Case Of Urethritis Research Articles

Male Urethritis Caused by Trichomonas vaginalis

Trichomoniasis is one of the most common sexually transmitted infections worldwide. In women, Trichomonas vaginalis infection may present with vaginitis, cervicitis, or pelvic inflammatory disease, while in men it is mainly asymptomatic or causes mild and transient symptoms of urethritis, epididymitis, or prostatitis. In the past, little importance had been given to the impact of T. vaginalis infection on men’s health, since it was believed to be a self-limited condition without sequelae. However, there is growing evidence it is associated with more serious disorders in both men and women and efforts to diagnose and treat this parasitic infection have increased. Recent advances in testing for sexually transmitted diseases using multiplex molecular assays have increased diagnostic opportunities for T. vaginalis infection, especially in men, as detection of the parasite by traditional methods is much more challenging. We describe an unusual case of male urethritis caused by T. vaginalis observed in our consultation of Sexually Transmitted Infections.

A Case of Urethritis Caused by Cefuroxime-Resistant Neisseria gonorrhoeae

A Case of Urethritis Caused by Cefuroxime-Resistant Neisseria gonorrhoeae

A Rare Case of Pantoea Agglomerans Causing Haematuria and Urethritis in a Patient with Acute Myeloid Leukaemia (AML)

A Rare Case of Pantoea Agglomerans Causing Haematuria and Urethritis in a Patient with Acute Myeloid Leukaemia (AML)

A case of gonococcal urethritis coexisting with genital warts in a human immunodeficiency virus-negative man

Gonorrhoea is an important sexually transmitted infection in both males and females which could consequently lead to different complications affecting both sexes. Despite availability of antimicrobials to treat the disease, transmission of the agent Neisseria gonorrheae (NG) is still prevalent. The ability of Neisseria gonorrhoeae to rapidly develop resistance to routinely used antimicrobials has made it a global public health challenge. We present a 26 year old single, male, professional who presented to our facility with a five weeks history of urethral discharge and painful micturition. He was initially managed at a private hospital with ciprofloxacin for 20 days with no improvement in symptoms. The patient then presented at our facility where he was diagnosed and managed for Neisseria gonorrhoeae urethritis after laboratory investigations. Susceptibility tests revealed penicillin and ciprofloxacin resistant NG. However, molecular characterization was not done as the stored isolate could not be reactivated for further analysis. We advocate for a review of the syndromic management of STIs in the country and a national surveillance on NG susceptibility profile. There is an urgent need to upgrade laboratory facilities to perform both cultural and molecular identification for sexually transmitted infections.

Corneal Perforation in a Patient with History of Unidentified Urethritis

Purpose: A 40-year-old male with a severe corneal melting, peripheral infiltration and nasal perforation in the right eye after a not affiliated case of urethritis is reported. Methods: Retrospective case report. Results: A sample of conjunctival discharge was sent to culture, in where Gram-diplococci grew and therefore a systemic antibiotic treatment was initiated. Given the severity of the clinic, a penetrating keratoplasty is conducted two days after admission and the corneal button was sent to microbiology, which polymerase chain reaction was positive for Neisseria gonorrhoeae. Conclusion: Despite it being a rare process in an adult, keratitis caused by Neisseria gonorrhoeae should be suspected in all sexually active patients with conjunctivitis and with a clinic genitourinary medical history. The systemic therapy showed a superior effectiveness in combination with topical therapy than the last one on its own.

Not a typical urinary tract infection: A case of urethritis due to an exogenous oil instillation in penile urethra of an infant

However, there are no reports of the exogenous oil instillation in penile urethra in infants or children. We report the first case of sterile urethritis caused as a result of cultural practicing of blowing oil into urethra of an infant.An 11-month-old male child was taken to the outpatient department of a tertiary care center of Central India with the complaints of increased frequency and excessive crying during micturition. There was no history of passing of loose stools, fever, and previous history of urinary tract infection or edema. There was no external gross deformity of the penis. Investigations revealed total leucocyte count of 5600/cumm (polymorphs 38%, lymphocytes 54%, monocytes 6%, and eosinophils 2%). Serum urea, creatinine, and electrolytes were within the normal limits. Urinalysis was also within normal limits except for the 40-50 white blood cells/high power field. Ultrasonogarphy of the abdomen was within normal limits. On detailed history taking from the parents it was admitted that mustard oil was instilled in the urethra of the infant. It was further admitted by the mother that this a common practice in their tribe to instill oil in urethra and blow it with mouth to relieve physiological phimosis in children. A diagnosis of sterile urethritis was made, and the parents were counseled to avoid such harmful customs. Patient was given a short course of paracetamol and prednisolone (1 mg/kg/day) for 5 days. A repeat urinalysis was done after a week which revealed no abnormality.Thus, in the present case, the urethritis was caused by the exogenous instillation of mustard oil and presented as sterile pyuria that is a common sign of intraurethral foreign body induced disorder.

Ciprofloxacin‐resistant Corynebacterium glucuronolyticum as a cause of male urethritis syndrome

Introduction: Corynebacterium glucuronolyticum is a non‐lipophilic coryneform species and a rare isolate from male patients with genitourinary tract infections. This organism is typically associated with urethritis or prostatitis syndrome, although it can also be isolated from other sites. Case Presentation: We describe a case of urethritis in a 24‐year‐old Croatian male caused by a strain of C. glucuronolyticum showing resistance to ciprofloxacin in an agar dilution susceptibility test procedure. The same drug was used as an empirical treatment before microbiological evaluation was conducted. Upon identification of the organism, the patient was successfully treated with doxycycline, which resulted in complete regression of symptoms and lack of growth of the organism in culture. Conclusion: Although uncommon detection of this organism hinders research efforts, C. glucuronolyticum should always be regarded as a possible cause of urogenital infections in male patients. In addition, antibiotic susceptibility testing should be performed due to possible resistance.

A Case of Urethritis Caused by Human Adenovirus Type 56

A Case of Urethritis Caused by Human Adenovirus Type 56

Urethritis due to Corynebacterium glucuronolyticum

We describe a case of urethritis in a young man caused by Corynebacterium glucuronolyticum. This bacterium is a synonym of Corynebacterium seminale, a known agent of non-gonococcal urethritis, that cannot be regarded as commensal flora in the urogenital region when is isolated in a symptomatic clinical context. Accuracy in diagnosis and correct treatment is important for avoiding probable complications, for example prostatitis. Bacterial isolation is convenient, and an antimicrobial susceptibility test should be conducted to discover antimicrobial resistance. In our case the patient was successfully treated with fluoroquinolones and was symptom-free in 2weeks.

A Case of Urethritis Due to Streptococcus pneumoniae

Streptococcus pneumoniae is a primary pathogen of many human infections such as pneumonia otitis media sinusitis and bacterial meningitides. It is a very rare pathogen of genital infections among women and only one case of urethritis in a male has been reported to date which occurred after an orogenital contact. This article presents a case of pneumococcal urethritis which was probably transmitted during sexual intercourse as a result of vaginal colonization with S. pneumoniae. In March 2007 a 43-year-old man who had multiple sex partners was admitted to our infectious disease clinic. The major complaints of the patient were a 1-month history of dysuria and a light brown semitranslucent urethral discharge after urinating. These symptoms were increased when he had an erection. During the first examination no significant findings were recorded. Biochemical and hematologic tests were normal. Immunologic tests were negative for human immunodeficiency virus and syphilis. A bacterial culture and Gram stain of the draining exudate were performed. Several lancet-shaped Gram-positive diplococci and 500 to 600 neutrophils/mL were observed in the Gram stain of the urethral fluid. After an overnight incubation mucoid a-hemolytic streptococcal colonies grew in blood agar. The isolate was positive in the bile solubility test and susceptible to optochin penicillin azithromycin and cotrimoxazole and intermediately resistant to ciprofloxacin in a disk diffusion antibiogram. The BD BBL Crystal test (Becton-Dickinson) confirmed the pathogen as S. pneumoniae. The patient was successfully treated with oral amoxicillin (2 x 1 g) for 1 week. (excerpt)

Orogenital transmission of Neisseria meningitidis serogroup C confirmed by genotyping techniques

Urethritis caused by Neisseria meningitidis in heterosexual patients is presumed to occur via orogenital contact, but confirmation has not been possible in most cases. Presented here is a case of urethritis caused by N. meningitidis, serogroup C, and the isolation of the same microorganism from the nasopharynx and endocervix of the patient's sexual partner. The similarity of the urethral and nasopharyngeal isolates' electrophoretic patterns, obtained using pulsed-field gel electrophoresis, proves the infection was transmitted via orogenital contact.

A case of urethritis due to Ureaplasma urealyticum associated with L�fgren?s syndrome

Lofgren’s syndrome is characterized by a clinical triad of associated erythema nodosum, bilateral hilar lymphadenopathy and arthritis. This syndrome has usually been considered a specific form of sarcoidosis. We recently observed a case of characteristic Lofgren’s syndrome in a patient who presented simultaneously with urethritis due to Ureaplasma urealyticum. To the best of our knowledge, this report represents the first case of Lofgren’s syndrome in association with U. urealyticum. A 32-year-old man, with no notable medical history, was admitted to hospital with a 10-day history of periarticular ankle inflammation associated with fever of 38°C and dysuria without urethral discharge of 2 days’ duration. On physical examination, the patient appeared well. His temperature was 37.7°C, pulse was 80 beats per minute, blood pressure was 130/80 mmHg and respiratory rate was 16 breaths per minute. No lymphadenopathy, parotid enlargement or anterior uveitis were noted. Lung, heart, abdomen and neurologic examinations were normal. Bilateral periarticular ankle inflammation (swelling of both ankles with acute inflammatory signs and preserved articular motion) and erythematous nodules and plaques involving the anterior part of the calf were observed on both legs. The hematocrit, leukocyte and platelet values were normal. The erythrocyte sedimentation rate was 88 mm/h. The aspartate aminotransferase (104 U/l), alanine aminotransferase (187 U/l) and alkaline phosphatase (373 U/l) levels were elevated. The levels of urea, creatinine, calcium, protein electrophoresis and all other routine blood chemical values were normal. Urinalysis was positive for leukocyte esterase, and multiple leukocytes were seen on microscopic examination of urine. Urine culture was negative. A Gram stain of the urethral smear showed polymorphonuclear neutrophils, but no typical intracellular gram-negative diplococci, while tissue culture grew U. urealyticum. A blood culture and a tuberculin skin test with 5 units of PPD were negative. Viral and bacterial serologic studies were negative for Brucella spp., Salmonella spp., Yersinia enterocolitica, hepatitis B surface antigen, hepatitis C, syphilis and HIV. Autoantibody screening was also negative for nuclear and DNA antibodies. Tests for rheumatoid factor and HLA-B27 antigen were negative, and complement levels were normal. The angiotensin-converting enzyme level was 46.8 U/l (normal range 7.8–51.6). A chest radiograph revealed bilateral hilar adenopathy without parenchymal infiltration. A thoracic computed tomography scan showed multiple mediastinal lymph nodes up to 1 cm and bilateral hilar lymphadenopathy. A gallium-67 lung scan showed a pattern of uptake enlarged nodes in the paratracheal and mediastinal regions. Pulmonary function tests showed evidence of minimal airflow limitation. A biopsy of skin nodules was indicative of erythema nodosum. The patient was treated successfully with doxycycline, 100 mg twice daily for 10 days, and both cutaneous and articular manifestations healed completely within 3 weeks. At 1-year follow-up the patient remained without symptoms, and repeat angiotensin-converting enzyme measurement, chest radiograph and thoracic computed tomography were normal. U. urealyticum is probably the most frequent cause of non-chlamydial non-gonococcal urethritis, although its role as a pathogen has been controversial. It clearly causes symptomatic urethral infection, but it has also been found to colonize as many as 60% of asymptomatic men attending sexually transmitted disease clinics [1]. With regard to extragenital infections, sexually acquired reacM. Lopez-Gomez (*) . M. A. Lopez-Ruz . J. Jimenez-Alonso Section of Infectious Diseases, Service of Internal Medicine, Hospital Universitario “Virgen de las Nieves”, Avenida Fuerzas Armadas 2, 18004 Granada, Spain e-mail: mlopezg@fundacionhvn.org Tel.: +34-95-8157687 Fax: +34-95-8020494

SEXUALLY TRANSMITTED DISEASES IN AND AROUND GUWAHATI (ASSAM).

Dear Editor, The prevalence of sexually transmitted diseases (STDs) in any community is an index of socioeconomic status, moral outlook and practice, presence of efficient machinery for early diagnosis, availability of treatment facilities and mass awareness of preventive measures. There are few regional studies available from India, the pattern of STDs in which has varied widely [1, 2, 3, 4, 5, 6]. Herein we present what we believe to be first reported study on STD pattern in and around Guwahati (Assam). Records of 405 fresh STD patients admitted at Military Hospital Guwahati from Jan 1995 to Dec 1999 were analysed. Only those STD patients with source of sexual contact in and around Guwahati area were included in our study. Diagnosis was based on history, clinical examination and relevant laboratory investigations. In the present study majority of the study subjects were in the age group of 19-35 years (91%). This is in accordance with most of the studies as sexual activity in this age group is at peak [1, 2, 3, 4, 5, 6], Dimapur, Silchar, Shillong and Guwahati were the main pockets of infection (42%). In the Armed Forces soldiers very often stay away from their families for a long time and this might be an important factor for high incidence of STDs among married persons in the present study. The incidence of chancroid varies from 5-38.9% in different reports [1, 2, 3, 4, 5, 6]. lt was the commonest STD (31.4%) in present study. This is in accordance with most of the reports but in contrast to reports from Port Blair [1], Chandigarh [2] and Pondicherry [3]. We feel it could be due to treatment of genital sores by general practitioners with pernicillin and when these cases do not respond to treatment they report to STD centers. Condyloma acuminata was the second common STD with incidence amounting to 20.74%. This is in contrast to most of the studies but in agreement to report from Chandigarh [2]. Non-gonococcal urethritis (NGU) was the third common STD amounting to 15.6%. This is in contrast to almost all studies except the report from Kurnool [4]. In the industrialized countries. NGU is more common than gonococcal urethritis. C trachomatis can be isolated from 20-50% of men with NGU and from 15-30% with gonococcal urethritis. The reason for high incidence of NGU in our study is probably because of the fact that private practitioners generally treat a case of urethritis as gonococcal urethritis by single dose of drug of quinolones or cephalosporins and when the discharge persists due to concomitant C trachomatis infection they report to the STD clinic. Lymphogranuloma venereum (LGV) was the fourth common STD (11.1%). On comparing our data we found the incidence was almost equal to that reported from Pondicherry [3] and Jammu & Kashmir [5] but much higher than those reported by others. Syphilis was the next common STD (6.91%) and early syphilis constituted the bulk. Early diagnosis, effective treatment and good follow up system are probably responsible for low incidence of late syphilis in the Armed Forces. Surprisingly the incidence of gonorrhoea in the present study was very low (4.93%). This is in contrast to most of the studies except the report from Chandigarh [2]. This declining trend could be attributed to the fact that most of the gonorrhoea cases are treated at the primary level with newer effective single dose regimen. TABLE 1 STDs in study population The incidence of psychosexual problem was seen in 4.7% of cases. Majority of the cases were of ‘dhat syndrome’. Only two patients presented with venereophobia. Herpes genitalis was seen in only 1.23%, which is in contrast to most of the reports. This low incidence may be due to under diagnosis of H genitalis due to lack of sophisticated laboratory facilities. Though the incidence of donovanosis in our country varies from 3.5-7.7% with highest from Pondicherry [3], interestingly not even a single case was seen in our study. To conclude chancroid appears to be the commonest STD in and around Guwahati followed by condyloma acuminata, NGU, LGV and syphilis. Moreover as the incidence of various STDs varies from place to place and from time to time it is advisable to have more and more such regional studies which will help in identifying the pattern of STDs all over the country and in turn facilitating formulation and implementation of national STD control programme more effectively.

Urethritis caused by Neissena meningitidis: A case report

Isolation of N. meningitidis from the male urethra has become more common in recent years and this has been attributed to sexual activities and changes in social attitudes. We describe a further case of acute urethritis caused by transmission of N. meningitidis occurring after a single sexual contact (fellatio) in a heterosexual man. The urethritis was initially diagnosed as being caused by N. gonorrhoeae on a presumptive basis, then attributed to N. meningitidis serogroup Y. This case shows the need of accurate diagnostic procedures in all cases resembling gonococcal urethritis.

An unusual cause of urethritis

Summary A case of acute urethritis, due to Neisseria flava is reported. The Gramstained smear was not typical of a gonococcal infection. The existence of a chronic genital infection might have favored the occurrence of this urethritis.

Maltose-negative Neisseria meningitidis isolated from a case of male urethritis

A maltose-negative strain of Neisseria meningitidis isolated from a male patient with urethritis was initially identified as a gonococcus on the basis of carbohydrate utilization tests. Additional investigations initiated because of atypical colony morphology and a negative superoxol reaction showed the isolate to be a meningococcus with defective maltose-phosphorylating capacity.

Gonococcal tysonitis

A case of gonococcal urethritis with bilateral tysonitis is discussed. The patient was treated successfully with oral tetracycline 500 mg 6 hourly for 10 days, with a complete resolution.

Isolation of a stable cell wall-defective form of Neisseria gonorrhoeae from a case of untreated gonococcal urethritis.

A cell wall-defective form of Neisseria gonorrhoeae from an exudate of an untreated patient with gonococcal urethritis was isolated on medium containing 7% polyvinylpyrrolidone. Initial attempts to grow the organism by standard microbiological methods had failed. This isolate was incapable of reversion to a normal gonococcus even after numerous subcultures and appeared to be a stable cell wall-defective form.

Double-blind trial of amoxycillin and ampicillin plus probenecid in the treatment of gonorrhoea in men.

In a double-blind study amoxycillin 3 g or ampicillin 3 g plus probenecid 1 g were randomly administered as a single oral dose to 160 men with uncomplicated gonococcal urethritis. The cure rate for each drug group was 98.6%. Tolerance to oral medication was good and no evidence of allergy or toxicity to either drug was shown. No case of post-gonococcal urethritis was observed over a 14-day follow-up period. Thus, both drug regimens proved very effective in treating uncomplicated gonococcal urethritis in men.

Genital occurrence of oral microbiota

Recent studies indicate that tonsillar gonococcal infection or colonization is fairly common. Carriage rates of about 8% have been found. These studies also indicate that oro-genital contacts are common. Since very little is known about the amount of oral microbiota transmitted to the genitals, we have studied the occurrence of oral streptococci and Neisseria species in urethra and cervix. Among 128 patients attending an STD-clinic we found 10 carriers of oral streptococci, one Streptococcus mitior, four Streptococcus sanguis, one Streptococcus mutans and four Streptococcus salivarius and case of urethritis due to Neisseria menigitidis. Seventy-three of the patients had recently had their genitals exposed to the oral flora of their partners. Despite the heavy contamination with oral microbiota that can be assumed to occur in these cases, there seems to be no colonization of the genitals with oral microbiota.