ARTICLE 13

Protocol of 2 to 3 weeks treatment of genitourinary tract infection.

(Urethra, bladder, prostate, and semen.)

Interpretation of laboratory tests:

Gram's stain of the anterior urethra, EPS, and semen is done. Normal - 0 pus cells indicates no infection. The mere presence of organisms seen may be the etiologic organism(s) infecting the prostate and/or semen. Pus cells indicates infection.

Urinalysis:

Presence of protein and WBC over 4/hpf and RBC over 4 indicates cystitis. Presence of bacteria and yeast cells considered contaminant or normal colony may be the same organisms infecting the prostate and/or semen.

Semen analysis:

Presence of WBC and RBC indicates infection. Cultures and sensitivity tests for all pathogens (see Article 3 - Sites of infection and organism involved and Art. 5 Culture and Sensitivity test). Results are available 2 to 5 days later.

Day 1 (day of consultation)

Results of Gram's stain, urinalysis and semen analysis are available within 15 minutes. Consistency of prostate is noted (See Article 10 - Technique of prostatic massage in relation to the consistency of the prostate)

Rx - Azithromycin 1 gm, s.d. Ciprofloxacin 500 mg s.d.

Day 2

All tests considered positive are repeated. Cultures are repeated.

Rx - Ofloxacin 400 mg. every 12 hours (bid) x 7 days, Doxycycline or Minocycline 100 mg bid x 7 days

Day 3

Pus cells in EPS may increase and size of prostate may decrease. Dual antibiotics are continued.

Day 4

Results of cultures and sensitivity tests of N. gonorrheae, Coliforms, Staph. and Strep., Gardnerella vaginalis, and ureaplasma urealyticum are now available. The dual antibiotic therapy is continued if lab. test shows improvement and target antibiotic(s) are incorporated if different from the initial drugs.
Pus cells of EPS may decrease or increase. Cystitis may persist. If so, we incorporate

Sporonox (itraconazole) 100 mg daily (OD) x 7 days.

By this time the prostate has been drained and all clogged ducts are cleared and the size of the prostate reduced. Ducts that are not unclogged will usually remain clogged and no longer be a source of infection. The contents of these ducts and glands will eventually be scarred up or calcified. Results of culture for mycoplasma are now available and drugs modified if necessary depending on results of sensitivity test. We will not hesitate to use 3 or even 4 different antibiotics. By this time anterior urethra and urine are sterile or free of contaminants.

Day 6

Results of C/S tests for anaerobes and Trichomonas vaginalis are now available and treated target antibiotic or empirically with either metronidazole 2 gm s.d. given on two successive days, or amoxicillin 500 mg every 6 hours (qid) .

Day 8

About 20 % of patients will be cured. For those that continue to have high count of pus cells in EPS and semen, usually asymptomatic by this time with improvement of erection and ejaculation, antibiotics will be replaced and new ones given for another 7 days. Antibiotics of choice are Augmentin, Ceclor, Erythromycin, etc.. based empirically. About 70% of patients will be cured. Cultures may or may not be repeated and antibiotics modified. Massage will be done every 2nd day and by the 12th drainage, 30 % of patients will go to 0 pus cells. The rest of the patients' pus cells will stabilize at a low count. 5% will remain high and these are what we consider failures and treatment may be continued with other antibiotics based on C/S or empirically administered or retreated after 1 or 2 months.

Note: The above protocol is a general guide for physician but may vary from patient to patient, taking into consideration the symptoms, consistency of prostate, pus cells in EPS and semen, and results of other laboratory tests.

It is strongly emphasized that self-medication is not advisable!!!

Antonio Novak Feliciano, M.D., F.P.C.S.

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