A 33-year-old Indian male had the following subjective symptoms from June 2016 till November 2016: Sharp pain in the right testicle radiating to the right buttock, right lower back, pelvic region both left and right sides, and perineal pain. He also experienced perspiration, generalized weakness and malaise in the body through the day.
The patient had a daily low-grade fever and chills: 37.5-37.7 C. No antipyretic was taken to reduce body temperature. He felt chills every morning that would last for about 1.5 h.
At this time, a urine culture was ordered, which was sterile after 48 h of aerobic incubation. A kidney, ureter, and urinary bladder (KUB) ultrasound showed both kidneys to be normal in size, shape, position, and echotexture. No evidence of any calculus or hydronephrosis was noted. The urinary bladder was normally distended with normal wall thickness. No calculus was observed. The prostate gland was considered to be of normal size.
A digital rectal exam (DRE) by a urologist revealed a tender prostate, and the patient was diagnosed with CBP. He had no history of urological problems before this diagnosis. Multiple antibiotic treatments were administered empirically in the patient's home country over a period of four months. These included single dose Azithromycin 1 g, followed by a course of Doxycycline 200 mg for 10 days, then the third course of antibiotics with Ofloxacin 400 mg for 23 days, and finally a combination of Ciprofloxacin 1 g taken orally and Amikacin 750 mg given intravenously for 10 days.
The patient experienced no improvement in symptoms during or after these antibiotic courses.
A transrectal ultrasound (TRUS) done in October 2016 showed the prostate size to be 21.98 ml.
In November 2016, the patient traveled to Tbilisi, Georgia, to explore phage therapy at the EPTC as a potential treatment for his condition. At the clinic, a full urologic workup was performed. The patient's prostate was found to be tender and boggy by rectal palpation. The patient's EPS and semen samples were collected and observed microscopically, as well as cultured for aerobic bacteria. The cultures were tested for sensitivity against Eliava Institute's standard phage cocktail preparations. The details of these phage preparations are given in Appendix Table A1. Table 1 shows the outcomes of these tests.
No fungal growth was detected in either sample. There was no presence of gonococcus. Blood tests showed normal blood counts, leukocyte counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and prostate-specific antigen (PSA) levels. Urinalysis and culture were sterile.
 S. epidermidis was considered non-pathogenic due to its low growth and low virulence.
The patient decided to undergo phage therapy. Pyo, Intesti, and Staphylococcal phage preparations were used for his treatment. The preparations were administered in three forms:oral liquid, rectal suppositories, and urethral instillations.
20 ml each of Pyo and Intesti oral phages were given to the patient per day for the first 14 days. Concurrently, the patient self-administered Staphylococcal phage suppositories twice a day for 10 days, and urethral instillations with Intesti phage were administered to him by the urologist at the EPTC once a day for 10 days.
On the fifth day after starting phage therapy, the patient's body temperature normalized, and did not subsequently increase beyond 37 C.
After the first 2 weeks, a long-term daily dose of 10 ml each of Pyo and Intesti oral phages was established for the next 2 months. Rectal suppositories of Pyo, Intesti, and Staphylococcal bacteriophages were used in rotation for 10 days each, with breaks of 10 days between different phage suppositories. Urethral instillations were not done after the initial 10 days to avoid urethral irritation.
The testicular and back pains increased initially after starting treatment and began to subside after 3 weeks of starting phage therapy. Subjective symptoms of weakness, night sweating, and chills also decreased gradually.
In March 2017, the patient visited the EPTC again, and his EPS and semen were tested to ascertain his progress. Table 2 shows the outcomes of the tests.
 S. aureus did not grow in this or any subsequent cultures. S. mitis was a new bacterium that grew in the EPS. This strain was resistant to all of Eliava Institute's standard phage preparations. The other bacteria were treated with Intesti and Fersis phage preparations from March till June 2017. A combination of oral phage, rectal suppositories, and urethral instillations was administered, similar to the previous course of treatment.
Through this course of treatment, the patient's symptoms continued to improve. Night sweats, chills, excessive perspiration, and weakness had fully subsided by the end of June 2017.
A custom phage (autophage) was prepared in September 2017 that was fully sensitive against the S. mitis isolated from the patient's sample. This was administered according to the previous protocol, along with Staphylococcal bacteriophage, from November 2017 till January 2018, during which time his only remaining symptoms of pelvic and perineum pain decreased in intensity and frequency.
A TRUS performed in November 2017 revealed that the prostate size had reduced to 14.38 ml, with no prostatic inflammation present. Figure 1 shows a comparison between the ultrasound images before, during and towards the end of the patient's phage therapy.
The patient's EPS and semen were tested again in May 2018. No pathogenic bacteria grew in these cultures, and the leukocyte counts in the EPS and semen were normal. The prostate was small and firm by rectal palpation. Repeated testing has continued to show the same results. The patient is in full remission, and his chief complaints have not returned.