Prostatitis Syndromes

Prostatitis is not one disease. The NIH/NIDDK classification separates four clinically different syndromes: - Category I: acute bacterial prostatitis — a sudden bacterial infection of the prostate, usually part of a systemic urinary tract infection. - Category II: chronic bacterial prostatitis — persistent or recurrent infection, often producing repeated urinary infections with the same organism. - Category III: chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) — pelvic or genitourinary pain lasting more than three months without a uropathogen identified by standard microbiological testing. Category IIIA has inflammatory cells in expressed prostatic secretions, post-massage urine, or semen; IIIB does not. This distinction does not change treatment. - Category IV: asymptomatic inflammatory prostatitis — inflammation found incidentally on biopsy, expressed prostatic secretions, or semen in a person without prostatitis symptoms. It does not require symptom-directed treatment. Acute bacterial prostatitis usually begins with ascending infection by enteric Gram-negative organisms, especially Escherichia coli and other Enterobacterales. In men with recent instrumentation or healthcare exposure, Pseudomonas and enterococci become more plausible. Infected urine can reflux into prostatic ducts, allowing organisms to establish an intraprostatic focus. In...