Lab to test antibiotic resistance

[Jkrungthep]

Is there any lab that can do a culture of a specimen and check for antibiotics resistance?

 

I don’t wanna go to one of the big hospitals as I feel they’re not doing a good job handling the specimen. The last time I saw my sample lying in a box on the nurse counter half hour later and all the nurses were busy handling patients. And who knows how long it takes from there to the actual lab then... (and this was already their Infectious Disease department)

 

In another hospital, the doc gave me some glass plates so I could take a sample at home and bring it to the hospital later.

 

Of course, all these cultures never find anything.

 

I went to doctors in Europe where they would put the sample in an incubator immediately, sometimes even in the same room. Does that exist in Thailand? 

Edited January 11, 2020 by Jkrungthep

[Sheryl]

What you describe, probably not. But a short delay before incubating is not going to kill off organisms.

 

What exactly is it you are having cultured? If testing for prostatitis this is very difficult to do.

 

Where in Thailand are you located?

[xylophone]

A specimen can be cultured in the laboratory and then tested for the antibiotics which will be effective against it, thereby ensuring that the wrong antibiotics are not administered.

 

It will take about five days to do this and a good laboratory, and a hospital, have access to the equipment to do these tests.

 

I have had to do this twice with a couple of different infections and one resulted in daily IV injections for 14 days, and the other was treatable by oral antibiotics, but not the "everyday" ones.
 

[Jkrungthep]

23 minutes ago, Sheryl said:

What you describe, probably not. But a short delay before incubating is not going to kill off organisms.

 

What exactly is it you are having cultured? If testing for prostatitis this is very difficult to do.

 

Where in Thailand are you located?

I’m in Bangkok and would like penile discharge to be cultured and tested.
 

I have urethritis symptoms for half year or so with all tests (cultures, NAAT PCR) negative. While in Europe recently, there was one odd NAAT PCR  coming back positive for Gonnorhea, then the one I took two days later came back negative again. Doctors gave antibiotics anyway but they didn’t change anything. Still waiting for the culture results but the doc already said prelim results look like it’s not Gonnorhea. Hospital took swabs for resistance tests before giving the antibiotics, but I had just peed before so I don’t trust those.

 

Either this one odd test was a false positive, or all the other 7 or 8 NAAT PCR tests (incl. 1 MicrogenDX) were false negatives (low bacterial load?) and I have caught a resistant strain. Hope it’s the first but want to make sure. 
 

 

Edited January 11, 2020 by Jkrungthep

[Jkrungthep]

10 minutes ago, xylophone said:

A specimen can be cultured in the laboratory and then tested for the antibiotics which will be effective against it, thereby ensuring that the wrong antibiotics are not administered.

 

It will take about five days to do this and a good laboratory, and a hospital, have access to the equipment to do these tests.

 

I have had to do this twice with a couple of different infections and one resulted in daily IV injections for 14 days, and the other was treatable by oral antibiotics, but not the "everyday" ones.
 

Any recommendations? I went to two of the top notch international hospitals here and made above mentioned experience. 

[xylophone]

23 minutes ago, Jkrungthep said:

Hospital took swabs for resistance tests before giving the antibiotics, but I had just peed before so I don’t trust those.

Yes, that's almost always a problem if someone wants to culture something in the urine, because if you just passed water, then the chances are any infection won't be picked up.

There is an antibiotic resistant strain of gonorrhoea which has reared its ugly head in Thailand, so let's hope you haven't contracted that.

Any of the major hospitals will be able to do it, however as a bit of advice, make an appointment to go and see them and ensure that you don't pass water for a couple of hours (or more) before you get there, just to be sure.

 

Azithromycin and/or doxycycline are regularly administered for chlamydia, if that's what you've got, however more stringent tests need to be carried out to find out exactly what it is, otherwise you will end up like I did when the doctor here kept prescribing different antibiotics without culturing it, and in the end when I insisted on a culture (as I got very sick) it turned out to be treatable by only one of four antibiotics – – and by the way, this infection was hospital-acquired through a bladder inspection!!

[Sheryl]

16 hours ago, Jkrungthep said:

Any recommendations? I went to two of the top notch international hospitals here and made above mentioned experience. 

 

Actually it is not usual to place the specimen instantly in an incubator, even in the best hospitals in the West. It may have occurred where you were treated previously because they happened to have the equipment right there in same room, but much more usually, anywhere in the world, the specimen is transported somewhere else and spends some time at room temperature on the way.

 

This would NOT explain the negative result and is not cause of concern as long as it was properly collected in a sterile container that is not opened or disturbed in transport.

 

Errors in culture specimen handling and transport  do nto usually lead to false negative rather they lead to contamination with multipel organisms growing.

 

To cause a negative growth result due to specimen handling they would have to expose the specimen to extreme heat or freeze it, neither of these at all likeley.

 

You are likely getting negative results for one of these reasons:

 

• There is no bacterial infection present - the condition  is viral, or noninfectious (can have inflammation without infection)
• You have been on antibiotics suppressing bacterial growth (even though perhaps not fully eradicating the infection) to the point that there is no enough to be seen (especially likely in a 48 hour report).
• They are attempting to culture the wrong type of fluid of using wrong technique to obtain the fluid, and/or it is culture of any area known to be very difficult to obtain robust culture from (e.g. prostate).

I think focusing ion finding another lab is likely wrong approach and rather you need a good specialist of the appropriate type or a totally different type of test (not normal culture and sensitivity) . If you would indicate what the problem is, and where you live, I can advise further on that.

[Jkrungthep]

 

Quote

If you would indicate what the problem is, and where you live, I can advise further on that.

I’m in Bangkok. I have urethritis symptoms for more than half year; penile discharge, feeling of itch/tickling/burning/fullness in the penis; frequency and nocturia; sometimes dull aching in the testicles. 
 

I had Doxycycline, Azithromyzin, and Metronidazole, and now (after the positive NG test), Ceftriaxone (IV) and Azithromyzin. 
 

- I did 1 rapid urine test that was negative for CT and NG;
- 6 NAAT PCR tests using first void urine that were negative for CT, NG, Trich, MG, MH, UU, UP;

- 1 NAAT PCR test using first void urine that was negative for CT, NG, and UU; 

- 1 NAAT PCR test using first void urine that was positive for NG and negative for MG and UU; 

- 1 MicrogenDX test that was negative in the PCR part for the same pathogens as mentioned above, and in the NGS part only found three common bacteria that we all have on our skin;

- 2 swab cultures and 2 urine cultures, both negative; still waiting for another swab culture but doctor said prelim results look like “it’s not NG; 

- Ultrasound of bladder, kidneys, prostate, without findings; 

- DRE of prostate without findings; 

- PSA level normal; 

- Residual urine ultrasound with some residual urine after urination; 

- Diabetes blood tests all negative. 
 

I went to two of the big hospitals here to see urologists and ID docs; I saw urologists, ID docs, and a dermatologist while in Europe:

1) The Uros here in Thailand say its irritation and will go away. But more than 6 months? 
2) Three Uros in Europe wanted to give more antibiotics “empirically” but all three a different one targeting a different hypothesis; 

3) Other than that they are baffled and suggest I should consider an MRI using contact dye before maybe a cystoscopy. 
 

The one positive NG test was after all the negative ones and before another one that came back negative. All tests except one were done at least three weeks after taking antibiotics. 

I don’t know how likely it is that 7-8 NAAT PCR tests are false negative and 1 in between is correct, or the other way round...

 

I’ve looked at the whole Prostatitis/CPPS/Interstitial Cystitis thing but don’t seem to match most cases (no prostate pain or golf ball feeling; no bladder pain; mostly lower urinary tract symptoms). 
 

 

Edited January 12, 2020 by Jkrungthep

[Sheryl]

It is not unusual for urethral inflammation to persist for some time after infection is treated. It can also be due to things other than infection e.g. excessive friction from sex (including masturbation) and some soaps.

 

Have you abstained from all sexual activity during this time? That would be important to avoid adding to the irritation. And avoid using soap or use only a really mild soap on your penis.

 

Occasionally urethritis can be due to a virus and this can be hard to diagnose.

 

Sometimes scar tissue can have developed from prior infection causes residual symptoms, this would be readily seen on cystoscopy.

[Jkrungthep]

1 hour ago, Sheryl said:

It is not unusual for urethral inflammation to persist for some time after infection is treated.

But so many months? 
 

1 hour ago, Sheryl said:

Have you abstained from all sexual activity during this time?

I certainly masturbate every other day. 

 

1 hour ago, Sheryl said:

Sometimes scar tissue can have developed from prior infection causes residual symptoms, this would be readily seen on cystoscopy.

Some questions regarding this:

 

1) Would an MRI using contact dye be able to show that? Doctors in Europe suggested I should do that first because it would provide the same or similar outcome but be less invasive.

 
2) Any doctor in Thailand/Bangkok recommended for this? If I go for this, I’d like someone who’s experienced in this and who’s using a flexible (rather than rigid) instrument. 

 

3) Can auch scar tissue be removed or would I risk bigger issues? 

[Sheryl]

Yes for so many months especially since you continue to frequently masturbate.

 

With any part of the body, when there is inflammation, it needs to be rested to allow for healing.  Try to refrain for 2 weeks or so, it may make a big difference.

 

As to your questions:

 

1 - I don't know. Certainly not as good as direct visualization which is what cystoscopy provides.

 

 

2- Any urologist will be experienced in this and flexible cystoscope is what is normally used.   These urologists are  well recommended:

https://www.bumrungrad.com/en/doctors/Charuspong-Dissaranan

https://www.bumrungrad.com/en/doctors/Viroj-Chodchoy

[xylophone]

On 1/12/2020 at 12:44 PM, Jkrungthep said:

I’m in Bangkok. I have urethritis symptoms for more than half year; penile discharge, feeling of itch/tickling/burning/fullness in the penis; frequency and nocturia; sometimes dull aching in the testicles. 

I had the same thing, but for much longer than six months and I thought it might initially be due to a cystoscopy I had, this to look at the bladder/bladder neck.

 

In addition I visited several urologists here and was put on several different antibiotics over time, and just occasionally I would get a few days relief, and then it would be back.

 

I searched and searched and found an article written by a doctor and a professor who were convinced that symptoms such as yours (and mine) could be caused by what they determined was "urethral syndrome" and/or a bacteria which had formed a type of biofilm over it, so that normal antibiotics couldn't touch it.

 

They came up with empirical testing of some antibiotics, and I wrote to them because I was desperate.

 

Luckily enough they answered and suggested that if I wanted to make an appointment to go to see them in London, they would fit me in as they were very interested in treating men in situations like this, which are more common than you think.

 

I was about to do this and happened upon another article doing my research, regarding an old antibiotic which has good penetration of the prostate and also of biofilms, and it is available here, though with a little difficulty, but I did manage to obtain some, and took it over a period of three days, mind you, 3 g per day for three days...............and I was cured, much to my huge relief.

 

I thought it courteous to get in touch with this doctor and Prof and explain what I had done and what I had used, and that I would not be needing an appointment, and their reply was along the lines of, if all of their empirical testing doesn't produce results, then this particular antibiotic is one they turn to and it has had extremely good results.

 

Send me a PM and I will give you further details, however I am very wary of posting something like this for all to see, and I don't want to get offside with anybody.

 

This is just one other aspect of what I experienced and what you are going through, and I do believe that the advice given by Sheryl is excellent.

 

In my case however, having had experience with urologists in four countries, countless antibiotics, bladder neck operations, many cystoscopies, a TURP, and latterly the "urethral syndrome", all this over some 30 or more years, has allowed me a little more insight into a condition which seems to affect many more men than we would believe.
 

[Jkrungthep]

Thanks both. It’s really confusing. The swab culture they did now came back negative for Gonnorhea (as well as for Chlamydia and Trich); not even any leukocytes. How do you even check for resistance when there’s no bacteria growing? So I have dozens of PCR tests and cultures and a MicrogenDX test using different specimen all saying negative for everything, but one PCR test in between saying positive for Gonnorhea (but antibiotics not doing anything). 

 

(The swab was taken before antibiotics treatment, same as the PCR tests and all other tests and cultures they did.) 

 

 

Edited January 14, 2020 by Jkrungthep

[Sheryl]

You cannot check for antibiotic sensitivity if you can't culture anything.

 

The GC has been adequately treated.

 

Sometimes urethritis has a viral cause. And sometimes it is just mechanical irritation, common after an infection.

 

Give it a thorough rest as suggested and see what happens.

 

 

[Jkrungthep]

 

On 1/14/2020 at 7:04 PM, Sheryl said:

And sometimes it is just mechanical irritation, common after an infection.

can this include discharge? It’s the discharge that’s freaking me out. 
 

I did a test of cure here in Bangkok, 2 cultures and 1 NAAT test, all negative. Same as the 7-8 NAAT Tests before.

[Jkrungthep]

 

On 1/14/2020 at 7:04 PM, Sheryl said:

 

Give it a thorough rest as suggested and see what happens.

I actually didn’t masturbate for two weeks when I was traveling with friends. Didn’t change much unfortunately.