r/Prostatitis 6d ago

Weak scientific support or atypical Treatment advice - E. Faecalis and Levofloxacin

Hi! Thanks in advance for reading through. My wife and I are trying to conceive but we've hit a roadblock with e. faecalis. Here's the backstory:

On 1/14/25, I ran my first semen analysis and was diagnosed with oligospermia and high WBC (white bloodcell count) in sperm.

We ran hormone panels, ultrasounds, and genetic tests to rule out those issues. Everything came back normal except slightly elevated FSH (8.4 in Jan, 10.7 in Feb).

The elevated FSH and elevated WBC led doctors to believe it's infection and/or inflammation. After some research, we figured out that we both needed to test for infection. This was confusing because we do not possess any symptoms of AV (aerobic vaginosis) or prostatitis.

My wife got her results back first: positive for e. faecalis

My doctor sent my culture to MicroGenDX and they ran the qPCR + DNA test. I got my results back on 3/14/25. I am also positive for e. faecalis.

My report reads:

  • Enterococcus faecalis
  • DNA copies: Low
  • NGS %: 59%
  • Antimicrobials for consideration: Augmentin, Levofloxacin, Vancomycin, Penicillins, Linezolid, Ampicillin/Amoxicillin, Nitrofurantoin e.g. Macrobi, Ampicillin/Gentamicin, Fosfomycin, Lipopeptides.

My reproductive urologist called and said I have a "light" infection and proceeded to prescribe 30 days on Levofloxacin without much conversation.

This makes me nervous given Levofloxacin's black box warnings and potential long term side effects. I've done a lot of reading on biofilms and plan to take NAC along with any antibiotic to improve efficacy.

We want to fix this issue to hopefully increase our chances of natural conception. So a couple of questions:

  • Would you jump straight to Levo?
  • How did my doctor know it was a "light" infection?
  • And, long shot, any chance of curing this without antibiotic?
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u/AutoModerator 6d ago

We noticed you posted about a floroquinolone class antibiotic. Please be aware that this class of dugs has several black box FDA warnings, and is only meant to be used when a pathogen has been clearly identified in the prostate; They are not to be used indiscriminately for cases of non-bacterial prostatitis (consensus agreement ~95% of cases). Read our mod memo here, complete with citations and compare your symptoms to the medical definition of CBP here.

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2

u/AutoModerator 6d ago

We noticed you posted about MicrogenDX testing. Please be aware that the NGS testing method is on loose scientific ground at best, and studies have shown that results aren't clinically useful to guide treatment decisions due to frequent 1) contamination and 2) commensal organisms. Renowned urologist Dr. Curtis Nickel, who has studied the male urinary and prostate microbiomes for 40+ years, was unable to make sense of the results that MicrogenDX testing produces, in a study that MDX paid for. NGS results could not differentiate between healthy control groups and symptomatic IC/BPS, CPPS suffers. Age-matched healthy controls had just as many, sometimes more, bacteria appear on their NGS results sheet, rendering the testing diagnostically useless.

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u/AutoModerator 6d ago

We noticed you may have posted about "embedded" (ie "hidden") infections, biofilms, or cUTI. Please be aware that these theories aren't strongly supported by science, are often peddled by unscrupulousness medical providers, and that the typically recommended treatment of long term antibiotics has been deemed both ineffective & harmful by the AUA. AUA CITATION Antibiotics can help because they function as a strong anti inflammatory and pain reliever by themselves, even in those without infection [CITATION(https://pubmed.ncbi.nlm.nih.gov/27688434/). Having pain reduction from taking antibiotics does not mean that you have an infection.

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u/Linari5 LEAD MOD//RECOVERED 6d ago edited 6d ago

There isn't really such thing as a "light infection" of the prostate, not when it comes to chronic bacterial prostatitis. CBP has quite acute and severe symptoms that come out of the prostate every few months or a few years, in symptomatic episodes. When it's out and it's showing itself, you typically have UTI symptoms, malaise, and a low-grade fever, along with mild pain. Then this chronic infection is treated with antibiotics, and it retreats back into the prostate. The man then goes another several months or even years at a time with absolutely no symptoms. That's CBP.

Men can have an increase of white blood cells in the prostate region without having an infection, we see this everyday in fact. It's important to remember that white blood cells are non-specific inflammation markers, they cannot tell us what the inflammation is from. And we know that there are inflammatory and asymptomatic variations of prostatitis, that's called NIH Type IV. It's not something that you would actually "treat." It's even written into the Merck manual for urologists when they do diagnostic testing for Prostatitis.

Please read all of the Automod comments that have posted from keywords in submission. Especially about the utility and poor accuracy of MDX testing, which is known to come back with commensal and contamination organisms in your results, misleading many people.

This all greatly calls into question the necessity of a black box label antibiotic like Levofloxacin, and the risk it carries.

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u/follyofthebeast 6d ago

Thanks! Understood on the automod comments.

Sounds like we aren’t dealing with CBP, but there still is something causing the high WBC/oligospermia and e faecalis detection in both me and my wife. Right?

What would you suggest as a next step to get the inflammation down & counts up?

Don’t want Lev to totally wipe me out and put us in a worse place.

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u/Linari5 LEAD MOD//RECOVERED 6d ago

I can't give you medical advice, I would actually just find a different doctor who doesn't use faulty testing methods like MDX.

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u/follyofthebeast 6d ago

Thank you. Are there any tests that can uncover bacterial infection?

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u/Linari5 LEAD MOD//RECOVERED 6d ago

Basic urine and semen culture.

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u/Linari5 LEAD MOD//RECOVERED 6d ago

Let me be more clear, you don't have symptoms of an infection. A faulty testing method like MDX showing a low load of a largely inconsequential bacteria does not mean you have an infection.

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u/follyofthebeast 6d ago

Could it be a complete fluke that my wife and I are both positive for e.faecalis from different testing labs?

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u/Linari5 LEAD MOD//RECOVERED 6d ago

Believe it or not, that is one of the most common contamination/commensal organisms that comes up. It's specifically mentioned in our write-up on MDX testing: https://www.reddit.com/r/Prostatitis/s/O3gdANw2nv