chronic prostatitis

Hello,


After several failed treatments for recurrent urethitis/prostatitis coming from an initial sexual infection, I have taken this "Manila protocol" treatment consisting of thrice weekly full drainage of prostate combined with targeted antibiotics, here in the Philippines.

I have now been for three months in this treatment and see no end.  It seems to go by cycles.  Each time the symptoms seem to disappear and the WBC count comes low on a clearer prostatic fluid, then there is a sudden reincrease wiht WBC count climbing to around 200 to 300 per hpf with some white precipitate visible in the prostatic fluid, so seemingly the result of opening of clogged ducts(lately there has also been precipitate at other drainages even on the improvement phase of the cycle).

WHAT IS THE MEANING OF ALL THAT? IS THE INFECTION TURNING AROUND
(WITH QUICK CREATION OF NEW MICRO-ABSCESSSES), OR IS THERE A
HUGE AMOUNT OF TRAPPED INFECTION THAT IS COMING OUT SLOWLY ONLY
BY STEPS? IN THIS LAST CASE, WHERE IS THE END? Is there no way to know how much trapped infection there still is? Can ultrasound detect it when it is the result of micro-abscesses like that,... or detect fibrous calcification obstucting ducts? Also, is there any way to accelerate the process (by helping to liberate trapped infection more quickly)? Or ANY OTHER IDEA ABOUT OTHER APPROPRIATE TREATMENT IN MY SITUATION? I must leave from here, and on the other hand cannot stay FOREVER on antibiotics.

The only permanent result that appears to have happened so far is the eradication of chlamydia (only dead chlamydia was found in the last test after a sudden reincrease in count), the remaining bacteria being of staph family or undetectable (also there is no more fungus). Besides, the antibiotics seem to be working as the count usually goes down regularly before the sudden reincrease and the repeated cultures show continued sentivity to mynocin (no creation of resistance... so far).


Thank you very much for your help.

[Kevin Pho, MD]

One consideration would be the presence of an abscess - which can certainly cause the prostatitis to return and not respond appropriately to antibiotics.  If this is the cause, surgical therapy and drainage would have to be considered.

To determine if this is the cause, a transrectal ultrasound would be considered to image the prostate and any possible abscess.  Also make sure that the bacteria that is growing out in culture is susceptible to the antibiotics given.  This should be routinely done if the prostatic fluid is being cultured.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

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