Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Chronic bacterial prostatitis

Alain Meyrier, MD
Thomas Fekete, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


The prostate is subject to various inflammatory disorders [1]. One of these syndromes is chronic bacterial prostatitis, which is characterized by chronic or recurrent urogenital symptoms in the setting of documented or suspected bacterial infection of the prostate.

Definitions of inflammatory conditions of the prostate and the syndrome of chronic bacterial prostatitis will be reviewed here. Other prostatic syndromes, including acute bacterial prostatitis and chronic prostatitis/pelvic pain syndrome, are discussed separately. (See "Acute bacterial prostatitis" and "Chronic prostatitis/chronic pelvic pain syndrome".)


While inflammatory or irritative conditions of the prostate are common clinical presentations, they often represent distinct pathogenic processes that may benefit from different management approaches. In order to standardize definitions, improve diagnosis and treatment, and facilitate research, the United States National Institutes of Health (NIH) established an International Prostatitis Collaborative Network to devise a classification approach for prostatitis [2]. The scheme developed by this group is the currently accepted categorization of prostatitis and defines the following syndromes (table 1):

I. Acute bacterial prostatitis — Acute urogenital symptoms with evidence of bacterial infection of the prostate (see "Acute bacterial prostatitis")

II. Chronic bacterial prostatitis — Chronic or recurrent urogenital symptoms with evidence of bacterial infection of the prostate

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 08, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Pontari MA, Joyce GF, Wise M, et al. Prostatitis. J Urol 2007; 177:2050.
  2. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282:236.
  3. Krieger JN, Jacobs RR, Ross SO. Does the chronic prostatitis/pelvic pain syndrome differ from nonbacterial prostatitis and prostatodynia? J Urol 2000; 164:1554.
  4. Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol 1998; 159:1224.
  5. de la Rosette JJ, Hubregtse MR, Meuleman EJ, et al. Diagnosis and treatment of 409 patients with prostatitis syndromes. Urology 1993; 41:301.
  6. Bradshaw CS, Tabrizi SN, Read TR, et al. Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis 2006; 193:336.
  7. Yoon BI, Kim S, Han DS, et al. Acute bacterial prostatitis: how to prevent and manage chronic infection? J Infect Chemother 2012; 18:444.
  8. Zhao WP, Li YT, Chen J, et al. Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis. Asian J Androl 2012; 14:715.
  9. Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med 2006; 355:1690.
  10. Naber KG, Busch W, Focht J. Ciprofloxacin in the treatment of chronic bacterial prostatitis: a prospective, non-comparative multicentre clinical trial with long-term follow-up. The German Prostatitis Study Group. Int J Antimicrob Agents 2000; 14:143.
  11. Lipsky BA, Byren I, Hoey CT. Treatment of bacterial prostatitis. Clin Infect Dis 2010; 50:1641.
  12. Cornia PB, Takahashi TA, Lipsky BA. The microbiology of bacteriuria in men: a 5-year study at a Veterans' Affairs hospital. Diagn Microbiol Infect Dis 2006; 56:25.
  13. Krieger JN, Ross SO, Limaye AP, Riley DE. Inconsistent localization of gram-positive bacteria to prostate-specific specimens from patients with chronic prostatitis. Urology 2005; 66:721.
  14. Krieger JN, McGonagle LA. Diagnostic considerations and interpretation of microbiological findings for evaluation of chronic prostatitis. J Clin Microbiol 1989; 27:2240.
  15. Bruce AW, Reid G. Prostatitis associated with Chlamydia trachomatis in 6 patients. J Urol 1989; 142:1006.
  16. Poletti F, Medici MC, Alinovi A, et al. Isolation of Chlamydia trachomatis from the prostatic cells in patients affected by nonacute abacterial prostatitis. J Urol 1985; 134:691.
  17. Mutlu N, Mutlu B, Culha M, et al. The role of Chlamydia trachomatis in patients with non-bacterial prostatitis. Int J Clin Pract 1998; 52:540.
  18. Ostaszewska I, Zdrodowska-Stefanow B, Badyda J, et al. Chlamydia trachomatis: probable cause of prostatitis. Int J STD AIDS 1998; 9:350.
  19. Gümüş B, Sengil AZ, Solak M, et al. Evaluation of non-invasive clinical samples in chronic chlamydial prostatitis by using in situ hybridization. Scand J Urol Nephrol 1997; 31:449.
  20. Meares EM Jr. Prostatitis: A review. Urol Clin North Am 1975; 2:3.
  21. Chuang AY, Tsou MH, Chang SJ, et al. Mycobacterium abscessus granulomatous prostatitis. Am J Surg Pathol 2012; 36:418.
  22. Larsen RA, Bozzette S, McCutchan JA, et al. Persistent Cryptococcus neoformans infection of the prostate after successful treatment of meningitis. California Collaborative Treatment Group. Ann Intern Med 1989; 111:125.
  23. Orland SM, Hanno PM, Wein AJ. Prostatitis, prostatosis, and prostatodynia. Urology 1985; 25:439.
  24. Müller A, Mulhall JP. Sexual dysfunction in the patient with prostatitis. Curr Opin Urol 2005; 15:404.
  25. Krieger JN, Egan KJ, Ross SO, et al. Chronic pelvic pains represent the most prominent urogenital symptoms of "chronic prostatitis". Urology 1996; 48:715.
  26. Schaeffer AJ, Wu SC, Tennenberg AM, Kahn JB. Treatment of chronic bacterial prostatitis with levofloxacin and ciprofloxacin lowers serum prostate specific antigen. J Urol 2005; 174:161.
  27. McNaughton Collins M, Fowler FJ Jr, Elliott DB, et al. Diagnosing and treating chronic prostatitis: do urologists use the four-glass test? Urology 2000; 55:403.
  28. Nickel JC, Shoskes D, Wang Y, et al. How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome? J Urol 2006; 176:119.
  29. Nickel JC, Downey J, Johnston B, et al. Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial. J Urol 2001; 165:1539.
  30. Aagaard J, Madsen PO. Bacterial prostatitis: new methods of treatment. Urology 1991; 37:4.
  31. Charalabopoulos K, Karachalios G, Baltogiannis D, et al. Penetration of antimicrobial agents into the prostate. Chemotherapy 2003; 49:269.
  32. Gardiner BJ, Mahony AA, Ellis AG, et al. Is fosfomycin a potential treatment alternative for multidrug-resistant gram-negative prostatitis? Clin Infect Dis 2014; 58:e101.
  33. Giannarini G, Mogorovich A, Valent F, et al. Prulifloxacin versus levofloxacin in the treatment of chronic bacterial prostatitis: a prospective, randomized, double-blind trial. J Chemother 2007; 19:304.
  34. Naber KG, Roscher K, Botto H, Schaefer V. Oral levofloxacin 500 mg once daily in the treatment of chronic bacterial prostatitis. Int J Antimicrob Agents 2008; 32:145.
  35. Bundrick W, Heron SP, Ray P, et al. Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology 2003; 62:537.
  36. Naber KG, European Lomefloxacin Prostatitis Study Group. Lomefloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis. Int J Antimicrob Agents 2002; 20:18.
  37. Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev 2013; :CD009071.
  38. Paglia M, Peterson J, Fisher AC, et al. Safety and efficacy of levofloxacin 750 mg for 2 weeks or 3 weeks compared with levofloxacin 500 mg for 4 weeks in treating chronic bacterial prostatitis. Curr Med Res Opin 2010; 26:1433.
  39. Grayson ML, Macesic N, Trevillyan J, et al. Fosfomycin for Treatment of Prostatitis: New Tricks for Old Dogs. Clin Infect Dis 2015; 61:1141.
  40. Cunha BA, Gran A, Raza M. Persistent extended-spectrum β-lactamase-positive Escherichia coli chronic prostatitis successfully treated with a combination of fosfomycin and doxycycline. Int J Antimicrob Agents 2015; 45:427.
  41. Karaiskos I, Moussas N, Sakka V, et al. Oral fosfomycin for the treatment of chronic prostatitis. Presented at the Interscience Conference of Antimicrobial Agents and Chemotherapy/International Congress of Chemotherapy and Infection, San Diego CA, September 2015, Abstract #L-1253.
  42. Martin DH, Mroczkowski TF, Dalu ZA, et al. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group. N Engl J Med 1992; 327:921.
  43. Chiarini F, Mansi A, Tomao P, et al. Chlamydia trachomatis genitourinary infections: laboratory diagnosis and therapeutic aspects. Evaluation of in vitro and in vivo effectiveness of azithromycin. J Chemother 1994; 6:238.
  44. Skerk V, Schönwald S, Krhen I, et al. Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. Int J Antimicrob Agents 2003; 21:457.
  45. Weidner W, Schiefer HG. Chronic bacterial prostatitis: therapeutic experience with ciprofloxacin. Infection 1991; 19 Suppl 3:S165.
  46. Schaeffer AJ, Darras FS. The efficacy of norfloxacin in the treatment of chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin. J Urol 1990; 144:690.
  47. Weidner W, Schiefer HG, Brähler E. Refractory chronic bacterial prostatitis: a re-evaluation of ciprofloxacin treatment after a median followup of 30 months. J Urol 1991; 146:350.
  48. van der Linden PD, Sturkenboom MC, Herings RM, et al. Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ 2002; 324:1306.