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My question regards least intrusive , but possible effective treatment for chronic bacterial prostatitis.

Non traditional symptoms ( nausea, abdomen discomfort, fatigue…. but no enlargement, urinary issues at all) resulted in 6 months of misdiagnosis as GI Issues.

Two day thorough work up at Mayo Clinic resulted in diagnosis 3.0 years ago “Methicillin Resistant Staph Aureus Prostatitis”

Sensitivities cultures showed many IV antibiotics susceptible plus Bactrim and Minocycline. ( I noticed Quinolones did not appear on sensitivity test as I was noted as allergic to quinolones – which is not the case, it was an error in self reporting)

Over the next 2.5 years , the symptoms would go from very flush to feeling well within a week on Bactrim. Five 4-6 weeks courses were needed and then months of feeling fine.
It seemed that sexual activity without condom would “activate “ infection two weeks later?

Once again no BPH ( prostate regular dimensions, no urinary issues at all.) There would be nausea, a little prostate discomfort, projection of pain to front left ( about one inch to left of belly button and two down). Symtpoms worst upon waking. As soon as Bactrim taken all symptoms would go away

Tried minocycline once and it had pretty strong hypothyroid consequences. Primarily very irregular heart beat. I never tried to overcome with extra thyroid supplementation .

Recently Bactrim was bacteriostatic at best. Doesn't seem to work now to "kill" it off.

I once had to take Zithromax for “travelers diarrhea “ while in Europe and prostate symptoms got better. Made me wonder , do I necessarily have the same bug years later.

When I get it I am quite sick and tired, almost like having flu.

Recently when visiting with a local urologist he said it may be time for a “hail Mary “ pass , a TURP. In visiting with a friend who is a preventative medicine MD he thought that was early and a bit extreme
Recent careful gray and color Doppler ultrasound study reveals a normal size and configuration prostate for my age. There are multiple calcification, more towards the base. There are no abscesses or masses. There is inflammatory evidence at left mid to apex measuring 12 by 7mm which is the likely location of the infection. It does not appear around the calcification.

I am now on 250mg Levaquin for two weeks or four weeks …..?


Being as I have no BPH , no urinary issues and localized infection along with a 3 year interval I wonder if there would not be options before a TURP.....which patients often report created new urinary and inflammatory issues along with a very painful process.

Could a procedure take prostatic fluid and or tissue for culture to identify offending bacterium.?
Could the offending bacterium then be finally eradicated with long term target use of an antibiotic
( it could be a wholly different organism then we have assumed)

In the alternative are their procedure short of a Hail Mary? ( a shorter pass perhaps That might "open" a channel to the infected area,or using laser to remove the area or TUNA or TUMT, or some other less intrusive technique than a turp which could create problems I don't have eg urinary issues.

if money is not an issue and it was you what alternative to identifying and addressing the specific location of the specific infection other than a TURP might you consider/

Any advice is greatly appreciated

Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
 30 Doctors Online

Thank You for your query at
I understand your concern.
Chronic prostatitis has waxing and waning course.
As you have experienced one can have intermittent episodes when the disease becomes more active and hence troublesome. The patient needs to be treated with antibiotics. You have been doing fairly well for last few years. You should start yourself on alpha blockers under the care of urologist. This shall increase your disease free period.

You should take prostatic massage and send the expressed prostatic secretions for culture and start antibiotic accordingly. The culture is extremely important since it helps to identify the appropriate organism and which antibiotic it is sensitive too.

Undergoing prostate surgery such as TURP, Tuna or Tumt shall only worsen your symptoms and you should avoid surgery. You should consider surgery only if you are being troubled by prostatic symptoms rather than by infection symptoms. Getting operated for infection is no solution and in all probability it shall make you worse.
Hope I have answered all your doubts.
Feel free to discuss further,


Patient replied :

Thank you Doctor
So perhaps the best avenue is to do a procedure throught the penus to retreive prostatic fluid since it does has never shown up well in a UA. Always negative urine, it took Mayo to determine it was an infection in the prostate.
By going in thru the Penus isnt there a process to obtain fluid to culture.
Is there a say to give better access to the infected area with antibiotic such as a laste opening
or channel. and to provide drainage, so the antibiotics have a better chance of success.
Thanks for your help

The prostatic secretions come out through penis after massage and are referred to as expressed prostatic secretions. These secretions are to be sent for culture.
Unfortunately there is no better way to deliver antibiotics to prostate. You need to take them orally only and very few antibiotics penetrate into prostate.
Feel free to discuss further,

Rajiv Goel

Patient replied :

I believe i read there was a procedure to go in and get a prostatic sample if UA and massage are questionable. The other part I wondered is wouldnt help the prostate drain better help the antibiotic. And couldnt drainage be "created'

Thanks for your time Doctor, I am trying to make decisions with good results and least collateral risk.

Paul Schoenecker

Dear Paul,

There is no safe way to get the sample other than expressed prostatic secretions. You can take direct samples but it is fraught with increasing your infection and making you sick.
Surgery or creating channel for surgery has not been shown to be helpful. Infact they lay open the capsule of prostate and thus breach of capsule responsible for limiting spread of infection.

Best Regards,
Rajiv Goel

Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
Dr. Rajiv Goel and 4 other Medical Specialists are ready to help you

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