Encyclopedia of Health and Medicine

334 The Reproductive System
prostatitis INFLAMMATION, INFECTION, or PAIN of the
PROSTATE GLAND. Prostatitis may be acute (come on
suddenly) or chronic (persist or recur over time).
Urologists classify five types of prostatitis:
• Acute bacterial prostatitis occurs as a result of
infection with BACTERIA, usually URINARY TRACT
INFECTION (UTI), that infiltrates the prostate
gland. SEXUALLY TRANSMITTED DISEASES (STDS),
notably GONORRHEA
and CHLAMYDIA, may also
cause acute bacterial prostatitis. Treatment with
appropriate ANTIBIOTIC MEDICATIONS usually cures
the infection.
• Chronic bacterial prostatitis occurs as a result of
an underlying chronic health condition that
allows continued or repeated bacterial access to
the prostate gland. Treatment requires longterm,
and sometimes repeated, antibiotic therapy
as well as efforts to resolve the underlying
condition.
• Chronic inflammatory prostatitis causes pain
and exists when there is inflammation but no
infection. Treatment is with NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS (NSAIDS) to reduce inflammation
and relieve pain.
• Asymptomatic inflammatory prostatitis does
not cause any symptoms and is sometimes a
factor in male INFERTILITY that shows up during
FERTILITY testing. NSAIDs may improve the
inflammation.
• Prostadynia, also called chronic noninflammatory
prostatitis, involves neither inflammation
nor infection though pain is persistent and
sometimes debilitating. Doctors do not know
what causes prostadynia. Medications such as
alpha blockers, used to treat BENIGN PROSTATIC
HYPERPLASIA (BPH), and NSAIDs sometimes provide
relief. BIOFEEDBACK, ACUPUNCTURE, and prostatic
massage are other methods to relieve
pain.
Symptoms and Diagnostic Path
The primary symptom of all but asymptomatic
inflammatory prostatitis is pain in the lower
pelvis. Men who have acute bacterial infection
often have FEVER and feel quite ill. Men who have
chronic bacterial prostatitis may feel intermittently
fatigued. The diagnostic path for prostatitis may
include DIGITAL RECTAL EXAMINATION (DRE) to palpate
the prostate gland, measurement of BLOOD
PROSTATE-SPECIFIC ANTIGEN (PSA) levels, urinalysis
including urine culture, and SEMEN analysis to look
for the presence of red blood cells (evidence of
bleeding), white blood cells (evidence of inflammation),
and bacteria (evidence of infection).
When symptoms are chronic, additional diagnostic
procedures may include transrectal ULTRASOUND
(TRUS), COMPUTED TOMOGRAPHY (CT) SCAN, prostate
biopsy, or CYSTOSCOPY.
Treatment Options and Outlook
Treatment and outlook depend on the identified
underlying cause for the symptoms. Because the
structure of the glandular tissue within the
prostate gland is such that it prevents blood components
from entering the prostate gland (a protective
mechanism to prevent ANTIBODY formation
and to keep the semen PSA concentration high),
the course of antibiotic therapy for bacterial prostatitis
is lengthy, typically four to eight weeks. A
complication of untreated or undertreated bacterial
prostatitis is prostatic ABSCESS (the formation of
a contained pocket of pus), which may require a
cystoscopic procedure under ANESTHESIA to drain
the abscess.
Risk Factors and Preventive Measures
Prompt diagnosis and treatment of UTIs and STDs
significantly reduce the risk for bacterial prostatitis.
There are no clear preventive measures for
other forms of prostatitis.
See also CHRONIC PAIN; CYSTITIS; MALDYNIA; SEXU-
ALLY TRANSMITTED DISEASE (STD) PREVENTION; URE-
THRITIS.
puberty The transition from childhood to the
sexual and reproductive maturity that marks
adulthood. Puberty occurs under the influence of
hormonal shifts. The path of puberty tends to start
and end about two years earlier for girls than for
boys. Puberty in most industrialized parts of the
world begins between ages 10 to 15 and concludes
between ages 17 to 19. SECONDARY SEXUAL CHARAC-
TERISTICS emerge during puberty, coinciding with
ADOLESCENCE, the emotional and psychologic
changes that occur during the shift from childhood
to adulthood.