Prostate Issues and Sex: Acute Prostatitis

Prostate infection or prostatitis is a condition where the prostate is swollen, red and painful, usually due to an infection. The most common infection is from the most common way we men use our prostates, from sex. All sexually active men are at risk. The most common bugs are chlamydia and gonococcus, which causes gonorrhea. In older men whose prostates are enlarged, other bugs can cause infections, but once these men are still sexually active and are not “eating at home” then the bugs are usually those transmitted via sexual activity. In older men, the symptoms of an acute prostatitis not caused by sex are different from those caused by sexually transmitted infections (STIs) seen in younger men.

 

The classic acute prostatitis, seen in younger men, starts 2 to 3 days following unprotected sex with someone who is already infected with gonorrhea, or 1-2 weeks with chlamydia. The young man usually experiences burning in the urine passage when he pees. This is accompanied by a discharge from the urine passage. Both the burning and the discharge are more with gonorrhea than with chlamydia and occur sooner after the sexual encounter. Then comes the lower back pain, the difficulty urinating, the feeling that he has not emptied his bladder and the constant urge to urinate.

 

This is usually accompanied by fever, saddle area or perineal pain and sometimes blood in the urine. As you can see, the man tends to develop a urinary tract (urethral) infection first, before he develops a prostatitis. Symptoms of the acute prostatitis are the lower back and perineal pain, fever and difficulty peeing. The gonorrheal prostatitis tends to be more symptomatic than the chlamydial. Indeed 1/3 to 1/2 of men with chlamydial prostatitis may not even know that they have it, because the symptoms can be non-specific like chronic lower back and perineal pain with some urinary symptoms.

 

It is only on questioning and doing a urinalysis that the diagnosis is made. As you would expect, any attempt to indulge in sexual activity will be painful, with the men complaining of lower back, perineal and sometimes testicular pain on ejaculation and noting bloody semen when they “come”. This is usually the frightening symptom for most men, as before this symptom, the lower back and perineal pain is usually treated with “painkillers” and the burning in the urine treated with a few “500” tablets given to them by a pharmacist over the counter.

 

The treatment of acute prostatitis involves a proper diagnosis, involving a urine culture, a long course of an appropriate antibiotic, a low dose of medication to help these men pee and a strong anti-inflammatory. In the absence of proper or adequate treatment, a lot of these young men progress to chronic prostatitis and their sex lives become hell, as do their daily lives. Next week, I will discuss chronic prostatitis. As you will expect, most men experiencing acute prostatitis will lose their desire for sex, but the few who don’t are the ones who will complain of hematospermia (blood in the semen).