Disease In Young Men Research Articles

A Young Man With Hereditary Motor And Sensory Neuropathy: A Rare Genetic Association

Hereditary motor and sensory neuropathies with early onset are uncommon conditions that include Dejerine-Sottas neuropathy, which begins in infancy, and congenital hypomyelinating neuropathy, which manifests in the early postnatal period. However, these two historically defined disease entities are only small parts of the clinical spectrum. It is well recognized that very early onset hereditary neuropathies are frequently caused by de novo dominant mutations in PMP22, MPZ, and EGR2. In addition, mutations in several other dominant and recessive genes for Charcot-Marie-Tooth disease may lead to similar phenotypes. A 20-year-old boy had complaints of weakness of both lower limbs for 1 year, followed by wasting and foot drop, which subsequently involved the upper limbs. Nerve conduction velocity and electromyography of both lower limbs revealed demyelinating sensory motor polyneuropathy. Histological examination of the sural nerve revealed a nerve trunk with perineural soft tissue, with the nerve bundles being irregular and separated by fibrous tissue bands. The later reveals small perivascular infiltration of chronic inflammatory cells, and no granuloma or AFB is seen. The genetic test of whole exome screening for heriditatory neuropathy showed pathogenic (PM2, PVS, PP5) with a gene impact of (NF2: c.363+1G>T), which is a rare entity in our case study to consider the diagnosis despite negative family history. We highlight this rare disease in young man with a high index of clinical suspicion for its diagnosis. Bangladesh J Medicine 2024; 35: 101-105

Seasonal and sex-related variation in vitamin D status and its association with other biochemical markers in young individuals: A cross-sectional study.

While several studies have investigated the association between vitamin D deficiency and biochemical parameters, the results are still inconsistent and mostly overlook seasonal variations. This study explored the relationships between 25-hydroxy-vitamin D (25(OH)D) concentrations, biochemical markers, and seasonal variation among young males and females. A cross-sectional study was conducted among 203 individuals aged 18-24 years of both sexes residing in Brasilia, Brazil (latitude: 15°S). Sociodemographic variables, season of blood collection, and serum levels of 25(OH)D, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin (HbA1c), glucose, insulin, hs-CRP, parathyroid hormone, ionized calcium, and alkaline phosphatase were included. Descriptive statistics and differences among groups, correlations, and linear regression tests were performed. The mean age of the participants was 21.17±1.7 years, and the mean serum 25(OH)D level was 25.76±7.0 ng/mL. Of the participants, 50.7% had vitamin D insufficiency (20 to 29.9 ng/mL), and 23.2% were vitamin D deficient (≤20 ng/mL). Vitamin D deficiency was higher in the spring (53.2%) and among females (29.5%). In young men with vitamin D insufficiency/deficiency (≤29.9 ng/mL) (n = 49), 25(OH)D levels were inversely correlated with HOMA-β (r = -0.234, p = 0.032) and triglyceride (r = -0.415, p = 0.003) levels. However, there were no significant correlations between 25(OH)D concentrations and biochemical markers among women with insufficient and deficient vitamin D levels. This study found a high prevalence of vitamin D insufficiency/deficiency among young individuals living in Brasília, Brazil, particularly women and during the spring season. Our findings suggest that lower 25(OH)D levels (≤29.9 ng/mL) may be associated with insulin resistance and an increased risk of cardiovascular disease in young men studied. However, further studies with larger representative samples are needed to explore the mechanisms underlying the association between vitamin D and biochemical parameters.

(079) Early Results of Universal Cardiovascular Disease Risk Assessment in Young Men Presenting with ED and/or Low T

Abstract Introduction Erectile dysfunction (ED) and low testosterone (low T) are common men’s health issues, affecting ~40 million and 4 million men in the United States, respectively. 1 Typical risk factors for early ED include cardiometabolic risk factors that may be associated with increased risk for premature CVD. Low T levels have also been strongly implicated as an independent risk factor for CVD development and progression. 2 Whether early screening for atherosclerotic disease in younger men with such conditions may identify potentially high-risk individuals for initiation of preventive therapies is unknown. Objective To assess the presence and burden of early atherosclerotic disease in young men with ED and/or low testosterone levels Methods Our study is a prospective, longitudinal assessment of cardiovascular risk for all men aged 18-55 presenting to a high-volume men’s health center with ED and/or hypogonadal complaints and serum TT <350ng/dL. Exclusion criteria included prior TRT, prior CVD history, or a history of having seen a cardiologist at any point in the past. All men meeting these basic criteria were automatically referred to a preventative cardiologist for cardiac risk assessment. Prior to cardiology evaluation, all patients had assessment of IIEF and AUA questionnaire scores, STOPBANG scores for obstructive sleep apnea (OSA) risk prediction, and serum hormone profile (TT, E2, PRL, FSH, LH). CVD risk assessment included a serum lipid profile, EKG, Coronary Artery Calcium (CAC) score as assessed by CT, carotid Doppler US, and other studies (e.g. echocardiography) as indicated. Results Of the first 35 men sent for CVD risk assessment, 15 (43%) patients with a mean age of 40 years (range 23-50) had completed all aspects of CVD risk assessment. Overall, 7/15 (40%) of these young men had a CAC >0, including 2/7 (28%) of men 40 years. Three of the men >40 years (38%) had very high CAC (87 to 138). Carotid US showed clinically significant plaque in 2/15 of the men (13%). Conclusions Our initial data suggest that undiagnosed early atherosclerotic disease is not uncommon in young men with ED and/or low T. Typically men 40 years may have a non-zero CAC slightly more often, the finding of increased CVD risk in 63% of such men in our cohort is much higher than the general male population. The presence of severe atherosclerotic disease with high CAC scores in nearly 40% of our cohort aged 40-50 is even more worrisome. While these are early results, they seem to point to a noteworthy increased risk of CVD based on CAC scoring in young men presenting with ED/low T issues. As our prospective data collection continues, we anticipate that information gathered will strengthen the tie between premature atherosclerotic disease and young men with ED/low T. We hope that such data, generated with a simple, universal referral pathway, may help serve as a basis for future guideline-mandated cardiology evaluation in this potentially at-risk patient population. Disclosure No

Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) : Arare urological emergency

Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) is arare, semi-acute disease in young, healthy men. In addition to an anatomical predisposition, perineal microtrauma is stated as the main risk factor. Acase report and the results of a literature search with descriptive-statistical processing of 57peer-reviewed publications are presented. Atherapy concept was drawn up for clinical practice. Our patient was treated conservatively and was consistent with the 87cases which have been published since 1976. IPTCC is adisease of young men (33.2years, range 18-70), which is associated with pain and perineal swelling in 88%. Sonography and contrast-enhanced magnetic resonance imaging (MRI) proved to be the diagnostic modality of choice, demonstrating the thrombus and in 89% aconnective tissue membrane inside the corpus cavernosum. Treatment included antithrombotic and analgesic (n = 54, 62.1%), surgical (n = 20, 23%), analgesic (n = 8, 9.2%), via injection (n = 2, 2.3%), as well as radiological interventional (n = 1, 1.1%) options. In 12cases, erectile dysfunction, mostly temporary, which required phosphodiesterase (PDE)-5 therapy developed. Recurrence and prolonged courses were rare. IPTCC is arare disease in young men. Conservative therapy with antithrombotic and analgesic treatment has shown good chances of full recovery. If relapse occurs or the patient refuses antithrombotic treatment, operative/alternative therapy management should be considered.

Хронический простатит и мужское бесплодие

One of the factors that can lead to the development of male infertility is an infection of the genitourinary tract. An infectious and inflammatory process affecting the male reproductive system can cause various disorders of reproductive function: a disorder of gametogenesis in the testicles, disorders of sperm maturation in the epididymis, and passage of sperm along the vas deferens, as well as a decrease in some parameters of the ejaculate due to inflammatory dysfunction of the male accessory glands. Prostatitis is one of the most common urological diseases in young men. Prostatitis accounts for 25% of all requests for medical help to a urologist, and from 2 to 10% of men suffer from prostatitis symptoms. The disease is polyethological, and infection, immunological reactions, urethro-prostatic reflux of urine, psychoemotional stress are mentioned as the main causes of its development today. It is obvious that a pathological process with complex pathogenetic mechanisms affecting the prostate gland can have a negative impact on male fertility. This review examines the key mechanisms of the development of male infertility in chronic prostatitis.

Retroperitoneal, Para-aortocaval Lymphatic Resection as the Surgical Treatment of Choice in Seminoma Grade II

Background Testicular cancer remains one of the most common malignant diseases in young men. The highest incidence was seen in the ages of 25-29 years. A significant part of them come from germ cell tumors, which are divided into seminoma and non-seminoma. Although the aggressiveness of tumors with germ cells remains high, it should be noted that there is a very high response to surgical and chemotherapeutic treatment, where a 5-year disease-free survival is evident in more than 95% of cases. The metastatic spread of these tumors follows the lymphatic drainage of the testes. The retroperitoneal and pre-aortocaval spread, which are resistant to chemotherapy, requires the intervention of an extended surgical procedure, which consists in the removal of the lymph nodes in these regions. The purpose of this procedure is the resection of pre-aortocaval lymph nodes remaining after orchidectomy, a procedure which represents one of the major components of the curative treatment. Case presentation There are three cases of patients, aged 37/32/39-years-old, who have undergone the surgical procedure of right orchidectomy. The biopsy obtained after the surgical intervention showed grade II seminoma. All three patients, who underwent orchidectomy in different years, were subjected to chemotherapeutic treatment with the 3 preparations bleomycin, etoposide and cisplatin. After that, for a period of 1.5-2 years, they carried out occasional checks, which they then stopped. The lack of control for a 5-year period, as well as the limitation of the surgical procedure only in the right orchidectomy, has led to the metastasis of the seminoma in the pre-aortocaval region. In this study, we consider the fact of performing the retroperitoneal lymphatic drainage procedure according to the lymphatic drainage route of the tests, in the cases of the biopsy result "Seminoma grade II" and above, as one of the major components of the curative treatment in addition to Chemotherapeutic treatment. Discussion The implementation of retroperitoneal, pre-aortocaval lymphadenectomy is considered mandatory, especially in the results of "Seminoma grade II" biopsy. In cases where laboratory and imaging examinations indicate residual retroperitoneal, pre-aortocaval masses, the surgical procedure of lymphadenectomy should be performed as soon as possible. The principle of the lymphadenectomy according to the way of drainage of the testes is important when we talk about oncological principles. Statistical data show the advantage of the extended surgical procedure, consisting of a disease-free survival period of 5 years at a rate of 95%. The choice of the retroperitoneal lymphadenectomy procedure has resulted in the normalization of tumor markers for at least a 2-year period after the intervention, also showing an improvement in the patient's prognosis. Conclusion In cases of histopathological response, where the result of Seminoma grade II and above is concluded, the surgical procedure should not be limited to simple orchidectomy or radical inguinal orchidectomy with the aim of avoiding metastatic spread along the lymphatic drainage route. Keywords: General surgery, Testicular cancer, Seminoma, Para-aortocaval retroperitoneal lymphatic resection, RPLND. DOI: 10.7176/ALST/95-06 Publication date: November 30 th 2022

Prostate diseases and microbiome in the prostate, gut, and urine.

The microbiome in various organs involves a vast network that plays a key role in the health and wellness of the human body. With recent advances in biological technologies such as high-throughput sequencing, transcriptomics, and metabolomics, it appears that the microbial signature varies dynamically among individuals, creating various roles in metabolism, local and systemic inflammation, and host immunity. Urinary and genital organs, including the prostate, seminal vesicles, and urinary bladder, are reservoirs of several bacterial, viral, and fungal communities. Accumulating evidence has suggested profound roles for the gut, urinary, and intraprostate microbiomes in genitourinary benign and malignant diseases. This review article addresses microbiome-related evidence for three major diseases involved in prostate cancer: chronic prostatitis (CP), benign prostatic hyperplasia (BPH), and prostate cancer (PCa). Symptomatic CP is known as CP/chronic pelvic pain syndrome. CP is one of the most common prostate diseases in young men, accounting for 8% of all men visiting a urologic clinic. Although oral medication is the gold standard therapy for patients with BPH, approximately 13% of men present with clinical progression within 4 years after the initiation of treatment, with 5% requiring surgical intervention. The identification of proinflammatory cytokines and pathogens responsible for the clinical progression of BPH is still underway. Several topics regarding the association between PCa and the microbiome are discussed in this review as follows: i) intraprostatic microbiome and the risk of PCa, ii) gut microbiome and PCa, iii) gut microbiome and the risk of radiation-induced side effects, iv) isoflavone intake and equol-producing intestinal flora on PCa, and v) the inhibitory effect of daidzein and equol on tumor growth and progression of PCa. Further studies are required for a comprehensive understanding between the urogenital microbiome and prostate pathogenesis to facilitate the development of preventive and therapeutic approaches for prostate diseases.

On some features of peptic ulcer disease in young men

Peptic ulcer disease in young men is in many cases atypical, often with micro-symptoms and even asymptomatic (2.97%); exacerbation of the disease in most cases occurs regardless of the season, that is, atypicality is combined with acyclicity and aseason.

Primary bladder neck obstruction is one of the rare causes for renal failure in young adult males

BackgroundPrimary bladder neck obstruction (PBNO) is one of the causes of bladder outlet obstruction (BOO) and rarely results in renal failure. We are presenting the clinical characteristics of young male patients with PBNO and renal failure.MethodsMedical records of patients between 18 and 40 years old with PBNO and renal failure were retrospectively reviewed (2014–2020). Patients with anatomical cause of BOO, and any urological or systemic disease or previous history of any surgical procedure associated with renal failure and/or lower urinary tract dysfunction were excluded. Serum creatinine measurement, ultrasonography, uroflowmetry, cystoscopy, and videourodynamics were performed.ResultsSeven male patients were identified, and the mean age of the patients was 28.8 years. Symptom duration was > 5 years in all patients. Two patients presented with difficult voiding, and five patients presented with both storage and voiding lower urinary tract symptoms (LUTS). Three patients were previously misdiagnosed as overactive bladder. At presentation, serum creatinine levels were between 1.7 and 2.4 mg/dl. One patient was under hemodialysis treatment and waiting for renal transplantation. Mean detrusor pressure at maximum measured flow rate, mean maximum flow rate (Qmax), and mean average flow rate (Qave) was 67.6 cm H2O, 9.5 ml/s, and 5.5 ml/s, respectively. With α-blocker treatment, serum creatinine levels were stable or decreased after 12 months follow-up and mean Qmax and Qave were increased to 14.8 ml/s and 10.1 ml/s, respectively.ConclusionsPBNO is a common disease in young men presenting with a long history of LUTS. Videourodynamics is mandatory for accurate diagnosis, but having a high clinical suspicion for PBNO is key to ensure the diagnosis. Clinicians should pay more attention to PBNO in young male patients with a long history of LUTS to prevent misdiagnosis, incorrect treatment, and possible decrease in renal function by years.

SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial

BackgroundAnkylosing spondylitis (AS) is a high-incidence disease in young men that interferes with patients’ physical and mental wellbeing and overall quality of life (QoL). It is often accompanied by arthralgia, stiffness, and limited lumbar flexibility. Acupuncture is safe and effective for reducing the symptoms of AS, but the underlying mechanisms by which it does so are not fully understood. Therefore, to objectively assess acupuncture efficacy, which is critical for patients making informed decisions about appropriate treatments, we will use shear-wave elastography (SWE) and superb microvascular imaging (SMI) ultrasound techniques to evaluate elasticity of lumbar paraspinal muscles and blood flow to the sacroiliac joint (SIJ) in AS.MethodsWe will recruit a total of 60 participants diagnosed with AS and 30 healthy subjects. Participants will be randomly allocated 1:1 to either an acupuncture group or a sham control acupuncture group. Primary-outcome measures will be musculoskeletal ultrasound, Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Metrology Index (BASMI), and the Visual Analogue Scale (VAS) for pain. Secondary outcome measures will be the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), and Fatigue Scale-14 (FS-14). We will monitor the effect of acupuncture or sham acupuncture on blood flow and SIJ inflammation using SMI, lumbar-muscle stiffness using SWE and the lumbar paraspinal-muscle cross-sectional area (CSA) using a two-dimensional (2D) grayscale imaging. QoL, physical function, and fatigue will be assessed using an evaluation scale or questionnaire developed for this study, with outcomes measured by the ASQoL, BASMI, BASDAI, BASFI, and FS-14. Healthy subjects will not receive acupuncture but undergo only musculoskeletal ultrasound at baseline. Acupuncture and sham control acupuncture interventions will be conducted for 30 min, 2–3 times/week for 12 weeks. Musculoskeletal ultrasound will be conducted at baseline and post-intervention, while other outcomes will be measured at baseline, 6 weeks, and post-intervention. The statistician, outcome assessor, and participants will be blinded to treatment allocation.DiscussionThe results of this single-blinded, randomized trial with sham controls could help demonstrate the efficacy of acupuncture and clarify whether musculoskeletal ultrasound could be used to evaluate AS.Trial registrationClinicalTrials.gov ChiCTR2000031476. Registered 3 April 2020.

Demographics of a Large International Population of Patients Affected by Leber’s Hereditary Optic Neuropathy

To study the demographics of Leber's hereditary optic neuropathy (LHON) using a large international database of people affected by LHON. Cross-sectional study. One thousand five hundred seventeen people affected by LHON with a known pathogenic genetic mutation. Self-reported genetic and demographic data were collected. The data were de-identified and then analyzed. Leber's hereditary optic neuropathy mutation, gender, age at vision loss onset, and geographical region. The data showed that both females and males can experience symptom onset at any age. We found a 3:1 male-to-female ratio. Interestingly, at younger than 5 years and older than 45 years, the male-to-female ratio of those becoming affected was approximately 1:1. A dramatic peak in age at onset of vision loss was found among males between 14 and 26 years of age. Disease onset in females occurred across all age groups, without any comparable dramatic peak of onset age. This study found that 10% of individuals become affected with LHON after 50 years of age. According to the literature, we found that the m.11778, m.14484, and m.3460 mutations were the most common LHON point mutations in both males and females, with a similar age at onset distribution. This was the largest study of LHON demographics to date. It showed that women carrying an LHON mutation are at higher risk of losing vision than is generally expected. Unlike the traditional 5:1 male-to-female ratio commonly reported in the literature, we found a 3:1 male-to-female ratio. Earlier studies may have harbored an ascertainment bias of overemphasizing the confirmation of this being a disease of young men. However, our data suggest that LHON is a disease that affects both females and males of all ages. This should prompt physicians to conduct genetic testing for LHON in all patients who meet the clinical criteria, regardless of whether they fit the demographics traditionally associated with the disease. Counseling about LHON should be offered to all maternal bloodline relatives, females and males of all ages, because they are at risk of sudden-onset legal blindness.

Knowledge and early detection of testicular germ cell cancer among adolescents and young adults

Malignant testicular germ cell tumors are the most common tumor disease in young men, affecting not only the period of his reproductive phase but also creating acomplex life situation. Therapy includes the risk of development of second neoplasia and sequelae. However, particularly in this age group, knowledge about this disease and risk factors is sparse, and preventive examinations are not available or are not or insufficiently used. In order to evaluate the state of knowledge on testicular tumors in adolescents, aknowledge survey was conducted at 6high schools in Hamburg from January to April 2019 among pupils of grades 11 and 12. This was carried out with aquestionnaire comprising 15items, which was analyzed and also evaluated on agender-specific basis. Only fully completed questionnaires were considered. The overall proportion of correctly answered questions was 60.04%. Broken down by gender, the proportion was 60.18% for female pupils and 59.14% for male pupils, while the gender ratio was 52.2 and 47.8% for female pupils. Special questions on testicular tumors were answered correctly by 59.71% of the female students and 54.8% of the male students, while general questions on the structure and function of the male sexual organs were answered 4.51% better by the male students with 64.9%. These were statistically significant in both cases. The survey shows agender-specific knowledge deficit on testicular tumors, which is more pronounced among boys. As intensified knowledge transfer on this topic alone is insufficient, apreventive examination should be established especially for boys. This would enable individual, risk-commensurate and needs-adapted monitoring and early detection of testicular tumor disease, but also of other health issues in male adolescents.

SENSITIVITY AND SPECIFICITY OF IMMUNOHISTOCHEMICAL MARKERS IN THE DIAGNOSIS OF GERMINOGENOUS TESTICULAR TUMORS

Germinogenous testicular tumors are a disease of young men of working age. The incidence rate is increasing every year and more often these tumors are found in developed countries. With the correct and timely diagnosis the effectiveness of treatment is close to 100%. For the diagnosis it is necessary to use immunohistochemical examination, which includes a wide panel of markers.

Erectile dysfunction is associated with subclinical carotid vascular disease in young men lacking widely-known risk factors.

This study aimed to gain insight into the underlying pathogenesis of erectile dysfunction in young men under the age of 40 years without widely-known risk factors. Compared with normal controls, patients with erectile dysfunction had increased carotid intima–media thickness, fasting levels of blood glucose and insulin, and homeostatic model assessment index, as well as lower flow-mediated vasodilation and testosterone levels (P < 0.05), though all of these values were within their respective normal range. Multivariate logistic regression analysis identified carotid intima–media thickness, flow-mediated vasodilation, insulin level, and homeostatic model assessment index as significant predictors of erectile dysfunction. Young men with flow-mediated vasodilation <10.65% were 11.645 times more likely to have erectile dysfunction, young men with carotid intima–media thickness >0.623 mm had a 4.16-fold, and young men with homeostatic model assessment index >1.614 had a 5.993-fold greater risk of having erectile dysfunction. In conclusions, in young men with normal results from general clinical screening, an increased carotid intima–media thickness and homeostatic model assessment index and reduced flow-mediated vasodilation were associated with a higher incidence of erectile dysfunction. Erectile dysfunction may appear before the detection of traditional cardiovascular risk factors and may be the earliest clinical sign of subclinical cardiovascular disease.

The changing face of major trauma in the UK

AimMajor trauma (MT) has traditionally been viewed as a disease of young men caused by high-energy transfer mechanisms of injury, which has been reflected in the configuration of MT services....

Association of hypoadiponectemia with smokeless/dipping tobacco use in young men.

BackgroundLow levels of adiponectin, an adipocytokine with anti-diabetic, antiatherogenic and cardioprotective properties, is associated with increased risk of coronary disease in young men. Previous studies have demonstrated that smokeless tobacco is linked with a reduction of plasma adiponectin levels. However, the influence of smokeless tobacco (dipping tobacco) on plasma adiponectin levels still remains unknown. This study was conducted to assess the plasma adiponectin levels in young men who were using dipping tobacco.MethodsThis was a community based study, which consisted of 186 young lean healthy males aged 20 to 35 years. Among these, 96 men were dipping tobacco users (BMI = 23.07 ± 2.68) and 90 were non-dipping tobacco users (BMI = 23.67 ± 1.46). Serum adiponectin levels were assessed by Enzyme Linked ImmunoSorbent Assay (ELISA).ResultsA statistically significant difference in the mean adiponectin level between tobacco dipper and non-dipper groups was observed (p = 0.0001). A significant difference between the two groups was also observed in baseline parameters including triglyceride and random blood sugar levels (p < 0.05). However, no significant difference was observed between the two groups in other clinical parameters.ConclusionsFindings of this study suggest that dipping tobacco use was significantly associated with low level of adiponetin in community dwelling young males. This emphasizes the importance of developing community intervention to reduce the use of dipping tobacco, which will reduce the tobacco associated disease burden in the community and will improve public health.

GW25-e2283 The risk factors and the characteristics of coronary disease in young men with acute myocardial infarction

GW25-e2283 The risk factors and the characteristics of coronary disease in young men with acute myocardial infarction

A cluster of invasive meningococcal disease in young men who have sex with men in Berlin, October 2012 to May 2013

Between October 2012 and May 2013, five cases of invasive meningococcal disease in young men who have sex with men (MSM) living in Berlin were notified to local health authorities in Germany. Three of the five cases died. All were caused by serogroup C variants with the finetype P1.5-1,10-8:F3-6. Awareness was increased through the use of community networks; an extension of the existing vaccination recommendation to all MSM is currently being considered.

Delay in Seeking Care for Sexually Transmitted Diseases in Young Men and Women Attending a Public STD Clinic

Background: Delay in seeking care for sexually transmitted diseases (STDs) has adverse consequences for both the individual and population. We sought to identify factors associated with delay in seeking care for STDs.Methods: Subjects included 300 young men and women (aged 15-24) attending an urban STD clinic for a new STD-related problem due to symptoms or referral for an STD screening. Subjects completed a structured interview that evaluated STD history, attitudes and beliefs about STDs, depression, substance use, and other factors possibly associated with delay. Delay was defined as waiting > 7 days to seek and obtain care for STDs.Results: Nearly one-third of participants delayed seeking care for > 7 days. Significant predictors for delay included self-referral for symptoms as the reason for visit (OR 5.3, 95% CI: 2.58 – 10.98), and the beliefs “my partner would blame me if I had an STD” (OR 2.44, 95% CI: 1.30 – 4.60) and “it’s hard to find time to get checked for STDs” (OR 3.62, 95% CI: 1.95 – 6.69), after adjusting for age, race, sex, and other factors. Agreeing with the statement “would use a STD test at home if one were available” was associated with a decrease in delay (OR 0.24, 95% CI: 0.09 – 0.60).Conclusions: Many young persons delay seeking care for STDs for a number of reasons. Strategies to improve STD care-seeking include encouragement of symptomatic persons to seek medical care more rapidly, reduction of social stigmas, and improved access to testing options.

Penile revascularization—contemporary update

Contemporary therapies for erectile dysfunction are generally targeted towards older men and universally engage pharmacological and/or device related treatment options. Penile revascularization, using microvascular arterial bypass surgical techniques, is a non-pharmacological, non-device-related, and reconstructive surgical strategy for men with erectile dysfunction that was first described by Dr Vaclav Michal in 1973. Contemporary penile revascularization attempts to 'cure' pure arteriogenic erectile dysfunction in young men with arterial occlusive pathology in the distal internal pudendal, common penile or proximal cavernosal artery secondary to focal endothelial injury from blunt pelvic, perineal or penile trauma. A microvascular anastomosis is fashioned between the donor inferior epigastric and recipient dorsal penile artery. Increased perfusion pressure is theoretically communicated to the cavernosal artery via perforating branches from the dorsal artery. This article will review the history, indications and pathophysiology of blunt trauma-induced focal arterial occlusive disease in young men with erectile dysfunction, current surgical techniques utilized and results of surgery. Contemporary use of penile revascularization is a logical and wanted therapeutic option to attempt to reverse erectile dysfunction in young men who have sustained blunt pelvic, perineal or penile trauma.