THIS IS A POST I READ ON WWW.MEDHELP.COM, IN THE UROLOGY FORUMS
SECTION. IT IS IN REGARDS TO THE MANILA PROTOCOL. ITS RELATIVELY NEW.

POSTER************************************************************

(26-May-04)

Hello,

After several failed treatments for recurrent urethitis/prostatitis
coming from an initial sexual infection, I have taken this "Manila
protocol" treatment consisting of thrice weekly full drainage of
prostate combined with targeted antibiotics, here in the Philippines.

I have now been for three months in this treatment and see no end. It
seems to go by cycles. Each time the symptoms seem to disappear and
the WBC count comes low on a clearer prostatic fluid, then there is a
sudden reincrease wiht WBC count climbing to around 200 to 300 per hpf
with some white precipitate visible in the prostatic fluid, so
seemingly the result of opening of clogged ducts(lately there has also
been precipitate at other drainages even on the improvement phase of
the cycle).

WHAT IS THE MEANING OF ALL THAT? IS THE INFECTION TURNING AROUND
(WITH QUICK CREATION OF NEW MICRO-ABSCESSSES), OR IS THERE A
HUGE AMOUNT OF TRAPPED INFECTION THAT IS COMING OUT SLOWLY ONLY
BY STEPS? IN THIS LAST CASE, WHERE IS THE END? Is there no way to know
how much trapped infection there still is? Can ultrasound detect it
when it is the result of micro-abscesses like that,... or detect
fibrous calcification obstucting ducts? Also, is there any way to
accelerate the process (by helping to liberate trapped infection more
quickly)? Or ANY OTHER IDEA ABOUT OTHER APPROPRIATE TREATMENT IN MY
SITUATION? I must leave from here, and on the other hand cannot stay
FOREVER on antibiotics.

The only permanent result that appears to have happened so far is the
eradication of chlamydia (only dead chlamydia was found in the last
test after a sudden reincrease in count), the remaining bacteria being
of staph family or undetectable (also there is no more fungus).
Besides, the antibiotics seem to be working as the count usually goes
down regularly before the sudden reincrease and the repeated cultures
show continued sentivity to mynocin (no creation of resistance... so
far).

Thank you very much for your help.

DOCTOR RESPONSE****************************************************

One consideration would be the presence of an abscess - which can
certainly cause the prostatitis to return and not respond
appropriately to antibiotics. If this is the cause, surgical therapy
and drainage would have to be considered.

To determine if this is the cause, a transrectal ultrasound would be
considered to image the prostate and any possible abscess. Also make
sure that the bacteria that is growing out in culture is susceptible
to the antibiotics given. This should be routinely done if the
prostatic fluid is being cultured.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical
advice - the information presented is for patient education only.
Please see your personal physician for further evaluation of your
individual case.

Kevin, M.D.
Medical Weblog:
http://www.kevinmd.com/blog/