ARTICLE 12
Principle of the three weeks course of treatment of Chronic Prostatitis:
Arya OMP et al: Diagnosis of Urethritis: Role of PMN count in Gram’s stain. Sexually Transmitted Diseases Journal of the American Venereal Disease Association, 11:10-17. 1984 recorded 11% of patients he documented with Chlamydia had 4 or less pus cells.
Krieger, J et al: Prokaryotic DNA Sequences in Patients with Chronic Idiopathic (etiology unknown) prostatitis were found to have bacterial prostatitis by using PRC and DNA analysis of prostatic biopsy.
The technique of prostatic massage varies depending on the consistency of the prostate in different patients and may change from day to day.
The combination of antibiotics also varies from patient to patient and length of time given or when to replace them, based on individual patient’s response, not only symptomatic, but more importantly based on movements of pus cells in the Gram’s stain smear of the anterior urethra and EPS, urinalysis, semen analysis, cultures and Elisa tests. Wet mount is also done on EPS to identify Trichomonas vaginalis.
Patients are seen daily for the first 4 to 8 visits. During the first visit, cultures for all pathogens that may be sexually transmitted (venereal) or transmissible (normal flora), are done on all sites (urethra, urine, prostatic fluid, and semen including the throat if oral sex is performed by the patient). Elisa tests are also done.
On succeeding visits, the results of urinalysis and Gram’ stain will be the basis whether to continue or replace the antibiotics. Semen analysis if infected will be repeated every 5 days.
Gram’s stain must not show any pus cells or organisms. The persistence of pus cells and organisms will also be a deciding factor to continue or replace the antibiotics. We do not accept the mere presence of bacteria in the urine. Results of cultures will be available 2 to 5 days. Target antibiotics will be prescribed for 7 to 14 days regardless of the results of other tests. Partner drugs given empirically may be replaced as early as 2 to 4 days if there no improvement in both symptoms and laboratory results. The organisms that are persisting in the anterior urethra and urine, contaminant or infectious, may be the same organisms in the prostate and semen not responding to the antibiotics.
A routine semen analysis will indicate fertility problems and may show WBC and RBC, indicating an infection seen under the high power field of the microscope usually used in a semen analysis, but may not show any organisms. Gram’s stain done on semen and examined under the oil immersion lens of the microscope mat shows gram-negative and gram-positive rods and cocci, gram-negative diplococci (N. gonorrheae) and gram-negative coccobacilli (Gardnerella vaginalis) accompanied by “clue” cells. Persistence of these organisms after a few days of antibiotics will make us decide to modify the drugs given empirically.
Only 30% of patients will be converted to 0 pus cells, which usually happens on the 4th to 8th visits. The majority will stabilize to a low count of less than 5 pus cells, usually on the 8th to 12th massage. The patients are usually asymptomatic and sexual dysfunctions are relieved at this time. To declare a cure, repeat cultures on the EPS must show no growth. Persistence of pus cells is attributed to trapped organisms in calculi or due to the calculi present in over 60% of patients, which we consider harmless and inconsequential.
In about 5% to 10% of patients, the pus cells may persist to a high count (over 20) and some will still manifest a slight pain or discomfort around the genital areas after the 12th visits or within 2 to 3 weeks. The patients will either elect to continue the treatment or return for re-treatment after several months. Realizing that the residual pain or discomfort that occurs usually on-and-off will now be tolerable and should not be of any concern to the patient so as to alter the quality of his life, and more important, he will no longer go from doctor to doctor in an effort to find a cure.
The technique and quality of massages varies depending on the consistency of the prostate, which may change from day to day. A small boggy lump within the prostate will be massaged more vigorously until it drains and disappears, which it often does. If the lump is hard or it persists, cancer must be ruled out. A rubbery or stony hard prostate may indicate a co-existing BPH (benign prostatic hyperplasia), which is treated by different drugs or method. We may apply more pressure or concentrate on a certain area of one or both lobes of the prostate. I have elaborated more on this topic in Article 10: Technique of Prostatic Massage in Relation to the Consistency of the Prostate, found in my web page.
In effect, not all patients will respond in the same manner, be prescribed the same antibiotics or be subjected to the same quality or frequency of massages.
It must be emphasized that correct dosage of antibiotics be given to maintain an effective blood level within the Minimum Inhibitory Concentration (MIC), sufficient to kill or inhibit the organisms. The combination of antibiotics must be synergistic or enhance the effect of the other. Antibiotics given adequately should result in a beneficial manner. Side effects of antibiotics are nil and rare, tolerable, harmless, and temporary, and should bring benefit if given correctly. It intolerable it must be replace by another antibiotic.
Antibiotics given for a prolonged period of time or in an on-and-off manner will not cure chronic prostatitis and may encourage the organisms to mutate and develop resistance to the antibiotics.
This principle of treatment we have developed after more than 30 years of research is intended to guide patients and doctors in the method that we have found simple and effective in the majority of patients, but should be under the guidance of an experienced doctor.