Prostatitis: symptoms and the STI connection

Prostatitis is inflammation or a pain syndrome of the prostate, and the official classification lists four categories. In the large majority of men no bacterium is found at all (Krieger, 1999). That means an STI test often comes back negative with these symptoms, even though the symptoms are entirely real.

I think a testing company should just say that out loud.

Most pages on this subject write as though there is always a cause to find. For a share of men that holds. But in the largest group the culture stays empty, and another test gets you nowhere.

Where the STI link is genuinely real, you will read further down.

What is prostatitis?

The prostate is a small gland below the bladder that makes fluid for semen. In prostatitis that tissue becomes irritated or inflamed. You usually feel it as pain between the scrotum and the anus, pain on urination, or a nagging feeling in the pelvis. The Dutch term is prostaatontsteking.

Where the gland sits explains a lot of the symptoms.

The urethra runs straight through the prostate. When the surrounding tissue inflames, that passage gets narrower and more sensitive. Hence the combination of going more often, a weaker stream, and pain while urinating.

Ejaculation can be tender or painful too. The prostate is directly involved there, so that is not strange.

How do you recognise prostatitis?

Usually by pain in the pelvic area that lasts for weeks, alongside urinary symptoms. Think burning, going more often, and a nagging feeling behind the pubic bone or between the legs. Pain during or after ejaculation often belongs to the picture. Fever usually does not.

That last part is the distinction that really matters.

Fever, chills and difficulty passing urine point to the acute bacterial form. It is uncommon, but you are clearly unwell with it. That means calling a doctor the same day, not waiting on a result.

Symptoms without fever that come and go for months fit the chronic form more often. There the timeline is the most useful thing you have. How long has it been going on, and what happened just before it started?

If the symptoms sit mainly in the urethra itself, that is often a different picture. You can read about it in urethritis in men.

Which categories are there?

The NIH classification from 1999 lists four categories, and they are still in use (Krieger, 1999). Two of them are bacterial, one is a pain syndrome with no detectable bacterium, and one causes no symptoms at all. The third category is by far the most common, and that is exactly where a culture finds nothing.

This table sets the four side by side.

What I like about that classification is the honesty of category III. The label says in plain words that no cause was found. That is different from "we did not look properly", and it is certainly different from an STI.

A table does not make a diagnosis. What it does is stop you waiting on a result when what you actually need is a doctor.

Is prostatitis caused by an STI?

Sometimes, and then usually in younger, sexually active men. Chlamydia and gonorrhoea can travel upward from the urethra, the same route that gives women pelvic inflammatory disease and men epididymitis (Darville, 2021). For pelvic pain that has been there for years, with no risk contact, that explanation is a lot less likely.

That ascending route is well described.

Research into chlamydia and gonorrhoea shows how both bacteria evade the local immune response. That lets them establish themselves higher in the genital tract (Darville, 2021). In women that ends in the fallopian tubes, in men it can reach the epididymis or the prostate.

The European guideline on epididymo-orchitis reports 2.45 cases per 1,000 men in the UK (Street, 2017). The same guideline splits management around the age of thirty-five. Below that line STIs are more often the cause, above it an ordinary urinary infection is more common.

So it is the same infection in different anatomy. The female side of that story is in pelvic inflammatory disease, the male side in epididymitis.

The Dutch national institute RIVM reports the same pattern year after year. Chlamydia is the most frequently found STI here, and the numbers are highest under twenty-five. That is also the group in which an ascending infection is seen most often.

When is an STI test worth doing?

Mainly when there has been a risk contact, or when urethral symptoms come with it. Think discharge, burning urination or itching at the opening. A targeted chlamydia and gonorrhoea test is then a sensible first step, even if it does not immediately explain your prostate symptoms.

Picture this: you are 28 and have had a nagging pain between your scrotum and anus for three weeks. Six weeks ago you had a new partner. No fever, not otherwise unwell.

A targeted test is a reasonable step there.

Even though the chance it explains your pain completely is small, you do rule out something treatable. That is what a test can do. Expecting more from it isn't fair to the test.

Timing matters here. Every test needs a window before a cause becomes detectable, so testing too early can reassure you for the wrong reason.

You can get checked with us through a test for chlamydia, gonorrhoea and trichomonas, without an appointment and without anything reaching your GP records.

If that result comes back negative and the symptoms stay, your GP is the next step. Not another test.

When should you call a doctor straight away?

With fever, chills and trouble passing urine. That combination fits the acute bacterial form, category I, and it is no longer a testing question. Sudden severe pain in the scrotum also needs same-day assessment. If you are unsure how ill you are, the same applies.

This is the one part of this article that carries urgency.

The acute form is uncommon, but it can worsen quickly. Waiting on a result then costs days you do not have. Thuisarts.nl explains in plain language when urinary symptoms with fever cannot wait.

Prostate symptoms can have several causes, inflammation being only one of them. Your GP is the right place to sort those apart.

How is prostatitis treated?

That depends on the category. For the bacterial ones a doctor prescribes antibiotics, sometimes for several weeks. For chronic pelvic pain syndrome that often does not work, and treatment aims more at the pain, the pelvic floor and the urinary symptoms. Which route fits is a doctor's call.

The Dutch GP standard on the STI consultation describes how GPs here look at STI-related symptoms in men. For the prostate itself a GP looks wider than infection alone.

What you do not do is reach for an old course of antibiotics in the cupboard.

That can muddy a later culture and encourage resistance. If an STI is found, your partner should be treated as well, otherwise you are reinfected.

Keep a two-week note of your symptoms: when they show up, how bad they are, and whether urinating or ejaculation changes anything. That note tells your GP more than a single snapshot.

Further reading

For the wider symptom picture in men: STI symptoms in men. It covers which symptoms fit which cause.

If you are unsure which check fits your situation, STI testing for men takes it further.

References

• Krieger JN, et al. NIH consensus definition and classification of prostatitis. JAMA, 1999;282(3):236-7. PMID 10422990.
• Street EJ, et al. The 2016 European guideline on the management of epididymo-orchitis. International Journal of STD and AIDS, 2017;28(8):744-749. PMID 28632112.
• Darville T. Pelvic Inflammatory Disease Due to Neisseria gonorrhoeae and Chlamydia trachomatis: Immune Evasion Mechanisms and Pathogenic Disease Pathways. The Journal of Infectious Diseases, 2021. PMID 34396413.
• RIVM, Sexually transmitted infections in the Netherlands, annual report. Accessed July 2026.
• NHG-Standaard Het soa-consult, Dutch College of General Practitioners. Accessed July 2026.
• Thuisarts.nl, Pain when urinating. Accessed July 2026.

Every test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.