Why are we not testing for bacteria in Prostatitis?

Last week saw multiple news reports (here) that telling patients to complete their entire antibiotic dosage may be contributing to the rise of antibiotic resistance! This makes perfect sense in my eyes. There are FAR too many of us on unnecessarily large dosages of antibiotics that could be a fraction of what they are if they are even needed at all!

If you are a Prostatitis or Chronic Pelvic Pain Syndrome (CPPS) patient then there is a very good chance that you have been given at least one round of antibiotics. I am so confident this is the case, I am willing to bet my house on it (and I am not a gambling man!). But let me ask you this – How many of you were tested for the presence of bacteria within the prostate? Some of you may have had urine and/or sperm tests both of which are very poor in identifying the presence of bacteria within the prostate and will often be positive anyway. No, I am talking about a 4 glass Stamey test or a 2 glass test also known as the pre and post prostate massage test (PPMT)? The Stamey test was considered to be the Gold standard of methods for identifying the presence of bacteria within the prostate gland yet it is rarely used, let alone mentioned to patients as an option! The 2 glass test or PPMT is considered to be 96% accurate when compared with the 4 glass version.

Current protocol for the treatment of Prostatitis and CPPS is to give antibiotics regardless of any testing! This in my opinion is completely the wrong kind of care, in fact I feel that the word care is vastly exaggerated here.

Oh yes, you have CPPS therefore we need to put you on one of the strongest antibiotics we can.” The confused patient responds to this flippant comment only to hear back – “Whats that sorry? You haven’t been tested for the presence of bacteria? Oh no thats ok this is just what we do!

The patient pipes up in response “But Doctor surely if 98% of all cases are non-bacterial then I don’t require these antibiotics?!”

Well, that is very interesting but I would advise taking these for at least 6 weeks anyway and then we can review your case” was the nonchalant reply that hung too long in the stifling surgery air.

Typically the patient returns to the doctor in 6 weeks time and is once again prescribed more antibiotics, maybe the exact same prescription as before. Or, maybe now he has been given Doxycycline for this next 6 week round. Wind the clock forward another 6 weeks and we enter groundhog day again – another 6 week dose of different strength antibiotics!

My point to this rather over exaggerated conversation (yes I was being somewhat obtuse there) is that the patient is not tested at all. If there was a 98% chance that there was bacteria present then I could totally understand the immediate prescription of antibiotics. But that simply is not the case. In my opinion this just feeds the fire of the antibiotic resistance argument mentioned at the top of this blog post.

In 1963 it was observed that antibiotics may be no better than placebo in the treatment of prostatitis (Gonder 1963), yet here we are 54 years later! Yes 54 years later using the same methods!

Why are we not testing for bacteria in Prostatitis? I wrote a blog post on this very matter on the “Trends in Urology and Mens Health” website. I asked the urologists on there if they thought the testing for bacteria in Prostatitis was relevant in todays age and if they did or didn’t carry out these tests. I also asked if a national directory of specialists who carried out these tests was necessary. You can read the blog and the replies here 

Sadly it seems modern medicine is no closer to addressing the individual experiencing pelvic pain. Instead most patients are brushed off with antibiotics, alpha blockers and anti-inflammatories, also known as the “Triple A Approach.” With the over and repeat prescription of antibiotics for a non-bacterial (in the most part) presentation we are just fuelling further antibiotic resistance! No wonder the typical CPPS and Prostatitis patient feels confused, brushed under the carpet and ignored!

 

Karl Monahan is the owner of The Pelvic Pain Clinic, London. He has been successfully treating male pelvic pain since 2009. His depth of knowledge and personal experience on the subject provides his patients with a compassionate approach that is rarely found. His holistic approach to treating male pelvic pain addresses, lifestyle, diet, exercise, stress management and therapeutic movement. The clinics approach is very much aimed at empowering the patient, teaching them the tools and techniques to manage and reduce their own symptoms allowing them to be the driver in their own recovery and not just a passenger. www.thepelvicpainclinic.co.uk

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