Semen! Need help

BCapstone bcapstone at aol.com
Fri Sep 30 19:44:02 EST 1994


I would like to suggest the following CLINICAL APPLICATION of PCR, and to
invite suggestions and criticism.  Anyone who can do so, please feel free
to utilize these ideas.  Anyone who has any experience please contact me. 
The concept is do the Meares and Stamey 4 glass test with PCR techiniques
instead of routine culture.  In 1968 Meares and Stamey published a
landmark paper establishing a localization procedure for diagnosing
infections of the male genitourinary tract. (The method has not been
improved upon in 25 years).  After cleaning the penis, the patient is
asked to void 5 cc into a sterile container.  The patient continues
urinating and a midstream urine is collected.  Prostatic massage is then
done and Epressed Prostatic Secretions are collected.  Finally, another
urine specimen is collected.  In other words:
VB1 (voided bladder 1) = first 5 ml of urine
VB2 = midstream urine specimen
EPS = expressed prostatic secretion (semen could be used also)
VB3 = voided urine after prostatic massage.
The urine and prostatic fluid is thought to be sterile in a healthy male.
Traditionally, if VB1 in culture has ten times the Colony Forming Units of
the other specimens the patient is thought to have urethritis.  If VB2 has
the most CFU's by a factor of 10 the patient is thought to have cystitis. 
If either EPS or VB3 has a ten fold greater quantity of CFU's than the
other aliquots the patient is thought to have prostatitis. The accuracy of
the Meares and Stamey test has never been validated.  One Chairman of
Urology in Chicagoland states that a positive Meares and Stamey test only
occurs in 15% of patients with acute prostatitis.  The Meares and Stamey
test is thought to have very low sensitivity, possibly even close to zero.
 Culture overgrowth may occur, the prostatic fluid secretes spermicin,
spermidine, and zinc, all of which are thought to be natural antibiotics,
and the disease my be caused by organisms that just will not grow well in
culture. PCR is extremely sensitive.  If technical difficulties can be
overcome it would seem logical to replace cultures with PCR.  I would also
suggest a VB0.  VB0 would represent the skin surrounding the penile meatus
and be collected by immersing the skin in saline. (Skin contamination has
never been addressed in the Meares and Stamey technique and with PCR it
should be.)  It would be a landmark in Urology, Infectious Disease, and
Infertility, if the low sensitivity of the Meares and Stamey technique
could be replaced with highly sensitive PCR technology.






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