ON THE ASSESSMENT AND TREATMENT OF PATIENTS WITH CHRONIC PROSTATITIS IN PERSISTENT UROGENITAL CHLAMYDIOSIS

摘要

Background: Urogenital chlamydial infection is the most prevalent among sexually transmitted disorders that is associated with high rates of complications (chronic prostatitis, salpingoophoritis, etc.) and adverse outcomes, such as sexual and reproductive dysfunction. In the last years, the frequency of persistent antibiotic-resistant chlamydial infections has been persistently increasing that is diagnosed by immunoenzyme assay of IgG antibodies to the heat shock protein of chlamydia with a molecular weight of 60 KDa (HSP60) and by detection of secretory IgA to Chlamydia trachomatis in the semen plasma. Aim: To assess the rates of persistent chlamydial infection in patients with chronic prostatitis by measurement of serum IgG anti-HSP60 antibodies to C. trachomatis and presence of anti-chlamydial IgG in the semen plasma. Materials and methods: In a  prospective study we examined 18 patients with chronic prostatitis, aged from 21 to 58  years. The control group included 30 subjects without chlamydial urogenital disease. Clinical assessment included past history, instrumental investigations, ultrasound examination of prostate and semen vesicles. Serological tests were performed by immunoenzyme analysis in 4  test systems (“Medac”, Germany) to two antigens: a  genus-specific chlamydial lipopolysaccharide r-ELISA (anti-chlamydial IgM, IgG and IgA antibodies) and to the main outer membrain protein (МОМР) of C.  trachomatis (IgG and IgA). Anti-HSP60 antibodies were measured in the test system with HSP60-IgG-ELISA (“Medac”). The levels of secretory IgA in the seminal fluid were assessed with a  test system Chlamydia trachomatis-IgA-pELISA. Results: In 13 (72.2%) of 18 patients the chronic prostatitis was of chlamydial etiology, and in 7 (38.9%) of 18 patients there was an underlying persistent chlamydial infections with concomitant high levels of serum IgG anti-HSP60 C. trachomatis and presence of anti-chlamydial IgA antibodies in the semen plasma. In the control group, IgG anti-chlamydial antibodies were not found. Conclusion: The results obtained confirm the diagnostic value of anti-C. trachomatis IgA antibodies in identification of the etiology of inflammation in the male genital tract. They also indicate a high rate of persistent chlamydial infection in patients with chronic prostatitis and the utility of serology tests for IgG anti-HSP60 C.  trachomatis and anti-chlamydial IgA antibodies in the semen plasma.