Prostatitis

Prostatitis is a syndrome label, not a single disease. The NIH classification prevents a common and harmful error: treating every person with pelvic pain as though they have a persistent bacterial infection. - Category I: acute bacterial prostatitis is an acute ascending infection of the prostate, usually caused by gram-negative uropathogens. Escherichia coli predominates; Klebsiella, Proteus, Pseudomonas, and Enterococcus can also be responsible. - Category II: chronic bacterial prostatitis causes recurrent urinary infections with the same organism, usually over more than 3 months. Bacteria can persist in prostatic ducts, calculi, or biofilm-like reservoirs that are difficult for many antibiotics to reach. - Category III: chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) causes pelvic pain, urinary symptoms, and sometimes sexual symptoms without an identifiable ongoing infection. This is by far the most common presentation. - Category IV: asymptomatic inflammatory prostatitis is inflammation identified incidentally, often during testing performed for another reason. A useful first distinction is time course plus systemic illness. Fever, abrupt dysuria, pelvic or perineal pain, and a tender prostate suggest acute bacterial disease. Months of fluctuating pelvic pain with...