Canadian Guidelines on Sexually Transmitted Infections - Prostatitis

[Clin Microbiol Infect 2023;29:32-7]

Prostatitis syndromes:

  • Acute bacterial prostatitis - severe symptoms, systemic infection, acute bacterial urinary tract infection.
  • Chronic bacterial prostatitis - chronic bacterial infection of prostate +/- signs/symptoms of prostatitis. Usually in setting of recurrent urinary tract infection (same strain).
  • Chronic pelvic pain syndrome - chronic pelvic pain +/- dysuria in absence of urinary tract infection. May be categorized as inflammatory or noninflammatory.
  • Asymptomatic inflammatory prostatitis - incidental finding (evaluation for infertility, elevated PSA) of inflammation of prostate in absence of genitourinary tract symptoms.  Antibiotic therapy is NOT recommended, regardless of PSA level.

Risk factors for bacterial prostatitis:

  • Genitourinary infections/unprotected sexual intercourse:  UTI, orchitis, epididymitis, urethritis
  • Obstruction:  benign prostatic hypertrophy, phimosis, ureteral stricture
  • Transurethral manipulation: catheterization, cystoscopy, transurethral surgery
  • Prostatic seeding:  post-prostate biopsy, pelvic trauma

Atypical causes of prostatitis to consider:

- Chlamydia trachomatis

- Trichomonas vaginalis

- Ureaplasma urealyticum

- Neisseria gonorrhoeae

- Brucella spp (rare)

- Mycobacterium tuberculosis

- Fungal pathogens:

  • Candida spp
  • Coccidioides immitis
  • Blastomyces dermatiditis
  • Histoplasma capsulatum

- Viral pathogens