Skip to main content
Symptom
dx.
Menu
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Medications
Drug reference
Calculators
Clinical calculators
OHIP Billing
Billing code lookup
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Symptom
dx.
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Medications
Drug reference
Calculators
Clinical calculators
OHIP Billing
Billing code lookup
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Get Started
Menu
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Medications
Drug reference
Calculators
Clinical calculators
OHIP Billing
Billing code lookup
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Loading...
Acute prostatitis
Cardiovascular Presentations
Abdominal aortic aneurysm
Acute coronary syndrome (NSTEMI)
Acute coronary syndrome (STEMI)
Acute decompensated heart failure
Acute limb ischemia
Acute mesenteric ischemia
Aortic dissection
Aortic stenosis
Atrial fibrillation and flutter
Bradyarrhythmia and heart block
Cardiac arrest
Deep vein thrombosis
Myocarditis
Pericarditis
Pulmonary embolism
Stable angina
Superficial thrombophlebitis
Superior vena cava syndrome
Supraventricular tachycardia
Syncope (cardiogenic)
Unstable angina
Ventricular tachycardia
Respiratory Presentations
Acute bronchitis
Acute respiratory failure
Aspiration pneumonia
Asthma exacerbation
Bronchiolitis
Community-acquired pneumonia
COVID-19 pneumonia
COPD exacerbation
Croup
Croup (laryngotracheobronchitis)
Epiglottitis
Hemothorax
Hospital-acquired pneumonia
Pleural effusion
Pneumothorax (traumatic)
Pulmonary contusion
Spontaneous pneumothorax
Neurological Presentations
Bell's palsy
Benign paroxysmal positional vertigo
Brain abscess
Cauda equina syndrome
Cervical radiculopathy
Concussion (mild traumatic brain injury)
Encephalitis
Guillain-Barré syndrome
Hemorrhagic stroke (intracerebral)
Ischemic stroke
Lumbar radiculopathy
Malignant spinal cord compression
Migraine
Peripheral neuropathy (acute)
Retropharyngeal abscess
Schizophrenia (acute exacerbation)
Seizure (breakthrough:known epilepsy)
Seizure (first-time)
Spinal cord injury
Status epilepticus
Subarachnoid hemorrhage
Tension headache
Transient ischemic attack
Traumatic brain injury (moderate-severe)
Vestibular neuritis
Viral meningitis
Gastrointestinal Presentations
Acute appendicitis
Acute cholecystitis
Acute diverticulitis
Acute pancreatitis
Anal fissure
Choledocholithiasis and cholangitis
Clostridioides difficile colitis
Gastritis
Gastroenteritis (viral and bacterial)
Gastroesophageal reflux disease
Incarcerated or strangulated hernia
Inflammatory bowel disease flare
Large bowel obstruction
Lower GI hemorrhage
Peptic ulcer disease
Perforated viscus
Small bowel obstruction
Upper GI hemorrhage
Genitourinary and Reproductive Presentations
Acute prostatitis
Acute urinary retention
Ectopic pregnancy
Epididymitis
Orchitis
Ovarian torsion
Paraphimosis
Pelvic inflammatory disease
Priapism
Pyelonephritis
Renal laceration
Ruptured ovarian cyst
Testicular torsion
Tubo-ovarian abscess
Urinary tract infection (uncomplicated)
Urolithiasis (renal colic)
Vaginal bleeding (non-pregnant)
Infectious Disease Presentations
Acute sinusitis
Acute tonsillitis
Acute upper respiratory infection
Animal bite
Bacterial meningitis
Cellulitis
Conjunctivitis (bacterial)
Dental abscess
Endocarditis
Febrile neutropenia
Fournier gangrene
Hand-foot-mouth disease
Hepatitis (acute)
Herpes zoster
HIV-related illness
Human bite
Impetigo
Infected diabetic foot ulcer
Infectious mononucleosis
Influenza
Necrotizing fasciitis
Osteomyelitis
Otitis externa
Parasitic infection
Periorbital cellulitis
Peritonsillar abscess
Scabies
Sepsis
Septic arthritis
Spontaneous bacterial peritonitis
Tick-borne illness (Lyme disease)
Tinea infection
Tuberculosis
Viral exanthem
Wound infection
Trauma Presentations
Achilles tendon rupture
ACL and mceniscus tear
Ankle fracture
Ankle sprain
Burn
Calcaneus fracture
Cervical spine fracture
Clavicle fracture
Dental avulsion
Distal radius fracture
Drowning
Elbow fracture and dislocation
Electrical injury
Facial bone fracture
Facial laceration
Femur fracture
Fingertip amputation
Forearm fracture (radius and ulna)
Frostbite
Hand:finger laceration
Heat exhaustion
Heat stroke
Hip fracture
Humeral shaft fracture
Knee dislocation
Knee sprain
Lightning injury
Mandible fracture
Metacarpal fracture
Metatarsal fracture
Muscle strain
Nasal fracture
Non-accidental trauma
Orbital fracture
Patella fracture
Phalanx fracture (finger)
Proximal humerus fracture
Pulmonary contusion
Rib fracture
Rotator cuff tear (acute traumatic)
Scalp laceration
Scaphoid fracture
Shoulder dislocation
Skull fracture
Splenic laceration
Sternal fracture
Supracondylar pediatric fracture
Tendon laceration (hand:wrist)
Thoracic and lumbar spine fracture
Tibia:fibula fracture
Tibial plateau fracture
Toe fracture
Traumatic epistaxis
Traumatic hyphema
Toxicologic Presentations
Acetaminophen toxicity
Alcohol intoxication
Alcohol withdrawal
Anticholinergic toxicity
Anticoagulant overdose
Benzodiazepine overdose
Benzodiazepine:sedative overdose
Beta-blocker and calcium channel blocker toxicity
Carbon monoxide poisoning
Caustic ingestion
Digoxin toxicity
Drug eruption
Foreign body ingestion
Opioid intoxication
Opioid overdose
Opioid withdrawal
Organophosphate
Salicylate toxicity
Serotonin syndrome
Stimulant intoxication (cocaine, methamphetamine)
Tricyclic antidepressant overdose
Psychiatric Presentations
Acute anxiety
Acute psychosis
Agitation:behavioral emergency
Bipolar disorder
Conversion disorder
Major depressive episode
Neuroleptic malignant syndrome
Suicidal ideation and attempt
Musculoskeletal and Rheumatologic Presentations
Acute low back pain (mechanical)
Bursitis
Cervical radiculopathy
Costochondritis
Gout (acute)
Lumbar radiculopathy
Pseudogout
Tendinitis
Dermatology Presentations
Acute eczema (Eczema acute flare)
Allergic contact dermatitis
Erythema multiforme
Henoch-Schönlein purpura
Pressure injury
Psoriasis (acute flare)
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Urticaria (acute)
Environmental and Exposure Presentations
Envenomation (snake, spider, insect)
High-altitude illness
Hypothermia
Hematologic and Oncologic Presentations
Acute chest syndrome
Coagulopathy
Hyperviscosity syndrome
Sickle cell crisis (vaso-occlusive)
Symptomatic anemia
Thrombocytopenia (severe)
Tumor lysis syndrome
Pediatric-Specific Presentations
Bronchiolitis
Croup
Emergency delivery
Febrile seizure
Kawasaki disease
Neonatal jaundice
Neonatal sepsis
Nursemaid's elbow
Pediatric fever 0 to 28 days
Pediatric fever 29 to 60 days
Pediatric fever 61 to 90 days
Pyloric stenosis
Slipped capital femoral epiphysis
Intussusception
Endocrine and Metabolic Presentations
Adrenal crisis
Diabetic ketoacidosis
Hypercalcemia
Hyperosmolar hyperglycemic state
Hypertensive emergency
Hypertensive urgency
Hypoglycemia
Myasthenia gravis crisis
Myxedema coma
Severe hyperkalemia
Severe hyponatremia
Thyroid storm
ENT and Maxillofacial Presentations
Acute laryngitis
Acute otitis media
Acute pharyngitis
Cerumen impaction
Epistaxis (anterior)
Nasal foreign body
Otitis externa
Tympanic membrane perforation
Ophthalmologic Presentations
Acute angle-closure glaucoma
Central retinal artery occlusion
Chemical eye injury
Corneal abrasion
Corneal ulcer
Globe rupture
Ocular foreign body
Orbital cellulitis
Retinal detachment
Obstetric Presentations
Hyperemesis gravidarum
Painful vaginal bleeding in pregnancy
Placenta previa
Placental abruption
Preeclampsia:eclampsia
Preterm labor
Threatened:inevitable:incomplete abortion
Systemic and Miscellaneous Presentations
Anaphylaxis
Angioedema
Cannabis-induced hyperemesis
Acute prostatitis
POCUS
Procedures
Medications
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
Approach to the Critical Patient
Immediate priorities
Stabilization and escalation
▶
Sepsis physiology
▶
Altered mental status
Hypotension
Tachypnea
Lactate elevation mmol/l
Early antimicrobials for high likelihood sepsis
▶
Antimicrobials within 1 hour for septic shock or high likelihood sepsis
Blood cultures before antibiotics if no meaningful delay
Hemodynamic support
▶
Isotonic crystalloid bolus for hypotension
Vasopressor for persistent hypotension after fluids
Urinary obstruction red flags
▶
Acute urinary retention
Anuria or severe oliguria
Airway and breathing triggers
▶
Respiratory failure signs
Refractory hypoxemia
Consultation triggers
▶
Urology for suspected abscess
Urology for urinary retention requiring suprapubic drainage
ICU for shock or escalating vasopressor requirement
Key concepts
Condition frame
▶
Acute bacterial prostatitis ICD-10 N41.0
Ascending infection from urinary tract
Common pathogens Enterobacterales
Complications
▶
Sepsis and bacteremia
Acute urinary retention
Prostatic abscess
Epididymo-orchitis
Pitfall
▶
Urethral instrumentation risk for bacteremia
Vigorous prostatic massage avoidance
History
Presenting features
Symptom pattern
▶
Fever and chills
▶
Duration
Persistent fever beyond 36 hours on antibiotics
Pelvic or perineal pain
▶
Rectal discomfort
Lower back pain
Lower urinary tract symptoms
▶
Dysuria
Frequency
Urgency
Hesitancy
Weak stream
Systemic toxicity
▶
Rigors
Malaise
Confusion
Risks and exposures
Predisposing factors
▶
Bladder outlet obstruction
▶
Benign prostatic hyperplasia history
Prior urinary retention
Recent instrumentation
▶
Catheterization
Cystoscopy
Transrectal prostate biopsy
Recurrent UTI history
▶
Prior culture results
Prior resistant organisms
Immunocompromise
▶
Diabetes mellitus
Steroids
Chemotherapy
HIV
STI risk
▶
New partner
Urethral discharge
Insertive anal intercourse
Medication and allergy context
Antibiotic constraints
▶
Fluoroquinolone contraindications or prior severe adverse effects
Sulfonamide allergy history
QT prolongation risk
Significant renal impairment history
Physical Exam
Core findings
Vital signs and perfusion
▶
Fever
▶
Documented temperature
Antipyretic response
Hemodynamics
▶
Hypotension
Tachycardia
Respiratory status
▶
Tachypnea
Oxygen saturation
Mental status
▶
Delirium features
Lethargy
Genitourinary and abdominal exam
Targeted exam
▶
Suprapubic tenderness
▶
Palpable bladder distension
External genital exam
▶
Epididymal tenderness and swelling
Testicular tenderness
Costovertebral angle tenderness
▶
Concurrent pyelonephritis concern
Digital rectal exam
▶
Prostate tenderness
Prostate bogginess
Prostate warmth
Avoid vigorous massage
PITFALLS
Misleading or high risk patterns
▶
Afebrile presentation in older adults or immunocompromise
▶
Sepsis despite normal temperature
DRE deferred when intolerable pain or hemodynamic instability
▶
Clinical diagnosis without DRE when unsafe
Differential Diagnosis
Genitourinary infectious and inflammatory
Close mimics
▶
Acute cystitis ICD-10 N30.0
▶
Minimal pelvic pain
Absent systemic toxicity
Pyelonephritis ICD-10 N10
▶
Prominent flank pain
Marked CVA tenderness
Epididymitis ICD-10 N45.1
▶
Localized epididymal tenderness
Scrotal swelling
Urethritis ICD-10 N34.1
▶
Urethral discharge
Minimal prostate tenderness
Prostatic abscess
▶
Persistent fever on antibiotics
Fluctuant prostate on DRE
Noninfectious emergent conditions
Must-not-miss
▶
Testicular torsion ICD-10 N44.0
▶
Sudden severe scrotal pain
High-riding testis
Fournier gangrene ICD-10 N49.3
▶
Perineal pain out of proportion
Crepitus
Skin necrosis
Cauda equina syndrome ICD-10 G83.4
▶
Urinary retention with saddle anesthesia
New neurologic deficits
Laboratory Tests
Urine studies
Urinalysis and culture
▶
Urinalysis
▶
Pyuria
Bacteriuria
Hematuria
Urine culture and susceptibilities
▶
Sample before antibiotics when feasible
Antibiotic adjustment to susceptibilities
Blood tests for systemic illness
Sepsis and complications evaluation
▶
Complete blood count
▶
Leukocytosis or leukopenia
C-reactive protein trend utility
▶
Treatment response marker
Basic metabolic panel
▶
Acute kidney injury
Electrolyte disturbances
Lactate mmol/l
▶
Tissue hypoperfusion marker
Blood cultures
▶
Febrile or toxic appearance
Concern for bacteremia
Glucose mmol/l
▶
Hyperglycemia and infection severity
STI testing
Gonorrhea and chlamydia testing
▶
NAAT urine
▶
STI risk features
Urethral discharge
HIV and syphilis testing
▶
High-risk sexual exposure context
Diagnostic Tests
Scoring Systems
Illness severity tools
▶
qSOFA
▶
Respiratory rate 22 or higher
Systolic blood pressure 100 or lower
Altered mentation
SIRS
▶
Temperature 38 C or higher
Temperature 36 C or lower
Heart rate 90 or higher
Respiratory rate 20 or higher
White blood cell count abnormal
NEWS2
▶
Escalation thresholds per local protocol
Trigger for higher level monitoring
MRI
Pelvic MRI considerations
▶
Abscess evaluation when CT contraindicated
▶
Contrast allergy history
Need for detailed soft tissue definition
Limitations
▶
Limited ED availability
Delayed time to imaging
CT
CT pelvis with contrast
▶
Prostatic abscess evaluation
▶
Persistent fever beyond 36 hours
Failure to improve within 48 hours
Severe systemic illness
Alternative diagnoses evaluation
▶
Necrotizing soft tissue infection concern
Pelvic collections
Cautions
▶
Renal function consideration
Contrast reactions history
Ultrasound
Ultrasound applications
▶
Bladder ultrasound
▶
Post-void residual measurement
Urinary retention confirmation
Transrectal ultrasound
▶
Prostatic abscess evaluation
Drainage planning with urology
Scrotal ultrasound
▶
Epididymo-orchitis evaluation
Torsion exclusion when indicated
Disposition
Admission and level of care
Hospital admission criteria
▶
Sepsis physiology
▶
Hypotension
Elevated lactate mmol/l
Altered mental status
Unable to tolerate oral intake
▶
Persistent vomiting
Inability to take oral antibiotics
Acute urinary retention
▶
Need for suprapubic catheter
Suspected prostatic abscess
▶
Persistent fever beyond 36 hours
Imaging showing collection
Significant comorbidity
▶
Immunocompromise
Advanced chronic kidney disease
Discharge criteria and follow-up
Copy
Outpatient management suitability
▶
Hemodynamic stability
▶
No hypotension
No new hypoxia
Adequate pain control with oral agents
▶
Able to ambulate
Reliable oral intake
▶
Hydration maintained
Follow-up plan within 48 to 72 hours
▶
Primary care or urology review
Return precautions understood
▶
Worsening symptoms
No improvement by 48 hours
Treatment
Supportive care
Symptom control
▶
Analgesia
▶
Acetaminophen dosing per local protocol
NSAID if appropriate
Antiemetic for vomiting
▶
Oral tolerance facilitation
Hydration
▶
Oral fluids
IV fluids for dehydration
Activity and irritant avoidance
▶
Avoid alcohol
Avoid caffeine
Avoid bicycling when painful
Antibiotics
Empiric antibiotic strategy
▶
Culture guided narrowing when available
▶
Urine susceptibilities review
De-escalation to narrowest effective agent
Total duration target
▶
Total course 2 to 4 weeks for acute bacterial prostatitis
Minimum 14 days then reassess
Oral first-line options
▶
Ciprofloxacin PO 500 mg every 12 hours
▶
Duration 14 days
Reassess at day 14
Extension additional 14 days if needed
Ofloxacin PO 200 mg every 12 hours
▶
Duration 14 days
Reassess at day 14
Extension additional 14 days if needed
Trimethoprim PO 200 mg every 12 hours
▶
Use when fluoroquinolone not appropriate
Duration 14 days
Reassess at day 14
Extension additional 14 days if needed
Oral second-choice after specialist discussion
▶
Levofloxacin PO 500 mg daily
▶
Duration 14 days
Reassess at day 14
Extension additional 14 days if needed
Co-trimoxazole PO 960 mg every 12 hours
▶
Use only with bacteriologic sensitivity
Duration 14 days
Reassess at day 14
Extension additional 14 days if needed
Intravenous options for severe illness or unable PO
▶
Review IV therapy at 48 hours
▶
Step down to oral when stable
Total 14 days then reassess
Ceftriaxone IV 2 g daily
▶
Add aminoglycoside if sepsis concern per local protocol
Transition to oral when afebrile and improving
Cefuroxime IV 1.5 g every 6 to 8 hours
▶
Transition to oral when improving
Ciprofloxacin IV 400 mg every 8 to 12 hours
▶
Fluoroquinolone restriction awareness
Levofloxacin IV 500 mg daily
▶
Fluoroquinolone restriction awareness
Gentamicin IV 5 to 7 mg/kg daily
▶
Therapeutic drug monitoring requirement
Renal function monitoring
Amikacin IV 15 mg/kg daily
▶
Maximum per dose 1.5 g daily
Therapeutic drug monitoring requirement
Renal function monitoring
STI-associated regimen when risk high
▶
Ceftriaxone IM per local gonorrhea dosing guidance
▶
Add doxycycline PO 100 mg every 12 hours
Duration 7 days for chlamydia coverage
Enteric coverage continuation when prostatitis strongly suspected
▶
Fluoroquinolone option if appropriate
Specialist input when dual coverage needed
Urinary retention management
Bladder drainage strategy
▶
Suprapubic catheter preferred when retention with severe prostatitis
▶
Urology involvement
Avoid urethral catheter if possible
If urethral catheter required
▶
Gentle technique
Smallest effective catheter
Bacteremia monitoring
Adjuncts and complications
Alpha blocker consideration
▶
Tamsulosin per local protocol
LUTS relief support
Prostatic abscess management
▶
Urology drainage planning
Antibiotic broadening pending cultures
Anticoagulation and NSAID caution
▶
Bleeding risk review
Renal function review
Special Populations
Pregnancy
Pregnancy considerations
▶
Rare clinical scenario framing
▶
Alternative pelvic pain etiologies prioritized
UTI and pyelonephritis pathways
Antibiotic safety constraints
▶
Fluoroquinolones generally avoided
Trimethoprim avoidance in first trimester when possible
Specialist involvement
▶
Obstetrics consultation for febrile urinary infection
Geriatric
Older adult considerations
▶
Atypical presentation
▶
Delirium without fever
Minimal urinary symptoms
Higher complication risk
▶
Sepsis
Urinary retention
Medication risks
▶
Fluoroquinolone adverse effects vigilance
QT prolongation monitoring
Disposition threshold
▶
Lower threshold for admission
Pediatrics
Pediatric considerations
▶
Rarity and alternate diagnoses
▶
Epididymo-orchitis
UTI with anatomic abnormalities
Imaging threshold
▶
Early evaluation for urinary tract anomaly
Antibiotic dosing
▶
Weight-based dosing required
Pediatric infectious diseases consultation
Background
Epidemiology
Epidemiologic frame
▶
Acute bacterial prostatitis as less common UTI phenotype
▶
Higher incidence with instrumentation
Higher incidence with obstructive uropathy
Pathogen distribution
▶
Enterobacterales predominance
Resistant organisms after transrectal biopsy
Pathophysiology
Mechanisms
▶
Ascending infection
▶
Intraprostatic reflux of infected urine
Ductal obstruction and inflammation
Hematogenous seeding
▶
Uncommon pathway
Complication pathways
▶
Prostatic edema causing retention
Microabscess coalescence
Bacteremia from inflamed tissue
Therapeutic Considerations
Treatment rationale
▶
Antibiotic penetration
▶
Agents with prostatic tissue penetration preferred
Fluoroquinolones and trimethoprim penetration advantage
Course length logic
▶
Longer courses reduce relapse risk
Reassessment at 14 days for stewardship
IV to PO step-down
▶
Early step-down when stable
Total duration maintained
Avoidance of unnecessary manipulation
▶
Prostatic massage avoidance to reduce bacteremia risk
Patient Discharge Instructions
copy discharge instructions
Copy
Discharge instructions
▶
Diagnosis explanation
▶
Prostate bacterial infection
Symptom improvement often takes days
Full recovery may take weeks
Medications
▶
Antibiotic exactly as prescribed
Do not stop early unless instructed
Pain control with acetaminophen or NSAID if safe
Hydration and activity
▶
Drink enough fluids to avoid dehydration
Avoid alcohol and caffeine while symptomatic
Avoid bicycling if it worsens pain
Follow-up
▶
Recheck within 48 to 72 hours if not improving
Review at 14 days for stop versus extend decision
Urology follow-up if severe, recurrent, or retention
Return to ED now
▶
Worsening fever or rigors
Symptoms not improving within 48 hours
New confusion
Fainting or low blood pressure symptoms
Inability to urinate
Severe vomiting or unable to keep fluids down
Increasing perineal pain
New scrotal swelling or severe testicular pain
References
Clinical guidelines and evidence sources
Core sources
▶
NICE NG110 Prostatitis acute antimicrobial prescribing updated 2024
▶
Visual summary last updated September 2024
Oral and IV dosing tables
European Association of Urology Guidelines on Urological Infections
▶
Acute bacterial prostatitis total therapy 2 to 4 weeks
Parenteral antibiotics for systemically ill then switch to oral
AAFP Acute Bacterial Prostatitis Diagnosis and Management 2016
▶
Persistent fever beyond 36 hours triggers imaging for abscess consideration
Surviving Sepsis Campaign Guidelines 2021
▶
Early antimicrobials within 1 hour for septic shock or high likelihood sepsis
StatPearls Acute Bacterial Prostatitis updated 2023
▶
Pathogens and general management overview
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
← Management Protocols
Home
Management Protocols
Acute prostatitis