Genital infections in men associated withChlamydia trachomatis

The advent of new diagnostic procedures has made it possible for urologists to detect chlamydial presence in genital infections. Many studies have shown chlamydial association with urethritis. However, its presence in prostatitis and epididymitis has not been clearly defined yet. In this study we investigated the presence of Chlamydia trachomatis using enzyme linked immuno assay (ELISA) antigen and antibody detection method in sexually active men with different genital infections. We have found that in 32.1% of patients with non-gonococcal urethritis chlamydial antigen is detectable. We also have been able to detect chlamydial antigen in two patients with chronic non-bacterial prostatitis, but in no patients with epididymitis. We conclude that besides its presence in urethritis, there is an association between chlamydia and chronic prostatitis. Yet, further studies are needed to delineate this association more clearly.     

Significance and problems of Chlamydia detection in urologic patients

Chlamydiae represent the aetiological agent in non-gonococcal urethritis in about 50% of the cases, but it is also increasingly recognized that Chlamydia trachomatis can cause prostatitis or epididymitis. The introduction of methods for the direct detection of chlamydia in clinical materials allows early diagnosis and therefore effective antibiotic therapy. The new tests however give both false positive and false negative results.     

Chlamydia trachomatis infection as a problem among male partners of infertile couples

Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease supposed to cause urethritis, epididymitis, prostatitis and infertility in men. The objective of this study was to assess the frequency of C. trachomatis infection in male partners of infertile couples at childbearing age. Sixty infertile couples and a control group of 40 healthy volunteers were included in the study. Urethral swabs were taken from all the male participants and cervical swabs from the female partners of the infertile couples. Culturing on McCoy cell line and PCR were the methods used for detection of the infection. C. trachomatis was found in five out of the 60 male urethral samples. Three of the female partners of these five positive males were diagnosed with C. trachomatis infection, too. We registered a woman with C. trachomatis infection whose partner's samples were negative for the bacterium. The control group showed one specimen positive for C. trachomatis . The frequency of C. trachomatis infection was 8.3% in the male partners of infertile couples at childbearing age when compared with 2.5% in the control group. It is most likely that infertility in the couples with chlamydial infection was due to the pathogen studied.     

Chlamydia trachomatis infection among sexual partners of the patients with non-gonococcal urethritis

During the past 3 years, 30 sexual partners including 18 married couples and 12 extramarital sexual pairs whose male partners were diagnosed as having non-gonococcal urethritis were examined for Chlamydia trachomatis infection. Twenty-three of the 30 couples (76.7%) had identical results either positive or negative for Chlamydia trachomatis infection. All 3 male partners of the 3 pairs who had the non-identical results for Chlamydia trachomatis infection, male negative and female positive, had history of urethritis or prostatitis. Fourteen of the 17 female partners (82.4%) who were positive for Chlamydia trachomatis, had no subjective complaints. The above findings suggest the necessity of treating the female sexual partners of the non-gonococcal urethritis patients irrespective of their symptom.     

性传播性尿道炎后慢性前列腺炎(附86例报告)

目的　探讨性传播性尿道炎后慢性前列腺炎患者的病因学特点。　方法　对 86例性传播性尿道炎后慢性前列腺炎患者进行前列腺按摩液 (EPS)的病原体检测并分析结果。　结果　EPS细菌培养阳性 5 7例 ,阳性率 6 6 .3% ,其中以淋球菌为主要致病菌 33例 (38.4 % )。前列腺液PCR检测淋球菌阳性 37例 (43.0 % ) ,沙眼衣原体阳性 2 2例 (2 5 .6 % ) ,解脲脲原体阳性 19例(2 2 .0 % )。PCR检测出复合病原体者 12例 (13.9% )。　结论　性传播性尿道炎后慢性前列腺炎的致病菌以淋球菌、衣原体和解脲脲原体为主 ,治疗前行EPS病原学检测有重要意义     

Urogenital infections in reproductive medicine

Urogenital infections with Chlamydia trachomatis belong to the most prevalent sexually-transmitted bacterial diseases. In women, they can cause chronic salpingitis with subsequent tubal infertility and ectopic pregnancies. In men, C. trachomatis can cause urethritis, prostatitis and epididymitis. Urogenital infections can be symptomatic or asymptomatic. Symptomatic urogenital infections might impair male fertility. In vitro, C. trachomatis affects sperm motility and viability. However, there is no clear evidence that asymptomatic urogenital infections have an adverse effect on male fertility. Because C. trachomatis can be sexually transmitted and lead to female infertility, it is also of significance in male infertility work-up. Because of their high sensitivity, nucleic acid amplification tests should be used to examine first-void urine specimens. Both partners should be treated. The role of Ureaplasma urealyticum in reproductive medicine has been discussed controversially. There is no evidence that U. urealyticum has a significant impact on female or male infertility.     

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.     

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.     

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.     

Chlamydial seminal vesiculitis without symptomatic urethritis and epididymitis

We previously reported that seminal vesiculitis was associated with acute epididymitis, and that Chlamydia trachomatis was the major causative pathogen for infection of the seminal vesicle, suggesting that seminal vesiculitis was a discrete disease entity. In this paper, we report two patients with bacteriologically and cytologically proven seminal vesiculitis who had asymptomatic urethritis but not epididymitis. The clinical courses of these patients suggest that chlamydial seminal vesiculitis may be a cause of asymptomatic infection of the urethra or subsequent development of acute epididymitis.     

Urethritis in white men--a microbiological appraisal.

The incidence of infections with Neisseria gonorrhoeae, Chlamydia trachomatis and mycoplasmas has been assessed in White men with urethritis who were attending a Johannesburg clinic for sexually transmitted diseases. Infection with N. gonorrhoeae was demonstrated in 54% of 212 patients with urethritis. C. trachomatis was isolated from 37% of patients with non-gonococcal urethritis, and from 25% with proven gonococcal infection. Although T-mycoplasmas were isolated significantly more often from patients with urethritis (41%) than from controls (23%) (P less than 0,05) their role in the aetiology of urethritis is uncertain.     

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.     

The importance and frequency of mixed infections with Chlamydia trachomatis and mycoplasmas in acute gonococcal urethritis

Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis are frequently involved in gonococcal urethritis. We investigated 143 male White and Black patients with gonococcal urethritis (average age 22,5 years). Of these 29% had coexisting Chlam. trachomatis infection, 34% U. urealyticum infection and 13% Mycoplasma hominis infection. Conventional penicillin therapy did not affect Chlam. trachomatis, U. urealyticum or Mycoplasma hominis, which persisted in the lower urogenital tract, causing a so-called 'post-gonococcal urethritis.' Additional therapy with tetracycline or erythromycin was successful in most cases.     

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.     

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.     

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.     

Male reproductive tract sequelae of gonococcal and nongonococcal urethritis.

Gonorrhea is the most frequent bacterial infection as well as the most frequently reported venereal disease. Nongonococcal urethritis has approximately the same incidence as acute gonorrhea in cases reported by many venereal disease clinics. The relative epidemiology of the two diseases, as well as their acute and chronic manifestations in the male genital tract (urethritis, prostatitis, and epididymitis), will be briefly discussed. Resultant obstructions of the lower genitourinary tract of possible consequence to male fertility, such as urethral stricture disease and strictures of the ejaculatory ducts, are described in terms of anatomy, pathophysiology, and treatment. The postulated and demonstrable effects of infectious agents on seminal fluid and sperm are reviewed, with emphasis on the recent literature concerning Chlamydia and Mycoplasma.     

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.     

Is seminal vesiculitis a discrete disease entity? Clinical and microbiological study of seminal vesiculitis in patients with acute epididymitis

PURPOSE: To our knowledge direct evidence of inflammatory involvement of the seminal vesicles has not previously been reported in patients with acute epididymitis. We verified the discrete disease entity of seminal vesiculitis associated with acute epididymitis. MATERIALS AND METHODS: The study included 13 patients who were clinically diagnosed with acute epididymitis. We report imaging, cytological and bacteriological findings in the seminal vesicles of patients with acute epididymitis. RESULTS: On transrectal ultrasonography 12 of the 13 patients (92.3%) had dilatation of the seminal vesicle on the side ipsilateral to epididymitis. Dilatation of the contralateral side was found in only 4 patients. Seminal vesicle fluid from the ipsilateral side showed inflammatory findings in all patients. In patients 40 years and younger Chlamydia trachomatis was detected in seminal vesicle fluid in 7 of the 8 patients with epididymitis with results positive for the microorganism on first voided urine. CONCLUSIONS: Inflammatory responses were found in the seminal vesicles of patients with acute epididymitis. Chlamydia trachomatis was the causative pathogen most frequently detected in seminal vesicle fluid. Seminal vesiculitis is clearly associated with acute epididymitis and it may be a discrete disease entity.     

用DNA探针检测沙眼衣原体

目的 :建立一种敏感而特异的沙眼衣原体分子生物学检测方法。　方法 :用PCR扩增 5 17bp的沙眼衣原体种特异性基因片段并标记成探针 ,建立DNA探针杂交检测沙眼衣原体的方法。　结果 :探针只与沙眼衣原体L2、TE5 5株DNA呈阳性杂交斑点 ,与其他两种衣原体、解脲支原体、淋病奈瑟菌、大肠埃希菌、金黄色葡萄球菌、流感嗜血杆菌及白色念珠菌DNA斑点膜无阳性杂交信号。从 10 0例慢性宫颈炎和前列腺炎病人生殖道分泌物中检出阳性 2 2例 ,阳性率 2 2 %。　结论 :建立的DNA探针检测沙眼衣原体方法具有较高的敏感性和特异性 ,可用于批量临床标本的检测