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Obafemi OA, Rowan SE, Nishiyama M, Wendel KA. Mycoplasma genitalium: Key Information for the Primary Care Clinician. Med Clin North Am 2024; 108:297-310. [PMID: 38331481 DOI: 10.1016/j.mcna.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission. Three Food and Drug Administration (FDA) approved tests are available. Testing should be focused to avoid inappropriate antibiotic use. The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis and state that testing should be considered in cases of PID. Testing is also recommended for sexual contacts of patients with MG. Testing is not recommended in asymptomatic patients, including pregnant patients, who do not have a history of MG exposure. Although resistance-guided therapy is recommended, there are currently no FDA approved tests for MG macrolide resistance, and tests are not widely available in the United States. The CDC recommends 2-step treatment with doxycycline followed by azithromycin or moxifloxacin. Moxifloxacin is recommended if resistance testing is unavailable or testing demonstrates macrolide resistance..
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Affiliation(s)
- Oluyomi A Obafemi
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Department of Family Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Sarah E Rowan
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Masayo Nishiyama
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA
| | - Karen A Wendel
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
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Astolfi RH, Lebani BR, Krebs RK, Dias-Filho AC, Bissoli J, Cavalcanti AG, Ximenes SF, Bertolla RP, Geminiani JJ. Specific characteristics of urethral strictures in a developing country (Brazil). World J Urol 2019; 37:661-666. [PMID: 30810832 DOI: 10.1007/s00345-019-02696-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/19/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil. METHODS This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient. RESULTS The mean age was 52.13 ± 16.9 years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39 years old group (42.8%), idiopathic in the 40-59 years old group (32.4%) and iatrogenic in patients over 60 years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%). CONCLUSION In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.
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Affiliation(s)
- R H Astolfi
- Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
| | - B R Lebani
- Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
| | - R K Krebs
- Division of Urology, Paraná Federal University (UFPR), Curitiba, Brazil
| | - A C Dias-Filho
- Division of Urology, Federal District Base Hospital, Brasília, Brazil
| | - J Bissoli
- Division of Urology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - A G Cavalcanti
- Urogenital Research Unit from Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - S F Ximenes
- Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
- Oswaldo Ramos Foundation, São Paulo, Brazil
| | - R P Bertolla
- Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
| | - Julio J Geminiani
- Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil.
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Tshokey T, Tshering T, Pradhan AR, Adhikari D, Sharma R, Gurung K, Dorji T, Wangmo S, Dorji U, Wangdi K. Antibiotic resistance in Neisseria gonorrhoea and treatment outcomes of gonococcal urethritis suspected patients in two large hospitals in Bhutan, 2015. PLoS One 2018; 13:e0201721. [PMID: 30067836 PMCID: PMC6070275 DOI: 10.1371/journal.pone.0201721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/20/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Gonorrhea is a major sexually transmitted infection (STI) globally with increasing trends. Despite limited data, gonorrhea remains an important public health problem in Bhutan. Methods A descriptive study was carried out in two Bhutanese hospitals; Jigme Dorji Wangchuck National Referral Hospital and Phuentsholing General Hospital in 2015. Patients suspected of gonococcal urethritis were sampled, treated and followed up at two weeks. Gonococcal isolates were identified and tested for antibiotic susceptibility by the Calibrated Dichotomous Sensitivity Test (CDS) method. Results Of the 524 patients, 2.3% (12) were females. Most (46.6%) patients belonged to the 26–35 years age group. About 58% were lost to follow up; 62% (277) of males and all (12) females. N. gonorrhoea was positive in 76% (398) of microscopy and 73.1% (383) by culture. Resistance against ciprofloxacin, penicillin, tetracycline and nalidixic acid were 85.1%, 99.2%, 84.8% and 99.7% respectively. Nearly all the isolates were sensitive to cefpodoxime, ceftriaxone and azithromycin. Sixty-seven percent (350) were treated with injection ceftriaxone alone, 32% (169) with ceftriaxone and oral doxycycline and 1% (5) with ceftriaxone, doxycycline and metronidazole. Probable treatment failure was seen only in one patient (0.5%). Conclusions Gonococcal resistance to currently used antibiotics was low and there was a high clinical cure rate. Compliance to treatment guidelines need reinforcement addressing antibiotic regimen, tracing sexual partners and addressing the social stigma. National STI programs should be more women-friendly for effective management, prevention and control of STIs. Laboratories must adopt more reliable susceptibility testing methods, the Minimum Inhibition Concentration method.
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Affiliation(s)
- Tshokey Tshokey
- Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan
- * E-mail:
| | | | | | - Deepika Adhikari
- Essential Medicine and Technology Division, Ministry of Health, Thimphu, Bhutan
| | - Ragunath Sharma
- Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan
| | - Kiran Gurung
- Phuentsholing General Hospital, Phuentsholing, Bhutan
| | | | | | - Ugen Dorji
- Department of Pharmacy, JDWNRH, Thimphu, Bhutan
| | - Kinley Wangdi
- Phuentsholing General Hospital, Phuentsholing, Bhutan
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Retchless AC, Kretz CB, Chang HY, Bazan JA, Abrams AJ, Norris Turner A, Jenkins LT, Trees DL, Tzeng YL, Stephens DS, MacNeil JR, Wang X. Expansion of a urethritis-associated Neisseria meningitidis clade in the United States with concurrent acquisition of N. gonorrhoeae alleles. BMC Genomics 2018; 19:176. [PMID: 29499642 PMCID: PMC5834837 DOI: 10.1186/s12864-018-4560-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/20/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Increased reports of Neisseria meningitidis urethritis in multiple U.S. cities during 2015 have been attributed to the emergence of a novel clade of nongroupable N. meningitidis within the ST-11 clonal complex, the "U.S. NmNG urethritis clade". Genetic recombination with N. gonorrhoeae has been proposed to enable efficient sexual transmission by this clade. To understand the evolutionary origin and diversification of the U.S. NmNG urethritis clade, whole-genome phylogenetic analysis was performed to identify its members among the N. meningitidis strain collection from the Centers for Disease Control and Prevention, including 209 urogenital and rectal N. meningitidis isolates submitted by U.S. public health departments in eleven states starting in 2015. RESULTS The earliest representatives of the U.S. NmNG urethritis clade were identified from cases of invasive disease that occurred in 2013. Among 209 urogenital and rectal isolates submitted from January 2015 to September 2016, the clade accounted for 189/198 male urogenital isolates, 3/4 female urogenital isolates, and 1/7 rectal isolates. In total, members of the clade were isolated in thirteen states between 2013 and 2016, which evolved from a common ancestor that likely existed during 2011. The ancestor contained N. gonorrhoeae-like alleles in three regions of its genome, two of which may facilitate nitrite-dependent anaerobic growth during colonization of urogenital sites. Additional gonococcal-like alleles were acquired as the clade diversified. Notably, one isolate contained a sequence associated with azithromycin resistance in N. gonorrhoeae, but no other gonococcal antimicrobial resistance determinants were detected. CONCLUSIONS Interspecies genetic recombination contributed to the early evolution and subsequent diversification of the U.S. NmNG urethritis clade. Ongoing acquisition of N. gonorrhoeae alleles by the U.S. NmNG urethritis clade may facilitate the expansion of its ecological niche while also increasing the frequency with which it causes urethritis.
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Affiliation(s)
- Adam C. Retchless
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Cécilia B. Kretz
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
- Present address: Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - How-Yi Chang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Jose A. Bazan
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH USA
- Sexual Health Clinic, Columbus Public Health, Columbus, OH USA
| | - A. Jeanine Abrams
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH USA
| | - Laurel T. Jenkins
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - David L. Trees
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA USA
| | - Jessica R. MacNeil
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
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Abstract
Secondary syphilis can have different clinical presentations, with corymbiform rash as its rarest manifestation. The disease is characterized by a central papule surrounded by smaller ones. We report the case of a man who has sex with man with corymbiform syphilis. The patient was subsequently diagnosed with HIV infection, hepatitis B, non-gonococcal urethritis, as well as infection of the central nervous system by treponema. This case not only illustrates a rare presentation of secondary syphilis, but also demonstrates the importance of further investigation of sexually transmitted infections, particularly among at-risk patients.
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Affiliation(s)
- John Verrinder Veasey
- Infeccious Disease Division of the Dermatology
Clinic at Santa Casa de São Paulo - São Paulo (SP), Brazil
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Abstract
Background Mycoplasma genitalium is very difficult to grow in culture but has been more able to be studied for disease associations since the advent of research molecular amplification assays. Polymerase chain reaction (PCR) and other molecular assays have demonstrated an association with adverse disease outcomes, such as urethritis or nongonococcal urethritis in men and adverse reproductive sequelae in women-for example, cervicitis, endometritis, and pelvic inflammatory disease (PID), including an association with risk for human immunodeficiency virus. The lack of commercially available diagnostic assays has limited widespread routine testing. Increasing reports of high rates of resistance to azithromycin detected in research studies have heightened the need available commercial diagnostic assays as well as standardized methods for detecting resistance markers. This review covers available molecular methods for the diagnosis of M. genitalium and assays to predict the antibiotic susceptibility to azithromycin. Methods A PubMed (US National Library of Medicine and National Institutes of Health) search was conducted for literature published between 2000 and 2016, using the search terms Mycoplasma genitalium, M. genitalium, diagnosis, and detection. Results Early PCR diagnostic tests focused on the MPa adhesion gene and the 16S ribosomal RNA gene. Subsequently, a transcription-mediated amplification assay targeting ribosomes was developed and widely used to study the epidemiology of M. genitalium. Newer methods have proliferated and include quantitative PCR for organism load, AmpliSens PCR, PCR for the pdhD gene, a PCR-based microarray for multiple sexually transmitted infections, and multiplex PCRs. None yet are cleared by the Food and Drug Administration in the United States, although several assays are CE marked in Europe. As well, many research assays, including PCR, gene sequencing, and melt curve analysis, have been developed to detect the 23S ribosomal RNA gene mutations that confer resistance to azithromycin. One recently developed assay can test for both M. genitalium and azithromycin resistance mutations at the same time. Conclusions It is recommended that more commercial assays to both diagnose this organism and guide treatment choices should be developed and made available through regulatory approval. Research is needed to establish the cost-effectiveness of routine M. genitalium testing in symptomatic patients and screening in all individuals at high risk of acquiring and transmitting sexually transmitted infections.
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Affiliation(s)
- Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
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7
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Wang JX, Shi YC. [Impact of Mycoplasma and Chlamydia infections on male reproduction]. Zhonghua Nan Ke Xue 2017; 23:183-188. [PMID: 29658260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Infertility can be attributed to reproductive tract infections (RTI), most commonly nongonococcal urethritis, mainly including Mycoplasma and Chlamydia infections, which may directly or indirectly damage spermatozoa and spermatogenic cells. In addition, a series of immune responses caused by such infections are also associated with male infertility. Methods for the clinical detection of these microbial infections are being constantly improved for more specific and precise control over the impact of Mycoplasma and Chlamydia infections on male fertility.
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Affiliation(s)
- Jia-Xiong Wang
- Center for Reproduction and Genetics, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu 215002, China
| | - Yi-Chao Shi
- Center for Reproduction and Genetics, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu 215002, China
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Vigneswaran HT, Baird G, Hwang K, Renzulli J, Chan PA. Etiology of symptomatic urethritis in men and association with sexual behaviors. R I Med J (2013) 2016; 99:37-40. [PMID: 27247972 PMCID: PMC5522176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Gonorrhea and chlamydia are sexually transmitted infections (STI) that are the most common causes of urethritis in men. The role of specific sexual behaviors and presentation of urethritis is often overlooked. METHODS Data was retrospectively reviewed on all men presenting at the major STI clinic in Providence, Rhode Island. Predictors of gonorrhea and chlamydia infection were modeled using a generalized model assuming a binary distribution. RESULTS Of the men with urethritis, 27% had chlamydia, 13% gonorrhea, 3% both, and 63% neither (non-gonococcal, non-chlamydial urethritis). MSM were more likely to test positive for gonorrhea than MSW (25% of MSM versus 6% of MSW; p<0.01). CONCLUSIONS MSM with urethritis were much more likely to test positive for gonorrhea which may be due to increased risk behaviors and spread within concentrated sexual networks. A large number of both MSM and MSW had non-gonococcal, non-chlamydial urethritis, which suggests the need for improved diagnostic testing. [Full article available at http://rimed.org/rimedicaljournal-2016-06.asp, free with no login].
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Affiliation(s)
- Hari T Vigneswaran
- Department of Urology, Alpert Medical School of Brown University, Providence, RI
| | - Grayson Baird
- Lifespan Biostatistics Core, Lifespan Hospital System, Providence, RI
| | - Kathleen Hwang
- Department of Urology, Alpert Medical School of Brown University, Providence, RI
| | - Joseph Renzulli
- Department of Urology, Alpert Medical School of Brown University, Providence, RI
| | - Philip A Chan
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, RI
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Abdrahmanov RM, Fajzullina EV, Abdrahmanov AR, Haliullin RR. [To the issue of local treatment in combination therapy of chronic urethritis, associated with sexually transmitted infections]. Urologiia 2015:40-46. [PMID: 28247679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The article shows the high efficacy of the additional local use of the drug Miramistin in combination therapy of chronic urethritis, associated with sexually transmitted infections (STIs). In accordance with the principles of evidence-based medicine, patients were assigned to the study group (n=110) treated with conventional therapy and Miramistin, and the comparison group (n=40) treated with conventional therapy only. The between-group comparison of treatment effectiveness was carried out by matching results of the etiological healing, the changes of the endoscopic picture of the urethra, and basic clinical manifestations of STI: the degree of inflammatory reaction of urethral mucous membrane, dysuria, pain and sexual syndrome.
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Affiliation(s)
| | - E V Fajzullina
- Kazan State Medical University of Minzdrav of Russia, Kazan
| | | | - R R Haliullin
- Kazan State Medical University of Minzdrav of Russia, Kazan
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Ninan GK, Pringle K, Patel R. Upper urinary tract inflammation and dilatation secondary to idiopathic urethritis: a plea for steroid treatment. Int J Urol 2014; 21:348-9. [PMID: 24000904 DOI: 10.1111/iju.12241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- George K Ninan
- Department of Pediatric Urology, Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.
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Romero FR, Romero AW, de Almeida RMDSSA, de Oliveira FC, Tambara R. Prevalence and risk factors for scrotal lesions/anomalies in a cohort of Brazilian men ≥ 40 years of age. SAO PAULO MED J 2014; 132:73-9. [PMID: 24714986 PMCID: PMC10896572 DOI: 10.1590/1516-3180.2014.1322495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 05/20/2013] [Accepted: 05/28/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of and risk factors for cutaneous lesions of the scrotum and intrascrotal lesions/anomalies among men included in a prostatic cancer screening program in a Brazilian metropolitan city. DESIGN AND SETTING Cross-sectional study, private outpatient healthcare service. METHODS 1731 men aged 40 years or over, participating in a prostate cancer screening program conducted by the municipal public employees' healthcare system, underwent systematic urological assessment by a single examiner. RESULTS The prevalence of scrotal diseases in our sample was 44.7% (773/1731). Tinea cruris occurred in 203 (11.7%) of the participants, with higher risk among diabetics and lower prevalence among nonwhite individuals; scrotal tinea in eight (0.5%), with higher risk among hypertensive men; subcutaneous nodules in 12 (0.7%), especially in individuals with low schooling level; hydrocele in 283 (16.4%), with higher frequency among participants over the age of 60 years, diabetics or individuals with previous histories of nonspecific urethritis; spermatoceles in 174 (10.1%), with greater prevalence among individuals over the age of 60 years or diabetics, and lower frequency among individuals who underwent vasectomy; unilateral testicular hypotrophy/atrophy in 167 (9.7%) and bilateral hypotrophy/atrophy in 93 (5.4%), both occurring more frequently in individuals over the age of 60 years; absence of palpable testicles due to cryptorchidism in 7 (0.4%); and epididymitis/orchitis in 5 (0.3%), with higher prevalence among diabetics. No cases of cancer were identified in this sample. CONCLUSIONS Scrotal diseases were highly prevalent in this population of Brazilian men.
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Affiliation(s)
- Frederico Ramalho Romero
- MD, MSc, PhD, Department of Surgery, Discipline of Urology, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil
| | | | | | - Fernando Cesar de Oliveira
- MD, MSc, Coordinator, Núcleo de Atenção à Saúde, Instituto Curitiba de Saúde (ICS), Curitiba, Paraná, Brazil
| | - Renato Tambara
- MD, MSc, PhD. Professor, Department of Surgery, Discipline of Urology, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil
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Llorente Abarca C, Hernández V, Díaz Goizueta FJ. [Overview of urethral strictures: etiology, epidemiology, physiopathology and classification. General principles of urethral repair]. ARCH ESP UROL 2014; 67:12-16. [PMID: 24531667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this article we present the causes of urethral stenosis in the adult male and review data about incidence. Regarding disease physiopathology we emphasize the inflammatory causes and, more specifically lichen sclerosus, as the clinical scenario that presents the greater difficulty for the management of urethral stenosis since we do not know its natural evolution. Regarding treatment of urethral stenosis we discuss the various options from excision and terminal-terminal anastomosis to oral mucosal graft augmentation urethroplasty, passing by two-step operations in more severe cases. Looking forward to the future a real gate opens with the application of tissue engineering to obtain oral mucosa.
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Neĭmark AI, Klepikova II, Aliev RT, Kondrat'eva IS. [Efficacy of combined physiotherapeutic methods in complex treatment of patients with chronic infectious urethroprostatitis]. Urologiia 2011:48-52. [PMID: 21815458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The study is aimed at investigation of efficacy and safety of a combined effect of laser therapy and vibromagnetotherapy in complex treatment of patients with chronic urethroprostatitis in the presence of sexually transmitted infection (STI). A total of 35 males aged 20 to 51 years entered the study. They were divided into 3 groups. Group 1 received standard basic therapy, group 2 received basic and laser therapy, group 3 - basic treatment and laser plus vibromagnetotherapy. Effectiveness of the treatment was assessed by the evidence obtained from clinical, bacteriological, device and functional examinations. The results of the treatments were evaluated after 2 weeks of the follow-up. It is shown that patients of groups 2 and 3 achieved more pronounced improvement of clinical and laboratory indices, parameters of basal blood flow. Thus, physiotherapy, added to antibacterial treatment, is safe and effective in the treatment of chronic urethroprostatitis and STI.
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Carrillo-Muñoz A, Onofre-Borja M, Borrego-Borrego R, Chávez-Mercado L, Navarro-Reynoso FP, Ibarra-Pérez C. Atypical intermediate-grade mediastinal carcinoid. Case presentation. CIR CIR 2011; 79:191-195. [PMID: 21631982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Approximately 25% of carcinoid tumors develop in the respiratory system. Neuroendocrine carcinoids represent ~5% of all mediastinal tumors and 1-5% of all intrathoracic neoplasms. They contain numerous neurosecretory granules that synthesize, store and release neurohumoral substances that can induce the carcinoid syndrome. CLINICAL CASE A 21-year-old male presented with a rapidly progressive paraneoplastic syndrome unleashed by an acute urethritis. Two left mediastinal masses were identified and resected. Postoperative evolution has been uneventful during the first year. CONCLUSIONS We emphasize the importance of early detection of primary and satellite lesions of these tumors including neurohumoral markers and PET/CT scans as in this case, as well as the participation of a multidisciplinary team.
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Affiliation(s)
- Araceli Carrillo-Muñoz
- Unidad 406, Servicio de Neumología y Cirugía de Tórax, Hospital General de México, México, D. F., Mexico.
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Aydoğdu O, Burgu B, Teber S, Altugan S, Gökçe I, Deda G, Soygür T. A challenging review of childhood incontinence: rare complications of dysfunctional elimination syndrome in an epileptic boy. Turk J Pediatr 2011; 53:100-103. [PMID: 21534350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A multidisciplinary approach is mandatory in defining the cause and directing the treatment of childhood urinary incontinence. Both pediatricians and pediatric urologists should carefully evaluate a child with incontinence for possible overlapping etiologies, before labeling him or her as a refractory case. We report an epileptic boy with dysfunctional elimination syndrome (DES) with associated rare complications of giggle incontinence and idiopathic urethritis, proving the need for a good voiding diary, patient history and structured symptom scores.
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Affiliation(s)
- Ozgü Aydoğdu
- Department of Pediatric Urology, Ankara University Faculty of Medicine, Ankara, Turkey
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Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician 2010; 81:873-878. [PMID: 20353145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria. A diagnosis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in first-void urine, or at least 10 white blood cells per high-power field in urine sediment. The primary pathogens associated with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Racial disparities in the prevalence of sexually transmitted infections persist in the United States, with rates of gonorrhea 40 times higher in black adolescent males than in white adolescent males. Recent studies have focused on identifying causes of nongonococcal urethritis and developing testing for atypical organisms, such as Mycoplasma genitalium and Ureaplasma species. Less common pathogens identified in patients with urethritis include Trichomonas species, adenovirus, and herpes simplex virus. History and examination findings can help distinguish urethritis from other urogenital syndromes, such as epididymitis, orchitis, and prostatitis. The goals of treatment include alleviating symptoms; preventing complications in the patient and his sexual partners; reducing the transmission of coinfections (particularly human immunodeficiency virus); identifying and treating the patient's contacts; and encouraging behavioral changes that will reduce the risk of recurrence. The combination of azithromycin or doxycycline plus ceftriaxone or cefixime is considered first-line empiric therapy in patients with urethritis. Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states. There is an association between urethritis and an increased human immunodeficiency virus concentration in semen.
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Affiliation(s)
- John R Brill
- University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA.
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de Carvalho JF, Ribeiro ACDM, de Moraes JCB, Gonçalves C, Goldenstein-Schainberg C, Bonfá E. Infliximab: a promising alternative therapy for refractory arthritis/urethritis/conjunctivitis triad. Isr Med Assoc J 2009; 11:511-513. [PMID: 19891245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Jozélio Freire de Carvalho
- Rheumatology Division, Faculty of Medicine, University of Sao Paulo, and Center for High Cost Medicines (CEDMAC), Sao Paulo, Brazil
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Sychev DA, Nizovtseva OA, Anikin GS, Burian EF, Butiakova IV, Ignat'ev IV, Serebrova SI, Guzhev DA, Dmitriev VA, Kukes VG. [A case of gastrointestinal hemorrage due to warfarin interaction with nalidixic acid resulting in massive blood loss]. Antibiot Khimioter 2009; 54:38-41. [PMID: 19711849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Koga T, Miyashita T, Watanabe T, Imadachi S, Osumi M, Sakito S, Kuga T, Eguchi K, Migita K. Reactive arthritis which occurred one year after acute chlamydial urethritis. Intern Med 2008; 47:663-6. [PMID: 18379157 DOI: 10.2169/internalmedicine.47.0581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 30-year-old Japanese man developed dactylitis with sausage-like fingers in addition to balanitis and stomatitis. One year prior to these symptoms, acute chlamydial urethritis had been successfully treated by levofloxacin. On admission, Chlamydia trachomatis DNA was not detected in the urine sediment by PCR method, however, he was diagnosed to have reactive arthritis based on the clinical findings of asymmetric dactylitis, circinate balanitis, stomatitis and positivity for HLA B27 antigen. He was treated with methotrexate and his arthritis improved. The past chlamydial infection may have been involved in the pathogenesis of reactive arthritis in this patient.
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Affiliation(s)
- Tomohiro Koga
- Department of General Internal Medicine, NHO National Nagasaki Medical Center, Omura, Japan
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Yin G, Liu YQ, Gao P, Wang XH. Male urethritis glandularis: case report. Chin Med J (Engl) 2007; 120:1460-1. [PMID: 17825180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- Gang Yin
- Department of Urology, Qilu Hospital, Shandong University, Jinan 250012, China.
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Mungadi IA, Ntia IO. Management of "watering-can" perineum. East Afr Med J 2007; 84:283-286. [PMID: 18254471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To review the management of watering-can perineum (WCP) in a Nigerian centre and to outline challenges of its management. DESIGN A retrospective review of cases of watering-can perineum over a seven-year period. SETTING Usmanu Danfodiyo University Teaching Hospital, Sokoto, a Nigerian tertiary health centre. SUBJECTS Forty one patients with the diagnosis of watering-can perineum managed from January 1997 to December, 2003. RESULTS There were 41 cases of watering-can perineum. The mean age at presentation was 46.0 years (range: 7 to 80). Characteristically, all the patients had long standing neglected urethral stricture. Eighteen (43.9%) presented with single active fistulae while eight (19.5%) had more than four (9.8%) active external openings. Fistulae were located in the perineum (58.5%), scrotum (41.6%), penis (14.6%), penoscrotal junction (9.8%) and thigh (49%). The strictures were post inflammatory in 73% of patients. Bulbar strictures constituted 63.4% of cases. At presentation, patients were in general planned for initial suprapubic cystostomy (SPC) followed by assessment of stricture and finally urethroplasty in six months. Patients who could not afford urethroplasty were offered dilatation. The immediate outcome of urethroplasty was satisfactory in 70.6% of patients. CONCLUSION Watering-can perineum was a common sequel of long standing neglected inflammatory urethral stricture. SPC followed by urethroplasty gave the best results. Prevention and adequate treatment of urethritis, prompt treatment of urethral stricture, and affordable and accessible reconstructive urologic service are recommended to reduce the incidence of WCP and suffering of the patients.
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Affiliation(s)
- I A Mungadi
- Urology Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, PMB 2370, Sokoto, Nigeria
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22
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Yang D, Dong ZH. [Integrated therapy of Reiter syndrome--a case report]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2007; 27:379. [PMID: 18972669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
AIM Trichomonas vaginalis may cause symptomatic or asymptomatic urethritis in men. There are few recent studies on the prevalence of T. vaginalis infection in Japanese men, and quantification of the number of cases of urethritis attributable to this pathogen has not been performed in Japan. The aim of this study was to determine the prevalence and morbidity of T. vaginalis infection in Japanese men. METHODS One hundred subjects with or without urethritis were examined for the presence of urethral T. vaginalis using culture swabs. RESULTS Urethral swabs from all subjects were negative for T. vaginalis. CONCLUSION These results indicate Japanese men, including those with urethritis, have a low incidence of urethral T. vaginalis infection or colonization. T. vaginalis appears to be an uncommon pathogen for male urethritis in Japan.
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Affiliation(s)
- Shin-Ichi Maeda
- Department of Urology, Toyota Memorial Hospital, Toyota, Japan
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Abstract
OBJECTIVES To describe how men narrate the process of bodily change as a trigger to presentation for a suspected sexually transmissible infection. METHODS The study was qualitative with 18 men presenting at a specialist sexual health centre in an urban setting. RESULTS All men gave narratives that included accounts of bodily changes prior to presentation. The nature, severity and persistence of those changes were unrelated to subsequent diagnosis. Men responded particularly to visual changes as cues to action. CONCLUSIONS The men exhibited limited skills in understanding the significance and the specifics of bodily change as they may relate to a sexually transmissible infection. While these men identified a broad range of changes as potentially indicative of a sexually transmissible infection, their ability to act on visceral rather than visual cues appears constrained in that they were less able to respond to the feel of their body than the way that it looked.
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Affiliation(s)
- M K Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.
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Zdrodowska-Stefanow B, Kłosowska WM, Ostaszewska-Puchalska I, Bułhak-Kozioł V, Kotowicz B. Mycoplasma hominis and Ureaplasma urealyticum infections in male urethritis and its complications. Adv Med Sci 2006; 51:254-7. [PMID: 17357320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE The aim of this study was to estimate the incidence of M. hominis and U. urealyticum infections among men with urethritis and its complications. MATERIAL AND METHODS Material for analysis were urethral swabs and EPS. Mycoplasma IST 2 kit was applied to diagnose mycoplasmal infections. All patients were additionaly tested for C. trachomatis, C. albicans and T. vaginalis and Gram stain specimens were obtained to identify the presence of PMN. RESULTS U. urealyticum was detected in 57/390 (14.6%), and M. hominis in 4/390 (1%) men. Exclusive U. urealyticum infection was found in 45 (11.5%) men, and only 2 patients had exclusive M. hominis infection. U. urealyticum infection the most frequently coexisted with C. trachomatis--5 (8.8%), next with C. albicans--4 (7%) and M. hominis--2 (3.5%) infections. Mycoplasmal infections were the most frequently found in patients aged 30 to 39 (35.1%) diagnosed with epididymitis (29.2%). The most commonly reported symptom was dysuria. CONCLUSIONS U. urealyticum is the common pathogen among men with urethritis and its complications. The most common symptoms in U urealyticum patients were: dysuria, hypogastric pains and urethrorrhoea, however, clinical symptoms are not frequently observed.
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Dolapçi I, Tekeli A, Koyuncu E, Sain Guven G, Unal S. [Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in human immunodeficiency virus positive men without urethritis symptoms]. MIKROBIYOL BUL 2006; 40:63-7. [PMID: 16775958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
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.
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Affiliation(s)
- Iştar Dolapçi
- Ankara Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Ankara
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Pontari MA, McNaughton-Collins M, O'leary MP, Calhoun EA, Jang T, Kusek JW, Landis JR, Knauss J, Litwin MS. A case-control study of risk factors in men with chronic pelvic pain syndrome. BJU Int 2005; 96:559-65. [PMID: 16104910 DOI: 10.1111/j.1464-410x.2005.05684.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Michel A Pontari
- Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Ducroix-Roubertou S, Genet C, Rogez JP, Weinbreck P, Denes E. Arthrite réactionnelle a Clostridium difficile. Med Mal Infect 2005; 35:419-21. [PMID: 15982847 DOI: 10.1016/j.medmal.2005.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- S Ducroix-Roubertou
- Service des maladies infectieuses et tropicales, CHU Dupuytren, 2, 87042 Limoges cedex, France
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Argüelles Salido E, Rodríguez Corchero J, López García MA, Pérez Espejo MP, Campoy Martínez P, Pena Outeiriño JM. [Cystic ureteritis in a kidney transplantation candidate]. Actas Urol Esp 2005; 29:226-9. [PMID: 15881924 DOI: 10.1016/s0210-4806(05)73228-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Morey AF. Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans). J Urol 2005; 173:2032-3. [PMID: 15879815 DOI: 10.1016/s0022-5347(05)60212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Guerra-Infante FM, Tapia-Yáñez JR, López-Hurtado M, Flores-Medina S, Díaz-García FJ. [Chlamydia trachomatis infection in men and its association with gynecologic alterations in their sexual partners]. Rev Invest Clin 2005; 57:406-14. [PMID: 16187700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
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.
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MESH Headings
- Abortion, Spontaneous/epidemiology
- Abortion, Spontaneous/etiology
- Adult
- Candidiasis, Vulvovaginal/epidemiology
- Cervix Uteri/microbiology
- Chlamydia Infections/complications
- Chlamydia Infections/epidemiology
- Chlamydia trachomatis/isolation & purification
- Comorbidity
- Female
- Humans
- Infertility, Female/epidemiology
- Infertility, Female/etiology
- Infertility, Male/epidemiology
- Infertility, Male/etiology
- Male
- Mexico/epidemiology
- Middle Aged
- Mycoplasma/isolation & purification
- Mycoplasma Infections/complications
- Mycoplasma Infections/epidemiology
- Occupations
- Pelvic Inflammatory Disease/epidemiology
- Pelvic Inflammatory Disease/etiology
- Pregnancy
- Pregnancy, Ectopic/epidemiology
- Pregnancy, Ectopic/etiology
- Prevalence
- Prospective Studies
- Salpingitis/epidemiology
- Salpingitis/etiology
- Semen/microbiology
- Sexual Partners
- Tissue Adhesions/epidemiology
- Tissue Adhesions/etiology
- Urethra/microbiology
- Urethritis/complications
- Urethritis/epidemiology
- Urethritis/microbiology
- Vaginosis, Bacterial/epidemiology
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Rha KH, Jarrett TW, Bove P, Ong AM, Pinto PA, Aydin H, Klein AS, Molmenti EP. Urethral stricture after pancreas-kidney transplantation due to polypoid urethritis. Urology 2004; 64:1030. [PMID: 15533506 DOI: 10.1016/j.urology.2004.06.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Accepted: 06/23/2004] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Koon H Rha
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
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.
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Affiliation(s)
- Yuk-Yuen Max Leung
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642-8668, USA
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Kaydos-Daniels SC, Miller WC, Hoffman I, Price MA, Martinson F, Chilongozi D, Namakwha D, Gama S, Phakati S, Cohen MS, Hobbs MM. The Use of Specimens from Various Genitourinary Sites in Men, to DetectTrichomonas vaginalisInfection. J Infect Dis 2004; 189:1926-31. [PMID: 15122531 DOI: 10.1086/386309] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 11/17/2003] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- S Cornelia Kaydos-Daniels
- Department of Epidemiology, University of North Carolina School of Public Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Wound, Ostomy, and Continence Nurses Society. Identifying and treating reversible causes of urinary incontinence. Ostomy Wound Manage 2003; 49:28-33. [PMID: 14712008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
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.
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McClean H. Urinary tract infection in patients with acute non-gonococcal urethritis -- 1. Int J STD AIDS 2003; 14:714; author reply 714-5. [PMID: 14596778 DOI: 10.1258/095646203322388009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Horner PJ, Taylor-Robinson D. Screening for non-gonococcal urethritis. Int J STD AIDS 2003; 14:715. [PMID: 14596780 DOI: 10.1258/095646203322407890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Taylor S, Sadiq ST, Weller I, Kaye S, Workman J, Cane PA, Bennett J, Copas AJ, Drake SM, Pillay D. Drug-resistant HIV-1 in the semen of men receiving antiretroviral therapy with acute sexually transmitted infections. Antivir Ther 2003; 8:479-83. [PMID: 14640396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
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.
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Affiliation(s)
- Stephen Taylor
- HPA Antiviral Susceptibility Reference Unit, Division of Immunity and Infection, University of Birmingham, UK.
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39
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Abstract
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.
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Affiliation(s)
- Brenda Jo Salinardi
- Department of Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana 70803-8410, USA
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40
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Abstract
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.
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Affiliation(s)
- Kate O Anteyi
- Department of Family Medicine, Jos University Teaching Hospital, Jos, Nigeria
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41
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Stav K, Zisman A, Leibovici D, Sandbank J, Lindner A. [Acute epididymitis]. Harefuah 2003; 142:451-5, 484. [PMID: 12858832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
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.
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Price MA, Zimba D, Hoffman IF, Kaydos-Daniels SC, Miller WC, Martinson F, Chilongozi D, Kip E, Msowoya E, Hobbs MM, Kazembe PN, Cohen MS. Addition of treatment for trichomoniasis to syndromic management of urethritis in Malawi: a randomized clinical trial. Sex Transm Dis 2003; 30:516-22. [PMID: 12782954 DOI: 10.1097/00007435-200306000-00009] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Matthew A Price
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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43
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Siebels M. [Urogenital infections in the male and the desire to father a child]. MMW Fortschr Med 2003; 145:37-9. [PMID: 12866275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
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.
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Affiliation(s)
- M Siebels
- Klinik und Poliklinik für Urologie, Klinikum Grosshadern, LMU München.
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44
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Wendel KA, Erbelding EJ, Gaydos CA, Rompalo AM. Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic. Sex Transm Infect 2003; 79:151-3. [PMID: 12690140 PMCID: PMC1744621 DOI: 10.1136/sti.79.2.151] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- K A Wendel
- Division of Infectious Diseases, Oklahoma University Health Science Center, Oklahoma, USA
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Komolafe AJ, Cornford PA, Fordham MVP, Timmins DJ. Periurethral abscess complicating male gonococcal urethritis treated by surgical incision and drainage. Int J STD AIDS 2002; 13:857-8. [PMID: 12537744 DOI: 10.1258/095646202321020189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gonococcal urethritis in a heterosexual male complicated by periurethral abscess and its treatment with antibiotics and surgical drainage is presented.
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Affiliation(s)
- A J Komolafe
- Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Abstract
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.
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Affiliation(s)
- V Harindra
- Department of GU Medicine, St Mary's Hospital, Milton Road, Portsmouth PO3 6AQ, UK.
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47
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Mena L, Wang X, Mroczkowski TF, Martin DH. Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans. Clin Infect Dis 2002; 35:1167-73. [PMID: 12410476 DOI: 10.1086/343829] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2002] [Revised: 07/16/2002] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Leandro Mena
- Louisiana State University Health Sciences Center and the Delgado Clinic, New Orleans Health Department, New Orleans, Louisiana 70112, USA
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48
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Deguchi T, Yoshida T, Yokoi S, Ito M, Tamaki M, Ishiko H, Maeda SI. Longitudinal quantitative detection by real-time PCR of Mycoplasma genitalium in first-pass urine of men with recurrent nongonococcal urethritis. J Clin Microbiol 2002; 40:3854-6. [PMID: 12354899 PMCID: PMC130874 DOI: 10.1128/jcm.40.10.3854-3856.2002] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Takashi Deguchi
- Department of Urology, Gifu University School of Medicine, 40 Tsukasa-Machi, Gifu City, Gifu 500-8705, Japan.
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49
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Meng AQ, Zheng SB, Chen WS, Chen T, Nie J. [Multifactorial analysis of the risk factors of chronic prostatitis]. Di Yi Jun Yi Da Xue Xue Bao 2002; 22:846-8. [PMID: 12297453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
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.
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Affiliation(s)
- An-qi Meng
- Department of Urinary Surgery, Nanfang Hospital, First Military Medical University, Guangzhou 510515, China.
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50
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Ballard RC, Fehler HG, Htun Y, Radebe F, Jensen JS, Taylor-Robinson D. Coexistence of urethritis with genital ulcer disease in South Africa: influence on provision of syndromic management. Sex Transm Infect 2002; 78:274-7. [PMID: 12181466 PMCID: PMC1744505 DOI: 10.1136/sti.78.4.274] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- R C Ballard
- Reference Centre for Sexually Transmitted Diseases, Department of Clinical Microbiology and Infectious Diseases, University of the Witswatersrand and South African Institute for Medical Research, Johannesburg, South Africa
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