Diagnosis of chronic bacterial prostatitis

Chronic bacterial prostatitis is defined as recurrent urinary tract infection (UTI) with culture of a recognised uropathogen from urine or prostatic fluid. Patients with chronic bacterial prostatitis often have a history of intermittent symptomatic episodes that resemble acute bacterial prostatitis, except fever is usually absent.

Chronic bacterial prostatitis is rare; less than 10% of males¹ with symptoms of chronic prostatitis (eg chronic prostatic pain, recurrent lower urinary tract symptoms) have a bacterial infection.

The diagnosis of chronic bacterial prostatitis is confirmed by comparing leucocyte count and the results of culture of pre– with post–prostatic massage urine samples (the ‘2-glass test’).

Patients without evidence of bacterial prostatitis on microbiological testing have chronic (nonbacterial) prostatitis or chronic pelvic pain syndrome and do not require antibiotic therapy. Treatment is symptomatic. These patients are best managed by a specialist multidisciplinary team.

For patients who do not have genitourinary symptoms, the presence of leucocytes or bacteria (or both) in expressed prostatic secretion or semen indicates asymptomatic inflammatory prostatitis. Antibiotic therapy is not indicated.