Prostatitis - Symposium on Etiology (causes)


Symposium on Etiology
In a symposium sponsored byContermporary Urology, three Urology researchers discussed the role of bacteria. Dr. Culley Carson of UNC Chapel Hill said that it is "widely known" that E. coli "is the predominant cause of bacterial prostatitis." Dr. Carson is referring to acute prostatitis
Dr. Stacy J Childs of the University of Colorado agreed, adding that he also sees " Klebsiella or Proteus mirabilis." Hospitalized patients with catheters have prostatitis involving staphylococci or gramnegative pathogens, "Pseudomonas in particular. " Gram-positive bacteria cause prostatitis, particularly Staphylococcus aureus.enterococci, Childs added.
Dr. Carson added Staphylococcus saprophyticus to the list. "A big controversy centers on the issue of whether nonbacterial prostatitis from the old schema is caused by Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis," Carson contributed.
Dr. Childs disagreed, saying Chlamydia, Ureaplasma and Mycoplasma "do not play a major role in bacterial disease. Yet, if a patient presents with prostatitis symptoms-bothersome urethritis, in particular-and tells me his partner has a documented chlamydial infection, I insist he be treated, even though I'm not sure one disease has anything to do with the other."
Dr John Krieger of the University of Washington in Seattle suggested that patients "should be treated regardless of whether they are symptomatic or symptom free. Many asymptomatic women have persistent long-term colonization with genital Mycoplasma species. "
"Another formidable issue concerns fastidious or nonculturable organisms," Dr. Krieger noted. "I prescribe antibiotics to patients with these pathogens, and some of them get better. Their improvement may not last for long, although it's not uncommon for men to note that when they're taking x, y, or z drug, they feel better, even if their cultures are negative."
Dr. Krieger also said that flora in patients'prostates can be identified using molecular technology or careful culturing. He said evidence of bacteria can be found in 50% or more of chronic prostatitis patients. Dr. Krieger said that identifying these flora requires cloning and sequencing RNA, and then conducting extensive database comparisons.
Dr Childs commented that researchers have "cultured out "certain gram-positive organisms, for example, streptococci, in addition to coagulase-negative staphylococci. But he asked whether these were "true pathogens?" Many patients get better following 30 days of treatment, Childs said, "which leads some clinicians to believe that if these men have Staphylococcus epidermidis in their expressed prostatic secretions [EPS], these organisms must be deep inside the prostate."
"I bought into that philosophy for a while," Dr Childs admitted. But he said further research showing the normal flora in the urethra makes him doubt they act as pathogens.
Dr. Krieger countered that UCLA researchers found " a tenfold increase in Cornyebacterium species," which does not meet some definitions of causing disease, but certainly points in a direction for further research.
In the symposium, Dr. Krieger spoke out about the difficulty most doctors have in getting good lab results. "Even in our well-known microbiology department, it took me a year to get our clinical lab to do what I wanted," Dr. Krieger recounted. " That all changed the day I asked if I could run the tests myself in our research lab. Such testing requires careful microbiology, which will uncover organisms in many normal patients. If your lab tests only patients with symptoms, and if your facility runs these tests only occasionally, your laboratorians' work won't be the same as that of those who do it on a regular basis."

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© 2002 The Prostatitis Foundation
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