Acute prostatitis

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

Last reviewed: 23 Apr 2025

Last updated: 21 Feb 2025

Acute prostatitis is the most frequent urologic diagnosis in men <50 years old.

Commonly caused by Escherichia coli bacteria.

Can cause extreme lower abdominal, ejaculatory, rectal, and perineal pain.

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.[1] It stands in contradistinction to 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.[2] Chronic pelvic pain originating in the prostate, or prostatodynia, completes the clinical presentations associated with the symptom complex.[2]

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

prostatic biopsy
serum prostate-specific antigen (PSA)

Full details

Tests to consider

transrectal ultrasound
4-glass or 2-glass test

Full details

Treatment algorithm

ACUTE

signs of sepsis

without signs of sepsis

Contributors

Authors

Christopher Chapple, BSc, MD, FRCS (Urol), FEBU

Honorary Senior Lecturer of Urology

University of Sheffield

Consultant Urological Surgeon

Department of Urology

Royal Hallamshire Hospital

Sheffield

Disclosures

CC is a consultant for Astellas, Contura, Ferring, Symimetic, Takeda, and Urovant Sciences. He is an author for Astellas and Ferring. He is an investigator for Allergan, Astellas, Ferring, Poesis Medical, and Bayer. He is a co-patent holder for Symimetic. He is a speaker for Allergan and Astellas.

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

Dr Christopher Chapple and Dr Altaf Mangera would like to gratefully acknowledge the contribution of Robyn Webber MB, ChB, MD, FRCSEd (Urol) to this topic. Not disclosed.

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.

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

Krieger JN, Lee SW, Jeon J, et al. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008 Feb;31(suppl 1):S85-90.Full text Abstract

European Association of Urology. Guidelines on urological infections. 2022 [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
- Acute bacterial prostatitis: diagnosis and management
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

Christopher Chapple, BSc, MD, FRCS (Urol), FEBU

Disclosures

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

Disclosures

Acknowledgements

Peer reviewers

Hans Hedelin, MD

Disclosures

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

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