Krieger John N, Riley Donald E
Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA.
J Urol. 2004 Dec;172(6 Pt 2):2557-60. doi: 10.1097/01.ju.0000144291.05839.a0.
Since few men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have culturable bacteria by traditional approaches, we used sensitive molecular methods to determine presence of fastidious microorganisms.
We evaluated 135 men with CP/CPPS by standardized clinical evaluation, and by lower tract localization cultures and chamber counts of expressed prostatic secretions of leukocytes. We excluded from study patients with bacteriuria, bacterial prostatitis, urethritis or positive urethral cultures. Prostate biopsy was obtained using a double-needle technique to limit contamination. We chose molecular approaches because previous studies had used culture antigen detection in urine, urethral swabs and expressed prostatic secretions. However, interpretation of such studies is complicated because urogenital samples often acquire bacteria while passing through the urethra. We used specific and broad-spectrum polymerase chain reaction (PCR) assays.
Only 10 (8%) of the 135 subjects had positive specific PCR assays, including Mycoplasmia genitalium, Chlamydia trachomatis and Trichomonas vaginalis. Our findings suggested that C. trachomatis, T. vaginalis and M. genitalium may be identified in some patients with CP/CPPS, even among men with no evidence of urethritis and with negative urethral cultures and other assays. The broad-spectrum PCR assays provided the most provocative findings. DNA encoding tetracycline resistance was identified in 25% of subjects, and 77% of subjects had evidence of 16S rDNAs. The white blood cell concentration in the prostatic secretions correlated with identification of 16S rDNAs in prostate tissue (p <0.01).
Delineating the precise role of these organisms in the etiology of CP/CPPS may help define better diagnostic and treatment algorithms.
由于采用传统方法，很少有慢性前列腺炎/慢性盆腔疼痛综合征（CP/CPPS）男性患者能培养出可培养细菌，我们使用敏感的分子方法来确定苛求微生物的存在。
我们通过标准化临床评估、下尿路定位培养以及对前列腺分泌物白细胞进行室计数，对135例CP/CPPS男性患者进行评估。我们将有菌尿、细菌性前列腺炎、尿道炎或尿道培养阳性的患者排除在研究之外。采用双针技术获取前列腺活检组织以限制污染。我们选择分子方法是因为之前的研究在尿液、尿道拭子和前列腺分泌物中使用培养抗原检测。然而，此类研究的解释很复杂，因为泌尿生殖系统样本在通过尿道时常常会沾染细菌。我们使用了特异性和广谱聚合酶链反应（PCR）检测方法。
135名受试者中只有10名（8%）特异性PCR检测呈阳性，包括生殖支原体、沙眼衣原体和阴道毛滴虫。我们的研究结果表明，在一些CP/CPPS患者中可鉴定出沙眼衣原体、阴道毛滴虫和生殖支原体，即使在没有尿道炎证据、尿道培养阴性以及其他检测结果为阴性的男性中也是如此。广谱PCR检测得出了最具启发性的结果。在25%的受试者中鉴定出编码四环素抗性的DNA，77%的受试者有16S rDNA的证据。前列腺分泌物中的白细胞浓度与前列腺组织中16S rDNA的鉴定相关（p<0.01）。
明确这些微生物在CP/CPPS病因学中的精确作用可能有助于制定更好的诊断和治疗方案。
