Enterococcus faecalis in Semen

[stillconcerned999]

last six months - increased urinary frequency & urgency - often little amounts of urine, and often comes out as a spray instead of a stream.  

Also, intermittent (from a couple of times per day to every couple of days) stinging/ shooting pain at tip of my penis, & reasonably constant itching around my genitals & rectum.  

Only possible exposure- a single incident of receiving oral sex from a female friend in August. SInce then, have taken Azythromycin, a week of CIPRO and 10 days of Doxycillan. Have seen urologists, had a colonoscopy, and physical with blood tests ruling out syphilis, gonorrhea, chlamydia & Herpes 1 & 2.  

Over 20 years, recurrent bouts of (what was "diagnosed" as) prostatitis. 2 years ago tested positive for Enterococcus faecalis in a semen culture. Took antibiotics for a month and symptoms went away (but I did not reculture my semen).  
Now, with the frequency and urgency issues are more prevalent (and the itching and stinging pains more of a distraction), my semen has just been retested and shows Enterococcus faecalis (test says sensitive to Penicilin and Vancomycin). Conventional, well respected doctor recommends antibiotics for a month to treat, but given I have been on so many antibiotics (NonHodgkins Lymphoma-Chemo/Radiation) in last few years, I am loath to do another course unless absolutely necessary.  

1. Much literature suggests prostatitis is often not cured by antibiotics and if it was (2 years ago), how did the Enterococcus faecalis return.  Was it from a single exposure to oral sex or likely something else?

2.If you think it was from something else (like food) how do I prevent another reoccurrence?

3. Recently recommended to try PEENUTS from a Dr. Wheeler whose website looks a bit suspicious- any knowledge about these "natural" substitutes?

4. Do I have something that is "transmittable" if I have intercourse or oral sex?

5. Any other thoughts?

Thanks

[Stephen Liroff, MD]

I do not know the mechanism for your initial infection. There may be some relationship to your altered immune status. Neither  do I know anything about this alternative treatment that you mentioned.
S.A.Liroff, M.D.

[stillconcerned999]

Thanks for your response but you didn't fully answer my questions:

1. I have never had rectal intercourse with anyone- either way.  On this basis how might I have got infected?

2. Any knowledge of Dr. Wheeler or PEENUTS?

Many Thanks

[Stephen Liroff, MD]

The persistence/recurrence of prostate infections is not well understood. There are only a few antibiotics which get into prostate tissue in high concentration unless there is a flagrant infection. Septra (bactrim), tetracyclines, fluoroquinolones (Cipro, Levaquin), and Geocillin (which may no longer be available) are the major ones. This difficulty in getting good tissue levels of the drugs is certainly a factor in treating prostatitis. Sometimes a long period of treatment is needed. Once treated, and I think that you should treat it as you do have symptoms, you would be wise to have a repeat culture a few weeks after finishing treatment, regardless of your symptoms.
The bacteria will be part of the fluid that comes out with an ejaculation, but it is not likely to infect your partner. Vaginas are not sterile and neither are mouths. On the other hand, bacteria vary in their virulence and I guess that there is some risk that this particular strain could cause an infection in another.
I have no knowledge of alternative treatments for prostatitis nor do I know of a way of avoiding future occurrences other than not having rectal intercourse without a condom.
S.A.Liroff, M.D.