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Third International Chronic Prostatitis Network

Prevalence of herpes virus in Category III B CPPS patients


J. Dimitrakov, J. Tchitalov, T. Zlatanov, D. Dikov, G. Rawadi,
Justus-Liebig University, Urology Clinic, Giessen, Germany; Higher Medical Institute,
Departments of Urology and Pathology, Plovdiv, Bulgaria;
Mycoplasma Laboratory, Institut Pasteur, France
Background
Analysis of virus expression in vitro and in vivo using the highly sensitive quantitative methods developed during the last 10 years is at present an absolute requirement for addressing the pathogenic mechanisms of viral infections and the virus-host interactions at the molecular level. As far as CPPS is concerned, an ideal molecular method for the quantitative analysis of viral nucleic acids is still currently available. The real prognostic-diagnostic role of the different quantitative molecular parameters analyzed in vivo (cell-free viral genome molecules in plasma or in different compartments, analysis of different classes of viral transcripts in infected cells, and provirus copy numbers in infected cells) has never been properly evaluated in viral infections of the prostate.
Material & Interest
Thirty male patients (median age 21, range 18-45) who met the criteria for category III B CPPS were enrolled in the study. Evaluation for the presence of herpesvirus types 1 (HSV-1) and 2 (HSV-2) was performed every week for 3 months using quantitative real-time PCR protocols and herpes-virus specific molecular beacons and dendrimers to document the presence and dynamics of viral production in the urethra, first-void urine, EPS and PPMU. Commercial ELISA kits were used to document inflammatory activity. Detailed pain-specific questionnaires were employed to characterize the quality of the pain. Herpesvirus-positive patients were treated either with valacyclovir alone or valacyclovir + Neupogen.
Results
The presence of herpes virus type 2 (genital herpes) was documented on a total of 30 days (range 2—75). Painful episodes or a change in the quality of pain demonstrated as positive (stimulation-induced paresthesia, dysesthesia, summation and after-sensation) or negative (neglect syndrome) sensory signs coincided with the transcription and presence of LATS in the prostate specific secretions. A negative correlation was found between the presence of leukocytes (absent during the episodes of pain) and the presence of LATS. A positive correlation was found with elevated levels of nerve growth factor and low levels of interferon gamma. Several specimens were found to be PCR negative but molecular-beacons-positive or dendrimer-positive which correlates with a different transcription of the PCR target proteins. Treatment failure rate was higher in the valacyclovir-alone (21 %) vs. the valacyclovir + neupogen group (11 %).
Conclusions
Detailed diagnostic technique should be used to diagnose the presence of herpesvirus in prostate-specific secretions. Overall, these results highlight a substantially different scenario from that imagined before the introduction of quantitative molecular methods. Very high viral turnover has been observed during the symptomless phases of important, persistent human infections which necessitate new paradigms in unraveling the pathogenic events and the virus-host relationships.
Supported by a grant from the Prostatitis Foundation of America
© 2002 The Prostatitis Foundation
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