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The least common form of prostatitis, acute bacterial prostatitis (ABP), is also the easiest to diagnose and treat. Its onset typically is sudden, painful and debilitating, causing the patient to seek medical attention quickly.
 

 

 
Causes
ABP is caused by bacteria traveling up the urethra and the backward flow of infected urine into the prostatic ducts. This may be brought on by the use of a urinary catheter during a medical procedure, or it may be caused by an enlargement of the patient's prostate, a congenital defect in his urinary tract or a recent bladder infection. Engaging in anal intercourse also can cause ABP, although the disease is not sexually transmitted (cannot be passed from partner to partner).

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What are the signs and symptoms of the condition?
Acute bacterial prostatis is characterized by its rapid onset, chills, fever, pain in the lower back and genital area, body aches, burning or painful urination, increased urinary frequency and urgency, often at night, and occasionally visible blood in the urine.

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How is this condition diagnosed?
Diagnosing the various forms of prostatitis is usually a three-step process.

The first is a digital rectal exam, in which the doctor inserts a gloved finger into the patient's rectum to determine if the prostate is enlarged or has lumps or other areas of abnormal texture. This procedure, while uncomfortable, is not painful and is useful in ruling out benign prostatic hyperplasia (BPH) and prostate cancer.

In the second procedure, prostate massaging, the physician will vigorously rub the prostate to make the gland secrete prostatic fluid into the urethra for microscopic examination to see if bacteria are present. If no fluid is expressed, a urine specimen may be taken to examine the washout of the prostatic channel. Examination is performed on the first few teaspoons of the urine specimen only. APB is readily identifiable by the presence of white blood cells and bacteria in the urine and prostatic fluid.

If the results of this procedure are unclear, a three-glass urine collection with prostate massage is performed. This involves collecting the first ounce of urine voided by the patient (urine from the urethra) followed by a sample of flowing, midstream urine (urine from the bladder). After this, the patient will almost empty his bladder by urinating into the toilet. The doctor then massages the patient's prostate to collect a specimen of prostatic fluid; if none is expressed, a third specimen of urine is taken, again capturing the first ounce voided. These three samples are examined microscopically, and three separate cultures will be made from the samples.

This process will determine if the patient's problem is an inflammation or an infection, and whether the problem is located in the urethra, bladder or prostate. It also will show what type of bacteria is present, so the proper type of antibiotic can be prescribed.

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What are the treatments?
A course of oral antibiotics given over 7 to 14 days is the usual treatment for ABP. Typically, the doctor will prescribe ciprofloxacin, trimethoprim or sulfamethoxazole. Infections brought on by the recent use of a urinary catheter may be caused by a broader range of bacteria, and usually are treated with aminoglycoside, fluoroquinolone or cephalosporin.

Patients suffering from high fevers or serious infections that may have spread throughout their bodies often are treated with ampicillin, gentamicin or other antimicrobal agents.

Hospitalization and intravenous antibiotics may be prescribed if the patient is elderly and infirm, has a serious secondary illness or suffers from a damaged immune system.

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