Visit Prostatitis.org    
View unanswered posts | View active topics It is currently Mon Dec 10, 2018 11:01 am



Reply to topic  [ 45 posts ]  Go to page 1, 2  Next
 enterococcus in semen.... 
Author Message

Joined: Fri Apr 22, 2016 8:53 am
Posts: 43
Post enterococcus in semen....
so I finally got my semen tested and bam! Enterococcus. Advice on the best treatment as the bacteria can form biofilm and is hard to kill.....Fosfomycin? Anyone have any experience they can share?


Thu Nov 17, 2016 4:13 pm
Profile

Joined: Sun May 01, 2016 9:48 am
Posts: 637
Post Re: enterococcus in semen....
Welcome to the club. I can tell you what *didn't* work for my enterococcus:

1. Doxycycline
2. Azithromycin
3. Ciprofloxacin
4. Levofloxacin
5. Moxifloxacin

Mine came back susceptible to:

1. Levofloxacin (obviously not though!!!!)
2. Vancomycin
3. Penicillin

I went on Augmentin (amoxicillin) for 6wks and I'm not sure whether that cured it as my symptoms persist (I'm going to get retested next week - it's now been over two months off the Augmentin). I contracted a C-diff infection from my Augmentin use and ultimately had to go on oral vancomycin to cure that, and during that treatment my prostatitis felt a lot better. May have just been luck as oral vancomycin isn't supposed to achieve MIC levels outside the gut when taken orally, but I can't deny the temporary improvement.

I think IV vancomycin would be the best option but it's not very realistic and probably super expensive. I'm very interested in fosfomycin after doing quite a bit of research lately, and if my culture comes back positive for enterococcus again then I'll be requesting that unless my uro has a better idea.


Thu Nov 17, 2016 7:41 pm
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
Same with me. Enterococcus in Semen, and coagulase negative staph in PES. Linezolid is supposed to be able to wreck both of those though, with zero resistance. I am not sure of prostate penetration though. I've seen one case report of Linezolid curing a patient of prostatitis, and another report saying that it should be combined with levaquin. I am thinking about giving it a try with Rifampin, and Joe's NAC method once my digestive issues settle down.


Thu Nov 17, 2016 9:21 pm
Profile

Joined: Fri Apr 22, 2016 8:53 am
Posts: 43
Post Re: enterococcus in semen....
Mine came back, sensitive to penicillin so that's what I am on for the next 21 days but I also have an appt with the Infectious Disease doc soon. Im glad I finally tested positive for something but not hopeful on this current treatment.....


Fri Nov 18, 2016 10:30 am
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
Yeah, penicillin is questionable at best for prostate penetration. They may try you on something else, let us know if it works though.


Fri Nov 18, 2016 11:23 am
Profile

Joined: Thu Nov 05, 2015 5:48 pm
Posts: 441
Post Re: enterococcus in semen....
why not just skip the pencilin and wait for the ID doctor?


Fri Nov 18, 2016 12:00 pm
Profile

Joined: Sun May 01, 2016 9:48 am
Posts: 637
Post Re: enterococcus in semen....
Yeah, penicillin is supposed to have questionable penetration into the prostate. Had I have known then what I know now I would have skipped the Augmentin and possibly avoided the c-diff infection as well.


Fri Nov 18, 2016 12:31 pm
Profile

Joined: Fri Apr 22, 2016 8:53 am
Posts: 43
Post Re: enterococcus in semen....
Ive been reading on enterococcus, one thing that makes someone susceptible to it is long term antibiotic use. Thinking that we have all been on a lot of drugs, maybe enterococcus is a secondary infection and the primary is still hidden/undetected.......thoughts?

My ID doc appt is 3 weeks away, which is exactly the end of the penicillin treatment. Im waiting a call from doc on advice on the penicillin.


Fri Nov 18, 2016 5:05 pm
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
I know that the bouts of prostatitis I've experienced begin with the acute phase's extreme prostate swelling, burning urination, and burning ejaculation. Sometimes there's the whole urinating blood thing too, when it's really bad. Those symptoms go away after about ten days of antibiotics (Cipro, Bactrim, Levaquin, Rocephin especially).

After that, the chronic phase sets in, which is no where near as bad as the acute phase's extreme prostate swelling. The chronic phase for me is mild prostate inflammation, and some hesitancy. The inflammation and hesitancy get worse though, if I am constipated.

I've yet to find a cure for the chronic phase's symptoms. Rocephin seems to halt the symptoms completely for me, but they come back after stopping, even after 21 days of continuous IVs.

Only Bactrim seemed to clear everything up once, and that was after year of antibiotic experimentation. I resigned myself to the fact that if I just stuck with a low dose of Bactrim everyday, it would eventually stop the infection. I gave up after about 3 months, while I was still suffering, and I decided that I would probably have to live with it. Within a month of stopping Bactrim, all my symptoms were gone, it was weird.


Fri Nov 18, 2016 5:19 pm
Profile

Joined: Fri Apr 22, 2016 8:53 am
Posts: 43
Post Re: enterococcus in semen....
Inflamed, does that mean you are healed? After extensive research, I have yet to find anyone who has beaten enterococcus in semen. Nasty bug that does not want to die......


Sun Nov 20, 2016 7:22 am
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
At the time when bactrim worked, I was infected with coagulase negative staph. Then I got reinfected via unprotected sex. So I decided to see Toth for injections and avoid the pill route. Injections helped, but it came back again. After Toth injections, I tested positive for enterococcus. I'm not sure if his injections caused that, or if it was already there. I'm dealing with chronic phase now. It's not horrible, but it's not fun. I'm eventually going to try a zyvox iv with rifampin. I'll try to combine prostate massages as well. Zyvox is interesting because it's supposed to kill staph and enterococcus with zero resistance. Only caveat is, we're not exalty sure of its prostate penetrate. Some sources say it penetrates well, other sources have no available data on it. One case showed that it cleared prostatitis up in one person.


Sun Nov 20, 2016 1:30 pm
Profile

Joined: Fri Apr 22, 2016 8:53 am
Posts: 43
Post Re: enterococcus in semen....
so we have a bug that is hard to kill in a place hard to get to.....not great odds

I noticed that enterococcus is listed as a major contributor to CPPS, I hope others have been healed, would give us some hope.


Sun Nov 20, 2016 6:27 pm
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
Yeah, definitely seems like it's a mighty bug. It may take a combination of things to get rid of it. Bactericidal and Bacteriostatic drugs, possibly some kind of a biofilm buster as well. Would be a good idea to combine prostate massages while undergoing treatment.

I personally would've thought Toth's injections would've zapped whatever it was that I had, but nope. It comes right back via unprotected sex with my girl (she's also tested negative for everything). I know some species of enterococcus reside in the mouth and vagina, there may be others of that same species that don't though. That might be what's going on with me, dunno.


Mon Nov 21, 2016 12:48 pm
Profile

Joined: Fri Apr 22, 2016 8:53 am
Posts: 43
Post Re: enterococcus in semen....
Inflamed, I had the same issue with it coming back. I was 100% symptom free, thought I was completely healed till unprotected sex with my long term girl, bam! its back.....I do not understand other than could our immune system be that out of whack? bug still hiding? its very confusing.....


Wed Nov 23, 2016 12:16 pm
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
Yeah man, it's friggin weird. Every time I have unprotected sex with my long term girl, it nails me. It starts with urethritis, then in a couple days my prostate blows up like baseball size. Both her and I have tested negative for any STIs, except for the enterococcus the semen analysis found in me. I can get infections via oral, or vaginal sex, so that means that whatever it is, it can live in both places in women. I've often wondered (from a scientific standpoint) if I would get these same infections via sex with someone else, but I'm not going to test that. I just wonder if this enterococcus can be generally worse than other sti's, it sure seems like it.


Wed Nov 23, 2016 6:38 pm
Profile

Joined: Fri Apr 22, 2016 8:53 am
Posts: 43
Post Re: enterococcus in semen....
I still think there is more to it. A deeper bug, not cultured properly, something.....


Mon Nov 28, 2016 9:58 am
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
I agree, especially since we keep getting hit by it every time we have unprotected sex with our significant others. The only time I am symptom free is with a Rocephin IV. The only other time I've actually managed to fight it off completely was after about a year of back to back various antibiotics with 3 months straight of Bactrim. When I stopped the Bactrim, I still had symptoms but they went away after a month. Has to be bacterial in our cases.


Tue Nov 29, 2016 11:22 am
Profile

Joined: Sun May 01, 2016 9:48 am
Posts: 637
Post Re: enterococcus in semen....
We need to go....deeper. Sorry, Inception popped into my mind there.


Tue Nov 29, 2016 1:44 pm
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
I thought this was worth looking at, taken from Merck's website:

Treatment

Varies by site of infection and susceptibility testing

(See also the American Heart Association's Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications .)

Enterococci associated with endocarditis are difficult to eradicate unless a combination of certain cell wall–active drugs (eg, penicillin, ampicillin, amoxicillin, piperacillin, vancomycin) plus an aminoglycoside (eg, gentamicin, streptomycin) is used to achieve bactericidal activity. However, some cell wall-active drugs have limited or no activity against enterococci; they include nafcillin, oxacillin, ticarcillin, meropenem, ertapenem, most cephalosporins, and aztreonam. E. faecium are more resistant to penicillin than E. faecalis. Imipenem is active against E. faecalis.

For complicated skin infections due to vancomycin-susceptible enterococci, daptomycin, linezolid tedizolid, and tigecycline are effective treatment options. Piperacillin-tazobactam and imipenem are recommended for complicated intra-abdominal infections when enterococci are known or presumed to be involved.

UTIs do not require bactericidal therapy and, if the causative organism is sensitive, are usually treated with a single antibiotic such as ampicillin. Nitrofurantoin and fosfomycin are often effective against vancomycin-resistant enterococcal UTI.
Resistance

In the past several decades, resistance to multiple antimicrobial drugs has increased rapidly, especially among E. faecium.

Resistance to aminoglycosides (eg, gentamicin, streptomycin), particularly with E. faecium, continues to emerge.

Vancomycin-resistant enterococci (VRE) may also be resistant to other glycopeptides (eg, teicoplanin), aminoglycosides, and cell wall–active β-lactams (eg, penicillin G, ampicillin). When identified, infected patients are strictly isolated. Recommended treatment includes streptogramins (quinupristin/dalfopristin for E. faecium only) and oxazolidinones (linezolid, tedizolid). Daptomycin and tigecycline have in vitro activity against VRE and may be off-label treatment options.

β-Lactamase–producing enterococci are occasionally encountered, particularly when large numbers of organisms are present (eg, in endocarditis vegetation). Resistance may be present clinically even though the organism appears susceptible based on standard testing. Vancomycin or combination β-lactam/β-lactamase inhibitor antibiotics (eg, piperacillin/tazobactam, ampicillin/sulbactam) can be used.


One of us needs to get on Nitrofurantoin or fosfomycin and see what happens. I would give either of those a try, but gastric issues I'm dealing with has me at an impasse.


Tue Nov 29, 2016 2:09 pm
Profile

Joined: Fri Oct 14, 2016 4:44 pm
Posts: 14
Post Re: enterococcus in semen....
Can I ask did you guys have a prostate expressed secretion test following a prostate massage or a semen culture?

I believe that my urologist is going to do the former but have not heard him say anything with regard to the latter.


Tue Nov 29, 2016 3:51 pm
Profile

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1089
Post Re: enterococcus in semen....
Hey Smurf,

Both tests are good, Semen analysis, and prostate massage culture both should tell you what's going on. We've had better luck with a straight up semen analysis though it seems.

If you're in the usa, your urologist, or PC doctor can order the two swab semen test via Labcorp test code 183111, which is Anaerobic and Aerobic Culture and Gram Stain.

Only certain labs in labcorp network will take semen though, so you'll need to call their 800 number and ask for a specific lab that will take it. Your doctor will then need to send it off to them for bacterial analysis.


Tue Nov 29, 2016 4:58 pm
Profile

Joined: Sun May 01, 2016 9:48 am
Posts: 637
Post Re: enterococcus in semen....
Smurf92 wrote:
Can I ask did you guys have a prostate expressed secretion test following a prostate massage or a semen culture?

I believe that my urologist is going to do the former but have not heard him say anything with regard to the latter.


It seems to be a bit of a crap shoot. Some prefer the EPS and others prefer the semen culture. My reading indicated that a semen culture might have higher sensitivity, and it's certainly less intrusive to come up with (though I've found it a nightmare to handle administratively). I wonder if the prostate massage followed by semen specimen would be the best of all worlds. I've now been cultured four times and all were semen without any sort of massage prior, though I did sort of self perform a prostate massage prior to my most recent semen culture.


Tue Nov 29, 2016 5:39 pm
Profile

Joined: Fri Oct 14, 2016 4:44 pm
Posts: 14
Post Re: enterococcus in semen....
Inflamed wrote:
Hey Smurf,

Both tests are good, Semen analysis, and prostate massage culture both should tell you what's going on. We've had better luck with a straight up semen analysis though it seems.

If you're in the usa, your urologist, or PC doctor can order the two swab semen test via Labcorp test code 183111, which is Anaerobic and Aerobic Culture and Gram Stain.

Only certain labs in labcorp network will take semen though, so you'll need to call their 800 number and ask for a specific lab that will take it. Your doctor will then need to send it off to them for bacterial analysis.


Alas I'm in the UK but thank you for the info!


Tue Nov 29, 2016 6:46 pm
Profile

Joined: Fri Oct 14, 2016 4:44 pm
Posts: 14
Post Re: enterococcus in semen....
prostate454 wrote:
Smurf92 wrote:
Can I ask did you guys have a prostate expressed secretion test following a prostate massage or a semen culture?

I believe that my urologist is going to do the former but have not heard him say anything with regard to the latter.


It seems to be a bit of a crap shoot. Some prefer the EPS and others prefer the semen culture. My reading indicated that a semen culture might have higher sensitivity, and it's certainly less intrusive to come up with (though I've found it a nightmare to handle administratively). I wonder if the prostate massage followed by semen specimen would be the best of all worlds. I've now been cultured four times and all were semen without any sort of massage prior, though I did sort of self perform a prostate massage prior to my most recent semen culture.


Thank you for the info!

I think I will ask must urologist when I am down for the EPS if he could possibly do me a semen culture too.


Tue Nov 29, 2016 6:49 pm
Profile

Joined: Sun May 01, 2016 9:48 am
Posts: 637
Post Re: enterococcus in semen....
Smurf92 wrote:
I think I will ask must urologist when I am down for the EPS if he could possibly do me a semen culture too.


If he's equipped to do the EPS culture then doing a semen culture at the same time should be a no-brainer for the lab. Given the choice I'd try to do the EPS first and then do the semen immediately following since it would be post-massage. You might have to follow through with the lab to make sure they do a culture and not an analysis on the semen (or do both). Over here in the Washington DC area I've had a lot of trouble with labs wanting to perform an analysis on semen and not a bacterial culture (apparently a semen culture is very rare). Maybe things are better where you are though.


Wed Nov 30, 2016 3:22 pm
Profile
Display posts from previous:  Sort by  
Reply to topic   [ 45 posts ]  Go to page 1, 2  Next

You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum

Search for:
Jump to:  
Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group.
Designed by STSoftware for PTF.