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How Relevant Is Semen Culture In The Treatment Of Prostatitis?

Posted on Thu, 23 Jun 2016

Question: I was diagonised with prostatitis in 2011 the doctor did prostrate massage & the resulting EPS fluid from penis though not tested confirmed prostatitis .The doctor did not recommend semen culture as he said its not conclusive . I was put on BactrimDS initially then Zenocin for 6 weeks . The symptoms subsided . However since then symptoms used to come & go I consulted different doctors & took various antibiotics from Cipro to livofloxacin to Doxy almost all . The symptoms as usual used to subside but I never felt completely cured . In between semen culture done was always positive with different organisms inspite of taking so many antibiotics but urine culture / urine culture after EPS were always normal / negative . Recently I was having problem of frequent urination especially in night at times very less urination , shooting pain in the penis , left leg & left toe , back ache , low sexual drive low libido , fatigue ,less erection to no erection . At times difficult to ejaculate even after erection , T level is 223.72 . Urine culture after EPS is normal but semen culture again is positive with enterococcus faeaclis (report attached ) . All TRU , Ultrasound KUB , Uroflowmetry etc are normal . PSA is normal Doc said clinically its seems non bacterial prostatitis (CPPS) but semen is +ve . Pls advise do I have CBP or CPPS & how relevant is semen culture in treatment of prostatitis, do I take antibiotics as per culture report attached . Regards/ XXXXXXX

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
You have Chronic Bacterial infection of Prostate (Chronic Prostatitis)

Detailed Answer:
Hello
Thanks for your query ,based on the facts and lab reports reports that you have posted it appears that you have Chronic Bacterial Prostatitis and were prescribed various antibiotics as per culture report but the symptoms do recur frequently .

In view of the symptoms and results of the tests that you have done I would state that you have Chronic Bacterial Prostatitis due to organisms Enterococcus Faecalis and it is very combursome disease both for patient and treating physician.

In given situation I would suggest you to continue antibiotics as per culture report .In addition to that doing a prostate massage daily at home for 2-3 months (with the help of a close relative or friend) does help to resolve the infection and get relief from symptoms .

I have been practicing this regime for last forty years of my practice for my patients of Chronic Refractory Prostatitis and getting good results .

Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you .
Thanks and Regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

a) Pls explain why every time a different organism was found in culture report when after 2011 I had no exposure or reasons to get infected am not married either & no sexual partner . The report should show the same organism due to which I got the infection . Also first time I consulted a doctor in XXXXXXX he did not recommend any semen culture , urine culture or EPS culture . He put me on to co-trimaxole ( BactrimDS) right away for 6 weeks then Ofloxacin ( Zenocin) for 6 weeks . There after I also had other antibiotics as mentioned earlier . I dont understand this line of treatment was it ok ?

b) As per the current semen report I have been advised levofloxacin for 3 months is it ok to take it for such a long period when I already have had so much antibiotics ..? will this ever be cured ?. Also I have lost sexual desire , cant ejaculate at times even after erection what do I do for that ..would appreciate if u kindly explain all the queries raised by me here ... Thanks

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
in any chronic infection there is always a change in bacterial flora

Detailed Answer:
Hello
Thanks for follow up .It is always advisable to take appropriate antibiotic as per culture report to combat infection .

In chronic Prostatitis bacteria always change their nature and sensitivity pattern hence one has to repeat semen culture at regular intervals and take appropriate antibiotics .

As regards loss of libido .you need to take Testosterone either in oral form or injectable depot .This will help to improve your sexual desire .

Chronic prostatitis takes long time to get cured completely hence one has to take antibiotics for years .

Thanks and Regards.
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (13 hours later)

Thanks Doctor for clarifying ,pls also clarify that first time when I was examined at XXXXXXX XXXXXXX the doc gave me Bactrim without any semen , EPS or urine test was it the correct way , shouldn't relevant tests needed to be done at that time ?

Levofloxacin 750mg has been advised to me for 3 months based on current semen report shall I then start this course ..?

Regards/ XXXXXXX

Answered by Dr. Dr. P. T. Patil (4 hours later)

Brief Answer:
I can not make any comment on somme ones diaagnosis or opinion .

Detailed Answer:
Hello
Thanks for follow up .I can not make any comment on why some one prescribed any particular medication without doing any specific test .

Since your recent semen culture revealed sensitivity to Leofloxacin continue taking it for 8-10 weeks.
Thanks and Regards
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar