[Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in human immunodeficiency virus positive men without urethritis symptoms]

Some of the sexually transmitted diseases' agents other than human immunodeficiency virus (HIV) take an active part in transmission of HIV infection. The objective of the study was to determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in 18 HIV positive men without urethritis symptoms and in 70 HIV negative men with urethritis symptoms as control group. The urine samples were screened for C. trachomatis and N. gonorrhoeae using polymerase chain reaction (PCR). The prevalence of N. gonorrhoeae in HIV positive men without urethritis symptoms was significantly higher than that in HIV negative men with urethritis symptoms (p<0.05). HIV positive individuals should be considered as a high-risk group in respect to the other sexually transmitted diseases, thus necessitating screening for N. gonorrhoeae in order to break the infectious chain in these patients.

A case-control study of risk factors in men with chronic pelvic pain syndrome

OBJECTIVE

To compare the demographic, behavioural, clinical and medical history characteristics of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and asymptomatic controls, to identify characteristics that might be associated with this syndrome.

PATIENTS AND METHODS

Self-administered epidemiological questionnaires were completed by 463 men with CP/CPPS and 121 asymptomatic age-matched controls. We compared the prevalence of possible risk factors between men with CP/CPPS and controls, using generalized Mantel-Haenszel tests, and developed multivariate predictive models using logistic regression methods, adjusting for clustering by clinical centre within both methods.

RESULTS

Compared to controls, men with CP/CPPS reported a significantly greater lifetime prevalence of nonspecific urethritis (12% vs 4%, P = 0.008), cardiovascular disease (11% vs 2%, P = 0.004), neurological disease (41% vs 14%, P < 0.001), psychiatric conditions (29% vs 11%, P < 0.001), and haematopoietic, lymphatic or infectious disease (41% vs 20%, P < 0.001).

CONCLUSION

A wide range of self-reported medical conditions was associated with CP/CPPS. Further studies are necessary to determine whether they play a role in the pathogenesis of CP/CPPS.

Arthrite réactionnelle a Clostridium difficile

Extracolonic manifestations of Clostridium difficile infections have rarely been reported as a cause of reactive arthritis. We report the case of a monoarticular arthritis following pseudomembranous colitis. A 45 year-old man was admitted for fever and monoarthritis of the left knee, 8 days after the onset of a C. difficile enterocolitis associated with urethritis. Samples obtained from the knee, urine, and blood cultures remained sterile. Bone scintigraphy revealed a left knee and forefoot hyperfixations. The association of arthritis and urethritis led us to the diagnosis of Fiessinger-Leroy-Reiter syndrome. Antibiotics for arthritis were ineffective and stopped, but they were continued for colitis. NSAIDs were prescribed and clinical manifestations disappeared within 24 hours, the patient resumed walking after 48 hours. Four months later there was no relapse and no sequela.

[Cystic ureteritis in a kidney transplantation candidate]

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney transplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-transplant study.

[Chlamydia trachomatis infection in men and its association with gynecologic alterations in their sexual partners]

OBJECTIVE

To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatología, as well as to compare the clinical data and lifestyle between C. trachomatis-infected and uninfected men to establish a possible association with gynecological damage in their sexual female partners.

METHODS

An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatología between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hybridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analyze clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05.

RESULTS

C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation of Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR = 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR = 2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5).

CONCLUSION

A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C. trachomatis.

Urethral stricture after pancreas-kidney transplantation due to polypoid urethritis

Urologic complications are common after pancreas-kidney transplantation using bladder drainage. We report a case of urethral stricture caused by polypoid urethritis occurring 4 years after simultaneous pancreas-kidney transplantation. Endoscopic exploration revealed irregular, ragged-appearing urethral mucosa. The diagnosis of polypoid urethritis was confirmed histopathologically.

Uroflow in murine urethritis

OBJECTIVES

To develop a noninvasive method to measure urinary flow rate in the mouse. This could be useful for the study of bladder outlet obstruction, as well as processes affecting detrusor function in the awake animal. Genetically engineered mice can improve our understanding of a variety of human bladder diseases.

METHODS

A metabolic cage without a fecal separation screen was placed above a precision balance that reported the mass of the excreta pan every 100 ms. A computational algorithm identified voids suitable for assessment of uroflow from other excretory events. These algorithms were verified by comparison with a series of images obtained automatically before and during the excretory events. Intraurethral acetic acid was used to induce urethritis and to verify the sensitivity of the measurement technique.

RESULTS

Automatic categorization and characterization of uroflow was successful. Brief exposures of the urethra of the female C57BL6/J mouse to 2% acetic acid decreased uroflow and increased the void duration without a change in the voided volume.

CONCLUSIONS

This method will enable studies of urologic function in mice of differing age, sex, strain, and genetic constitution. Murine urethritis can be differentiated from cystitis, known to be associated with a decrease in voided volume. The observed changes were consistent with urethral obstruction induced by local swelling and inflammation.

The Use of Specimens from Various Genitourinary Sites in Men, to DetectTrichomonas vaginalisInfection

Variations in estimates of prevalence of trichomoniasis in men may reflect true differences in the burden of disease but are also affected by the performance of diagnostic methods and the type of specimen tested. In this study, men were evaluated at baseline and at follow-up, to evaluate syndromic management of urethritis and the effects of human immunodeficiency virus and trichomoniasis, in Lilongwe, Malawi. First-void urine specimens and urethral swabs were obtained at enrollment, for Trichomonas vaginalis culture; semen specimens were also obtained at follow-up. The sensitivities of testing methods using urine specimens and urethral swabs were equal; 67% of cases were identified by use of either specimen, and, in 47% of cases, both specimens tested positive. When semen specimens were included, all 3 specimens tested positive in only 19% of cases. Semen was the most sensitive single specimen, and, in 25.6% of cases, only semen specimens tested positive. Thus, prevalence of T. vaginalis infection in men is underestimated if only 1 specimen is tested.

Identifying and treating reversible causes of urinary incontinence

Urinary incontinence can be a symptom of a variety of reversible conditions. Common and reversible causes of urinary incontinence include polyuria, exposure to irritants (including concentrated urine), infection, urinary retention, use of pharmaceuticals, stool impaction or constipation, atrophic urethritis or vaginitis, restricted mobility or dexterity, psychological conditions, and delirium or acute confused state. Healthcare professionals can use existing assessment strategies, tools, and parameters to guide decisions and treatment options to manage these conditions. First-line assessment tools are reviewed, including the use of a voiding and bowel diary, simple dipstick urinalysis, catheterization for post-void residual, the Folstein Mini Mental Status evaluation, and the Geriatric Depression Scale. Guidelines for estimating normal ranges of urine output, the influence of irritants, the risk of incontinence caused by stool impaction, and urinary retention are discussed. Primary care providers are well positioned to rule out or treat many of the reversible causes of urinary incontinence using simple assessment tools and pragmatic guidelines.

Drug-resistant HIV-1 in the semen of men receiving antiretroviral therapy with acute sexually transmitted infections

Sexually transmitted infections may enhance the sexual transmission of HIV-1. It is possible that loss of virological control in patients with such infections receiving antiretroviral therapy (ART) may even facilitate the transmission of drug-resistant HIV. We have recently demonstrated that in those on maximally suppressive ART this effect is reduced. We have examined the virus obtained from the blood plasma and seminal plasma of six HIV-1-infected men receiving poorly suppressive ART with acute urethritis for the presence of drug resistance-associated mutations. In four men with gonorrhoea the blood and seminal plasma HIV-1 had mutations conferring reduced susceptibility to one or more available drugs. In one of these men the viral load of drug-resistant virus in seminal plasma was 20-fold higher during gonorrhoea than following antibiotic treatment, with no change in blood plasma viral load. We conclude that in the presence of suboptimal ART, sexually transmitted infections may enhance the spread of drug-resistant HIV-1.

The use of a low-profile cystostomy tube to relieve urethral obstruction in a dog

A 10-year-old, spayed female Dalmatian was diagnosed with granulomatous urethritis causing urethral obstruction. Due to the extensive involvement of the urethra, a urethrostomy was not possible. A commercially available, silicone, low-profile gastrostomy tube was placed as a prepubic cystostomy tube to achieve urinary diversion. This tube is easy to use, has a one-way valve, and lies flush with the skin margin, thereby decreasing the likelihood of inadvertent removal. This tube should be considered to achieve long-term urinary diversion when urethral involvement is extensive.

Oral manifestations of HIV-AIDS in Nigerian patients

Because of the unique features of the AIDS epidemic in West Africa, we sought to determine if the spectrum of oral lesions among Nigerian patients with HIV-AIDS differs from that found in other regions. Of 500 patients examined, 266 (53%) had oral lesions. Lesions due to candidiasis were present in 244 (49%), while other oral lesions were infrequent (<3% for each of the other types). Oral lesions were associated with advanced disease stage (P < 0.001), a history of urethritis in men (P < 0.001), and alcohol (P < 0.001) and tobacco use (P = 0.03). A significantly lower prevalence of oral lesions (6%) was found among the 32 patients receiving antiretroviral drug treatment.

[Acute epididymitis]

Epididymitis may be acute (symptoms last less than 6 weeks) or chronic (more than 3 months). Acute epididymitis is almost always unilateral. In sexually active men under 35 years of age, acute epididymitis is frequently caused by Chlamydia trachomatis and less frequently by Neisseria gonorrhoeae and is usually associated with overt or subclinical urethritis. Acute epididymitis in older men, children or following urinary tract instrumentation is commonly caused by gram-negative bacilli. The epididymis is sometimes the site of metastatic infection, such as tuberculosis. It is important to differentiate epididymitis from other causes for acute scrotum, such as testicular torsion and tumor. The cause of acute scrotum especially in children cannot always be identified. Therefore, Doppler ultrasonography and radionuclide scans are often used. In infants and young boys, genitourinary abnormalities are causative factors, and therefore should be excluded by imaging. Supportive measures and antimicrobial agents are the mainstay of therapy.

Addition of treatment for trichomoniasis to syndromic management of urethritis in Malawi: a randomized clinical trial

BACKGROUND

Male urethritis is generally treated syndromically, but failure of empirical treatment is common.

GOAL

The study goal was to evaluate the addition of metronidazole to the syndromic management of urethritis in Malawi in a randomized clinical trial.

STUDY DESIGN

Men with urethritis were randomized to receive either 2 g of metronidazole by mouth or placebo, in addition to standard care for urethritis (i.e., a single intramuscular dose of 240 mg gentamicin and 100 mg doxycycline twice daily for 7 days). The primary endpoints of the study included measurement of the effects of treatment on Trichomonas vaginalis, signs and symptoms of urethritis, and the concentration of HIV RNA in semen in dually infected subjects.

RESULTS

The overall prevalence of T vaginalis was 17.3% (71/411), and treatment with metronidazole cleared 95% of culture-positive infections, compared with 54% clearance among men receiving placebo (P = 0.006). Prevalence of persistent urethritis was observed in approximately 16% of both groups at the end of 1 week (29/179 of those receiving metronidazole versus 29/187 in the placebo group; P = 0.86). For a subset of HIV-infected men with trichomoniasis, the seminal plasma HIV RNA concentration was higher than in a group of HIV-positive control subjects (median copies/mL:35,000 vs. 1800 P = 0.06) [correction].

CONCLUSION

In areas with a high prevalence of trichomoniasis, the addition of metronidazole to the syndromic management of male urethritis can eliminate infection with T vaginalis and may help to reduce the transmission of HIV. Such treatment should be strongly considered as part of empirical therapy for urethritis in men in Malawi and places where T vaginalis infection in men is common.

[Urogenital infections in the male and the desire to father a child]

Urogenital infections may often have a major effect on fertility. For the most part, however, the pathogenetic aspects of such cases have not yet been clarified. In the future, the integration of functional and molecular parameters will be decisive for defining an interaction between urogenital infection and male fertility. As a rule, infection-related alterations to the ejaculate require antimicrobial treatment, although the effect of the latter on fertility remains uncertain.

Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic

OBJECTIVE

To determine the prevalence and clinical features of Trichomonas vaginalis (TV) infection in men.

METHODS

Men attending a public STD clinic in Baltimore, Maryland, were evaluated between March and July 2000. Clinicians recorded a standardised history and clinical examination. Urethral swab specimens were collected for Gram stain and Neisseria gonorrhoeae culture. First fraction urine samples were evaluated with TV culture and chlamydia and TV polymerase chain reaction (PCR). True positive TV was defined as a positive TV culture or a positive TV PCR confirmed with a second primer set.

RESULTS

355 men were evaluated in 363 visits. The prevalence of gonorrhoea, TV, and chlamydia were 19%, 13%, and 11%, respectively. In men over 28 years, the prevalence of TV was significantly higher than chlamydia. Age and urethritis by Gram stain were associated with a positive result on TV culture (p=0.03 and p=0.02, respectively) but not associated with TV infection as defined by a positive TV culture or a confirmed TV PCR. Discharge or dysuria was reported in 47% and 22% of men with TV, respectively.

CONCLUSIONS

TV prevalence in an urban STD clinic setting was high. Older age and urethritis were not significantly associated with TV infection as defined by a positive TV culture or a confirmed TV PCR.

Periurethral abscess complicating male gonococcal urethritis treated by surgical incision and drainage

Gonococcal urethritis in a heterosexual male complicated by periurethral abscess and its treatment with antibiotics and surgical drainage is presented.

Opportunistic chlamydia screening; should positive patients be screened for co-infections?

This study examines the requirement for testing patients for other sexually transmitted infections (STIs) and bacterial vaginosis (BV) when diagnosed with genital chlamydia during opportunistic screening. Data were collected on all patients participating in the Department of Health chlamydia screening pilot study in Portsmouth. One thousand two hundred and forty-five women and 490 men with genital chlamydia were seen in Portsmouth genitourinary medicine (GUM) department. Of the women screened in GUM, 28% had coexisting STIs and 21% had BV. The corresponding figures for those initially screened in the community were 4% and 17%. An increased number of female sexual partners of male patients (76%) and male partners of female patients (55%) of the GUM group had co-infections; 58% of male partners from the community group had another STI. The increased morbidity associated with these infections warrants screening of all patients with chlamydia for other STIs and BV.

Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans

We report the results of a study of Mycoplasma genitalium (detected with a modified polymerase chain reaction [PCR] assay) in men with urethritis and in asymptomatic control subjects at a sexually transmitted diseases clinic in New Orleans. Data for 97 men with urethritis and 184 asymptomatic men were available for analysis. M. genitalium infection rates in symptomatic and asymptomatic men who were negative for Chlamydia trachomatis and Neisseria gonorrhoeae were 25% and 7%, respectively (P=.006). M. genitalium coinfection rates among men with chlamydial and gonococcal urethritis were 35% and 14%, respectively. Men with M. genitalium urethritis resembled those with C. trachomatis in that both groups were younger and more likely to experience milder urethral symptoms. Among men with urethritis, the sensitivities of PCR of urine and swab specimens for the detection of M. genitalium were 87% and 91%, respectively. M. genitalium is associated with nongonococcal urethritis in this population.

Longitudinal quantitative detection by real-time PCR of Mycoplasma genitalium in first-pass urine of men with recurrent nongonococcal urethritis

By using a TaqMan assay we monitored longitudinal changes in Mycoplasma genitalium loads in five men with recurrent M. genitalium-positive nongonococcal urethritis. We observed regrowth of M. genitalium persisting in hosts after treatment and a possible association of the increase in the M. genitalium load with emergence of symptoms and signs of nongonococcal urethritis in four of these patients.

[Multifactorial analysis of the risk factors of chronic prostatitis]

OBJECTIVE

To investigate the risk factors of chronic prostatitis.

METHODS

An epidemiological survey of 1,168 patients with chronic prostatitis was conducted and both single factor and multifactorial logistic regression analyses were performed.

RESULTS AND CONCLUSION

Many risk factors were identified, including urethritis, uncontrolled sexual activity, frequent masturbation, urinary system injury, fixed body posture (especially long-time riding), excessive drinking, long-time holding urine. The findings may provide reference for the prevention, treatment and measures for coping with recurrence of chronic prostatitis.

Coexistence of urethritis with genital ulcer disease in South Africa: influence on provision of syndromic management

OBJECTIVE

To assess whether syndromic management of genital ulcer disease was sound, if based on the premise that men with genital ulcers rarely have a concomitant urethral infection.

METHODS

Specimens were taken in 1998 from 186 mine workers in Carletonville, South Africa, who were seen consecutively with genital ulcers. The specimens comprised a swab from the ulcer, a urethral swab for a Gram stained smear, and 10-15 ml of a first catch urine sample. The latter was tested by ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis specific DNA sequences and by a polymerase chain reaction (PCR) assay for Mycoplasma genitalium. Ulcer inducing micro-organisms were detected either by a multiplex PCR assay, or in the case of lymphogranuloma venereum (LGV) serologically, and human immunodeficiency virus (HIV) infection was detected by an enzyme linked immunosorbent assay (ELISA) test.

RESULTS

Most (54%) of the ulcers were chancroidal, 18% were herpetic (HSV type 2), 6.5% primary syphilitic, and 3.2% due to LGV. More than one micro-organism was detected in 9.1% of the ulcers and less than 10% were undiagnosed. Microscopic examination of the urethral smears showed that 99 (53%) of the men had urethritis, of whom 45 (45%) were infected with N gonorrhoeae. Of the 54 men (55%) who had non-gonococcal urethritis (NGU), 11 (19.6%) harboured C trachomatis or M genitalium. Almost two thirds (64.5%) of the men had HIV infection, but this did not seem to have influenced the aetiology of the ulcers. Nor was a particular ulcer associated with one type of urethritis more than the other. Neither C trachomatis nor M genitalium was associated significantly with non-gonococcal urethritis (NGU) in either HIV positive or HIV negative men.

CONCLUSION

The combination of antibiotics used for the management of genital ulcer disease in men in this South African mining population needs to be widened to encompass frequently occurring concomitant gonococcal urethritis and NGU infections. This means treatment with long acting penicillin, combined with ciprofloxacin and azithromycin or erythromycin. A similar situation may exist in other geographical locations with a need to provide appropriate antimicrobial combinations depending on the patterns of infection detected.