Follicular Prostatitis Causes Symptoms and Treatment
What is Follicular Prostatitis?
Follicular or suppurative prostatitis is an acute bacterial infection that causes inflammation of the individual prostatic glandular structures (individual segments) with pustules limited to the size of a pea. Follicular prostatitis occurs when bacteria colonize the prostatic parenchyma as a consequence of complications from catarrhal prostatitis. It is characterized by lower urinary tract symptoms, such as painful and difficult urination (dysuria), weak urine stream, and intense perineal pain, sometimes radiating to the anus, aggravated by defecation. Without prompt treatment, follicular prostatitis may lead to the formation of microabscesses
The perineum is an area located between the scrotum and the anus
Catarrhal prostatitis is an inflammation of the prostatic glandular epithelium and the ducts of the seminal glands (seminal vesicles) that occurs as complications of severe acute respiratory syndrome (SARS) or with other diseases
Prostatitis is divided into follicular, catarrhal and parenchymal
During ejaculation, your prostate gland squeezes the seminal fluid into the urethra
What happens if a prostate infection goes untreated?
If left untreated, acute bacterial prostatitis may cause acute urinary retention (inability to urinate) and male infertility due to poor semen quality (lower sperm viability, sperm total motility, and sperm morphology).
Men with untreated acute bacterial prostatitis may be more likely to develop chronic bacterial prostatitis. In chronic bacterial prostatitis, you experience prolonged mild symptoms of a chronic urinary tract infection, and you may have frequent UTIs (urinary tract infections)
Can you die from prostatitis?
Without prompt treatment with systemic antibiotics, acute bacterial prostatitis can cause sepsis (blood poisoning) and death. Sepsis is also known as bacteremia, or septicemia.
Combination antimicrobial therapy (antibacterial combinations) may also be the most efficient treatment for bacterial prostatititis
Can I pass prostatitis to my partner?
In most cases, infectious follicular prostatitis is caused by bacterial infections or sexually transmitted diseases (STDs) that can be passed on to your partner during sex; however, sex won’t worsen prostatitis
Follicular prostatitis typically causes lower pelvic pain and urinary symptoms, such as frequent urination, painful ejaculation (dysorgasmia), and dysuria (pain on passing urine) that can interfere with the enjoyment of sex
Is prostatitis common?
In the United States, up to 50 percent of males between 20 and 55 will experience prostatitis during their lifetimes. In fact, about 1 in 10 men (from 5 to 10 percent of males) have prostatitis at any given time, and thus prostatitis is one of the most common urological diseases in America
Only 10% of men with symptomatic prostatitis have bacterial prostatitis and about 33% of men reporting prostatitis symptoms had resolution after 1 year of combined therapy with antibiotics
Chronic pelvic pain syndrome (CPPS), also known as chronic nonbacterial prostatitis, is the most common type of prostatitis characterized by lower abdominal pain and other signs and symptoms of a chronic urinary tract infection (cystitis) that last longer than 90 days. The symptoms of chronic nonbacterial prostatitis often mimic those of acute bacterial prostatitis.
Prostatitis affects all men, regardless of their ethnic backgrounds; however, men of african descent report the condition more often than Caucasians and Hispanics
Prostatitis occurs more often in African American men than in men of other racial or ethnic groups.
Can prostatitis be a sign of prostate cancer?
Prostatitis can be caused by an infection or by inflammation of the prostate; however, it is not a form of prostate cancer. Prostatitis can cause a variety of symptoms, which vary from man to man.
Men with prostate cancer may experience symptoms ranging from mild to severe that may mimic symptoms of prostatitis.
Prostatitis is not the same as having an enlarged prostate (benign prostatic hyperplasia).
What are the symptoms of acute bacterial prostatitis?
Symptoms of bacterial prostatitis can last more than three months. Early signs and symptoms of prostate inflammation include: Dysuria (a burning and painful sensation with urination), urinary urgency, frequent urination, groin pain, lower abdominal pain, or lower back pain, a feeling of pain and pressure in the bladder area, penile pain, testicular pain, urinary hesitancy (trouble starting a stream of urine when wanting to urinate, weak urine stream, and dribbling), painful ejaculation, and recurrent UTIs.
What are the symptoms of follicular prostatitis?
Common signs and symptoms that may be present with follicular prostatitis include: frequent urination, dysuria, hematuria (blood in the urine), penile discharge, episodes of chills and fever, malaise, a clear urethral discharge, hematospermia (blood in the semen), pain with ejaculation (dysorgasmia or orgasmalgia), difficulty getting an erection (sexual dysfunction), nocturia (frequent urination at night), penile pain, testicular pain (pain in the scrotum), lower abdominal pain, groin pain, rectal pain, and/or lower back pain. Many patients with bacterial prostatitis are aggressive and violent and some suffer from psychological difficulties (i.e, sexually, socially, or both)
In its most common form, Follicular Prostatitis is caused by bacterial infections and is associated with fever, chills, sweats, malaise, burning, painful urination, painful ejaculation, hematuria, and other UTI symptoms
What are the symptoms of an enlarged prostate?
Symptoms of enlarged prostate can include: acute dysuria, urinary hesitancy (a need to strain, a weak stream of urine, urine stream that starts and stops, and dribbling at the end of urination), vesical tenesmus (a feeling of incomplete bladder emptying following urination), frequent urination, urinary urgency (compelling urge to urinate), nocturia (excessive urination at night).
Can you have discharge with prostatitis?
Common signs and symptoms that may be present with prostatitis include a clear urethral discharge and hematospermia (blood in the semen).
Can prostatitis lead to infertility?
If left untreated, acute bacterial prostatitis may cause male reversible infertility due to poor semen quality (low sperm viability, poor sperm motility, and low sperm morphology). However, antibiotics may reverse the inflammation and the infertility.
Chronic bacterial prostatitis is a rare cause of infertility
Is prostatitis painful?
Swelling and inflammation of the prostate gland often causes difficult or painful urination (dysuria). Other common symptoms include flu-like symptoms, penile pain and pain in the area between the scrotum and anus.
Can prostatitis cause erectile dysfunction?
Erectile dysfunction (ED) is found in approximately 50% of patients with moderate to severe forms of follicular prostatitis. In most cases, erectile dysfunction was mild or moderate in severity.
Severe follicular prostatitis can cause erectile dysfunction directly.
When you ejaculate, the muscles of the prostate gland contract to help propel the seminal fluid into the urethra. It makes up a large portion of your semen.
What is the main cause of prostatitis and how do you get acute prostatitis?
Acute prostatitis is often caused by a bacterial infection that occurs when urine infected with bacteria flows backward through the urethra into the prostatic ducts. However, acute bacterial prostatitis can also be caused by hematogenous spread via bacterial sepsis, direct spread from the rectum, or lymphatic spread from the rectum. It can also occur after transrectal ultrasound guided (TRUS) biopsy of the prostate, or after transurethral procedures, such as cystoscopy (flexible or rigid) and male urethral catheterization
Acute prostatitis is usually caused by the same bacteria that cause urinary tract infections (UTIs); however, it can also be caused by sexually transmitted organisms such as Chlamydia trachomatis, Neisseria gonorrhoeae, or HIV
The infection most commonly develops during or just after a urinary tract infection
Acute bacterial prostatitis typically starts suddenly and may cause flu-like symptoms. Without prompt treatment with systemic antibiotics, people with acute bacterial prostatitis usually develop follicular prostatitis.
If left untreated, people with follicular prostatitis usually develop chronic bacterial prostatitis, which is characterized by recurrent bacterial infections of the prostate gland.
Signs and symptoms of chronic bacterial prostatitis develop more slowly and usually are not as severe as those of acute bacterial prostatitis.
Without adequate and prompt treatment with an appropriate antimicrobial agent, people with acute bacterial prostatitis usually develop chronic prostatitis
Bacterial prostatitis can become chronic if you fail to complete a course of antibiotics, or if antibiotics fail to eliminate all the bacteria in the prostate due to antibiotic resistance or improper dosing
What is the most common cause of acute bacterial prostatitis?
The most common bacteria to cause acute bacterial prostatitis are: escherichia coli, proteus mirabilis, klebsiella pneumoniae, chlamydia trachomatis, enterobacter, staphylococcus aureus, serratia marcescens, enterococcus spp., pseudomonas aeruginosa, and other gram negative rods. Moreover, prostatitis can also be caused by protozoans, like trichomonas vaginalis
What is the most common cause of urinary tract infections (UTIs)?
The most common bacteria that causes urinary tract infections are: Escherichia coli (E. coli), nontyphoidal Salmonella, shigella sonnei, enterobacter cloacae, enterobacter aerogenes, pseudomonas aeruginosa, Helicobacter pylori (H pylori), Moraxella (Branhamella) catarrhalis, Stenotrophomonas (Xanthomonas) maltophilia, Bdellovibrio bacteriovorus, and Legionella
Can prostatitis be caused by stress and what can make your prolactin level high?
Stress and emotional health play an important role in immunity to infectious diseases. Stress can cause elevated prolactin levels. High serum prolactin levels may interfere with the immune system and cause inflammation
How to diagnose follicular prostatitis and how do you know if you have a prostate infection?
Follicular prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. Diagnosis of follicular prostatitis is made based on history, clinical symptoms, physical examination and diagnostic test results (urinalysis)
The causative agent of follicular prostatitis may be found in blood or urine, and sometimes in both.
The physical examination should include abdominal, genital, and digital rectal examination to assess for abnormal signs, such as an uneven, enlarged, hard, tender, or boggy prostate. Palpation of the prostate gland will reveal an enlarged, uneven, tender and boggy gland, for the majority of patients who present with symptoms of prostatitis.
On abdominal examination, a palpable suprapubic mass may represent a distended bladder. This may indicate urinary retention.
Urinary retention is usually diagnosed based on clinical symptoms and by palpation or CT scans. CT findings for urinary retention include a distended bladder associated with mild bilateral ureterohydronephrosis. CT scans help to identify the cause of the urinary retention, such as tumors, benign prostatic hyperplasia, prostatitis, prostate cancer, urolithiasis (urinary tract stones), or any cysts.
Initial diagnostic tests might include:
1- Urinalysis and Urine Culture: Your doctor might have a midstream specimen of urine (MSU) analyzed to look for signs of infection in your urine in order to confirm the diagnosis of a urinary tract infection. Midstream urine cultures should be collected in all suspected patients to identify the responsible bacterial species and its antibiotic sensitivity pattern. Antibiotic sensitivity pattern of bacterial pathogens should be carried out to serve as a guide for antibiotic therapy of acute bacterial prostatitis.
2- Abdominal and pelvic CT scan with IV contrast: CT scan of the abdomen and pelvis with IV contrast is a widely used modality in the diagnosis of follicular prostatitis, prostate cancer, and benign prostatic enlargement
Contrast-enhanced pelvic CT is the best imaging tool to confirm a diagnosis or rule out prostatic abscess in patients with persistent fever
A fever lasting more than 36 hours should be evaluated with Contrast-enhanced pelvic CT to rule out prostatic abscess
3- Blood culture remains the best approach to identify bacteria in patients who are immunocompromised, and in patients with a body temperature greater than 38.4°C (101.1°F), complicated infections (e.g., sepsis or septicemia blood infection), or a possible hematogenous source of infection (e.g., endocarditis with staphylococcus aureus)
Blood cultures are indicated in patients with hyperpyrexia
4- Prostate-specific antigen (PSA) test: Prostate-specific antigen testing is used for early detection of prostate cancer. However, this test is not indicated in the evaluation of acute bacterial prostatitis. A prostate biopsy is recommended when the PSA level at diagnosis is higher than 4.0 ng/mL
Can prostatitis raise PSA levels?
The PSA test is a good screening tool for prostate cancer; however, it is not very specific. Prostatitis can cause high PSA levels.
What causes elevated PSA other than cancer?
In addition to prostate cancer, a number of benign conditions can cause high PSA levels. The most common benign prostatic conditions that cause high PSA levels are benign prostatic hyperplasia (BPH) and prostatitis
5- Urine analysis, Interpretation of abnormal urine: The increased turbidity or cloudiness of the second portion of the urine may indicate the follicular development of prostatitis
6- Prostate massage therapy: Prostatic massage is a technique performed similarly to a digital rectal exam (DRE) in order to relieve symptoms by draining the prostate. The patient is asked to bend over the examining table. The physician then puts on gloves and applies lubricant to the index finger. Next, the physician inserts the index finger into the anus to reach the prostate gland and then he moves his finger in circles around the prostate, he applies even pressure to the area with quick vibration-like motions to extract expressed prostatic secretions (EPS). The physician strokes the prostate with the tip of his index finger several times in order to allow the expressed prostatic secretions to reach the urethra. The EPS specimen is then collected and examined under a microscope. Prostate massage therapy has value in both diagnosis and treatment.
Prostate massage therapy should be avoided in patients suspected of having acute bacterial prostatitis
7- A pelvic X-ray can be used to detect air in the bladder wall
8- Blood tests. Your doctor might have a sample of your blood analyzed to look for signs of infection and other prostate problems
Additional lab studies can be obtained based on severity of illness and risk factors
How to treat follicular prostatitis?
Most patients with bacterial prostatitis can be treated as outpatients with oral antibiotics and supportive measures such as alpha-blockers, NSAIDs, sitz baths, and muscle relaxants (diazepam)
Empirical treatment with a broad-spectrum β-lactam antibiotic (eg, piperacillin or tazobactam) or a cephalosporin (eg, cefotaxime or ceftazidime) combined with an aminoglycoside (eg, streptomycin, gentamicin, or amikacin) should be considered for patients who are severely ill
Acute bacterial prostatitis occurring after a transrectal ultrasound-guided prostate biopsy should be treated with a broad spectrum antibiotic to effectively eradicate fluoroquinolone-resistant bacteria and extended spectrum β-lactamase producing E. coli and prevent antibiotic resistance
In most cases, fluoroquinolone antibiotics are effective as an antibiotic prophylaxis for transrectal ultrasound-guided prostate biopsy
CT-guided pigtail drainage of the abscess should be carried out if imaging studies show abscess
Can prostatitis be cured with antibiotics?
Most patients with bacterial prostatitis can be treated as outpatients with prostate-penetrating antibiotics, such as fluoroquinolones or co-trimethoprim (TMP/SMX, Bactrim, Bactrim DS); however, unlike the acute form, chronic bacterial prostatitis can begin insidiously with no obvious inciting event and persist for weeks or even months
Hospitalization and broad spectrum iv antibiotics should be considered in patients who are unable to tolerate oral intake, unable to voluntarily urinate, or systemically ill. Additionally, hospitalization and broad spectrum iv antibiotics should be considered in patients with infections caused by antibiotic-resistant bacteria
What is the best treatment for prostatitis?
Treatment typically consists of 4-8 weeks of prostate-penetrating antibiotics, such as fluoroquinolones (such as ciprofloxacin, ofloxacin, or levofloxacin) or trimethoprim-sulfamethoxazole (co-trimethoprim).
Combination antibiotics, such as Tazocin or ZOSYN® (piperacillin and tazobactam) are often used to reduce the development of drug-resistant bacteria. ZOSYN® is given intravenously (IV) to treat serious bacterial infections such as follicular prostatitis, septicaemia (blood poisoning), etc.
Chronic prostatitis and asymptomatic inflammatory prostatitis may be treated with the above mentioned antibiotics, along with sitz baths, muscle relaxants such as diazepam (at a dose of 5 mg three or four times daily), and alpha-blockers, like Flomax (tamsulosin), Rapaflo (silodosin), Uroxatral (alfuzosin), Cardura (doxasozin), Hytrin (terazosin).
Sitz baths involve soaking the lower half of your body in a tub of warm water for about 30 to 40 minutes
Topical 2% diazepam cream can provide short term relief of rectal pain
Fluoroquinolones, such as ciprofloxacin, can be used before transrectal prostate biopsy to reduce the risk nosocomial bacterial prostatitis
What is the best antibiotic for acute prostatitis?
Typical antibiotic regimens include ceftriaxone plus doxycycline, ciprofloxacin, Trimethoprim-sulfamethoxazole, Norfloxacin. etc.
Common Antibiotic Regimens for Acute Bacterial Prostatitis include:
1- Trimethoprim-sulfamethoxazole (Bactrim DS, or Septra DS) 1 tablet (160/800 mg) twice a day
2- Cipro® (Ciprofloxacin) 500 mg twice a day
3- Noroxin (Norfloxacin) 400 mg twice a day
4- Vibramycin (Doxycycline) 100 mg twice a day
Is Cipro good for prostatitis?
Ciprofloxacin (Cipro®) is a fluoroquinolone antibiotic that is used to treat or prevent certain bacterial infections, including bacterial prostatitis.
Verified by: Dr.Diab (July 14, 2018)
Citation: Dr.Diab. (July 14, 2018). What is Follicular Prostatitis? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 33(2). urn:medcoi:article20622.