Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications

Abstract

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.

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

“…22 Following the prostatic massage needed to obtain expressed prostatic secretions and post-massage voided urine, the total ejaculate was collected and subjected to the same tests as described previously. 23 Total ejaculate was obtained and processed according to the World Health Organization laboratory manual for the examining and processing of human semen. 24 Patients abstained from sexual intercourse and masturbation for 5-7 days.…”

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

“…This study represents a subset analysis of a retrospective clinical investigation (Magri et al. , 2009), which was notified to the Ethical Committee of the Principal Investigator’s hospital, according to Italian bylaws (Determinazione AIFA 20/3/2008, GU 76, 31/3/2008).…”

“…For diagnosis of prostatitis, published recommendations and internationally acknowledged guidelines have been followed (Nickel, 2003), and have been described in detail elsewhere (Magri et al. , 2009).…”

“…a 4‐glass lower urinary tract segmented localisation test, collecting VB1, VB2, EPS and VB3 samples according to Stamey (1981), followed by analysis and culture of total ejaculate (this fifth sample was denominated TE5 ), obtained immediately after emission of VB3 urines. This modified test has been described in detail elsewhere (Magri et al. , 2009).…”

Role of gram‐positive bacteria in chronic pelvic pain syndrome (CPPS)

“…[5][6][7] Uro-pathogenic bacteria in prostatitis are predominantly gram-negatives such as Escherichia coli, with the occasional exception of pathogenic gram positives such as Enterococcus faecalis and Staphylococcus aureus. 7 Interestingly, most other gram-positive bacteria [8][9][10][11][12][13][14] are currently deemed asymptomatic, clinically insignificant, and transient colonizers of the lower urinary tract in patients. 15 However, appreciable levels of clinical benefit have been observed following fluoroquinolone antimicrobial treatment in prostatitis patients with either gram-negative or gram-positive bacteria.…”