The role of chlamydia trachomatis in the etiology of chronic prostatitis

INTRODUCTION & OBJECTIVES: Basic factors for the classification of prostatitis syndrome are clinical symptoms and signs and the presence of bacteria and leukocytes in selectively collected urine samples and in EPS by Meares and Stamey localisation technique. The aim of this study was to investigate the etiology of chronic bacterial prostatitis and inflammatory chronic pelvis pain syndrome i.e. nonbacterial prostatitis. MATERIALS & METHODS: We examined a total of 388 patients, older than 18 years of age, with symptoms of chronic prostatitis. The inclusion criteria for chronic bacterial prostatitis was as follows: - a bacterial count of 103 cfu/ml or more (if only Gram-positive cocci are found in EPS, a bacterial count of 10 x 104 cfu/ml or more is required), and 10 or more WBCs/hpf (including macrophages) in EPS or VB3 -finding of 10 or many times greater number of bacteria in EPS and urine bladder sample collected immediately after prostatic massage, than in first voided urine or midstream urine. The inclusion criteria for Chlamydia trachomatis prostatitis was the presence of 10 or more WBCs/hpf in EPS or VB3, the presence of Chlamydia trachomatis in EPS or VB3, absence of Chlamydia trachomatis in urethral swabs and other possible pathogens of chronic prostatitis in VB1, VB2, EPS or VB3. The inclusion criteria for nonbacterial prostatitis or inflammatory chronic pelvis pain syndrome was the isolation of Ureaplasma urealyticum, Mycoplasma hominis or Trichomonas vaginalis and 10 or more WBCs/hpf in EPS of VB3. RESULTS: Disease etiology was determined in 276 (71, 13%) patients. Chlamydia trachomatis was proved to be causative in 109 patients, Trichomonas vaginalis in 52, Escherichia coli in 26, Enterococcus in 25, Proteus mirabilis in 14, Klebsiella pneumoniae in 6, Streptococcus agalactiae in 8, Ureaplasma urealyticum in 7patients with chronic prostatitis. Other patients with had mixed infection. CONCLUSION: Chlamydia trachomatis was proved to be the causative pathogen in one third of patients with chronic prostatitis. Since Chlamydia trachomatis is a bacterium, chlamydial prostatic infection should be defined as chronic bacterial prostatitis.