Leukocyte and Bacterial Counts Do Not Correlate With Severity of Symptoms in Men With Chronic Prostatitis: The National Institutes of Health Chronic Prostatitis Cohort Study

Schaeffer, Anthony J.; Knauss, Jill; Landis, J. Richard; Propert, Kathleen J.; Alexander, Richard B.; Litwin, Mark S.; Nickel, J. Curtis; O’Leary, Michael P.; Nadler, Robert B.; Pontari, Michel A.; Shoskes, Daniel A.; Zeitlin, Scott I.; Fowler, Jackson E.; Mazurick, Carissa A.; Kusek, John W.; Nyberg, Leroy M.

doi:10.1097/00005392-200209000-00035

Cited by 49 publications

(67 citation statements)

References 17 publications

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“…This is shown in Table 1: addition of semen to a four-glass test allowed the detection of largely increased numbers of Enterococcus spp., E. coli, Staphylococcus, and Streptococcus spp. isolates, in agreement with the findings of a CPCRN study [20].…”

Section: Discussionsupporting

confidence: 92%

“…Inflammatory WBCs were counted on fourglass specimens and semen using the more stringent composite criteria (10 + in EPS, 5 + in VB3) described by Schaeffer et al [20]. …”

Section: Study Design Inclusion Criteria and Diagnostic Proceduresmentioning

confidence: 99%

“…For this reason, ejaculate culture has not been recommended as a firstline diagnostic assay in men with suspected CBP [18,19]. However, semen analysis has been associated with the standard four-glass assay for the detection of pathogenic bacteria and inflammatory leukocytes in important clinical studies performed by the NIH-CPCRN [20].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications

Magri¹,

Wagenlehner²,

Montanari³

et al. 2009

Asian J Androl

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The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the 'two-glass' pre-/post-massage test and the standard 'four-glass' test with a 'five-glass' test (four-glass plus post-VB3 semen culture). The 'five-glass' test showed 3.6-or 6.5-fold increases in relative sensitivity and lesser reductions (-13.2% or -14.7%) in relative specificity for traditional uropathogens (TUs) compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden's index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the 'five-glass' assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs (Enterobacteriaceae, Enterococci, etc.) in 120, 33, and 20 patients and unusual pathogens (Streptococci, other Gram-positive species, Mycoplasmata, and others) in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup of prostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.

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Section: Discussionsupporting

confidence: 92%

“…Inflammatory WBCs were counted on fourglass specimens and semen using the more stringent composite criteria (10 + in EPS, 5 + in VB3) described by Schaeffer et al [20]. …”

Section: Study Design Inclusion Criteria and Diagnostic Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications

Magri¹,

Wagenlehner²,

Montanari³

et al. 2009

Asian J Androl

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“…No significant intergroup differences between WBC counts in VB3/EPS/semen (VB3/EPS, P50.14; semen, P50.85) were recorded at baseline (V0). Consistently, patients with frank 'inflammatory' (WBCo10/high-power field 41 ) or 'non-inflammatory' (WBC,10) CBP were present in equal proportions at the V0 time point (x 2 51.52, P50.21; x 2 51.45, P50.22) in VB3/EPS or semen, respectively. In both cohorts, combination therapy induced a highly significant reduction of WBC counts in all tested specimens and at all analysed time points.…”

Section: Antimicrobial Combination Therapy For Chronic Bacterial Prosmentioning

confidence: 68%

Fluoroquinolone–macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

Magri¹,

Montanari²,

Škerk³

et al. 2011

Asian J Androl

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We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category II chronic bacterial prostatitis (CBP). The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin (500 mg, thrice-weekly) with a once-daily 500-or 750-mg dose of ciprofloxacin (Cipro-500 or Cipro-750 cohort, respectively). Combined administration of azithromycin (1500 mg week 21 ) with ciprofloxacin at the rate of 750 mg day 21 for 4 weeks rather than at 500 mg day 21 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen (PSA) were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction (ED) at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.

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“…Bacterial and leukocyte counts do not correlate with symptom severity. 29 However, reductions in cytokine counts in the prostate gland through antioxidant therapy do correlate with measureable symptomatic improvement in pain and quality of life scores. [9][10][11] …”

Section: Categories Of Prostatitismentioning

confidence: 99%

Acupuncture and Traditional Chinese Medicine for the management of a 35-year-old man with chronic prostatitis with chronic pelvic pain syndrome

Ohlsen

2013

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe the resolution of pain in a patient with chronic prostatitis and chronic pelvic pain syndrome after receiving a course of management using acupuncture and Chinese herbal medicine. Clinical features: A 35-year-old man presented with chronic prostatitis with chronic pelvic pain syndrome. He scored 38 out of a possible 43 on the National Institutes of Health/Chronic Prostatitis Symptom Index (NIH/CPSI) that rates pain, urinary symptoms, and quality of life impact, indicating severe symptoms. The patient had experienced recurrent episodes of nonbacterial prostatitis over a 3-year period, and this was the most severe. Intervention and outcome: After 8 acupuncture treatments over an 8-week period and daily use of Ba Zheng San and Yi Guan Jian, the patient scored his symptoms 9 on the NIH/CPSI. The patient was then put on a supportive anti-inflammatory regimen of green tea. He rated his symptoms 4 on the NIH/CPSI 4 months later, 2 on the NIH/CPSI 8 months later, and 0 on the NIH/CPSI 1 year later. Conclusion: This case demonstrated that the patient experienced long-lasting relief from chronic prostatitis with chronic pelvic pain syndrome after a course of 8 treatments of acupuncture and Chinese herbs.

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Leukocyte and Bacterial Counts Do Not Correlate With Severity of Symptoms in Men With Chronic Prostatitis: The National Institutes of Health Chronic Prostatitis Cohort Study

Cited by 49 publications

References 17 publications

Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications

Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications

Fluoroquinolone–macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

Acupuncture and Traditional Chinese Medicine for the management of a 35-year-old man with chronic prostatitis with chronic pelvic pain syndrome

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