Prostatitis
Prostatitis covers three distinct problems -- acute bacterial, chronic bacterial, and chronic pelvic pain syndrome -- each requiring different management, per a 2025 JAMA clinical review.
Symptoms
Pelvic, perineal, or genital pain, urinary frequency and urgency, painful urination, and, in acute bacterial cases, fever and chills that can develop quickly.
Causes and risk
Acute and chronic bacterial prostatitis are caused by bacterial infection, often the same organisms that cause UTIs. Chronic pelvic pain syndrome, the most common form, has no identified infection and is thought to involve pelvic floor muscle dysfunction and nerve sensitization.
How it is evaluated
History, exam, and urinalysis/culture guide diagnosis; prostate massage is avoided in suspected acute infection because of bacteremia risk.
Treatment
Acute bacterial prostatitis is treated with antibiotics for 2-4 weeks; chronic bacterial prostatitis needs a longer course, with sources citing anywhere from 4 to 6 weeks depending on the antibiotic and response. Chronic pelvic pain syndrome responds better to a multimodal approach -- pelvic floor physical therapy, alpha-blockers, and pain management -- than to antibiotics alone.
When to seek care
Fever, chills, and pelvic pain together can signal a serious infection with a meaningful bacteremia risk -- roughly 1 in 5 cases with fever -- and inability to urinate is a related emergency; both need prompt, not routine, evaluation.