The role of Chlamydia trachomatis in prostatitis.

Ascending chlamydial infections have been thought to be an infective cause of prostatitis for the last three decades. Unfortunately, the definitive association between isolation of an infective agent and its prostatic origin is limited by various factors, although modern techniques of molecular biology for identification of the microorganisms are available. Two major problems are: (1) diagnostic material passing the urethra may reflect only urethral contamination, (2) prostatic biopsy specimens from the gland may also contain urethral material. The ejaculate has the same limitations, and an ideal test for detection of Chlamydia species in ejaculate specimens is not available yet. Investigations for local chlamydial IgA-antibodies may be useful; the overlap with Chlamydia pneumoniae and Chlamydia psittaci means a clear differentiation on an type-specific basis is necessary, which is normally provided by the 'elaborate' microimmunofluorescence test. Modern p-ELISAs using major outer membrane protein parts as antigens may deliver identical results in the future. In the follow-up of standardized prostatitis patients, a combination of such urological tests in EPS and seminal plasma combined with genital chlamydial DNA material, may further elucidate the chlamydial aetiology of prostate infection.