A common complication of UTI in men is prostatitis. Bacterial prostatitis is usually caused by the same gram-negative bacilli that cause UTI in female patients; 80% or more of such infections are caused by Escherichia coli. The pathogenesis of this condition is poorly understood. Antibacterial substances in prostatic secretions probably protect against such infections. A National Institutes of Health (NIH) expert consensus panel has recommended classifying prostatitis into three syndromes: acute bacterial prostatitis, chronic bacterial pros-tatitis, and chronic pelvic pain syndrome (CPPS). Acute bacterial prostatitis is a febrile illness characterized by chills, dysuria, urinary frequency and urgency and pain in the perineum, back, or pelvis. The bladder outlet can be obstructed. On physical examination, the prostate is found to be enlarged, tender, and indurated. Pyuria is present, and urine cultures generally grow E. coli or another typical uropathogen.

Chronic bacterial prostatitis is a clinically more occult disease and may be manifested only as recurrent bacteriuria or variable low-grade fever with back or pelvic discomfort. Urinary symptoms usually relate to the reintroduction of infection into the bladder, with both pyuria and bacteriuria. A chronic prostatic focus is the most common cause of recurrent UTI in men. CPPS is the diagnosis for the large group of men who present with minimal signs on physical examination but have a variety of irritative or obstructive voiding symptoms; perineal, pelvic, or back pain; and sexual dysfunction. These men can be divided into those with and those without inflammation (defined as >10 WBCs/hpf in expressed prostatic secretions). The etiology and appropriate management in these patients, regardless of inflammatory status, is unknown.


Pregnant women should be screened for asymptomatic bacteriuria in the first trimester of pregnancy (Wadland and Plante, 1989) (SOR: A).

Pregnant women who have asymptomatic bacteriuria should be treated with antimicrobial therapy for 3 to 7 days (Nicolle et al., 2005) (SOR: B).

Pyuria accompanying asymptomatic bacteriuria should not be treated with antimicrobial therapy (Nicolle, 2003) (SOR: C1). A 3-day course of TMP-SMX (Bactrim, Septra) is recommended as empiric therapy of uncomplicated UTIs in women, in regions where the rate of resistant E. coli is less than 20% (Warren et al., 1999) (SOR: C).

Fluoroquinolones are not recommended as first-line treatment of uncomplicated UTIs, to preserve their effectiveness for complicated UTIs (Warren et al., 1999) (SOR: C). A randomized, placebo-controlled trial of 150 women over 12 months found that cranberry juice and cranberry extract tablets significantly decreased the number of patients having at least one symptomatic UTI per year (Stothers, 2002) (SOR: B).


William E, Roland Key Points

• Laboratory findings in acute tick-borne infection often include a normal or low WBC count, thrombocytopenia, hyponatremia, and elevated liver enzymes.

• Doxycycline is the drug of choice for patients with RMSF.

• Appropriate antibiotic treatment should be initiated immediately with strong suspicion of ehrlichiosis.

• If left untreated, Lyme disease can progress to cognitive disorders, sleep disturbance, fatigue, and personality changes.

In the United States, more vector-borne diseases are transmitted by ticks than by any other agent. Tick-borne diseases can result from infection with pathogens that include bacteria, rickettsiae, viruses, and protozoa. Most tick-borne diseases are transmitted during the spring and summer months when ticks are active. A knowledge of which species of tick is endemic in an area can help narrow the diagnosis (Table 16-16).

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