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Am Fam Physician. 2024;110(1):45-51

Author disclosure: No relevant financial relationships.

Prostatitis is a common clinical syndrome classified into four categories: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic. Bacterial prostatitis (acute and chronic) is primarily diagnosed with history and microbiologic studies, although physical examination can be helpful to localize infection within the genitourinary system. Bacterial prostatitis is treated with antibiotics; the span of treatment is guided by the duration of symptoms and presence of complications. Chronic prostatitis/chronic pelvic pain syndrome is the most common form of prostatitis and is a diagnosis of exclusion with no standardized treatments. Asymptomatic prostatitis does not require treatment and is usually diagnosed incidentally during the workup for other urologic presentations.

Prostatitis encapsulates a spectrum of clinical syndromes that affects approximately 10% to 15% of individuals assigned male at birth.13 It presents with varying degrees of lower urinary tract symptoms (e.g., obstructive, irritative, storage related), pelvic pain, sexual dysfunction, and systemic features. The National Institutes of Health organizes prostatitis into four categories. Categories I and II constitute 10% of cases and include acute and chronic bacterial prostatitis, respectively. Category III (chronic prostatitis/chronic pelvic pain syndrome [CPPS]) and category IV (asymptomatic inflammatory prostatitis) are noninfectious and comprise the remaining 90% of cases.4 Identifying prostatitis as bacterial (categories I and II) or nonbacterial (categories III and IV) is critical for timely treatment and appropriate antibiotic use (Table 1).5

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