We have previously shown the presence of a cellular autoimmune response against prostate antigens in a group of chronic prostatitis patients. Our main goal was to investigate whether chronic prostatitis either caused by an infection or an autoimmune response to the prostate gland could have a deleterious effect on semen quality. Healthy normal individuals were included as controls. Measurements for sperm concentration, motility, morphology, prostate and seminal vesicle markers, antisperm antibodies, white blood cells and pro-inflammatory cytokines were performed accordingly. RESULTS: The most severe abnormalities were seen in patients with no evident infection and an autoimmune response against prostate antigens.
Porstatitis Exam A physical exam may help diagnose prostatitis. This content does not have an Arabic version. An appraisal of cephalexin monohydrate levels in semen and prostatic tissue. Semen samples were collected directly into a sterile container by masturbation after 2—7 days of sexual abstinence. Chronic bacterial prostatitis. Most antibiotic agents penetrate the acutely inflamed prostate, but experience favors empirical treatment with a broad-spectrum beta-lactam drug—either a penicillin eg, prostaritis tazobactam or a cephalosporin eg, cefotaxime or ceftazidime —perhaps combined with an aminoglycoside for patients who are severely ill or who have recently received antibiotic therapy. We review recent pharmacological and Ass furtados nelly data on treating bacterial prostatitis. The bladder begins to contract even when it contains small Acute prostatitis clear ejaculate of urine, causing more frequent urination.
Mo private investigator. Introduction
Urodynamic tests include a variety of procedures that cleqr at how well the bladder and urethra store and release urine. Sacral neuromodulation. Tender, boggy, enlarged prostate on digital rectal examination; distended prowtatitis prostatic massage contraindicated. Acute prostatitis happens when your prostate gland becomes suddenly inflamed. Daily news summary. Urologists usually prescribe oral antibiotics for at least 2 weeks. Symptoms include pain, mainly at the Menstrual flow clots of the penis and around the anus. The mainstay of therapy is Acute prostatitis clear ejaculate antimicrobial regimen. I would guaranty you that it would work for you but I think it would be overkill for your problem. Choose a single article, issue, or full-access subscription.
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- The prostate is a small gland that surrounds a man's urethra, the tube that takes urine and semen out of the body.
We have previously shown the presence of a cellular autoimmune response against prostate antigens in a group of chronic prostatitis patients.
Our main goal was to investigate whether chronic prostatitis either caused by an infection or an autoimmune response to the prostate gland could have a deleterious effect on semen quality. Healthy normal individuals were included as controls. Measurements for sperm concentration, motility, morphology, prostate and seminal vesicle markers, antisperm antibodies, white blood cells and pro-inflammatory cytokines were performed accordingly.
RESULTS: The most severe abnormalities were seen in patients with no evident infection and an autoimmune response against prostate antigens.
Moreover, significantly increased levels of pro-inflammatory cytokines were detected in seminal plasma from these patients.
We speculate that an autoimmune response against prostate antigens and the inflammatory process involved may affect male fertility. Chronic prostatitis is a common diagnosis but very little is understood about the aetiology and the pathogenesis of the disease Bierklund Johansen and Weidner, ; Krieger and Riley, Men with chronic prostatitis present an episodic and relapsing condition characterized by pelvic pain, irritative voiding symptoms and effects on sexual function McNaughton et al.
However, a large body of evidence accumulated over many years has failed to provide convincing proof that some fastidious organisms are responsible for symptoms in a significant proportion of men who present symptoms of chronic prostatitis Domingue and Hellstrom, The National Institutes of Health proposed a classification of prostatitis syndromes in four categories Krieger et al.
Regarding the last two categories, the use of this classification has not generated an improvement, neither in the therapeutic approaches nor in the clarification of their aetiologies.
Given the lack of a clear infectious aetiology for the majority of men diagnosed as chronic prostatitis patients, several groups including ours wondered whether men with this kind of condition might have an autoimmune component to their disease. Recently, we have reported that a significant proportion of men with chronic prostatitis have evidence of cellular response to prostate antigens Motrich et al.
We and others Alexander et al. Male infertility is a multifactorial disease and diagnosis and therapy must be oriented as such. Although the relationship between prostatitis and infertility remains unclear, bacteria, viruses, leukocytes, reactive oxygen species, cytokines, obstruction and immunological abnormalities must be seen as cofactors in the development of infertility in patients with male accessory glands infections and prostatitis Weidner et al.
Some reports have associated chronic prostatitis, mainly of infectious origin, with abnormalities in semen quality and function Schoor, However, evidence supporting a correlation of an inflammatory state due to an autoimmune response against the prostate gland and the different seminal parameters does not exist. In the present study, we analysed a group of patients with chronic prostatitis in order to investigate whether an autoimmune response to prostate antigens could have any effect on the seminal plasma quality of these patients.
Normal individuals answered a questionnaire and had no history of any genitourinary symptoms, instrumentation or surgery. They underwent the same assessment as patients. Patients and controls agreed to donate blood samples and semen; they had not been taking antibiotics, non-steroidal anti-inflammatory drugs NSAID or steroids for 4 weeks prior to, or during, the study.
Volunteers who had undergone vasectomy were specifically excluded. All patients underwent a standard evaluation, including digital rectal examination, microscopic examination and culture of urine and semen. To discriminate between patients with infectious and non-infectious chronic prostatitis, conventional and non-conventional bacterial cultures were performed in their urine and semen.
We could detect infection of known prostatic pathogens e. Neither the patients from group A nor individuals from group D showed positive proliferative responses against prostate antigens. The proliferation assay was performed as described previously Rivero et al. Peripheral blood mononuclear cells from each patient and controls were divided into two aliquots to use as responder and as antigen-presenting cells APC. All cell combinations were set up in quadruplicate.
The response was expressed as a stimulation index SI calculated from c. Semen samples were collected directly into a sterile container by masturbation after 2—7 days of sexual abstinence. Semen samples and blood were obtained at the same visit. Standard clinical semen analysis was performed according to World Health Organization criteria.
Semen analysis consisted of determination of sample volume, sperm density concentration , progressive motility, vitality eosin exclusion , morphology World Health Organization classification and Kruger classification, pH, and concentrations of citrate and fructose. Citrate and fructose were measured as tests of function of the prostate and seminal vesicles respectively. Identification of leukocytes and other cells was done by a peroxidase cytochemical technique Politch et al. To assess the functional integrity of sperm membrane, hypo-osmotic swelling HOS test was used as previously described World Health Organization, The assay was performed according to the manufacturer's instructions in an automatic analyser Immulite.
Statistical analysis was performed using Fisher's least significant difference test or the Kruskall—Wallis test, as appropriate. In order to investigate whether an autoimmune cause might be the reason for discomfort seen in all chronic prostatitis patients enrolled in our study, we performed PBMC proliferation assays in response to different prostate antigens.
None of the patients from group A who were coursing with an infection at the time of the study showed positive lymphoproliferative response against the autoantigens assayed. In contrast, we detected a positive proliferative response against most of the antigens examined in 10 patients group B Table I. These patients had no signs of infection. The rest of the patients examined, who also did not have signs of infection, showed negative proliferation against prostate antigens group C Table I.
To examine whether there might be a correlation between an inflammatory state due to an autoimmune response against the prostate gland and the different seminal parameters, we performed semen analyses in the groups of patients under study. The results are presented in Table II and Figure 1. No significant differences were found in the pH and volume of the ejaculates of any of the groups under study Table II. When prostate and seminal vesicle markers citric acid and fructose respectively , were evaluated, no significant differences from the control levels were found.
However, citric acid levels appeared to be reduced although non-significantly in all the patients with clinical symptoms of prostatitis, being more evident in group B patients. Significantly elevated levels of peroxidase-positive cells were only detected in patients bearing an infection at the time of the study group A , which could be related to the low percentage of sperm viability observed in this group.
It should be kept in mind that this test only detects macrophages and polymorphonuclear leukocytes, providing no information about the presence or absence of lymphocytes Table II. Sperm motility appeared to be diminished, although not significantly, in samples from groups A and B patients Table II.
As can be seen in Figure 1 , striking abnormalities in some of the ejaculate parameters could be detected in patients of group B. The morphology of the sperm was also altered in a high percentage of group B and also group A patients, when analysed by World Health Organization criteria Figure 1C. The percentage of normal sperm was significantly diminished only in samples from group B patients when stricter criteria Kruger were used Figure 1D. It is important to emphasize that none of the patients under study presented antisperm IgG or IgA, excluding another autoimmune syndrome as a possible cause of the observed abnormalities data not shown.
Taking all these data together, we can conclude that patients who had positive lymphoproliferative autoimmune responses against prostate components group B; Table I showed severe alterations in sperm quality Table II. Furthermore, for some of the parameters under analysis, these alterations were more marked than those observed in patients bearing an infection Table II. Chronic prostatitis is a very common disease in the male genitourinary system. However, the relationship between chronic prostatitis and fertility has been controversial for many years Weidner et al.
Leib et al. Menkveld et al. In contrast, Weidner et al. Supporting these data, Pasqualotto et al. Moreover, Ludwig et al. One possible explanation for the contradictory findings could be that chronic non-bacterial prostatitis comprises a heterogeneous group of patients.
These results are in accordance with data reported by Alexander et al. Interestingly, in the present work, the major abnormalities in some of the ejaculate parameters could be detected in patients with chronic non-bacterial prostatitis who presented signs of an autoimmune response against the prostate gland group B.
When the comparative analysis of sperm parameters was performed with patients from groups B and C grouped together, no significant differences were found.
We can hypothesize that, in the same way, these significant differences could have been masked in the other studies mentioned. We observed that when patients had positive lymphoproliferative responses against prostate components, important alterations in sperm quality could be observed.
Certainly, for some of the parameters under analysis, such as sperm concentration, HOS test and sperm morphology evaluated by Kruger's criteria, these alterations were even more marked than those observed in patients with an infection. Existing data on the relationship between sperm parameters and hormonal profile have been derived from infertile men, men with andrological problems, men exposed to environmental toxins Uhler et al. Neither antisperm IgG nor IgA antibodies nor alterations in the endocrine status of the hypothalamic—testicular axis were present in the patients in our study data not shown , excluding the hormonal factor and the presence of antisperm antibodies as a possible cause of the observed seminal alterations.
Three hypotheses could be postulated to explain the alterations observed in sperm. Prostate secretion meets sperm cells during ejaculation, thus one possibility would be that the damage occurs in the short time during ejaculation. The second possibility would include a direct effect of inflammation on the testis and epididymis. The third possibility would be a combination of both of them. Furthermore, it has been reported that some men with chronic prostatitis have elevated levels of inflammatory cytokines in seminal plasma Alexander et al.
Indeed, Estrada et al. Moreover, the prostate secretes components that are involved in the total antioxidant capacity TAC of the seminal plasma, and the balance between reactive oxygen species ROS present in seminal plasma and TAC is important for the survival of sperm Sikka, Pasqualotto et al.
Moreover, chronic prostatitis has been proved to cause scarring of the prostatic and ejaculatory ducts with inflammatory-associated obstructions of the male reproductive tract Dohle, These data may explain the oligozoospermia and asthenozoospermia found in our patients. On the other hand the deleterious effect of ROS on semen quality has been documented Sharma and Agarwal, and a diminished prostate secretory function could be associated with enhancement of sperm apoptosis.
On the other hand, a possible direct testicular or epididymal effect of inflammation could be responsible for the alterations observed in semen from these patients with an autoimmune response against prostate antigens. Moreover, an increase of sperm alterations during longstanding inflammation could be expected. Although we cannot rule out this hypothesis, findings in our animal model of experimental autoimmune prostatitis demonstrate that the inflammation due to an autoimmune response against prostate has detrimental effects on the quality of seminal sperm but not on epidydimal sperm unpublished data.
In this work, we demonstrate for the first time that a proliferative response against prostate antigens is associated with a marked alteration of semen quality in patients with chronic prostatitis. These results argue in favour of the importance of prostate functionality in the quality of the semen. It is possible that the autoimmune response against prostate antigens and the associated inflammation could be involved in the seminal alteration observed. As a secretory organ, the prostate produces large amounts of soluble proteins which are secreted into the ejaculate and optimizes the conditions for successful fertilization, giving an adequate medium for the survival of sperm, and enhances their motility in the female reproductive tract Chow and O, Some researchers found that seminal PSA levels were diminished in patients with low sperm motility Yoshida et al.
Zinc, which to a high degree also originates from the prostate, also plays an important role in sperm function mainly via its effect on chromatin stability Richthoff et al. The ectonucleotidase, another prostatic enzyme, has a significant role in the regulation of sperm motility in vitro Aumuller et al. It is possible that the autoimmune response against prostate antigens and the associated inflammation observed could modify the prostate function and be the cause of the seminal alterations and infertility associated with some cases of prostatitis Ahlgren et al.
We speculate that an autoimmune response against prostate antigens in some patients with non-infectious prostatitis, and the involved inflammatory process, may seriously compromise the quality of their semen, and therefore affect fertility.
Small studies provide limited support for the use of nonpharmacologic modalities. Your doctor may also prescribe alpha-blockers to help relieve symptoms. Int Urogynecol J. Prostate got angry. It's an herbal supplement And to be honest I'm willing to give anything a shot. Br J Urol.
Acute prostatitis clear ejaculate. What is prostatitis?
Prostatitis - NHS
Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid semen that nourishes and transports sperm. Prostatitis often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.
Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn't identified. If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics. Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment.
Some types of prostatitis last for months or keep recurring chronic prostatitis. If you have pelvic pain, difficult or painful urination, or painful ejaculation, see your doctor. If left untreated, some types of prostatitis can cause worsening infection or other health problems. The prostate gland is situated just below the bladder and surrounds the urethra.
Prostatitis is a disease of the prostate that results in pain in the groin, painful urination, difficulty urinating and other symptoms. Acute bacterial prostatitis is often caused by common strains of bacteria. The infection can start when bacteria in urine leak into your prostate.
Antibiotics are used to treat the infection. If they don't eliminate the bacteria prostatitis might recur or be difficult to treat chronic bacterial prostatitis. Nerve damage in the lower urinary tract, which can be caused by surgery or trauma to the area, might contribute to prostatitis not caused by a bacterial infection. In many cases of prostatitis, the cause isn't identified.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men.
Request an Appointment at Mayo Clinic. Prostate gland The prostate gland is situated just below the bladder and surrounds the urethra. More Information Recurrent prostate infection.
Share on: Facebook Twitter. Show references Meyrier A, et al. Acute bacterial prostatitis. Accessed Oct. Meyrier A, et al. Chronic bacterial prostatitis. Prostate Cancer Foundation. Prostatitis: Inflammation of the prostate. Pontari M. Sharp VJ, et al. Prostatitis: Diagnosis and treatment. American Family Physician. Castle EP expert opinion. Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.