Dr. Mazzoli (Italy) — In Italy, Prostatitis = Chlamydia

[MARCO3772]

Yes... thank you very much to this forum... This help me to understand that the world of genital problems don't finish with Mazzoli's theories

[jj77]

Marco,

how's the position of Guercini about chronic prostatitis / chronic pelvic pain syndrome right now? What does he actually do in his practice? Won't comment on Mazzoli, she found chlamydia on me back when I didn't know anything about this forum

[MARCO3772]

hy,
Guercini now thinks that chronic prostatitis / chronic pelvic pain syndrome can be cured by "Stanford/Wise-Anderson Protocol" ... he in his office in Rome has built a very good business and with €350 gives to patient visit+ultrasound and information about Stanford/Wise-Anderson Protocol... the strange thing is that on his site (last update 2007-3-31) is speaks about prostatitis like a bacteriology problem... and proposes antibiotic cocktail directly in prostate... and I don't want imagine the collaterals effects..!!! (in Italy more people have undertaken legal ways... ) .. I tell you more... he is a member of "AISPEP italy forum" and when he tell about chronic prostatitis / chronic pelvic pain syndrome .. speak only of nerves problems, anxiety, .. and gives some information about his office = business....about Mazzoli I have already tell too much... stay away from her... if you have read my before stories you can understand because.. about of my point of view she search Chlamydia everything ....
Did you know Guercini or Mazzoli ?

[jj77]

No, I haven't met them. I had an exam on the MST center where Mazzoli works, and invariably came out with a Chlamydia diagnosis. Guercini has been infamous for many years on this board, but to be frank, I have understood quite early that no italian doctor can handle the situation down there. Has Guercini met David Wise? It would be interesting to understand if they had a direct meeting and what came out of it.

(wonder what does "information" means...does he talk you about the SP? )

[MARCO3772]

It's incredible that Mazzoli wishes to demonstrate in every case that Chlamydia is responsible of everything about genital apparatus problems...
When I met Mazzoli in her clinic... she told me that interleukin 8+ positive = Chlamydia even if PCR is negative... incredible!!!.. Handfield and other famous Italian microbiology doctors told me (medhelp forum) that Chlamydia is positive only with PCR.. IGa positive means that your body has had the chlamydia.. Mazzoli thinks for killing the chlamydia is not sufficient a 15g of doxycycline... and however I ask myself ... in USA there are 1,5 million new case of Chlamydia urethritis ... all this people have till microbe inside their body?.. results ? 300 euro in less in my hands..!!
Guercini I think that .. perhaps.. last year has studied "Stanford/Wise-Anderson Protocol" and he was been in Wise's clinic..
You think that last year my first traditional urologist told me..."Marco .. your genital apparatus is perfect.. I don't know the origin of your penis problem.. probably is in your anxiety.. in your mind.. "
I thought .. "it's impossible..".. and searched on the web for a answer... and unfortunately.. read about Mazzoli theory....
Now I think that problem is really in the sensitivity of my genital apparatus... there is a cause for starting it, like an infection, but only at one time and now this is gone away .. but there remains the memory in your mind... and you must fight vs yourself...
do you think about this ?

[jj77]

I don't think the start of chronic prostatitis / chronic pelvic pain syndrome is an infection, I believe chronic prostatitis / chronic pelvic pain syndrome comes out from some anxiety disorder that somatizes into muscle tension. I have suffered of muscle tension issues for years, not only in the pelvic region: that new research done on adrenal pathways is possibly a breaktrough, but more studies are needed.

[MARCO3772]

I tell that can be an infection because .. often... there are some people who have prostatitis/urethritis infection and after antibiotic therapy symptoms like burning eiacul/urine go away and always remains pain or annoyances to genital apparatus...(like me) and this is results personal sensitivity ...
In fact after my chlamydia urethritis go away all except hypersensitivity tip on my penis...
The problem is that every people ..like me... is very very expectant and is very difficult to stop think my "tip of penis"

[jj77]

I've managed to read a bit of that AISPEP, and here's what I think about it. Italy's urologist practice is really out of date right now: Italian medicine has some really advanced fields, like cardiology or oncology, along with many outdated ones. Urology is badly dated, because is made by essentially by surgeons, so if you have chronic prostatitis / chronic pelvic pain syndrome everyone will tell you that you have an infection, or worse, that it's in your mind. As I've noticed, many people in the AISPEP board still think they have an infection, because their doctors told them so, even doctors on the board (and Mazzoli is one of them!) are pretty open on that.

I may be wrong, but current research is pointing in many other ways. We have had really good results from SP, there has been an important study made by Dr. Dimitrakov (correct me if I'm wrong!), which pointed out that even people with no CPPS/prostatitis have bacteria in their prostates, etc. etc. I guess Webslave, who has an incredible preparation for a non-medical poster, could add many considerations to this.

This is just my penny, which is worthless considering that I'm no doctor at all.

[MARCO3772]

Yes.. webslave is a incredible help for this forum... he help me very very to understand that Mazzoli theories are out of world....
About of my point of view, believe in Italy there aren't in generally advanced research or clinic.. I tell more.. unfortunately the most famous doctors go away from Italy and study or do research in other country (often in USA) where they can earn more and to have more money spending for their theory...
An interesting answer for me is in medhelp if you want read http://www.medhelp.org/posts/show/433450
In particular : "If you Google chronic pelvic pain syndrome, you will find lots of information about it. Start your reading with the Wikipedia article, which is very good; I believe you will find your symptoms fit pretty well. chronic prostatitis / chronic pelvic pain syndrome is uncomfortable but not dangerous."

Interesting is also this :

Category III: CP/CPPS
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

The name of this disorder is evolving. In 2007, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) began using the umbrella term Urologic Chronic Pelvic Pain Syndromes (UCPPS), for research purposes, to refer to pain syndromes associated with the bladder (i.e. interstitial cystitis/painful bladder syndrome, IC/PBS) and the prostate gland (i.e. chronic prostatitis/chronic pelvic pain syndrome, CP/CPPS).[16]

Signs and symptoms

In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterised by pelvic or perineal pain without evidence of urinary tract infection,[17]
lasting longer than 3 months,[18] as the key symptom. Symptoms may wax and wane. Pain can range from mild discomfort to debilitating. Pain may radiate to back and rectum, making sitting difficult. Dysuria, arthralgia, myalgia, unexplained fatigue, abdominal pain, constant burning pain in the penis, and frequency may all be present. Frequent urination and increased urgency may suggest interstitial cystitis (inflammation centred in bladder rather than prostate). Ejaculation may be painful, as the prostate contracts during emission of semen, although nerve- and muscle-mediated post-ejaculatory pain is more common, and a classic sign of CP/CPPS. Some patients report low libido, sexual dysfunction and erectile difficulties. Pain after ejaculation is a very specific complaint that distinguishes CP/CPPS from men with BPH or normal men.

Theories of etiology

Theories behind the disease include stress-driven hypothalamic-pituitary-adrenal axis dysfunction and adrenocortical hormone abnormalities,[19][20] neurogenic inflammation,[21][22][23] and myofascial pain syndrome.[24][25] In the latter two categories, dysregulation of the local nervous system due to past trauma, infection or an anxious disposition and chronic albeit unconscious pelvic tensing lead to inflammation that is mediated by substances released by nerve cells (such as substance P). The prostate (and other areas of the genitourinary tract: bladder, urethra, testicles) can become inflamed by the action of the chronically activated pelvic nerves on the mast cells at the end of the nerve pathways. Similar stress-induced genitourinary inflammation has been shown experimentally in other mammals.[26] However, there is no correlation between inflammation on histological examination of the prostate and the National Institutes of Health Chronic Prostatitis Symptom Index.[27]

The bacterial infection theory that for so long had held sway in this field was shown to be unimportant in a 2003 study from the University of Washington team led by Dr Lee and Professor Richard Berger. The study found that one third of both normal men and patients had equal counts of similar bacteria colonizing their prostates.[28] This view was endorsed by Dr Anthony Schaeffer, Professor and Chairman of the Department of Urology at Northwestern University, in a 2003 editorial of The Journal of Urology, in which he stated that "...these data suggest that bacteria do not have a significant role in the development of the chronic pelvic pain syndrome",[29] and a year later with his colleagues he published studies showing that antibiotics are essentially useless for CP/CPPS.[30][31] Since the publication of these studies, the research focus has shifted from infection to neuromuscular, behavioral, psychological, and genetic etiologies for UCPPS (CP/CPPS and IC/PBS), where the interplay between the lower urinary tract and other physiological systems is stressed.[32] UCPPS is now studied as a systemic disorder.[32] In support of this approach, a 2005 study showed that stress is correlated to Cat III prostatitis.[33]

Additional theories and observations include:

Possible role of unculturable bacteria in CPPS
A 2007 Croatian study, without controls, suggested that "prostatitis syndrome"[sic] patients may be infected with a wide variety of microbes. The study used McCoy culture and Lugol stain or by immunofluorescent typing with monoclonal antibodies to come to these findings.[34] If this study refers to men with Chronic Pelvic Pain Syndrome, it is not in line with major studies from other centres.[28][35] In a preliminary 2005 study (not a randomized, double blind, placebo controlled study) of 16 treatment-recalcitrant chronic prostatitis / chronic pelvic pain syndrome patients, controversial entities known as nanobacteria were proposed as a cause of CPPS,[36] although some scientists expressed strong doubts about the theory.[37][38]


CPPS as a form of interstitial cystitis

Some researchers have suggested that chronic prostatitis / chronic pelvic pain syndrome is a form of interstitial cystitis/painful bladder syndrome (IC/PBS). A large multicenter prospective randomized controlled study showed that Elmiron was slightly better than placebo in treating the symptoms of CPPS, however the primary endpoint did not reach statistical significance.[39] Other therapies shown more effective than Elmiron in treating interstitial cystitis, such as quercetin and Elavil (amitriptyline), can help with chronic prostatitis. In 2007 the NIDDK began to group IC/PBS and CP/CPPS under the umbrella term Urologic Chronic Pelvic Pain Syndromes (UCPPS).


Virus theory

The evidence supporting a viral cause of prostatitis and chronic pelvic pain syndrome is weak. Single case reports have implicated Herpes simplex virus (HSV) and Cytomegalovirus (CMV) but a study using PCR failed to demonstrate the presence of viral DNA in patients with chronic pelvic pain syndrome undergoing radical prostatectomy for localized prostate cancer. [40] The reports implicating CMV must be interpreted with caution because in all cases the patients were immunocompromised. [41][42][43] For HSV the evidence is weaker still and there is only one reported case and the causative role of the virus was not proven, [44] and there are no reports of successful treatments using antiviral drugs such as aciclovir.

Diagnosis

There are no definitive diagnostic tests for CP/CPPS. This is a poorly understood disorder, even though it accounts for 90%-95% of prostatitis diagnoses.[10] It is found in men of any age, with the peak onset in the early 30s. CP/CPPS may be inflammatory (category IIIa) or non-inflammatory (category IIIb). In the inflammatory form, urine, semen, and other fluids from the prostate contain pus cells (dead white blood cells or WBCs), whereas in the non-inflammatory form no pus cells are present. Recent studies have questioned the distinction between categories IIIa and IIIb, since both categories show evidence of inflammation if pus cells are ignored and other more subtle signs of inflammation, like cytokines, are measured. In 2006, Chinese researchers found that men with categories IIIa and IIIb both had significantly and similarly raised levels of anti-inflammatory cytokine TGFβ1 and pro-inflammatory cytokine IFN-γ in their expressed prostatic secretions when compared with controls; therefore measurement of these cytokines could be used to diagnose category III prostatitis.[45]

For CP/CPPS patients, analysis of urine and expressed prostatic secretions for leukocytes is debatable, especially due to the fact that the differentiation between patients with inflammatory and non-inflammatory subgroups of CP/CPPS may not be useful.[46] Serum PSA tests, routine imaging of the prostate, and tests for Chlamydia trachomatis and Ureaplasma are not really proven to provide benefit for the patient.[46]

Extraprostatic abdominal/pelvic tenderness is present in half of the patients with chronic pelvic pain syndrome but only 7% of controls.[47]

Normal men have slightly more bacteria in their semen than men with CPPS.[35] The traditional Stamey 4-glass test is invalid for diagnosis of this disorder, and inflammation cannot be localized to any particular area of the lower GU tract.[35]

Men with CP/CPPS are more likely than the general population to suffer from Chronic Fatigue Syndrome (CFS),[48] and Irritable Bowel Syndrome (IBS). Prostate specific antigen levels may be elevated, although there is no malignancy.

Experimental tests that could be useful in the future include tests to measure semen and prostate fluid cytokine levels. Various studies have shown increases in markers for inflammation such as elevated levels of cytokines, myeloperoxidase, and chemokines.

Bladder neck hypertrophy and urethral stricture may both cause similar symptoms through urinary reflux (inter alia), and can be excluded through flexible cytoscopy and urodynamic tests.[49][50][51]

Treatment

A 2007 review article by Drs Potts and Payne in the Cleveland Clinic Journal of Medicine states:

"Indeed, chronic abacterial prostatitis (also known as chronic pelvic pain syndrome) is both the most prevalent form and also the least understood and the most challenging to evaluate and treat. This form of prostatitis may respond to non-prostate-centered treatment strategies such as physical therapy, myofascial trigger point release, and relaxation techniques."[52]

Physical and psychological therapy

For chronic nonbacterial prostatitis (Cat III), also known as CP/CPPS, which makes up the majority of men diagnosed with "prostatitis", a treatment called the "Stanford/Wise-Anderson Protocol",[53], has recently been published. This is a combination of medication (using tricyclic antidepressants and benzodiazepines), psychological therapy (paradoxical relaxation, an advancement and adaptation, specifically for pelvic pain, of a type of progressive relaxation technique developed by Edmund Jacobson during the early 20th century), and physical therapy (trigger point release therapy on pelvic floor and abdominal muscles, and also yoga-type exercises with the aim of relaxing pelvic floor and abdominal muscles).[24][25] While these studies are encouraging, definitive proof of efficacy would require a randomized, sham controlled, blinded study, which is not as easy to do with physical therapy as with drug therapy.

Cat. III prostatitis may have no initial trigger other than anxiety, often with an element of Obsessive Compulsive Disorder or other anxiety-spectrum problem. This is theorized to leave the pelvic area in a sensitized condition resulting in a loop of muscle tension and heightened neurological feedback (neuronal windup). Current protocols largely focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as trigger points), physical therapy to the area, and progressive relaxation therapy to reduce causative stress. Biofeedback physical therapy to relearn how to control pelvic floor muscles may be useful.[54]

Aerobic exercise can help those sufferers who are not also suffering from Chronic Fatigue Syndrome (CFS) or whose symptoms are not exacerbated by exercise.[55] Acupuncture has reportedly benefited some patients.[56]

but.. do you know italy language ?

[jj77]

sure, I'm italian

[MARCO3772]

I N C R E D I B L E...
Mazzoli is came back on site "Italy CPPS"...
In doctor forum she tells about her new researchs about Chlamydia...
in two words during 2007 she used a particular antibiotic therapy with several types of antibiotic... and only with this therapy chlamydia go away!!!
More... during 2008 she tells about this results... she tells that her theory in the future will be the new base for the urology treatments...
I don't want tell more.. but at this point I don't believe that she lives in his world...

[jj77]

Her work should be judged from the resonance it has on the scientific world. I don't think it made any kind of wave at conventions.

[MARCO3772]

I agree with you... if really.. her research are so incredible.. and also her therapy.. why the medicine world.. above all in USA where all is new is "welcome"... doesn't worry about her ?... Again... why the world research (USA) goes in another direction than her theory ?...

[webslave]

There's probably money involved, Marco. She may be funded to push this line, or has received grant money in order to pursue this angle. There are lots of bee-in-the-bonnet, one-idea academics all over the world who are generally ignored. She's just another one of them.

[MARCO3772]

yesterday.. I looked on "aispep" (Italy forum about CPPS) a participation dated 15 april 2008...dott.ssa Mazzoli tell this

"Guardi, sono tanto "datate" che sono pubblicate su European Urology nel Maggio 2007. Quando parlo di ricerche scientificamente provate vuol dire pubblicate su riviste internazionali prestigiose, cosa che altri non hanno fatto, almeno sul ruolo di Chlamydia nelle prostatiti/CPPS. quindi questi signori prima di parlare dovrebbero leggere e non si permettessero di sparare giudizi su colleghi, oltretutto con i pazienti, cosa che ritengo non abbia nulla di etico, MA DELL'ETICA IN MEDICINA ABBIAMO ANCORA DA IMPARARE MOLTO! guardi, continui a pensare quello che vuole e faccia quello che vuole ma la diffido dal nominarmi piu' con chicchessia"

... that in two words means : my research is the future...all my colleagues aren't ethical...she told that her research on European Urology dated may 2008 is the future and her publication on this important international review means that her ways is right... but is so important this publication ?... I don't know....