{"id":4378,"date":"2021-11-12T21:53:08","date_gmt":"2021-11-12T14:53:08","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=4378"},"modified":"2026-08-23T03:47:34","modified_gmt":"2026-08-22T20:47:34","slug":"%e1%80%94%e1%80%ac%e1%80%90%e1%80%ac%e1%80%9b%e1%80%be%e1%80%8a%e1%80%ba-prostatitis-%e1%80%80%e1%80%af%e1%80%9e%e1%80%99%e1%80%be%e1%80%af","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/my\/2021\/11\/12\/chronic-prostatitis-treatment\/","title":{"rendered":"Chronic Prostatitis: Why Antibiotics Usually Are Not the Answer"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Best Urologist working in Chonburi and Cambodia\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, 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2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Chronic prostatitis is one of the most frustrating conditions in urology, for the patient far more than for the doctor. Men arrive having had pelvic pain for months or years, having been given three, four, sometimes six courses of antibiotics, none of which helped for long. They usually believe they have a stubborn infection that nobody has managed to kill.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Almost always, they do not. And that is the single most useful thing to understand about this condition.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urology center Bangkok hospital Thailand\u00a0<a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Booking online<\/a>\u00a0<a href=\"tel:02-310-3009\">02-310-3009<\/a>\u00a0<a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a><\/li>\n\n\n\n<li>Samitivej Sriracha hospital Chonburi&nbsp;<a href=\"tel:088-022-1445\">088-022-1445<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">A Correction to What This Page Used to Say<\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4393\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2021\/11\/12\/chronic-prostatitis-treatment\/3d-render-of-bacteria-virus-cell\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;3D render of Bacteria, virus, cell;&quot;,&quot;created_timestamp&quot;:&quot;1398368552&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;3D render of Bacteria, virus, cell&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Most common etiology of Chronic prostatitis is bacterial-caused.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Most common etiology of Chronic prostatitis is bacterial-caused.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Illustration of bacteria \u2014 true bacterial infection accounts for only a small minority of chronic prostatitis cases\" class=\"wp-image-4393\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Bacteria.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">True bacterial infection accounts for only a small minority of chronic prostatitis \u2014 not the majority.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">An earlier version of this article carried a caption stating that the commonest cause of chronic prostatitis is bacterial. <strong>That is wrong, and it contradicted this article\u2019s own FAQ.<\/strong> It has been corrected.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The great majority of men with chronic prostatitis \u2014 the usual figure quoted is around nine in ten \u2014 have <strong>Category III chronic prostatitis, better called chronic pelvic pain syndrome (CPPS)<\/strong>, in which no infection can be found. Chronic <em>bacterial<\/em> prostatitis, Category II, is genuinely uncommon and is diagnosed by growing an organism, not by assuming one. That distinction determines everything that follows, and getting it the wrong way round is how men end up on antibiotic after antibiotic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The recommendations previously given here were also drawn from literature published in 2000. Understanding of this condition has moved a long way since.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Go to an Emergency Department for These<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Chronic prostatitis is not dangerous. Its acute cousin is, and the two get confused. Attend an emergency department, or call <strong>1669<\/strong> in Thailand, if you have:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fever and chills with pelvic or perineal pain<\/strong>, feeling generally unwell \u2014 this is acute bacterial prostatitis, which can progress to sepsis<\/li>\n\n\n\n<li><strong>Complete inability to pass urine<\/strong> with a painfully full bladder<\/li>\n\n\n\n<li><strong>Worsening pain with fever despite antibiotics<\/strong> \u2014 a prostate abscess can form and may need draining<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Separately, and not an emergency but not to be dismissed: <strong>blood in the urine, unexplained weight loss, or new bone pain<\/strong> should be assessed rather than attributed to prostatitis, particularly in a man over fifty. Prostatitis is a common label and occasionally the wrong one.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">When Antibiotics Genuinely Are the Treatment<\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4390\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2021\/11\/12\/chronic-prostatitis-treatment\/medicine-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Yeko Photo Studio&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Medicine, healthcare. Tablets on the table&quot;,&quot;created_timestamp&quot;:&quot;1455574060&quot;,&quot;copyright&quot;:&quot;Yeko Photo Studio&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Medicine&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Long term oral antibiotic is recommended when suspected bacterial-caused prostatitis\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Long term oral antibiotic is recommended when suspected bacterial-caused prostatitis.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Oral antibiotic capsules \u2014 prolonged antibiotic courses are appropriate only for culture-proven chronic bacterial prostatitis\" class=\"wp-image-4390\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Oral-antibiotic.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">A long antibiotic course is right for culture-proven infection \u2014 and wrong for everyone else.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">In <strong>chronic bacterial prostatitis<\/strong>, where an organism has actually been grown, a prolonged course of an antibiotic that penetrates prostate tissue is the treatment, typically measured in weeks rather than days. The choice of drug follows the culture and sensitivity result, and an alpha blocker is sometimes added.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This article does not print drug names with cure rates and durations, as the earlier version did. Two reasons. First, those figures came from small old studies and read as promises. Second, the class of antibiotic most used for this \u2014 the fluoroquinolones \u2014 now carries serious regulatory warnings in both the United States and Europe: <strong>tendon inflammation and rupture, aortic aneurysm and dissection, peripheral nerve damage, and effects on mood and sleep<\/strong>, some of them lasting. Those risks are acceptable for a proven prostate infection with no good alternative. They are <em>not<\/em> acceptable for a man who probably never had an infection, given a long course on suspicion. If you are taking one and develop <strong>tendon pain, especially in the heel, or sudden severe abdominal, chest or back pain<\/strong>, stop and seek advice.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Actually Helps in CPPS<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The modern approach abandoned the search for a single cure. CPPS is not one disease; it is a pattern of symptoms with different drivers in different men, so treatment is aimed at the drivers <em>that man<\/em> actually has. Assessment looks across several domains \u2014 urinary symptoms, psychological state, whether the pain is confined to the organ or widespread, infection, neurological features, and the pelvic floor muscles \u2014 and treatment is built from what is found. Two or three treatments together usually beat one, and this is the reason single-drug trials in this condition so often disappoint.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pelvic floor physiotherapy.<\/strong> For men whose pelvic floor muscles are tight and tender \u2014 a large group \u2014 this is among the most effective options there is, and it involves no drug at all. It is specialised work, not ordinary exercise, and Kegel-type squeezing can make a tight pelvic floor worse rather than better.<\/li>\n\n\n\n<li><strong>Alpha blockers.<\/strong> Useful where urinary symptoms dominate. Worth being honest, though: the evidence in men who have not been treated before is weaker than this page once implied, and the older claim that they reliably improve outcomes and cut recurrence overstated it.<\/li>\n\n\n\n<li><strong>Medication that acts on nerve pain<\/strong> rather than on the prostate, for men whose pain has become centrally driven \u2014 which is common once pain has lasted a long time.<\/li>\n\n\n\n<li><strong>Psychological support, including cognitive behavioural approaches.<\/strong> This is not a suggestion that the pain is imaginary, and it should never be offered as though it were. Chronic pain of any kind alters how the nervous system processes signals, and catastrophising is one of the strongest predictors of how badly a man does. Addressing it works.<\/li>\n\n\n\n<li><strong>Anti-inflammatories and heat<\/strong> for symptom relief, with the usual limits on long-term anti-inflammatory use.<\/li>\n\n\n\n<li><strong>Practical measures<\/strong> \u2014 reducing alcohol, caffeine and chilli if they clearly aggravate things, avoiding long periods of sitting, and regular gentle exercise. Modest individually; worth having.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4391\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2021\/11\/12\/chronic-prostatitis-treatment\/portrait-of-guy-wearing-denim-shirt-standing-with-crossed-hands-while-laughing-isolated-over-white-background-attractive-hairdresser-greets-new-visitor-offering-him-cup-of-coffee\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;5.6&quot;,&quot;credit&quot;:&quot;Seva Levitsky&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;Portrait of guy wearing denim shirt, standing with crossed hands while laughing, isolated over white background. Attractive hairdresser greets new visitor offering him cup of coffee.&quot;,&quot;created_timestamp&quot;:&quot;1514629504&quot;,&quot;copyright&quot;:&quot;Cookie Studio 2017&quot;,&quot;focal_length&quot;:&quot;70&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.00625&quot;,&quot;title&quot;:&quot;Portrait of guy wearing denim shirt, standing with crossed hands while laughing, isolated over white background. Attractive hairdresser greets new visitor offering him cup of coffee&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"&amp;#8220;Improving on quality of life&amp;#8221; is the main treatment objective.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;&amp;#8220;Improving on quality of life&amp;#8221; is the main treatment objective.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A relaxed man outdoors \u2014 the aim of chronic pelvic pain syndrome treatment is restoring function and quality of life\" class=\"wp-image-4391\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Happy-man.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">The goal is a life that works again \u2014 measured in what you can do, not in a test result.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Progress is tracked with a symptom questionnaire rather than a blood test, because there is no biochemical cure to measure \u2014 the target is function and quality of life. The scoring system used is explained in <a href=\"https:\/\/drsoaraweeurology.com\/2022\/03\/25\/chronic-prostatitis-symptom-index\/\">the NIH chronic prostatitis symptom index<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two honest closing points. Improvement in CPPS is usually gradual and partial rather than sudden and complete, and a man told otherwise is being sold something. But most men do improve substantially with the right combination \u2014 and the men who do worst are, in my experience, the ones who spent years on repeated antibiotics for an infection they never had.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Is chronic prostatitis usually an infection?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">No. Around nine in ten men with chronic prostatitis have Category III chronic pelvic pain syndrome, in which no infection is found. Chronic bacterial prostatitis, Category II, is uncommon and is diagnosed by growing an organism rather than by assuming one. Getting this the wrong way round is why so many men receive course after course of antibiotics without lasting benefit.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Why did my antibiotics not work?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Most likely because there was no infection to treat. Men often feel slightly better early in a course and then relapse, which is easily mistaken for a resistant organism and leads to another course. Repeated antibiotics are not harmless: they disturb the gut, drive resistance, and in the case of fluoroquinolones carry warnings about tendon rupture, aortic problems and nerve damage. If cultures are negative, the answer is a different approach rather than a different antibiotic.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What treatment works for chronic pelvic pain syndrome?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment aimed at the specific drivers in that man, usually combining two or three approaches: pelvic floor physiotherapy where the pelvic floor is tight and tender, alpha blockers where urinary symptoms dominate, medication acting on nerve pain where the pain has become centrally driven, psychological support including cognitive behavioural approaches, and practical measures such as reducing aggravating foods and avoiding prolonged sitting. Single-drug treatment usually disappoints, which is why the condition acquired its reputation.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Does pelvic floor physiotherapy really help?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">For men whose pelvic floor muscles are tight and tender, it is among the most effective options available, and it involves no medication. It is specialised treatment rather than general exercise, and it matters that it is done properly: Kegel-style squeezing exercises can worsen a pelvic floor that is already too tight.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When is prostatitis an emergency?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Fever and chills with pelvic or perineal pain and feeling unwell suggests acute bacterial prostatitis, which can progress to sepsis and needs same-day assessment. So does complete inability to pass urine, and worsening pain with fever despite antibiotics, which can indicate a prostate abscess. Attend an emergency department or call 1669 in Thailand. Separately, blood in the urine, unexplained weight loss or new bone pain should be assessed rather than attributed to prostatitis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Will chronic prostatitis ever go away?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Most men improve substantially with the right combination of treatments, but improvement is usually gradual and partial rather than sudden and complete, and symptoms can fluctuate. Anyone promising a rapid cure is overselling. The realistic and achievable goal is getting your life back to normal, which is why progress is measured with a symptom questionnaire rather than a laboratory test.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Book an Appointment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Soarawee Weerasopone assesses and treats chronic prostatitis and chronic pelvic pain at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital, Chonburi \u2014 Urology department <a href=\"tel:0880221445\">088-022-1445<\/a>. If you have already had several antibiotic courses without lasting benefit, bring the details \u2014 including any culture results \u2014 because that history is itself diagnostic information. Questions about cost are answered by the hospital rather than by Dr. Soarawee \u2014 for Bangkok Hospital, by email to <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. It suits reviewing a long symptom history and previous results; examination and testing require an in-person visit. Samitivej Sriracha is in-person only.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This article is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is educational only, is not medical advice, and does not create a doctor\u2013patient relationship. It gives no antibiotic doses or durations: those follow culture results and are prescribed individually. Do not start or stop a prescribed treatment on your own. No diagnosis, prescription or individual medical advice is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account \u2014 any account offering private consultation in his name is fraudulent. Fever with pelvic pain, or inability to pass urine, means an emergency department or 1669 in Thailand.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/12\/chronic-prostatitis-treatment\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/12\/chronic-prostatitis-treatment\/\",\n      \"name\": \"Chronic Prostatitis: Why Antibiotics Usually Are Not the Answer\",\n      \"description\": \"Why the great majority of chronic prostatitis is chronic pelvic pain syndrome rather than infection, why repeated antibiotic courses fail and carry risk, and what phenotype-directed multimodal treatment involves.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-11-12\",\n      \"dateModified\": \"2026-08-23\",\n      \"lastReviewed\": \"2026-08-23\",\n      \"specialty\": \"https:\/\/schema.org\/Urologic\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"medicalAudience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/12\/chronic-prostatitis-treatment\/#cpps\" },\n      \"disambiguatingDescription\": \"Corrected August 2026. An earlier version stated that the commonest cause of chronic prostatitis is bacterial, which contradicted its own FAQ and is incorrect: approximately ninety per cent of cases are Category III chronic pelvic pain syndrome with no identifiable infection. The earlier version also published antibiotic regimens with cure rates and durations drawn from literature published in 2000; these have been removed, and fluoroquinolone safety warnings added. No drug doses or durations are given.\"\n    },\n    {\n      \"@type\": \"MedicalCondition\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/12\/chronic-prostatitis-treatment\/#cpps\",\n      \"name\": \"Chronic prostatitis and chronic pelvic pain syndrome\",\n      \"alternateName\": \"CP\/CPPS, NIH Category III prostatitis\",\n      \"description\": \"Persistent pelvic, perineal or genital pain with variable urinary and sexual symptoms. 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Haematuria, unexplained weight loss or new bone pain warrant assessment rather than attribution to prostatitis.\"\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/12\/chronic-prostatitis-treatment\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/12\/chronic-prostatitis-treatment\/#webpage\" },\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Is chronic prostatitis usually an infection?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"No. Around nine in ten men with chronic prostatitis have Category III chronic pelvic pain syndrome, in which no infection is found. Chronic bacterial prostatitis, Category II, is uncommon and is diagnosed by growing an organism rather than by assuming one. Getting this the wrong way round is why many men receive repeated antibiotic courses without lasting benefit.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Why did antibiotics not work for my chronic prostatitis?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Most likely because there was no infection to treat. Men often feel slightly better early in a course and then relapse, which is mistaken for resistance and leads to another course. Repeated antibiotics disturb the gut, drive resistance, and in the case of fluoroquinolones carry warnings about tendon rupture, aortic problems and nerve damage. With negative cultures the answer is a different approach rather than a different antibiotic.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What treatment works for chronic pelvic pain syndrome?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Treatment directed at the specific drivers present in that man, usually combining two or three approaches: pelvic floor physiotherapy where the pelvic floor is tight and tender, alpha blockers where urinary symptoms dominate, neuropathic pain medication where pain has become centrally driven, psychological support including cognitive behavioural approaches, and practical measures. Single-drug treatment usually disappoints.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Does pelvic floor physiotherapy help chronic prostatitis?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"For men whose pelvic floor muscles are tight and tender it is among the most effective options available and involves no medication. It is specialised treatment rather than general exercise, and Kegel-style squeezing exercises can worsen a pelvic floor that is already too tight.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"When is prostatitis a medical emergency?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Fever and chills with pelvic or perineal pain and feeling unwell suggests acute bacterial prostatitis, which can progress to sepsis and needs same-day assessment. So do complete inability to pass urine and worsening pain with fever despite antibiotics, which can indicate a prostate abscess. Blood in the urine, unexplained weight loss or new bone pain should be assessed rather than attributed to prostatitis.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Does chronic prostatitis ever go away?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Most men improve substantially with the right combination of treatments, but improvement is usually gradual and partial rather than sudden and complete, and symptoms fluctuate. Anyone promising a rapid cure is overselling. The realistic goal is restoration of normal function, which is why progress is measured with a symptom questionnaire rather than a laboratory test.\"\n          }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>Most men told they have chronic prostatitis do not have an infection at all \u2014 and repeat courses of antibiotics are the commonest thing done wrong in this condition. Dr. Soarawee Weerasopone explains what chronic pelvic pain syndrome actually is and what genuinely helps.<\/p>","protected":false},"author":185281453,"featured_media":10030,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Chronic prostatitis explained by a urologist \u2014 why the great majority of cases are chronic pelvic pain syndrome rather than infection, why repeat antibiotics fail, and what phenotype-directed treatment involves.","jetpack_seo_html_title":"Chronic Prostatitis: Why Antibiotics Are Usually Not the Answer | Dr. Pom","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1362],"tags":[1465],"class_list":["post-4378","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-infection","tag-chronic-prostatitis"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-18C","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Chronic-Prostatitis.webp?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts\/4378","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/comments?post=4378"}],"version-history":[{"count":19,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts\/4378\/revisions"}],"predecessor-version":[{"id":11615,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts\/4378\/revisions\/11615"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/media\/10030"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/media?parent=4378"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/categories?post=4378"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/tags?post=4378"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}