[Size=4]Chronic Prostatitis[/size]
Chronic prostatitis now has a new definition. Thanks to the persistence of scientists dedicated to urological research, [Size=4]this extremely common condition of adult men is now being increasingly recognized as nearly always bacterial in origin–even if bacteria can not be grown in culture.[/size]
The former diagnosis of chronic, non-bacterial prostatitis–the “dumping ground” for thousands of frustrated patients, has been greatly over-used in the past. This reflects primarily only our inability to demonstrate the causative bacteria, not their absence.
[Size=4]Most people with chronic prostatitis will respond to the proper use of antibiotics combined with diligent prostatic massage.[/size] But what about those who have no symptoms referable to the prostate gland but are still harboring infection?
Recent published results of prostate tissue examinations from routine autopsies reveal a sobering 75-80% incidence of chronic infection. Most of these men, dying from the usual triad of heart disease, cancer or stroke, had no symptoms referable to the prostate gland. One can infer from this largely irrefutable data that asymptomatic chronic prostatitis is not only frequent in our society, but rampant!
[Size=4]Again and again the Gardnerella vaginalis organisms keep appearing in bacteriologic analyses of prostatic secretions from chronic cases[/size]–[Size=4]naturally not as the only causative organism, but a very common one[/size]. This ubiquitous organism, so common in vaginitis patients, also appears to be a major player in chronic prostatitis. One can now say that Gardnerella–the scourge of the fastidious woman–may well also be a key player in PSA elevations.
[Size=4]Gardnerella Vaginitis[/size]
Vaginitis associated with Gardnerella organisms is one of the most common conditions seen by primary care physicians. Nearly 50 percent of women presenting with typical vaginitis symptoms will be diagnosed with a Gardnerella infection. This infection was formerly known as Hemophillus vaginitis, and more recently as non-specific vaginitis.
Its prevalence is vastly under-reported because of the reality that many women carrying this organism will have only minimal symptoms–or no symptoms at all. Most of these women are greatly surprised when informed that routine microscopic examination of their vaginal secretions has revealed "abnormal vaginal flora."
Some will be in their doctor’s office for evaluation of a mildly atypical Pap smear and will be quite relieved to learn that the presence of a subtle infection with Gardnerella may be the culprit. Others will complain only of abundant vaginal mucus for months and, in some cases, even years may have passed during which time such a discharge is accepted as normal.
Other women, during their yearly checkup, will complain only of a disagreeable fishy odor after intercourse. And many “carriers” of Gardnerella organisms will have no complaints at all. Usually the question of sexual transmission will come up early in the office discussion, especially when considering the advisability of treating sexual partners.
Frequently, the office atmosphere can become quite emotionally charged when a patient will almost immediately blame their partner. The fact of the matter however, is that although Gardnerella vaginitis is most definitely a sexually transmitted disease, Gardnerella organisms can frequently be found in many women–and even young girls having no prior sexual contact.
Thus Gardnerella seems to be a two-faced Janus–capable of both innocence and harm. Wearing its candid, innocent face, Gardnerella can exist in many females as part of their normal vaginal flora. Wearing its worldlier, sultry face, it is both acquired and transmitted by sexual contact.
Complicating the mystery of this Janus organism is its ability to change its face occasionally from innocent to harmful, through the recruitment of anaerobes–other members of the vaginal flora. Activated Gardnerella then emerge to lead their oxygen fearing “hit squads” in a combined attack on the vaginal mucosa creating irritation, inflammation and discharge.
The diagnosis of this common condition is especially easy if the patient mentions a fishy or ammonia-like smell immediately after intercourse. In cases of Gardnerella infection, ammonia is released by the alkaline nature of semen–a purely chemical reaction.
This is the basis of the well known “sniff test,” wherein a drop of potassium hydroxide is added to a drop of vaginal secretion on a slide and held to the nose. The other test is the microscopic examination of the vaginal smear. The “clue” cells: Shed vaginal epithelial cells, studded with Gardnerella organisms, are very characteristic. So to is the abundance of other frequently associated bacteria having pleomorphic coccobacillary shapes.
[Size=4]Spread of Gardnerella to sexual partners seems almost inevitable, if sexual contact occurs during the acute phase of infection. [/size]This simple fact prompts most physicians to treat both patients and their partners simultaneously, although some physicians will withhold treatment of the partners if the patient is only mildly symptomatic, or of carrier status–insisting first on a therapeutic trial of treatment just for the patient.
[Size=4]The end result of all this is the likely exposure of the male urogenital tract to Gardnerella organisms many times in his life; some based on rampant sexuality and others to simple chance. You might call it the “roll of the dice.” [/size]When considering these facts, the commonality of this organism in chronic prostatitis should come as no surprise.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Full Article: spacedoc.com/prostatitis.html
Dr. Graveline is the author of several books on Statin medications and their side effects.
