Prostatitis is an inflammation of the prostate gland which is a chestnut sized structure found in the pelvic area between the bladder and rectum in males. During ejaculation, the prostate gland adds the greatest volume of secretions to the semen. The gland is lobular and contains connective tissue and smooth muscle. The urethra, which is the structure conducting urine from the bladder to the tip of the penis, courses through the prostate. In the prostate the ejaculatory duct, which is connected to the seminal vesicles and vas deferens and through which flows semen, connects to the urethra.
Prostatitis is defined as four different entities: acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis and prostatodynia. Chronic bacterial prostatitis is seen in older men and rarely if ever in adolescents and will not be discussed in this chapter.
Acute bacterial prostatitis is an infection of the prostate with a bacterial organism. In adolescents the causative organisms are usual E. coli or N. gonorrhea. E. coli is the most common cause of urinary tract infection in teens, and it is thought that infected urine from the bladder that refluxes into the prostate is the cause of prostatitis. Gonorrhea produces urethritis in males; it is believed that the infection spreads up the urethra and into the prostate. Gonorrhea is one of the most common sexually transmitted infections in adolescent males.
Non-bacterial prostatitis and prostatodynia are felt by some experts to be the same entity. In both situations, bacterial causes for the problem cannot be found and the symptoms wax and wane over a long period. The cause of non-bacterial prostatitis and prostatodynia is uncertain. Some feel that as yet unidentified microorganisms cause the problem while others feel these syndromes have no infectious etiology. Others feel that these symptoms are due to a chemical inflammation initiated by urine. They propose that the sphincter in the bladder that prevents urine from refluxing into the prostate does not work well and allows occasional reflux of urine into the prostate. The urine brings on inflammation and symptoms follow.
Who is likely to develop prostatitis?
Acute prostatitis is likely to be seen in sexually active males who are at risk for sexually transmitted infection. Adolescent males who do not use barrier methods such as condoms are at a higher risk for acquiring a sexually transmitted infection, and gonorrhea is one of the most common in that age group. Also, males who are prone to urinary tract infections could have a higher chance that bacteria from the infection could infect the prostate gland. No particular subset of adolescent males is prone to non-bacterial prostatitis or prostatodynia.
What are the symptoms of prostatitis?
Adolescents with acute bacterial prostatitis usually have a dramatic onset of fever, chills, and pain in the lower back and in the area between the scrotum and anus. There may be some difficulty in urinating, and some teens have pain on urination. These adolescents also have increased frequency of urination and often must get up from sleep several times during the night in order to urinate. Teens who have non-bacterial prostatitis or prostatodynia may complain of intermittent burning on urination, dribbling and intermittent discomfort in the area between the anus and scrotum. Some teens may notice blood in their urine or in their ejaculate, and some complain of discomfort in the genital region after ejaculation.
How is prostatitis evaluated?
A careful physical examination of the abdomen, scrotum and penis is the first step in evaluating acute bacterial prostatitis. Other conditions including sexually transmitted infections, epididymitis and incarcerated hernia should be ruled out. A rectal examination is often done to evaluate the prostate for enlargement, tenderness and changes in its consistency. Most clinicians will check the urine for signs of infection including increase in white blood cells, and obtain a bacterial culture. Some clinicians will also obtain prostatic secretions by prostatic massage methods. Prostatic message is performed by vigorous massaging of the prostate during a rectal examination. This may produce secretions that can be evaluated for presence of white blood cells.
In non-bacterial prostatitis and prostatodynia many of these steps will also be performed. Often the prostate in these conditions feels normal, but occasionally it is enlarged and tender. Occasionally a clinician will try to obtain prostatic secretions by prostatic massage.
How is prostatitis treated?
Acute bacterial prostatitis is treated with antibiotics. Most teens do not need hospitalization for this treatment. Antibiotics such as trimethoprim-sulfa, ciprofloxacin or doxycyline work well for this infection. If a specific organism such as the bacterium that causes gonorrhea is identified, then antibiotic treatment aimed at that organism is usually recommended. Some experts propose three weeks of antibiotic treatment to prevent the acute bacterial prostatitis from becoming established in the prostate gland and causing chronic bacterial prostatitis. Warm baths two to three times a day, bed rest, pain relief and medication to relieve fever are also recommended.
The approach to non-bacterial prostatitis and prostatodynia is several fold depending on what is believed to be the cause of the problem. If the clinician feels there is a bacterial cause, then medications including doxycyline or trimethoprim-sulfa may be used. Analgesics including ibuprofen may also be recommended. If the clinician feels the problem is due to refluxing of urine from the bladder into the prostate, then medications aimed at reducing the change of reflux will be prescribed. Some clinicians recommend regular ejaculations by masturbation or with a partner for individuals affected with this disorder. Dietary restrictions are probably of no help unless spicy foods seem to aggravate the symptoms.
How is prostatitis prevented?
Using safer sex methods including condoms can prevent acute bacterial prostatitis that is due to a sexually acquired organism. If a teen has a history of urinary tract infections, then careful follow up with his clinician should be done if symptoms of a urinary infection occur. Since the etiology of non-bacterial prostatitis and prostatodynia are not known, there are no recommended preventive measures. Although non-bacterial prostatitis and prostatodynia cannot be sexually transmitted to a partner, acute bacterial prostatitis due to a sexually acquired organism may be transmitted to a sex partner. In any case, the use of condoms is an appropriate measure to consider.
Related topics:
Condoms, masturbation, sexually transmitted diseases, urinary tract infection
