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.     

The relevance of Chlamydia trachomatis in acute epididymitis in young men

Young men presenting to a General Surgical Unit with acute epididymitis underwent microbiological investigation, including culture for Chlamydia trachomatis. The results were compared with similar investigations in an asymptomatic control population and with patients presenting to the Department of Genito-urinary Medicine with urethral discharge. Chlamydia trachomatis was cultured from 15% of patients with acute epididymitis and a further 15% had serological evidence of exposure to Chlamydia. Nearly 50% of patients attending the Genito-urinary clinic grew Chlamydia from the urethra. The background prevalence of Chlamydia in the control population was low. It is necessary to identify the significant minority of young men with acute epididymitis associated with chlamydial infection, because of the risk of pelvic inflammation and infertility in their female partners. At present this can only be achieved by submitting all young men with acute epididymitis to full microbiological investigation.     

Chlamydia trachomatis epididymitis diagnosed by fluorescent monoclonal antibody

Two cases are described of atypical presentation of epididymitis requiring surgical exploration to rule out the presence of testicular tumor. In each case epididymal biopsy confirmed the diagnosis of epididymitis, and the causative organism, Chlamydia trachomatis was identified by fluorescent monoclonal antibody technique.     

Local antibody in semen for rapid diagnosis of Chlamydia trachomatis epididymitis

Etiologic studies including micro-immunofluorescence serology for Chlamydia trachomatis were done on 45 consecutive men with acute epididymitis. Of the men 21, all less than 35 years old, had type specific Chlamydia trachomatis antibody in the semen. All patients with semen antibody also had Chlamydia trachomatis antibody in the serum, while only a few of the patients without semen antibody had serum antibody. Chlamydia antibody titers in the semen specimens were higher than those in the sera and they persisted longer. In only 1 patient with semen antibody was another potential etiological agent for epididymitis demonstrated, while most of the patients without semen antibody had bacterial causes for the epididymitis. It was concluded that measurement of Chlamydia trachomatis antibody in semen offered a noninvasive, sensitive and specific method, useful despite prior antibiotic therapy, for diagnosis of the etiology of epididymitis in young men.     

IgG and IgA antibodies specific for Chlamydia trachomatis in acute epididymitis

The possibility of using elevated Chlamydia trachomatis-specific serum IgG and IgA as a screening test for Chlamydia-associated epididymitis was analyzed in 28 acute epididymitis patients and 42 apparently healthy men by the single antigen (L2) immunoperoxidase assay. The prevalence rates of C. trachomatis IgG antibody titer greater than or equal to 64 and elevated C. trachomatis IgG titers (greater than or equal to 128) were significantly higher in the epididymitis patients (75 vs. 40%, p less than 0.01, and 39 vs. 14%, p less than 0.025, respectively) than in controls. The prevalence rate of C. trachomatis IgA antibodies (titer greater than or equal to 8) was significantly higher (p less than 0.001) in epididymitis patients as compared to controls (46 vs. 10%, respectively). The potential application of elevated serum C. trachomatis IgG and IgA antibodies as a noninvasive screening marker in epididymitis patients is discussed.     

The possible role of Chlamydia trachomatis in perineal suppurative hidradenitis.

OBJECTIVE: To find out if there is an association between perineal suppurative hidradenitis and Chlamydia trachomatis infection. DESIGN: Open study. SUBJECTS: Seven consecutive patients treated for perineal suppurative hidradenitis during the past three years, and 10 control subjects who were being treated for acute cryptogenic perianal abscesses. MAIN OUTCOME MEASURE: Presence of C. trachomatis detected by direct immunofluorescent staining. RESULTS: All but one patient had serological evidence of C. trachomatis infection. All 10 control subjects failed to react to IgA antibodies to C. trachomatis, and two reacted to IgG antibodies. CONCLUSION: There may be a link between C. trachomatis infection and suppurative hidradenitis, but it is uncertain whether it is a direct cause or a predisposing factor.     

The role of chlamydiae in epididymitis

In 21 men suffering from acute or chronic epididymitis who underwent scrotal surgical exploration, diagnostic microbiological studies consisting in cultures of the epididymal tissues and mid-stream urine specimens, as well as examination of the urethral swabs—before and after prostatic massage—were performed. Laboratory tests revealed that 55 per cent of the patients younger than 40 years were infected byChlamydia trachomatis, and 36 per cent by urinary tract bacteria. On the other hand, in only 10 per cent of the patients older than 40 years the causative organisms were Chlamydiae, whereas in 70 per cent the common urinary tract bacteriae were the agents of epididymal infection. The aforementioned microbiological examinations were proved to be reliable in demonstrating the causative bacteria for epididymitis.     

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.     

The clinical presentation of Chlamydia trachomatis in a urological practice

Fifty-nine men with Chlamydia trachomatis (CT) infection have been studied. Epididymitis was the most common presentation (26) compared with urethritis (8) and prostatitis (9). Only 13 patients gave a history of a urethral discharge. Fifteen of 21 female consorts screened were CT positive and 13 of these were asymptomatic. This demonstrates the major aetiological role of CT in lower genitourinary infection and indicates the importance of screening and treating consorts.     

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 usefulness of Chlamydia testpack for the diagnosis of Chlamydia trachomatis infection in genito-urinary tract

A comparative study between Chlamydia Testpack and Chlamydiazyme for the detection of chlamydial antigen was performed. In 61 cases suspected of being chlamydial infection, Chlamydia Testpack had a specificity of 92% and a sensitivity of 88% when compared with Chlamydiazyme. On the result of study using Chlamydia trachomatis serotype B, the sensitivity of Chlamydia Testpack which had a lower limit of 6 x 10(4)/ml of EB was less than that of Chlamydiazyme which had a lower limit of 0.7 x 10(4). However, the large number of EB presented in almost all positive specimen, indicated that Chlamydia Testpack could be used to screen the clinical materials.     

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.     

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.     

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.     

Cytodiagnosis of Chlamydia trachomatis by the immunoperoxidase technic

The PAP-immunocytochemistry using a monoclonal antibody against Chlamydia trachomatis was applied to male patients with clinically manifest urethritis and their female sex partners. In addition, serum levels of the antibody were determined by means of an ELISA system. Immunoperoxidase reactions were recognized on urethral scrapes in 53 (33%) out of 160 cases, and on endocervical specimens in 13 (59%) out of 22 sex partners of PAP-positive patients. In patients with gonococcal urethritis, an infection of C. trachomatis was revealed immunocytochemically in 11 (31%) out of 36 cases, and in 29 (46%) out of 62 cases with non-gonococcal urethritis. Following medication with 200 mg of minocycline or doxycycline per day, PAP staining became negative in 23 (66%) out of 35 cases. The levels of serum antibody against C. trachomatis were undetectable in 8 (26%) out of 29 PAP-positive cases, but positive in 7 (15%) out of 44 PAP-negative cases.     

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