Help! Microbiology and sci.med.prostate.prostatitis (long)

John Garst garst at sunchem.chem.uga.edu
Thu Jul 18 15:16:05 EST 1996

[Also posted to sci.med.laboratory]

The newsgroup sci.med.prostate.prostatitis is populated mostly with
prostatitis patients.  However, a few physicians, including at least one
urologist, are regular contributors.  There are no regular contributors,
apparently, who are professional microbiologists.  This is unfortunate for
reasons given below.  If you are a qualified microbiologist, then please
help us out by monitoring sci.med.prostate.prostatitis and lending us your

Chronic prostatitis is an all-too-common disease that can destroy the
quality of life of the sufferer by generating pain (sometimes disabling)
and interfering with urinary and sexual functions.  Using today's
conventional procedures, 95% of chronic cases are classified as
non-bacterial because cultures are negative.  The non-bacterial disease
classifications are "non-bacterial prostatitis" (if there are excess (over
"normal") white blood cells in the expressed prostatic secretion, or EPS)
and "prostatodynia" (no excess WBC).

There are strong indications, however, that some (or perhaps many or even
all) cases of "non-bacterial prostatitis" and "prostatodynia" are really
bacterial infections.  Among these indications are the following: (1) Many
patients obtain temporary symptomatic relief from empirical antibiotic
therapy.  (2) Many patients' first episodes were bacterial.

Dr. A. E. Feliciano, Jr., Manila, Philippines, is a
urologist/microbiologist who has made prostatitis his specialty.  He
claims to cure ("permanently") a large fraction of his patients.  He
believes that the common diagnostic methods currently in use in the U.S.
are flawed, even when the recommended procedures (Meares-Stamey "4 glass
test") are followed meticulously (which is apparently almost never, in
practice).  His explanations are (1) that Meares-Stamey samples are so
dilute in pathogens that they are easily missed in cultures and (2) that
"first-try" urine, EPS, or post-prostate-massage urine samples are taken
to be definitive, whereas frequent, repeated prostate massages are
necessary to open some of the occluded acini and release bacteria and pus
that are not released in the "first try."  Dr. Feliciano finds that WBC
counts in EPS increase dramatically in most patients as the first few
vigorous prostate massages (3x weekly, MWF), he calls them "drainages"
because he attempts to express everything in the prostate, are carried
out.  Bacteria seen in a Gram-stained smears of EPS may also increase.

Dr. Feliciano's therapy consists of antibiotic therapy accompanied by 3x
weekly prostate drainages, tracked by WBC and bacteria counts in
Gram-stained EPS smears, pH of the EPS, cultures of the EPS, and patient
symptoms.  He regards anything that is cultured from the EPS as a
pathogen, and his antibiotic selection is guided by sensitivities.  When
it appears from cultures and Gram stains that all pathogens have been
eradicated, he finishes with anti-fungal therapy (he frequently finds that
yeasts are evident in the Gram stains after a few weeks of antibiotics). 
A cure is declared when there is no evidence of bacteria, yeast, or other
pathogens; the pH of the EPS is acidic; the WBC count approaches zero; and
symptoms have disappeared.  His experience since about 1980 indicates that
cures are permanent except when there is reinfection from a sexual
partner.  In cases where both partners are treated, reinfection appears to
be very rare.

Much of this is dismissed by American urologists, who hold views such as:
(1) Feliciano's WBC count increases are from prostatic trauma.
(2) EPS cannot be cultured successfully.
(3) The normal skin flora cultured from EPS is contamination.
(4) So are the Gram-positive bacteria seen in EPS smears.
(5) The Meares-Stamey procedure was rigorously tested and cannot be invalid.
(6) Diseases of the chronic prostatitis syndrome are multi-faceted and
have multiple origins, with many cases being psychosomatic. 

Against these views are Feliciano's apparent track record.  A study of 35
cases was carried out by a visiting physician, Dr. Brad Hennenfent, who
left convinced of Feliciano's methods.  Two Americans made special trips
to Manila for treatment.  Both returned claiming to be cured.  That was
some months ago.  Both report that they  remain symptom-free.  One, at
least, was on disability from his pain before being treated by Dr.

Dr. Feliciano's methods are now being tested in formal clinical trials. 
These are aimed, however, at establishing their efficacy, not at
understanding all of the details.

We (prostatitis sufferers and sci.med.prostate.prostatitis) need expert
microbiological advice.  Some of us accept everything Dr. Feliciano says
at face value.  Others, even some who seem convinced that his methods
often lead to cures, are skeptical that he is doing exactly what he thinks
he is, especially in the area of identifying pathogens.

Related to this are the findings and claims of Dr. Paul Fugazzotto (Rapid
City, SD).  Dr. Fugazzotto claims to use urine culture techniques that
catch some things that conventional methods might miss.  It is his
experience that in 95% of chronic uro-genital infections (including
prostatitis) the pathogens are Enterococcus or Micrococcus species. 
Interestingly, no Enterococcus or Micrococcus were identified as such by
Dr. Feliciano in the 35 cases surveyed by Dr. Hennenfent.

Who's right?  Who's wrong?  What's going on?


John Garst  garst at sunchem.chem.uga.edu
Laws of Tradition:  (1) Nothing is ever lost.
                    (2) Nothing ever stays the same.

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