Identification of potential causative infectious agents of chronic prostatitis

Analysis of the data on etiology and pathogenesis of inflammatory processes in prostate including acute and chronic prostatitis as well as chronic pelvic pain syndrome is presented. It has been noted that about 50% of men of fertile age had clinical signs of chronic prostatitis at least once in life and that more than 60% of admissions to urologists in outpatient practices are related with clinical signs of chronic prostatitis. An appreciable decrease in quality of life similar to that due to myocardial infarction or Crohn's disease is observed in patients with chronic prostatitis. Prostatitis often has a chronic cyclic course with exacerbation and remission phases. Not rarely the disease has primary chronic course--without an apparent beginning as acute prostatitis. This leads to late diagnostics and difficulties with identification of etiologic factor, which commonly is a conditionally pathogenic microorganisms and mixed infections. Such difficulties can be a reason for inadequate treatment and complications of chronic prostatitis such as abscess, paraprostatitis, impotence, and infertility.     

细菌性前列腺炎病原菌及临床耐药情况分析

目的 分析汕头地区慢性前列腺炎（CP）病原菌的分布及耐药情况,为确定病原菌分布情况和临床治疗提供参考依据。方法 细菌鉴定及药敏试验采用VITEK-60全自动细菌鉴定仪。结果 葡萄球菌是汕头地区CP的主要致病菌（67％）,其中表皮葡萄球菌的检出率最高,为21．58％。葡萄球菌引起的CP对苯唑西林、头孢唑林、氨苄西林-舒巴坦、阿莫西林-克拉维酸和红霉素等基本无效;而肠球菌对青霉素耐药率为0。治疗首选万古霉素、呋喃妥因、克林霉素和利福平等抗生素。结论 该地区CP的致病菌以葡萄球菌为主,其中表皮葡萄球菌已成为CP的主要病原菌。为减少浪费、提高疗效,建议根据药敏结果选择抗生素。     

慢性前列腺炎患者前列腺液的微生物研究

目的探讨慢性前列腺炎患者前列腺内的微生物种类。方法慢性前列腺炎81例,其中Ⅱ型前列腺炎（慢性细菌性前列腺炎）11例,Ⅲ型前列腺炎（慢性非细菌性前列腺炎）70例。前列腺液取材行细菌培养、解脲脲原体（UU）和人型支原体（MH）的培养、沙眼衣原体（CT）检测,并行淋病奈瑟菌（NG）、结核分枝杆菌（TB）、UU、CT、HPV、HSV-2、CMV的PCR检测,以及细菌16SDNA检测。结果Ⅱ型前列腺炎的病原谱涵盖多种革兰阳性菌和革兰阴性菌,还有CT、CMV、HSV-2和HPV。Ⅲ型前列腺炎中解脲支原体阳性率为37.0%（30/81）,沙眼衣原体阳性率为13.6%（11/81）。前列腺液病毒感染率分别为HPV8.6%（7/81）,HSV-211.1%（9/81）,CMV18.5%（15/81）。研究组前列腺液细菌16SDNA阳性率为66.7%,其中Ⅱ型前列腺炎为100%,Ⅲ型前列腺炎为61.4%。结论慢性前列腺炎患者前列腺内微生物种类繁多,其中许多微生物可能是Ⅲ型前列腺炎的致病因素。     

性病后慢性前列腺炎的病原菌及其耐药性研究

目的:探讨本地区性病后慢性前列腺炎的病原菌分布及其对抗生素的耐药性状况.方法:对131例性病后慢性前列腺炎患者的前列腺液细菌培养和药物敏感试验结果进行统计分析.结果:131例性病后慢性前列腺炎患者的前列腺液细菌培养阳性率为86.3%,从113例阳性标本中共分离培养出14种117株细菌,其中以凝固酶阴性表皮葡萄球菌最为常见(45.2%),其构成比显著高于其他病原菌,药物敏感试验结果显示前列腺液分离菌对临床常用的多种抗生素耐药,而对万古霉素、丁胺卡那霉素、呋喃唑酮、多粘菌素B等耐药率相对较低.结论:凝固酶阴性表皮葡萄球菌是性病后慢性前列腺炎的主要病原菌,病原菌检查和药敏试验对临床诊断和治疗性病后慢性前列腺炎具有重要作用.     

Quantitative studies on the role of Ureaplasma urealyticum in non-gonococcal urethritis and chronic prostatitis

Quantitative determinations of U. urealyticum and M. hominis have been performed in 164 men with non-gonococcal urethritis (NGU) and 597 patients with chronic prostatitis. Evidence is provided that U. urealyticum plays an etiologic role in 29.3 percent of patients with non-gonococcal urethritis. Mixed infections of C. trachomatis and U. urealyticum, in high numbers, do occur in 11 percent of NGU cases. A constellation suggesting ureaplasma-associated disease could be observed in 13.7 to 15.2 percent of 597 patients with chronic prostatitis. M. hominis does not appear to be a causative agent of NGU or chronic prostatitis.     

Experimental autoimmune prostatitis induces chronic pelvic pain

Pain is the hallmark of patients with chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS). Despite numerous hypotheses, the etiology and pathogenesis remain unknown. To better understand CP/CPPS, we used a murine experimental autoimmune prostatitis model to examine the development, localization, and modulation of pelvic pain. Pelvic pain was detected 5 days after antigen instillation and was sustained beyond 30 days, indicating the development of chronic pain. The pain was attenuated by lidocaine treatment into the prostate, but not into the bladder or the colon, suggesting that pain originated from the prostate. Experimental autoimmune prostatitis histopathology was confined to the prostate with focal periglandular inflammatory infiltrates in the ventral, dorsolateral, and anterior lobes of the mouse prostate. Inflammation and pelvic pain were positively correlated and increased with time. Morphologically, the dorsolateral prostate alone showed significantly increased neuronal fiber distribution, as evidenced by increased protein gene product 9.5 expression. Pelvic pain was attenuated by treatment with the neuromodulator gabapentin, suggesting spinal and/or supraspinal contribution to chronic pain. These results provide the basis for identifying mechanisms that regulate pelvic pain and the testing of therapeutic agents that block pain development in CP/CPPS.     

A severely symptomatic case of anaerobic chronic bacterial prostatitis successfully resolved with moxifloxacin therapy

It has been demonstrated that patients showing symptoms of chronic bacterial prostatitis but culture-negative prostate-specific specimens can benefit from administration of antibacterial agents. This suggests that organisms that are not isolated in the routine practice may be responsible for prostate infection in an undefined fraction of subjects. Anaerobic bacteria have been proposed to play a pathogenic role in CBP, on the basis of studies describing clinical remission after eradication of pathogens like Peptostreptococcus spp or Bacterioides spp from prostatic secretions of symptomatic patients, or the significant association between prostatic infection by anaerobes and the presence of inflammation markers in prostatic secretions.In this paper, we report in detail a case of severely symptomatic chronic prostatitis in a patient with evidence of infection by Peptostreptococcus. We also report for the first time that treatment with the 3rd generation fluoroquinolone moxifloxacin was successful in eradicating the pathogen and in causing dramatic resolution of signs and symptoms of chronic bacterial prostatitis.The strict association between eradication of Peptostreptococcus and the rapid disappearance of clinical signs/symptoms points to a causative role of this anaerobe in the chronic bacterial prostatitis case described in this report.     

慢性前列腺炎患者假丝酵母菌感染及耐药性分析

目的 了解慢性前列腺炎与假丝酵母菌感染的相关性及假丝酵母菌的耐药性。方法 采用常规沙堡平板分离360例慢性前列腺炎患者的前列腺液标本中的假丝酵母菌,疑似菌落用ATB Expression鉴定仪进行鉴定。采用ATB-Fungus真菌药敏板,对假丝酵母菌株进行药敏试验。结果 11．7％前列腺液标本（42／360）似丝酵母菌阳性,其中自假丝酵母菌23例（54．7％）,近平滑假丝酵母菌13例（30．9％）,其它6例（14．3％）。假丝酵母菌菌株对两性霉素B和制霉菌素敏感率均为100％,其次为酮康唑,敏感率为97．0％;对5-氟胞嘧啶耐药性最强,其耐药率为56．5％。结论 白假丝酵母菌和近平滑假丝酵母菌是慢性前列腺炎假丝酵母菌感染的优势菌种,假丝酵母菌株最敏感的药物是两性霉素B和制霉菌素。     

PCR for diagnosis of male Trichomonas vaginalis infection with chronic prostatitis and urethritis

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.     

Use of therapeutic polycomponent vaccine "Immunovac VP-4" for the treatment of chronic bacterial prostatitis

A complex of clinical and laboratory examinations of patients with bacterial chronic prostatitis was carried out. The patients were divided into two groups: 55 patients treated by the method of immunotherapy and 20 patients (controls) undergoing basic therapy. Immunotherapy was carried out with the use of polycomponent vaccine VP-4 containing Staphylococcus aureus, Klebsiella pneumoniae, Proteus vulgaris and Escherichia coli antigens. Vaccinal therapy was indicated in cases with infection focus associated with opportunistic bacteria, a prolonged torpid course of prostatitis and when different schemes of etiotropic therapy proved to be ineffective. The vaccine was introduced in 4 or 5 subcutaneous injections at an interval of 5-7 days. The study revealed that in cases of chronic prostatitis accompanied by microecological and immune disturbances the use of complex therapy allowed to achieve good clinical and laboratory results in 91% of the patients. In the patients undergoing immunotherapy the elimination of opportunistic bacteria from the urogenital tract and the restoration of affected microflora occurred.     

Anaerobic seminal fluid micro-flora in chronic prostatitis/chronic pelvic pain syndrome patients

We investigated the seminal micro-flora of 116 men. Eighty-four men had chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and 34 of them were also leukocytospermic. Thirty-two asymptomatic men formed the control group. Micro-organisms were found in all of the 116 seminal fluid specimens. More than 20 different micro-organisms were found in both groups. Neisseria gonorrhoeae and Chlamydia trachomatis were not found. A high frequency of anaerobic bacteria was found in all groups (68-79%), and in most of the specimens, anaerobic micro-organisms were equal to or outnumbered the aerobic strains. We found 1-8 different micro-organisms in each semen sample, the total count of micro-organisms ranged from 10(2) to 10(7)/mL of semen. Both parameters were significantly higher in leukocytospermic CP/CPPS (NIH IIIA category) patients (median=5 different micro-organisms; total median count 5 x 10(4)) than in the control group (median=3 different micro-organisms; total median count 10(3)). In the CP/CPPS patients, the prevalence and/or count of some opportunistic bacteria was higher than in the control group. To show that the micro-organisms do not originate from the urethra, first voided urine was also investigated in 17 prostatitis patients and 15 controls. One patient had significantly fewer micro-organisms (median 1 vs. 4) and a lower total count of micro-organisms (median 10(2) vs. 10(4)/mL) in the first-catch urine than in the seminal fluid. We found only one third of the micro-organisms to be similar in urine and semen while anaerobic bacteria and some aerobic opportunists were infrequent in urine. Semen is a suitable specimen for the diagnosis of prostatitis.     

Distinction des prostatites aiguës récidivantes et chroniques

The E.A.U. (European Association of Urology) published its Guidelines on Urinary and Male Genital Tract Infections in 2001. In the chapter devoted to prostatitis, epididymitis and orchitis, the E.A.U suggests a classification distinguishing prostatitis (usual clinical picture and demonstrated infection) from chronic pelvic pain syndrome (same clinical picture without demonstrable infection). Prostatitis is divided into three categories: acute bacterial prostatitis (type I), chronic bacterial prostatitis (type II) and asymptomatic inflammatory prostatitis (histological prostatitis, type IV). Type I and II prostatitis are considered here. The E.A.U. guidelines do not mention recurrent prostatitis. The authors discuss whether or not recurrent prostatitis should be distinguished from chronic prostatitis by raising three questions: does the literature provide precise data in favour of this distinction? Does this theoretical distinction have any practical consequences? Is this distinction feasible, especially in general practice? The Stanford sesearch team (Stamey and Shortliffe) has provided documented bacteriological data demonstrating recurrence of prostatitis with different bacteria in some cases and persistence of the same pathogen in other cases. The main consequence of these two situations concern treatment (which antibiotics? for how long?) On the basis of personal unpublished data, the authors discuss the feasibility of this distinction in general practice. They show that, in the case of several recurrences of prostatitis per year, it may be difficult to distinguish recurrent prostatitis from chronic prostatitis. They also show that the duration of symptoms is not a sufficiently discriminant factor and that bacteriological findings should be considered. In conclusion, recurrent prostatitis is a particular disease which should be distinguished from chronic prostatitis. The main consequence of this distinction concerns several unresolved questions about the therapy of recurrent prostatitis. In general practice, the distinction may be difficult when only routine bacteriological tests are available. The use of Meares and Stamey’s four glass technique is unusual in this setting, making it difficult to confirm prostatic disinfection.     

单纯治疗慢性前列腺炎对其合并早泄的影响

目的:探讨单纯治疗慢性前列腺炎对其合并早泄的影响。方法:选择372例前列腺炎继发早泄的患者进行单纯针对前列腺炎的治疗,评价前列腺炎的治疗效果(包括前列腺炎症状评分(NIH-CPSI)、前列腺液常规等)及早泄的治疗效果(包括患者性生活满意度评分、配偶性生活满意度评分及阴道内射精潜伏期等)。结果:慢性前列腺炎经综合治疗后,患者的NIH-CPSI评分及前列腺液白细胞计数均显著降低(P0.05)。前列腺炎治愈或好转后,大多数患者的早泄情况得到明显改善,患者性生活满意度、配偶性生活满意度均较治疗前显著提高,阴道内射精潜伏期亦较治疗前明显延长,差异均具有统计学意义(P0.05)。结论:单纯治疗慢性前列腺炎继可使大部分患者并发的早泄明显改善,而对少数前列腺炎好转后早泄症状改善不明显者,可联合应用SSRIs等药物治疗。     

Prostatites: mise au point

Prostatitis is frequent and appears to corresponds to a very heterogeneous group of diseases. The diagnosis of acute prostatitis has always been well defined, while that of chronic prostatitis has always been much more difficult. The conventional classification distinguishes acute prostatitis comprising a systemic infectious syndrome, accompanied by alteration of the general state, voiding disorders and especially a painful prostate on digital rectal examination, and chronic prostatitis corresponding to all other diseases associating voiding disorders, perineal or pelvic pain and possible urethral discharge. More recently, a more objective classification, based on bacteriological and histological criteria derived from analysis of urine and prostatic liquid was proposed by the NIH (National Institutes of Health). This classification defines 4 categories: acute bacterial prostatitis (category 1), chronic bacterial prostatitis (category 2), non-bacterial prostatitis (category 3A), prostatodynia (category 3B). Well conducted treatment appears to be very important to prevent recurrence and the development of chronic prostatitis. The presence of an urethral stricture must be excluded. The management of chronic prostatitis is more difficult and requires bacteriological examination. Finally the patient’s androgen status must be verified, as androgen deficiency can promote infection.     

泄浊通淋汤联合左氧氟沙星对慢性细菌性前列腺炎患者 IL-2、CRP和TNF-γ水平的影响

目的观察泄浊通淋汤联合左氧氟沙星对慢性细菌性前列腺炎患者IL-2、CRP和TNF-γ水平的影响。方法选择116例湿热下注型慢性细菌性前列腺炎患者为研究对象,随机分为研究组和对照组各58例。对照组患者口服左氧氟沙星治疗,研究组在对照组治疗的基础上口服泄浊通淋汤,两组患者均治疗4周。比较两组患者治疗效果、治疗前后EPS-WBC个数、NIH-CPSI评分以及血清IL-2、CRP和TNF-γ含量和不良反应发生情况。结果研究组患者治疗总有效率显著高于对照组(93.10%vs 77.59%,χ~2=5.583,P0.05)。研究组患者治疗后EPS-WBC个数、NIH-CPSI评分、血清IL-2、CRP和TNF-γ含量均低于对照组(均P0.05)。结论泄浊通淋汤联合左氧氟沙星可有效降低慢性细菌性前列腺炎患者EPS-WBC数量,改善NIH-CPSI评分,降低血清中IL-2、CRP和TNF-γ含量,且治疗期间不良反应少,值得临床推广应用。     

High frequency of chronic bacterial and non-inflammatory prostatitis in infertile patients with prostatitis syndrome plus irritable bowel syndrome

Background

Although prostatitis syndrome (PS) and irritable bowel syndrome (IBS) are common disorders, information on the prevalence of IBS in infertile patients with PS is relatively scanty. Therefore, this study was undertaken to estimate the frequency of PS and IBS and to evaluate the prevalence of the various diagnostic categories of prostatitis.

Methodology/Principal Findings

This study enrolled 152 patients with PS, diagnosed by the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) in an andrological setting, and 204 patients with IBS, diagnosed according to the Rome III diagnostic criteria in a gastroenterological setting. The patients with PS were asked to fulfill the Rome III questionnaire for IBS, whereas patients with IBS were asked to complete the NIH-CPSI. The simultaneous presence of PS and IBS was observed in 30.2% and 31.8% of the patients screened by andrologists and gastroenterologists, respectively. Altogether, 111 patients had PS plus IBS (31.2%). They had a total NIH-CPSI and pain subscale scores significantly higher than patients with PS alone. Gastrointestinal symptoms in patients with PS plus IBS were similar to those reported by patients with IBS alone and significantly greater in patients with PS alone. Patients with PS plus IBS had a significantly higher frequency of chronic bacterial prostatitis (category II) and lower of non-inflammatory prostatitis (category IIIB), compared to patients with PS alone. The frequency of inflammatory prostatitis (category IIIA) resulted similar.

Conclusions/Significance

Prostatitis syndromes and IBS are frequently associated in patients with PS- or IBS-related symptoms. These patients have an increased prevalence of chronic bacterial and non-inflammatory prostatitis.     

Alpha-blockers for the treatment of prostatitis-like syndromes

Prostatitis is a common medical diagnosis. The etiology of this symptomatic syndrome can be an acute or chronic bacterial infection, a noninfectious initiator (the most common cause), or iatrogenic heat or radiation; the syndrome may coexist with benign prostatic hyperplasia. Alpha-blockers have a role in the treatment of the prostatitis syndromes. In Category I, acute bacterial prostatitis, alpha-blockers have been shown to possibly ameliorate obstructive and irritative voiding symptoms. In Category II, chronic bacterial prostatitis, alpha-blockers seem to reduce the risk of clinical and bacteriological recurrence. In Category III, chronic pelvic pain syndrome, alpha-blockers improve symptoms and quality of life. Alpha-blockers also seem to ameliorate the symptoms and reduce the risk of acute urinary retention in patients who suffer from either heat- or radiation-induced prostatic inflammation. Alpha-blockers improve lower urinary tract symptoms, including pain, in patients who are diagnosed with both prostatitis and benign prostatic hyperplasia. Evidence has proven there is definitely a role for alpha-blockers in the management of the prostatitis syndromes.     

广东湛江地区前列腺炎患者病原体检测及临床治疗

目的:对广东湛江地区前列腺炎患者前列腺液病原菌分布及药敏情况进行分析,为临床合理用药和制定最佳治疗方案提供依据。方法:湛江市两间最大三甲医院2009年1月至2013年4月间共308例前列腺炎患者的前列腺液进行细菌学和药敏试验。运用全自动微生物分析仪鉴定细菌,采用K-B法测定药物敏感性。结果:308例前列腺液标本中,共17例(17/308,5.52%)分离出致病菌。这些致病菌以革兰氏阳性菌为主,共13株(13/17,76.47%),其中溶血葡萄球菌检测出6株(6/13,46.15%),全部是耐甲氧西林凝固酶阴性葡萄球菌。革兰氏阴性菌4例(4/17,23.53%),包括大肠埃希菌2株(其中一株产超广谱β-内酰胺酶(ESBLs)),粘膜炎莫拉氏菌1株,肺炎克雷伯菌亚种1株。结论:绝大多数前列腺炎患者属于慢性前列腺炎/慢性骨盆疼痛综合症,无需常规使用抗生素治疗。慢性细菌性前列腺炎致病菌感染以革兰氏阳性菌为主。对前列腺炎患者进行病原学检测及药敏试验是临床合理用药、制定最佳治疗方案的基础。     

Analysis of cytokines in seminal plasma and blood sera of patients with chronic prostatitis during immunotherapy with natural complex of cytokines and antimicrobial peptides

Levels of pro- and anti-inflammatory cytokines (TNFalpha, IL-6, IL-8, IL-10) were studied in blood sera and seminal plasma of healthy volunteers and patients with chronic bacterial prostatitis (CBP) or chronic abacterial prostatitis (CABP). Assessment of effect of immunotropic drug Superlymph with direct antimicrobial action for treatment of mentioned groups of patients was performed. It was shown that seminal plasma of patients with CBP and CABP contained higher levels of IL-6 compared with healthy subjects. IL-8 level was increased in small part of patients with CBP and CABP. Changes in cytokine status of patients with CBP and CABP that occurred during treatment and manifested in decrease of proinflammatory cytokines levels (IL-6 and IL-8) and increase of antiinflammatory cytokine level (IL-10) point to reduction of inflammatory process in prostate. Clinical effect of complex treatment in patients with CBP considering eradication of pathogen and shortening of duration of antibacterial treatment amounted 95%. Monotherapy of patients with CABP with Superlymph was effective in 72%.     

Eradication of <Emphasis Type="Italic">Enterococcus faecalis</Emphasis> by phage therapy in chronic bacterial prostatitis — <Emphasis Type="Italic">case report</Emphasis>

The treatment of three patients suffering from chronic bacterial prostatitis who were qualified for an experimental phage therapy protocol managed at the Phage Therapy Unit in Wrocław is described. They had previously been treated unsuccessfully with long-term targeted antibiotics, autovaccines, and laser biostimulation. Rectal application of phage lysates targeted against Enterococcus faecalis cultured from the prostatic fluid gave encouraging results regarding bacterial eradication, abatement of clinical symptoms of prostatitis, and lack of early disease recurrence.