多聚酶链反应对慢性非细菌性前列腺炎的病原学诊断研究

目的 探讨慢性非细菌性前列腺炎的病原学。方法 应用多聚酶链反应（ＰＣＲ）对７６例慢性非细菌性前列腺炎的前列腺液作为单纯疱疹病毒（ＨＳＶ－Ⅱ），沙眼衣原体（ＣＴ），解脲支原体（ＵＵ）检测，同时设对照检测。结果 三种病原体总阳性率为７１％，对照组为６．７％（Ｐ〈０．００５）。两种及两种以上病原体阳性的混合感染率为１５．８％，对照组则为阴性（Ｐ〈０．０１）。结论 ＨＳＶ－Ⅱ，ＣＴ，ＵＵ均为慢性非细菌性前     

解脲支原体和沙眼衣原体感染与慢性前列腺炎

解脲支原体和沙眼衣原体感染与慢性前列腺炎蒋云仙万声贵王新满毕克菊刘守炎自１９８９年１１月～１９９４年１２月对７８５例慢性前列腺炎患者前列腺液进行了细菌普通培养，解脲支原体（ＵＵ）培养和衣原体（ＣＴ）免疫荧光检测，提示ＵＵ与ＣＴ为慢性非细菌性前列腺炎的...     

聚合酶链技术在慢性前列腺炎诊治中的应用

目的：探索慢性前列腺炎的病因，提高其诊治水平。方法：应用聚合酶链技术(PCR)对门诊疑诊为慢性前列腺炎患者的前列腺液进行淋球菌(NG)、沙眼衣原体(CT)及解脲支原体(UU)检测。结果：检出单纯淋球菌感染33例，阳性率9．09％；沙眼衣原体感染32例，阳性率5．15％；解脲支原体感染250例，阳性率23．00％，沙眼衣原体与解脲支原体合并感染13例；淋球菌合并解脲支原体感染5例；淋球菌合并沙眼衣原体感染4例；并应用PCR监测治疗效果。结论：PCR检测慢性前列腺炎病原体快速、敏感性高、特异性强，是一种较为理想、值得推广的临床应用技术。     

应用多聚酶链反应检测前列腺液中沙眼衣原体

从１９９４年１０月至１９９５年５月对７５例慢性前列腺炎患者应用多聚酶链反应（ＰＣＲ）技术检测其前列腺液中沙眼衣原体，并同时进行对照组的前列腺液检测。结果在前列腺液中沙眼衣原体阳性率为２６．７％，而且均为非细菌性前列腺炎。对照组均为阴性。前列腺按摩前初始尿和尿道脱落上皮细胞ＰＣＲ检测沙眼衣原体结果是前列腺液阳性者，尿及尿道上皮细胞均为阴性。本实验结果不仅表明沙眼衣原体是慢性非细菌性前列腺炎的病原体之一，而且为沙眼衣原体性前列腺炎提供了特异性诊断方法和治疗后监测手段。     

前列腺衣(支)原体感染的中西医结合治疗

我们从 1 998年 3月～ 1 999年 3月 ,采用中西医结合方法治疗沙眼衣原体 (ＣＴ)、解脲支原体 (ｕｕ)所致前列腺炎 30例 ,取得较好疗效 ,报告如下。1　临床资料6 2例均符合衣 (支 )原体性前列腺炎的诊断标准 :有不洁性交史 ,尿道刺痒 ,会阴部胀痛不适 ,尿道口有粘性分泌物 ;直肠指检 :前列腺大小不等 ,部分腺体可出现小结节 ,或有压痛。前列腺液 (ＥＰＳ)镜检 :白细胞 >1 0个 /ＨＰ ,或脓、白细胞堆集 ,卵磷脂小体减少或消失。前列腺液ＣＴ、ｕｕ检测分别采用免疫层析法和培养法 ,检出ＣＴ和 (或 )ｕｕ。符合上述 4项或单独第 4项均可诊断。…     

几种性传播疾病病原体的PCR联合检测

近年来⒇,性传播疾病（ＳＴＤ）在国内的发病率逐年上升,其中以淋病奈瑟菌（Ｎ．ｇｏｎｏｒｒｈｏｅａｅ,ＮＧ）、解脲支原体（Ｕ．ｕｒｅａｌｙｔｉｃｕｍ,ＵＵ）、沙眼衣原体（Ｃｈｌａｍｙｄｉａｔｒａｃｈｏｍａｔｉｓ,ＣＴ）和人乳头瘤病毒（Ｈｕｍａｎｐａｐｉ...     

慢性前列腺炎200例治疗总结

19994年 1月～ 1999年 1月 ,我们治疗慢性前列腺炎 (ＣＰ)患者 2 0 0例 ,疗效较好 ,报告如下。临床资料　本组 2 0 0例。年龄 2 6～ 6 6岁。病程 0 .5～ 2 2年。特点 (1)病程长 ,症状明显 ,平均治疗半年以上 ;(2 )直肠指诊前列腺有不同程度的炎症肿胀或硬化 ;(3)前列腺液 (ＥＰＳ)镜检每高倍视野下ＷＢＣ 2 0～满视野 ;(4 )长期过量使用抗生素 ;(5 )曾接受双囊四腔管药物灌注和射频、微波等物理治疗。 2 0 0例均行ＥＰＳ细菌培养及药敏试验 ,其中12 4例有细菌生长 ,结果见表 1。2 0 0例淋球菌 (ＧＣ)、解脲支原体(ＵＵ)培养和沙眼衣原体 (Ｃ…     

泌尿生殖道肺炎支原体感染的研究进展

支原体（mycoplasma）是能够在无生命培养基中复制的最小原核生物。单个支原体的直径为0．125～1．0μm，大小介于细菌与病毒之间，能通过一般滤菌器。其繁殖方式多样，呈高度多形性。支原体在自然界分布广泛，许多动物、植物和昆虫都能携带。近年来，有关支原体对泌尿生殖道感染的研究有了迅速的发展，特别是解脲支原体，同沙眼衣原体和淋球菌一样是引起泌尿生殖道感染的主要病原体。美国疾病控制中心资料：30％～40％的非淋球菌性尿道炎（NGU）病例是由沙眼衣原体引起，30％～40％NGU病例由解脲支原体或人型支原体、阴道毛滴虫、单纯疱…     

解脲支原体、沙眼衣原体与精液白细胞及精子形态的关系

目的 探讨解脲支原体、沙眼衣原体、精液白细胞与精子形态的关系.方法 对1023例男性不育患者精液样本进行检测,解脲支原体采用培养法,沙眼衣原体采用生化酶法进行检测,白细胞采用联苯胺染色方法进行检测,精子形态检测采用计算机辅助系统下人工修正的方法进行分析.结果 UU阳性率为27.57%,CT阳性率为30.11%.UU阳性组、CT阳性组及UU CT阳性组正常形态精子百分率均显著低于对照组(P＜0.01),亦均显著低于阴性组(P＜0.05,P＜0.01).UU阳性组、CT阳性组及UU CT阳性组白细胞异常率均显著高于对照组(P＜0.001),亦均显著高于阴性组(P＜0.001).白细胞异常组正常形态精子百分率显著低于对照组和白细胞正常组(P＜0.001).结论 UU、CT感染、白细胞、精子形态关系密切,UU、CT感染可能直接影响精子形态,亦可能通过激发白细胞异常,通过白细胞机制影响精子形态.     

前列腺液内毒素测定在慢性前列腺炎诊治的意义

测定４７例慢性前列腺炎，１５例前列腺痛病人和１１例对照者中段尿（ＶＢ２，称标本１），前列腺按摩后前列腺液和尿液（ＶＢ３，与ＥＰＳ合称标本２）内毒素浓度，同时作细菌培养。结果表明，革兰阴性菌或Ｇ＾－菌合并革兰阳性菌性前列腺炎患者标本２的内毒素浓度较标本１升高非常显著高于对照组和前列腺痛组（Ｐ＜０．００１），显著高于Ｃ＾＋菌性慢性前列腺炎或细菌数低于低于诊断标准的慢性前列腺炎患者（Ｐ＜０．０５）；Ｇ＾     

Case-control study of men with suspected chronic idiopathic prostatitis

We studied prospectively 50 asymptomatic men (24 men from infertile couples and 26 normal volunteers) with no history of genitourinary infection and 34 men referred for symptoms of chronic prostatitis. Both groups were evaluated by urethral and prostatic secretion cultures for Chlamydia trachomatis, 4-glass prostatic localization cultures for facultative aerobic bacteria (Ureaplasma urealyticum, Mycoplasma hominis and selected fungi) and counts of prostatic fluid leukocytes. The men with symptoms of prostatitis had more than 1,000 leukocytes per mm. in prostatic secretions more often than did controls (11 of 27 versus 0 of 44, p less than 0.001). The concentration of Ureaplasma urealyticum in prostatic secretions was 1 log higher in prostatic fluid localization cultures than in first voided urine in 0 of 30 patients versus 13 of 50 controls (p equals 0.0014). Chlamydia trachomatis was not isolated from any patient or control. No other significant differences were found between patients and controls. We did not identify an infectious cause of chronic nonbacterial prostatitis.     

Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases.

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners.     

Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia

PURPOSE: Ureaplasma urealyticum is a commensal of the lower genitourinary tract of many sexually active adults. The organism is more common in partners of infertile than fertile marriages. We conducted a prospective study at our tertiary care center to confirm a possible association between U. urealyticum and abnormal sperm function parameters. MATERIALS AND METHODS: A total of 50 consecutive male patients seeking general urology consultation for lower urinary tract symptoms characteristic of chronic prostatitis were evaluated. Urine and semen localization cultures were performed with additional semen cultures for U. urealyticum, Chlamydia trachomatis and Mycoplasma hominis. Specimens from 21 healthy men were used as controls. Specimens were analyzed by a computer assisted semen analyzer, and verified manually for concentration, percent motility and morphology. Leukocytospermia was measured by the Endtz test. Semen specimens were also analyzed for reactive oxygen species (ROS), acrosome reaction and mannose binding assay. RESULTS: Of the patients 17 had positive U. urealyticum cultures and the other cultures were negative. Patients with U. urealyticum had significantly higher ROS levels (log [ROS + 1] = 2.52 +/- 0.25) than those without U. urealyticum (1.49 +/- 0.20, p = 0.002) or controls (1.31 +/- 0.19, p = 0.002). Leukocytospermia was detected in only 1 of the 17 (6%) positive specimens and 4 (12%) negative specimens. CONCLUSIONS: Seminal ROS levels are elevated among patients with U. urealyticum. ROS induces lipid peroxidation, which reduces membrane fluidity and sperm fertilization capability, and may be the mechanism by which U. urealyticum impairs sperm function. Absence of leukocytospermia does not exclude U. urealyticum.     

Acute epididymitis: etiology and therapy.

Fifty patients with acute epididymitis were evaluated prospectively by history, examination, and microbiologic studies, including cultures for aerobes, anaerobes, N. gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. E. Coli was the predominant pathogen isolated from the urine of men over 35 years old and C. trachomatis and N. gonnorrheae were the predominant pathogens isolated from the urethra of men under 35. The etiologic role of E. Coli and C. trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine of urethral cultures for these agents. C. trachomatis epididymitis accounted for two thirds of "idiopathic epididymitis" in men, and was often associated with oligozoospermia. Of nine female sexual partners of men with C. trachomatis infection, six had antibody to C. trachomatis, of whom two had positive cervical cultures for this organism, and the others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with C. trachomatis epididymitis, and should be offered to their female sex partner.     

Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls

PURPOSE: Previous reports have identified bacteria in the prostate of men with chronic pelvic pain syndrome. To examine whether prostatic bacteria are more prevalent among patients with chronic pelvic pain syndrome than among those without pelvic pain, we compared 4-glass urine test and prostate biopsy results. MATERIALS AND METHODS: A total of 120 patients with types IIIa and IIIb chronic pelvic pain syndrome and 60 asymptomatic controls underwent a standard 4-glass urine test, examination of expressed prostatic secretion leukocytes by hemocytometer and transperineal, digitally guided prostate biopsies. Tissue was cultured for aerobes, anaerobes, Trichomonas vaginalis, Chlamydia trachomatis and herpes simplex virus. Skin cultures were performed on a subset of patients and controls. RESULTS: Positive prostate biopsy cultures were obtained from patients and controls. Bacteria were found in 45 of 118 pain patients (38%) and in 21 of 59 controls (36%) (p = 0.74). Older men were more likely to have positive cultures. Men with type IIIa chronic pelvic pain syndrome were more likely than those with type IIIb to have positive prostate biopsy cultures. CONCLUSIONS: Bacteria cultured from transperineal prostatic biopsies do not differ between men with and without chronic pelvic pain syndrome. Prostatic bacteria obtained by biopsy are probably not etiologically related to the symptoms in the majority of men with chronic pelvic pain syndrome.     

Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls

PURPOSE: Chronic prostatitis has been traditionally characterized by inflammation and/or infection of the prostate gland, objectively categorized by white blood cells and cultured bacteria in prostate specific specimens. We compared leukocyte counts and localization rates for bacterial cultures of segmented urine samples (VB1, VB2, VB3), expressed prostatic secretion (EPS) and semen in men diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) to men without pelvic pain (controls). MATERIALS AND METHODS: A total of 463 men enrolled in the National Institutes of Health Chronic Prostatitis Cohort study and 121 age matched men without urinary symptoms had leukocyte counts performed and 5-day bacterial cultures on specimens obtained from a standard 4-glass test (VB1, VB2, EPS, VB3) and semen. All risk factor comparisons between case and control analyses were tested using generalized Mantel-Haenszel methods, and multivariable models were developed using logistic regression methods, adjusting for clustering by clinical center within both methods. RESULTS: Men with CP/CPPS had statistically higher leukocyte counts in all segmented urine samples and EPS, but not in semen compared to asymptomatic control men. However, the control population also had a high prevalence of leukocytes. Of the men with CP/CPPS 50% and 32% had 5 or more, or 10 or more white blood cells (WBCs) per high power field, respectively, in EPS compared to 40% and 20% of the control population. Similarly, 32% and 14% of the patients with CP/CPPS had 5 or more, or 10 or more WBCs per high power field in VB3 compared to 19% and 11% in the control population. Localization of uropathogenic bacteria in EPS, VB3 and/or semen was similar in men with CP/CPPS (8.0%) and asymptomatic men (8.3%). CONCLUSIONS: Men with CP/CPPS have significantly higher leukocyte counts in all segmented urine samples and EPS but not in semen as compared to controls. There is no difference in rates of localization of bacterial cultures for men with CP/CPPS compared to control men. The high prevalence of WBCs and positive bacterial cultures in the asymptomatic control population raises questions about the clinical usefulness of the standard 4-glass test as a diagnostic tool in men with CP/CPPS.     

Epididymal stereocilia in semen of infertile men: evidence of chronic epididymitis?

As free stereocilia in semen samples from infertile men could be related to a subclinical chronic infection of the seminal tract, we carried out a retrospective analysis of 14 files of infertile men with stereocilia in semen (group 1) and in two control groups: 30 infertile men from the same study population (group 2) and 40 fertile sperm donors (group 3). Clinical, bacteriological, sonographic and microscopic findings associated with these semen samples were compared. Epididymal cysts were found in two of 14 men in group 1 and in four of 28 in group 2. Positive semen cultures for Chlamydia trachomatis, Mycoplasma hominis or Ureaplasma urealyticum (chi(2) = 8.20; P = 0.002; OR: 7.22) and varicocele (chi(2) = 8.96; P = 0.002; OR: 2.25) were associated to the presence of free stereocilia in semen. These data suggest that a silent chronic infection of the epididymis by C. trachomatis, M. hominis, U. urealyticum and/or inflammation produced by varicocele might be the cause of stereocilia loss in the semen.     

The characterization of nonbacterial prostatitis: search for an etiology.

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.     

Comparison of the incidence of Ureaplasma urealyticum in infertile men and in donors of semen

569 infertile patients and 75 fertile men (donors of semen) were included in our study from 1985 to 1987. We compared the frequency of Ureaplasma urealyticum in semen specimens in these two groups: 40 infertile men (7%) and 4 donors of semen (5.3%) had U. urealyticum in semen cultures. This difference was not statistically significant. We concluded that U. urealyticum was not more frequent in infertile than in fertile men. We also report the results of semen cultures for other bacteria and the parameters of routine semen analysis in these two groups. All infertile patients infected by U. urealyticum were treated with doxycycline: the infection was eradicated in 77.5% of them.     

Accurate detection of male subclinical genital tract infection via cervical culture and DNA hybridization assay of the female partner

The accuracy of the PACE2 DNA hybridization assay of the cervix and cervical culture in female partners for the diagnosis of male subclinical genital tract infection were assessed in a male infertility population. A total of 184 men were screened for the presence of Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis. Seventy-one men were identified with a positive test for one or more of the above mentioned micro-organisms. The overall prevalence of bacterial infection was 39%. Female partners of all men were tested with the PACE2 DNA hybridization assay to detect a C. trachomatis infection. Sensitivity was 100% and specificity was 100%. In 67 female partners (94%) of men who tested positive for U. urealyticum and/or M. hominis, a cervical swab culture was performed. The sensitivity of the cervical swab culture was 100%. In view of the high prevalence of U. urealyticum and M. hominis in the male genital tract and the role these sexually transmitted pathogens may play in infertility, one might question whether all couples should be screened for the presence of these pathogens. Transurethral swab culture after digital prostatic massage is disincentive to men. The cervical culture in their female partner, performed as part of the routine fertility work-up, is a suitable alternative to detect the presence of these micro-organisms in the male genital tract.