Infection can set off CPPS

[webslave]

Infect Immun. 2010 Nov 15. [Epub ahead of print]
Uropathogenic E. coli induces chronic pelvic pain.

Rudick CN, Berry RE, Johnson JR, Johnston B, Klumpp DJ, Schaeffer AJ, Thumbikat P.
Departments of Urology, Microbiology-Immunology, Northwestern University Feinberg School of Medicine, 16-703 Tarry, 303 East Chicago Avenue, Chicago, Illinois 60611; Infectious Diseases, Room 3B-105, VA Medical Center, One Veterans Drive, Minneapolis, Minnesota 55417.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating syndrome of unknown etiology often postulated, but not proven, to be associated with microbial infection of the prostate gland. We hypothesized that infection of the prostate by clinically relevant uropathogenic Escherichia coli (UPEC) can initiate and establish chronic pain. We utilized an E. coli strain newly isolated from a patient with CP/CPPS (strain CP1) and examined its molecular pathogenesis in cell culture and in a murine model of bacterial prostatitis. We found that CP1 is an atypical isolate, distinct from most UPEC in its phylotype and virulence factor profile. CP1 adhered to, invaded and proliferated within prostate epithelia, and colonized the prostate and bladder of NOD and C57BL/6J mice. Using behavioral measures of pelvic pain, we showed that CP1 induced and sustained chronic pelvic pain in NOD mice, an attribute not exhibited by a clinical cystitis strain. Furthermore, pain was observed to persist even after bacterial clearance from genitourinary tissues. CP1 induced pelvic pain behavior exclusively in NOD mice and not in C57BL/6J mice despite comparable levels of colonization and inflammation. Microbial infections can thus serve as initiating agents for chronic pelvic pain through mechanisms that are dependent on both the virulence of the bacterial strain and the genetic background of the host.

PMID: 21078846 [PubMed - as supplied by publisher]

[critthinker]

This is EXACTLY what happened to me (E.Coli and all). Good find, webslave.

[webslave]

It was actually Dr Shoskes who alerted me to this. We need to thank him.

[alprost]

This is EXACTLY what happened to me (E.Coli and all). Good find, webslave.

Me too. As unpleasant as it was, treating the infection was the easy part; finding out what was at the root of my CPPS symptoms and getting appropriate treatment was a bit more tricky!

I have to say that I don't think infection automatically leads to CPPS in all patients though. I would imagine it depends on how quickly it is caught (the first round of ABX had no effect on me), and also if the patient is already in a 'stressed out' state with a hypervigilant CNS, then this is likely to have an impact.

[critthinker]

You're totally right Alprost. I was on six different antibiotics before the infection went away (five weeks). How about you?

WEBSLAVE, hoping you can clarify something from the article. I read the full study and was a bit confused. It seems as though they extracted an E.Coli strain from a CPPS patient. Are they saying the bacteria were still there after CPPS set in? Or did they manage to extract/analyze a sample taken from someone who LATER developed CPPS?

[webslave]

I don't have the full paper, but it appears that this was an atypical patient from whom bacteria could be cultured. Such bacteria cannot be cultured from the vast majority of patients.

The key finding is that once CPPS is provoked, it continues even when the bacteria are eliminated. It has a life of its own.

[critthinker]

Hmm okay,that makes sense. I do think it was an atypical patient, as they mention that even in the CPPS subgroup for whom infection is the initiating factor, this was the exception rather than the rule.

Gotta control my catastrophic thinking

[alprost]

The key finding is that once CPPS is provoked, it continues even when the bacteria are eliminated. It has a life of its own.

Spot on.

[random321]

This is very interesting. Do you think that the infection even needs to be treated once it's in chronic phase?

So far I have no tests that indicate any infection after a recent flare up. I think I may have had a UTI that went away with D-mannose. Could a UTI set off CPPS even if there is no infection of the prostate?

I think I may have had an acute infection that I never sought treatment for several years ago that went away on its own.

[webslave]

If there is an infection, it does need to be treated. Chronic bacterial prostatitis has a distinct profile, however, and you don't seem to have it.

[jcacciat]

I am new here, and I am a little confused. My CPPS was initiated by a bona fide bacterial infection of the prostate, but that infection was cleared quickly about 7 months ago. I first noticed CPPS symptoms while taking the antibiotic that was used to treat the infection. Should I assume that my CPPS was caused by protective muscle spasm that accompanied the infection, which has led to the development of trigger points? Or does this article suggest that CPPS initiated by bacteria is somehow different than other forms and initiates an inflammatory process in the organ separate from the neuromuscular action discussed on this forum? Have those who have CPPS due to an initial E.Coli infection get any benefit from the Wise-Anderson methods? Any wisdom appreciated.

[webslave]

We have no reason to suspect, at this stage, that the neuronal windup and allodynia caused by one form of trauma to the pelvis is different from another. Infection is a known pathway to the condition, as is chronic tension and even a history of physical or sexual abuse (1) (2), inter alia.

[jcacciat]

Thank you, webslave. This forum is a great resource. Even though I have had symptoms for several months, I am realizing that I am just beginning my journey to find a way to manage this condition. Earlier this year, I had a 90 day course of antibiotics to treat what was diagnosed as prostatitis. Also, 60 days of NSAIDS. Very little effect. Went to a physical therapist who is unfamiliar with CPPS and he taught me Kegel-type exercises, and this did relieve certain pain symptoms. I also have been receiving acupuncture treatments for about 10 weeks, but this provides transient relief at best. I also had a 30 day course of Elavil 25 mg, but this did not seem to help and caused some disorientation. Aerobic exercise helps. I have been taking quercetin and pollen-aid for about 6 weeks, but any effects so far have been slight. I have recently developed a GI issue that remains unidentified despite a colonoscopy, blood tests, etc. I have ordered the Wise-Anderson book and have found a physical therapist who is familiar with trigger point release and claims to help patients with pelvic pain. I will start with PT next week. I also know a counsellor who teaches meditation techniques and am thinking about contacting him. Any advice would be greatly appreciated. Thank you.

[webslave]

For starters, don't do Kegels. Search the forum for the word and you'll see why.