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Guiton R, Drevet JR. Viruses, bacteria and parasites: infection of the male genital tract and fertility. Basic Clin Androl 2023; 33:19. [PMID: 37468865 DOI: 10.1186/s12610-023-00193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/05/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Infertility affects one couple out of six worldwide. Male infertilty can result from congenital or acquired factors, of which pathogens that reach the genital tract through sexual contact or blood dissemination. The impact of major viral, bacterial and parasitic infections on the male genital tract and fertility has been summarized. RESULTS AND CONCLUSIONS A systematic review of articles published in the Google Scholar and PubMed databases was conducted. It turns out that viruses, as well as bacteria and parasites are major inducers of male genital tract infections and ensuing infertility through damage to the organs and subsequent loss of function and/or through direct damage to the sperm cells. Moreover, not only male infertility results from such infections but these can also be transmitted to women and even to the offspring, thus highlighting the need to efficiently detect, treat and prevent them.
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Affiliation(s)
- Rachel Guiton
- Université Clermont Auvergne, CNRS UMR6293, GReD Institute, 63001, Clermont-Ferrand, France.
| | - Joël R Drevet
- Université Clermont Auvergne, CNRS UMR6293, GReD Institute, 63001, Clermont-Ferrand, France
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Angerer M, Lübbersmeyer F, Gübitz R, Wülfing C, Dieckmann KP. Tertiary Syphilitic Gumma Mimicking Testicular Neoplasms. Cureus 2023; 15:e37392. [PMID: 37051441 PMCID: PMC10085538 DOI: 10.7759/cureus.37392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/14/2023] Open
Abstract
Palpable testicular masses in men aged 20 to 50 years usually represent testicular germ cell tumors. Diagnostic work-up involves ultrasound examination as well as serum tumor markers alpha fetoprotein, beta-human chorionic gonadotropin and lactate dehydrogenase, and particularly the novel marker M371. Orchidectomy is mandatory for germ cell tumors. We report the rare case of testicular involvement by tertiary syphilis mimicking testicular neoplasms with testis-sparing management. A 46-year-old Caucasian male presented with a painless firm mass in the right testicle and multiple cutaneous plaques at the skin of the scrotum, penis and right forearm. Testicular serum tumor markers were negative. Syphilis Rapid Plasma Reagin test and Treponema pallidum immunoglobulin antibodies tests were positive. Radiological examination revealed bilateral testicular lesions as well as bipulmonal pleural-based opacities. Conservative management was attempted and treatment with ceftriaxone (2 g/day) intravenously for 14 days was administered. The testicular findings improved rapidly and significantly during antibiotic treatment. Radiological follow-up examinations after two weeks and two months showed further regression of the testicular and pulmonary lesions. This case represents an extremely rare testicular manifestation of tertiary syphilis. Due to rising syphilis incidence in Europe, tertiary syphilis with formation of gumma should be a differential diagnosis of testicular tumor. Thus, syphilis-specific treatment is safe and orchidectomy can be avoided.
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Affiliation(s)
- Markus Angerer
- Department of Urology, Asklepios Klinik Altona, Hamburg, DEU
| | | | - Raphael Gübitz
- Department of Radiology, Asklepios Klinik Altona, Hamburg, DEU
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Koch L, Fink-Puches R, Cerroni L, Aigelsreiter A, Sadoghi B. [Orchiectomy due to early syphilis]. Urologe A 2022; 61:767-769. [PMID: 35166861 DOI: 10.1007/s00120-022-01776-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
Granulomatous and abscessing testicular inflammations are important differential diagnoses of testicular tumors. Infectious orchitis should always be considered in unclear testicular masses with negative tumor markers. We report the case of a 45-year-old man with abscessing orchitis due to early syphilis diagnosed after orchiectomy with the suspicion of a seminoma.
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Affiliation(s)
- Lukas Koch
- Abteilung für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8010, Graz, Österreich.
| | - R Fink-Puches
- Abteilung für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8010, Graz, Österreich
| | - L Cerroni
- Abteilung für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8010, Graz, Österreich
| | - A Aigelsreiter
- Diagnostik & Forschungsinstitut für Pathologie, Medizinische Universität Graz, Graz, Österreich
| | - B Sadoghi
- Abteilung für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8010, Graz, Österreich
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Nepal SP, Nakasato T, Fukagai T, Shichijo T, Morita J, Maeda Y, Oshinomi K, Nakagami Y, Unoki T, Noguchi T, Inoue T, Kato R, Amano S, Mizunuma M, Kurokawa M, Tsunokawa Y, Yasuda S, Ogawa Y. Hard bilateral syphilitic testes with vasculitis: a case report and literature review. BMC Urol 2021; 21:120. [PMID: 34479520 PMCID: PMC8414464 DOI: 10.1186/s12894-021-00886-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report the case of a patient with syphilitic testicular gumma and vasculitis with adrenal failure due to chronic steroid use. CASE PRESENTATION A 63-year-old male presented with hard right eye swelling and very firm bilateral testes on palpation, which he had for 2 years. Testicular tumor markers were negative; syphilis test was positive. Radiological examination suggested aortitis and bilateral testicular malignancy. The patient received ampicillin for the infection and prednisolone for vasculitis. Left orchidectomy was performed to confirm the presence of testicular tumor; histological examinations revealed granulomatous orchitis. The prednisolone doses were adjusted because of relapses and adverse effects of steroid use. Unfortunately, the patient died in the intensive care unit because of uncontrolled blood pressure and pneumonia. CONCLUSIONS This is a rare case of syphilis with testicular involvement and vasculitis. This report shows the importance of broadening the differential diagnoses of testicular firmness.
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Affiliation(s)
- Sat Prasad Nepal
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan.
| | - Takehiko Nakasato
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Takashi Fukagai
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Takeshi Shichijo
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Jun Morita
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yoshiko Maeda
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Kazuhiko Oshinomi
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yoshihiro Nakagami
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Tsutomu Unoki
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Tetsuo Noguchi
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Tatsuki Inoue
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Ryosuke Kato
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Satoshi Amano
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Moyuru Mizunuma
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Masahiro Kurokawa
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yoshiki Tsunokawa
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Sou Yasuda
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yoshio Ogawa
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
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Abstract
BACKGROUND Sexually transmitted infections (STI) are common worldwide and can cause impairment of fertility. In women pelvic inflammatory disease with subsequent tubal sterility is well-documented but the influence of STI on male fertility is still controversely discussed OBJECTIVE: The effects of various bacterial and viral STI on male fertility are discussed. MATERIAL AND METHODS An evaluation of the international literature up to 30 April 2018 was carried out including studies on larger collectives from the Asiatic region. RESULTS There is still an inconsistent picture of the influence of various bacterial and viral STI on male fertility. Direct or indirect evidence of the impact of a pathogen alone on the quality of ejaculates could not be clearly demonstrated; however, there are indications of a negative effect by Mycoplasma and Ureaplasma species in large Asiatic collectives. The transmission of viral pathogens, such as human papillomavirus (HPV), herpes simplex virus (HSV) and hepatitis B virus (HBV) possible impairs the success of assisted reproductive techniques. In contrast, manifest inflammatory processes of the male genital tract caused by STI (in particular Chlamydia and gonococci) or human immunodeficiency virus (HIV) infections often result in impairment of sperm qualtity. CONCLUSION In cases of male fertility disorders a microbiological clarification is recommended. Further studies on the effect of STI on male fertility in larger collectives are necessary, particularly for Caucasian populations. The utilization of existing preventive measures, such as screening for Chlamydia in young women and HPV vaccination also for young males, should be intensively promoted.
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Affiliation(s)
- P Spornraft-Ragaller
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - D Varwig-Janßen
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Abstract
Syphilis is notorious and a great imitator of all diseases. It is a chronic bacterial infection, caused by the sexually transmitted spirochete, Treponema pallidum. Though it has drastically reduced in prevalence, its recent resurgence (especially with HIV disease) is worrying. Without treatment, the disease can progress over years through a series of clinical stages and lead to irreversible neurological or cardiovascular complications. The disease may occur in any organ, including the testis, and is commonly mistaken for malignancy. We report a case of scrotal abscess consequent on epididymo-orchitis, confirmed by histopathological examination to be syphilitic in origin, in an immunocompromised HIV-positive patient.
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Affiliation(s)
- Vivek Agrawal
- 1 Director Professor, Department of Surgery, UCMS and GTB Hospital, New Delhi, India
| | - Rohit Ranjan
- 2 Junior Resident, Department of Surgery, UCMS and GTB Hospital, New Delhi, India
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Abstract
A 31-year-old male came to our clinic for suspicious testicular masses. Frozen-section examination of an excisional biopsy revealed inflammatory tissue, so we did not perform orchifuniclectomy. Definitive hystopatology revealed mio-fibroblastic nodules, which were considered consistent with testicular localization of luetic lesions. The patient was tested for syphilis and was found to be positive. HIV and other sexually transmitted diseases (STDs) tests were negative. He underwent antibiotic treatment and is doing well.
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Syphilis presenting as retinal detachment and orchitis in a young man with HIV. Sex Transm Dis 2014; 41:114-6. [PMID: 24413491 DOI: 10.1097/olq.0000000000000078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Retinal detachment and testicular lesions are 2 rare presentations of syphilis. We describe a man with bilateral retinal detachment from ocular syphilis and syphilitic orchitis as a manifestation of syphilis and HIV coinfection.
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Xu XG, Li YH, Gao XH, Chen HD, Zhang YQ. A case of tertiary neurosyphilis presenting with moth-eaten bone lesions. Dermatol Ther 2014; 26:486-8. [PMID: 24552413 DOI: 10.1111/dth.12020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Syphilis, the "great imitator," with regard to skin diseases, is a chronic systemic infectious disease with a clinical course that waxes and wanes. The incidence of tertiary syphilis had decreased drastically these decades. We report a case of tertiary neurosyphilis presenting with moth-eaten bone lesions of the lower extremities. To the best of our knowledge, we have not seen such reports.
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Affiliation(s)
- Xue-Gang Xu
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China; Department of Dermatology, No.1 Hospital of China Medical University, Shenyang, China
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Abstract
A 37-year-old Caucasian male presented with what appeared clinically and diagnostically as testicular and kindey tomour's. However, syphilis serology and histology confirm that the lesions were gumma's. Without routine syphilis serology, the correct diagnosis may have been missed.
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Affiliation(s)
- Raymond Liang
- Department of Medicine, Hackensack University Medical Center – Mountainside, New Jersey, USA
| | - Shauhab Chaudhry
- Department of Medicine, Hackensack University Medical Center – Mountainside, New Jersey, USA
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Teo SY, Morris G, Fairley I. The great mimic: syphilis mimicking testicular tumour. Conservative management using antibiotics alone with testicular sparing. Int J STD AIDS 2013; 24:415-8. [DOI: 10.1177/0956462412472833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Summary We present the case of a 47-year-old man who attended a genitourinary (GU) medicine clinic with posthitis and a painless testicular mass on examination. Initial ultrasound revealed a 2-cm well-defined hypoechoic mass within the right testis and he was referred to urology on suspicion of malignancy. Subsequent syphilis serology was positive and the penile lesion and testicular mass were felt to be consistent with syphilis. After liaising with the urology department, and in view of negative tumour markers (lactate dehydrogenase, alfa-fetoprotein and human chorionic gonadotrophin) and known penicillin allergy, he was managed conservatively with four weeks of oral doxycycline. Follow-up ultrasound scans revealed adequate response of the testicular mass, with the last scan, performed at 10 months post-treatment, showing complete resolution. This is the first documented case of conservative management of a testicular syphilitic lesion using antibiotics alone with testicular sparing.
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