
- Possible factors: infection, inflammation, autoimmune processes, neurological damage
- Clinical features
- Multimodal approach combining pharmacological and supportive treatment
- Pharmacological treatment options
- Supportive treatment options
- Sacral neurostimulation
- Thermal therapy
- Bacterial prostatitis is a clinical diagnosis based on history and physical examination, including digital rectal examination (DRE).
- Obtain urine studies to support the diagnosis and identify the causative pathogen.
- Consider additional studies based on individual risk, e.g., STI testing, laboratory studies, and imaging.
- Consult urology as needed for specific diagnostic tests (e.g., fractional urine examination).
Urine studies 
- Urinalysis (midstream urine); may show characteristic (e.g., ↑ WBC).
- Urine Gram stain may be used to visualize bacteria.
- Urine culture: E. coli is most common pathogen (approx. 80% of cases). 
STI testing 
- Sexually active patients < 35 years old
- Adults of any age with non-age-related
- Test: for C. trachomatis and N. gonorrhoeae via urine or urethral swab
- Laboratory studies
- Localization tests for chronic bacterial prostatitis (based on )
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. 
Empiric antibiotics for prostatitis 
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
- Oral fluoroquinolones (e.g., ciprofloxacin; , levofloxacin ) (off-label for acute prostatitis) 
- Trimethoprim/sulfamethoxazole (off-label for both acute and chronic prostatitis) 
- Alternative options for chronic bacterial prostatitis include macrolides (e.g., azithromycin) and tetracyclines (e.g., doxycycline). 
- 2–4 weeks for mild acute infections
- 4–12 weeks for chronic infections
- Suspected STI: Ceftriaxone followed by doxycycline ) 
Severe acute infections 
- Options (beta-lactam and aminoglycoside use is off-label) 
- Duration: 4–6 weeks
- Adjust antibiotics to culture results.
- Repeat urine culture ≥ 1 week after the end of treatment to ensure resolution. 
- Evaluate for 36 hours and arrange drainage if present.  if no improvement in
Supportive care 
- NSAIDs for pain and inflammation
- Alpha blockers (e.g., tamsulosin) for lower urinary tract symptoms
- Catheterization for
- Cognitive behavioral therapy and/or physiotherapy for reduction of chronic prostatitis symptoms
- Consider inpatient management for patients with any of the following:
- Consider urology consult for all patients, especially those with chronic or severe acute prostatitis.
- Prostatic abscess
- Acute urinary retention
- Pyelonephritis and sepsis
We list the most important complications. The selection is not exhaustive.