Chronic prostatitis is an inflammation of the prostate gland that develops gradually, continues for a prolonged period, and typically has subtle symptoms.

Chronic prostatitis is usually caused by a bacterial infection. It may be associated with or follow urinary tract infection, urethritis, epididymitis, or acute prostatitis. The most common causes are Escherichia coli and proteus, Enterobacter, and klebsiella bacteria.

The disorder is diagnosed in 5 of every 1,000 outpatient visits. It is estimated that as many as 35% of men older than 50 may have chronic prostatitis.

Increased risk is associated with men over age 30. Certain factors may predispose a man to develop chronic prostatitis, such as excessive alcohol intake, perineal injury, and certain sexual practices (particularly anal sex without a condom). These factors may cause congestion of the prostate gland, which produces an excellent breeding ground for various bacteria.

• History of recurrent urinary tract infections
• Low-grade or subtle symptoms may include:
  • Low back pain
  • Perineal or pelvic floor pain
  • Testicular pain
  • Pain and burning with urination
  • Pain with ejaculation
  • Pain with bowel movement
• Recurrent low-grade fever
• Pain on urination
• Decreased urinary stream
• Urinary hesitancy (delayed start of urination)
• Frequent urination
• Blood in the urine
• Incontinence

A physical examination may reveal an enlarged, mildly tender prostate. The examination may reveal enlarged or tender lymph nodes in the groin area, scrotal swelling and tenderness, and a urethral discharge.

Triple-void urine specimens may be collected for urinalysis and urine culture:

• #1 -- initial stream
• #2 -- midstream
• #3 -- after prostatic massage by examiner

A urinalysis reveals increased white blood cells (WBCs) and bacterial growth upon culture of urine #3. Culture of prostatic secretions shows in increased levels of WBCs and more concentrated bacterial growth.

A semen analysis may also show increased numbers of white blood cells and decreased numbers of sperm, with poor motility.