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Dhawan B, Raj JS, Rawre J, Dhawan N, Khanna N. Mycoplasma genitalium: A new superbug. Indian J Sex Transm Dis AIDS 2022; 43:1-12. [PMID: 35846530 PMCID: PMC9282694 DOI: 10.4103/ijstd.ijstd_103_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Mycoplasma genitalium (MG) is an emerging sexually transmitted pathogen. It is an important cause of nongonococcal urethritis in men and is associated with cervicitis and pelvic inflammatory disease in women, putting them at risk of infertility. Multiple factors that aid pathogenesis of MG include its ability of adhesion, gliding motility, and intracellular invasion by means of the tip organelle. Through intracellular localization and antigenic variation, MG could result in treatment-resistant chronic infection. There are limited data on the prevalence of MG in Indian patients with urogenital syndromes. Recently, a high prevalence of extra genital infection with MG has been reported. Molecular assays are the major diagnostic techniques of MG infection. Antimicrobial agents such as macrolides, along with fluoroquinolones, are the treatment of choice for MG infections. The issue of drug resistance to azithromycin and fluoroquinolones in MG is rising globally. As molecular tests are becoming available for MG, both for the diagnosis and the detection of antimicrobial resistance, any patient with MG infection should then be tested for antimicrobial resistance. Consideration of MG as a cause of sexually transmitted disease in the Indian population is crucial in diagnostic algorithms and treatment strategies. The purpose of this review is to understand the prevalence of MG in different clinical scenarios, molecular mechanisms of pathogenesis, current status of antimicrobial resistance, and its impact on MG treatment.
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Liu Y, Wazir J, Tang M, Ullah R, Chen Y, Chen T, Zhou X. Experimental autoimmune prostatitis: different antigens induction and antigen-specific therapy. Int Urol Nephrol 2020; 53:607-618. [PMID: 33200334 DOI: 10.1007/s11255-020-02703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/29/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has uncertain etiology and lacks effective treatment. Autoimmunity is an important pathogeny, and experimental autoimmune prostatitis (EAP) models have long been used for studying CP/CPPS. This review presents the detailed current knowledge of EAP models based on evaluation criteria aspects to provide a tool for model selection in pathogenesis studies and therapeutic drug screening. METHODS We extensively searched the published literature on CP/CPPS and different antigen-induced EAP models focusing on the histopathology, clinical-related phenotypes, and biochemical indicators. We also cover the changes in the prostate function and other organs in EAP. Finally, we try to get some insights about antigen-based therapeutic approaches for CP/CPPS. RESULTS Several inciting autoantigens were reported in EAP, including male accessory gland extracts, prostate extracts (PE), prostatic steroid-binding protein, prostatic spermine-binding protein (p25), prostatic acid phosphatase, seminal vesicle secretory protein 2, and T2 peptide. All of these models mimicked histological prostatitis, however only p25- and T2-induced models developed both pelvic pain and voiding behaviors. PE immunization is the most widely used method. Diminished fertility and mental health disorders can be found in PE model. Oral and intravenous T2 peptide have been studied for antigen-specific therapy and achieved preliminary progress in EAP models. CONCLUSIONS PE-induced model is the most commonly used, while T2- or p25-model could serve as a promising CP/CPPS model. Antigen-specific therapy in CP/CPPS deserves further study.
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Affiliation(s)
- Yuqian Liu
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Junaid Wazir
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Meng Tang
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Rahat Ullah
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Yueting Chen
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Tingting Chen
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Xiaohui Zhou
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, Jiangsu, People's Republic of China. .,Department of Surgery, Nanjing Shuiximen Hospital, Nanjing, 210017, Jiangsu, People's Republic of China.
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3
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Bielecki R, Ostaszewska-Puchalska I, Zdrodowska-Stefanow B, Baltaziak M, Skawrońska M, Sokołowska M. The presence of Chlamydia trachomatis infection in men with chronic prostatitis. Cent European J Urol 2020; 73:362-368. [PMID: 33133666 PMCID: PMC7587489 DOI: 10.5173/ceju.2020.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of the study was to evaluate the frequency of occurrence of Chlamydia trachomatis (C.t.) DNA in the prostate material in the group of individuals with the chronic prostatitis. Material and methods The study included 65 males aged between 47 and 68 years of age, reporting for transrectal prostate biopsy because of the elevated serum prostate-specific antigen concentration and/or abnormalities detected in prostate palpation per rectum. The urethral smear collection was performed in all the patients in order to detect C.t. DNA. After that, the transrectal prostate biopsy was performed (histopathology tests, C.t. DNA). Additionally, the levels of anti-C.t. IgG antibodies and anti-C.t. IgA antibodies were checked in the serum. The DNA isolation from prostate specimens was conducted with the use of the Chelex method, while the C.t. DNA detection - with the ligase chain reaction. Specific antibodies were detected with the use of the ELISA method. Results C.t. DNA in the prostate gland was found in 7 out of 65 men (10.8%). In urethral smear, C.t. was found in none of the individuals. Anti-C.t. IgA antibodies were detected in the serum of 16/65 (24.6%), while anti-C.t. IgG antibodies in 6/65 (9.2%) of the examined males. IgA antibodies were found in two and IgG in one out of the 7 men who had C.t. infection in the prostate. Conclusions The presence of C.t. DNA in the prostate gland may be indicative of the role of chlamydia in the development of chronic prostatitis.
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Affiliation(s)
- Rościsław Bielecki
- Department of Urology, The Jędrzej Śniadecki Memorial Integrated Hospital, Białystok, Poland
| | - Iwona Ostaszewska-Puchalska
- State College of Computer Science and Business Administration, Łomża, Poland.,Center for STD Research and Diagnostics, Białystok, Poland
| | | | - Marek Baltaziak
- Department of Clinical Pathology, Medical University, Białystok, Poland
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Sasikumar A, Kamalasanan K. Nanomedicine for prostate cancer using nanoemulsion: A review. J Control Release 2017; 260:111-123. [PMID: 28583444 DOI: 10.1016/j.jconrel.2017.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 01/15/2023]
Abstract
Prostate cancer (PCa) is a worldwide issue, with burgeoning rise in prevalence, morbidity and mortality. Targeted drug delivery, a long sort solution in this regard using controlled release (CR) - nanocarriers, is still a challenge. There is an emerging criticism that, the challenges are due to less appreciation for the biological barriers and lack of corresponding newer technologies. Over the years, more understanding about the biological barriers has come with the progress in characterization techniques. Correspondingly, there is a change in opinion about approaches in clinical trial that; focus of the end point need to be shifted towards disease stabilization for these explorative technologies. Currently, there is a requirement to overcome these newly identified challenges to develop newer affordable therapeutics. The ongoing clinical protocol for therapy using CR-nanocarriers is intravenous injection followed by local targeting to cancer site. This is the most accepted protocol and new CR-nanocarriers are being developed to suit this protocol. In this review, recent progress in treatment of PCa using CR-nanocarriers is analyzed with respect to newly identified biological barriers and design challenges. Possibilities of exploring nanoemulsion (NE) platform for targeted drug delivery to PCa are examined. Repurposing of drugs and combination therapy using NE platform targeted to PCa can be explored for design and development of affordable nanomedicine. In 20yrs. from now there expected to be numerous affordable nanomedicine technologies available in market exploring these lines.
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Affiliation(s)
- Aravindsiva Sasikumar
- Department of Pharmaceutics, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham University, Amrita University, AIMS Health Sciences Campus, Kochi, Kerala, India
| | - Kaladhar Kamalasanan
- Department of Pharmaceutics, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham University, Amrita University, AIMS Health Sciences Campus, Kochi, Kerala, India.
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5
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Prostatitis, Epididymitis and Orchitis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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Affiliation(s)
- David Taylor-Robinson
- MRC Sexually Transmitted Disease Research Group, Jefferiss Wing, St Mary's Hospital, Paddington, London W2 1NY, UK
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7
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Abstract
The cause of chronic pelvic pain syndrome (CPPS) has yet to be established. Since the late 1980s, cytokine, chemokine, and immunological classification studies using human samples have focused on identifying biomarkers for CPPS, but no diagnostically beneficial biomarkers have been identified, and these studies have done little to deepen our understanding of the mechanisms underlying chronic prostatic pain. Given the large number of men thought to be affected by this condition and the ineffective nature of current treatments, there is a pressing need to elucidate these mechanisms. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. Mast cell activation is also known to suppress regulatory T cell (Treg) control of self-tolerance and also activate neural sensitization. This combination of established autoimmunity coupled with peripheral and central neural sensitization can result in the development of multiple symptoms, including pelvic pain and bladder irritation. Identifying these mechanisms as central mediators in CPPS offers new insight into the prospective treatment of the disease.
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8
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Weinstein SA, Stiles BG. Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium. Expert Rev Anti Infect Ther 2012; 10:487-99. [PMID: 22512757 DOI: 10.1586/eri.12.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Mycoplasma genitalium is a globally important sexually transmitted pathogen. Men infected with M. genitalium frequently present with dysuria, while women may present with or without urogenital symptoms. In some populations, M. genitalium is significantly associated with HIV-1 infection, and is also an etiological agent in pelvic inflammatory disease. However, there is insufficient evidence to establish a causative role of the organism in obstetric complications, including tubal factor infertility. Although several nucleic acid amplification tests offer rapid, sensitive methods for detecting M. genitalium, there is no standardized assay. Available evidence supports treatment of M. genitalium infections with an extended regimen of azithromycin and resistant strains respond to moxifloxacin. Accumulating evidence indicates growing fluoroquinolone resistance, including against moxifloxacin, emphasizing the need for new therapeutic strategies to treat M. genitalium infections.
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Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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9
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Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev 2011; 24:498-514. [PMID: 21734246 DOI: 10.1128/cmr.00006-11] [Citation(s) in RCA: 345] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The history, replication, genetics, characteristics (both biological and physical), and factors involved in the pathogenesis of Mycoplasma genitalium are presented. The latter factors include adhesion, the influence of hormones, motility, possible toxin production, and immunological responses. The preferred site of colonization, together with current detection procedures, mainly by PCR technology, is discussed. The relationships between M. genitalium and various diseases are highlighted. These diseases include acute and chronic nongonococcal urethritis, balanoposthitis, chronic prostatitis, and acute epididymitis in men and urethritis, bacterial vaginosis, vaginitis, cervicitis, pelvic inflammatory disease, and reproductive disease in women. A causative relationship, or otherwise strong association, between several of these diseases and M. genitalium is apparent, and the extent of this, on a subjective basis, is presented; also provided is a comparison between M. genitalium and two other genital tract-orientated mollicutes, namely, Mycoplasma hominis, the first mycoplasma of human origin to be discovered, and Ureaplasma species. Also discussed is the relationship between M. genitalium and infertility and also arthritis in both men and women, as is infection in homosexual and immunodeficient patients. Decreased immunity, as in HIV infections, may enhance mycoplasmal detection and increase disease severity. Finally, aspects of the antimicrobial susceptibility and resistance of M. genitalium, together with the treatment and possible prevention of mycoplasmal disease, are discussed.
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Taylor BD, Haggerty CL. Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges. Infect Drug Resist 2011; 4:19-29. [PMID: 21694906 PMCID: PMC3108753 DOI: 10.2147/idr.s12715] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Indexed: 12/13/2022] Open
Abstract
Chlamydia trachomatis is a prevalent sexually transmitted infection that can lead to serious reproductive morbidity. Management and control of C. trachomatis is a challenge, largely due to its asymptomatic nature and our incomplete understanding of its natural history. Although chlamydia screening programs have been implemented worldwide, several countries have observed increasing rates of reported chlamydia cases. We reviewed the literature relating to the long-term complications of C. trachomatis, as well as screening strategies, treatment, and prevention strategies for reducing chlamydia in the population. Articles from 1950-2010 were identified through a Medline search using the keyword "Chlamydia trachomatis" combined with "screening", "pelvic inflammatory disease", "endometritis", "salpingitis", "infertility", "ectopic pregnancy", "urethritis", "epididymitis", "proctitis", "prostatitis", "reinfection", "cost-effectiveness", "treatment", "vaccines", or "prevention". Progression of C. trachomatis varies, and recurrent infections are common. Currently, there is limited evidence on the effectiveness of chlamydia screening. Higher quality studies are needed to determine the efficacy of more frequent screening, on a broader range of sequelae, including infertility and ectopic pregnancy, in addition to pelvic inflammatory disease. Studies should focus on delineating the natural history of recurrent infections, paying particular attention to treatment failures. Furthermore, alternatives to screening, such as vaccines, should continue to be explored.
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Affiliation(s)
- Brandie D Taylor
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
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11
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Prostatitis, epididymitis and orchitis. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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The role of the prostatic stroma in chronic prostatitis/chronic pelvic pain syndrome. Inflamm Res 2009; 58:829-36. [DOI: 10.1007/s00011-009-0086-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/17/2009] [Accepted: 08/19/2009] [Indexed: 11/25/2022] Open
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13
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Badalyan RR, Fanarjyan SV, Aghajanyan IG. Chlamydial and ureaplasmal infections in patients with nonbacterial chronic prostatitis. Andrologia 2009. [DOI: 10.1111/j.1439-0272.2003.tb00854.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Trei JS, Canas LC, Gould PL. Reproductive tract complications associated with Chlamydia trachomatis infection in US Air Force males within 4 years of testing. Sex Transm Dis 2008; 35:827-33. [PMID: 18562984 DOI: 10.1097/olq.0b013e3181761980] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) is a common sexually transmitted infection for which young, sexually active persons are at highest risk. Health consequences such as orchitis/epididymitis, prostatitis, infertility, and urethral stricture have been described among CT-infected males, although not all of these are indisputably linked to CT. Current literature lacks population-based studies needed to examine these associations on a larger scale, to evaluate the true risk of developing complications after a CT infection. The US Air Force contains a large population of young, sexually active males, making it suitable for conducting such a study. METHODS We conducted a retrospective cohort study between 2001 and 2005 comparing the incidence of orchitis/epididymitis, prostatitis, infertility, and urethral stricture among male Air Force members with and without prior CT infections. Cumulative incidence rates were calculated and Cox proportional hazard models were generated to evaluate the risk of developing complications and to adjust for potential confounders. RESULTS Among 17,764 men enrolled in the study, 913 (5.14%) experienced a reproductive tract outcome. Among CT-positive men, cumulative incidences of orchitis/epididymitis, prostatitis, infertility, and urethral stricture were 4.28%, 1.41%, 1.27%, and 0.13%, respectively. Orchitis/epididymitis [Hazard ratio (HR) = 1.38 (1.13-1.70)] and "any" outcome [HR = 1.37 (1.16-1.61)] were positively associated with CT; infertility was marginally associated [HR = 1.36 (0.93-2.00)]. CONCLUSIONS Overall, the burden of reproductive health outcomes among Air Force males is small. Significant associations were observed between CT and both orchitis/epididymitis and any outcome; a larger cohort or longer follow-up may have detected a significant association between CT and infertility.
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Affiliation(s)
- Jill S Trei
- Air Force Institute for Operational Health, Brooks City-Base, Texas 78235, USA.
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15
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Abstract
PURPOSE We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS A literature review for the years 1966 to 2003 was performed using the MEDLINE database of the United States National Library of Medicine. RESULTS National Institutes of Health categories I and II prostatitis result from identifiable prostatic infections, whereas patients with category IV are asymptomatic. The majority of symptomatic cases are category III or chronic prostatitis (CP)/CPPS. The etiology of CP/CPPS is unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, does not correlate with the predominant symptom of pelvic pain. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. The imbalance in some men may result from polymorphisms at the cytokine loci. An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. Recent findings include possible defects in the androgen receptor. The prostate may not even be the source of the symptoms. Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and influence the other processes. The role of normal prostatic bacterial flora in inciting the inflammatory response has also been reconsidered. CONCLUSIONS The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.
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Affiliation(s)
- Michel A Pontari
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
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Schaeffer AJ. Epidemiology and evaluation of chronic pelvic pain syndrome in men. Int J Antimicrob Agents 2008; 31 Suppl 1:S108-11. [PMID: 18164597 DOI: 10.1016/j.ijantimicag.2007.08.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 12/24/2022]
Abstract
Chronic pelvic pain syndrome (CPPS), formerly known as chronic abacterial prostatitis, is characterised by pelvic or perineal pain without evidence of urinary tract infection. It manifests as pain in a variety of areas including the perineum, rectum, prostate, penis, testicles and abdomen [Litwin MS, McNaughton-Collins M, Fowler Jr FJ, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol 1999;2:369-75]. It is also frequently associated with symptoms including urinary urgency, frequency, hesitancy and poor or interrupted flow. CPPS may be associated with white cells in the prostatic secretions (inflammatory) (NIH-3A), or white cell absence in the prostatic secretions (non-inflammatory) (NIH-3B) [Krieger JN, Nyberg Jr L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999;3:236-7].
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Affiliation(s)
- A J Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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18
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Ostaszewska-Puchalska I, Zdrodowska-Stefanow B, Badyda J, Galewska Z. Antichlamydial antibodies and citric acid in patients with chronic prostatitis. Arch Immunol Ther Exp (Warsz) 2007; 55:57-60. [PMID: 17277893 PMCID: PMC3234122 DOI: 10.1007/s00005-007-0006-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 10/06/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the correlation between the presence of anti-C. trachomatis (C.t.) antibodies in serum and expressed prostatic secretions (EPS) and the concentration of citric acid in patients with chronic prostatitis. MATERIALS AND METHODS The study involved 34 men with chronic prostatitis. The leukocyte count, presence of anti-C.t. antibodies (IgA, IgG), and citric acid concentration were determined in the EPS. The serum was examined for IgM, IgA, and IgG anti-C.t. antibodies. Specific antibodies were determined using the EIA method. The concentration of citric acid was measured using the ultraviolet method. RESULTS Inflammation of the prostate (210 PMN) was found in 61.8% of the patients. A reduction in citric acid concentration in the EPS was detected in 58.8% of the men. Specific serum antibodies were detected in 58.8% of the patients, including 23.5% with IgM, 32.4% with IgA, and 44.1% with IgG. In all patients, serum IgM and IgA antibody titers were low, while those of IgG antibodies were strongly positive in 46.7% of the patients. Anti-C.t. antibodies in the EPS were detected in 44.1% of the patients, including 32.4% with IgA and 35.3% with IgG. In contrast to serum, the titers of IgG antibodies in the EPS were low in all the patients, while those of IgA were strongly positive in 54.5% of cases. In patients with positive serological outcomes, 85% had reduced concentrations of citric acid. CONCLUSIONS The occurrence of anti-C.t. antibodies is usually accompanied by a decrease in the concentration of citric acid in the prostatic secretion.
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Wagenlehner FME, Weidner W, Naber KG. Chlamydial infections in urology. World J Urol 2006; 24:4-12. [PMID: 16421732 DOI: 10.1007/s00345-005-0047-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022] Open
Abstract
Chlamydia trachomatis is the most frequent cause for sexually transmitted diseases in European countries. The organism has an intracellular habitat with a very specific life cycle. A variety of diagnostic tests have been developed with different sensitivity and specificity. Interpretation of these tests can sometimes be difficult. Diseases caused by C. trachomatis in men comprise urethritis, prostatitis, epididymitis, infertility and reactive arthritis. Especially in prostatitis, the exact role of C. trachomatis is still under debate for the technical difficulties localizing the pathogen to the prostate. For treatment, only some antibiotics are effective because of the intracellular habitat of the pathogen. Prevention of infection comprises treatment and screening efforts.
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20
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Abstract
PURPOSE We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS A literature review for the years 1966 to 2003 was performed using the MEDLINE database of the United States National Library of Medicine. RESULTS National Institutes of Health categories I and II prostatitis result from identifiable prostatic infections, whereas patients with category IV are asymptomatic. The majority of symptomatic cases are category III or chronic prostatitis (CP)/CPPS. The etiology of CP/CPPS is unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, does not correlate with the predominant symptom of pelvic pain. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. The imbalance in some men may result from polymorphisms at the cytokine loci. An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. Recent findings include possible defects in the androgen receptor. The prostate may not even be the source of the symptoms. Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and influence the other processes. The role of normal prostatic bacterial flora in inciting the inflammatory response has also been reconsidered. CONCLUSIONS The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.
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Affiliation(s)
- Michel A Pontari
- Department of Urology, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
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21
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Pontari MA. Chronic prostatitis/chronic pelvic pain syndrome in elderly men: toward better understanding and treatment. Drugs Aging 2004; 20:1111-25. [PMID: 14651434 DOI: 10.2165/00002512-200320150-00004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common of the prostatitis syndromes. It is characterised by pelvic pain, with or without voiding symptoms. CP/CPPS accounts for 2 million office visits in the US alone. Recent epidemiological studies have shown that CP/CPPS can affect men at any age, including those in their 80s. The aetiology is unknown but proposals include infectious, autoimmune, neurologic and psychiatric causes. Men with CP/CPPS are much more likely to have had a past medical history of cardiovascular, neurologic, psychiatric or infectious disease (particularly sinusitis) as compared with asymptomatic individuals. Although leucocytes are commonly found in the prostatic fluid of these men, they do not correlate with the symptoms. The clinical evaluation now includes a validated, self administered symptom score, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which was designed as an outcome measure for treatment trials. This can aid in diagnosis and follow-up of patients' response to therapy. Treatment for CP/CPPS is empiric and limited by a lack of randomised, placebo-controlled clinical trials. Antimicrobials are commonly used to treat the symptoms of CP/CPPS. However, the finding that asymptomatic men have equal or greater numbers of bacteria which localise to the prostatic fluid, compared with men with CP/CPPS, has raised doubts about the contribution of infection to the symptoms. Other commonly used drugs include alpha-adrenoceptor antagonists, anti-inflammatory drugs, tricyclic antidepressants and anticholinergic agents. The adverse effects of these medications are a concern in older men with CP/CPPS. Other therapies available include minimally invasive procedures such as microwave thermotherapy and transurethral needle ablation, and now neuromodulation devices.Although much progress has been made, particularly in the last 7 years, considerable work still remains to be done to determine the aetiology and pathogenesis of CP/CPPS, and to develop mechanism based therapy that is shown to be effective in controlled trials.
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Affiliation(s)
- Michel A Pontari
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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22
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Badalyan RR, Fanarjyan SV, Aghajanyan IG. Chlamydial and ureaplasmal infections in patients with nonbacterial chronic prostatitis. Andrologia 2003. [DOI: 10.1046/j.1439-0272.2003.00582.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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23
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Abstract
The role of Chlamydia trachomatis in the cause of male infertility is under discussion. This paper attempts to summarize data from the literature, which support the role of C. trachomatis in male infertility or oppose this suggestion. The following observations are based on a survey of the literature: 1) Chlamydia trachomatis is a frequent pathogen in male genital inflammation, the micro-organisms are rarely present in healthy men. 2) Without doubt, C. trachomatis causes inflammations of the male urethra and the epididymis. Prostatitis and glandulitis vesicalis are discussed controversially. 3) Chlamydia trachomatis antigen or DNA is not demonstrable in secretions of the male accessory glands including the semen with sufficient reproducibility. However, it is easily demonstrable in urethral swabs and the urine. 4) Determination of chlamydial antibodies in serum or semen does not conclusively indicate a current infection with C. trachomatis. 5) There are no conclusive studies showing that men infected with C. trachomatis are less fertile than uninfected men. 6) The male genital chlamydial infection is a threat to the female genital organs, because C. trachomatis infection of the female genital organs may be deleterious to female fertility.
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Affiliation(s)
- W Krause
- Department of Andrology and Venerology, University Hospital, Philipp University, Marburg, Germany.
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24
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Skerk V, Schönwald S, Krhen I, Markovinović L, Beus A, Kuzmanović NS, Kruzić V, Vince A. Aetiology of chronic prostatitis. Int J Antimicrob Agents 2002; 19:471-4. [PMID: 12135835 DOI: 10.1016/s0924-8579(02)00087-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A total of 388 patients with symptoms of chronic prostatitis and inflammatory findings in expressed prostatic secretion (EPS) or in a urine sample collected immediately after prostate massage, were examined over a 2 year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases 'Dr Fran Mihaljević', Zagreb, Croatia. The infective aetiology was determined in 276 (71.13%) patients. Chlamydia trachomatis was the causative pathogen in 109 patients, Trichomonas vaginalis in 52, Escherichia coli in 26, enterococci in 25, Proteus mirabilis in 14, Klebsiella pneumoniae in six, Streptococcus agalactiae in eight, Ureaplasma urealyticum in seven patients with chronic prostatitis. Other patients had a mixed infection.
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Affiliation(s)
- Visnja Skerk
- University Hospital for Infectious Diseases, Dr Fran Mihaljević, Mirogojska 8, 10 000 Zagreb, Croatia.
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25
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Weidner W, Diemer T, Huwe P, Rainer H, Ludwig M. The role of Chlamydia trachomatis in prostatitis. Int J Antimicrob Agents 2002; 19:466-70. [PMID: 12135834 DOI: 10.1016/s0924-8579(02)00094-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ascending chlamydial infections have been thought to be an infective cause of prostatitis for the last three decades. Unfortunately, the definitive association between isolation of an infective agent and its prostatic origin is limited by various factors, although modern techniques of molecular biology for identification of the microorganisms are available. Two major problems are: (1) diagnostic material passing the urethra may reflect only urethral contamination, (2) prostatic biopsy specimens from the gland may also contain urethral material. The ejaculate has the same limitations, and an ideal test for detection of Chlamydia species in ejaculate specimens is not available yet. Investigations for local chlamydial IgA-antibodies may be useful; the overlap with Chlamydia pneumoniae and Chlamydia psittaci means a clear differentiation on an type-specific basis is necessary, which is normally provided by the 'elaborate' microimmunofluorescence test. Modern p-ELISAs using major outer membrane protein parts as antigens may deliver identical results in the future. In the follow-up of standardized prostatitis patients, a combination of such urological tests in EPS and seminal plasma combined with genital chlamydial DNA material, may further elucidate the chlamydial aetiology of prostate infection.
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Affiliation(s)
- W Weidner
- Department of Urology, Universitätsklinikum Giessen, Rudolf-Buchheim-Strasse 7, D-35392 Giessen, Germany.
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26
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Abstract
Prostatitis is a common condition that accounts for a significant number of visits to both the emergency department and the urologist. The precise pathogenic mechanism of prostatitis is not known. The most prevalent theory is that reflux of urine from the urethra into the intraprostatic ducts promotes ascending infection and leads to chemical or bacterial prostatitis. Treatment is challenging because many antimicrobial agents do not effectively diffuse into prostatic tissue and many cases of prostatitis are not found to have an infectious etiology. Prostatitis can be divided into different classifications which range from acute severe infections, to chronic indolent infections, to chronic pain syndromes. The differentiation and management of these entities can be difficult. This article seeks to clarify the different infections, and provide a rational approach to treatment and disposition of these patients.
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Affiliation(s)
- W E Lummus
- Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA
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27
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Mehik A, Hellström P, Lukkarinen O, Sarpola A, Järvelin M. Epidemiology of prostatitis in Finnish men: a population-based cross-sectional study. BJU Int 2000; 86:443-8. [PMID: 10971269 DOI: 10.1046/j.1464-410x.2000.00836.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the lifetime occurrence of prostatitis in Finnish men and their exposure to the disease. Subjects and methods A population-based cross-sectional survey was conducted in the two most northerly provinces of Finland (Oulu and Lapland). Altogether, 2500 male residents aged 20-59 years were chosen at random to complete a questionnaire on prostatitis. The data were collected between June 1996 and October 1997. Replies were received from 1832 men, giving a response rate of 75%. RESULTS The overall lifetime prevalence of prostatitis was 14.2%. The risk of having or having had prostatitis increased with age, being 1.7 times greater in men aged 40-49 years than in those aged 20-39 years, and 3.1 times greater in those aged 50-59 years. The overall incidence was 37.8/10 000 person years. More than a quarter of the 261 men who had or had had prostatitis symptoms (27%) suffered from them at least once a year, while 16% suffered from persistent symptoms; 63% of the men with prostatitis had their worst symptoms during the winter (November-March). Neither education nor profession had much influence on the occurrence of prostatitis, but divorced and single men had a lower risk than married men. Most patients felt they had not received enough information about the disease at their first visit to a general practitioner. CONCLUSIONS The results of this survey showed that the occurrence of prostatitis symptoms in men living in northern Finland is higher than that reported in other parts of the world. This could be partly caused by the cold climate.
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Affiliation(s)
- A Mehik
- Division of Urology, Department of Surgery, Oulu University Hospital, Oulu, Finland
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28
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Abstract
Prostatitis is a common genitourinary disease in men. The National Institutes of Health has defined four types of prostatitis. The bacteriology of acute and chronic bacterial prostatitis is well understood. Causative organisms can be isolated by four-glass urine cultures. Chronic pelvic pain syndrome (CPPS; chronic abacterial prostatitis) is an enigma; whether there is a microbiologic cause for this condition is unknown. Researchers have postulated that CPPS may be an infectious disease of the prostate. This article reviews current literature regarding the microbiology of the prostate in CPPS.
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Affiliation(s)
- J C Lee
- Department of Urology, University of Washington, Box 356510, 1959 Pacific NE, Seattle, WA 98195, USA. jayclee @u.washington.edu
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29
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Abstract
PURPOSE The role of bacteria in the chronic pelvic pain syndrome (nonbacterial prostatitis and prostatodynia) is controversial and difficult to assess because the bacterial flora of the prostate is not well defined. Polymerase chain reaction (PCR) is a highly sensitive molecular method of bacterial detection. It confirms the sterility of tissue with a high level of confidence and detects small numbers of microbial agents that may represent pathogens. We performed PCR to determine bacterial colonization of the prostate in presumably healthy men and in those undergoing simple or radical prostatectomy. MATERIALS AND METHODS We analyzed 28 prostate samples from 18 organ donors from whom prostate tissue was obtained under sterile surgical conditions at organ withdrawal, 14 sterile surgical prostate specimens from 7 patients undergoing radical prostatectomy for prostate cancer who previously underwent transrectal biopsy and 6 sterile surgical specimens from 2 men who underwent simple prostatectomy for benign prostatic hyperplasia (BPH), including 1 with an indwelling catheter for several weeks. For PCR we used 2 sets of primers to detect bacterial 16S rRNA gene sequences. Normal prostate tissue seeded in vitro with known numbers of Escherichia coli was used to assess the sensitivity of PCR. RESULTS Only 3 of the 28 organ donor samples had histological signs of minimal inflammation and all other samples appeared to be normal without evidence of inflammatory reaction. All of these samples were PCR negative. Of several PCR control reactions the mixture of prostate tissue seeded with known numbers of E. coli demonstrated the high sensitivity of the assay, allowing the detection of as few as 6 bacteria in the presence of 25 mg. of prostate tissue. A focal and heterogeneous distribution of inflammation and infection was noted in the 14 radical prostatectomy specimens. In the prostate cancer and BPH groups there was a strong association of inflammation with positive PCR findings. Of 11 samples 3 without but all 9 with inflammation were PCR positive. CONCLUSIONS PCR is a highly sensitive method for detecting bacteria in the prostate. In our study negative PCR reactions in the prostate tissue of apparently healthy men made the presence of normal bacterial flora in the prostate extremely unlikely. The presence of bacteria and/or inflammation in radical prostatectomy specimens was found to be a localized process. Concordance between inflammation and positive PCR results in simple and radical prostatectomy specimens suggests that bacteria may frequently have a role in histologically inflammatory prostatitis.
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30
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EVALUATION OF THE BACTERIAL FLORA OF THE PROSTATE USING A 16S rRNA GENE BASED POLYMERASE CHAIN REACTION. J Urol 2000. [DOI: 10.1097/00005392-200001000-00030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Abstract
The laboratory diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in clinical laboratories. Chronic bacterial prostatitis, and especially chronic idiopathic prostatitis (most often referred to as abacterial prostatitis), presents a real challenge to the clinician and clinical microbiologist. Clinically, the diagnosis of chronic idiopathic prostatitis is differentiated from that of acute prostatitis by a lack of prostatic inflammation and no "significant" (controversial) leukocytes or bacteria in the expressed prostatic secretions. Despite these diagnostic criteria, the etiology of chronic idiopathic prostatitis is unknown. While this review covers the entire spectrum of microbially caused acute prostatitis (including common and uncommon bacteria, viruses, fungi, and parasites) and microbially associated chronic prostatitis, a special focus has been given to chronic idiopathic prostatitis. The idiopathic syndrome is commonly diagnosed in men but is poorly treated. Recent data convincingly suggests a possible bacterial etiology for the condition. Provocative molecular studies have been published reporting the presence of 16S rRNA bacterial sequences in prostate biopsy tissue that is negative for ordinary bacteria by routine culture in men with chronic idiopathic prostatitis. Additionally, special culture methods have indicated that difficult-to-culture coryneforms and coagulase-negative staphylococci are present in expressed prostatic secretions found to be negative by routine culture techniques. Treatment failures are not uncommon in chronic prostatitis. Literature reports suggest that antimicrobial treatment failures in chronic idiopathic prostatitis caused by organisms producing extracellular slime might result from the virulent properties of coagulase-negative staphylococci or other bacteria. While it is difficult to definitively extrapolate from animal models, antibiotic pharmokinetic studies with a murine model have suggested that treatment failures in chronic prostatitis are probably a result of the local microenvironment surrounding the persistent focal and well-protected small bacterial biofilms buried within the prostate gland. These conclusions support the molecular and culture data implicating bacteria as a cause of chronic idiopathic prostatitis.
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Affiliation(s)
- G J Domingue
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
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32
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DONADIO A, GAGLIANO H, REMEDI M, NOWOTNY E, DEPIANTE-DEPAOLI M. TIME-COURSE STUDY OF CELLULAR IMMUNE RESPONSE AND TESTOSTERONE METABOLISM IN AN AUTOIMMUNE MODEL FOR CHRONIC PROSTATIC INFLAMMATION. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62610-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A.C. DONADIO
- From the Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba Cordoba, Argentina
| | - H. GAGLIANO
- From the Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba Cordoba, Argentina
| | - M.M. REMEDI
- From the Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba Cordoba, Argentina
| | - E. NOWOTNY
- From the Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba Cordoba, Argentina
| | - M. DEPIANTE-DEPAOLI
- From the Departamento de Bioquimica Clinica, Facultad de Ciencias Quimicas, Universidad Nacional de Cordoba Cordoba, Argentina
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33
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Jantos CA, Augustin J, Durchfeld-Meyer B, Baumgärtner W, Schiefer HG. Experimental genital tract infection with Chlamydia psittaci (GPIC agent) in male rats. Infection 1998; 26:126-30. [PMID: 9561385 DOI: 10.1007/bf02767776] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The course of experimental chlamydial infection of the male genital tract was studied. Inoculation of the Chlamydia psittaci agent of guinea pig inclusion conjunctivitis (GPIC agent) into the vas deferens of rats resulted in chlamydial infection of the epididymis, testis and the prostate gland. The inflammatory response was most prominent at 14 days after infection. Chlamydiae were recovered from the epididymides and the prostate glands for up to 90 and 60 days post inoculation, respectively. Histopathological changes associated with chlamydial infection of the epididymis or prostate gland were characterized by intratubular and interstitial purulent inflammation. Chlamydia-specific IgM- and IgG-antibodies were found in sera of nearly all infected animals. Results of this study indicate that this animal model may be useful to study the pathogenesis, immune responses and sequelae of chlamydial infections of the male genital tract.
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Affiliation(s)
- C A Jantos
- Institut für Medizinische Mikrobiologie, Klinikum der Justus-Liebig-Universität Giessen, Germany
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34
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Alexander RB, Brady F, Ponniah S. Autoimmune prostatitis: evidence of T cell reactivity with normal prostatic proteins. Urology 1997; 50:893-9. [PMID: 9426720 DOI: 10.1016/s0090-4295(97)00456-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine whether men with chronic prostatitis/chronic pelvic pain syndrome have evidence of an autoimmune response to prostatic proteins. We examined men with a history of chronic prostatitis/ chronic pelvic pain syndrome for evidence of T lymphocyte reactivity to seminal plasma. METHODS Patients underwent automated leukopheresis to obtain peripheral blood mononuclear cells. We performed a recall antigen proliferation assay to detect specific proliferation of peripheral helper T lymphocytes in men. with chronic prostatitis/chronic pelvic pain syndrome and compared the results with those of normal men. The antigen for these studies consisted of seminal plasma from normal donors and men with seminal vesicle atresia. RESULTS A specific recall proliferative response to seminal plasma was observed in 3 of 10 men with a history of chronic prostatitis/chronic pelvic pain syndrome compared with none of 15 normal men. The CD4 T cell proliferative response to seminal plasma was statistically significant when compared with medium alone in men with a history of chronic prostatitis/chronic pelvic pain syndrome but it was not statistically significant in normal men. The recall responses of both the chronic prostatitis/chronic pelvic pain syndrome group and normal subjects to the recall antigens tetanus toxoid and Candida extract were equivalent. CONCLUSIONS The data represent the first direct evidence that some men with chronic prostatitis/chronic pelvic pain syndrome have an autoimmune component to their disease. Autoimmunity is a potential etiology for chronic nonbacterial prostatitis.
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Affiliation(s)
- R B Alexander
- Urology Section, VA Maryland Health Care System, Baltimore 21201, USA
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35
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Gümüş B, Sengil AZ, Solak M, Fistik T, Alibey E, Cakmak EA, Yeter M. Evaluation of non-invasive clinical samples in chronic chlamydial prostatitis by using in situ hybridization. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1997; 31:449-51. [PMID: 9406305 DOI: 10.3109/00365599709030640] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Seventy-eight non-invasive prostate specimens collected from patients with chronic non-bacterial prostatitis were evaluated by in situ hybridization (IH) for evidence of Chlamydia trachomatis. Intracellular Chlamydia bodies were detected in 18 of 78 cases (20.6%). Homogeneous blue-black bodies in the cellular cytoplasm were accepted as in situ positive. Chlamydial antigen detected by enzyme immuno assay (EIA) was positive in 12 cases (13.7%), but only nine of them were positive by IH. Our study confirms previous reports implicating C. trachomatis as an aetiological agent in chronic non-bacterial prostatitis, and underscores the applicability of DNA probes for detection and identification of C. trachomatis in prostatic materials.
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Affiliation(s)
- B Gümüş
- Department of Urology, Faculty of Medicine, University of Celal Bayer, Manisa, Turkey
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36
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Roberts RO, Lieber MM, Bostwick DG, Jacobsen SJ. A review of clinical and pathological prostatitis syndromes. Urology 1997; 49:809-21. [PMID: 9187684 DOI: 10.1016/s0090-4295(97)00235-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R O Roberts
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
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37
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Berger RE, Krieger JN, Rothman I, Muller CH, Hillier SL. Bacteria in the Prostate Tissue of Men With Idiopathic Prostatic Inflammation. J Urol 1997. [DOI: 10.1016/s0022-5347(01)65066-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Richard E. Berger
- Departments of Urology, and Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - John N. Krieger
- Departments of Urology, and Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ivan Rothman
- Departments of Urology, and Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Charles H. Muller
- Departments of Urology, and Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Sharon L. Hillier
- Departments of Urology, and Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
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38
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Arakawa S. Strategies for the Treatment of Prostatitis. J Infect Chemother 1997; 3:184-189. [PMID: 29681340 DOI: 10.1007/bf02490032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/1997] [Accepted: 05/08/1997] [Indexed: 10/24/2022]
Affiliation(s)
- Soichi Arakawa
- Department of Urology, Kobe University School of Medicine, 7-5-1, Kusunokicho, Chuo-ku, 650, Kobe, Japan
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Krieger JN, Riley DE, Roberts MC, Berger RE. Prokaryotic DNA sequences in patients with chronic idiopathic prostatitis. J Clin Microbiol 1996; 34:3120-8. [PMID: 8940458 PMCID: PMC229469 DOI: 10.1128/jcm.34.12.3120-3128.1996] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Half of all men experience symptoms of prostatitis at some time in their lives, but the etiology is unknown for more than 90% of patients. Optimal clinical and culture methods were used to select 135 men with chronic prostatitis refractory to multiple previous courses of antimicrobial therapy. The subjects had no evidence of structural or functional lower genitourinary tract abnormalities of bacteriuria or bacterial prostatitis by traditional clinical tests, or of urethritis or urethral pathogens by culture. Specific PCR assays detected Mycoplasma genitalium, Chlamydia trachomatis, or Trichomonas vaginalis in 10 patients (8%). Broad-spectrum PCR tests detected tetracycline resistance-encoding genes, tetM-tetO-tetS, in 25% of patients and 16S rRNA in 77% of subjects. The tetM-tetO-tetS-positive cases constituted a subset of the 16S rRNA-positive cases. Patients with 16S rRNA were more likely to have > or = 1,000 leukocytes per mm3 in their expressed prostatic secretion than men whose prostate biopsy specimens were negative for 16S rRNA (P < 0.001). Based on direct sequencing and repetitive cloning, multiple sources of 16S rRNA were observed in individual patients. Sequences of 29 cloned PCR products revealed 16S rRNAs distinct from those of common skin and gut flora. These findings suggest that the prostate can harbor microorganisms that are not detectable by traditional approaches. These organisms may be associated with inflammation in the expressed prostatic secretions. Molecular methods hold great promise for identifying culture-resistant microorganisms in patients with chronic prostatitis.
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MESH Headings
- Adult
- Animals
- Base Sequence
- Chlamydia trachomatis/genetics
- Chlamydia trachomatis/isolation & purification
- Chlamydia trachomatis/pathogenicity
- Chronic Disease
- DNA Primers/genetics
- DNA, Bacterial/genetics
- DNA, Bacterial/isolation & purification
- DNA, Protozoan/genetics
- DNA, Protozoan/isolation & purification
- Genes, Bacterial
- Humans
- Male
- Middle Aged
- Molecular Sequence Data
- Mycoplasma/genetics
- Mycoplasma/isolation & purification
- Mycoplasma/pathogenicity
- Polymerase Chain Reaction/methods
- Prostatitis/etiology
- Prostatitis/microbiology
- RNA, Ribosomal, 16S/genetics
- RNA, Ribosomal, 16S/isolation & purification
- Sequence Homology, Nucleic Acid
- Tetracycline Resistance/genetics
- Trichomonas vaginalis/genetics
- Trichomonas vaginalis/isolation & purification
- Trichomonas vaginalis/pathogenicity
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Affiliation(s)
- J N Krieger
- Department of Urology, School of Medicine, University of Washington, Seattle, USA
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40
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Abstract
OBJECTIVES Chronic prostatitis is a common diagnosis, but the etiology of this disease is unknown. We sought to catalog symptoms and etiologic factors for chronic prostatitis to gather epidemiologic data about the disease. We also sought to determine the feasibility of doing this using the Internet. METHODS A 54-questions survey was designed and posted to several Internet newsgroups dealing with chronic prostatitis. The questions dealt with symptoms, predisposing factors, demographic data, and sexual practices. Responses were collected by electronic mail and tabulated at a central site. RESULTS We received 163 completed surveys over a 2-month period. Nine percent of responses came from individuals outside the United States or Canada. Only 9.8% of complete surveys contained one or more unreadable answers. The responding population consisted of relatively young men (mean age 43 years) with a chronic, relapsing set of symptoms mostly characterized by pain at various locations in the pelvis, irritative voiding symptoms, and pain associated with ejaculation. Most respondents were potent and had a single sexual partner. CONCLUSIONS This catalog of symptoms will be useful in the design of a standardized instrument to distinguish the population of men with prostatitis from normal men or men with benign prostatic hyperplasia. The facility of conducting patient surveys by Internet is demonstrated.
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Affiliation(s)
- R B Alexander
- Division of Urology, University of Maryland School of Medicine, Baltimore, USA
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41
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Corradi G, Bucsek M, Pánovics J, Verebélyi A, Kardos M, Kádár A, Frang D. Detection of Chlamydia trachomatis in the prostate by in-situ hybridization and by transmission electron microscopy. INTERNATIONAL JOURNAL OF ANDROLOGY 1996; 19:109-12. [PMID: 8737042 DOI: 10.1111/j.1365-2605.1996.tb00446.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chlamydia trachomatis infection has been investigated in the prostate gland using in-situ DNA hybridization and transmission electron microscopy. Sixty-four samples of tissue removed by trans-urethral resection or by open surgery from men with benign prostatic hypertrophy (BPH), were examined histologically and 20 of the cases were found to be positive for mononuclear cell infiltration. Some samples were then investigated using in-situ hybridization and transmission electron microscopy. Out of 20 tissue samples with mononuclear cell infiltration, nine were found to be positive for C. trachomatis infection.
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Affiliation(s)
- G Corradi
- Semmelweis University of Medicine, Budapest, Hungary
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42
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Persson BE, Ronquist G, Ekblom M. Ameliorative effect of allopurinol on nonbacterial prostatitis: a parallel double-blind controlled study. J Urol 1996. [PMID: 8583618 DOI: 10.1016/s0022-5347(01)66358-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Nonbacterial prostatitis is a common problem in young men. It is a disease that is often recurrent and each episode lasts for several months. Different causative mechanisms of the disease have been discussed, including identified and unidentified microorganisms, stone formation and psychological factors. We have demonstrated in a previous study that urinary reflux (as shown by a high creatinine concentration in prostatic fluid) occurs to a varying extent into the prostatic ducts, and this reflux has been related to prostatic pain and urate concentration in expressed prostatic secretion. MATERIALS AND METHODS We performed a paralled double-blind controlled study of the objective and subjective effects of allopurinol on patients with nonbacterial prostatitis. Twenty patients received placebo, 18 received 300 mg. allopurinol daily and 16 received 600 mg allopurinol daily for 240 days. All patients began medication at the same time regardless of whether the disease was in an active state. No side effects were noted in the treatment groups. RESULTS Significant effects were noted on the concentrations of serum urate, urine urate, expressed prostatic secretion urate, expressed prostatic secretion xanthine and subjective discomfort. CONCLUSIONS Allopurinol has a significant, positive effect on nonbacterial prostatitis. It is safe and worthy of trial for all at least a 3-month period at each episode to relieve the symptoms of nonbacterial prostatitis.
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Affiliation(s)
- B E Persson
- Department of Urology, University Hospital, Uppsala, Sweden
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43
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Evidence for a Mechanistic Association Between Nonbacterial Prostatitis and Levels of Urate and Creatinine in Expressed Prostatic Secretion. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66357-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Affiliation(s)
- A Doble
- Addenbrooke's NHS Trust, Cambridge, UK
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45
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46
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Abstract
Nonbacterial prostatitis is a common clinical entity which is often difficult to diagnose and treat. Little is known with regard to the etiology and pathogenesis of this disease process. To develop an animal model and characterize the immune parameters of nonbacterial prostatitis, we harvested the prostates from SJL, AJ, Balb/c, C57bl/6 and C57bl/6 lpr mice. These prostates were homogenized and injected into syngeneic mice. Controls were injected with Freund's complete adjuvant only. Mice from each group were sacrificed 30 days after injection, and the prostates were harvested. Prostatic tissue was examined histologically for degree of inflammation. None of the Balb/c mice exhibited prostatic inflammation. The SJL and AJ mice exhibited varying degrees of prostatic inflammation. All of the C57bl/6 mice were found to have lymphocytic infiltration of the stroma and periglandular region. The C57bl/6 lpr mice did not appear to be more susceptible than the parental strain. Adoptive transfer studies demonstrated the prostatic inflammation to be at least in part immune mediated. We conclude that injection of syngenic prostate antigen induces prostatic inflammation similar to clinical nonbacterial prostatitis. Nonbacterial prostatitis may be an autoimmune process.
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Affiliation(s)
- D W Keetch
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63141
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47
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Purvis K, Christiansen E. Infection in the male reproductive tract. Impact, diagnosis and treatment in relation to male infertility. INTERNATIONAL JOURNAL OF ANDROLOGY 1993; 16:1-13. [PMID: 8468091 DOI: 10.1111/j.1365-2605.1993.tb01146.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The following are the conclusions that can be derived from a review of the literature regarding the role of infection in the aetiology of male infertility. (i) Temporary inflammatory episodes in the male reproductive tract which are self-limiting are probably common. (ii) Caution should be exercised in the use of leukospermia or bacteriospermia as parameters for glandular infection. (iii) There is a need for alternative techniques for detecting non-symptomatic deep pelvic infections in the male; one technique of great promise is rectal ultrasound. (iv) Rectal ultrasound indicates that a large number of men with poor sperm quality have a non-symptomatic, chronic prostatovesiculitis. (v) Increasing evidence implicates Chlamydia trachomatis as being a major cause of chronic non-bacterial prostatitis. (vi) An important aspect of chlamydial infections in men may be that the male accessory sex glands may function as reservoirs for the organism, increasing the probability of infection in the female. (vii) Ureaplasma urealyticum may also play an important aetiological role in male infertility but its significance is confounded by its acknowledged function as a commensal in the reproductive tract. (viii) One of the manifestations of male reproductive tract infection is the induction of sperm autoantibodies. (ix) There is a need for more systematic controlled studies of the effects of antibiotic treatment on sperm quality with different preparations for extended periods using patient groups in which a glandular infection has been verified, e.g. by rectal ultrasonography.
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Affiliation(s)
- K Purvis
- Andrology Laboratory, National Hospital, Oslo, Norway
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48
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Montorsi F, Guazzoni G, Bergamaschi F, Galli L, Consonni P, Matozzo V, Barbieri L, Rigatti P. Is there a role for transrectal microwave hyperthermia of the prostate in the treatment of abacterial prostatitis and prostatodynia? Prostate 1993; 22:139-46. [PMID: 8456052 DOI: 10.1002/pros.2990220206] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Transrectal microwave hyperthermia of the prostate was administered to 54 patients with chronic abacterial prostatitis or prostatodynia, who failed to respond to several courses of conventional therapies. Hyperthermia was delivered in 60-min long sessions with three randomly chosen regimens (1 session/week for 4 weeks; 1 session/week for 6 weeks; 2 sessions/week for 3 weeks). A prostatic temperature of 42.5 +/- 0.5 degrees C was maintained throughout the entire duration of each session. Patients were assessed pre- and postoperatively by scoring of subjective symptoms, uroflowmetry with flow nomograms, determination of residual urine volume, and transrectal ultrasonography of the prostate. At the long-term follow-up, the subjective symptom score was significantly improved in all patients. Fifty percent of the patients also reported an improvement of life quality, 47% reported their condition unchanged, and 3% reported deterioration, despite therapy. Urodynamic parameters improved but did not reach statistical significance. No major complications were encountered. Our preliminary data indicate that transrectal microwave hyperthermia of the prostate is a safe therapy that can be beneficial as a second line treatment in selected patients with recurring symptoms of abacterial prostatitis or prostatodynia, which do not respond to medical therapy.
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Affiliation(s)
- F Montorsi
- Institute of Human Anatomy, University of Milan School of Medicine, Italy
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49
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Shortliffe LM, Sellers RG, Schachter J. The characterization of nonbacterial prostatitis: search for an etiology. J Urol 1992; 148:1461-6. [PMID: 1279213 DOI: 10.1016/s0022-5347(17)36940-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nonbacterial prostatitis is often difficult to differentiate from other prostatic complaints and remains a vaguely characterized syndrome. Prostatic fluid inflammatory cells and elevated immunoglobulins raise the suspicion that this syndrome is caused by some undetected infection. Prostatic fluid antibodies against Chlamydia trachomatis, Ureaplasma urealyticum, staphylococcus, Staphylococcus faecalis, Bacteroides fragilis and Clostridium perfringens were measured in men with nonbacterial and bacterial prostatitis, and men without urinary symptoms by an enzyme-linked immunosorbent assay. Prostate specific antigen and prostatic acid phosphatase were measured in the prostatic fluid as indirect measures of secretory activity. Of 44 men with nonbacterial prostatitis 9 (20%) had detectable prostatic fluid antichlamydial antibody titers, compared with 3 of 25 control men (12%) and 2 of 13 (15%) with bacterial prostatitis--no evidence for a higher prevalence of prostatic fluid antichlamydial antibody in men with nonbacterial prostatitis. Prostatic antibodies to the other organisms were rarely detected. When compared with unaffected men the low levels of prostate specific antigen and prostatic acid phosphatase, and more alkaline prostatic fluid in men with bacterial and nonbacterial prostatitis suggest that secretory dysfunction accompanies the inflammation. These data show that none of the organisms studied caused the majority of the cases of nonbacterial prostatitis and that either an agent as yet unidentified or multiple agents may be involved in the etiology of nonbacterial prostatitis.
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Affiliation(s)
- L M Shortliffe
- Department of Urology, Stanford University School of Medicine, California
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50
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Abstract
The role of Chlamydia trachomatis in infections of the male genital tract is reviewed. The organism is an important cause of non-gonococcal urethritis, post-gonococcal urethritis and epididymitis, but does not appear to play a major part in the pathogenesis of chronic abacterial prostatitis or in proctitis in anoreceptive homosexual men.
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