Chronic Prostatitis Symptom Research Articles

Uric acid crystals in the semen of a patient with symptoms of chronic prostatitis

To report the finding of red and brownish precipitates with morphology and chemistry compatible with uric acid crystals in semen in a patient with symptoms of chronic prostatitis. Case report. Academic clinical biochemistry and immunology laboratory. A 35-year-old man with clinical symptoms of prostatitis. Uric acid crystals were detected in the semen samples. Treatment with a low purine diet relieved the symptoms. Study of chemical and morphological characteristics of crystals found in the semen using standard semen analysis and transrectal ultrasound. Analysis of serum, urine, and seminal plasma uric acid levels. Uric acid crystals were detected in semen. A transrectal ultrasound revealed the presence of microcalcifications in the prostate gland. After treatment with a low purine diet, the patient experienced considerable relief of the clinical symptoms. Determination of uric acid and creatinine levels in serum and seminal plasma were carried out before and after treatment. There were no abnormalities or presence of crystals in the post-treatment semen analysis. The presence of uric acid crystals in semen of a patient with symptoms of chronic prostatitis can be attributed to the pelvic pain.

Comparative Randomized Pilot Study of Azithromycin and Doxycycline Efficacy and Tolerability in the Treatment of Prostate Infection Caused by Ureaplasma urealyticum

A total of 1,442 patients with symptoms of chronic prostatitis were examined over a 4-year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia. The inclusion criteria for chronic prostatitis caused by Ureaplasma urealyticum were the presence of clinical symptoms, presence of U. urealyticum in expressed prostatic secretion (EPS) or voided urine collected immediately after prostatic massage (VB₃), absence of U. urealyticum in urethral swabs and absence of other possible pathogens of chronic prostatitis in EPS or VB₃. A total of 63 patients with prostate infection caused by U. urealyticum were available for this pilot study. The patients were randomized according to a computer randomization list to receive a total dose of 4.5 g of azithromycin given as a 3-day therapy of 1 × 500 mg weekly for 3 weeks or doxycyline 100 mg b.i.d. for 21 days. Patients’ sexual partners were treated at the same time. Clinical efficacy and tolerability of the administered drug as well as possible adverse events were evaluated during, at the end and 4–6 weeks after completion of therapy. Bacteriological efficacy was evaluated 4–6 weeks after completion of therapy. Treatment groups did not differ regarding age, distribution of urethral, prostatic, sexual and other symptoms, or digitorectal prostatic examination. Five patients treated with doxycycline had nausea. In the group of patients with prostate infection caused by U. urealyticum, the eradication rate was not significantly different with regard to the administered azithromycin (25/32) or doxycycline (23/31). Clinical cure did not significantly differ with regard to the administered azithromycin (22/32) or doxycycline (21/31).

Inconsistent localization of gram-positive bacteria to prostate-specific specimens from patients with chronic prostatitis

Objectives To determine the rate of gram-positive localizations and whether repetitive cultures demonstrate consistent localization of gram-positive bacteria in patients with chronic prostatitis symptoms. Methods We repeated localization cultures at different visits for untreated patients with chronic prostatitis symptoms. Results A total of 470 patients with chronic prostatitis had lower urinary tract localization cultures done. Ten-fold increases in the concentrations of gram-positive bacteria were noted when the postprostatic massage (VB3) or expressed prostatic secretions cultures were compared with first-void urine (VB1) cultures from 29 patients (6%). This was comparable to the 7% rate of gram-negative chronic bacterial prostatitis. We studied 49 patients who had undergone 130 repeated localization studies (median 2, range 2 to 4). Repeatedly negative studies were found in 20 patients, including 19 who each had undergone two studies and 1 who had undergone four studies. Of 9 patients who each had undergone three or four studies, 9 demonstrated localization of at least one gram-positive species. Of the 29 patients with gram-positive localizations, 27 (94%) did not have consistent localization of the gram-positive species. Conclusions Patients with chronic prostatitis demonstrated localization of gram-positive bacteria, but the results were seldom reproducible in untreated patients. Gram-positive localizations may represent nonpathogens, transient bacterial colonization of the lower urinary tract, or intermittent shedding of prostatic pathogens. The limitations of traditional cultures highlight the need for better diagnostic approaches and improved recommendations for antimicrobial therapy.

The role of unusual pathogens in prostatitis syndrome

A total of 1442 patients with symptoms of chronic prostatitis were examined over a 4-year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb, Croatia. An infectious aetiology was determined in 1070 (74.2%) patients. In 561 of 1070 (52.4%) patients the inflammatory finding (>10 WBC/hpf) was found in expressed prostatic secretions (EPS) or voided bladder urine (VB 3). Normal, <10 WBCs/hpf was found in 362 of 536 (67.5%) patients with symptoms of chronic prostatitis in whom Chlamydia trachomatis was detected in EPS or VB 3, in 51 of 151 (33.8%) patients with isolated Trichomonas vaginalis and in 40 of 72 (55.6%) patients with isolated Ureaplasma urealyticum. Escherichia coli was the causative pathogen in 95, Enterococcus in 68, Proteus mirabilis in 37, Klebsiella pneumoniae in 16, Streptococcus agalactiae in 19, and Pseudomonas aeruginosa in 3 patients with chronic prostatitis. Other patients had a mixed infection. In patients with chronic bacterial prostatitis (CBP) caused by E. coli, P. mirabilis, K. pneumoniae, E. or S. agalactiae, an inflammatory finding was regularly found in EPS or VB 3.

Comparative randomized pilot study of azithromycin and doxycycline efficacy in the treatment of prostate infection caused by Chlamydia trachomatis

The study included 125 adult patients (>18years of age) who had symptoms of chronic prostatitis and proven presence of Chlamydia trachomatis. The presence of C. trachomatis was confirmed in expressed prostatic secretion or in voided bladder urine collected immediately after prostatic massage by a DNA/RNA hybridization method and/or by isolation on McCoy culture and then by immunofluorescent typing with monoclonal antibodies. The patients were randomized in the ratio 2/1; azithromycin/doxycycline, to receive a total of 4.0 g azithromycin over 4 weeks, given as a single dose of 1×1000 mg weekly for 4 weeks or doxycycline 100 mg b.i.d. for 28 days. Patients’ sexual partners were treated at the same time. Clinical and bacteriological efficacy was evaluated 4–6 weeks after the end of therapy. In the group of patients with chlamydial infection of the prostate, there was no significant difference between the eradication rates (azithromycin 65/82, doxycycline 33/43; P=0.82) and the clinical cure rates (azithromycin 56/82, doxycycline 30/43; P=0.94) of the two antimicrobials.

Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis

A total of 89 patients, (>18 years), with symptoms of chronic prostatitis and inflammatory findings as well as the presence of Chlamydia trachomatis confirmed by DNA/RNA DIGENE hybridization method and/or by isolation, McCoy culture and Lugol stain in expressed prostatic secretion or in voided bladder urine collected immediately after prostatic massage, were examined. The patients were randomized to receive a total of 4.5 g of azithromycin for 3 weeks, given as a 3-day therapy of 1×500 mg weekly or ciprofloxacin 500 mg b.i.d. for 20 days. Patients’ sexual partners were treated at the same time. Clinical and bacteriological efficacy were evaluated 4–6 weeks after the end of therapy. Significantly higher eradication (36/45: 17/44; P=0.0002) and a significantly higher clinical cure (31/45: 15/44; P=0.0021) were achieved in the group of patients treated with azithromycin than in the ciprofloxacin group.

Aetiology of chronic prostatitis

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.

Chronic Prostatitis Caused by Trichomonas vaginalis – Diagnosis and Treatment

(2002). Chronic Prostatitis Caused by Trichomonas vaginalis – Diagnosis and Treatment. Journal of Chemotherapy: Vol. 14, No. 5, pp. 537-538.

The role of chlamydia trachomatis in the etiology of chronic prostatitis

INTRODUCTION & OBJECTIVES: Basic factors for the classification of prostatitis syndrome are clinical symptoms and signs and the presence of bacteria and leukocytes in selectively collected urine samples and in EPS by Meares and Stamey localisation technique. The aim of this study was to investigate the etiology of chronic bacterial prostatitis and inflammatory chronic pelvis pain syndrome i.e. nonbacterial prostatitis. MATERIALS & METHODS: We examined a total of 388 patients, older than 18 years of age, with symptoms of chronic prostatitis. The inclusion criteria for chronic bacterial prostatitis was as follows: - a bacterial count of 103 cfu/ml or more (if only Gram-positive cocci are found in EPS, a bacterial count of 10 x 104 cfu/ml or more is required), and 10 or more WBCs/hpf (including macrophages) in EPS or VB3 -finding of 10 or many times greater number of bacteria in EPS and urine bladder sample collected immediately after prostatic massage, than in first voided urine or midstream urine. The inclusion criteria for Chlamydia trachomatis prostatitis was the presence of 10 or more WBCs/hpf in EPS or VB3, the presence of Chlamydia trachomatis in EPS or VB3, absence of Chlamydia trachomatis in urethral swabs and other possible pathogens of chronic prostatitis in VB1, VB2, EPS or VB3. The inclusion criteria for nonbacterial prostatitis or inflammatory chronic pelvis pain syndrome was the isolation of Ureaplasma urealyticum, Mycoplasma hominis or Trichomonas vaginalis and 10 or more WBCs/hpf in EPS of VB3. RESULTS: Disease etiology was determined in 276 (71, 13%) patients. Chlamydia trachomatis was proved to be causative in 109 patients, Trichomonas vaginalis in 52, Escherichia coli in 26, Enterococcus in 25, Proteus mirabilis in 14, Klebsiella pneumoniae in 6, Streptococcus agalactiae in 8, Ureaplasma urealyticum in 7patients with chronic prostatitis. Other patients with had mixed infection. CONCLUSION: Chlamydia trachomatis was proved to be the causative pathogen in one third of patients with chronic prostatitis. Since Chlamydia trachomatis is a bacterium, chlamydial prostatic infection should be defined as chronic bacterial prostatitis.

Comparative Analysis of Azithromycin and Clarithromycin Efficacy and Tolerability in the Treatment of Chronic Prostatitis Caused by Chlamydia trachomatis

A total of 123 patients, older than 18 years of age, with symptoms of chronic prostatitis and inflammatory findings as well as the presence of Chlamydia trachomatis confirmed by DNA/RNA DIGENE hybridization method in expressed prostatic secretion or in voided bladder urine collected immediately after prostatic massage, were examined. The patients were randomized to receive a total of 4.5 g of azithromycin for 3 weeks, given as a 3-day therapy of 1×500 mg weekly or clarithromycin 500 mg b.i.d. for 15 days. Patients' sexual partners were treated at the same time. Clinical and bacteriological efficacy were evaluated 4-6 weeks after the end of therapy. In the group of patients with chronic chlamydial prostatitis the eradication rates (azithromycin 37/46, clarithromycin 36/45) and the clinical cure rates (azithromycin 32/46, clarithromycin 32/45) were not significantly different with regards to the administered drug (p>0.05). In the group of patients with asymptomatic chlamydial prostatitis the eradication rates (azithromycin 11/16, clarithromycin 10/15) were not significantly different with regards to the administered drug (p=1.00, OR=1.1).

PSA is a candidate self-antigen in autoimmune chronic prostatitis/chronic pelvic pain syndrome.

Previous studies demonstrated that recognition of seminal plasma antigens can occur in patients with chronic prostatitis/chronic pelvic pain syndrome. This suggests that an autoimmune component may contribute to symptoms in some men. To determine if any of the principal secretory proteins of the prostate could be candidate antigens in autoimmune prostatitis, we examined the recall proliferative response of purified CD4 T cells in patients with chronic prostatitis and in normal volunteers using purified seminal plasma antigens and autologous dendritic cells. Peripheral blood mononuclear cells were harvested from 14 patients with chronic prostatitis and 12 normal volunteers by density gradient centrifugation. The stimulating cells were irradiated autologous dendritic cells produced by culture of monocyte-enriched fractions with IL-4 and Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF). Purified CD4 T cells were the responding population. Recall proliferation assays were performed, using purified seminal plasma proteins as antigens. In 14 patients with chronic prostatitis, we detected a greater than 2-fold increase in proliferative response to PSA compared to control in 5 patients (36%). No response to Prostatic Acid Phosphatase (PAP) or beta-microseminoprotein was observed in these 14 patients. In 12 normal volunteer donors with no history of genitourinary disease or symptoms, no proliferative response above background was observed for any prostatic antigen. The data suggest that some men with symptoms of chronic prostatitis have evidence of a proliferative CD4 T-cell response to PSA. PSA is a candidate antigen in chronic prostatitis/chronic pelvic pain syndrome and may be an appropriate target for immunotherapy for prostatic cancer.

Transurethral Microwave Hyperthermia in the Treatment of Chronic Nonbacterial Prostatitis

Chronic nonbacterial prostatitis is an ill-understood and difficult-to-diagnose disease. Symptoms of chronic nonbacterial prostatitis are similar to those of chronic prostatitis and include low back pain, frequency, dysuria, perineal discomfort, and painful ejaculation. In view of uncertainty about etiology, treatment of chronic nonbacterial prostatitis remains speculative. Most treatment is aimed at relieving symptoms and not at curing the disease. Because of the troublesome nature of chronic nonbacterial prostatitis and the poor results obtained from traditional treatment methods, a new modality of transurethral microwave hyperthermia was investigated. Six patients were treated from January 1994 through June 1995 by use of transurethral microwave hyperthermia. These men were treated four times during a 2-week period. Their average symptom score decrease was 74.9% and was associated with minimal morbidity. Based on this result, it is concluded that transurethral microwave hyperthermia is a safe and effective treatment modality for chronic nonbacterial prostatitis.

Ciprofloxacin treatment in chronic prostatitis.

Objective: To investigate the effectiveness of ciprofloxacin in the treatment of chronic bacterial prostatitis due to various microorganisms. Methods: Patients with chronic prostatitis symptoms were evaluated by culture of their expressed prostatic secretion and fractionated urine samples according to the four-glass localization test of Meares and Stamey. Patients with an isolated microbial agent were treated with ciprofloxacin 500 mg twice a day for 4 weeks and re-evaluated 1 week and 6 months after the treatment. Results: Sixteen of the 68 (23.5%) evaluated patients were diagnosed as having chronic prostatitis with an isolated microbial agent. Ureaplasma urealyticum was the most common microorganism related to chronic prostatitis. Eradication of the previously isolated microbial agent was found in 11 of the 16 patients at the first-week evaluation. At the 6-month control evaluation no growth was observed on the cultures of seven of the 16 (43.8%) patients, which was accepted as successful treatment. Conclusions: U. urealyticum can be the responsible agent in some chronic prostatitis patients. Ciprofloxacin may be a treatment option in chronic prostatitis.

Sickness Impact of Chronic Nonbacterial Prostatitis and its Correlates

Purpose There is evidence that many patients experiencing chronic idiopathic prostatitis or prostadynia not only have recurrent physical symptoms but also display a range of psychological symptoms, such as depression or anxiety, suggesting that the symptoms of chronic prostatitis may seriously impact on quality of life and functioning. We investigated the degree of sickness impact of chronic prostatis, and the differential importance of physical and psychological symptoms in predicting sickness impact. Materials and Methods The sickness impact profile as well as several symptom measures were administered to 39 patients with chronic prostatitis. Multiple regression analyses were performed to evaluate what proportion of the variance in quality of life or functional status was explained by physical and psychological symptoms. Results The sickness impact profile mean total score of chronic prostatitis patients was within the range of scores reported in the literature for patients suffering myocardial infarction, angina or Crohn's disease. Pain was the only physical symptom that significantly contributed towards explaining variance in sickness impact. Psychological symptoms added significantly to the amount of predicted variance. Conclusions The results indicate a need for careful evaluation and attention to sickness related dysfunction in patients with chronic prostatitis.

Staphylococcus saprophyticus in males with symptoms of chronic prostatitis

Staphylococcus saprophyticus was isolated in 17 percent (12 of 71 men) during one year, but with a peak in August and September to 21 percent in patients referred to the urology department with a suspicion of chronic bacterial prostatitis. Seven of the 12 men had S. saprophyticus in highest number at the prostatic level. Three of these were designated as chronic bacterial prostatitis. In this study the occurrence, of S. saprophyticus appears to follow, and possibly depends on, previous antibiotic therapy. S. saprophyticus disappeared without treatment in all cases.