Infectious Diseases The Presence of Chlamydia Is Associated With Increased Leukocyte Counts and Pain Severity in Men With Chronic Pelvic Pain Syndrome Heeyoon Park, Seon-mi Sim, and Gilho Lee OBJECTIVE METHODS

RESULTS

CONCLUSION

To examine the role of urinary chlamydial infection in patients with chronic prostatitis and/or chronic pelvic pain syndrome (CP-CPPS). We recruited men aged 18-55 years over 4 years. We excluded patients with acute urethritis and any acute genitourinary infections. The participants evaluated their CP-CPPSelike symptoms with the Korean version National Institutes of HealtheChronic Prostatitis Symptom Index questionnaires. We measured white blood cell (WBC) counts in expressed prostatic secretion (EPS). In-house nucleic acid amplification test for Chlamydia trachomatis and Neisseria gonorrhoeae detection and WBC counts were performed from the patient’s first-voided urine. A total of 765 eligible men were classified into 3 groups: 196 in noneCP-CPPS, 410 in noninflammatory CP-CPPS, and 159 in inflammatory CP-CPPS groups. The chlamydia-infected men showed higher pain, poor quality of life (QOL), and total scores in National Institutes of HealtheChronic Prostatitis Symptom Index questionnaires than the negative men (P ¼ .041 for pain; P ¼ .043 for QOL, and P ¼ .027 for total). Multivariate analysis found that urinary chlamydial infection increased the risk of WBC count 16 in EPS (adjusted odds ratio [OR], 2.189; 95% confidence interval [CI], 1.021-4.690; P ¼ .044) and WBC count between 2 and 4 in urine (OR, 5.227; 95% CI, 2.503-10.918; P ¼ .001). In addition, chlamydial infection also increased the risk of inflammatory CP-CPPS than the noneCP-CPPS group (OR, 2.448; 95% CI, 1.010-5.932; P ¼ .044), whereas the patients with noninflammatory CP-CPPS were not affected (OR, 1.6557; 95% CI, 0.738-3.717; P ¼ .221). Urinary chlamydial infection increased the pain scores and WBC counts in EPS and worsens the QOL in the patients with CP-CPPS. UROLOGY 85: 574e579, 2015.  2015 Elsevier Inc.

P

rostatitis is a common urologic disorder with pain or discomfort in the genitourinary system, urination symptoms, and poor quality of life (QOL).1 Approximately, only 10% of patients with chronic prostatitis and/or chronic pelvic pain syndrome (CP-CPPS) have clinically significant bacteria in their prostates.2 In addition, category III CP-CPPS is the most common type in prostatitis syndrome in visits to urologists and primarycare physicians in the world.3 Some fastidious organisms, Heeyon Park and Gilho Lee have designed the experiment, collected the samples, extracted deoxyribonucleic acid from the samples, and taken conventional multiplex polymerase chain reaction. Seon-mi Sim has made the process of real-time polymerase chain reaction using DiaPlexQ CT/NG detection kit. All participants in this study have performed the analysis of the data and written the article. Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Dankook University College of Medicine, Cheonan, Korea; and the Department of Molecular Diagnostics, SolGent, Daejeon, Korea Address correspondence to: Gilho Lee, M.D., Department of Urology, Dankook University College of Medicine, San 29, Anseo-dong, Dongnam-gu, Cheonan, Chungnam 330-714, Korea. E-mail: [email protected] Submitted: July 9, 2014, accepted (with revisions): November 11, 2014

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particularly Chlamydia trachomatis (C trachomatis) and unculturable bacteria, are commonly suggested for the etiology of chronic nonbacterial prostatitis.3-6 The nature of C trachomatis such as small size, chronicity, frequent pathogen in male urethritis, and its difficult ordinary culture can be used to deduce that C trachomatis plays some roles in the pathogenesis of CPCPPS, or C trachomatis can be an important etiology for chronic prostatic inflammation. This inference, however, remains controversial during the last several decades.3-7 In addition, current research for C trachomatis still focuses on women, who develop the most serious complications, leaving the study of male genitourinary infection unexplored. It is a general rule in CP-CPPS study that those with urethral discharge must be tested to rule out gonorrhea or chalmydial urethritis.8-11 Unfortunately, most men with urinary chlamydial infection do not exhibit urethritis symptoms or exhibit atypical genitourinary pain or discomforts.8 Furthermore, we do not have much information http://dx.doi.org/10.1016/j.urology.2014.11.008 0090-4295/15

Table 1. Clinical characteristics of study subjects Patient Groups Parameter

NoneCP-CPPSy

Noninflammatory CPPSz

Inflammatory CPPSx

P Value

410 42.72  9.55

159 41 86  10.06

.273

27 383

15 144

.127

315 91 0

0 0 159

.001*

362 39 9

123 15 21

.001*

Number of subjects 196 Age (y) 43.52  9.49 Chlamydia trachomatis (No) Positive 8 Negative 188 WBCs in EPS (No) 0-4 162 5-15 25 16 0 Unknown 13 WBCs in urine (No) 0-1 176 2-4 20 5-10 0

CP-CPPS, chronic prostatitis and/or chronic pelvic pain syndrome; EPS, expressed prostatic secretion; WBCs, white blood cells. The age variables were expressed as mean  standard deviation. *P

The presence of Chlamydia is associated with increased leukocyte counts and pain severity in men with chronic pelvic pain syndrome.

To examine the role of urinary chlamydial infection in patients with chronic prostatitis and/or chronic pelvic pain syndrome (CP-CPPS)...
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