Bacterial prostatitis: Bacterial virulence, clinical outcomes, and new directions

According to the internationally accepted National Institutes of Health (NIH) classification, there are four prostatitis syndromes (1). Category I is acute bacterial prostatitis that presents as an acute urinary tract infection, most commonly caused by E. coli. Category II is chronic bacterial prostatitis that presents as recurrent bacterial infections caused by the same bacterial species, most commonly E. coli. Category III is chronic prostatitis/chronic pelvic pain syndrome, the most common clinical syndrome, characterized by pelvic pain complaints in the absence of urinary tract infection recognized by standard testing. Category IV is asymptomatic prostatitis in which patients are diagnosed with prostatic inflammation in the absence of symptoms, for example, prostatic inflammation (pathologist’s definition of “prostatitis”) in an asymptomatic patient undergoing biopsy to evaluate possible prostate cancer.