Semen! Need help

"Miller, J. Michael PhD ", Mike JMM8 at CIDHIP1.EM.CDC.GOV
Tue Oct 4 06:43:22 EST 1994


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




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