Prostatitis Symptoms and Treatment

Prostatitis Treatment in Indore

Prostatitis is one of the most common urologic problems in men and one of the most misunderstood. This can result in chronic pelvic pain, urinary symptoms, painful ejaculation and a significant impact on sexual wellbeing and quality of life. But it is frequently misdiagnosed, undertreated, or dismissed as “just stress.” There are many men who suffer from prostatitis symptoms for years, going from doctor to doctor, without ever getting a proper diagnosis or an effective treatment.

It is not one disease. Prostatitis is a syndrome, a group of disorders with the same name but fundamentally different in cause, mechanism and treatment. Antibiotics are needed for bacterial prostatitis. The most common form, chronic pelvic pain syndrome (CPPS), is best managed with a multimodal approach that addresses the nervous system, pelvic muscles, psychological state, and lifestyle rather than with antibiotics alone. The prerequisite for treatment that actually works is getting the diagnosis right.

What Is Prostatitis?

Prostatitis is inflammation of the prostate gland, with or without infection, that causes a variety of pelvic pain, urinary dysfunction, and sexual symptoms. It occurs in men of all ages but is most common in men 25 to 50 years old. It is responsible for approximately 25 percent of all urological office visits by young and middle-aged men, and is therefore one of the most common urological conditions encountered in this age group. Prostatitis is different from benign prostatic hyperplasia (BPH), which is primarily an ageing male condition over 50; it affects men in their most productive decades and has profound consequences on quality of life, work and relationships.

Types of Prostatitis – Complete Classification

The National Institutes of Health (NIH) Classification System categorizes prostatitis into four different types based on mechanisms, diagnosis and treatment. Correct classification is the first step in effective management.

Type 1 – Acute Bacterial Prostatitis (Sudden Severe Infection)

Severe systemic infection with acute onset of fever, rigors, pelvic pain and dysuria, often necessitating hospitalization and IV antibiotics.
Most common: ascension of E. coli or other enteric gram negative bacteria from the urethra or through haematogenous spread.
Urine culture to confirm diagnosis Avoid prostate massage in acute phase (risk of bacteraemia).
Prostatic abscess is a rare complication which requires surgical drainage and antibiotics.

Type 2 – Chronic Bacterial Prostatitis (Recurring Infection)

Recurrent UTIs due to bacterial persistence in the prostate, same organism on repeat cultures
Symptoms of urinary urgency, frequency, mild pelvic pain and sometimes haematospermia less dramatic than in acute prostatitis
Takes 4 to 6 weeks (sometimes 12 weeks) of fluoroquinolone antibiotics to adequately eradicate the bacteria.
accounts for 5 to 10 percent of prostatitis cases and is the most common type people think of.

Type 3 – Chronic Pelvic Pain Syndrome (CPPS) – Non-Bacterial

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) >3 months with or without urinary and sexual symptoms The most common prostatitis
No bacteria in cultures of urine or prostatic fluid, antibiotic treatment is ineffective and inappropriate.
The mechanism is neurological sensitisation, pelvic floor muscle dysfunction and psychological amplification of pain
In more than 90 percent of cases of prostatitis, multimodal management is required, rather than simple antibiotics.

Type 3A – Inflammatory CPPS (WBC in Semen & Prostatic Fluid)

CPPS subtype with white blood cells (WBCs) in expressed prostatic secretions (EPS) or semen and no bacterial cultures.
Suggests an inflammatory process, possibly autoimmune or post-infectious or neurogenic, without active bacterial infection.
May respond to a trial of antibiotics (for occult bacteria) with anti inflammatories and alpha blockers.
The distinction from Type 3B is diagnostic and requires examination of prostatic secretion and not just urine.

Type 3B – Non-Inflammatory CPPS (No WBC Found)

CPPS without inflammatory markers in any sample, the pure neuropathic/myofascial form of chronic pelvic pain syndrome .
Key drivers are pelvic floor muscle hypertonicity (spasm), pudendal nerve sensitisation and changes in central pain processing.
No response to antibiotics, primary management is pelvic floor physiotherapy, neuromodulators and psychological intervention.
Often misdiagnosed and treated with multiple courses of antibiotics which are of no benefit.

Type 4 – Asymptomatic Inflammatory Prostatitis

Incidental WBCs in prostatic fluid or prostate biopsy tissue, no symptoms reported by the patient.
Clinical significance unknown May be detected during infertility work-up or incidental finding in biopsy.
Generally no treatment required unless associated with infertility or unexplained PSA elevation before a diagnostic procedure.
Asymptomatic and therefore should not be treated based on the finding alone without clinical context.

What Causes Prostatitis & Who Is at Risk?

The causes of prostatitis are diverse depending upon the type. Types 1 and 2—acute and chronic bacterial prostatitis are caused by bacteria, most commonly Escherichia coli and other gram-negative enteric organisms in older men, and Chlamydia trachomatis or Neisseria gonorrhoeae in sexually active young men. Bacterial prostatitis is associated with recent urethral instrumentation (catheterisation, cystoscopy), rectal examination with concomitant bacteraemia, phimosis causing ascending urethral infection and predisposing structural abnormalities of the urinary tract giving a bacterial reservoir.

Chronic pelvic pain syndrome (Type 3 prostatitis) , which makes up 90 percent of cases . There is no single bacterial cause for this condition . The etiology is multifactorial and not fully understood. Suggested mechanisms include: incomplete bacterial eradication leading to an autoimmune response to prostate antigens, neurogenic inflammation and peripheral sensitisation of pelvic nociceptors, pelvic floor muscle hypertonicity and trigger points causing referred perineal and pelvic pain, pudendal nerve entrapment or sensitisation, central sensitisation of pain processing pathways and psychological amplification through anxiety, catastrophising and stress. Risk Factors For CPPS Previous history of prostatitis or urogenital infection Sedentary occupation, or prolonged sitting (especially cycling) Psychological stress, anxiety and depression

Symptoms of Prostatitis You Should Not Ignore

Symptoms of prostatitis vary widely by type but include a common thread of pelvic pain, urinary dysfunction and sexual symptoms. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) is a validated tool to assess symptom severity in three domains of pain, urinary function and impact on quality of life.

Pelvic Pain – Pain Between Scrotum & Anus (Perineum)

The hallmark symptom in prostatitis is deep, aching pain in the perineum, the area between the scrotum and anus.
It can be described as a heaviness, pressure or burning in the perineum, often worse when sitting down.
Worse usually with prolonged sitting, cycling, bowel movements, better with walking or standing.
The NIH-CPSI pain domain specifically measures perineal pain as a key prostatitis diagnostic criterion.

Pain in Lower Back, Hips & Inner Thighs

Dull, persistent ache in lower lumbar spine, sacrum and inner thighs, referred pain from pelvic floor and prostatic inflammation.
They are often misdiagnosed as musculoskeletal in origin and patients can spend years in physiotherapy with no improvement before the prostate aetiology is recognised.
The radiation pattern follows the distribution of the pudendal and obturator nerve, which is characteristic of pelvic floor involvement.

Burning or Pain During Urination (Dysuria)

Burning or stinging at the urethral meatus or along the urethra while urinating (all types of prostatitis).
Severe dysuria with systemic symptoms of infection is usually present in bacterial prostatitis.
Dysuria in CPPS can be mild to moderate and is more often described as discomfort or urethral awareness rather than true burning.
Persistent dysuria not improving with standard UTI antibiotics should raise suspicion for prostatitis evaluation.

Frequent Urination Day & Night (Frequency & Nocturia)

Increased urinary frequency (more than 8 times a day) and nocturia (waking up to urinate more than once) are common in all types of prostatitis.
Caused by inflammation of the bladder neck, leading to irritative voiding symptoms that are indistinguishable from overactive bladder.
Uroflowmetry and post-void residual assessment offer a quantification of the functional voiding impact and guide management.
Small volumes passed despite strong urgency, especially suggestive of bladder neck involvement in prostatitis.

Weak Urine Stream & Difficulty Starting Urination

Bladder neck spasm and peri-prostatic inflammation lead to obstructive voiding symptoms , hesitancy , reduced flow rate .
Prostatitis and bladder neck hypertonia should be considered in young men with obstructive voiding without BPH on ultrasound.
Alpha-blockers (tamsulosin, alfuzosin) work on bladder neck and prostate smooth muscle spasm , a mainstay of CPPS treatment.

Painful Ejaculation & Blood in Semen (Haematospermia)

Painful ejaculation, acute or burning pain at the moment of orgasm, is very characteristic of prostatitis, especially CPPS.
Haematospermia (pink or brown discoloration of semen) is due to inflammation causing small vessel bleeding in the prostate or seminal vesicles
Both symptoms are distressing and may lead to avoidance of sexual activity and considerable relationship strain.
In men over 40 years of age, persistent haematospermia, assessment of PSA and TRUS in addition to prostatitis evaluation.

Erectile Dysfunction Associated With Prostatitis

ED is common in men with chronic prostatitis and occurs by several mechanisms including direct pain inhibiting erection, performance anxiety, depression and neurogenic dysregulation.
In CPPS, the sympathetic nervous system is dominated by the chronic pain and its psychological burden, which affects the parasympathetic-mediated erection reflex.
Proper treatment of the underlying prostatitis may improve erectile function without specific ED treatment.
In cases where ED persists despite treatment of prostatitis, PDE5 inhibitors are safe to use and may have additional anti-inflammatory effects in the prostate.

Fever, Chills & Body Ache in Acute Bacterial Prostatitis

Acute bacterial prostatitis is distinguished from other forms of prostatitis by the presence of high fever (above 38.5°C), shaking rigors, and severe malaise.
A man with systemic infection signs and pelvic pain needs prompt emergency evaluation and IV antibiotics.
Urinary retention is common in acute prostatitis and supra-pubic catheterisation (not urethral) is preferred to avoid bacteraemia from prostatic manipulation.
If there is no improvement after 48 hours on IV antibiotics then CT or TRUS assessment for prostatic abscess should be considered.

Generalised Pelvic Discomfort & Sitting Pain

A common pelvic sensation of heaviness, pressure or ‘fullness’ that increases during the day, particularly with and after sitting.
Many CPPS patients report the feeling of sitting on a golf ball. This is considered a characteristic descriptor and suggests pelvic floor muscle involvement .
Greatly improved by walking , standing or warm baths , worse by sitting for a long time , driving or cycling .
The deterioration pattern associated with sitting supports a pelvic floor myofascial component requiring physiotherapy.

Chronic Prostatitis & Sexual Health – What You Need to Know

Chronic prostatitis has a profound effect on sexual health, through direct physical mechanisms, the psychological burden of chronic pain and the strain on relationships that results from long-standing sexual dysfunction. Addressing the sexual health impact in prostatitis management is not an optional extra, but an essential component of complete care.

How Prostatitis Causes Painful Ejaculation & Reduced Libido

The contracting pain of the prostate during orgasm is made worse by inflamed prostatic tissue, producing the sharp, burning pain at the time of ejaculation characteristic of prostatitis.
The chronic pelvic pain and the anticipatory anxiety of painful ejaculation are gradually diminishing the sexual desire, the pain cycle suppresses the libido .
Anti-inflammatory treatment, alpha blockers to reduce smooth muscle spasm and pelvic floor physiotherapy all help in the resolution of ejaculatory pain.
Avoidance often worsens the condition, and regular ejaculation (2–3 times per week) may actually help reduce prostatic congestion and improve symptoms in some CPPS patients.

Erectile Dysfunction Due to Chronic Prostatitis & Pelvic Pain

ED in chronic prostatitis is mainly psychogenic , the cycle of pain anticipation, performance anxiety and depression results in the persistent state that prevents erection.
Chronic pain causes sympathetic nervous system dominance inhibiting the parasympathetic response needed for erection.
The first step in restoring erectile function is to break the pain cycle by effective prostatitis treatment.
There are 4 PDE5 inhibitors (tadalafil daily low dose) that have evidence for both improvement in erectile function and reduction in inflammatory markers in CPPS.

Haematospermia (Blood in Semen) – Is It Always Prostatitis

Haematospermia is mainly caused by prostatitis or seminal vesiculitis , particularly in men under 40, where it is almost always benign and self-limiting.
In men older than 40 years of age, in addition to haematospermia, evaluation for prostatitis should include PSA measurement, TRUS and systemic blood pressure assessment.
Uncommon causes of haematospermia such as seminal vesicle calculi, prostate cancer, haemangioma and arteriovenous malformation are excluded by appropriate imaging.
Most cases of haematospermia resolve spontaneously within four to eight weeks with treatment of the underlying prostatitis, however persistent cases require further investigation.

Treatment of Sexual Dysfunction Associated With Prostatitis

Address the prostatitis first, with pain relief and inflammation control often restoring sexual function without specific sexual dysfunction treatment.
Daily low-dose tadalafil (5 mg) has dual benefit: improving erectile function and reducing CPPS symptom scores in published studies.
Psychosexual counseling and couple therapy are used to treat the relationship strain and performance anxiety that prostatitis-associated sexual dysfunction creates.
Pelvic floor physiotherapy that reduces muscle tension directly alleviates ejaculatory pain and may re-establish erectile confidence through alleviation of pain.
Antidepressants (especially low dose SSRIs used for CPPS) can paradoxically worsen ejaculatory function, doses and agents should be carefully selected.

Does Prostatitis Affect Sperm Quality & Male Fertility

Inflammatory CPPS (Type 3A) correlates with elevated reactive oxygen species (ROS) levels in the seminal fluid which have a direct damaging effect on sperm DNA and lower sperm motility.
Chronic prostatitis may change the biochemistry of seminal plasma, with a reduction in zinc, citric acid and other components of prostatic secretion important for sperm function .
Leukocytospermia (white blood cells in semen) caused by prostatitis-associated inflammation is linked to reduced sperm motility and increased sperm DNA fragmentation.
Successful treatment of prostatitis can improve the quality of semen. Men with prostatitis and abnormal semen analysis should be evaluated and treated for prostatitis prior to proceeding to IVF/ICSI.

Lifestyle & Home Management for Prostatitis

Lifestyle modification is not a substitute for medical treatment, but an important adjunct, especially in CPPS where dietary triggers, physical factors and psychological stress directly contribute to worsening of symptoms.

Dietary Changes – Foods That Trigger & Foods That Help

Bladder and prostate irritants to reduce or eliminate include: caffeine (coffee, tea, energy drinks), alcohol, spicy foods, acidic foods (citrus, tomatoes), artificial sweeteners.
An elimination diet whereby all potential irritants are removed for two to four weeks, then one at a time is reintroduced, identifies individual triggers that vary between patients.
anti-inflammatory food choices that can help: omega-3 rich foods (oily fish, flaxseeds), lycopene-rich foods (cooked tomatoes), quercetin (onions, green tea) and zinc-rich foods.
High fluid intake (2–2.5 litres a day) ensures dilute urine and reduces bladder irritation and maintains prostatic fluid flow, which is important in recovery from both CPPS and bacterial prostatitis.

Hydration & Its Role in Prostatitis Recovery

Adequate hydration helps dilute irritating urinary solutes and promotes healthy urinary flow , helping to minimize bladder and urethral irritation that exacerbates prostatitis symptoms.
Try to keep your urine a light straw colour at all times of the day. Dark, concentrated urine will irritate the urethra and make dysuria worse.
Spread fluid intake evenly throughout the day; reduce fluid intake 2 h before bedtime to reduce nocturia without causing general dehydration.
Water is the best fluid, so ditch the caffeinated and alcoholic drinks for water, herbal teas or diluted fruit juices.

Warm Sitz Baths for Perineal Pain Relief

Warm (38–40°C) sitz baths for 15–20 minutes, 2–3 times daily are of significant symptomatic pain relief in acute and chronic prostatitis.
Heat relaxes the pelvic floor muscles, improves local blood flow and decreases the concentration of inflammatory mediators in the peri-prostatic tissue.
A sitz bath can be taken in a regular bath or in a specially-designed shallow basin, no equipment is needed other than warm water.
Simple, effective, safe, immediately available, one of the highest value simple interventions for the management of perineal pain in CPPS.

Avoiding Triggers – Caffeine, Alcohol, Spicy Food & Cycling

Caffeine stimulates the detrusor muscle and irritates the bladder mucosa , exacerbating urinary frequency and urgency in prostatitis . Reduce or eliminate during active flares .
Alcohol irritates the bladder and also suppresses the immune response. Frequent alcohol consumption prolongs recovery from both bacterial and CPPS prostatitis.
Long hours of cycling cause the perineum to be compressed against the bicycle saddle, which directly irritates the pudendal nerve and pelvic floor , a known trigger for CPPS flares. Use a wide, padded saddle or avoid cycling during flares.
Extended sitting is a major trigger for CPPS, use a standing desk, take regular standing breaks every 30 minutes, and use a doughnut-shaped or cutout cushion to reduce perineal pressure.

Stress Reduction Techniques & Their Role in CPPS Management

Chronic psychological stress activates the sympathetic nervous system , resulting in chronic pelvic floor tension , heightened pain sensitivity , and immune dysregulation that perpetuates CPPS .
Mindfulness-based stress reduction (MBSR) Practised for 8 weeks. Published evidence for reducing CPPS symptom scores and improving quality of life.
Cognitive behavioural therapy (CBT) targeting pain catastrophising, the tendency to exaggerate the importance of pain and feel helpless in the face of pain, significantly reduces the severity of chronic pelvic pain .
Regular moderate exercise (30 minutes of walking or swimming daily) reduces systemic inflammation, improves mood, and reduces sympathetic nervous system overactivity, all beneficial for CPPS.

Pelvic Floor Relaxation Exercises for Chronic Prostatitis

Unlike stress incontinence (which requires pelvic floor strengthening), CPPS requires pelvic floor relaxation , the muscles are usually overactive and hypertonic, not weak.
Paradoxical relaxation exercises, learning to consciously let go of pelvic floor tension, are the cornerstone of physiotherapy for CPPS and are best taught by a specialist pelvic physiotherapist.
Stretches targeting the hip flexors, piriformis, adductors, and iliopsoas muscle groups , which connect to the pelvic floor through fascial chains . Decrease referred pelvic floor tension.
Most patients have measurable improvement in CPPS symptoms within six to twelve weeks with daily practice for 20–30 minutes plus specialist physiotherapy sessions.

Prostatitis & Fertility – Does It Affect Your Chances of Having a Baby?

One of the most underrated aspects of the impact of the condition is that prostatitis can affect male fertility in a number of mechanisms. The prostate gland produces prostatic fluid that makes up approximately 25 to 30 percent of the volume of semen, contributing enzymes, zinc, citric acid and other factors that are important to the function of sperm. Inflammation of the prostate directly impairs this secretory function and alters the composition of the seminal plasma in such a way as to reduce sperm motility and viability.

In inflammatory prostatitis (Type 3A), the presence of leukocytes in seminal fluid creates reactive oxygen species (ROS) that result in oxidative damage to the sperm membrane and DNA, increasing the sperm DNA fragmentation index (DFI) and reducing the fertilization capacity. Increased DFI due to inflammation from prostatitis could influence the spontaneous fertility, reduce the success rate of IUI and deteriorate the quality of embryos in IVF and ICSI even when sperm count and the standard motility parameters are normal on routine semen analysis.

The important clinical message is that men with prostatitis who are trying to conceive should not take a ‘normal’ semen analysis result as definitive evidence that prostatitis is not impacting their fertility. More complete information is provided by testing sperm DNA fragmentation, detection of leukocytes in the semen (assessment for leukocytospermia) and detailed analysis of the prostatic fluid. Effective treatment of prostatitis, particularly inflammatory CPPS, can improve semen quality and DFI in three to six months, which can lead to the restoration of natural fertility or increase the success rates of any assisted reproduction. Dr. Vikas Singh provides integrated evaluation of prostatitis and fertility in couples where the male partner has prostatitis and also has issues of infertility.

Real Patient Experiences in Urology Care

Frequently Asked Questions About Prostatitis

Is prostatitis the same as a prostate infection?

No, prostatitis is not always an infection. Acute bacterial prostatitis (type 1) and chronic bacterial prostatitis (type 2) are caused by bacteria and are treated with antibiotics. But chronic pelvic pain syndrome (Type 3, the most common, accounting for more than 90 percent of prostatitis diagnoses) has no bacterial cause and does not respond to antibiotics. It is driven by neurological sensitisation, pelvic floor muscle dysfunction and psychological factors. The term ‘infection’ is misleading when applied to all forms of prostatitis and results in the most frequent treatment error: the use of antibiotics for CPPS, which is ineffective and delays the use of suitable multimodal therapy.

How long does prostatitis take to cure?

When it comes to treatment time, the type is everything. Acute bacterial prostatitis will typically respond to IV antibiotics within 48 to 72 hours but requires four to six weeks of oral antibiotics to completely eradicate the bacteria. Chronic bacterial prostatitis requires four to twelve weeks treatment with antibiotics and can recur. Chronic pelvic pain syndrome (CPPS) is not cured but managed. Most patients improve dramatically with multimodal treatment over six to twelve weeks but complete resolution may take months and some patients have periodic flares. The goal of CPPS treatment is not the total permanent elimination of all symptoms, but rather a clinically meaningful reduction in symptoms and improvement in quality of life.

Can prostatitis go away without treatment?

Acute bacterial prostatitis will not resolve without treatment with antibiotics. If left untreated it may progress to prostatic abscess, septicaemia and urinary retention. Chronic bacterial prostatitis is not usually a self-limited disease, and the bacterial focus in the prostate persists and results in recurrent infections. Some patients with CPPS have spontaneous improvement, especially those with a short duration of disease, but most men with CPPS lasting longer than three months need active management. If left untreated CPPS is often self-perpetuating . Pain causes anxiety. Anxiety causes muscle tension . Tension worsens pain . The cycle deepens.

Can prostatitis cause cancer?

There is no evidence that prostatitis, bacterial or CPPS, causes prostate cancer. But prostatitis can cause PSA levels to increase significantly, possibly raising concerns about prostate cancer in men undergoing screening. Very high PSA values can be obtained from an acutely inflamed prostate (50 to 100 ng/ml or more in acute bacterial prostatitis). In these conditions, it is important to treat the prostatitis and wait 4-6 weeks for the PSA to stabilize before interpreting the PSA level in the context of cancer screening. Persistent PSA elevation following prostatitis treatment necessitates further evaluation with mpMRI and possibly biopsy.

Is prostatitis a sexually transmitted infection?

In sexually active young men, some cases of prostatitis are caused by sexually transmitted organisms, especially Chlamydia trachomatis and Neisseria gonorrhoeae, which can ascend from the urethra to the prostate during infection. STI testing and treatment as appropriate should be provided in this subset and sexual partners may need to be treated concurrently. However, most prostatitis, particularly CPPS, is not sexually transmitted, with no particular infecting organism, and is not contagious. Men with CPPS can have sex with their partner and do not have to abstain from sexual activity except when painful ejaculation makes sexual activity too uncomfortable during treatment.

What is the NIH-CPSI score and how is it used?

The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) is a validated nine-item questionnaire that quantifies prostatitis symptom severity in three domains: pain (location and severity , maximum 21 points), urinary symptoms (obstructive and irritative , maximum 10 points), and impact on quality of life (maximum 12 points). The total score ranges from 0 to 43, mild symptoms ranging from 0 to 14, moderate symptoms ranging from 15 to 29, and severe symptoms ranging from 30 to 43 . The NIH-CPSI is used at initial assessment to help determine the severity and type of symptoms, and at follow-up visits to objectively measure response to treatment. A four to six point decrease in the total score is considered a clinically meaningful improvement.

Does prostatitis affect PSA levels?

Yes, prostatitis, especially bacterial prostatitis, raises the PSA quite a bit. The inflamed prostate destroys the blood prostate barrier allowing PSA to leak into the bloodstream in amounts far in excess of the normal. During acute bacterial prostatitis , PSA can rise to very high levels; values of 10, 50, or even 100 ng/ml are possible. These increased PSA levels will return to normal within four to six weeks after successful treatment of the infection. Any PSA elevation due to prostatitis should be confirmed to have returned to normal after treatment before any decision to biopsy. If the PSA remains elevated after the prostatitis has resolved, a formal work-up for prostate cancer is indicated.

Can I have sex if I have prostatitis?

Most of the time, yes, and for CPPS patients, sexual activity is usually encouraged on a regular basis rather than discouraged. Frequent ejaculation (2-3 times per week) may relieve prostatic congestion and possibly improve CPPS symptoms in some patients. Fear of painful ejaculation that results in avoiding sexual activity often exacerbates the anxiety cycle that perpetuates CPPS, and reduces intimate connection that is important for relationship wellbeing. Sexual activity should be deferred in acute bacterial prostatitis while acutely ill and until antibiotics have been administered for at least a week. If prostatitis is due to a sexually transmitted infection, it is important to abstain or use barrier contraception until both partners have been treated.

What tests are needed to diagnose prostatitis?

The workup for prostatitis begins with the history and physical examination, determining symptom type, duration, severity (NIH-CPSI score) and risk factors for bacterial versus CPPS. The four-glass test (Meares-Stamey localisation test) collecting sequential urine and expressed prostatic secretion (EPS) samples is the gold standard for differentiating bacterial prostatitis and identifying the infecting organism. In practice, a two-glass test (urine before and after massage) is usually sufficient. Microscopy and culture of urine, culture of semen and microscopy of EPS complete the microbiological assessment. Functional and anatomical assessment is done with uroflowmetry, post-void residual ultrasound, TRUS (to assess prostate anatomy and rule out abscess) and validated symptom scoring.