Prostatitis is inflammation of the prostate. Acute bacterial prostatitis is a sudden, feverish infection that needs urgent antibiotics. Chronic prostatitis, or chronic pelvic pain syndrome, causes pelvic, testicular or perineal pain and urinary symptoms for months, often with no infection found, and needs a structured plan rather than repeated courses of antibiotics.
Prostatitis is a frustrating diagnosis, because the word covers several different conditions and only one of them is a straightforward infection. Men are often given course after course of antibiotics for pain that antibiotics cannot fix. Mr Vinod Nargund sorts out which kind of prostatitis you have, treats the infection where there is one, and offers a proper plan for the chronic pain that is far more common.
What are the types of prostatitis?
- Acute bacterial prostatitis comes on quickly with fever, chills, pain in the pelvis or lower back and difficulty passing urine. It is a genuine infection and needs prompt antibiotics, sometimes in hospital.
- Chronic bacterial prostatitis is a low-grade infection that keeps returning, often showing as repeated urine infections in a man.
- Chronic prostatitis, or chronic pelvic pain syndrome, is by far the most common. It causes pain in the perineum, testicles, penis, lower back or bladder for three months or more, often with urinary symptoms and pain on ejaculation, and no bacteria are found. The prostate may not even be the source.
What are the symptoms?
Pain or discomfort in the area between the scrotum and the back passage, in the testicles, the tip of the penis or the lower abdomen; pain during or after ejaculation; a burning or frequent need to pass urine; and, in the acute form, fever and feeling generally unwell. Symptoms often come and go, which adds to the frustration.
How is prostatitis diagnosed?
Mr Nargund will take a careful history, examine the prostate, and test the urine, and in some cases prostatic fluid, for infection. A PSA test, an ultrasound and a check of how well the bladder empties are used where they add something. The point is to establish whether there is an infection to treat, and to rule out the other conditions that mimic prostatitis, including bladder problems, stones and nerve-related pain.
How is it treated?
- Antibiotics for confirmed bacterial prostatitis, usually a longer course than for a simple urine infection.
- A structured plan for chronic pelvic pain, which may combine medication to relax the bladder and prostate, anti-inflammatory and nerve-targeted treatment, pelvic floor physiotherapy and advice on the triggers that make it flare.
- Honesty about what will not help. Repeated antibiotics for pain without infection do harm without benefit, and Mr Nargund will say so.
When should you see a specialist?
If you have pelvic or testicular pain that has lasted more than a few weeks, if you have been treated for prostatitis more than once without lasting improvement, or if you have fever with urinary symptoms now, which needs urgent care.
Sources
NICE clinical knowledge summaries on prostatitis, European Association of Urology guidelines on chronic pelvic pain, and NHS patient information.
Reviewed by Mr Vinod Nargund, MBBS, PhD, FRCS(Urol), FEBU. Last updated 12 September 2026.