Can the Body Naturally Heal Enterococcus in the Prostate?
No, the body cannot reliably clear Enterococcus from the prostate without antibiotic treatment, and untreated bacterial prostatitis—including Enterococcus infections—requires antimicrobial therapy to prevent progression to chronic infection or serious complications. 1, 2
Why Natural Clearance Is Unlikely
The prostate gland's unique anatomy and physiology create an environment where bacterial infections, particularly Enterococcus species, cannot be effectively cleared by the immune system alone:
Enterococcus faecalis is a documented pathogen in chronic bacterial prostatitis, representing one of the gram-positive organisms that cause acute and chronic prostatic infections alongside gram-negative bacteria 1, 3
The prostate's relative impermeability to immune defenses makes it difficult for the body to eradicate established bacterial infections without antimicrobial assistance 4
Bacterial biofilm formation by Enterococcus strains in prostatic tissue further protects these organisms from both immune clearance and antibiotic penetration 3
Clinical Evidence Against Natural Resolution
Untreated bacterial prostatitis typically progresses rather than resolves spontaneously:
Stopping antibiotics prematurely leads to chronic bacterial prostatitis, demonstrating that even partial treatment is insufficient—natural clearance without any treatment is even less likely 5
Chronic bacterial prostatitis affects up to 74% of cases with persistent gram-negative or gram-positive organisms when inadequately treated, with Enterococcus species being a significant contributor 1
Historical data shows that bacterial prostatitis "is often difficult to cure and usually requires extended therapy (4-16 weeks)", indicating the body cannot eliminate these infections on its own 2
Treatment Requirements for Enterococcus Prostatitis
When Enterococcus is identified in prostatic specimens, antimicrobial therapy is indicated:
For health care-associated infections, antimicrobial therapy for enterococci should be given when recovered from patients 6
Empiric anti-enterococcal therapy should be directed against Enterococcus faecalis, with antibiotics including ampicillin, piperacillin-tazobactam, or vancomycin based on susceptibility testing 6
Fluoroquinolones (particularly levofloxacin and ciprofloxacin) show low resistance rates (4.8-9.7%) against E. faecalis in chronic bacterial prostatitis, making them suitable first-line agents in many regions 7
Treatment duration for chronic bacterial prostatitis requires 2-4 weeks minimum, with some cases requiring extended courses up to 2-3 months to achieve cure 1, 4
Critical Pitfall to Avoid
Do not adopt a "watch and wait" approach for documented Enterococcus prostatitis:
The only exception where observation might be considered is when Enterococcus is an incidental finding on needle biopsy in a completely asymptomatic patient with minimal tissue violation 6
However, this recommendation comes from fungal (Coccidioides) prostatitis literature and should not be extrapolated to bacterial infections, which have different pathophysiology 6
Any symptomatic patient or patient with significant tissue manipulation (such as prostatectomy) requires immediate antimicrobial therapy 6
Resistance Considerations
Enterococcus faecalis demonstrates variable resistance patterns that influence treatment selection:
High resistance rates exist for tetracycline (97.5%), erythromycin (95%), and gentamicin (46.3%), making these agents inappropriate for empiric therapy 7
Ampicillin shows excellent activity (0% resistance) against E. faecalis, making it a preferred agent when susceptibility is confirmed 7
Vancomycin resistance, while still uncommon, has been reported and represents a concerning development requiring culture-directed therapy 6, 8