Gonococcal inflammation of paraurethral glands around the external urethral orifice in males: a commonly encountered disease?

Gonococcal Infection of the Glans Skin, a Rare Local Complication of Gonorrhea: A Clinical Study of 13 Cases

The study aimed to understand the incidence, site, skin lesion manifestations, and treatment of gonococcal infection of the glans skin. We enrolled men with gonococcal infection of the glans skin and men with gonococcal urethritis from January 2014 to February 2020. Demographic data, site of onset, and skin lesion manifestations were recorded for all patients. Ceftriaxone (1 g) was injected intramuscularly once daily for 5 days in patients with lesions comprising abscesses or nodules. A single dose of ceftriaxone (1 g) was injected intramuscularly in patients with pustules. Incision and drainage were performed in patients with nonruptured abscesses. Thirteen patients had gonococcal infection of the glans skin (0.65%; 95% confidence interval = [0.30, 1.01]) among 1,989 patients with gonococcal urethritis. Mean age was 35.48 ± 2.37 (range = 26-45) years. Nonmarital sexual behavior patterns were genital-genital in eight patients (61.54%) and genital-oral in five patients (38.46%). All skin lesions occurred on the ventral side of the glans. Eleven patients (84.62%) had a single lesion and two (15.38%) had multiple lesions. The lesions manifested as abscesses in five patients (38.46%), nodules in five patients (38.46%), and pustules in three patients (23.08%). All lesions exhibited tenderness. All 13 patients were cured after treatment. The study shows that gonococcal infection of the glans skin is a rare local complication of gonorrhea. Lesions often occur on the ventral side of the glans, presenting as abscesses, nodules, and pustules. Ceftriaxone treatment was effective for gonococcal infection of the glans skin.

Gonococcal tysonitis, a rare local complication of gonorrhea: a clinical study of 15 cases

To investigate the incidence, clinical manifestations, and treatments of gonococcal tysonitis in men. We enrolled men with gonococcal tysonitis and men with gonococcal urethritis from January 2000 to December 2020. Demographic data, interval from non-marital sexual contact to the onset of symptoms of gonococcal tysonitis, occurrence sites, and manifestations were recorded for all patients. Ceftriaxone (1 g) was injected intramuscularly once daily for 5 days in patients with lesions comprising abscesses or nodules. A single dose of ceftriaxone (1 g) was injected intramuscularly in patients with sinus-like lesions. Incision and drainage were performed in patients with non-ruptured abscesses. Fifteen patients with gonococcal tysonitis (0.29%; 95% confidence interval: 0.15-0.44%) were observed among 5087 patients with gonococcal urethritis. The mean age was 38.64 years (range, 17-74 years). The mean gonococcal tysonitis incubation period was 6.02 ± 1.37 days (range, 2-11 days). Lesions were present in the right side of the preputial frenulum in seven patients (46.67%), in the left side of the preputial frenulum in six patients (40%), and in both sides of preputial frenulum in two patients (13.33%). The lesions manifested as abscesses in 7 patients (46.67%), nodules in six patients (40%), and sinus-like lesions in two patients (13.33%); all lesions exhibited tenderness. All 15 patients were cured after treatment. Gonococcal tysonitis is a rare local complication of gonorrhea. Gonococcal urethritis with concurrent gonococcal tysonitis was less common than gonococcal urethritis with concurrent paraurethral gonococcal infection or gonococcal urethritis with concurrent gonococcal epididymitis. Gonococcal tysonitis lesions manifest as abscesses, nodules, and sinus-like lesions. Treatment with ceftriaxone is effective for gonococcal tysonitis.

Is Gonococcal Paraurethral Duct Infection a Local Complication of Urethral Gonorrhea in Men?

Gonococcal paraurethral duct infection in males has previously been regarded as a local complication of urethral gonorrhea. To verify this, pathogens were investigated in urethral secretions from 81 male patients with gonococcal paraurethral duct infection. In patients with gonococcal infections of both the urethra and the paraurethral duct, the times of onset of the first symptoms associated with urethral gonorrheal and gonococcal paraurethral duct infection were compared. Among 81 male patients with gonococcal paraurethral duct infection, gonococci were detected in the urethras of 76 patients and no pathogens were detected in the urethras of the remaining 5 patients. The first symptom associated with urethral gonorrhea and gonococcal paraurethral duct infection occurred simultaneously in 10 cases. In 7 cases, the first symptom of gonococcal paraurethral duct infection occurred 2–4 days (2.29 ± 0.76 days) earlier than that of urethral gonorrhea and in 59 cases, the first symptom of urethral gonorrhea occurred 1–6 days (3.07 ± 1.19 days) earlier than that of gonococcal paraurethral duct infection. This study shows that gonococcal paraurethral duct infection in males can be caused by primary infection of Neisseria gonorrhoeae.

High-Frequency Ultrasound Imaging-Guided Wedge Resection: An Effective Treatment for Paraurethral Duct Dilatation Following Gonococcal Paraurethral Duct Infection in Men

This study was performed to evaluate the therapeutic effects of wedge resection on male paraurethral duct dilatation following gonococcal paraurethral duct infection. Twenty-six men with paraurethral duct dilatation following gonococcal paraurethral duct infection were enrolled. Their lesions underwent wedge resection after examination using an ACUSON X300 ultrasound system. The anesthetic method, surgical duration, intraoperative blood loss, wound healing time, complications, sequelae, and curative effect were assessed. All 26 men received local infiltration anesthesia. The mean surgical duration was 18.65 ± 2.50 min (range, 14-23 min), the mean intraoperative blood loss was 10.50 ± 1.68 ml (range, 8-14 ml), and the mean wound healing time was 14.73 ± 1.31 days (range, 13-17 days). The lesions were cured in all patients (100%). The postoperative wounds healed in all patients. No complications or glans defects were observed in any patients. The study identifies that high-frequency ultrasound imaging-guided wedge resection is an effective and safe therapy for paraurethral duct dilatation following gonococcal paraurethral duct infection in men.

Risk Factors associated with Paraurethral Duct Dilatation following Gonococcal Paraurethral Duct Infection in Men

No studies have explored the risk factors for paraurethral duct dilatation following paraurethral duct infection by Neisseria gonorrhoeae in men undergoing ceftriaxone therapy. The present study was performed to explore the risk factors for paraurethral duct dilatation following paraurethral duct infection by N. gonorrhoeae in men undergoing ceftriaxone therapy and thus guide clinical interventions. We compared the demographic, behavioral, and clinical data of men with paraurethral duct infection by N. gonorrhoeae with and without dilatation of the paraurethral duct. Univariate analysis showed significant differences in age, disease course of the infected paraurethral duct, Chlamydia trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae between the patient and control groups (P<0.05). Multivariate logistic regression analysis showed consistent results (P<0.05). This study that shows delayed treatment may be a major risk factor for paraurethral duct dilatation secondary to paraurethral duct infection by N. gonorrhoeae in men. Age, C. trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae are also risk factors. Thus, educating patients to undergo timely therapy and treating the C. trachomatis infection may be effective interventions.

Pathogen profile in men with inflammation of paraurethral glands

OBJECTIVE

To investigate the pathogen profile in men with inflammation of the paraurethral glands.

METHODS

We enrolled 40 patients with first-onset, drug-naive inflammation of the paraurethral glands. Discharge from the lesions was collected for Gram staining. Microscopy was performed for screening for trichomonads and detecting Gram-negative intracellular diplococci within phagocytes. Cultures for detection of Neisseria gonorrhoeae, Ureaplasma urealyticum and other bacteria, and Chlamydia-trachomatis-associated antigens were performed. PCR was conducted for herpes simplex virus type 1 or 2.

RESULTS

From these 40 patients, there were nine microbial species, which included Gram-negative bacteria (23 cases, 54.8%), Gram-positive bacteria (15 cases, 35.7%) and other pathogens (4 cases, 9.5%). The top three pathogens were gonococci (38.1%), Staphylococcus aureus (16.7%) and Escherichia coli (14.3%).

CONCLUSIONS

Inflammation of paraurethral glands in men may be caused by a variety of pathogens and not just by gonococcal infection.

Risk factors for male patients with gonorrhoea complicated by inflammation of the paraurethral glands around the external urethral orifice

Gonococcal inflammation of paraurethral glands around the external urethral orifice is a local complication of gonorrhoea in men. To investigate the risk factors for this complication we compared prepuce factors, Chlamydia trachomatis infection, demographic data and behavioural indicators of gonorrhoeal patients with and without this complication. Results showed that a prolonged disease course of gonorrhoea, sexual intercourse during gonorrhoea, repeated squeezing of the penis and a redundant prepuce were risk factors for this complication.

Sequential therapy for gonococci inflammation of paraurethral glands in males

OBJECTIVE

To approach the method of sequential therapy in gonococcal inflammation of the paraurethral glands around the external urethral orifice in males.

METHODS

Step one: ceftriaxone sodium (1 g intramuscularly (IM) once daily for 5 days) was used for all patients. Step two: refractory patients from step one were treated with incision and drainage, followed by administration of IM ceftriaxone sodium. Step three: patients' sinus tracts were cauterized with a monopulse CO(2) laser.

RESULTS

After step one, 34 patients recovered (recovery rate 70.83%). However, 14 patients were unaffected, and sinus tracts appeared in two patients. After step two, 11 of 14 patients recovered and three patients developed sinus tracts, two of whom had sinus tracts in step one that did not heal in step two. After step three, all patients with sinus tracts that had been treated with monopulse CO(2) laser therapy recovered in 2 weeks.

CONCLUSION

This sequential therapy can be used to successfully treat gonococcal inflammation of the paraurethral glands around the external urethral orifice in males.