Prostatitis

**Prostatitis** is any form of inflammation of the prostate gland and forms can be either acute (new) or chronic (long term).

It can cause sexual dysfunction as well as pain, urinary incontinence, and may be a sign of serious disease in men. Because women do not have a prostate gland, it is a condition only found in men, although women do have microscopic paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate, and may cause symptoms.

## Nomenclature
The term prostatitis refers in its strictest sense to histological (microscopic) inflammation of the tissue of the prostate gland, although historically the term has loosely been used as a rubric to describe a set of quite different conditions. To try to remedy this, the National Institutes of Health (NIH) devised a new classification system in 1999.

## Classification
According to the 1999 National Institute of Health (NIH) Classification, there are four categories of prostatitis:

* Category I: Acute prostatitis (bacterial)
* Category II: Chronic bacterial prostatitis
* Category III: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), Pelvic Myoneuropathy
:: Subdivisions of IIIa (inflammatory) and IIIb (non-inflammatory) exist based on levels of pus cells in expressed prostatic secretions, but these subcategories are of limited use clinically
* Category IV: Asymptomatic inflammatory prostatitis

## Category I: Acute prostatitis (bacterial)
### Signs and symptoms
People with this disease often have chills, fever, pain in the lower back and genital area, urinary urgency and frequency (polyuria) a lot of times at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as shown by white blood cells and bacteria in the urine. There may be discharge from the penis.

### Diagnosis
Acute prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. Common bacteria are E. Coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Enterococcus, Serratia, and Staphylococcus aureus. This can be a medical emergency in some patients and hospitalization with intravenous antibiotics may be required. A full blood count reveals increased white blood cells. Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultures, which are often positive in sepsis.

### Treatment
Antibiotics are the first line of treatment in acute prostatitis (Cat. I). Antibiotics usually resolve acute prostatitis infections in a very short period of time. Appropriate antibiotics should be used, based on the microbe causing the infection. Some antibiotics have very poor penetration of the prostatic capsule, others, such as Ciprofloxacin, Co-trimoxazole and tetracyclines penetrate well. Severely ill patients may need hospitalization, while nontoxic patients can be treated at home with bed rest, analgesics, stool softeners, and hydration.

### Prognosis
Full recovery without sequelae is usual.

## Category II: Chronic bacterial prostatitis
### Signs and symptoms
Chronic bacterial prostatitis is a relatively rare condition (
* Nickel J.C., Moon T., "Chronic bacterial prostatitis: an evolving clinical enigma", *Urology* **66**:1:2-8 (July 2005).
* Shoskes D.A., "Use of antibiotics in chronic prostatitis syndromes", *Can. J. Urol.* 8 Suppl **1**:24-8 (June 2001).
* Dimitrakov JD, Kaplan SA, Kroenke K, Jackson JL, Freeman MR., Management of chronic prostatitis/chronic pelvic pain syndrome: an evidence-based approachUrology. 2006;67(5):881-8
* Stevermer, James J., Easley, Susan K., "Treatment of Prostatitis", *American Family Physician* **61**:10 (May 15, 2000) http://www.aafp.org/afp/20000515/3015.html 

## Footnotes
## Related pages
* Pelvic Myoneuropathy
* Quercetin (alternative medicine- a flavonoid which has anti-inflammatory properties; found in various foods)
* Trigger Points
* Saw Palmetto (alternative medicine- a small North American palm, used by American Indians for treating a variety of urinary and genital problems.
* Interstitial cystitis - men with IC may have prostatitis, and vice versa.

## Other websites
* ChronicProstatitis.com  - a site devoted to CP/CPPS, male IC, and pelvic myoneuropathy.
* Diagrams of the Pelvic Floor Muscles  - muscles involved in causing prostatitis symptoms.
* Mayo Clinic - prostatitis at the Mayo Clinic.
* Interstitial Cystitis Network - Providing support for men with IC.