Prostatitis

What is prostatitis?

The prostate gland is a male sexual organ, implicated in reproduction that is situated at the base of the urinary bladder, at the junction of the urinary tubes and the genitals. Prostatitis refers to an inflammation of the prostatic gland (produces and secretes the ejaculatory fluid that mixes with sperm upon ejaculation). Prostatitis is a condition that afflicts many men, of all ages.

Is prostatitis frequent ?

Prostatitis is a condition that afflicts one in ten adult men. The risks of developing prostatitis appear to increase with age.

How is prostatitis transmitted?

Prostatitis is not, in general, considered to be a sexually transmitted illness. The presence or previous diagnosis of prostatitis does not increase the risk for the development of other prostate associated diseases. Prostatitis does not increase the risk for prostate cancer. Prostatitis does not protect against the development of future prostate disease.

What are the symptoms of prostatitis?

Prostatitis is generally considered to be an infection of bacterial origin. The initial symptoms are often those similar to a urinary tract or bladder infection (the urge to pee more often, slight discomfort upon urination, etc.). It is important that upon early symptom recognition, that a consultation be made with your physician to determine the origin of the symptoms and initiate treatment when appropriate. Early treatment with medications tends to ensure an uncomplicated and timely recovery. Delays in treatment may bring about complications.

The clinical scenario is quite similar for the various types of prostatitis (acute, chronic and inflammatory). The wide range of symptoms include those mentioned above as well as occasional symptoms of urinary obstruction (difficulty peeing), perineal pain or discomfort (the region found between the scrotum and the anus) and ejaculatory difficulties.

Acute infectious prostatitis is caused by a bacterial infection. It is typically sudden in the onset of its symptoms and requires immediate medical attention. The primary symptoms include the urge to urinate frequently, pain or discomfort in the region of the lower abdomen, a burning sensation upon urination, fever and/or chills. There may, at times, be blood in the urine.

Chronic infectious prostatitis is believed to be caused by a bacterial infection. It may be associated with recurrent urinary tract infections (bladder infections). In some patients, the primary symptom is frequent urinary tract infections. In some men, chronic prostatitis presents with a burning sensation upon urination, pain upon urination or a frequent urge to urinate. There may be occasional associated pain in the lower abdomen.

Acute prostatitis

• Toxic syndrome (severe) with fever and chills
• Lower abdominal or pelvic pain
• Urinary difficulties (difficulty urinating, pain with urination, frequent urge)
• The clinical scenario may resemble acute pyelonephritis (kidney stones).
• Your physician will tend to avoid putting you through a rectal exam when you are acutely ill.
• The bacteria responsible are typically identified in the urine test (culture), and may occasionally be identified in blood cultures (not always indicated).
• It is prudent to envisage a full STI screening test to exclude the possibility of urethritis (chlamydia, gonorrhea, etc.)

Chronic prostatitis

Chronic prostatitis is a chronic inflammation of the prostate gland. At times, chronic prostatitis is the complication of several recurrent episodes of acute prostatitis. This said, chronic prostatitis may present itself insidiously without any obvious cause. Chronic prostatitis may be found in association with a narrowing of the urethral canal or with an infection of this same canal (urethritis). In the event of scarring or infection, the bacteria commonly associated with sexually transmitted illnesses are typically responsible (chlamydia, gonorrhea, mycoplasma, etc.).

How is prostatitis diagnosed?

While prostatitis is an entity that has been well described and documented, it remains a difficult diagnosis and is often challenging to treat. On occasion the hope for a complete and definitive cure is evasive. In the case of an acute prostatitis, the urinary culture may often enable your physician to identify the bacteria responsible for the infection. In the case of chronic prostatitis, an effective test may be the direct microscopic examination and culture of prostatic liquid subsequent to a prostatic massage performed by your physician. Urinary cultures are typically not helpful in the event of a chronic prostatitis.

On occasion, urethral cultures or spermocultures (bacterial culture of the ejaculate) may be requested. A specialist may request an ultrasound evaluation of the urinary tracts, and on occasion an ultrasound evaluation of your prostate.

Over the age of 40, it may be considered prudent to exclude the possibility of a prostate cancer (the symptoms are not specific). Your physician or specialist may evaluate your risks for prostate cancer with the use of a digital rectal examination and a blood test known as PSA (prostate specific antigen). This latter test is not always 100% accurate and should be performed in association with your physician.

Is there a treatment for prostatitis?

While prostatitis is an entity that has been well described and documented, it remains a difficult diagnosis and is often challenging to treat. On occasion the hope for a complete and definitive cure is evasive. The treatment depends on the type of prostatitis diagnosed. Infectious prostatitis is always treated with antibiotics or antimicrobials that are specially conceived to penetrate the prostate gland (not always easy to do) and eradicate the microbes responsible for the infection. Prostatitis: treat early so as to avoid the complications.

The recommended treatment period for acute prostatitis is variable. In the patient under the age of 40, if the diagnosis is clear-cut, a 15-day or two-week treatment period with an appropriate antibiotic (quinolone) may be sufficient. In those patients aged 40 years and older, the situation is often quite different. The treatment may be prolonged for several months (from several weeks up to three months). In the follow-up to the treatment of prostatitis, monthly visits will include the repetition of tests so as to conclude a resolution of infection. It is upon the normalization of your laboratory test results that your treating physician may terminate the antibiotic treatment.

Who is at risk of contracting prostatitis?

Prostatitis is not a contagious infection and is not felt to be transmitted to a sexual partner during sexual relations. Prostatitis does not increase the risk for prostate cancer. Prostatitis does not protect against the development of future prostate disease.

How can an individual with prostatitis prevent transmission?

Prostatitis is not a contagious infection and is not believed to be transmitted to a sexual partner during sexual relations. Prostatitis does not increase the risk for prostate cancer. Prostatitis does not protect against the development of future prostate disease.

How can I prevent myself from developing prostatitis?

Prostatitis is not a contagious infection and is not believed to be transmitted to a sexual partner during sexual relations. Prostatitis does not increase the risk for prostate cancer. Prostatitis does not protect against the development of future prostate disease.

Nonetheless:

• Use a condom (male, female condom for sexual relations or a dental dam for oral sex) at all times and with all sexual partners.
• Make an appointment for screening tests for STI’s – discuss the frequency of such tests with your physician.
• Abstinence or a stable monogamous sexual relationship with a partner negative for sexually transmitted illnesses is an effective means of preventing chlamydia as well as other STI’s.