Prostatitis--diagnostic criteria, classification of patients and recommendations for therapeutic trials.

Infections of the prostate may occur despite the numerous host defences of the male urogenital tract. It is important to distinguish patients with genuine inflammation of the gland from the larger number of men with symptoms but no signs of an inflammatory response (prostatodynia). To define prostatitis, the degree of the inflammatory reaction must first be determined. Increased numbers of leucocytes in expressed prostatic secrections (EPS) are essential for this diagnosis. Careful lower urinary tract studies may then be used to classify the patients into two major groups of bacterial and nonbacterial prostatitis. Chronic bacterial prostatitis is primarily due to Escherichia coli. Gram-positive prostatitis is debatable. In chronic bacterial prostatitis, secretory dysfunction is common. The increased alkalinity of the pH of expressed prostatic secretions is one of the reasons for poor results of antibiotic therapy. Uncommon microorganisms, such as Chlamydia trachomatis and Ureaplasma urealyticum may be involved in some cases of the "nonbacterial" form. Routine culture for these microorganisms is not recommended.