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Medical Forum / Diseases and Disorders / Prostatitis / September 2004Antibiotic road
For 5 months I was in the hands of quacks who didn't know that prostatitis can produce rectal and other pains. Finally I discovered on my own that Cipro greatly reduced my symptoms, and I've been on Cipro (or Levaquin, or for 3 weeks Septra) for 3 months. I almost immediately got 75% better on Cipro/Levaquin, but not 100% better. Possibly my epididymitis got worse. The pain is bad enough -- sometimes spending afternoons with ice cubes against my left testicle for relief. What to do? I can't take Cipro forever. And I am no longer improving. THEORIES 1. I *can* take Cipro forever -- just take microdoses (a dreadful desparate choice). 2. Stop Cipro and try Zithomax or Doxy (or even both at the same time -- they're both statics, not -cidals). My research below suggests Cipro may PERPETUATE chlamydia (!) and maybe that's what I have. 3. I finally convinced one of the quacks to authorized a testicular sonogram. Presto, I have multiple cysts. But does that mean removing the cysts gives me a better chance of recovery? 4. Shouldn't I have had transrectal ultrasound by now?!! 5. Shouldn't I have had a cystoscopy by now ?!! NUTS! Antibiotics improved me so much so fast, and so reduced the swelling of my prostate, I have reason to hope I really have an infection. But I've never had any bacteria cultured (except for quickie piss tests, which are negative). My PSA is low. I have zero medical training. I'm just another schmo with an aching butt (mostly prostate and testicular pain, but sometimes pain sitting, tailbone pain, etc.). Why after 3 urologists and 7 other doctors am I stuck trying to figure this out on my own? If prostate massage might help, why is there no place in New York City I can find to get it? Grrrrrrrrrrrrrrrrrrrrrrr In pain too long and getting damn pissed! - Carlos northernsp y1@aol.com [remove space] PS yes I take hot baths, drink little coffee, religiously offer myself daily "hand relief". I'm avoiding Quercetin since I read it may interfere with Quinolones like Cipro. I take anti-inflammatories like Naproxen. ===================== CIPRO NOT GOOD FOR CHLAMYDIA ? http://www.prostatitis.org/ciprochlamydia.html "Persistence of Chlamydia trachomatis Is Induced by Ciprofloxacin and Ofloxacin In Vitro" "esumption of overt chlamydial growth occurred after withdrawal of ciprofloxacin, confirming the viability of persisting chlamydia. In vitro ciprofloxacin results are consistent with clinical data, thereby providing an explanation for treatment failures of ciprofloxacin." MAYBE THE PROBLEM IS PHYSICAL -- BUT NO ONE EVEN SUGGESTS TESTS! From http://www.prostatitis.org/chinesepills.html Now back in May I had an ultrasound exam (see http://www.prostate.org/trus.html). It showed a cyst on one ejaculatory duct. The doc has always talked about this being on the right, but today he mentioned that he look another look at the images, and it's really on the left. We have speculated whether drainages without surgery might have drained that cyst. Symptomwise, I have much less pain than in May, but a sore spot has persisted that still causes frequent urination. So he pressed on the left side today and I said right away that a lot of fluid had been released; he pressed a second time, and I felt the same kind of flow again. I got a nice puddle on the microscope slide. When he looked at it in the microscope, he said the fluid was "packed" with white blood cells. He said this was true pus, not just a high white-cell count. Could this have been that nasty cyst, popped by drainage #46? I believe it was, because I feel better. Not quite cured, but maybe darned close. I also believe that the Chinese pills were important in setting up the gland so this could happen. This evening, I saw my Chinese-American friend again. I told him a short version of this story, so many treatments, now things speeded up. He said "Those pills were not for the prostate. They are kidney pills." All I know is they work wonders in conjunction with drainages. Just think if I had taken the right pills! I may yet find the true prostate pills as Richard posted this evening, but maybe I won't need them. >For 5 months I was in the hands of quacks who didn't know that prostatitis can >produce rectal and other pains. Finally I discovered on my own that Cipro [quoted text clipped - 6 lines] > >What to do? I can't take Cipro forever. And I am no longer improving. Join the club my friend. I had to get off Cipro years back after suffering from conective tissue inflammation and damage that it caused. Am currently on and off of Doxycycline for my symptoms. >THEORIES > [quoted text clipped - 12 lines] > >5. Shouldn't I have had a cystoscopy by now ?!! I chose to avoid that route after hearing a horror story or two. >NUTS! > [quoted text clipped - 3 lines] >But I've never had any bacteria cultured (except for quickie piss tests, which >are negative). My PSA is low. Not unusual, Same for me. >I have zero medical training. I'm just another schmo with an aching butt >(mostly prostate and testicular pain, but sometimes pain sitting, tailbone >pain, etc.). > >Why after 3 urologists and 7 other doctors am I stuck trying to figure this out >on my own? Because most doctors don't give a sh.t, they are of the mind that this is a condition that is predestined to happen for some. They just hope it never happens to them. >If prostate massage might help, why is there no place in New York City I can >find to get it? [quoted text clipped - 10 lines] >"hand relief". I'm avoiding Quercetin since I read it may interfere with >Quinolones like Cipro. I take anti-inflammatories like Naproxen. For my prostate I found that cutting out ALL acidic drinks and carbonation really helped. That means no: Sodas, Tea, Coffee, pasteurized fruit drinks. Also stay away from spicy foods. Eat plenty of leafy greens and steamed/cooked vegetables. Fiber is important,use rice bran because it's not as harsh as wheat. Get a hemorroid ointment with a vaso-constrictor to reduce swelling. Keep up the hot soaks, at least until the pain and swelling are under control. >===================== >CIPRO NOT GOOD FOR CHLAMYDIA ? [quoted text clipped - 34 lines] >right pills! I may yet find the true prostate pills as Richard posted this >evening, but maybe I won't need them. All I can say is that I know what you are going through. I am in my 6th week of Cipro and my results are similar. The severe lower back pain is gone, but not completely. I have a feeling that it will be right back as soon as I stop taking it. My energy level is low, and I am not enjoying life at all. I'm 37 but feel like I'm 80. >For 5 months I was in the hands of quacks who didn't know that prostatitis can >produce rectal and other pains. Finally I discovered on my own that Cipro [quoted text clipped - 92 lines] >right pills! I may yet find the true prostate pills as Richard posted this >evening, but maybe I won't need them. >All I can say is that I know what you are going through. I am in my >6th week of Cipro and my results are similar. The severe lower back >pain is gone, but not completely. I have a feeling that it will be >right back as soon as I stop taking it. My energy level is low, and I >am not enjoying life at all. I'm 37 but feel like I'm 80. Part of your symptoms may be from the Cipro itself. I stopped recently because I was beginning to get quinolone arthritis -- pain in joints, especially one of my ankles. I am told the pains will fade, and so far that's true, but not everyone is so lucky, and they haven't faded completely. What I didn't realize until I stopped was how much of that "80 year old" feeling was the result of the Cipro, which can also cause insomnia, shortness of breath, and muscle ache (among other things). Those side-effects are only rare if you take it the 7 to 14 days that is normal. If you're already on Cipro road you have an incentive to keep with it, I guess, as long as joint or tendon pains don't start. I wish I had started with Zithromax or Doxyclycline, which are taken for shorter periods, and kill different things. Did anyone suggest doing a culture or other tests for bacteria before they prescribed Cipro? - Carlos (New York) > >All I can say is that I know what you are going through. I am in my > >6th week of Cipro and my results are similar. The severe lower back > >pain is gone, but not completely. I have a feeling that it will be > >right back as soon as I stop taking it. My energy level is low, and I > >am not enjoying life at all. I'm 37 but feel like I'm 80. Carlos, Why not get a Semen culture and see if there is really and bacteria? Get a PCR-based Chlamydia test. Most labs perform this test. It usually requires a urine sample. And is pretty accurate. Mak >Why not get a Semen culture and see if there is really and bacteria? Hey, I'd love to! I've learned by painful experience the dangers of mindlessly eating antibiotics (including my partly fading cipro-induced joint pains); so why not get a semen culture done first. Makes sense. BUT HOW? I apologize for being so lame about this, but I've seen 6 urologists already (including one winner of "best doctors of the year" award, and another at one of New York's most prestigious hospitals). Chlamydia is THE MOST COMMON cause of epididymal pain, but I have to beg for even quickie urine tests -- let alone the semen test you mention. Who in New York City will do a semen test? Why have the 6 uros so far NOT done it? Why did NONE of them even suggest an EPS test? [whine mode /off] [sorry! but I am frustrated]. I know there's a lot of (justified) skepticism here about antibiotics, but they made me dramatically better, but not cured. And I had sweating and back pain and other things that suggest infection. The idea I have some infection is at a minimum not crazy. >Get a PCR-based Chlamydia test. Most labs perform this test. >It usually requires a urine sample. And is pretty accurate. I had some sort of urine test -- but I don't know if it was PCR, and I was on Cipro at the time. I also have a swab test pending, but since whatever I have involves no discharge, chlamydia (if I have it) is presumably not urethral. Difficult to believe the swab contained anything. {THAT quack told me if I had no discharge I could not have chlamydia which is black-book plain 100% wrong. Who is nuts: me or every doctor I've seen so far?} Feel free to call me an idiot -- if you have suggestions. I'm obviously doing something wrong. What is it? - Carlos > >Why not get a Semen culture and see if there is really and bacteria? > [quoted text clipped - 37 lines] > > - Carlos Carlos, Hey, its okay man. Ummm I dont know if the health-care system changes that dramatically between states. I dont know what kind of health care you have. However, urinalysis/urine culture and semen culture are fairly routine tests. If your doctor is not doing the STD tests for you, you know what? Go to a FREE STD Clinic. They will do testing for you that includes urine and swab tests. I am not sure if they do Semen. Best of luck, Mak > > >Why not get a Semen culture and see if there is really and bacteria? > > [quoted text clipped - 54 lines] > > Mak Good suggestion Mak but he already had one done for chlamydia and it came back negative. The specialists know common variety chlamydia and they know chronic prostatitis. >Mak but he already had one done for chlamydia and it came back negative. 9 months, 5 (or 6? I forget) urologists, and not one did an EPS, and not one did a semen culture. None did a chlamydia culture until I begged for one, and then they did a swab test despite the fact I do not have urethral discharge. The results have not come back yet. You don't see a problem there? > The specialists know common variety chlamydia and they know >chronic prostatitis. The 5 (or 6?) urologists I have met -- including one at Columbia Presb. and one a "doctor of the year" per New York Magazine -- could not find a testicle if they were force fed one. Among their statements: 1. Cipro kills chlamydia (wrong) 2. Chlamydia cannot be present if there is no urethral discharge (wrong) 3. Chlamydia cannot be tested while the patient is taking Cipro. 4. If Cipro doesn't cure epididymitis, no antibiotic will (wrong) 5. Zithromax is not the drug of choice for epididymal chlamydia because it does not penetrate. Only Doxycycline is indicated (wrong) 6. Sometimes prostatitis takes a long time to cure -- 2 months or 3 months or 4 months of Cipro, whatever it takes (maybe, but they should have added that joint pains and other serious sometimes irreversible side effects are almost inevitable when you take Cipro for such durations). 7. I should take Flomax (maybe, but I have no urinary frequency or voiding problems, and I was previously prescribed Uroxatral for 3 weeks without benefit -- the uro should have known that Uroxatral and Flomax are both alpha blockers, and both may reduce prostate spasm, and if one didn't work the chance the other will is small -- I'm just being led in circles). 8. I must have cancer (and oh they are sooooooooo disappointed when PSA after PSA while I am on antibiotics is very very low -- 0.6). Why has no one suggested I get an EPS? Why has no one suggested TRUS? Why did *I* have to beg for a testicular sonogram when months of Cipro did not improve my epididymitis? (it revealed non-vascular cysts and swelling but no other abnormality). Uro after Uro after Uro seems not to order even the basic tests, and it has taken me 9 months of intense pain, sitting with ice cubes on my balls, and Internet purchased Tramadol for me to figure out just how poor my medical advice has been. Anyone know any urologist in the New York area who is not COMPLETELY incompetent as the record above suggests? - Carlos > >Mak but he already had one done for chlamydia and it came back negative. > > 9 months, 5 (or 6? I forget) urologists, and not one did an EPS, and not one > did a semen culture. All come back negative anyways. True bacterial prostatitis shows up in the urine culture so no need to do semen cultures or EPS. They use broad spectrum antibiotics anyways early on. None did a chlamydia culture until I begged for one, and > then they did a swab test despite the fact I do not have urethral discharge. > The results have not come back yet. Chlamydial cultures are worthless as PCR is more accurate and you do not need a discharge ie white cells. The chlamydia infect other cells and they shed the DNA through the genital urethral passage way. > You don't see a problem there? > [quoted text clipped - 4 lines] > a "doctor of the year" per New York Magazine -- could not find a testicle if > they were force fed one. Among their statements: Then go to a chiropractor. > 1. Cipro kills chlamydia (wrong) Yes it does most of the time only rare is it that it won't because of resistance and it is a regional thing that area doctors are well aware of the strain that is in their community as public health newsletters tell them exactly where those strains are at. There are treating protocols as to what antibiotic to use in certain regions based on this. > 2. Chlamydia cannot be present if there is no urethral discharge (wrong) That is also a true statement meaning that some discharges are not very noticeable and sometimes you see very small stains on shorts if at all. They are asymptomatic and do not notice anything wrong most of the time. > 3. Chlamydia cannot be tested while the patient is taking Cipro. PCR based testing is used because it does not rely on chlamydial cultures which are not reliable as the bug is dead before it can grow in culture. PCR yes and cultures are no. > 4. If Cipro doesn't cure epididymitis, no antibiotic will (wrong) Cipro is a broad spectrum antibiotic with activity against a large number of bacteria. If a culture or PCR proven pathogen is detected then resistance can be taken into account. When no organism is detected then that is a correct statement. > 5. Zithromax is not the drug of choice for epididymal chlamydia because it > does not penetrate. Only Doxycycline is indicated (wrong) Doxycycline can be used to treat chlamydia without complications in those not resistance to it. Antibiotic use is regional based on community epidemiological studies. What to use is based on where you live. > 6. Sometimes prostatitis takes a long time to cure -- 2 months or 3 months or 4 > months of Cipro, whatever it takes (maybe, but they should have added that > joint pains and other serious sometimes irreversible side effects are almost > inevitable when you take Cipro for such durations). They are not saying that now and if you tell people every single reaction one gets to antibiotics then no one will take them. They shouldn't be taking antibiotics for 2 months. > 7. I should take Flomax (maybe, but I have no urinary frequency or voiding > problems, and I was previously prescribed Uroxatral for 3 weeks without benefit > -- the uro should have known that Uroxatral and Flomax are both alpha blockers, > and both may reduce prostate spasm, and if one didn't work the chance the other > will is small -- I'm just being led in circles). He didn't tell you about the side effects of alpha blockers? > 8. I must have cancer (and oh they are sooooooooo disappointed when PSA after > PSA while I am on antibiotics is very very low -- 0.6). Too bad you missed out on biopsy. > Why has no one suggested I get an EPS? OK it is normal or no it shows a lot of white cells. So what. > Why has no one suggested TRUS? OK you have calcium deposits there and they do surgery to rid the stones and then the bugs are already resistant to everything after your 2 months of antibiotics. > Why did *I* have to beg for a testicular sonogram when months of Cipro did not > improve my epididymitis? (it revealed non-vascular cysts and swelling but no [quoted text clipped - 9 lines] > > - Carlos >> 1. Cipro kills chlamydia (wrong) > >Yes it does most of the time only rare is it that it won't because of >resistance and it is a regional thing Okay, doc, let me educate you. [1] Cipro is not effective against chlamydia [2] Cipro induces resistance in chlamydia [1]================================= www.emedmag.com/html/pre/fea/features/011501.asp One exception, however, is ciprofloxacin, which is not reliably active against C. trachomatis and C. pneumoniae. [2]================================= http://www.prostatitis.org/ciprochlamydia.html Persistence of Chlamydia trachomatis Is Induced by Ciprofloxacin and Ofloxacin In Vitro Antimicrobial Agents and Chemotherapy December 2000, p. 3288-3297, Vol. 44, No. 12 =================================== >> 4. If Cipro doesn't cure epididymitis, no antibiotic will (wrong) > >Cipro is a broad spectrum antibiotic with activity against a large number of Please see above. Cipro does not cure chlamydia. Zithromax and doxycline are the drugs of choice. Now you know. >> 6. Sometimes prostatitis takes a long time to cure -- 2 months or 3 months or 4 >> months of Cipro, whatever it takes (maybe, but they should have added that >> joint pains and other serious sometimes irreversible side effects are >>almost inevitable when you take Cipro for such durations). > >They are not saying that now and if you tell people every single reaction >one gets to antibiotics then no one will take them Maybe no one should take them for 3 months. At the very least, the doctor had a duty to warn me that joint pains were likely, and might not be reversible (I've read papers that suggest at 3 months of Cipro 67% experienced side effects from them). > They shouldn't be taking antibiotics for 2 months. Doctor's fault -- he PRESCRIBED THEM for that long. He would have had me take them longer , if the severe side effects hadn't started. >He didn't tell you about the side effects of alpha blockers? He did not. I actually mentioned I heard that Flomax caused retrograd ejaculation. He agreed, and prescribed Uroxatral instead. No other side-effects were mentioned. I told him repeatedly I had no urinary frequency or voiding problems, but when I returned after 3 weeks and did a flow test he said "well! I guess that Uroxatral really helped!" I said "but I never had frequency or voiding problems". So he agreed I didn't need an alpha-blocker. (if he for a minute intended the uroxatral for its anti-spasm effects, he never said so). >> 8. I must have cancer (and oh they are sooooooooo disappointed when PSA after >> PSA while I am on antibiotics is very very low -- 0.6). > >Too bad you missed out on biopsy. I don't understand that comment. Are you saying I should get one? Would not a TRUS reveal tumors -- and should not a TRUS be done to see if there is anything to biopsy? >> Why has no one suggested I get an EPS? >OK it is normal or no it shows a lot of white cells. So what. Are you saying that EPS is pointless? Is that the mainstream view? >> Why has no one suggested TRUS? >OK you have calcium deposits there and they do surgery to rid the stones and >then the bugs are already resistant to everything after your 2 months of >antibiotics. Are you saying a TRUS is pointless? Are you saying removing stones is pointless? Are you like the rest: take Cipro, and if it doesn't work after 4 weeks, go to hell? In fact, I am in hell, but I would like to leave, please. - Carlos > >> 1. Cipro kills chlamydia (wrong) > > [quoted text clipped - 8 lines] > [1]================================= > www.emedmag.com/html/pre/fea/features/011501.asp Like your article says" Resistance to fluoroquinolones increasing, especially in Asia and Cleveland, Ohio; provide treatment for concomitant Chlamydia infection." Are you from Cleveland, Ohio? Cipro was the drug of choice until more resistant strains came into being. That does not mean all strains are resistant only a safe guard in case one is. Repeat after me. There is no antibiotic that can kill all bacteria. There are bacteria that are resistant to all antibiotics. That does not mean all antibiotics are worthless. Here is the recommendations http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=3239&nbr=2465 Where does it say 2 months treatment? Notice the diagnostic workup and positive findings involved. Here is an article in which proves the point that recommendations change based on the prevailing regional susceptibility. Eur Urol. 2004 Oct;46(4):522-5. Related Articles, Links Management of acute epididymitis: are European guidelines being followed? Drury NE, Dyer JP, Breitenfeldt N, Adamson AS, Harrison GS. Department of Urology, Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 5DG, UK. Objective: Acute epididymitis is increasing in men aged 35 years or under due to sexually-transmitted Chlamydia trachomatis. This study examines whether Urological surgeons are following European guidelines for the management of acute epididymitis in these patients. Methods: A postal questionnaire survey was conducted of specialists in Urology in two regions of the UK. Results: Of 79 completed replies, 41 (52%) take a detailed sexual history but only 34 (43%) refer patients to a Genitourinary medicine clinic. Quinolones are the most commonly prescribed first-line antibiotic by 56 (71%) respondents, principally ciprofloxacin. Conclusions: The current management of acute epididymitis in young men must be improved. Ciprofloxacin is not the optimal antimicrobial for the treatment of urogenital chlamydial infection. We recommend that all such patients be referred to local Genitourinary medicine services for contact-tracing and treatment of their sexual partners. PMID: 15363571 [PubMed - in process] >Cipro was the drug of choice until more resistant strains came into being. which sounds kinda dumb, or maybe you didn't read that second citation about cipro inducing persistence. I have not seen a single citation that supports your contention that Cipro was ever justifiably the drug of choice against chlamydia. >Repeat after me. There is no antibiotic that can kill all bacteria. There >are bacteria that are resistant to all antibiotics. That does not mean all >antibiotics are worthless. DUH. That is exactly my point! Rather than bash my ligaments for months with Cipro, the urologists might have tried something else -- you know, like Zithromax, which is unequivocally the drug of choice against epididymitis. Instead, all 5 basically said "If Cipro didn't work, we have no more suggestions. Try meditition" (!) >Where does it say 2 months treatment? Notice the diagnostic workup and >positive findings involved. Tell that to my 5 urologists. They would have kept me on Cipro without stopping indefinitely until the symptoms stopped. That was not my idea. >Ciprofloxacin is not the optimal antimicrobial for the treatment of >urogenital chlamydial infection. well, well. You claim to disagree with me, and they provide me with more ammunition that my quintet of urologists deserve the firing squad. Thanks. note that the article you identified also states this: "Failure to improve within 3 days of the initiation of treatment requires reevaluation of both the diagnosis and therapy. Swelling and tenderness that persist after completion of antimicrobial therapy should be evaluated comprehensively. The differential diagnosis includes tumor, abscess, infarction, testicular cancer, tuberculosis, and fungal epididymitis." 3 days! WELL MY EPIDIDYMITIS HAS BECOME WORSE OVER 9 MONTHS. It was only at month 7 that I got a testicular sonogram because I begged for it. Certainly tuberculosis and fungal epididymitis have not been considered in my case. - Carlos > >Cipro was the drug of choice until more resistant strains came into being. > > which sounds kinda dumb, or maybe you didn't read that second citation about > cipro inducing persistence. I have not seen a single citation that supports > your contention that Cipro was ever justifiably the drug of choice against > chlamydia. > >Repeat after me. There is no antibiotic that can kill all bacteria. There > >are bacteria that are resistant to all antibiotics. That does not mean all [quoted text clipped - 5 lines] > Instead, all 5 basically said "If Cipro didn't work, we have no more > suggestions. Try meditition" (!) Int J Antimicrob Agents. 2004 Mar;23 Suppl 1:S79-82. Related Articles, Links Azithromycin treatment follow-up: antibacterial susceptibility of Chlamydia trachomatis in patients with chronic prostatitis. Smelov V, Krylova T, Smelova N, Norman L. Department of Microbiology, St Petersburg State Medical University, St Petersburg, Russia. vsmelov@hotmail.com The antibacterial susceptibility of Chlamydia trachomatis in 138 patients with chronic prostatitis (CP) and clinical failures after antibacterial treatment with azithromycin (AZI) were investigated. Azithromycin was not found to be top-of-the-line drug in the follow-up treatment, showing only average results in vitro. The investigation of the susceptibility of chlamydia to antibiotics in causes of chronic prostatitis is highly recommended. PMID: 15037332 [PubMed - indexed for MEDLINE] > >Where does it say 2 months treatment? Notice the diagnostic workup and > >positive findings involved. > > Tell that to my 5 urologists. They would have kept me on Cipro without > stopping indefinitely until the symptoms stopped. That was not my idea. Comparison of first void urine and urogenital swab specimens for detection of Mycoplasma genitalium and Chlamydia trachomatis by polymerase chain reaction in patients attending a sexually transmitted disease clinic. Jensen JS, Bjornelius E, Dohn B, Lidbrink P. Mycoplasma Laboratory, Department of Respiratory Infections, Meningitis, and Sexually Transmitted Infections, Statens Serum Institut, Copenhagen S, Denmark. jsj@ssi.dk OBJECTIVE: The objective of this study was to compare urogenital swab specimens and first void urine (FVU) specimens from male and female patients at a sexually transmitted disease clinic for the detection of Mycoplasma genitalium and Chlamydia trachomatis infections using in-house, inhibitor-controlled polymerase chain reaction (PCR). STUDY DESIGN: Urethral swabs and FVU were collected from 1856 men and 753 women who also had a cervical swab collected. A positive diagnosis of infection was made if any 1 of the specimens tested positive and were confirmed in a second PCR assay targeting independent genes. RESULTS: M. genitalium DNA and C. trachomatis DNA were detected in 126 (6.8%) and 246 (13.3%) of the male sample sets and in 51 (6.8%) and 73 (9.7%) of the female specimen sets, respectively. Using our in-house PCR and sample preparation methods, FVU was found to be the most sensitive diagnostic specimen for both pathogens, but for optimal sensitivity, it should be supplemented with a cervical specimen in women. In a small subset of female FVUs, storage at -20 degrees C led to false-negative M. genitalium PCR results in 27% of specimens found positive when a sample preparation was performed before freezing. The age-specific prevalence of M. genitalium in men was almost constant between 18 and 45 years of age in contrast to C. trachomatis infections, which were more common in younger men. CONCLUSION: Urine appeared to be a better diagnostic specimen than the urethral swab for M. genitalium and C. trachomatis detection by PCR in this cohort of sexually transmitted disease clinic attendees but should be supplemented with a cervical specimen in women. Publication Types: Evaluation Studies PMID: 15273584 [PubMed - indexed for MEDLINE] > >Ciprofloxacin is not the optimal antimicrobial for the treatment of > >urogenital chlamydial infection. [quoted text clipped - 19 lines] > > - Carlos > >Why not get a Semen culture and see if there is really and bacteria? > [quoted text clipped - 30 lines] > I could not have chlamydia which is black-book plain 100% wrong. Who is nuts: > me or every doctor I've seen so far?} How did you get the chlamydia if not urethral in origin in the first place? Answer most people with chlamydia only require a urethral swab for positive findings on PCR based testing. If most people with chlamydia had a propensity for the prostate only, then that would not be the case. Are you saying you had a discharge early on in the course and then it became prostatic or are you saying that you never had a discharge? So you are saying that you never had a discharge and never had symptoms of chlamydial infection and never had a postitive chlamydial test and you then conclude that the doctor is a quack. > Feel free to call me an idiot -- if you have suggestions. I'm obviously doing > something wrong. You are an idiot if 5 doctors say you don't have chlamydia and you still think you do. > What is it? I know what it's not. > - Carlos > How did you get the chlamydia if not urethral in origin in the first place? What I know is this: - a great percentage (around 50%) of epididymitis is believed to be caused by chlamydia - chlamydia can occur without symptoms, or without urethral symptoms - Cipro does not cure chlamydia. At least one study says Cipro causes chlamydia to persist. Do you deny those facts? If not, consider: - I have been diagnosed with epididymitis - for 9 months no one suggested that I get tested for chlamydia - at month 6 doctors decided to ask me to try Cipro, and I tried it for 3 months. They never told me that joint pains were a likely side effect with such prolonged use. And you're telling me you don't see a problem? > Answer most people with chlamydia only require a urethral swab for positive > findings on PCR based testing Recall that chlamydia can occur without urethral discharge. What's the chance in that circumstance that a urethral swab will be effective to test? > Are you saying you had a discharge early on Never had a urethral discharge. Still don't. One uro told me this proves I cannot possibly have had chlamydia. That's a black letter, blatant, please-put-me-in-jail-now mistake. How come I know that, and a specialist in the field does not? Epdidymal chlamydia is well recognized, as is the fact it can spread to the prostate -- all without urethal discharge. > infection and never had a postitive chlamydial test and you then conclude > that the doctor is a quack I had a condition (epididymitis) that in 50% or so cases is said to be caused by chlamydia, and not one of the 5 uros suggested a test for chlamydia. Instead the prescribed the one antitiobic that not only does not kill chlamydia, but may cause it to persist. You begin to see the problem? I'm not saying I have chlamydia. I'm saying it was crazy to go 9 months to several doctors of the year and not to get tested for it -- and not to have an EPS test of ANY kind. I pay over $500/month for medical insurance for just me, but I only get to see bums. Why? > You are an idiot if 5 doctors say you don't have chlamydia and you still > think you do. >> What is it? > I know what it's not. You must be a urologist. You can't listen, and you don't know the simplest rules about the major cause or treatment of one of the diseases supposedly within your speciality. - Carlos > > How did you get the chlamydia if not urethral in origin in the first place? > > What I know is this: > > - a great percentage (around 50%) of epididymitis is believed to be caused by > chlamydia Which has classic symptoms of chlamydia besides epididymitis and gives positive chlamydia testing. > - chlamydia can occur without symptoms, or without urethral symptoms So now you are saying that you do not have any symptoms? Yes, that is true most don't know they have chlamydia as symptoms are not always there and they have positive testing. So to you then if you don't have symtoms then that proves you have chlamydia. > - Cipro does not cure chlamydia. At least one study says Cipro causes > chlamydia to persist. So now you are saying that you have chlamydia, with no symptoms, that can not be tested for, and that Cipro does not work when taken. > Do you deny those facts? If not, consider: > > - I have been diagnosed with epididymitis If you have symptoms of chlamydial infection severe enough to cause epididymitis then you are surely infected enough to get a postive result for testing. epididymitis and chlamydia symptoms are not synonymous. > - for 9 months no one suggested that I get tested for chlamydia > > - at month 6 doctors decided to ask me to try Cipro, and I tried it for 3 > months. They never told me that joint pains were a likely side effect with > such prolonged use. And prolonged use is needed for chlamydial testing negative patients that have severe symptoms? Maybe you have the type of chlamydia that no one can test for and that no antibiotics work for? > And you're telling me you don't see a problem? The problem is see is that they treated you for chlamydia and that it didn't work so what is the next move? > > Answer most people with chlamydia only require a urethral swab for positive > > findings on PCR based testing > > Recall that chlamydia can occur without urethral discharge. What's the chance > in that circumstance that a urethral swab will be effective to test? Chlamydia does not infect the white cells or the discharge. Chlamydia infects the epithelial cells and as a matter of fact you want to get rid of the exudate and only use non pus swabs. They have urine testing that does not need urethral swabing. > > Are you saying you had a discharge early on > [quoted text clipped - 3 lines] > the field does not? Epdidymal chlamydia is well recognized, as is the fact it > can spread to the prostate -- all without urethal discharge. Chlamydia spreads through the urethra if at all. Just because you do not notice ie asymptomatic, does not mean you did not have infection ie an unnoticeable discharge. > > infection and never had a postitive chlamydial test and you then conclude > > that the doctor is a quack [quoted text clipped - 10 lines] > EPS test of ANY kind. I pay over $500/month for medical insurance for just me, > but I only get to see bums. Why? Because they have experience in testing EPS and found it to be useless. Why test for something to only keep on taking antibotics. Just take every antibiotic known to man and forget about testing. > > You are an idiot if 5 doctors say you don't have chlamydia and you still > > think you do. [quoted text clipped - 6 lines] > > - Carlos Not a urologist only trying to see the problem with people like you who go in to a doctors office and then start saying things like I know I have chlamydia but I have no symptoms directly related to chlamydia and you can never find any chlamydia and every antibotic used to treat chlamydia does not work. You are and idiot doctor as I know I have chlamydia and you are a quack. See how stupid that sounds. >> - a great percentage (around 50%) of epididymitis is believed to be >>caused by chlamydia > >Which has classic symptoms of chlamydia besides epididymitis and gives >positive chlamydia testing. Wrong. Chlamydia often has NO symptoms. Of its many possible symptoms, a patient may have some, but not others. Epdidymitis itself -- without urethal discharge, without Reiters -- alone raises the strong possibility of Chlamydia. Here, learn something: "Urethral discharge may precede acute epididymitis by more than 30 days ***or*** may not occur at all" http://www.emedicine.com/med/topic704.htm Here's another: "BRIAN BOYLE, MD: I think it's important to make that distinction which is that the symptoms can be like many other types of infections. They may be frequent urination or pain with urination. There may be discharge; there may not be discharge" http://coolnurse.healthology.com/webcast_transcript.asp?f=sexual_health&c= infect_chlamydia&spg=FIP So the statement by one of my quintet of urologists that "I cannot have chlamydia because I do not have urethral discharge" is WRONG. Epididymitis ALONE is enough to raise the strong possibility of chlamydia. I never said I had chlamydia, but it would have been nice if one of the quacks thought to do a test. - Carlos > >> - a great percentage (around 50%) of epididymitis is believed to be > >>caused by chlamydia [quoted text clipped - 11 lines] > "Urethral discharge may precede acute epididymitis by more than 30 days > ***or*** may not occur at all" http://www.emedicine.com/med/topic704.htm "Obtain a urethral swab culture (before void, after prostate massage) for gonorrheal and chlamydial infections if the patient is in the right age group or if the patient is older than 40 years and not monogamous." > Here's another: > [quoted text clipped - 13 lines] > > - Carlos |
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