Mycoplasma As a Frequent Factor of Chronic Scrotal Pain Syndrome (CSPS) in HIV Seropositive Male Patients in Lviv, Ukraine

Background:  Chronic scrotal pain syndrome (CSPS) –  is a common clinical condition  of HIV +  male  patients evaluated by infectious disease physicians  in Lviv Regional AIDS Center (LRAC) .  The purpose of this study was to define the most frequent causes of CSPS in HIV + male patients.

Methods:  Patients  recruited to the study  were males from Lviv region of Ukraine with CSPS according to chronic pelvic pain classification by European Association of Urology. Ultrasound  examination of the scrotum, semen  analysis, and semen and urine PCR (polymerase chain reaction) for Chlamydia trachomatis(CT), Trichomonas vaginalis (TV),  Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Mycoplasma hominis(MH) and Neisseria gonorrhoeae( NG) were performed for the study group. Physical examination and detailed patient history were taken into consideration as well.

Results: During September 2011 - October 2013  52 eligible men (age range  19- 46 years; mean 33 years) with CSPS were enrolled in the study.  Ultrasound examinations of the scrotum revealed the following:   varicocele ( 4,2%), hydrocele (2,1%), small epididymal cyst ( 2,1%), testicular tumour ( 2,1%), and normal ultrasound examination (89,6%).  The semen analysis revealed that 18,6% patients  had < 1,000,000/ml  white blood cell count while 81,3% patients had  1,000,000- 8,000,000/ml . PCR testing for infectious diseases demonstrated that MH, MG, UU or combination was identified in 59 ,8 %  while CT and NG were found in 12,4% of patients. In 27.8% of patients PCR testing was negative.  Pain was reported in 81,3% as a primary complaint and a history of multiple, unsuccessful treatments had low correspondence between symptoms and medical findings.

Conclusions: This study suggests that Mycoplasma is common in HIV + male  patients with CSPS.  However, this finding needs to be confirmed in a larger sample population  and calls for further research to explore the potential role of these microorganisms in the pathogenesis of CSPS.