Cryptococcosis

Cryptococcus neoformans has risen to a worldwide highly recognizable major opportunistic pathogen with deadly consequences. It has become a model fungus to study a variety of paradigms in the host-fungus relationships. Genomic studies are advancing knowledge on its evolution and dissecting its virulence composite. Studies designed to understand host immunology to this fungus are leading to development of active and passive prevention and therapeutic strategies. This article collates and analyzes both new and old knowledge about the pathogen to help frame the meaning of human cryptococcosis as it starts to evolve in the new millennium.

PROPIONIBACTERIUM ACNESASSOCIATED WITH INFLAMMATION IN RADICAL PROSTATECTOMY SPECIMENS: A POSSIBLE LINK TO CANCER EVOLUTION?

PURPOSE

Inflammation is commonly observed in the prostate gland and has been implicated in the development of prostate cancer. The etiology of prostatic inflammation is unknown. However, the involvement of a carcinogenic infectious agent has been suggested.

MATERIALS AND METHODS

Prostatic tissue from 34 consecutive patients with prostate cancer was cultured to detect the presence of bacterial agents. Prostatic inflammation was assessed by histological examination of wholemount tissue sections.

RESULTS

The predominant microorganism detected was Propionibacterium acnes, found in 35% of prostate samples. A significantly higher degree of prostatic inflammation was observed in cases culture positive for P. acnes (p =0.007). P. acnes was separated into 3 groups based on cell surface properties, phenotype and genetic grouping. All skin control isolates were classified as group 1 whereas most prostatic isolates were classified as groups 2 and 3.

CONCLUSIONS

P. acnes has been isolated from prostatic tissues in men who underwent radical prostatectomy for localized cancer and has been shown to be positively associated with prostatic inflammation. This inflammation may then be linked to the evolution of carcinoma. Furthermore, organisms infecting these patients with prostate cancer differ genetically and phenotypically from the commonly identified cutaneous P. acnes isolates, suggesting that specific subtypes may be involved in development of prostatic inflammation.

The int-2 gene product acts as an epithelial growth factor in transgenic mice

The induction of mammary tumors by mouse mammary tumor virus (MMTV) is thought to occur through proviral activation of one or more cellular genes. One of these, int-2, encodes a 27 kd protein which exhibits striking homology to the basic fibroblast growth factor family. To assess directly the role of the int-2 protein in cell proliferation, we have established transgenic mice which carry the int-2 gene driven by the MMTV promoter/enhancer. Expression of the int-2 gene in female transgenic mice results in pronounced mammary gland hyperplasia. Interestingly, expression of the MMTV-int-2 transgene in the prostate gland of male carriers results in a benign, but dramatic, epithelial hyperplasia similar to benign prostatic hypertrophy (BPH), a common but poorly understood disorder in human populations. Together, these results indicate that the int-2 product can act as a potent growth factor in these epithelial tissues.

Studies on the role of Ureaplasma urealyticum and Mycoplasma hominis in prostatitis

It has definitely been demonstrated that Ureaplasma urealyticum is one etiologic agent of nongonococcal urethritis, a sexually transmitted disease. For this reason it seemed possible that the organisms might cause ascending inflammatory reactions of the prostate. Quantitative determinations of ureaplasmas and Mycoplasma hominis, together with localization studies, were therefore performed to elucidate the importance of these microorganisms in patients with chronic prostatitis. U. urealyticum was found in high numbers in expressed prostatic secretions and urine voided after prostatic massage from 82 (13.7%) of 597 patients with chronic prostatitis. Because numbers of ureaplasmas in first-voided urine and midstream urine were significantly lower, the source of the organisms in these patients was assumed to be the prostate. These data and the results of tetracycline treatment provide sufficient evidence for the etiologic importance of ureaplasmas in chronic prostatitis.

Persistent exposure to Mycoplasma induces malignant transformation of human prostate cells

Recent epidemiologic, genetic, and molecular studies suggest infection and inflammation initiate certain cancers, including those of the prostate. The American Cancer Society, estimates that approximately 20% of all worldwide cancers are caused by infection. Mycoplasma, a genus of bacteria that lack a cell wall, are among the few prokaryotes that can grow in close relationship with mammalian cells, often without any apparent pathology, for extended periods of time. In this study, the capacity of Mycoplasma genitalium, a prevalent sexually transmitted infection, and Mycoplasma hyorhinis, a mycoplasma found at unusually high frequency among patients with AIDS, to induce a malignant phenotype in benign human prostate cells (BPH-1) was evaluated using a series of in vitro and in vivo assays. After 19 weeks of culture, infected BPH-1 cells achieved anchorage-independent growth and increased migration and invasion. Malignant transformation of infected BPH-1 cells was confirmed by the formation of xenograft tumors in athymic mice. Associated with these changes was an increase in karyotypic entropy, evident by the accumulation of chromosomal aberrations and polysomy. This is the first report describing the capacity of M. genitalium or M. hyorhinis infection to lead to the malignant transformation of benign human epithelial cells and may serve as a model to further study the relationship between prostatitis and prostatic carcinogenesis.

Immortalization of human adult normal prostatic epithelial cells by liposomes containing large T-SV40 gene

Simian virus SV40 has been widely used to immortalize epithelial cells of mammalian origin. We report here, for the first time to our knowledge, the immortalization of normal adult prostatic epithelial cells in culture by transfection of a plasmid containing SV40 genome with a defective replication origin (SV40 ori-) encapsulated into liposomes. These cells (PNT1) have now been cultured for more than 12 months, and shown to contain the SV40 genome. They express large T protein, present the phenotype of differentiated luminal prostatic cells (positive with antibodies to cytokeratin 18, 19, weakly positive for prostatic acid phosphatase and prostatic specific antigen, negative with anticytokeratin 14 and KL2 antibody). PNT1 cells contain high affinity receptors for dihydrotestosterone. These cells provide a useful tool to study the biology and the pathology of adult prostatic epithelial cells, specially to understand the steps leading to prostatic transformation.

The toll-like receptor pathway: a novel mechanism of infection-induced carcinogenesis of prostate epithelial cells

BACKGROUND

Inflammation and infection have been linked to the pathogenesis of many cancers including prostate cancer. Components of bacteria and viruses have been identified within pathological specimens of men with prostate cancer.

METHODS

We characterized the in vitro response of benign prostate epithelial cells to components of infectious agents as they relate to toll-like receptors.

RESULTS

Primary and immortalized prostate epithelial cells (RWPE) exhibited increased proliferation in response to exposure to lipopolysaccharide (LPS) and CpG DNA. These molecules are well-characterized surrogates for gram negative bacteria (e.g., E. coli) and DNA viruses (e.g., HPV and HSV), which are common in the genitourinary system. Our experiments show that RWPE cells express both TLR 4 (LPS-specific) and TLR 9 (CpG-specific). Targeted knock down of individual TLR expression using siRNA abrogated the proliferative response of RWPE cells to LPS and CpG, respectively. In addition, compared to non-stimulated cells, LPS and CpG up-regulate active NF-kB expression. Increased NF-kB activation was confirmed using RWPE cells that were stably transfected with a NF-kB reporter construct. Interestingly, NF-kB activation was both concentration- and time-dependent when stimulated with LPS. RWPE cells were less susceptible to TNF-alpha induced apoptosis as measured by TUNEL staining when stimulated with CpG or LPS. High concentrations of LPS also prevented cell death as measured by LDH release.

CONCLUSIONS

Our study has identified a unique mechanism that describes how components of pathogens common in the urinary system may contribute to the malignant transformation of benign prostate epithelia.

How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?

PURPOSE

The Meares-Stamey 4-glass test is the standard method of assessing inflammation and the presence of bacteria in the lower urinary tract in men presenting with the chronic prostatitis syndrome. However, most urologists do not use it in daily practice because of the time and difficulty in performing it, as well as the additional expense. We evaluated a simpler test, the 2-glass pre-massage and post-massage test, and compared it with the Meares-Stamey 4-glass test to detect inflammation and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome.

MATERIALS AND METHODS

The study population included 353 men enrolled in the National Institutes of Health Chronic Prostatitis Cohort study with baseline leukocyte counts and 2-day bacterial cultures on specimens obtained from a standard 4-glass test (VB1, VB2, expressed prostatic secretions, VB3). The chi-square test was performed to assess associations of white blood cell counts in expressed prostatic secretions and VB3. A receiver operating characteristic curve was constructed to determine the optimal cut point of white blood cells in VB3 in predicting white blood cells in expressed prostatic secretions. Sensitivity and specificity of VB3 cultures predicting expressed prostatic secretions and positive Meares-Stamey results were calculated from 2 x 2 contingency tables.

RESULTS

Analysis of binary leukocyte outcomes (no white blood cells vs any white blood cells) suggests that white blood cells tend to be present in expressed prostatic secretions when there are any white blood cells in VB3, p <0.0001, the optimal cut point being white blood cell counts of 3 in VB3 (best predictive ability with area under ROC 0.771) to predict 5+ in expressed prostatic secretions with a sensitivity of 76% and specificity of 70%. The optimal cut point of white blood cells in VB3 to predict 10 white blood cells in expressed prostatic secretions was 4 (62% sensitivity and 75% specificity). Uropathogens localizing to expressed prostatic secretions or VB3 confirms a positive 4-glass Meares-Stamey localization test. The sensitivity and specificity of a VB3 localizing culture only in predicting a positive Meares-Stamey 4-glass test result for any uropathogen were 44% to 54% (depending on definition) and 100%, respectively. The pre-massage and post-massage test predicted a correct diagnosis in more than 96% of subjects.

CONCLUSIONS

The value of localizing leukocytes and uropathogens to prostate specific specimens remains controversial in chronic heavily pretreated patients, but these data may help direct therapy (anti-inflammatory or antimicrobial) when obtained at first presentation. The pre-massage and post-massage test has strong concordance with the 4-glass test and is a reasonable alternative when expressed prostatic secretions are not obtained.

Herpesvirus type 2 in the male genitourinary tract

A population study of 190 randomly selected male patients with no history of genital herpesvirus infection revealed a high incidence of herpesvirus type 2 in genitourinary specimens. This indicates that men serve as a reservoir of genital herpesvirus.

Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial

PURPOSE

To our knowledge antibiotics are the most popular choice of therapy for all categories of the chronic prostatitis/chronic pelvic pain syndrome. We determine if culture, leukocyte and/or antibody status of prostate specific specimens predicts patient response to antibiotic therapy.

MATERIALS AND METHODS

Patients clinically diagnosed with the chronic prostatitis/chronic pelvic pain syndrome according to the National Institutes of Health (NIH) definition had a lower urinary tract evaluation that included standard microscopy and culture of prostate specific specimens, and determination of the ratio of voided bladder 3 and voided bladder 2 antibody levels against a panel of identified prostate pathogens (enzyme linked immunosorbent assay methodology). Symptom evaluation consisted of the NIH chronic prostatitis symptom index (derived) pain scale 0 to 21, symptom severity index scale 0 to 100, symptom frequency questionnaire scale 0 to 50 and quality of life scale 0 to 6. Patients were stratified according to microscopy, culture and immune status, were treated with 12 weeks of ofloxacin, and were assessed at 4, 12 and 24 weeks with symptom scores as well as global assessments.

RESULTS

Based on leukocyte and culture results, 102 evaluable patients were stratified into categories II (14%), IIIA (48%) and IIIB (38%) of the chronic prostatitis/chronic pelvic pain syndrome. Of the cases 23% were categorized as antibody positive and 77% as antibody negative. Average age was 42 +/- 10 years and 92% of patients were white. Of the patients 57% believed that they had moderate to marked improvement. All categories of the chronic prostatitis/chronic pelvic pain syndrome and patients in whom antibody was positive or negative had significant improvement in the NIH chronic prostatitis symptom index, symptom severity index, symptom frequency questionnaire and quality of life scores compared with baseline (p <0.001). There was no significant difference in patient response to the stratification based on culture, leukocyte, that is categories II, IIIA and IIIB had same beneficial response, or antibody status.

CONCLUSIONS

Culture, leukocyte and antibody status of prostate specific specimens does not predict antibiotic response in patients with the chronic prostatitis/chronic pelvic pain syndrome. The perceived beneficial effect of antibiotics needs to be evaluated in a randomized placebo controlled trial.

Replication of bovine viral diarrhoea virus in the bovine reproductive tract and excretion of virus in semen during acute and chronic infections

Five mature bulls were studied during an acute transient infection with bovine viral diarrhoea virus (BVDV). The bulls had been infected experimentally by the intranasal instillation of blood and serum from a cow which was a persistent carrier of the virus. Infection was confirmed by the demonstration of a low titred viraemia in four of the five animals and by the seroconversion of all five. Semen samples were collected from each bull on four occasions between seven and 14 days after infection. The virus was isolated from the semen of three of the five bulls and from nine of 12 batches of semen from them. In contrast to other studies of the infection of semen, BVDV was isolated with similar efficiency from raw, unprocessed semen and from diluted, extended semen. The titres of virus in the semen ranged from 5 to 75 TCID50/ml. The infection did not appear to affect the quality of the semen. Shedding of virus continued after the end of the period of viraemia and appeared to be a consequence of the replication of the virus in the reproductive tract and its subsequent excretion in the seminal fluid. Virological studies of the reproductive tracts of these bulls suggested that the most productive sites of virus replication were the seminal vesicles and the prostate gland. Concurrent studies in a persistently infected bull supported these findings.

Cytotoxic necrotizing factor type 1-positive Escherichia coli causes increased inflammation and tissue damage to the prostate in a rat prostatitis model

Infection of rat prostates with cytotoxic necrotizing factor type 1 (CNF1)-positive uropathogenic Escherichia coli caused more inflammation-mediated morphological and histological tissue damage than did infection with isogenic CNF1-negative mutants. These striking differences occurred despite the finding that bacterial counts for the strain pairs were indistinguishable. We conclude that CNF1 contributes to E. coli virulence in a model of acute prostatitis. To our knowledge, the results of this study provide the first demonstration of a role for any uropathogenic E. coli virulence factor in acute prostatitis.

Search for uro-genital tract infections in patients with symptoms of prostatitis. Studies on aerobic and strictly anaerobic bacteria, mycoplasmas, fungi, trichomonads and viruses

Seventy-nine patients with symptoms of nonacute prostatitis and 20 healthy volunteers were examined for uro-genital tract infection with bacteria, mycoplasmas, fungi, trichomonads and viruses. No differences in the results of the bacterial cultures were found between the patients and the controls. In only a few cases were established urinary tract pathogens found, but in no instance were these findings reproducible in later specimens. The cultures of the expressed prostatic fluids and the samples of semen gave no information of the occurrence of bacteria over and above that obtainable from examination of the urethral specimens. Significant bacteriuria was not found in any of the patients. Though Neisseria gonorrhoeae could not be isolated from any of the subjects, immunofluorescent studies revealed such organisms in seminal fluid in 8% of the patients. Nine of the patients had 1 to 3 years been considered successfully treated for gonorrhoea. Five of these nine patients were still found to harbour gonococci, as judged from the immunofluorescent studies. Corynebacterium vaginale was recovered in an equally low frequency (5%) from the patients and the volunteers. There was no significant difference in the incidence of T-mycoplasmas between the patients (46%) and the controls (35%), while Mycoplasma hominis was only found in the patients (10%). Trichomonas vaginalis could not be detected in wet smears of expressed prostatic fluid in any of the subjects, but could be cultured from one such specimen. Metacycline treatment (performed according the double blind cross-over technique) was studied for effects on the bacterial flora. In about 10% of the patients, an earlier not observed relative dominance of gram-negative rods was found on the cultures made after the therapy. Candida albicans was only isolated from the patients. It was found more often after (24%) than before the (15%) treatment. Complement-fixing antibodies to N. gonorrhoeae, cytomegalovirus and Chlamydia were found in 10, 19, and 33% of the patients, respectively. The corresponding figures for the healthy males were 0, 20 and 5%.

The problem of infection after prostatic biopsy: the case for the transperineal approach

The incidence of infection after needle biopsy of the prostate by different techniques was compared in 45 patients. Aerobic and anaerobic culture was made of the biopsy needle, prostate, urine and blood. In addition, endotoxin assays were determined by a new chromogenic method using Limulus lysate. All of the patients undergoing transrectal biopsy were found to have a bacteraemia; 27% were symptomatic and 87% had a post-operative urinary tract infection. A double-blind controlled trial using cefamandole with the premedication showed a significant reduction in the incidence of bacteraemia to 53% and the prevention of a urinary tract infection. Following transperineal biopsy, although the incidence of bacteraemia was 40% and urinary tract infection 27%, none of these patients was symptomatic and the organisms causing the bacteraemia were predominantly skin contaminants. The endotoxin assays showed differences between the groups with higher endotoxin values in the unprotected transrectal group.

Coagulase-negative staphylococcus in chronic prostatitis

Three male patients with a clinical history of prostatitis with coagulase-negative staphylococci localized to the expressed prostatic secretion and who did not respond to antibiotics were studied intensively 4 weeks after cessation of therapy with repeat culture of the prostatic fluid, as well as with culture, and histological and ultrastructural examination of multiple prostatic biopsies. Coagulase-negative staphylococci were cultured in the biopsied prostatic tissue, and gram-positive staphylococci were identified in sparse and focal microcolonies adherent to the prostatic ductal walls. Coagulase-negative staphylococci may be implicated in the pathogenesis of chronic bacterial prostatitis.

Isolation of Chlamydia trachomatis from the prostatic cells in patients affected by nonacute abacterial prostatitis

To assess the presence of Chlamydia trachomatis in nonacute abacterial prostatitis 30 patients with urethral cultures positive for Chlamydia trachomatis underwent microbiological studies, including cultures of transrectal aspiration biopsies of the prostate. Chlamydia trachomatis was isolated from 10 of the prostatic specimens (33 per cent). In 3 cases a nonspecific cytopathogenic effect caused the destruction of the tissue cultures. Our findings demonstrate that Chlamydia trachomatis may cause ascending infections of the prostate and that this microorganism may have an etiological role in the pathogenesis of nonacute abacterial prostatitis.

Detection of human papillomavirus DNA in prostate gland tissue by using the polymerase chain reaction amplification assay

Human papillomavirus (HPV) is associated with specific benign and malignant lesions of the epithelial and mucosal surfaces. Of the sexually transmitted types, HPV type 16 (HPV 16) and HPV 18 are commonly associated with severe dysplasia and carcinoma of the uterine cervix. In men, genital HPV infections which have been studied are manifest as external lesions usually involving types other than 16 and 18. The nature of HPV 16 and 18 infections in men has not been explored. Since the most common neoplasias of the male genital tract involve the prostate gland, we assayed benign hyperplastic and cancerous prostate tumors for the presence of HPV DNA, using type-specific primers in polymerase chain reaction amplifications. Normal prostatic tissue obtained at autopsy was included in the survey. Amplified sequences specific for HPV 16 were found in 14 of 15 benign prostatic hyperplasias and in all of four carcinomas tested. In contrast, HPV 18 was identified in only three benign hyperplasias, which also contained HPV 16 DNA. Four of five normal prostates demonstrated no HPV infection; one contained HPV 16 sequences. The presence of these oncogenic HPV types in prostate tissues suggests a reservoir for sexual transmission; a potential role for the virus in the etiology of prostatic neoplasia remains to be demonstrated.

Intracapsular prostatic omentalization: a new technique for management of prostatic abscesses in dogs

Twenty dogs with abscessation of the prostate gland were treated by celiotomy, drainage, and digital exploration of the gland through bilateral capsulectomy wounds. Omentum was introduced through the capsulectomy wounds and packed into the abscess cavities around the prostatic urethra. Most dogs were discharged from the hospital within 48 hours of the surgery. Long-term resolution of the problem (no recurrence within 12 months) was achieved in 19 dogs. One dog had recurrent abscessation that was managed by the placement of dependent Penrose drains. Temporary tube cystostomy was performed postoperatively in one dog for the management of transient dysuria. One dog with septic peritonitis resulting from preoperative abscess rupture was managed by concurrent open peritoneal drainage. Intracapsular prostatic omentalization was a simple and effective means of managing prostatic abscessation with minimal requirement for postoperative hospitalization of the patient. The frequency of serious complications, including postoperative urinary incontinence, was low.

Acute bacterial inflammation of the mouse prostate

BACKGROUND

Prostatic inflammation is gaining increasing attention as a potential etiologic factor in prostate cancer, benign prostatic hyperplasia, lower urinary tract symptoms, and CPPS. This study was performed to address the need for a well characterized model of acute prostatic inflammation that may be used to study the effect of acute inflammation on epithelial and stromal cell proliferation, voiding behavior, and neurovascular physiology.

METHODS

Uropathogenic E. coli 1677 was instilled transurethrally into adult C57BL/6J male mice. Prostates were analyzed at 1, 2, 3, 5, 7, or 14 days post-instillation and compared to saline-instilled and naïve controls. Time course and severity of inflammation were characterized by the quantity and type of inflammatory infiltrate present, hemorrhage, proliferation, and reactive hyperplasia. RT-PCR was performed to characterize inflammatory mediators including IL-1α, IL-1β, IL-1RA, IL-18, IL-6, IL-10, IL-8, TNFα, and COX-2.

RESULTS

Inflammation was evident in all lobes of the prostate with the DLP most severely affected. Infection consistently led to a significant increase in neutrophils and macrophages in the early stages of prostate infection, followed by lymphocytic inflammation at the later time points. Inflammation was accompanied by induction of several inflammatory genes, including IL-1 family members, IL-6, and COX-2, and induced a significant increase in epithelial proliferation and reactive hyperplasia in all three prostate lobes.

CONCLUSIONS

Transurethral inoculation of uropathogenic E. coli 1677 reliably infects the mouse prostate, produces a significant inflammatory response, and induces quantifiable epithelial proliferation and reactive hyperplasia.

Long-term persistence of cytomegalovirus genome in cultured human cells of prostatic origin

Cells from prostatic tissue obtained from a 3-year-old male donor exhibited scattered foci of cytopathology on primary culture. A virus was isolated and shown by serological analysis to be cytomegalovirus (CMV). After a number of cell culture passages, a cell line (disignated CMV-Mj-P) was obtained in which foci of infection could no longer be demonstrated, nor could virus be rescued. On continued passage the doubling time of the cells decreased markedly, and the fibroblastoid cells ceased to demonstrate contact inhibition. CMV-specific antigen(s) was detected on the surface of the cells by indirect immunofluorescence techniques after exposure of the cultures to iododeoxyuridine. Microcytotoxocity tests established that CMV-Mj-P cells, but not control human prostate cells or human embryonic lung cells, share a membrane antigen with hamster cells transformed by CMV. Nucleic acid hybridization studies revealed that virus genetic information was carried by the human prostate cells and that the cells contained an average of about 10 to 15 genome equivalents of CMV DNA. Karyotypic analysis confirmed that the CMV-Mj-P cells were of human male origin. These results indicate that the cells either have been transformed by CMV or are chronically infected with CMV and releasing virus at levels below detection.

Direct visualization of Propionibacterium acnes in prostate tissue by multicolor fluorescent in situ hybridization assay

Prostate tissues from patients with prostate cancer and benign prostatic hyperplasia (BPH) frequently contain histological inflammation, and a proportion of these patients show evidence of Propionibacterium acnes infection in the prostate gland. We developed a multicolor fluorescent in situ hybridization (FISH) assay targeting P. acnes 23S rRNA along with a 14-kb region of the P. acnes genome. This assay was used to analyze prostate tissues from patients with prostate cancer and BPH. P. acnes infection of the prostate gland was demonstrated in prostatic tissue in 5 of 10 randomly selected prostate cancer patients. FISH analysis and confocal laser microscopy imaging revealed intracellular localization and stromal biofilm-like aggregates as common forms of P. acnes infection in prostate tissues from both prostate cancer and BPH patients. A sequential analysis of prostate tissue from individual patients suggested that P. acnes can persist for up to 6 years in the prostate gland. These results indicate that P. acnes can establish a persistent infection in the prostate gland. Further study is needed to clarify the link between this bacterium and prostatic inflammation which may contribute to the development of BPH and prostate cancer.

Outcome of antibiotic therapy with ciprofloxacin in chronic bacterial prostatitis

Chronic bacterial prostatitis (CBP) is a rare infection of the prostate with Escherichia coli being the predominant causative pathogen. Appropriate antimicrobial therapy is mandatory for cure. We report on our experience with a 4-week regimen of ciprofloxacin in 40 men suffering from CBP due to E. coli. Follow-up was conducted over a period of 12 to 24 months. The microbiological work-up included an analysis of expressed prostatic secretions (EPS) and semen. Eradication of the pathogen in EPS was achieved in 92% of patients 3 months after therapy and in about 70 to 80% of patients evaluated 12 and 24 months after treatment, respectively. Treatment failure was not associated with the presence of prostatic calculi, as assessed by transrectal ultrasonography. After successful therapy, mean EPS pH decreased significantly from 7.95 to 7.35. Significant bacteriospermia with E. coli was detected in 21/22 (95.5%) patients before treatment and in 6/22 (27.3%) patients 6 months after therapy. Our data reconfirm ciprofloxacin as an excellent antimicrobial agent in the therapy of CBP. However, eradication of the pathogen is unpredictable and cannot be achieved in every case. Further studies should correlate microbiological treatment success with symptomatic relief, as assessed by standardised questionnaires.

High prevalence of human papillomavirus in prostate tissues

Specific human papillomavirus (HPV) types are associated with benign and malignant lesions of the anogenital region including the prostate gland. Using polymerase chain reaction (PCR) amplification of type-specific HPV sequences, we have assessed the prevalence of HPV DNA in prostate tissue from 88 individuals. Amplified sequences specific for HPV 16 were found in 34 of 56 benign prostatic hyperplasias and in 14 of 27 prostatic carcinomas. In contrast, HPV 18 was identified in only three benign hyperplasias and one carcinoma, all of which also contained HPV 16 DNA. Four of five normal prostates obtained at autopsy had no detectable HPV infection; one contained HPV 16 sequences. No significant difference in the prevalence of HPV DNA is observed between patients with benign disease and those with evidence of malignancy when fragments of surgical material are analyzed. Surgical method (transurethral resection or suprapubic prostatectomy) had no effect on the frequency of HPV detection. The prevalence of HPV DNA in the small number of normal prostates analyzed was not significantly different from that in the surgical samples. The presence of HPV in prostate tissues suggests a possible reservoir for sexual transmission of types with oncogenic potential. A role for the virus in the etiology of prostatic neoplasia remains to be demonstrated.

Bacterial localization in antibiotic-refractory chronic bacterial prostatitis

Chronic bacterial prostatitis, that has become resistant to antibiotic therapy, remains a frustrating clinical entity for both clinicians and patients. Twenty men with a history of documented bacterial prostatitis, that had become resistant to appropriate antibiotic therapy, were studied in an attempt to determine where the bacteria had become localized, and possibly explain their survival in a relative bactericidal environment. The antibiotics were discontinued for 4 weeks, and cultures of the expressed prostatic secretions, tissue biopsies, histology, and ultrastructure were correlated. Twelve (60%) of the tissue biopsies cultured presumed pathogens. In six of the tissue-positive cases, the expressed prostatic secretion was negative. Specific electron micrographs demonstrate exopolysaccharide coated microcolonies of bacteria firmly attached to the ductal and acinar walls. This mode of growth helps explain some of our difficulties in the diagnosis and treatment of chronic bacterial prostatitis.