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Acute Prostatitis

Adrienne Carmack, MD, Mike Weinstock, MD, and Mizuho Morrison, DO
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Mike and Miz consult Dr.Carmack to discuss presentation and evaluation of acute prostatitis. Age groups affected, underlying organisms to consider and management of this infectious/inflammatory process as well as other differential diagnosis to consider.

 

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Mike W., MD -

Comment by BC: In your may presentation of Acute Prostatitis, you concluded that all males with GU symptoms and neg UA need prostate exam to r/o prostatitis. Fair enough. What about the male patient with GU symptoms that has positive UA for infection. This could be cystitis or prostatitis. For decades I have treated them with cipro and referred to urology (sparing the patient and myself the rectal exam they will surely get at urology). Doesn't change my treatment (all get 10 days cipro for first episode, urine culture, and Urology referral). Right or Wrong?
Response (MW): You are correct that the treatment may not be different, however a few points:
1. A UTI in a young man is very rare, so a more definitive diagnosis may change management as the treatment for prostatitis may need to be longer or repeated w treatment failure. Also, differentiating from sexually transmitted disease is important
2. The treatment for acute v chronic prostatitis is different duration
3. A rectal exam in an older or even middle aged person may reveal a mass, which could affect outcome
4. With this additional information, a urology referral, with it's costs and hassle (lost work, etc) may be avoided
I hope this is helpful!

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