Study of Chlamydia trachomatis in chronic prostatitis]

To assess the pathogenetic role of Chlamydia trachomatis in non-bacterial prostatitis (NBP), aspiration biopsied specimens were examined for C. trachomatis by using in situ DNA hybridization and antibody titer to C. trachomatis was measured. An enzyme-linked immunosorbent assay (ELISA) for C. trachomatis specific IgA was employed using purified C. trachomatis type L2 EBs. The positive rates of IgA antibodies to C. trachomatis in serum, EPS and VB3 were 25.6%, 31.5% and 29.4%, respectively. They were significantly higher (p less than 0.05) in the control groups. A good correlation (0.78) of IgA antibody titer to C. trachomatis was found between EPS and VB3. In 9 husbands with positive antibodies to C. trachomatis, 5 wives showed positive serum antibodies. In the NBP patients with a high positive antibody titer, the decrease of titers was shown after treatment with drugs effective against C. trachomatis. Transrectal aspiration biopsies were performed on 7 patients with high positive IgA antibody titers to C. trachomatis, and 2 specimens showed hybrids in the cells by using in situ DNA hybridization. These findings indicate that C. trachomatis is a predominant pathogen for NBP.     

Role of Chlamydia trachomatis and mycoplasmas in chronic prostatitis. A review

Acute bacterial prostatitis caused by common urinary tract pathogens is an infrequent disease, and diagnostic difficulties are rarely encountered. On the other hand, chronic prostatitis is a common disease requiring rather elaborate diagnostic procedures. We applied the localization protocol of the four-specimen technique and combined quantitative determinations of microorganisms and quantitative cytologic analysis plus, in chlamydial infections, serologic investigations. Our studies provide good evidence that Ureaplasma urealyticum and Chlamydia trachomatis must be considered etiologic agents in many cases of chronic bacterial prostatitis. These unconventional microorganisms are assumed to infect the prostate by way of intracanalicular ascension from the urethra.     

Clinical studies of Chlamydia trachomatis in male urethritis

From January through December 1986, the urethral smear specimens from 132 male urethritis patients were examined by using Chlamydia trachomatis direct specimen test (Micro Trak). C. trachomatis was detected in 59 (44.7%) out of 132 male urethritis patients, 8 (30.8%) out of 26 patients with gonococcal urethritis (GU), and 51 (48.1%) out of 106 patients with non-gonococcal urethritis (NGU). In 5 (31.3%) out of 16 cases, already treated in other hospitals, infection of C. trachomatis was revealed. The age distribution of the patients with chlamydial urethritis (NGU-C) was between 19 and 52 years old, and the average was 30.9 years old. The peak incubation periods of GU and NGU-C were seen within 7 days and between 8 and 14 days, respectively. In NGU-C patients, 70.6% of them showed WBC less than or equal to 9/hpf in first voided urine sediment. The source of infection was a non-prostitute in 22.2% and a prostitute in 72.2% of GU, while in NGU-C 23.5% was infected from a non-prostitute, and 62.7% from a prostitute. Ofloxacin (OFLX) was administered in a daily dosage of 600 mg (in 3 divided oral doses) for 5 to 14 days in 38 NGU-C patients, and C. trachomatis was eliminated in all cases after the treatment.     

Chronic prostatitis, chlamydia trachomatis and infertility

Seventy-one infertile men were studied for the presence of seminal leucocytosis, and for the levels of acid phosphatase activity and Chlamydia trachomatis antibodies of IgA class using a novel method of solid-phase radioimmunoassay. The findings were compared with those of 56 fertile men. Chlamydial IgA antibodies were found in the semen of 51.1% of infertile men with seminal leucocytosis and decreased seminal acid phosphatase activity, i.e. those defined as having asymptomatic chronic prostatitis. This frequency was significantly higher than among fertile men (23.2%, P less than 0.01) and those infertile men who had no signs of chronic prostatitis (26.9%, P less than 0.05). It is concluded that Chlamydia trachomatis seems to be a common cause of prostatitis and may also interfere with fertility.     

The role of Chlamydia trachomatis in chronic abacterial prostatitis: a study using ultrasound guided biopsy

We studied 50 patients with chronic abacterial prostatitis as defined by the Stamey procedure via transrectal prostatic ultrasound and subsequent transperineal biopsy of the abnormal areas of the prostate to ascertain the role of Chlamydia trachomatis organisms (chlamydiae) in this condition. Chlamydiae were detected by an immunofluorescence technique in the urethra of 1 patient (2 per cent) but they were not recovered in McCoy cell culture from the prostatic tissue of any patient nor were they detected in the tissue by immunofluorescence. In addition, serum antibody to Chlamydia trachomatis was not found even in moderate titer. The approach in this study has overcome the problem of urethral contamination in the assessment of prostatic specimens from patients with chronic abacterial prostatitis. There is no evidence that chlamydiae are directly implicated in the disease, although the possibility of an earlier active role cannot be excluded.     

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.     

Clinical studies of male urethritis caused by Chlamydia trachomatis

From January through June 1983, 178 male patients with urethritis were investigated on the etiology and epidemiological and clinical features. By using Chlamydia trachomatis direct specimen test (Micro Trak), C. trachomatis was detected in 60 (47.2%) among 127 patients with non-gonococcal urethritis, while it was detected 8 (15.7%) among 51 patients with gonococcal urethritis. The source of infection was a non-prostitute in 30% of chlamydial urethritis, while in gonorrheal urethritis only one patient was infected from a non-prostitute. Mean incubation period of chlamydial and gonorrheal urethritis was 28.5 and 9.2 days, respectively. In chlamydial urethritis, 33.3% of patients did not complain of urination pain and 20.4% showed no urethral discharge. Symptoms of chlamydial urethritis were milder than those of gonorrheal urethritis.     

Eradication of Chlamydia trachomatis parallels symptom regression in chronic bacterial prostatitis patients treated with a fluoroquinolone-macrolide combination

To investigate the association between eradication of Chlamydia trachomatis (CT) and symptom regression in chronic prostatitis, 55 symptomatic patients were subjected to segmented tests to localise CT in first voided urine (VB1), prostatic secretions (EPS), post-massage voided (VB3) or semen specimens. Patients were divided in three treatment groups: the 'urethral involvement' group ('U': VB1 positive, EPS/VB3/Semen negative) was treated with 500 mg day(-1) azithromycin for 3 days. The 'prostatitis' group ('P': VB1 negative, EPS/VB3/semen positive) with 4-week levofloxacin-azithromycin combination. A third group, 'U+P' (VB1, EPS/VB3/semen positive) received both treatments in sequence. In P patients, eradication of CT was paralleled by marked, sustained symptom improvement and by significant decrease of serum prostate-specific antigen (PSA) levels. Compared with U patients, undergoing rapid regression of symptoms related to painful micturition after short-term azithromycin, U+P patients showed symptom and pathogen persistence in VB3/EPS/semen and required additional treatment with 4-week levofloxacin-azithromycin to achieve pathogen eradication, symptom regression, and decrease of PSA. Our results support a causative role of CT in chronic bacterial prostatitis. In the presence of a positive urethral localisation of the pathogen, thorough microbiological investigation together with focused symptom analysis may reveal an underlying chlamydial prostatitis and direct effective therapy with appropriate antibacterial agents.     

Chlamydia trachomatis survival in the presence of two fluoroquinolones (lomefloxacin versus levofloxacin) in patients with chronic prostatitis syndrome

Fluoroquinolones are recommended in the therapy of chronic prostatitis. Chlamydia trachomatis is one of the possible aetiological agents of chronic prostatitis. However, little is known about chlamydia survival in the presence of fluoroquinolones in patients with chronic prostatitis syndrome. For the first time, chlamydia survival in vitro in the presence of lomefloxacin (LOMX) (mostly recommended in the treatment of chronic prostatitis) versus levofloxacin (LVFX) (recommended in the therapy against chlamydia infection) is examined and analysed in the 33 chlamydia-infected patients with chronic prostatitis syndrome in this study. Antichlamydial activity in vitro of LOMX in patients with C. trachomatis and prostatitis was found to be more effective than LVFX. However, further clinical trials for these agents are recommended.     

Chlamydia trachomatis infection in male infertility--the clinical usefulness of the detection of antibodies against Chlamydia trachomatis]

BACKGROUND: The objective of this study is to investigate the clinical usefulness of the detection of antibodies against Chlamydia trachomatis (C. trachomatis) in potential male infertility patients. PATIENTS AND METHODS: Analysis of serum samples for the presence of antibodies against C. trachomatis by enzyme immunoassay was performed in 83 male infertility patients. RESULTS: Immunoglobulin A (IgA) and G (IgG)-antibodies against C. trachomatis were found in 16 and 10 of 83 serum samples (19.3 and 12.0%) respectively. IgA and/or IgG-antibodies against C. trachomatis were found in 20 of 83 serum samples (24.1%). Serum IgA, IgG, or IgA and/or IgG positive patients showed increased semen and urine leukocytes numbers and reduced semen volume and sperm numbers, compared with negative patients, respectively, although these effects are not statistically significant. By Spearman's correlation analysis, however, significant positive correlations with serum IgA or IgG antibody index were found in semen and urine leukocytes numbers. Significant negative correlations with serum IgA antibody index was found in semen volume. In serum IgA positive patients, only 1 of 8 first-voided urine samples was positive for C. trachomatis-DNA by PCR. Moreover, the positive rates of surum IgA antibody and cervical antigen in the 8 female partners of IgA positive patients were only 25% (2 of 8 serum samples) and 12.5% (1 of 8 cervical specimens) respectively. CONCLUSION: There was a high prevalence (24.1%) of serum IgA and/or IgG-antibodies against C. trachomatis from infertility patients. The existance of antibodies against C. trachomatis in serum samples possibly influence semen quality, suggesting that C. trachomatis infection may play an important role in male infertility.     

The role of Chlamydia trachomatis in epididymitis

Microbiological studies have identified an infective micro-organism in 28 of 54 patients (52%) with epididymitis. Chlamydia trachomatis was the commonest infection isolated, occurring in 15 patients. An additional 17 patients (31%) who were culture negative had serological evidence which suggested recent chlamydial infection. Most patients with chlamydia were under 26 years of age, in contrast to patients over 35 years, in whom coliform infections predominated. Of the 12 consorts of patients with chlamydial epididymitis who were screened, nine were also positive for this micro-organism. These findings have important implications in the management of epididymitis, especially in young men.     

Chlamydia trachomatis and sperm lipid peroxidation in infertile men

Aim: To relate the presence of anti-Chlamydial trachomatis IgA in semen with sperm lipid membrane peroxidation and changes in seminal parameters. Methods: Semen samples of the male partners of 52 couples assessed for undiagnosed infertility were examined for the presence of IgA antibody against C. trachomatis. The level of sperm membrane lipid peroxidation was estimated by determining the malondialdehyde (MDA) formation. Results: Sperm membrane of infertile males with positive IgA antibodies against C. trachomatis showed a higher level of lipid peroxidation than that of infertile males with negative IgA antibody (P<0.05). There was a positive correlation (P< 0.01) between the level of C. trachomatis antibody and the magnitude of sperm membrane lipid peroxidation. All the other tested semen parameters were found to be similar in the two groups. Conclusion: The activation of immune system by C. trachomatis may promote lipid peroxidation of the sperm membrane. This could be the way by which C. trachomatis a     

Prostatitis associated with Chlamydia trachomatis in 6 patients

A number of studies have shown that Chlamydia trachomatis bacteria are important pathogens in urogenital tract infections, such as acute urethritis, acute epididymo-orchitis in male patients and pelvic inflammatory disease in female patients. We confirm a previously reported association between Chlamydia trachomatis and prostatitis. We report on 6 patients with definitive confirmation via tissue culture and an immunofluorescent technique. The results demonstrate that chlamydial prostatitis occurs in patients with nonbacterial disease. Efforts should be made to detect and eradicate the organisms from the prostate.     

The frequency of Chlamydia trachomatis in acute epididymitis

Twenty-five patients with bacteriologically proven epididymitis were studied between 1984 and 1986. Thirteen were less than 35 years old and in 11 of them Chlamydia trachomatis was isolated; of the 2 remaining patients Escherichia coli was found in 1 and Neisseria gonorrhoeae in the other. In patients more than 35 years old, gram negative bacteria were the cause of infection in 10 and only 1 case was attributable to Chlamydia trachomatis. These results suggest that Chlamydia trachomatis is much more frequent in men under the age of 35 and the difference is statistically significant.     

Prevalence,concordance and reproductive sequelae after Chlamydia trachomatis infection in Mexican infertile couples

There are few concordance studies on the Chlamydia trachomatis (infection among infertile couples. The objective of this research was to know the prevalence, concordance and reproductive sequelae that couples may develop when both partners show a C. trachomatis infection. A cross-sectional study among 688 infertile couples using the C. trachomatis detection by real-time PCR was performed. The infertility causes were obtained from their medical records. The prevalence of infection was 8.68%. The percentage of concordance was 22.4% (13 couples). A presence of tubal occlusion was only associated with infected-discordant women [RR = 3.46, 95% CI (1.54–7.74), p < .003]. Seminal values were not associated with discordant men. The concordant couples showed association with the infection and tubal occlusion [RR = 3.19, 95% CI (1.09–9.34), p < .05], and oligozoospermia [RR = 12.17, 95% CI (4.29–34.54), p < .001], hypospermia [RR = 14.13, 95% CI (4.78–41.84), p < .001]. An alteration in semen quality was shown particularly in men whose sexual partners show a tubal pathology. This could occur due to a C. trachomatis infection in the testis, which underlines the need to carry out effective and efficient strategies to identify and treat all sexual partners exposed to C. trachomatis.     

Research Progress on Chlamydia trachomatis Infection and Related Cytokines

Chlamydia trachomatis(Ct) infection can induce host cells to produce numerous cytokines. Cytokines play important roles in inflammatory response. Although inflammation can protect the body, persistent inflammation can lead to pathological changes and tissue damages. Further research should determine whether cytokine production directly affects development and outcomes of inflammation. This study summarizes Ct infection and related cytokines.     

Acute urethritis caused by Neisseria meningitidis and Chlamydia trachomatis

A 16-year-old heterosexual man presented to our hospital with a purulent urethral discharge and pain at voiding. These symptoms began seven days after oral-genital contact (fellatio) with his partner. A Gram-stained smear from the urethral discharge showed Gram-negative diplococci, and the antigen of Chlamydia trachomatis from urine was positive. We initially made a diagnosis of urethritis caused by Neisseria gonorrhoeae and C. trachomatis. However, N. meningitidis was isolated by culture. Clinicians should pay attention to the possibility of N. meningitidis infection in all cases resembling gonococcal urethritis.