Common in men under 50, often mismanaged, and frequently not an infection at all.
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Prostatitis means inflammation of the prostate — but the word covers two very different situations, and confusing them is why so many men spend years on antibiotics that were never going to work.
Acute bacterial prostatitis is uncommon and genuinely serious: fever, shivering, severe pain and feeling very unwell. It needs urgent assessment, because it can lead to sepsis, an abscess, or an inability to pass urine.
Chronic prostatitis / chronic pelvic pain syndrome accounts for well over nine in ten cases — and it is not an infection. No bacteria are found, and antibiotics do not help. It is a persistent pain condition involving the pelvic floor muscles, the nerves and the way pain is processed, and it responds to a completely different set of treatments.
That distinction is the whole point of this page. Men with chronic pelvic pain are routinely given course after course of antibiotics, each of which fails, while the treatments that actually work — pelvic floor physiotherapy, alpha blockers, nerve-modifying medication and pain management — are never started.
One practical note: prostatitis raises PSA. A PSA test taken during or shortly after an episode will be misleadingly high and cause a great deal of avoidable alarm.
Pain lasting three months or more, without infection:
Bacteria reaching the prostate, usually the same organisms that cause urine infections. More likely after catheterisation, prostate biopsy, urinary instrumentation, or with an enlarged prostate causing incomplete emptying.
Uncommon. Recurring urinary infections with the same organism each time, from a reservoir within the prostate. This one genuinely does need a prolonged antibiotic course — but it must be confirmed rather than assumed.
Not an infection, and not caused by anything you did. Several mechanisms overlap:
Much of this is worked out from the history and the pattern, which a video consultation handles well. The most valuable thing we do is separate the small number who need urgent treatment from the majority who need a different approach entirely.
Do not have a PSA test during or soon after an episode of prostatitis. Inflammation raises it substantially, and a falsely high result leads to unnecessary alarm, referral and sometimes biopsy. Wait at least six weeks after symptoms have settled, and mention the prostatitis to whoever requests it.
Prompt antibiotics, and a prolonged course — usually several weeks, because the prostate is difficult for antibiotics to penetrate. Anyone systemically unwell, unable to pass urine, or not improving quickly needs hospital assessment, and we will direct you there rather than treating remotely.
The evidence favours tailoring treatment to which symptoms dominate, rather than one approach for everyone:
Where bacterial infection is genuinely plausible, a single four to six week course is reasonable. But if that course does not help, further courses will not either.
This is the most important thing on the page: men are routinely given five, six, ten courses of antibiotics over years for a condition that is not an infection — accumulating side effects and resistance while the treatments that work are never started. If antibiotics have not helped, the answer is a different treatment, not another prescription.
Urology for diagnostic uncertainty, retention, recurrent infection or resistant symptoms; specialist male pelvic health physiotherapy; and pain services where symptoms are entrenched.
Go to A&E or seek same-day care for:
Seek prompt assessment for:
Book an appointment for:
This is the opposite of the usual advice, and it matters. Chronic pelvic pain in men usually involves muscles held too tight:
Stress increases pelvic muscle tension through a real physiological pathway — which is a mechanism, not a suggestion that you are imagining the pain. Anything that reliably lowers your stress load is legitimate treatment here, and relaxation practice specifically targets the muscles involved.
Honest expectations help more than optimism. Chronic pelvic pain syndrome fluctuates — flares and quieter spells — and most men improve substantially over months with the right combination of treatments, rather than resolving overnight with one prescription. Progress is usually gradual and worth tracking, because it is easy to miss when it is slow.
And worth stating plainly: this is not prostate cancer, it does not lead to it, and it is not something you can pass to a partner. A great deal of the distress here comes from not knowing that.
Prostatitis is genuinely difficult, and the most useful thing is honesty about that.
Acute bacterial prostatitis is uncommon, unmistakable and needs prompt antibiotics — fever, rigors, severe pain, feeling very unwell. That is an urgent NHS matter and needs a four-week antibiotic course, sometimes hospital treatment.
The overwhelming majority of prostatitis is chronic pelvic pain syndrome, and it is not an infection at all — which means repeated antibiotic courses do not help. Men frequently receive four, five, six courses of ciprofloxacin over years with no benefit and real harm, and recognising that pattern is the single most valuable thing a consultation offers.
NHS care is free, and NHS urology and specialist pelvic pain services are the right route.
What actually helps in chronic pelvic pain syndrome is multimodal and largely free: pelvic floor physiotherapy, which is available on the NHS and consistently under-offered; alpha blockers such as tamsulosin; heat; and — where pain has become persistent — the approaches used for chronic pain generally, including psychological support. That last point is not dismissive: persistent pain changes how the nervous system processes signals, and treating that is legitimate medicine.
Where money is wasted: repeated private antibiotic courses, prostate massage marketed commercially, and supplements sold for prostate health.
Fever with severe pain, or inability to pass urine, needs same-day assessment.
NICE Clinical Knowledge Summary, Prostatitis — acute and Prostatitis — chronic, are the principal references. They distinguish acute bacterial prostatitis, requiring prompt antibiotics for two to four weeks, from chronic prostatitis/chronic pelvic pain syndrome, which is usually non-bacterial.
CKS advises against repeated empirical antibiotic courses in chronic pelvic pain syndrome where cultures are negative — the basis for the position above.
CKS recommends a multimodal approach — alpha blockers, analgesia, and referral to urology or a specialist pain service for persistent symptoms.
European Association of Urology guidelines on chronic pelvic pain recommend phenotype-directed treatment using the UPOINT framework, and identify pelvic floor physiotherapy as an effective component.
NICE NG193, Chronic pain, applies where pain has become persistent, supporting exercise and psychological approaches over escalating medication.
Because in over nine in ten cases this is not an infection. Chronic prostatitis / chronic pelvic pain syndrome is a persistent pain condition involving the pelvic floor muscles and the nervous system, and no antibiotic will touch it. One fair four to six week trial is reasonable if bacteria are genuinely plausible — but if that does not help, further courses will not either, and men lose years to repeating them.
Specialist pelvic floor physiotherapy has the best evidence and is the most under-used treatment. Alongside it: an alpha blocker where urinary symptoms dominate, low-dose amitriptyline or pregabalin where the pain feels burning or neuropathic, treating constipation, heat, and pain management approaches. Most men improve substantially over months with a combination rather than a single prescription.
Almost certainly not the strengthening kind. In male chronic pelvic pain the pelvic floor is usually held too tight, and Kegels make it worse. What helps is the opposite: diaphragmatic breathing, letting the pelvic floor soften and drop, stretches, and noticing habitual clenching. Only do strengthening work if a specialist physiotherapist has assessed you and told you to.
No. Prostatitis is not cancer, does not turn into cancer, and does not increase your risk of it. It is a common source of fear, and knowing this is genuinely part of the treatment — anxiety increases pelvic muscle tension, which increases pain.
Not now. Prostatitis raises PSA substantially, and a test taken during or soon after an episode will be misleadingly high — leading to unnecessary alarm, referral and sometimes biopsy. Wait at least six weeks after symptoms have settled, and tell whoever requests it that you have had prostatitis.
No. Chronic pelvic pain syndrome is not an infection and is not transmissible. There is no need to avoid sex — and regular ejaculation is often helpful rather than harmful, though pain on ejaculation is common and worth mentioning to us.
Not during a flare. Perineal pressure from a narrow saddle is a well-recognised aggravator. When you go back, use a wide or split-nose saddle, check the saddle height and tilt, and build up gradually. A cut-out cushion for sitting at work is worth having too.
Stress genuinely worsens it — through a real physical pathway, by increasing pelvic muscle tension. That is a mechanism, not a way of saying the pain is in your head. The pain is entirely real and physical. It simply means that relaxation work, better sleep and reducing stress are legitimate treatments here rather than an afterthought.
August 23, 2026
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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