1. Introduction

Persistent infections involving underrecognized pathogens present unique diagnostic and therapeutic challenges, particularly when associated with secondary inflammatory and autoimmune conditions (Mazzoli, 2007; Ruiz-Gómez, 2019). Gardnerella vaginalis and coryneform species are often excluded from male urogenital diagnostic frameworks due to historical bias and testing limitations (Smith et al., 1992; Kılıç et al., n.d.; Lam et al., 1988). This report examines the long-term clinical outcome of a patient whose persistent symptoms may be attributed to chronic, biofilm-embedded polymicrobial infection and presents a novel hypothesis connecting such infections with Peyronie’s disease and erosive lichen planus.

2. Clinical Timeline and Symptom Progression

2.1 Initial Exposure and Symptoms

In early 2015, following oral sexual activity with a symptomatic partner, the patient experienced irritation at the urethral meatus. Symptoms initially subsided but returned with greater severity upon resuming sexual activity. A false-positive gonorrhea result was later dismissed, and subsequent treatment provided only temporary relief.

2.2 Escalation of Symptoms

Pain progressively extended into the mid-urethra, vas deferens, and right testicle. A dramatic change in semen color to dark green was observed, coinciding with heightened pelvic discomfort. Despite numerous clinical evaluations, standard testing failed to identify causative organisms.

2.3 Notable Events and Complications

A “pop” in the right groin region—believed to involve a lymph node—preceded a redistribution of pain toward the right thigh. Symptoms evolved to include radiating nerve-like pain, recurrent cloudiness of urine, and chronic urethral inflammation. Eventually, the patient underwent a right-sided orchiectomy, which partially alleviated pain but failed to resolve the infection.

3. Diagnostic Findings

3.1 Laboratory Results and Sequencing Discrepancies

In 2020, Aperiomics performed next-generation sequencing (NGS) testing on a semen sample obtained via the PEUS Protocol. The test revealed:

• Corynebacterium pseudogenitalium: 58% relative abundance (RPM: 36,649.2)
• Gardnerella vaginalis: 42% relative abundance (RPM: 17,015.7)

Follow-up testing using qPCR (MicroGenDX) in 2024 reported no microbial detection, illustrating inconsistencies between methodologies (Altmäe et al., 2019). The closure of Aperiomics further complicates replication efforts.

3.2 Anatomical Collection Technique (PEUS Protocol)

The Post-Ejaculate Urine Sample (PEUS) Protocol was developed to isolate urethral and prostatic fluid contributions and represents an innovative approach to DNA profiling and stealth pathogen detection in male urogenital health. By combining urine with a small amount of semen, this method expands the scope of microbial analysis within a single test, enabling the identification of elusive pathogens in the male urogenital tract, prostate, and seminal vesicles. The methodology leverages anatomical insights to enhance microbial capture from localized infections that are often missed by traditional semen or urine collection techniques.

4. Microbial Pathogenesis and Implications

Both G. vaginalis and coryneform bacteria are increasingly recognized for their role in chronic infections (Türk et al., 2007; Antunes-Lopes et al., 2020). Gardnerella’s ability to traverse mucosal and reproductive tissues—commonly associated with pelvic inflammatory disease (PID) in women—may also apply to men (Ravel et al., 2021; Morrill et al., 2020). Its anaerobic nature and biofilm-forming capacity complicate detection and treatment (Catlin, 1992).

Coryneforms, including C. pseudogenitalium, have been implicated in inflammatory prostatitis and sperm abnormalities (Wu et al., 2020; Damke et al., 2018). Their role as opportunistic pathogens continues to evolve in clinical understanding.

5. Autoimmune Associations and Theoretical Progression

5.1 Erosive Lichen Planus

Erosive lichen planus onset in 2017 correlated with intensification of infection symptoms. Phototherapy and palmitoylethanolamide provided effective symptomatic relief, suggesting an inflammatory or immune-mediated component (Vičić et al., 2023).

5.2 Peyronie’s Disease

Plaque formation began in 2018, with subsequent flares coinciding with intensification of infection symptoms (increased inflammation, pain, and semen discoloration). Management with shockwave therapy and nutraceuticals slowed progression. A temporal correlation between flares of Peyronie’s disease, lichen planus, and elevated infection symptoms suggests immune system activation secondary to chronic microbial presence (Ventimiglia et al., 2015; Porter et al., 1997).

Updated Side-Note:  No penile trauma was reported or observed prior to formation. The patient was not sexually active for many months due to pain, supporting a non-traumatic etiology. While often mistakingly attributed to trauma, Peyronie’s disease may also result from chronic inflammation triggered by infection or autoimmunity, aligning with emerging evidence of non-traumatic origins (Campbell & Alzubaidi, 2017; Wynn, 2008).

6. Treatment Considerations and Novel Approaches

6.1 Tigecycline Hypothesis

A 2018 study demonstrated tigecycline’s efficacy against resistant PID (Perutelli et al., 2018). Given the similarities in Gardnerella pathogenesis across sexes, tigecycline may offer therapeutic potential in men with persistent G. vaginalis infection.

6.2 Other Therapy Potentials

• Antibiotic cycling with biofilm-active agents (Bush & Vazquez-Pertejo, 2023)
• Probiotic support to restore mucosal flora
• Phage therapy or enzybiotic application (Sousa et al., 2023)
• Intra-prostatic or vesicular delivery of targeted antimicrobials

7. Discussion

This case demonstrates the danger of diagnostic over-reliance on conventional culture or PCR methods. The detection of pathogens via NGS, coupled with clear symptomatic correlation, validates the clinical significance of overlooked organisms. Furthermore, the proposed link between chronic infection and autoimmune pathology (lichen planus, Peyronie’s disease) deserves further investigation. If substantiated, this could prompt a paradigm shift in how urologists and immunologists approach idiopathic presentations (Sfriso et al., 2010; Rose, 1998; Molina & Shoenfeld, 2005).

8. Conclusion

Chronic infections involving organisms like G. vaginalis and C. pseudogenitalium may play a causative role in persistent prostatitis, urethritis, and autoimmune sequelae in male patients. Improved diagnostic techniques, such as anatomically informed collection protocols and advanced sequencing, are critical for detecting these pathogens accurately. Innovative therapeutic strategies—including those adapted from female-centric infectious disease research—may offer hope for previously untreatable cases.

Although formal documentation in the literature is limited or altogether absent, this is likely due to the considerable difficulty in detecting these pathogens with standard diagnostic protocols. The underrecognition of such infections may mask their true prevalence and clinical relevance. For the full case report, please visit the Contact tab. For information on natural or immediate treatment or management options, click here.

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Author:
Dr. David M Robertson
Wichita, Kansas

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Collaboration & Inquiries:

This condensed version represents a high-level overview of a much more comprehensive 25-page clinical investigation and theoretical model. The full report includes expanded literature synthesis, clinical data, and diagnostic methodologies. It is available upon request for academic, clinical, or collaborative purposes.

To discuss research collaboration, clinical consultations, or publication rights, please contact the author directly at grassfireindustries@gmail.com

Last Update: April 2025

This report is being released directly to the public—not due to a lack of merit but because of the unfortunate constraints typically imposed by academic bureaucracy and disciplinary silos.

This content bridges several domains—infectious disease, urology, immunology, and behavioral science—areas that often fall outside the scope of narrowly focused journals. Rather than wait for editorial gatekeepers hesitant to challenge prevailing diagnostic norms, this work is offered freely to patients, clinicians, and researchers who are willing to explore beyond outdated frameworks. The hope is that the right researcher or physician finds this and chooses to step forward.

In a world where chronic conditions are increasingly dismissed as "idiopathic," meaningful insights are too often lost to institutional inertia. This report is a testament to persistence—both in pathology and in the pursuit of truth. Indeed, in many ways, it challenges conventional thinking by presenting both a highly unique and overlooked case and a novel hypothesis that connects chronic polymicrobial infections with autoimmune sequelae, offering a foundation for further exploration and innovation.

For those interested in extended analysis or collaborative inquiry, I encourage you to reach out. The problem is real. So are the solutions.