Enterococcus: Its Role in Chronic Prostatitis and Oral Sex Risks

What is Enterococcus doing in the prostate? I am a patient with chronic prostatitis?

In September 2017, my then-girlfriend performed oral sex on me without brushing her teeth before bed and upon waking up.
I could clearly smell a strong odor, and that day I experienced pain in my urethra.
Later, I developed a high fever and was diagnosed with acute bacterial prostatitis, which subsequently turned into a chronic condition.
By June 2018, I felt completely recovered.
In June 2019, with a new girlfriend, during oral sex, she continuously licked the opening of my urethra, which made me feel very uncomfortable and painful.
Even after I asked her to stop, she continued for a short while.
After the sexual activity, I experienced pain again and was diagnosed with bacterial prostatitis once more.
It was later identified as Enterococcus, but despite over a year of treatment, I have not healed.
In January 2021, I decided to change doctors, and as of February 2021, I still have not recovered.
1.
I would like to ask the doctor if the second occurrence of prostatitis is a continuation of the first or if it is a new condition purely caused by oral sex?
2.
During the first episode of bacterial prostatitis, no specific bacteria were identified.
In the second episode, both urology clinics identified "Enterococcus." Could Enterococcus have invaded the prostate through oral sex, or could there be other reasons? Is it possible for the oral cavity to cause an Enterococcus infection?
3.
Given that both episodes of my condition seem clearly related to oral sex, would the doctor recommend that I refrain from engaging in oral sex in the future?
4.
My current doctor has prescribed me two types of antibiotics.
He mentioned that my Enterococcus does not show antibiotic resistance.
Therefore, he prescribed "Penicillin" (out-of-pocket) and "Ciprofloxacin." However, I had already been on antibiotics for quite a long time before.
I read online that it takes about six months for antibiotics to penetrate the prostate effectively, yet it has been 20 months since my second episode, and I've been on antibiotics for nearly 20 months with no effect.
Did my previous doctor prescribe the wrong medication? What is the current effectiveness of the treatment? It has been three weeks since I changed doctors, and I still experience some pain.
5.
This year, I found a new doctor and underwent out-of-pocket extracorporeal shock wave therapy, but so far, after three weeks, I have not noticed any significant changes.
What is the efficacy of extracorporeal shock wave therapy? How much benefit can it provide for patients with bacterial prostatitis?
I apologize for asking so many questions, and I would greatly appreciate your help in clarifying these issues.
Thank you very much.

Nìmíng, 40~49 year old female. Ask Date: 2021/02/07

Dr. Li Xinyi reply Urology

Enterococcus is widely distributed in various locations, including the oral cavity and gastrointestinal tract.
It can cause urinary tract infections and even prostatitis, which are not uncommon.
The problem is that, generally speaking, it has a strong resistance to antibiotics.
Given your situation, your immune system seems to be struggling against it, which is why it is difficult to treat.
It sounds like oral medications have become ineffective; if you are experiencing symptoms, hospitalization for intravenous antibiotics may be necessary.
Regarding sexual activity, it is advisable to drink plenty of water before intercourse and to urinate afterward.
Continuous friction at the urethral opening can lead to wound infections, so it should be avoided.
Alternatively, you may consider taking oral antibiotics before and after sexual activity.
If that doesn't work, using condoms throughout the entire process may be the only option left.

Reply Date: 2021/02/07

More Info

Understanding Enterococcus and its Role in Chronic Prostatitis
Chronic prostatitis is a complex condition that can be influenced by various factors, including bacterial infections. Enterococcus, a type of bacteria commonly found in the gastrointestinal tract, has been implicated in some cases of prostatitis, particularly when there is a history of urinary tract infections or other urogenital issues. Your experience with acute bacterial prostatitis followed by a chronic condition raises several important questions regarding the relationship between oral sex, Enterococcus, and the management of your symptoms.

1. Relationship Between Initial and Subsequent Infections: The first episode of acute bacterial prostatitis could have been caused by a variety of bacteria, and without identifying the specific organism, it is difficult to determine if the second episode is a continuation of the first or a new infection. The fact that you developed symptoms after oral sex with a partner who had poor oral hygiene suggests that there could be a link, but it is also possible that the second infection was due to a different source or a reactivation of the initial infection.

2. Enterococcus and Oral Transmission: Enterococcus is not typically found in the oral cavity; however, it can be introduced into the urogenital tract through various means, including sexual activity. While it is less common for oral bacteria to cause prostatitis, the act of oral sex can introduce bacteria from the mouth to the urethra, potentially leading to infection. It is important to note that the presence of Enterococcus in your prostate does not necessarily mean it originated from oral sex, as it could also be a result of other factors, such as a urinary tract infection.

3. Considerations for Oral Sex: Given your history of prostatitis and the association you have made with oral sex, it may be prudent to discuss with your healthcare provider whether to avoid this practice until your condition is fully resolved. Open communication with sexual partners about hygiene and health can also help mitigate risks.

4. Antibiotic Treatment and Efficacy: The treatment of Enterococcus infections can be challenging due to the potential for antibiotic resistance. If you have been on antibiotics for an extended period without improvement, it is possible that the initial treatment regimen was not effective against the specific strain of Enterococcus you are dealing with. It is crucial to work closely with your healthcare provider to ensure that the antibiotics prescribed are appropriate for your specific infection. If symptoms persist, further evaluation, including culture tests to determine antibiotic sensitivity, may be necessary.

5. Extracorporeal Shock Wave Therapy (ESWT): This treatment modality is sometimes used for chronic prostatitis and may help alleviate symptoms by promoting blood flow and reducing inflammation. However, the effectiveness of ESWT can vary from patient to patient. While some individuals report improvement, others may not experience significant changes. It is essential to have realistic expectations and to continue monitoring your symptoms in collaboration with your healthcare provider.

In conclusion, your situation is multifaceted and requires a comprehensive approach to treatment. It is essential to maintain open communication with your healthcare provider, adhere to prescribed treatments, and consider lifestyle modifications that may help reduce the risk of future infections. If you have ongoing concerns or if your symptoms do not improve, seeking a second opinion or further specialized care may be beneficial. Your health and well-being are paramount, and addressing these issues proactively can lead to better outcomes.

Similar Q&A

Understanding Enterococcus Infections: Arthritis, Neuropathy, and More

Hello Dr. Liao: I have seen many doctors without improvement in my condition, so I am here to seek your advice regarding my medical history: Last August, I was diagnosed with prostatitis and took broad-spectrum antibiotics, specifically tetracycline, for one month with no effect....

Dr. Liao Zhongxin reply Internal Medicine
Dear readers, Recently, there have been reports of an increase in cases of vancomycin-resistant enterococci (VRE) infections in hospitals in Hong Kong. Once infected, treatment can be very challenging, with a mortality rate as high as 30%. This outbreak has quickly garnered publ...

Chronic Prostatitis Caused by Enterococcus: Treatment Challenges and Insights

Hello Doctor, I have been diagnosed with chronic prostatitis (Enterococcus faecalis). I have been undergoing treatment with fosfomycin for a month, but it seems there hasn't been much improvement; the bacterial culture of my semen still shows bacteria. Additionally, I feel t...

Dr. Chen Jiansheng reply Urology
Please seek medical attention.

Understanding Enterococcus in Prostate Infections: Seeking Urology Expertise

Hello, Doctor: ... I'm back again @@ Over the past three months, I've seen more than 10 doctors in various hospitals. I've taken a bunch of antibiotics (broad-spectrum antibiotics, tetracycline, and injected third-generation cephalosporins) with no effect... I'...

Dr. Sun Hongshun reply Urology
Hello, I apologize for not being able to specify a particular physician. Please visit the urology outpatient department at a large medical center in the northern region. Based on what you have described, I believe they will provide you with appropriate examinations and treatment....

Chronic Prostatitis and Semen Analysis: Understanding Bacterial Findings

Hello, Doctor. Due to frequent urination, prolonged waiting time to urinate, and lower abdominal pain after masturbation around mid-September, I sought medical attention. Urinalysis, uroflowmetry, and abdominal ultrasound were performed, all of which returned normal results, and ...

Dr. Du Shixi reply Urology
Hello: The information provided here is for reference only and cannot replace a physician's examination, testing, or diagnosis. 1. Is it possible that the presence of Staphylococcus epidermidis was due to improper cleaning before the sample collection (only disinfecting th...