Comparative analysis of the detectability of microorganisms in the prostatic fluid and ejaculate according to the results of bacteriological analysis
Authors: Pochernikov D. G. , Postovoytenko N. Т. , Yakovleva L. V. , Strelnikov A. I. , Kosterin I. S. 
Published: April 2021

Introduction. Currently the chronic prostatitis (NIH type IV) remains insufciently studied and difcult to treat with antibiotics. When making the diferential diagnosis of chronic prostatitis it is generally accepted by the EAU   and Russian guidelines that the detected microorganisms in the prostatic fuid and the ejaculate practically do not difer from each other. The tactics of treating patients with asymptomatic prostatitis by means of antibacterial drugs remains disputable. Most reputable authors believe that this category of patients shall receive treatment in case   of infertility, pregnancy miscarriage or forthcoming surgery on the prostate gland. Recently, EAU guidelines have expressed doubts regarding the identity of the microbiota found in the prostatic secretions and the ejaculate.

The study objective. Comparative analysis of the detectability of microorganisms in prostatic secretions and the ejaculate by means of bacteriological analysis among the men with chronic prostatitis of category IV.

Materials and methods. The study involved 117 men who went to the urological clinic to pregravid examination or on the occasion of infertility. All patients were diagnosed with prostatitis of category IV based on a standard examination, and then a bacteriological analysis of prostatic secretions and ejaculate was performed. During the research the prostatic fuid and ejaculate were taken simultaneously and the analysis was carried out in one and the same bacteriological laboratory. In case the titer of the detected microorganisms was signifcant, the patients were ofered to undergo treatment without the use of antibiotics but with combination of bovhyaluronidase azoximer with prostate protectors and/or OM-89; after that a control bacteriological study was performed.

Results. In the prostatic secretions and in the semen, the most commonly found gram-positive microorganisms were Staphylococcus spp. and Enterococcus spp.; the representatives of the Enterobacteriaceae were found less frequently. It was statistically proven that the titer of bacteria in the prostatic secretions was considerably higher than that in the ejaculate (p <0.01). Sterile cultures were statistically-proven to be more frequent in ejaculate compared with prostatic secretions (13.7 % vs 3.4 %, p <0.01). When analyzing the coincidences for bacteria, low concordance was obtained for all identifed microorganisms (gram-positive bacteria varied from 48.3 to 79.5 %, gram-negative bacteria varied from 57.1 to 80.0 %). After the combined therapy, the bacterial mass signifcantly decreased in the prostate secretion from 104.3 ± 1.6  CFU/ml to 103.3 ± 2.0 CFU/ml (p = 0.008), while in the semen the bacterial mass decreased from 103.5 ± 1.8 CFU/ml to 102.6 ± 2.1 CFU/ml (p = 0.02). In the prostatic secretions, there was a statistically-proven decrease in the number of gram-negative bacteria (p = 0.05). As soon as the treatment was completed all the patients demonstrated the normalized number of leukocytes according to microscopy of prostate secretions or spermogram.

Conclusion. The ejaculate is a more sterile biomaterial compared with the prostatic fuid, which should be taken into account in the diferential diagnostics of the chronic prostatitis of category IV and MAGI. The use of non-antibacterial treatment regimens, such as bovhyaluronidase azoximer, prostate protectors and OM-89, can reduce the titer of bacteria to insignifcant values both in the prostatic secretions and in the semen; and in some cases make the ejaculate sterile.