Does the four-glass test still have a place in microbiological evaluation of chronic prostatitis? Findings from an Indian tertiary care centre

Abstract

Background: Chronic prostatitis (CP) is a bothersome disease affecting young and middle-aged men. Routine cultures often fail to localize the source of infection. Although the four-glass test is considered the gold-standard test for evaluating CP, it has found less favour in clinical practice. We re-inspected its utility in patients suffering from CP. Methods: Seventy cases of CP of Indian origin were enrolled. The four-glass test was conducted, and the samples were labelled as VB1, VB2, VB3 and EPS. A quantitative culture and drug sensitivity test for 16 antimicrobials was performed. Results: Samples from 61 patients ( Mage=36 years) were analysed. Chronic bacterial prostatitis was identified in 29 (47.5%) cases. Enterococcus spp. were the most common isolate, followed by Escherichia coli. A wide variability in positivity pattern was noted in the four-glass test. The most common pattern was for only the EPS sample to be positive (nine cases; 16.1%), followed by all four samples to be positive (seven cases; 12.5%). High susceptibility was found (94–100%) against third-generation cephalosporins, meropenem, amikacin, gentamicin and nitrofurantoin. Conclusions: The four-glass test is still important in the evaluation of CP. In about half of the cases examined in this study, bacterial localization could be made to the prostate. Level of evidence: Level IIIb.