Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (251 page)

   In men over age 35,
Escherichia coli
, other coliforms, and
Pseudomonas
species are more common. Less common pathogens include
Ureaplasma
species,
Mycobacterium tuberculosis
, and
Brucella
species, cytomegalovirus or
Cryptococcus
(patients with HIV infection).

   In boys before puberty,
E. coli
is a common cause.

   In children, epididymitis may be a response following infection by enterovirus, adenovirus, or
Mycoplasma pneumoniae
.

Suggested Readings

Doble A, Taylor-Robinson D, Thomas BJ, et al. Acute epididymitis: a microbiological and ultrasonographic study.
Br J Urol.
1989;63:90–94.

Hawkins DA, Taylor-Robinson D, Thomas BJ, et al. Microbiological survey of acute epididymitis.
Genitourin Med.
1986;62:342–344.

Wampler SM, Llanes M. Common scrotal and testicular problems.
Prim Care.
2010;37: 613–626.

PROSTATITIS

   Definition

   Prostatitis refers to histologic inflammation of the prostate gland, although the term is used loosely to describe several different conditions. The 1999 classification system of the National Institutes of Health Prostatitis Collaborative Network comprises four classes of prostatitis:

   I. Acute bacterial prostatitis: Acute urogenital symptoms, with evidence of bacterial infection of the prostate. Route of entry is nearly always via the urethra or bladder through the prostatic duct, with intraprostatic reflux of urine and, sometimes, concomitant infection of the bladder or epididymis.

   II. Chronic bacterial prostatitis: Chronic or recurrent urogenital symptoms with evidence of bacterial infection of the prostate. The route of entry is the same as for acute bacterial prostatitis.

   IIIA. Chronic prostatitis/chronic pelvic pain syndrome, inflammatory: Chronic or recurrent urogenital symptoms with evidence of inflammation but not bacterial infection of the prostate.

   IIIB. Chronic prostatitis/chronic pelvic pain syndrome, noninflammatory: Chronic or recurrent urogenital symptoms without evidence of inflammation or bacterial infection of the prostate.

   IV. Asymptomatic inflammatory prostatitis: Absence of urogenital symptoms; evidence of inflammation of the prostate is found incidentally.

   Who Should Be Suspected?

   Acute bacterial prostatitis (WHO class I) is manifested by a spiking fever, chills, malaise, myalgia, dysuria, irritative urinary symptoms (frequency, urgency, urge incontinence), pelvic or perineal pain, and cloudy urine. On exam, the prostate is often warm, firm, edematous, and exquisitely tender.