Recurrent Bacterial Prostate Infection

Patient

Q: I am 30yrs old healthy individual having a recurrent UTI for last 4 years. Earlier the Urine Culture was positive but now for last one year, the urine culture is Negative but the Semen culture shows infection with bacteria majorly ECOLI Esbl Positive and sometimes Proteus vulgaris, Pseudomonas aeruga and Staphylococcus aureus. I have been regularly seeing my urologist and have taken continuous antibiotics since last 4 years as I experience mild pain and burning while passing urine when off antibiotics. Earlier I had Mildly Enlarged Prostrate earlier but now not tender and enlarged. I even got MRI done of Urethra, Kidney and Seminal Vessels in July 2011 which revealed no abnormality and also got Dilation of Urethra done on July 2011, with no abnormality seen. I have received various long term courses of Antibiotics since 2007 Ciprofloxacin, Ofloxacin, Nitrofurantion, Amikacin Injections IV, Gentamicin Injections IV, Cefixime, Netilmycin 300mg of which I took only two injections after dilation of urethera but had side effects, so discountinued. Side effects were numbness on face, tounge and fingers. Two recent Seminal Culture reports indicate Ecoli ESBL Positive and the very recent one has a different organism, Staphylococcus aureus and yesterday report indicates Ecoli ESBL positive again. The bacteria has been changing in last 4 years. My question is that I have taken the antibiotics regularly but still the infection continues, so is there something more I can do as MRI and Dilation did not reveal any abnormality. Why is the organism changing from E coli sometimes ESBL positive and sometimes esbl negative to sometimes Proteus vulgaris, Pseudomonas aeruga and Staphylococcus aureus. What could be the possible cause of this infection as all reports seem to be normal and how do I control this recurrent infection and gain immunity to this type of recurrent infection

Doctor

A:   Your symptoms and test results are probably indicative of chronic bacterial prostatitis. Unfortunately, chronic prostatitis can be difficult to treat. The mainstay in the treatment of chronic bacterial prostatitis is the use of oral antimicrobial agents. Usually the best treatment options available are trimethoprim sulphate and sulphamethoxazole and fluroquinolones.
Since you've tried all measures and antibiotics, you many consult with your doctor on the benefit of prostatectomy in your case. TURP and TUVP may help remove the nidus of infection causing the chronic infection.

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