title: Sexually transmitted infections, benign prostatic hyperplasia and lower urinary tract symptom-related outcomes: results from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.
abstract: OBJECTIVE
  To examine whether a history of sexually transmitted infections (STIs) or positive STI serology is associated with prevalent and incident benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS)-related outcomes in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.
  
  
  METHODS
  Self-reported history of STIs (gonorrhoea, syphilis) was ascertained at baseline, and serological evidence of STIs (Chlamydia trachomatis, Trichomonas vaginalis, human papillomavirus (HPV)-16, HPV-18, herpes simplex virus type 2, human herpesvirus type 8 and cytomegalovirus) was detected in baseline serum specimens. We used data collected on the baseline questionnaire, as well as results from the baseline prostate-specific antigen (PSA) test and digital rectal examination (DRE), to define prevalent BPH/LUTS-related outcomes as evidence of LUTS (self-reported diagnosis of an enlarged prostate/BPH, BPH surgery or nocturia [waking ≥2 times/night to urinate]) and evidence of prostate enlargement (PSA > 1.4 ng/mL or prostate volume ≥30 mL) in men without prostate cancer. We created a similar definition of incident BPH using data from the follow-up questionnaire completed 5-13 years after enrolment (self-reported diagnosis of an enlarged prostate/BPH or nocturia), data on finasteride use during follow-up, and results from the follow-up PSA tests and DREs. We used Poisson regression with robust variance estimation to calculate prevalence ratios (PRs) in our cross-sectional analysis of self-reported (n = 32 900) and serologically detected STIs (n = 1 143) with prevalent BPH/LUTS, and risk ratios in our prospective analysis of self-reported STIs with incident BPH/LUTS (n = 5 226).
  
  
  RESULTS
  Generally null results were observed for associations of a self-reported history of STIs and positive STI serologies with prevalent and incident BPH/LUTS-related outcomes, with the possible exception of T. vaginalis infection. This STI was positively associated with prevalent nocturia (PR 1.36, 95% confidence interval (CI) 1.18-1.65), prevalent large prostate volume (PR 1.21 95% CI 1.02-1.43), and any prevalent BPH/LUTS (PR 1.32 95% CI 1.09-1.61); too few men had information on both STI serologies and incident BPH/LUTS to investigate the associations between T. vaginalis infection and incident BPH/LUTS-related outcomes.
  
  
  CONCLUSIONS
  Our findings do not support associations of several known STIs with BPH/LUTS-related outcomes, although T. vaginalis infection may warrant further study.
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.affiliation: Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Huang
authors.affiliation: Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Rabkin
authors.affiliation: School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Alderete
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Ratna
authors.initials: R
authors.lastname: Pakpahan
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Tracey S
authors.initials: TS
authors.lastname: Beason
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Kenfield
authors.affiliation: Information Management Services, Rockville, MD, USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Mabie
authors.affiliation: Westat, Rockville, MD, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ragard
authors.affiliation: Coeus Health, Chicago, IL, USA.
authors.forename: Kathleen Y
authors.initials: KY
authors.lastname: Wolin
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.|Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.|Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.|Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Sutcliffe
mesh_terms: D000368:Aged; D006801:Humans; D015994:Incidence; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000453:epidemiology*; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*
keywords: Prostate lung colorectal and ovarian cancer screening trial; benign prostatic hyperplasia; nocturia; sexually transmitted infection