Treatment of chronic prostatitis against the background of chlamydial infection

Treatment of chronic prostatitis, like many diseases, is often ineffective, since it does not take into account the individual characteristics of the organism and is directed mainly etiotropically, and pathogenetic therapy is undeservedly neglected.

Urogenital chlamydia is a problem that does not lose its relevance. Intracellular localization and persistence of the pathogen contribute to this to a large extent, which makes the monotherapy with the most modern antibiotics inefficient. To the persistence of chlamydia results in treatment with drugs that are inactive for this infectious agent, subtherapeutic doses of antichlamydia drugs, and lack of immunotherapy.

In nature, there are two forms of cell death - apoptosis and necrosis. Apoptosis is the natural death of a cell in the due time by shrinking and fragmentation. Deceased as a result of apoptosis cells do not cause harm to surrounding tissues, their fragments are absorbed by macrophages. Inside macrophages, microorganisms, be it mycobacteria or chlamydia, die. On the contrary, cell necrosis leads to the release into the environment of chemically aggressive components of cytoplasm and dissemination, which are in the cell of microorganisms, which leads to the spread of infection. Hence, it is clear how great the role of apoptosis and the value of drugs that regulate this process.

The biologically active additive indigal, which appeared recently in the drug market, contains at least 90 mg of pure indole-3-carbinol and at least 15 mg of pure epigallocatechin-3-gallate in each capsule, which normalizes apoptosis processes, which has been shown in a number of foreign studies. In vitro and in vivo experiments demonstrated the expressed inhibitory effect of indole-3-carbinol on prostate cancer cells and a stimulating effect on apoptosis processes. Epigallocatechin-3-gallate, the second component of indigal, reduces cell proliferation, induces apoptosis, and cures inflammatory cascades.

With respect to chlamydia, macrolides are most active, followed by fluoroquinolones, which also act bactericidal. Among fluoroquinolones, sparfloxacin occupies a special place with regard to intracellular pathogens, the degree of penetration of which into macrophage is 3 times higher than that of ciprofloxacin and lomefloxacin. In addition, by double blocking the DNA of the microorganism, sparfloxacin prevents the development of drug resistance.

In addition to the antibacterial effect and prevention of necrosis, one more pathogenetic effect is needed, aimed at accelerated elimination of degradation products, arresting inflammation, and restoring local immunoreficiency. These properties are fully available herbal preparation kanefron-H, containing a water-alcohol extract of a herb of a gold-bearing mill, roots of medicinal lavender and leaves of rosemary.

Drug treatment of chronic prostatitis against chlamydial infection

The aim of the study was to develop and test a treatment regimen for patients with urogenital chlamydia resistant to standard therapy. Under supervision were 14 men with verified urogenital chlamydia. In 5 of them, clinical signs of urethritis prevailed, and in 9 cases urethroprostatitis prevailed. The diagnosis was established in terms of 3 to 11 years, an average of 7.4 ± 1.2 years. Patients received repeated courses of antibacterial therapy, resulting in 6 of them developed intestinal dysbiosis II-III degree, 2 - candidiasis, 4 - intolerance to antibiotics of the group of macrolides in the toxic-allergic type. If 6 men did not exclude reinfection, 8 of them did not have unprotected and / or accidental sexual contacts and, therefore, their illness was regarded as chronic and resistant to therapy. Only 2 patients had chlamydial monoinfection. In the remaining 12 patients in the discharge urethra and / or exprimates of the gonads, the study identified the following pathogens:

• Staphylococci - 4 cases;
• enterococci - 2 cases;
• Mycoplasma hominis - 4 cases;
• Ureaplasma - 4 cases;
• streptococcal infection - 1 case;
• E. Coli - 1 case.

Most men were simultaneously more than two infectious agents.

To exclude tuberculosis of the urogenital system, patients undergoing a 3-glass urine sample before a digital rectal examination. In the presence of leukocyturia in the second portion, which was detected in 1 patient, kidney ultrasound, urine culture on mycobacterium tuberculosis and luminescent microscopy of smears were performed.

The epidemiological history was carefully collected, and it was established that no patient had previously been ill with tuberculosis, had no contacts with people with tuberculosis, had no people and animals, and Mantoux did not have a sample in the family with children. All 14 patients underwent fluorography on a regular basis, the last study was performed less than 12 months prior to treatment.

Given the ineffectiveness of previous therapy, it was decided to select sparfloxacin 200 mg twice a day for 10 days with urethritis and 20 days for urethrostrostitis as an antibiotic. The choice fell on sparfloxacin, because it:

• bactericidal in relation to chlamydia;
• affects not only actively dividing, but also persistent microorganisms;
• has a high ability to penetrate inside the cell.

In order to normalize apoptosis, indigal was given 800 mg twice a day for 2 months, since this is the period that is necessary for the death of a cell infected with chlamydia. To improve the rejection of the ejaculated epithelium, restore microcirculation and arrest inflammation, patients took kanefron A 50 drops 4 times per day for 1 month.

The final results were evaluated 2 months after the beginning of the complex therapy. The dynamics of complaints, the analysis of prostate secretion with native light microscopy and Gram stain smear (leukocyte count, saturation with lecithin grains, presence and type of microflora), spermogram, bacteriological studies, urethral discharge analysis, ultrasound of the prostate, examination of the urethra scraping and prostate secretion method of PCR, enzyme immunoassay (ELISA) of blood.

Upon admission, all 14 men complained of discharge from the urethra, from meager to plentiful, frequent urination (in 8 patients with a cut), including at night, persistent aching pain in the perineum (in 6 patients - with irradiation into the scrotum), violation sexual function.

In the primary digital rectal examination, all patients were diagnosed with prostate tone disorder and soreness, and 12 patients were palpated with dense foci. The sponges of the urethra were swollen and hyperemic in all. In the secretion of the prostate was found a large number of white blood cells (from 43.7 + 9.2 to the level when counting is impossible), the number of lecithin grains was reduced.

All patients were prescribed a set of etiopathogenetic therapy, described above; all were advised to avoid being in the sun (considering the potential phototoxic effect of sparfloxacin), sexual rest (or, in extreme cases, the use of a condom), abundant drinking. All the sexual partners of the patients also underwent examination and treatment in the required amount.

Clinical efficacy was manifested from 5.4 ± 0.2 days, and was expressed in the reduction of dysuria, pain and the termination of urethral discharge. At the end of the antibacterial stage of therapy in patients (85.7%) there was a complete sanation of the prostate secretion, while the remaining 2 (14.3%) had a significant improvement. After 2 months only 1 patient (7.1%) had a moderately high number of leukocytes in the secretion of the prostate. TRUS, performed at the same time, showed a pronounced positive dynamics with regard to the echostructure and blood supply of the prostate. All patients underwent microbiological purification - no pathogenic microflora was detected in stained smears, or by the method of inoculation, nor by DNA-diagnostics. Also, there was no negative effect of the tested scheme on spermatogenesis - qualitative and quantitative indicators of ejaculate did not have significant differences in comparison with the initial ones.

The tolerability of treatment was good. The patient experienced dyspepsia when taking fasting medications; reception after meals allowed to avoid this side reaction without reducing the dose or the appointment of additional therapy.

Thus, the combination of sparfloxacin with indigal helps to prevent the persistence of intracellular microorganisms and their dissemination, which leads to a rapid decrease in the total Chl population. Trachomatis. Kanefron-N provides relief of inflammation, diuretic effect, accelerated elimination of decay products and depleted epithelium. This combination together provided a clinical and bacteriological cure for patients with urogenital chlamydia resistant to standard therapy in 92.9% of cases.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Ozone therapy

The effectiveness of ozone therapy has been analyzed and a pathogenetic justification for its as a factor improving hemodynamics and microcirculation has been proposed. The study included 72 patients with chronic urethroprostatitis against a chlamydial infection who received identical basic therapy: clarithromycin (fromilide-A), meglumine acridone acetate (cycloferon), vobenzyme.

• The first group consisted of 34 patients with chronic urethroprostatitis (clinical symptoms of urethritis and prostatitis were equally expressed) against a background of chronic prostatitis of Chlamydia nature. They received complex basic therapy for the treatment of sexually transmitted infections: clarithromycin (forromylid), meglumine acridon acetate (cycloferon), vobenzyme.
• The second group included 20 patients with chronic urethroprostatitis on a background of chronic prostatitis of Chlamydia nature. They were dominated by complaints about the urinary tract, the clinical manifestations of prostatitis were less pronounced. In these patients, basic therapy was supplemented with regional transurethral ozone therapy.
• The third group consisted of 18 patients with chronic urethro-prostatitis against a background of chronic prostatitis of chlamydial nature with dominant complaints indicating a prostate injury. In this group, basic treatment was supplemented with regional transrectal ozone therapy.
• The comparison group consisted of 11 men aged 21 to 45 years without a pathology on the part of the genitourinary system (confirmed TRUS of the prostate and LDF of the urethra and prostate) and with negative results of ELISA and PCR for Chl DNA. Trachomatis.

All 72 patients with chronic prostatitis in the background of chlamydia and in the comparison group were examined microdynamics of the urethra and the prostate by the method of LDF and TRUSI PZ before treatment and again at the time of 5-6 weeks after the end of therapy.

The etiological efficacy of the treatment was assessed 6 weeks after the completion of the course of therapy for the analysis of scraping material from the urethra and prostatic secretions using the ELISA and PCR method according to the following indices:

• eradication - lack of Ch. Trachomatis in control studies;
• absence of effect - preservation of pathogens in control studies.

Clinical efficacy of treatment of chronic prostatitis of chlamydial nature was assessed by the dynamics of the main complaints (pain, dysuria, sexual dysfunction).

For a more complete collection of the anamnesis, a questionnaire was used on the system for the total assessment of symptoms in chronic prostatitis (SOS-CP) proposed by OBLoran and A.S. Segal (2001), which includes a number of questions on the presence, severity and persistence of symptoms, as well as on the quality of life of patients. Questions are indicated by numbers from I to XII and are divided into four groups: pain and paresthesia, dysuria, pathological discharge from the urethra (prostatea) and quality of life. The patient independently answered each question in writing. Questions I and II provided for the possibility of several variants of the answer, which are indicated by the letters of the generally accepted English alphabet. Each of the positive answers was rated at 1 point. Questions from III to XII are given only one variant of the answer, estimated from 0 to 3-5 points, that is, from complete absence to the extreme degree of the expression of the analyzed indicator.

The questionnaire completed by the patient was analyzed. First of all, the sum of the points scored for the main groups of questions was calculated: pain and paresthesia, dysuria, quality of life. Then, the index of symptoms (IS - CP) was determined - the sum of the points reflecting pain, dysuria and prostatea. The last to establish the clinical index of chronic prostatitis (CI - CP) - the sum of IC - HP and the index of quality of life. Depending on the severity of clinical manifestations, CI - CP is divided into insignificant, moderate and significant. Thus, all clinical manifestations of HP are represented by the following digital series:

• pain =;
• dysuria =;
• prostatirea =;
• quality of life =
• IS-HP =;
• CI-HP =.

This system was used in 60 patients for chronic prostatitis of chlamydial nature. The questionnaire was understandable to patients, questions and answers excluded the ambiguity of their interpretation, and the results were clear.

During the collection of the anamnesis, much attention was also paid to the previous diseases of the urogenital tract, the state of health of the sexual partner.

When examining patients, they took into account their constitutional features, skin condition and visible mucous membranes, severity of secondary sexual characteristics (distribution of hair, subcutaneous fat, skin turgor, folding and scrotal pigmentation). Palpable examination of the testicles was performed, rectal finger examination of the prostate. Palpation was also performed on the penis in order to exclude its deformation, pathological changes in the gallbladder. Physically assessed the condition of surrounding peripheral veins and arteries, especially the lower limbs and scrotum.

In patients selected for the study, the presence of Chl. Trachomatis was confirmed by the complex application of laboratory methods for the diagnosis of ELISA and PCR.

Diagnosis of circulatory disorders and microcirculation was carried out by means of the prostatic TRUS using the standard procedure and LDF microcirculation of the urethra and prostate gland; techniques are described in detail in the corresponding section of the monograph.

The method of regional ozone therapy

For the regional ozonotherapy, a medical ozonizer of the Medozons VM series was used.

The following methods of local ozone therapy were used:

• transurethral ozone therapy. In the urethra, ozonized olive oil was introduced with an ozone concentration of 1200 μg / l, heated to a temperature of 38-39 ° C, in a volume of 5-7 ml with an exposure of 10-15 min, once a day. The course of treatment 10 procedures daily;
• transrectal ozone therapy. The procedure consists in introducing into the rectum 10 ml of ozonized olive oil with a concentration of ozone in it of 1200 mg / l, the duration of the procedure is from 5 minutes, followed by an increase in the duration of the procedure to 25 minutes. The procedure should be performed after the cleansing enema in the supine position. The course of treatment 10 procedures daily.