Background

Chronic pelvic pain syndrome (CPPS) in men is an important and common condition in genitourinary medicine (GUM) and other sexual health services. It has a lifetime prevalence of 2%–14%.1–4 The terms CPPS and chronic prostatitis are often used interchangeably to describe a syndrome which causes perineal and genital pain that can be unrelenting and physically, as well as emotionally, exhausting.1–5 The median age of patients affected is 43 years and the syndrome is usually of sudden onset,2 ,4 though classically CPPS is only diagnosed when symptoms have been present for at least 3 months.1 ,5 Due to the nature of CPPS pain, including dysuria, penile tip, perineal, testicular and ejaculatory pain, as well as other commonly associated symptoms such as urinary frequency, patients often present to GUM departments, usually at onset of the acute phase; however no data are available as to the frequency of presentation.1 ,5

Managing men with CPPS is challenging as the aetiology is poorly understood, diagnosis is one of exclusion and management strategies are suboptimal.1 ,4 ,5 A number of hypotheses have been proposed as to the causes of CPPS, both infective and non-infective. It is well recognised that men with acute non-gonococcal urethritis (NGU) may go on to develop chronic urethritis.6 Although published data are limited, men with CPPS may have urethritis, and indeed symptom profiles overlap.1 ,6 ,7 ^{W1 W2} Both Mycoplasma genitalium and Ureaplasma urealyticum are associated with chronic NGU although in the majority no infection is detected.6 ^W3 Chronic bacterial prostatitis is identified in up to 10% and is associated with recurrent urinary tract infections.4 ,5 Evidence supports a non-infective aetiology in the majority of cases. An infectious or inflammatory initiator may result in neurological dysfunction …