Patients present with varying complaints of suprapubic or genital pain, back pain, perineal pain, voiding difficulties, frequency, dysuria, pain with ejaculation, and fever and chills. Patients at risk include those with anatomic or neurophysiologic lower urinary tract obstruction, acute epididymitis or urethritis, unprotected rectal intercourse, phimosis, and indwelling urethral catheter. The causative organism is Escherichia coli in most cases, with Pseudomonas, Klebsiella, Enterobacter, Serratia, or Staphylococcus causing the remainder. Physical examination usually reveals perineal, rectal, and prostate tenderness. The diagnosis is clinical as urinalysis and culture are often negative even after prostate massage. Treatment is ciprofloxacin 500 milligrams twice daily, or levofloxacin 500 milligrams PO daily, or ofloxacin 300 milligrams PO twice daily. All treatments should be for a total of 30 days. Pain medicine may be required. Admission is not necessary unless the patient is septic, immunocompromised, has significant comorbidities, or has worsened on outpatient therapy.