Postcatheterization urethral strictures following cardiac surgery in children

Ten children among 221 with congenital cardiac anomalies developed urinary symptoms after removal of urethral catheters, which were routinely inserted for monitoring purposes during and after cardiac surgery. Six children developed urethral strictures. Poor tissue perfusion concomitant with serious congenital cardiac anomalies, together with secondary urine infection in the presence of a urethral catheter, are proposed as significant factors in the causation of such strictures in children undergoing cardiac surgery.

Ureaplasmal infections of the male urogenital tract, in particular prostatitis, and semen quality

Ureaplasma urealyticum is considered an etiologic agent in urogenital tract infections, especially prostatitis. Using the 'four-specimen technique', diagnosis can be based upon significant numbers of these microorganisms. In ejaculate, the critical number seems to be 10(3) cfu/ml of semen to discriminate between real infection and contamination during urethral passage. In our study, 46 of 412 samples (11.2%) exceeded this critical number. Most but not all patients suffering from ureaplasma-associated prostatitis established by the 'four-specimen technique' revealed significantly high ejaculate numbers, whereas all samples from patients with prostatodynia and healthy controls had lower numbers. In these cases, numbers of round cells in semen, i.e. all leukocytes and spermatides, were significantly increased as compared to prostatodynia. A significantly negative correlation was detected between the numbers of ureaplasmas and zinc concentration in semen, and an almost identically negative correlation to the content of fructose, thus indicating secretory dysfunction of the accessory glands in ureaplasmal infections of the prostate.

Framboesiform lesions in primary herpes simplex infection: a case report

A 27 year old homosexual man developed unusual sacral lesions during a disseminated primary herpetic attack, which was confirmed by viral culture and rising antibody titre. The lesions had a striking framboesiform appearance and healed without ulceration or scarring. Review of modern and historical published reports suggests that this may be the first illustrated description of such infection.

The importance and frequency of mixed infections with Chlamydia trachomatis and mycoplasmas in acute gonococcal urethritis

Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis are frequently involved in gonococcal urethritis. We investigated 143 male White and Black patients with gonococcal urethritis (average age 22,5 years). Of these 29% had coexisting Chlam. trachomatis infection, 34% U. urealyticum infection and 13% Mycoplasma hominis infection. Conventional penicillin therapy did not affect Chlam. trachomatis, U. urealyticum or Mycoplasma hominis, which persisted in the lower urogenital tract, causing a so-called 'post-gonococcal urethritis.' Additional therapy with tetracycline or erythromycin was successful in most cases.

Nongonococcal urethritis

Nongonococcal urethritis is a frequent genital infection, in most cases caused by Chlamydia trachomatis or Ureaplasma urealyticum. Diagnosis requires demonstration of urethritis and exclusion of Neisseria gonorrhoeae infection. Preferred treatment is seven days of tetracycline hydrochloride or doxycycline, to both the patient and partners. Physical sequelae are infrequent but include epididymitis and Reiter's syndrome.

Intraurethral immunoglobulin in the treatment of non-specific urethritis

We report on a 25 year old man with agammaglobulinaemia and refractory non-specific urethritis. After seven months of unsuccessful antibiotic treatment, his symptoms responded to the administration of intraurethral immunoglobulin.

Chlamydia trachomatis infections in men with Reiter's syndrome

Chlamydia trachomatis was isolated from 9 of 19 men with acute, nondiarrheal Reiter's syndrome who had not recently taken antibiotics. None of 8 untreated men with other forms of arthritis were infected with this organism. Chlamydia trachomatis-specific antibody titers and cellular immune responses were positive significantly more often in 35 treated and untreated men with acute, nondiarrheal Reiter's syndrome than in 7 men with diarrhea-associated Reiter's syndrome and 8 men with other forms of arthritis. Mean peak chlamydial antibody titers and mean lymphocyte transformation stimulation indices were significantly higher in C. trachomatis-infected men with Reiter's syndrome than in C. trachomatis-infected men with uncomplicated nongonococcal urethritis. We concluded that C. trachomatis is capable of "triggering" Reiter's syndrome in susceptible men and that an exaggerated immune response to this organism may play a role in the pathogenesis of the disease.

A combined treatment in prevention of postgonococcal urethritis

The authors report a study carried out on 82 patients affected with gonococcal urethritis, in order to investigate the activity of minocyclin in the prevention of postgonococcal urethritis.

Urogenital syndromes and spondarthritis

During the last 50 years there has been an obvious change in the relationship between Reiter's syndrome and spondarthritis, probably due to the introduction of antibiotics. Postgonorrhoeic prostatovesiculitis was formerly common: Romanus' spondylitics in the 1940s had a history of gonorrhoea in 35% of cases and 50% of my patients with chronic uro-arthritis in the 1950s had had gonorrhoea. Urogenital syndromes nowadays rarely develop into ankylosing spondylitis; on the other hand, sacroiliitis is still a rather common late sequela, especially in females, however often asymptomatic. The HLA-B27 tissue type is much less frequent in the urogenital syndromes than in ankylosing spondylitis. Accordingly one may postulate that patients with HLA-B27 negative sacroiliitis run a small risk that the disease will progress to ankylosing spondylitis.

Rheumatoid factor-negative arthritis, especially ankylosing spondylitis, and infections of the male urogenital tract

146 men with rheumatoid factor-negative (sero-negative) arthritis, i.e., 97 patients with ankylosing spondylitis, 36 patients with Reiter's syndrome, and 13 patients with reactive arthritis, were examined for infections of the urogenital tract by following recently established criteria. 74 patients (50.7%) had infections of the male adnexes: 3 patients suffered from balanitis, 14 patients from urethritis, 49 patients from prostatitis, 1 patient from epididymitis, and 7 patients from urinary tract infection. Balanitis and urethritis were almost exclusively associated with Reiter's syndrome. In 37 of 97 patients with ankylosing spondylitis, a urogenital tract infection, mainly a prostatitis (31 patients), was detected. The microorganisms isolated most frequently from patients suffering from urethritis and prostatitis, were Chlamydia trachomatis and Ureaplasma urealyticum.

Clinical aspects of Reiter's disease

The clinical manifestations and results of investigations in a series of 221 patients diagnosed as suffering from Reiter's disease are described in detail. Attention is drawn to the very varied natural history of the disease, the relapse rate of 60% and the development of serious complications and disability in young people. The failure to establish the cause of the condition or to unravel its relationship to nonspecific urethritis and bacillary dysentery contrasts with the reported presence of the human leucocyte antigen HLA-B27 in 76% of patients. There is no curative treatment but symptomatic treatment will relieve pain and stiffness and may shorten the duration of individual attacks. Prolonged follow-up of established cases, monitoring of activity of the disease by regular measurements of the erythrocyte sedimentation test and prompt treatment of relapses may prevent the development of serious locomotor disability.

Urethral strictures in children

During a 12-year period 57 children presented for treatment of urethral strictures. The patients ranged in age from 2 months to 18 years and there was 1 girl. Of the strictures 8 were congenital, 34 were iatrogenic, 4 were inflammatory and 11 were traumatic. Diagnosis can be suspected from the history and physical examination (observation of the voided stream), and confirmed radiographically and endoscopically. Urethral dilation was definitive treatment in only 28.6 per cent of the patients in whom it was used. Of 4 inflammatory strictures 2 responded to dilation as the only treatment, while only 1 of 5 congenital strictures and 1 of 5 iatrogenic strictures responded to dilation. Direct vision urethrotomy was successful in 1 of 2 congenital and in 5 of 5 iatrogenic bulbar strictures. A 1-stage urethroplasty seems preferable to multistaged procedures, since only 2 of 7 patients managed with staged procedures were treated successfully in 2 operations, while 5 of 9 treated with a 1-stage procedure have required no further intervention.

Factors associated in the aetiology of peyronie's disease

In a retrospective study of 408 patients with Peyronie's disease 8 (1.9%) patients gave a positive family history for the condition. Sixty-three (15.4%) patients had a Dupuytren's contracture and trauma was considered to be an aetiological factor in 88 (21.5%) patients. One hundred and twenty-two (29.9%) patients had evidence of atherosclerosis and this is thought to be a factor in the pathogenesis of the disease. Peyronie's disease is not a single disease entity and is associated with many aetiological factors.

Urinary tract infection in the adult. A guide to treatment

Urinary tract infection usually responds to any general urinary chemotherapeutic agent. In this article, the another describes therapies for specific infections that he has used for over 20 years in hundreds of patients, with excellent results.

[Studies on the aetiology of non-gonococcal urethritis (author's transl)]

Tests performed on urethral secretion and morning urine specimen identified the causative micro-organism in 143 of 164 males with non-gonococcal urethritis. In 59 patients (36%) there was an infection with Chlamydia trachomatis, in 48 (29.2%) with Ureaplasma urealyticum in significantly high bacterial counts (greater than or equal to 10(4) KbU/ml) urethral secretion (greater than or equal to 10(3) KbU/ml first urine sample), and in a further 18 patients (11%) double infections with Chlamydia trachomatis and Ureaplasma urealyticum. Other causative organisms such as Mycoplasma hominis, enterococci, streptococci of groups A and B, enterobacteria and Trichomonas were isolated in 18 patients (11%). In 21 patients (12.8%) no causative organism was demonstrated. In several instances, Chlamydia was demonstrated in ureaplasma-negative non-gonococcal urethritis, while Ureaplasma was demonstrated in Chlamydia-negative cases. In cases of urethritis caused by Chlamydia gonorrhoeal urethritis was more frequent in the past history than when urethritis was due to Ureaplasma. Treatment with tetracyclines led to clinically and microbiologically good results in 77% of patients with Ureaplasma urethritis, in 64% of patients with Chlamydia urethritis. Adnexial infections such as prostatitis and epididymitis were among the complications seen.

Gonorrhoea and non gonococcal urethritis. The GP view

This article attempts to provide a practical view of the treatment of gonorrhoea and non gonococcal urethritis.

Treatment of uncomplicated gonorrhea with cefotaxime

Patients with uncomplicated gonorrhea due to beta-lactamase-negative Neisseria gonorrhoeae were treated with cefotaxime (1.0 g given im in a single dose) or with aqueous procaine penicillin G (APPG; 4.8 x 10(6) units given im) plus probenecid (1.0 g given orally). Genital or rectal gonococcal infection was cured in 51 (93%) of 55 patients given cefotaxime and in 23 (96%) of 24 patients given APPG plus probenecid. Gonococcal isolates from homosexual men were less susceptible to cefotaxime (geometric mean MIC, 0.021 microgram/ml) than were strains isolated from heterosexual men (geometric mean MIC, 0.012 microgram/ml; P less than 0.05). Genital infection with Chlamydia trachomatis persisted in four of eight patients given cefotaxime and was first detected after treatment in three others. Of 23 men with gonococcal urethritis who were treated with cefotaxime and followed for 11--30 days, ten (43%) developed postgonococcal urethritis; five of these were associated with chlamydial infection. Administration of cefotaxime or APPG caused equal pain, but cefotaxime was better tolerated because of the need for only one injection. Cefotaxime and APPG plus probenecid are comparable for treatment of uncomplicated genital and rectal infection with beta-lactamase-negative N. gonorrhoeae.

Reiter's syndrome. Evaluation of preliminary criteria for definite disease

A retrospective evaluation of 83 patients with Reiter's syndrome (RS) and 166 comparison arthritis patients was conducted in order to assess the preliminary criteria for definite RS. Data analysis was based on the statement that Reiter's syndrome consists of an episode of peripheral arthritis of more than 1 month duration occurring in association with urethritis and/or cervicitis. During the initial episode of RS, 70 of the 83 RS patients satisfied the criteria, yielding a sensitivity of 84.3%.

Gonococcal urethritis with bilateral tysonitis and periurethral abscess

A case of gonococcal urethritis with bilateral tysonitis and periurethral abscess is described. The diagnosis of gonococcal urethritis was made by microscopic detection of typical gram-negative intracellular diplococci in cells of the urethral discharge. The patient was treated with oral ampicillin and probenecid for ten days together with oral oxytetracycline for seven days; he responded favorably to antibiotics, and surgical intervention was unnecessary.

Nongonococcal urethritis

Nongonococcal urethritis is a venereal disease whose incidence is almost double that of gonorrhea. Despite this, the diagnosis, origin, treatment, and complications of nongonococcal urethritis remain unclear. Although some cases are undoubtedly caused by infection with Chlamydia trachomatis, the origin of many cases is uncertain. Treatment is recommended to shorten symptoms and prevent complications. This review presents the current status of this confusing disease.

Urethrography in urethral trauma: tissue reaction to extravasation of contrast dye and iatrogenic infection

The reaction of periurethral tissue to retrograde urethrography with 30 or 60% contrast dye and/or iatrogenic infection following a sharp, penetrating injury of the urethra was investigated in rabbits. Urine was diverted continuously by tubeless cystostomy throughout the experiment. The local healing processes did not differ from the normal reaction after urethrography with 10 ml 30 or 60% sodium-meglumine-amidotrizoate or instillation of 1--2 . 10(6) E. coli in 10 ml saline. An increased inflammatory reaction was only observed when urethrography and the instillation of E. coli saline was combined, thus increasing the total fluid volume instilled and with it probably also the intraurethral pressure. The results suggest that retrograde urethrography as a diagnostic procedure immediately after an acute urethral trauma is free of adverse effects on the normal healing processes if performed under aseptic standards, with a small volume of contrast dye and as low as instillation pressure as possible.

Tetracycline in nongonococcal urethritis. Comparison of 2 g and 1 g daily for seven days

In a previous study treatment with minocycline 100 mg orally every day for seven days was as effective for nongonococcal urethritis (NGU) as 200 mg for seven days or 100 or 200 mg for 21 days. In this prospective, randomised study men with NGU received tetracycline either 500 mg or 250 mg four times daily for seven days. of 200 men initially enrolled, Chlamydia trachomatis was isolated from 40% and Ureaplasma urealyticum from 48%. Eight of 10 homosexual men compared with 39 (21%) of 190 bisexual or heterosexual men had negative culture results for both C trachomatis and U urealyticum (x2 = 15.5, P < 0.0005). U urealyticum was isolated more frequently from chlamydia-negative men and from men with 10 or fewer sex partners during their lifetime. Both regimens were equally effective in their in-vivo activity against C trachomatis and U urealyticum. Failure rates were similar with the two regimens. More obvious failure with purulent or profuse mucoid discharge and pyuria occurred more frequently with the 250-mg regimen (20% of 76 men on the 250-mg regimen compared with 7% of 67 men on the 500-mg regimen; x2 = 4.45, P < 0.05). Failure occurred more frequently in men who were initially chlamydia-negative and in men in whom U urealyticum persisted after medication. Thus, the 250-mg regimen appeared to be as effective as the 500-mg regimen in the initial treatment of NGU. However, one-third of men had persistent or recurrent urethritis with these regimens, and there is a need for antimicrobial agents with greater in-vivo activity, especially against chlamydia-negative NGU.

Recognition and treatment of nongonococcal urethritis in clinical practice

Nongonococcal urethritis is a relatively common disorder in sexually active individuals. The incidence is almost as high, if not higher, than gonorrhea. This syndrome may present with signs and symptoms indistinguishable from acute gonococcal urethritis. It is essential to differentiate the two diseases, as treatment protocols are different. Early recognition of nongonococcal urethritis and proper therapy will often lead to complete resolution and prevention of annoying complications.

Urethritis due to Schistosoma haematobium with superimposed gonorrhea

A case of urethritis due to Schistosoma haematobium with superimposed gonorrhea is described. The diagnosis was confirmed by the presence of gram-negative intracellular diplococci in the urethral discharge and of characteristic terminal spined Schistosoma haematobium ova in the urine, as well as by the favorable clinical response to treatment with the antischistosomal drug niridazole. A diagnosis of schistosomiasis should be considered for patients in whom treatment with drugs that are active against the common causes of urethritis fails, particularly when such patients live in an area where bilharzia is endemic or epidemic.

Syndromes of vesical incoordination

An analytic approach to the continuum of micturitional disorders is provided, as is a discussion of the pharmacologic regimens that provide symptomatic relief.

Aseptic arthritis after gonorrhoea

Sixteen patients with aseptic arthritis developing after gonorrhoea and 14 patients with arthritis after nongonococcal urogenital infection have been analysed with respect to clinical course, roentgenological signs, and humoral as well as cellular immune responses to Neisseria gonorrhoeae antigen. Fifty-eight healthy blood donors were used as controls. The clinical pattern did not differ significantly between the 2 groups. Eye or skin lesions indicative of Reiter's syndrome were found in 5 patients of both groups. Signs of sacroiliac arthritis were found in 8 and 6 patients respectively. Gonococcal complement fixation was positive in 9 of 16 patients in the postgonorrhoeal arthritis group and in 0 of 14 patients in the arthritis group with nongonococcal urogenital infection. The lymphocyte stimulation induced by gonococcal antigen was significantly greater in patients with postgonorrhoeal arthritis than in healthy controls. When reference was made to the results of stimulation of the lymphocytes with PPD, there was also a significant difference in the lymphocyte reactivity to gonococcal antigen between the group of patients with postgonorrhoeal arthritis and that of patients with arthritis after non-gonococcal urogenital infection. No such difference was noted between the latter group and the healthy controls. The clinical and immunologic data argue in favour of the hypothesis that Neisseria gonorrhoeae may induce an aseptic arthritis which sometimes presents as a complete Reiter's syndrome.

Simultaneous scabies and gonococcal infection

A case is presented of an unusual complication arising in a man with scabies and gonococcal urethritis: the secondary infection of excoriated genital lesions by Neisseria gonorrhoeae. This occurred after he had occluded his genitals with a plastic wrap.

Male reproductive tract sequelae of gonococcal and nongonococcal urethritis

Gonorrhea is the most frequent bacterial infection as well as the most frequently reported venereal disease. Nongonococcal urethritis has approximately the same incidence as acute gonorrhea in cases reported by many venereal disease clinics. The relative epidemiology of the two diseases, as well as their acute and chronic manifestations in the male genital tract (urethritis, prostatitis, and epididymitis), will be briefly discussed. Resultant obstructions of the lower genitourinary tract of possible consequence to male fertility, such as urethral stricture disease and strictures of the ejaculatory ducts, are described in terms of anatomy, pathophysiology, and treatment. The postulated and demonstrable effects of infectious agents on seminal fluid and sperm are reviewed, with emphasis on the recent literature concerning Chlamydia and Mycoplasma.