Prostate Infections (cont.)

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Medical Author:

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Prostate Infection Diagnosis

The diagnosis of both acute and chronic prostate infections begins with the history of the symptoms described above, the physical exam, including the digital exam of the prostate and often confirmed by culture and identification of the infecting organism.

Acute bacterial prostatitis diagnosis

Usually an enlarged, firm, and tender prostate is enough to make a presumptive diagnosis and start treatment (prostatic massage is not done for acute bacterial prostatitis).
Because there is usually a low level of bacteria in urine, the doctor will perform a urinalysis to quantitate and identify infecting bacteria by urine culture.
If the person has symptoms suggesting the infection has spread outside the prostate (high fever, chills, urine retention), blood cultures and other blood tests are likely to be ordered.
If a spread of the infection is suspected, a doctor will often perform an ultrasound to help confirm the diagnosis and to rule out an abscess. If this ultrasound is not available, the doctor may perform a CT scan or MRI of the pelvis.

Chronic bacterial prostatitis diagnosis

One of two tests are sometimes performed to help with the diagnosis:

The classic test is a Meares-Stamey 3-glass test. Three separate urine samples are collected and examined during this test. The last sample is taken after prostatic massage.

Premassage and postmassage test (PPMT)

In this test, urine samples are obtained before (pre-M) and after (post-M) prostatic massage and are sent for microscopic exam and culture.
Patients will be diagnosed with chronic bacterial prostatitis if both bacteria and white blood cells are present in their post-M sample.
In healthy men, the number of white blood cells in prostatic fluid could be as high for up to 2 days after ejaculation, so this may affect test results.

Men with recurrent urinary tract infections should have ultrasound imaging of their upper urinary tract and a plain abdominal X-ray or an intravenous urography (IVU) to exclude a possible structural problem or a kidney stone.

Certain other disorders that are very common display symptoms similar to chronic bacterial prostatitis, for example, pelvic area pain, decreased sex drive, and impotence. No one knows what causes them. Men who have these disorders often become depressed. Symptoms may be worsened by a number of factors, for example, diet, posture, or alcohol.

Doctors use the same tests, premassage and postmassage test (PPMT) or Meares-Stamey test, to diagnose these disorders. Doctors also use similar treatment methods.
General home care measures include hot baths, regular ejaculations, increasing fluids, and avoiding factors that worsen the condition.

The role of antibiotics is unclear in chronic bacterial prostatitis, but because prostate infections often go unnoticed, doctors may often try antibiotics to help stop the infection. Antibiotics reported to be helpful include erythromycin (E-Mycin, Erythrocin), doxycycline (Atridox, Vibramycin), or a fluoroquinolone (ciprofloxacin [Cipro, Cipro XR, Proquin XR], ofloxacin [Floxin]).

Other possible diagnostic tests/treatments for chronic bacterial prostatitis may include the following: