Eradication of Chlamydia trachomatis parallels symptom regression in chronic bacterial prostatitis patients treated with a fluoroquinolone-macrolide combination

Abstract

To investigate the association between eradication of Chlamydia trachomatis (CT) and symptom regression in chronic prostatitis, 55 symptomatic patients were subjected to segmented tests to localise CT in first voided urine (VB1), prostatic secretions (EPS), post-massage voided (VB3) or semen specimens. Patients were divided in three treatment groups: the 'urethral involvement' group ('U': VB1 positive, EPS/VB3/Semen negative) was treated with 500 mg day(-1) azithromycin for 3 days. The 'prostatitis' group ('P': VB1 negative, EPS/VB3/semen positive) with 4-week levofloxacin-azithromycin combination. A third group, 'U+P' (VB1, EPS/VB3/semen positive) received both treatments in sequence. In P patients, eradication of CT was paralleled by marked, sustained symptom improvement and by significant decrease of serum prostate-specific antigen (PSA) levels. Compared with U patients, undergoing rapid regression of symptoms related to painful micturition after short-term azithromycin, U+P patients showed symptom and pathogen persistence in VB3/EPS/semen and required additional treatment with 4-week levofloxacin-azithromycin to achieve pathogen eradication, symptom regression, and decrease of PSA. Our results support a causative role of CT in chronic bacterial prostatitis. In the presence of a positive urethral localisation of the pathogen, thorough microbiological investigation together with focused symptom analysis may reveal an underlying chlamydial prostatitis and direct effective therapy with appropriate antibacterial agents.

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

“…Microbiological eradication rates were 40-77% for ciprofloxacin [65][66][67], 75% for levofloxacin [65], 80% for azithromycin [66,68,69], 77% for doxycycline [68], 80% for clarithromycin [69], and 62-77% for azithromycin + ciprofloxacin (depending on ciprofloxacin dose) [70]. Higher eradication rates (>90%) were reported with azithromycin and levofloxacin either alone, in combination or sequentially, depending on the locality of infection (urethral, prostatic or both) in patients with CBP with C. trachomatis infection [71]. Significant differences in symptom severity, as assessed by changes in NIH-CPSI scores, were seen between baseline and the end of treatment in two trials [70,71].…”

“…Higher eradication rates (>90%) were reported with azithromycin and levofloxacin either alone, in combination or sequentially, depending on the locality of infection (urethral, prostatic or both) in patients with CBP with C. trachomatis infection [71]. Significant differences in symptom severity, as assessed by changes in NIH-CPSI scores, were seen between baseline and the end of treatment in two trials [70,71]. Others reported improvements in clinical outcomes but failed to use validated tools to report these [65][66][67][68][69] Of the identified comparative studies in patients with CBP, one (n = 408) found that levofloxacin offered advantages over ciprofloxacin for bacterial eradication rates and clinical improvement [67], while another of similar size (n = 377) and design showed no significant differences between these agents [65].…”

Chronic Prostatitis/Chronic Pelvic Pain Syndrome

“…Blacklock et al [31], noted that some patients with CP / CPPS had some pathogens identified in vaginal cultures of their sexual partners. Magri et al [32], evaluated 55 symptomatic patients with CP / CPPS they were subjected to segmented tests to localise Chlamydia trachomatis in first voided urine (VB1), prostatic secretions (EPS), post-massage voided (VB3) or semen specimens. Patients were divided in three treatment groups: the 'urethral involvement' group (VB1 positive, EPS/VB3/Semen negative) was treated with 500 mg day(-1) azithromycin for 3 days.…”

Macrolides for the treatment of chronic bacterial prostatitis: An effective application of their unique pharmacokinetic and pharmacodynamic profile (Review)

“…Results of recent observational studies show that therapy based on the combination of azithromycin and levofloxacin is characterized by high eradication (94%) and low relapse rates (77).…”