STDs Expert Forum
Prostatitis/Chlamydia
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Prostatitis/Chlamydia

Doctors:

My apologies for coming back with a similar questions that was posted in May but pain and worry gf will never sleep with me again is seeking some peace of mind, grateful for your direct STD expertise.  I continue to suffer from chronic prostatitis & working with a urologist.  Recently I told him that I had chlamydia 5 years ago and these off and on symptoms of ache in scrotum and pelvic aches began shortly after that treatment.  I know from my previous post and other threads that credible sources disagree on the extent if any chlamydia causes or gets into the prostate.  My urologist suggested it could be a possibility but seem confused as to best way to check, I told him I was negative per NAAT urine test.  He wanted to culture semen but I believe that semen is toxic to cell lines in culturing semen and thus unreliable. He did not want to do prostate massage due to inflammation and would harm me.  My specific questions concerning Chlamydia bacteria and testing:

1) Even if rare would NAAT Urine pick up Chlamydia infection in prostate or does this test only approved for urethra infection?
2) Can Chlamydia bacteria survive or isolate itself this long in prostate and cause re-curring symptoms? Biofilm conerns.
3) Would there be other tests you would recommend to get to bottom of this?
4) Even if in prostate would not ejaculations infect urethra thus impossible for prostate to be infected and urethra not to be infected?

Appreciate your continued advice, like I said credible sources like UCLA Urology Dept, Mayo Clinic all say complicated Chlamydia infection can potentially cause chronic prostatitis and several prostatitis clinics seems to suggest they find this STD in prostate but little to no information if routine NAAT urine screening is sufficient or the extent this bacteria can or could continue to cause problems. Urologists seems clueless when it comes to STD's. I don't understand why not more clarity with two very common issues for men. Thanks
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Sorry to hear of your continued difficulties.  I will not repeat what I have already said about prostatitis but will add a little bit.  Prostatitis is difficult to study because in order to know if bacteria are really in the prostate, you have to do a biopsy to demonstrate that the organism is present.  This makes prostatitis very difficult to study as most men do not readily volunteer for prostate biopsies.  . In the studies that have been performed the evidence that chlamydia or other STD bacteria are present are suspect at best.  Irrespective of what is causing your problems (and I continue to say it is not chlamydia) you will likely need a prolonged course of therapy and the drugs used often have activity against chlamydia as well as the other organisms more commonly associated with prostatitis.  Rather than repeat myself here, I will go directly to your questions:

1.  NAATs are the most sensitive tests for diagnosis of chlamydia and do not require living chlamydia to be present to yield a positive test.  There are no studies to tell us how well these tests (or any other) perform for diagnosis of prostatitis but these are the tests I would utilize in efforts to rule pout chlamydial infection.
2.  There are no evidence that chlamydia get incorporated in biofilms and their biology, as intracellular organisms makes it biologically unlikely that they would.  No one know how long a chlamydial infection can persist if untreated ( and you are not- you have taken a number of antibiotics)
3.  No
4.  You already know I do not feel that chlamydia causes prostatitis. I won't get trapped into a bunch of "could it ever...." or "what if...." questions. These do not help you.  

Hope this helps .  EWH
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Thank You Dr Hook!  Grateful for access to your expertise in such a quick manner! I am now very clear that urine test is enough to confirm or deny urogenital chlamydia infection and need to drop it.  As well as that chlamydia is not an etiological agent of prostatitis (in my case I have had enough antibiotics to kill anything down there)  Hopefully our two detailed threads will help other folks that are dealing with these two very common issues and in an area that seems to be so much contradiction in the medical community.
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Glad to help.  I hope your prostattis improves soon.  EWH
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H. Hunter Handsfield, M.D.Blank
University of Washington
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