Regarding the semen/prostate organisms, the media listed as being used for
culture would not easily detect Gardnerella. Enriched chocolate agar would
be helpful. Gardnerella usually appear first as tiny colonies on chocolate
agar (CA) at 24h but may not even appear on blood agar during this period.
By 48h, colonies are larger on CA and are just beginning to appear on blood
agar. If gram negative "poorly staining" rods are appearing microscopically
but are not being cultured, one might consider the following: the
therapeutic regimen in use may have killed the vegetative cells in the
prostate/semen but may not have reached the site responsible for seeding the
prostate...or...we sometimes see Mycobacterium sp. as "ghosts" or poorly
stained rods when using the Gram stain. There are commercial probes
available for M. tuberculosis and M. avium-intracellulare. Depending on
patient history, one might consider these approaches to rule out this remote
possibility.
Ciprofloxacin or norfloxacin has also been used as primary therapy in
acute/chronic prostatis. In chronic cases, only 80% cure was achieved. SXT
(trimethoprim-sulfamethoxazole) has been used in some cases and resulted in
improvement in 3/4, and cure in only 1/3. Clearly, yours is not an easy
case.
My guess is that the coagulase negative staphylococci have little to do
with the infection.
JMM8 at CIDHIP1.EM.CDC.GOV
