Acute prostatitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Sep 2025

Last updated: 17 Sep 2025

Acute prostatitis is usually caused by organisms entering the prostate from urinary tract infections.

Commonly caused by Escherichia coli bacteria.

Symptoms include dysuria, perineal or genital pain, and urinary frequency alongside a clinical picture of sepsis.

May be successfully treated with antibiotics, but a prolonged course is frequently required if chronic prostatitis follows the acute occurrence.

Definition

Acute prostatitis is a painful inflammation within the prostate that is usually accompanied by evidence of recent or ongoing bacterial infection. Its hallmark is the acute onset of lower urinary tract symptoms (e.g., dysuria, urinary frequency, perineal discomfort) accompanied by variable systemic signs of fever, chills, and malaise.[1] Acute prostatitis may cause referred pain into the genitalia, perineum, and lower back or suprapubic areas.[2] It differs from chronic prostatitis, a condition of prolonged prostatic irritation lasting ≥3 months that may be bacterial or abacterial in nature. Chronic prostatitis is characterized by persistent prostatitis or recurrent urinary tract infections.[3] Patients with chronic prostatitis may also experience chronic pelvic pain originating in the prostate, or prostatodynia.[4]

History and exam

Key diagnostic factors

fever, chills, malaise
tender prostate

Full details

Other diagnostic factors

age <50 years
urinary frequency
dysuria
diminished urinary stream
perineal pain
warm or soft, boggy gland
indwelling urinary catheter
recent transrectal prostate biopsy
recent transurethral surgery

Full details

Risk factors

urinary tract infection (UTI)
benign prostatic enlargement
urinary tract instrumentation/manipulation
poor general health/immunosuppression
smoking and alcohol consumption
genetics

Full details

Diagnostic tests

1st tests to order

urinalysis
urine culture
blood cultures

Full details

Tests to avoid

serum prostate-specific antigen (PSA)

Full details

Tests to consider

transrectal ultrasound
4-glass or 2-glass test
urine cytology

Full details

Treatment algorithm

ACUTE

signs of sepsis

without signs of sepsis

Contributors

Authors

Altaf Mangera, MBChB (Hons), MD, FRCS (Urol)

Consultant Urologist

Department of Urology

Royal Hallamshire Hospital

Sheffield

Disclosures

AM declares that he has no competing interests.

Acknowledgements

Altaf Mangera would like to gratefully acknowledge Christopher Chapple and Robyn Webber, previous contributors to this topic. CC is a consultant for Proverum, MUVON Therapeutics, and Pierre Fabre.

Peer reviewers

Hans Hedelin, MD

Department of Urology and Centre for Research and Development

Karnsjukhuset

Skovde

Sweden

Disclosures

HH declares that he has no competing interests.

Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP

Professor of Medicine

University of Washington

VA Puget Sound Health Care System

Seattle

Disclosures

BAL has received research funding from, and been a consultant to, several pharmaceutical companies that make antibiotic agents that might be used for treating bacterial prostatitis.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Rothman JR, Jaffe WI. Prostatitis: updates on diagnostic evaluation. Curr Urol Rep. 2007 Jul;8(4):301-6. Abstract

European Association of Urology. Guidelines on urological infections. Mar 2025 [internet publication].Full text

Nickel JC. Prostatitis. Can Urol Assoc J. 2011 Oct;5(5):306-15.Full text Abstract

National Institute for Health and Care Excellence. Prostatitis (acute): antimicrobial prescribing. Oct 2018 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Benign prostatic hyperplasia (BPH)
- Prostate cancer
- Urinary tract infection (UTI)
More Differentials
Guidelines
- Urological infections
- AAUS guideline for acute bacterial prostatitis 2021
More Guidelines
Patient information
Prostatitis
More Patient information
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Acute prostatitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to avoid

Tests to consider

Treatment algorithm

signs of sepsis

without signs of sepsis

Contributors

Authors

Altaf Mangera, MBChB (Hons), MD, FRCS (Urol)

Disclosures

Acknowledgements

Peer reviewers

Hans Hedelin, MD

Disclosures

Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice