BERKELEY, CA (UroToday.com) - The role of Chlamydia trachomatis (CT) in sexually transmitted diseases is well established, with 90 million cases annually detected worldwide. In male patients, CT is strongly associated with lower urinary tract infections, prostatitis-like symptoms and decreased fertility. The association between chronic bacterial prostatitis and premature ejaculation is most likely to be detrimental on patients’ quality of life. Although the role of Chlamydia trachomatis as an etiological agent of chronic bacterial prostatitis has been extensively investigated, no data are available on the role of a prostatic infection caused by this pathogen in the onset and/or worsening of premature ejaculation in patients affected by chronic bacterial prostatitis.
In order to assess a possible link between infection by Chlamydia trachomatis and the onset of premature ejaculation (PE), we investigated the prevalence and severity of PE in patients affected by chronic bacterial prostatitis linked to Chlamydia trachomatis, or caused by other common uropathogens. To this aim, we enrolled a consecutive series of 317 patients with clinical and instrumental diagnosis of chronic bacterial prostatitis linked to Chlamydia trachomatis (Group A). Clinical and instrumental assessments from these patients were compared with data obtained from a control group of 639 patients (Group B) diagnosed with chronic bacterial prostatitis caused by common uropathogen bacteria (Enterobacteriaceae, Enterococci, etc.). Prostatitis symptoms were assessed with the National Institutes of Health-Chronic Prostatitis Symptom Index questionnaire (NIH-CPSI), while the ejaculatory status of patients was evaluated using the premature ejaculation Diagnostic Tool (PEDT). All participants were asked to complete the NIH-CPSI, the Erectile Function Domain of the International Index of Erectile Function-15 (IIEF-15-EFD), the PEDT and the SF-36 questionnaires. As a result of this investigation, premature ejaculation was assessed in 118 patients in Group A (37.2%) and in 73 subjects in Group B (11.5%). The two groups are different in terms of premature ejaculation prevalence (p < 0.0002, Z-test). Compared to group B, group A showed significantly higher scores of the PEDT test (11.3±2.6 vs 4.5±2.9, p < .0001, unpaired t-test), and lower scores of the SF-36 tool (96.5±1.1 vs 99.7±1.3, p < .0001, unpaired t-test). In our multivariate model assessment, being positive for a Chlamydia trachomatis infection marker was independently associated with the PEDT score even after adjusting for age, smoking habit, body mass index, and education level (adjusted odds ratio [OR]= 3.21; 95% CI: 2.02 to 4.27; p < 0.003). In conclusion, we found that patients affected by chronic bacterial prostatitis associated with Chlamydia trachomatis findings reported a higher prevalence of premature ejaculation, significantly worse premature ejaculation symptoms, and worse quality of life when compared to subjects affected by chronic bacterial prostatitis caused by common, non-Chlamydial uropathogens. Additional prospective studies are warranted to elucidate the role of inflammation and of the infection of the prostate gland in sexual dysfunction. In fact, recent evidence shows that the most important features of Chlamydia trachomatis infection are its chronic nature and the presence of a mild inflammation that remains subclinical in most individuals. The presence of subclinical prostate inflammation can induce a local production of cytokines/chemokines, which in turn may cause chronic symptomatic inflammation. The higher prevalence of premature ejaculation in patients affected by Chlamydia trachomatis-induced chronic bacterial prostatitis may be linked to the effects of chronic inflammation on neuronal networks within prostatic/periprostatic tissues.
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Tommaso Caia and Gianpaolo Perlettib as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
aDepartment of Urology, Santa Chiara Regional Hospital, Trento, Italy
bBiomedical Research Division, Dept. of Theoretical and Applied Sciences, Università degli Studi dell'Insubria, Busto Arsizio, Italy; Department of Basic Medical Sciences, Faculty of Medicine and Medical Sciences, University of Ghent, Belgium