No secure identification of Contursi Terme, where ancient remains confirm a settlement at the confluence of the Tanagro (ancient Tanager) with the Sele, is likely. The Roman Ursentum noted in Pliny's Natural History (III.2), is more usually identified with Caggiano. The local historian A. Filomarino, based on etymologies of toponyms, placed the commune's origins as early as the fourth century AD, the result of efforts by the inhabitants of the former Saginara and Contursi to fortify a site that was destroyed by Alaric's Goths at the end of the fourth century. Under the Lombards it appears to have belonged to the gastaldate of Conza, when a fortress was built in 840 by Orso, count of Conza, from whom the stronghold probably took its name Castrum comitis Ursi, the "castle of count Orso") Orso took the part of his kinsman Siconulf of Salerno (839-51) in internecine wars with Radelchis I of Benevento, who had been a former gastaldo of Conza.

The later history of Contursi Termi formed a local part of the Principality of Salerno, which was retained as a title until the territory was divided in three by Charles II of Naples in 1287, Contursi passing to the prince of Citerione (or Citra) and held by the family Sanseverino. In 1348, Contursi was taken by Louis of Taranto, king of Naples by right of his wife Joanna; he passed the title to his adherents, the Origlia. In 1448 Antonio Sanseverino succeeded in reclaiming title to Contursi, but the Sanseverino heirs held it only until the early sixteenth century, under the Viceroys of Naples. From the seventeenth century the commune passed successively through a number of families, the Bernalli, Pepe, Ludovisi and Parisani Bonanno. The last to hold the contado before the reunification of Italy were the Pisani di Tolentino, marchesi di Caggiano.

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