Chronic Bacterial Prostatitis
Chronic bacterial prostatitis is the second type of prostatitis caused by a bacterial infection, but what makes it different from acute bacterial prostatitis is that the chronic form develops slowly and lasts for three months or longer. Doctors do not see a lot of cases of chronic bacterial prostatitis because it affects less than 5% of men who get prostatitis. However, it is also a difficult condition to diagnose because symptoms can come and go over a period of weeks and months, and so it is not always easy to detect the bacteria that are causing the inflammation. You may think you have gotten better only for the symptoms to come back after a few weeks. Some bacteria do not grow well when cultured, making them even harder to identify.
The main bacterium is Escherichia coli (E. coli) although there are others that can directly or indirectly trigger the disease. They include:
- Enterobacter cloacae
- Chlamydia trachomatis (they also cause Chlamydia)
- Enterococci sp.
- Klebsiella pneumonia
- Neisseria gonorrhea (which causes gonorrhea)
- Proteus mirabilis
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Trichomonas vaginalis (which causes trichomoniasis)
- Ureaplasma urealyticum
- Mycoplasma hominis
- Serratia marcescens
After E. coli, which accounts for 80% of the cases, the next three most common bacterial causes are Klebsiella spp, Pseudomonas aeruginosa, and Proteus spp. Three types of bacteria–Ureaplasma urealyticum, Chlamydia trachomatis, and Mycoplasma hominis–do not grow in standard culture conditions so they are harder to identity and treat.
How Does the Bacteria Get to the Prostate?
Bacteria usually enter through the urethra and make their way up the male plumbing to the prostate. Bacteria can also form in the bladder and enter its way down in the urine. Bacteria can also be contracted when an instrument such as a catheter is inserted in to the urethra. You can contract bacteria through sexual activity from a partner who has a bacterial infection. Having anal sex without a condom is one way for bacteria to get into the bladder and make their way to the prostate. Another way bacteria can get into the prostate is that E. coli can creep up into the bladder from the rectum. Then the bacteria get in the urine and make their way into the prostate. One main cause of this could be food contamination. If chicken and animal products are contaminated with E. coli, the bacteria can get into your intestinal tract and lead to bladder infections.
Am I at Risk?
About 1 in 10 men who have chronic prostatitis have bacterial prostatitis, so it is not very common. Over time the rate of relapse is 50%. It is possible that abnormalities of the prostate make it more susceptible to recurrent infection. Some men may have chronic bacterial prostatitis for many years before they start to have symptoms. You can lower your risk by wearing a condom (especially if engaging in anal sex), cooking your chicken and other animal products really well, eating a prostate-friendly diet and being aware of other causes of bacterial prostatitis or urinary tract infections.
Men who get chronic bacterial prostatitis usually have urinary tract infections along with their other prostatitis symptoms, which can include blood in the urine, needing to urinate often and urgently, and low-grade fever, among others. In between episodes, some men experience few or no symptoms of chronic bacterial prostatitis at all while others have symptoms of inflammation all the time. Chronic bacterial prostatitis is treated with antibiotics, but they are not always effective and may need to be repeated. Doctors should prescribe two to four weeks worth of antibiotics. In more difficult cases, surgery may be necessary. Lifestyle changes, such as modifications to diet, as well as alternative treatments such as acupuncture can be helpful. There are also supplements you can take for prostate health in addition to antibiotics.
Another challenge with chronic bacterial prostatitis is the risk of long-term complications that can have an impact on a man’s fertility. Therefore, while it is important to treat all cases of chronic bacterial prostatitis, men who want to be fathers should be especially vigilant about seeking medical help if they experience any symptoms of acute or chronic bacterial prostatitis.