“I have been having what I think is prostatitis for a long time, although local doctors have not diagnosed it. I feel pain during sex and pain around the bottom/pelvic area. Sometimes I do not feel like having sex. I also have headaches, fever, difficulty concentrating and forgetfulness. I am looking for treatment. Do I need to travel to get treatment?”
Quick Answer
Your pelvic pain and pain with ejaculation could occur with prostatitis or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but symptoms alone cannot confirm the diagnosis.
It is particularly important not to assume that chronic prostatitis always means a persistent bacterial infection. Many men with symptoms lasting at least three months have CP/CPPS, where no ongoing bacterial infection can be demonstrated.
Because you also describe fever, you should be medically assessed rather than trying to manage this only as chronic pelvic pain. Fever can suggest infection or another condition that needs investigation.
You usually do not need to travel internationally as a first step. A local doctor or urologist can perform the initial examination, urine testing and other appropriate investigations.
Do Your Symptoms Mean You Have Chronic Prostatitis?
Not necessarily, although some of the symptoms you describe are compatible with prostatitis.
Pain during or after ejaculation is a recognized symptom of chronic prostatitis/chronic pelvic pain syndrome. Men can also experience pain or discomfort in the:
- area between the scrotum and anus
- lower abdomen
- penis
- scrotum
- pelvis
- lower back
Urinary frequency, urgency, discomfort during urination or a weak urinary stream can occur as well.
However, these symptoms are not specific enough to diagnose prostatitis by themselves.
Pelvic pain can arise from the prostate, urinary tract, pelvic-floor muscles, nerves, bladder, bowel or other structures.
What Does “Chronic Prostatitis” Actually Mean?
The term can be confusing because it includes more than one condition.
| Condition | What it means | Typical features |
|---|---|---|
| Acute bacterial prostatitis | A sudden bacterial infection of the prostate. | Fever, chills, urinary symptoms and pelvic or prostate pain can develop quickly. |
| Chronic bacterial prostatitis | A persistent or recurrent bacterial infection involving the prostate. | Symptoms may be milder, recur over time and may be associated with repeated urinary infections. |
| Chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) | Pelvic pain lasting or recurring for at least about three months without evidence of an ongoing bacterial infection. | Pelvic pain, painful ejaculation, urinary symptoms and sexual difficulties may occur. |
| Asymptomatic inflammatory prostatitis | Inflammation detected during testing without prostatitis symptoms. | Usually discovered incidentally. |
The distinction matters because the treatment for chronic bacterial prostatitis is different from treatment for CP/CPPS.
Is Chronic Prostatitis Always an Infection?
No.
This is the most important correction to the old answer.
Chronic bacterial prostatitis is an infection. But chronic prostatitis/chronic pelvic pain syndrome is usually not caused by a persistent bacterial infection that can simply be eliminated with antibiotics.
CP/CPPS is the most common chronic prostatitis presentation.
Its causes are not completely understood and may involve several interacting factors, including:
- pelvic-floor muscle dysfunction
- nerve sensitization
- inflammation
- previous infection
- urinary factors
- stress and the body’s response to chronic pain
That is why one treatment does not work for every man.
What About the Fever?
This deserves particular attention.
Persistent fever is not something I would simply attribute to uncomplicated CP/CPPS.
Fever and chills are more characteristic of bacterial infection, particularly acute bacterial prostatitis, urinary infection or another infectious illness.
You also mention headaches, difficulty concentrating and forgetfulness. These symptoms are nonspecific and could have many causes unrelated to the prostate.
Complete inability to urinate requires urgent medical care.
How Is Chronic Prostatitis Diagnosed?
There is no single blood or urine test that diagnoses every type of prostatitis.
A doctor will usually begin with your history and physical examination.
Important questions include:
- How long have the symptoms been present?
- Is the pain continuous or intermittent?
- Where exactly is the pain?
- Is ejaculation painful?
- Do you have urinary frequency or urgency?
- Is your urinary stream weak?
- Have you had fever or chills?
- Have you previously had urinary infections?
- Have you had an STI?
- Do you have testicular, bowel or back symptoms?
What Tests Might Be Needed?
Testing depends on the symptoms rather than using the same panel for every patient.
A clinician may consider:
- urinalysis
- urine culture
- STI testing when appropriate
- blood tests when fever or systemic illness is present
- physical examination, including assessment of the prostate when appropriate
- assessment of bladder emptying or urine flow if urinary symptoms are significant
- pelvic-floor examination in men with suspected CP/CPPS
- additional imaging or specialist tests when another diagnosis is suspected
A complete blood count may be useful when infection or systemic illness is suspected, but a CBC does not by itself diagnose chronic prostatitis.
Many men with CP/CPPS have no bacteria in routine urine cultures because an ongoing bacterial infection is not the cause.
What If Bacteria Are Found?
If testing and the overall clinical picture support bacterial prostatitis, antibiotics are appropriate.
The antibiotic should be selected according to the suspected or identified organism, antibiotic susceptibility, the man’s medical history and other clinical factors.
Chronic bacterial prostatitis generally requires a longer antibiotic course than an uncomplicated bladder infection because adequate drug penetration into prostate tissue is important.
But treatment should not be described as simply taking an antibiotic “with vitamins until all bacteria are killed.”
Vitamins are not a standard treatment for bacterial prostatitis unless a specific nutritional deficiency exists.
Does Chronic Bacterial Prostatitis Always Come Back?
No.
The old answer stated that if you have chronic prostatitis, antibiotics will help temporarily but the problem will inevitably return.
That is too pessimistic.
Chronic bacterial prostatitis can recur in some men, particularly when the infection is difficult to eradicate or when underlying urinary factors contribute to recurrence.
But recurrence is not inevitable.
Likewise, symptoms lasting less than three months do not guarantee that treatment will permanently cure the problem.
The outcome depends on the actual diagnosis.
How Is CP/CPPS Treated When No Infection Is Found?
For chronic prostatitis/chronic pelvic pain syndrome, treatment is usually based on the specific symptoms affecting the individual man.
It may include several approaches.
Alpha-blockers
Men who also have voiding symptoms may benefit from an alpha-blocker such as tamsulosin or another medicine in this group.
These medicines relax smooth muscle around the prostate and bladder outlet. They do not treat infection.
Anti-inflammatory or pain treatment
Anti-inflammatory medicines may help selected men, particularly during painful flares, although prolonged use is not appropriate for everyone.
Pelvic-floor physical therapy
A tight or painful pelvic floor is an important contributor in some men with CP/CPPS.
Specialized pelvic-floor physical therapy may therefore be helpful.
This does not necessarily mean performing more Kegel exercises. If the pelvic muscles are already excessively tense, repeated tightening exercises can sometimes worsen pain.
Stress and chronic-pain management
Persistent pelvic pain can affect sleep, concentration, mood, relationships and sexual function.
Addressing these factors does not mean that the pain is psychological or imaginary.
Chronic pain can alter nervous-system processing, and some men benefit from combining physical and medical treatment with approaches aimed at stress, sleep and pain coping.
Lifestyle measures
Regular activity, avoiding prolonged sitting when it aggravates symptoms, and identifying personal urinary or dietary triggers may help.
Some men find alcohol, excessive caffeine or very spicy foods worsen symptoms, although there is no universal prostatitis diet that cures the condition.
Should Antibiotics Be Tried for CP/CPPS?
Sometimes, particularly early in evaluation when bacterial infection has not yet been confidently excluded.
However, repeated courses of antibiotics should not become the default treatment when cultures remain negative and an appropriate initial antibiotic trial has failed.
Current European guidance recognizes that some patients improve with an initial antimicrobial course, but also emphasizes avoiding unnecessary antibiotic use and moving to other therapies when antibiotics are unsuccessful.
What About Pain During Sex and Low Sexual Desire?
Pain during or after ejaculation is common in CP/CPPS.
Chronic pain can also reduce sexual desire.
When intercourse repeatedly causes pain, men may begin to anticipate discomfort and avoid sexual activity altogether.
This does not automatically mean the prostate is infected.
Treatment should address the underlying pelvic pain, urinary symptoms, pelvic-floor function and any associated erectile or sexual difficulties.
Should You Stop Having Sex During Treatment?
Not automatically.
The old advice to avoid intercourse whenever receiving prostatitis treatment is too broad.
For ordinary CP/CPPS, sexual activity is not routinely forbidden. Some men may choose to reduce sexual activity temporarily if ejaculation causes substantial pain.
The situation is different if an active sexually transmitted infection has been diagnosed. In that case, follow the specific abstinence and partner-treatment instructions given for that infection.
Does Your Partner Need Testing?
Not simply because you have prostatitis.
If testing identifies a sexually transmitted infection such as chlamydia or gonorrhea, then sexual partners need appropriate evaluation and treatment.
But CP/CPPS itself is not regarded as an STI that automatically requires partner testing.
Do You Need to Travel Abroad for Treatment?
Usually not as the first step.
A local family doctor or urologist should normally be able to perform the initial assessment and basic investigations.
A urologist may be particularly useful when:
- pain has continued for months
- urinary symptoms are significant
- infections keep recurring
- blood appears in the urine
- initial treatment has failed
- the diagnosis remains uncertain
- pelvic-floor or chronic-pain treatment is being considered
If specialist pelvic-floor therapy or a dedicated chronic pelvic pain service is unavailable locally, then travelling to a center with that expertise may become reasonable later.
But I would first establish the diagnosis rather than travelling specifically to obtain another course of antibiotics.
Could These Symptoms Be Something Other Than Prostatitis?
Yes.
Pelvic pain and urinary symptoms can overlap with several other conditions, including:
- urinary tract infection
- urethritis or sexually transmitted infection
- bladder disorders
- pelvic-floor dysfunction
- testicular or epididymal disease
- urinary stones
- benign prostatic hyperplasia
- neurological or musculoskeletal pain
- less commonly, other urological disease
This is why I would not tell you from an online description that you “most probably have prostatitis.”
If urinary symptoms are prominent, you may also find it helpful to compare them with enlarged prostate symptoms.
When Should You Seek Urgent Medical Care?
- high fever or shaking chills
- complete inability to urinate
- rapidly worsening pelvic or lower abdominal pain
- vomiting or severe weakness
- blood in the urine with significant symptoms
- painful urinary symptoms together with fever
- marked testicular swelling or severe testicular pain
Ali, the pain you describe during sex and around the pelvic area deserves proper evaluation, but I would not diagnose chronic prostatitis from those symptoms alone. The most important distinction is whether you have bacterial prostatitis, CP/CPPS or another cause of pelvic pain. Because you also report fever, I would arrange medical assessment rather than assuming this is simply a long-standing nonbacterial condition. In most cases, the initial investigation can be performed locally before considering travel abroad.
European Association of Urology. Guidelines on Chronic Pelvic Pain: Management.
American Urological Association. Male Chronic Pelvic Pain Guideline.
Medical information notice: This educational article cannot diagnose the cause of pelvic, urinary or abdominal symptoms. Persistent or worsening symptoms require individualized medical assessment. Fever, severe pain, inability to pass urine or other concerning new symptoms require prompt medical care.