Prevalence of Sexually Transmitted Diseases in Asymptomatic Renal Transplant Recipients

Diagnostic and treatment patterns in urinary and genital tract infections: insights from a referral clinic in Beirut, Lebanon

BACKGROUND

Urinary Tract Infections (UTIs) and Genital Tract Infections (GTIs) are common yet serious health concerns. Precise diagnosis is crucial due to the potential severe consequences of misdiagnosis. This study aims to distinguish between UTIs and GTIs, highlighting the importance of accurate differentiation.

MATERIALS AND METHODS

The study encompassed 294 patients, categorized into 4 groups: Group GNI (no infection, N = 57), Group GUI (urinary infection, N = 52), Group GGI (genital infection, N = 139), and Group GGUI (both infections, N = 46). Methods included patient interviews, clinical examinations, and laboratory tests such as urine and vaginal swab cultures.

RESULTS

The investigation revealed no significant differences in age, BMI, residency, or nationality across groups. However, socioeconomic status varied, with Group GNI having the lowest proportion of low socioeconomic status. In obstetrical characteristics, non-pregnancy rates were higher in Groups GUI and GGUI, with GGUI showing a notably higher abortion rate. Symptom analysis indicated lower symptom prevalence in Group GNI, with pain, itching, pruritus, and vaginal discharge being less frequent, suggesting a link between infection presence and symptom severity. Treatment patterns showed higher usage of ciprofloxacin, antifungals, and vaginal tablets in Groups GUI and GGUI. Laboratory findings highlighted significant Leucocyte Esterase presence and variations in WBC and RBC counts, particularly in Group GGUI.

CONCLUSION

The study emphasizes the need for advanced diagnostic techniques, especially those focusing on individual microbial patterns, to enhance UGTI diagnosis. Variations in symptom presentation and treatment across groups underline the necessity for personalized diagnostic and treatment strategies.

Female Reproductive Health and Contraception Use in CKD: An International Mixed-Methods Study

Rationale & Objective

Female reproductive health is recognized as a predictor of morbidity, mortality, and quality of life, although data in the setting of chronic kidney disease (CKD) are limited.

Study Design

A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey. Phase 2 was semistructured interviews offered to all respondents upon survey completion.

Setting & Participants

The survey was disseminated internationally from October 4, 2021, to January 7, 2022, to individuals aged 18-50 years with both a uterus and CKD diagnosis.

Outcomes

Menstrual health and contraceptive use by CKD stage (dialysis, nondialysis CKD, and transplant).

Analytical Approach

Survey data were analyzed using descriptive statistics. Interview data were analyzed using the framework method of analysis.

Results

Of 152 respondents, 98 (mean age 33 ± 0.7 years; n = 20 dialysis, n = 59 nondialysis CKD, n = 19 transplant) satisfied the inclusion criteria, representing 3 continents. The most common causes of CKD among survey respondents were hereditary causes in dialysis (n = 6, 30%) and glomerulonephritis in nondialysis CKD (n = 22, 37%) and transplant (n = 6, 32%). The majority reported heavy menstrual bleeding (n = 12, 86% dialysis; n = 46, 94% nondialysis CKD; n = 14, 100% transplant). Less than half of participants were consistently able to afford period products. Condoms were the most common contraceptive reported. Most participants reported no contraceptive use (n = 10, 50% dialysis; n = 37, 63% nondialysis CKD; n = 7, 37% transplant), primarily because of "fear". Interviews (n = 6) revealed a perception of a relationship between kidney function and menstrual health, concerns about contraceptive use, and a desire for greater multidisciplinary care to improve kidney and reproductive health.

Limitations

Self-reported outcomes, need for internet access and a device.

Conclusions

Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population.

Plain-Language Summary

Chronic kidney disease (CKD) in female individuals is accompanied by menstrual disorders and low contraceptive use. However, most data are limited to the dialysis and transplant populations. Therefore, this mixed-methods study aimed to describe self-assessed menstruation and contraceptive use across all stages of CKD. People aged 18-50 years with a uterus and CKD diagnosis were invited to participate in an online survey shared internationally as well as an optional telephone interview. Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population.

Chlamydia Infection from Androgical Perspective

Chlamydia trachomatis is a microorganism known for years to cause ocular, urogenital, and neonatal infections in humans. It usually causes urogenital system infections. The pathogen, which is the most common cause of urethritis in males, is one of the sexually transmitted microorganisms. As most males are asymptomatic, they do not realize they are infected and act as reservoirs. This causes the incidence of urethritis due to chlamydia to increase day by day. Chlamydia urethritis, which poses a risk to sexual partners, can cause serious complications if left untreated. In this section, we assess the approach to male urethritis due to chlamydia, which is very common in urology practice and can cause serious problems if left untreated.

Cefoperazone-sulbactam and ornidazole for Gardnerella vaginalis bloodstream infection after cesarean section: A case report

BACKGROUND

Gardnerella vaginalis (G. vaginalis) is a facultative anaerobic bacteria known to cause bloodstream infections. However, cases are very rare in clinics. There is very limited clinical experience in the treatment of bloodstream infections caused by G. vaginalis. Therefore, there is an urgent need for effective antibacterial drugs to treat patients with bloodstream infections caused by G. vaginalis.

CASE SUMMARY

A woman who underwent a cesarean section presented with a sudden onset of high fever 1-d post-surgery. The blood cultures suggested an infection due to G. vaginalis, and treatment with cefoperazone-sulbactam was started. After 5 d of treatment, there was a decrease in the hemogram; however, the temperature and C-reactive protein levels remained high. Based on clinical experience and a review of literature, the treatment was modified to include ornidazole in combination with cefoperazone-sulbactam. Following a week of treatment, the temperature, hemogram and C-reactive protein levels returned to normal, and blood cultures turned negative, suggesting a therapeutic effect of the combination treatment.

CONCLUSION

This case highlighted the effective use of cefoperazone-sulbactam combined with ornidazole for bloodstream infection caused by G. vaginalis following a cesarean section.

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Introduction

We hypothesized that post transplantation anaemia and persistent secondary hyperparathyroidism are potential determinants of diastolic function in stable kidney transplant recipients.

Methods

We assessed traditional and non-traditional cardiovascular risk factors and determined carotid artery intima-media thickness and plaque by ultrasound, arterial function by applanation tonometry using SphygmoCor software and diastolic function by echocardiography in 43 kidney transplant recipients with a transplant duration of ≥6 months, no acute rejection and a glomerular filtration rate of ≥15 mL/min/1.73m².

Results

Mean (SD; range) transplant duration was 12.3 (8.0; 0.5–33.8) years. Post transplantation anaemia and persistent secondary hyperparathyroidism were identified in 27.9% and 30.8% of the patients, respectively; 67.5% of the participants were overweight or obese. In established confounder adjusted analysis, haemoglobin (partial R=−0.394, p=0.01) and parathyroid hormone concentrations (partial R=0.382, p=0.02) were associated with E/e’. In multivariable analysis, haemoglobin (partial R=−0.278, p=0.01) and parathyroid levels (partial R=0.324, p=0.04) were independently associated with E/e’. Waist–height ratio (partial R=−0.526, p=0.001 and partial R=−0.355, p=0.03), waist circumference (partial R=−0.433, p=0.008 and partial R=−0.393, p=0.02) and body mass index (partial R=−0.332, p=0.04 and partial R=−0.489, p=0.002) were associated with both e’ and E/A, respectively, in established confounder adjusted analysis. The haemoglobin-E/e’ (partial R=−0.422, p=0.02), parathyroid hormone-E/e’ (partial R=0.434, p=0.03), waist–height ratio-e’ (partial R=−0.497, p=0.007) and body mass index-E/A (partial R=−0.386, p=0.04) relationships remained consistent after additional adjustment for left ventricular mass index and cardiac preload and afterload measures.

Conclusion

Haemoglobin and parathyroid hormone concentrations as well as adiposity measures are independently associated with diastolic function in kidney transplant recipients. Whether adequate management of post transplantation anaemia, persistent secondary hyperparathyroidism and excess adiposity can prevent the development of heart failure with preserved ejection fraction in kidney transplant recipients merits further investigation.

Development of Pelvic Inflammatory Disease after Ectopic Removal

Although ectopic pregnancy and pelvic inflammatory disease (PID) are separately commonly seen in practice, development of PID after surgical removal is rare. Here, we present the case of a 41-year-old female who was admitted for pelvic inflammatory disease diagnosed after laparoscopic salpingectomy for a ruptured ectopic pregnancy. Treatment required drainage of TOAs with interventional radiology and antibiotic treatment. This case report demonstrates how treatment of PID following ectopic pregnancy is complex and may require surgical- or radiology-guided drainage of infection in addition to common antibiotic treatment. Follow-up and duration of treatment are highlighted.

Urinary tract infections (UTIs) or genital tract infections (GTIs)? It's the diagnostics that count

Urinary tract infections (UTIs) and genital tract infections (GTIs) are both very common infectious diseases. Thus, accuracy and rapidity in recognition and treatment of sexually transmitted urogenital tract infections (ST-UGTIs) is a major concern in global public health systems. The application of reliable, accurate diagnostic tools is the key to definite detection, identification and treatment. This literature review focused on different characteristics of UGTIs in patients and the importance of diagnostic methodologies.

The articles published and indexed from 1980 through October 2018 in the databases of PubMed and MEDLINE, as well as the Google Scholar web search engine, were collected and studied. MeSH keywords of “Sexual intercourse”, “Urinary Tract Infections”, “Genital Tract Infections” and “Toll-Like Receptors” were used for searching articles. Then, the proper articles (original and review articles) were subjected to a very rigorous selection process.

The clinical symptoms and signs or asymptomatic properties of UTIs and GTIs are similar and often overlap. In many cases, the lack of suitable diagnostic techniques leads to misdiagnosed/undignosed GTIs and overdiagnosed UTIs. The outcome of poor diagnostics is failure of definite identification and treatment.

The application of advanced techniques comprising PCR, microarray and next-generation sequencing promises to be more effective, together with the use of the microbial pattern of the individual’s UGT to provide reliable detection, identification and definite treatment. This will be an option in the near future.