To test or not to test (for bacterium in prostatitis), that is the question!
Does testing for bacterium in prostatitis feature in your practice? Once considered the ‘gold standard’ of testing for bacterial prostatitis, the four-glass Stamey test has fallen out of favour in recent years, yet patients are still prescribed antibiotics for symptoms of prostatitis as par for the course. With less than 5% of all cases presenting as bacterial, the pendulum appears to have swung too far in the wrong direction. Quinolone antibiotics still remain the drug of choice in combating the effects of prostatitis (bacterial or not) with limited results at best. So what, if anything has replaced the Stamey glass test? The two-glass or pre-post-massage test (PPMT) has shown 96% accuracy in identifying the presence of bacterium when compared with the four-glass test, yet patients do not receive either.
Patients at The Pelvic Pain Clinic, London (dedicated to treating male pelvic pain, including chronic pelvic pain syndrome and nonbacterial prostatitis), are rarely, if ever, given four- or two-glass tests to confirm the presence of bacteria. They are more likely to be given a semen and/or urine test, yet used alone these tests are not accurate enough to give a clear diagnosis of bacterial prostatitis. On average these patients have had their symptoms for 12 months, seen at least one urologist and had multiple rounds of antibiotics at varying lengths and dosages with little, if any, symptom relief.
Successful treatment of prostatitis has remained elusive to healthcare providers since the earliest recordings of treatment in the 19th Century. Clear and accurate diagnosis of the presence of bacterium is imperative to ensure appropriately tailored care for this group of patients.
Does testing for bacterium feature in your practice? If you do not test, what are the barriers you face in using the tests? Would a UK-wide directory of urologists who carry out these tests be useful?
Your thoughts and wisdom would be appreciated.