Purulent Urethral Discharge Research Articles

Reactive arthritis: the convoluted history of Reiter's disease.

Reactive arthritis, previously known as Reiter's Syndrome or Disease was a post-dysenteric, asymmetrical acute large joint polyarthritis, with fever, conjunctivitis, iritis, purulent urethral discharge, rash and penile soft tissue swelling. Although the eponym was given to Hans Reiter, various forms of the condition have been recorded in history a few hundred years before Reiter. Two French doctors, Noel Fiessinger (1881-1946) and Edgar Leroy (d. 1965), presented a paper at la Societe des Hopitaux-in Paris on the 8th December 1916 on dysentery in 80 soldiers on the Somme, and four of whom developed a "syndrome conjunctivo-uretro-synovial". Their paper was given 4days before Reiter's presentation on 12th December 1916 at the Society of Medicine in Berlin, on a German army officer with an illness similar to those described by Fiessinger and Edgar Leroy. It is documented that Hans Reiter was one of a number of University professors who signed an oath of allegiance to Adolf Hitler in 1932. For socio-ethical reasons and for clinical utility, Reiter's syndrome is now known as reactive arthritis.

Pattern Of Seminal Fluid Parameters And Their Clinical Correlates Amongst Infertile Men In The Niger-Delta Region Of Nigeria

Background: Infertility is a foremost reproductive health problem globally, with sub-Saharan Africa nations most affected. The male contributions to this burden have not been properly documented in this environmentMethods: This was a cross-sectional study conducted in Central Hospital Benin City, involving 355 male partners of women with infertility. Specific clinical information was extracted and two semen analyses were conducted two weeks apart.Results: The mean duration of infertility was 4.5 years (SD 2.17), and secondary infertility was the commonest (82.3%). Over half (59.7%) were of low socioeconomic status. Over two-thirds (66.5%) had seminal fluid abnormality; and Oligospermia was thecommonest (22.8%). About two-fifth took alcohol regularly (43.9%), had previous history of urethral discharge (39.4%), or of testicular pain (42.8%). About One-fifth had a past history of mumps-orchitis (20.3%), or smoked cigarette (22.3%). Less than a tenth had varicocele (8.8%), or undescended testes (8.5%); while more than one-tenth reported use of Cimetidine (12.4%), herniorrhaphy (14.7%), scrotal surgery (15.8%), or sexual dysfunction (14.6%). There were significantly more participants with sexual dysfunction, herniorrhaphy, scrotal surgery, undescended testes; mumps orchitis; testicular pains; varicocele; history of purulent urethral discharge; tobacco smoking; alcohol consumption; and use of Cimetidine who have abnormal seminal fluid parameters. However on multivariate logistic regression analysis, history of urethral discharge, undescended testes, and Cimetidine use had negativecorrelation with abnormal semen parameters.Conclusion: The prevalence of male factor infertility in our setting was high with significant association between male infertility and wide range of clinical and psychosocial problems.

Direct Visual Internal Urethrotomy in Supine Position in a Patient with Complex Deformities of Both Lower Limbs and Neurogenic Bladder: A Case Report

Direct visual internal urethrotomy (DVIU) is a minimally invasive treatment for urethral stricture and is usually done in lithotomy position. We presented a case of a 35-year-old man with complex deformities of both lower limbs from birth. The lower limbs were severely wasted with ankylosis of the hips, flexion of the knee joints and dorsiflexion at the ankle joints. He had a history of progressively worsening difficult in urination characterized by frequency, urgency, urgency incontinence, nocturia, poor urinary stream (improved by straining), intermittency and feeling of incomplete bladder emptying. He had occasional dysuria and total hematuria. He was not a known hypertensive or diabetic patient. No history of trauma, previous urethral instrumentation, and no history of purulent urethral discharge before the onset of problems. On presentation, his abdomen was full with slight suprapubic distention. The anal sphincter was spastic and the prostate was not enlarged. He had normal non-circumcised male external genitalia. There was no spinal deformity and the upper limbs were normal. White cell count was 14,000 cells/ mm3 with a differential neutrophil of 85.5% and urine culture showed moderate growth of coliforms. Abdominopelvic ultrasound showed a thickened bladder wall with mild hydronephrosis bilaterally and a retrograde urethrography and micturating cystourethrography showed 3 short segment bulbar urethral strictures. There was also a Christmas tree appearance of the bladder. A diagnosis of bladder outlet obstruction secondary to multiple short segment idiopathic bulbar urethral strictures on background neurogenic bladder was made. He had intravenous antibiotics for 48 hours and subsequently a DVIU under spinal anesthesia and in the supine position. Catheter was removed on the 7th day post procedure and he started clean intermittent catheterization (CIC) with 12 French catheters. Seven months post procedure, patient is still satisfied with the outcome of his treatment. We concluded that DVIU can be done safely in the supine position and CIC can help improve post procedure outcome and in managing comorbid neurogenic bladder.

Renal dysplasia, ectopic ureter, septic ureterectasia and cryptorchidism in an 11‐month‐old Cob colt presenting with ascending pyoureter and pyocystis

SummaryAn 11‐month‐old entire male Cob colt was presented for unilateral cryptorchid castration and intermittent purulent urethral discharge. Cystoscopy, trans‐cutaneous and trans‐rectal abdominal ultrasonography and contrast enhanced computed tomography examinations confirmed unilateral cryptorchidism, ipsilateral renal dysplasia and pyoureter with dilatation and ectopia. While nephrectomy may be a viable treatment approach for some cases of unilateral renal dysplasia, surgical intervention was not attempted in this case owing to financial constraints and the yearling was subjected to euthanasia. To the authors’ knowledge, this is the first report of a case of complex congenital urogenital malformation including ipsilateral renal dysplasia, pyoureter with dilatation and ectopia and cryptorchidism, a finding which has been reported more commonly in human males.

Prostatic utricles without external genital anomalies in children: our experience, literature review, and pooling analysis

BackgroundIt has been recognized that the incidence of prostatic utricle in boys is increasing and is closely associated with diseases such as hypospadias. However, the clinical features of prostatic utricle with normal external genitalia have received little attention.MethodsBased on this, a series of 22 male children with prostatic utricles has been compiled by adding our 3 patients to 19 cases reported. All children enrolled had normal external genitalia. Clinical data of the case was reviewed.ResultsUrinary tract infection, purulent urethral discharge and pyuria were the most common presenting chief complaint (41%), irritative lower urinary tract symptoms were present in 17% of cases, obstructive lower urinary tract symptoms were noted in 14%. Urinary retention has been reported in 18% and epididymitis has been reported in 14%. Relatively rare clinical symptoms are abdominal pain, hematuria, and hematospermia. A case of calculus formation and a case of neoplasia within the prostatic utricle has been reported. A cystic mass found by digital rectal examination is the most common presenting sign. A utricular lesion posterior to the bladder was revealed by imaging examination. Unilateral renal agenesis was associated in 32% of reports. Non-surgical approach was chosen in 3 cases, transrectal ultrasonography guided aspiration has been reported in 1 case. Endoscopic techniques were used in 3 cases. Open excision was used in 11 cases. The laparoscopic excision was chosen in 3 cases and Robot-assisted laparoscopy was reported in 1 case. Symptoms and signs disappeared after treatment in all children, and no recurrence occurred during follow-up.ConclusionsProstate utricles without external genital anomalies are rarely reported in children, and are easily missed and misdiagnosed, often accompanied by recurrent urinary tract infections, lower urinary tract symptoms, epididymitis, dysuria and other symptoms. Imaging studies can confirm the diagnosis. Symptomatic and large utricles should be actively treated. The treatment program should be based on the age, clinical symptoms, and size and location of the utricle.

Male urethritis with or without discharge: a clinico aetiological study in Hi-tech Medical College and Hospital Bhubaneswar, Odisha

<p class="abstract"><strong>Background:</strong> Urethritis or inflammation of the urethra is a multifactorial condition. Urethritis is called gonococcal urethritis (GU) when Neisseria gonorrhoeae is detected in urethral smear of the patient and nongonococcal urethritis (NGU) when this organism cannot be visualized.</p><p class="abstract"><strong>Methods:</strong> Urethritis cases were identified from the dermatology OPD record. A retrospective analysis of data of patients diagnosed as GU and NGU for a period of 5 years (from August 2012-July 2017) was made. We have included only male patients more than 10 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Neisseria gonorrhoeae (61.42%) and Chlamydia trachomatis (45.9%) were the most common causative organism among urethritis and nongonococcal urethritis (NGU) respectively. Chlamydia urethritis had been confirmed by demonstrating ≥5 polymorphonuclear lymphocytes (PMNLs) from the anterior urethra using a Gram stained urethral smear. Acute condition (7-14 days) more common in GU. Dysuria and purulent urethral discharge (68.6%) was more common in GU. In urine specimen pus cells count were more than 10. The most common age group was 21-30 year (42.86%). Most patients were from low socio-economic status (62.85%). Sexual exposure was more common in unmarried patients (94.74%). Heterosexual exposure (93.75%) was more common. Urethritis was also associated with other infection in 18 patients.</p><p class="abstract"><strong>Conclusions:</strong> Urethritis is inflammation of urethra which is manifested by dysuria with or without urethral discharge. Though there is increased incidence of Chlamydia infections, still now Gonococcal infection is the most common cause of urethritis.</p><p class="abstract"> </p>

Prostatic utricle cyst presenting with recurrent urethral discharge in the newborn: A case report

A 6 month old boy with normal external genitalia, presented with purulent urethral discharge from the neonatal period and recurrent urinary tract infections. Radiologic and urethrocystoscopic evaluation showed a midline structure connected to the prostatic urethra and discharging with pus. This structure, considered to be a prostatic utricle cyst was successfully drained endoscopically.

Evaluation of the Copan eSwab®, a liquid-based microbiology transport system, for the preservation of Neisseria gonorrhoeae at different temperatures

Aims and objectives: To evaluate the survival duration of Neisseria gonorrhoeae from male urethral discharge specimens collected using the Copan eSwab® liquid-based microbiology transport system, at both ambient and refrigerator temperatures.Methods: Three urethral swabs (one Dacron, two Copan eSwabs®) were collected from each male patient presenting with purulent urethral discharge to a community-based primary healthcare centre in Johannesburg. The Dacron swab was directly inoculated onto New York city agar medium, and the Copan eSwabs® transported and held at room and refrigerator temperature, for daily sub-culture onto New York city agar over a total period of seven days (168 h). The utility of Copan eSwabs® for the transport and survival of N. gonorrhoeae at different temperatures was determined by comparison to culture obtained by ‘gold standard’ direct plate inoculation.Results: N. gonorrhoeae isolation rates from Copan eSwabs® at fridge temperature and ambient temperature were as follows: 87.9% vs 79.3% at 48 h; 67.2% vs 60.3% at 72 h; 60.3% vs 22.4% at 96 h; and, 53.4% vs 3.4% at 120 h, respectively. The viability of subculture decreased significantly from eSwabs® maintained at room temperature from 96 h onwards of specimen collection.Conclusion: To ensure the preservation and an acceptable isolation rate of N. gonorrhoeae from urethral discharge specimens, Copan eSwabs® should be transported and maintained at refrigerator temperatures, and must reach the processing laboratory by at least 120 h (5 days) after collection.

Poncet\u2019s disease after the intravesical instillation of Bacillus Calmette\u2013Gu\xe9rin (BCG): a case report

BackgroundPoncet’s disease is a rare syndrome characterized by articular impairment in a form of rare tuberculid. One of the theories of its cause involves an autoimmune response induced by the intravesical administration of the Calmette–Guerin Bacillus or the treatment of bladder carcinoma. Furthermore, there may be an appearance of oligoarticular or polyarticular arthritis, beginning 1–3 months after the start of therapy. Few physicians know the disease and the literature related to that syndrome is scarce and restricted to case reports, which contributes to its under diagnosis.Case presentationFemale patient, 64 years old, Caucasian, in whom was noticed firstly dark urine, without haematuria or dysuria. Later felt also colic pain in the hypogastric region. Microscopically, the conclusive diagnosis was a high grade non-invasive papillary urothelial carcinoma. Thereupon, the treatment of the tumour began with transurethral resection technique and intravesical instillation of Calmette–Guérin Bacillus as adjuvant treatment. Eight months after the beginning of treatment, the lingering presence of the carcinoma was identified. Nevertheless, arthritis was identified through radiographs, after an increase in the clavicle capitation, right knee and left ankle in bone scintigraphy. Coinciding with the joint manifestations, the patient developed fever and purulent urethral discharge (culture was negative). Therefore, trying to investigate the cause of the arthritis, Purified Protein Derivate was taken, with reactive results. An increase of acute phase reactants was found, with other tests resulting normal: blood chemistry, Complete Blood Count, immunology and serology. Human Leukocyte Antigen typing by polymerase chain reaction revealed the presence of A24/AX, B44, B27, BW4/BW4, DQ7 and DQ5. Consequently, Poncet’s disease was the diagnostic conclusion. The treatment with intravesical Calmette–Guérin Bacillus was immediately discontinued. The patient received corticosteroids associated with etoricoxib and isoniazid for 4 months, achieving disappearance of the inflammatory joint signs in 3 months. After 6 months, no joint pain recurrence or other manifestations suggesting active disease had been seen.ConclusionsTherefore, such diagnosis should be considered when confronted with an osteoarticular clinical picture in patients treated with intravesical Calmette–Guérin Bacillus, especially patients with HLA-B27 (+) and B7 (+), as Poncet’s disease is a reactive arthritis.

Evaluation of the Copan eSwab®, a liquid-based microbiology transport system, for the preservation ofNeisseria gonorrhoeaeat different temperatures

Aims and objectives: To evaluate the survival duration of Neisseria gonorrhoeae from male urethral discharge specimens collected using the Copan eSwab® liquid-based microbiology transport system, at both ambient and refrigerator temperatures. Methods: Three urethral swabs (one Dacron, two Copan eSwabs®) were collected from each male patient presenting with purulent urethral discharge to a community-based primary healthcare centre in Johannesburg. The Dacron swab was directly inoculated onto New York city agar medium, and the Copan eSwabs® transported and held at room and refrigerator temperature, for daily sub-culture onto New York city agar over a total period of seven days (168 h). The utility of Copan eSwabs® for the transport and survival of N. gonorrhoeae at different temperatures was determined by comparison to culture obtained by ‘gold standard’ direct plate inoculation. Results: N. gonorrhoeae isolation rates from Copan eSwabs® at fridge temperature and ambient temperature were as follows: 87.9% vs 79.3% at 48 h; 67.2% vs 60.3% at 72 h; 60.3% vs 22.4% at 96 h; and, 53.4% vs 3.4% at 120 h, respectively. The viability of subculture decreased significantly from eSwabs® maintained at room temperature from 96 h onwards of specimen collection. Conclusion: To ensure the preservation and an acceptable isolation rate of N. gonorrhoeae from urethral discharge specimens, Copan eSwabs® should be transported and maintained at refrigerator temperatures, and must reach the processing laboratory by at least 120 h (5 days) after collection.

Neisseria gonorrhoeae DNA bacterial load in men with symptomatic and asymptomatic gonococcal urethritis

ObjectivePrevious studies have quantified bacterial loads of Neisseria gonorrhoeae in the pharynx and rectum of men but not the urethra. We quantified the bacterial load of N. gonorrhoeae in men...

Selection for a CEACAM receptor-specific binding phenotype during Neisseria gonorrhoeae infection of the human genital tract.

Infections by Neisseria gonorrhoeae are increasingly common, are often caused by antibiotic-resistant strains, and can result in serious and lasting sequelae, prompting the reemergence of gonococcal disease as a leading global health concern. N. gonorrhoeae is a human-restricted pathogen that primarily colonizes urogenital mucosal surfaces. Disease progression varies greatly between the sexes: men usually present with symptomatic infection characterized by a painful purulent urethral discharge, while in women, the infection is often asymptomatic, with the most severe pathology occurring when the bacteria ascend from the lower genital tract into the uterus and fallopian tubes. Classical clinical studies demonstrated that clinically infectious strains uniformly express Opa adhesins; however, their specificities were unknown at the time. While in vitro studies have since identified CEACAM proteins as the primary target of Opa proteins, the gonococcal specificity for this human family of receptors has not been addressed in the context of natural infection. In this study, we characterize a collection of low-passage-number clinical-specimen-derived N. gonorrhoeae isolates for Opa expression and assess their CEACAM-binding profiles. We report marked in vivo selection for expression of phase-variable Opa proteins that bind CEACAM1 and CEACAM5 but selection against expression of Opa variants that bind to the neutrophil-restricted decoy receptor CEACAM3. This is the first study showing phenotypic selection for distinct CEACAM-binding phenotypes in vivo, and it supports the opposing functions of CEACAMs that facilitate infection versus driving inflammation within the genital tract.

Corynebacterium propinquum Associated With Acute, Nongonococcal Urethritis

Corynebacterium propinquum is usually considered part of the normal human oropharyngeal flora and is rarely responsible for clinical infection. We report here what seems to be the first case of acute purulent urethral discharge in a young Iranian man with urethritis acquired after orogenital contact. Attention should be devoted to less common nondiphtheriae Corynebacterium species for differential diagnosis.

Urethritis and antimicrobial resistance

Abstract Urethritis is a clinical syndrome which is characterized by mucopurulent or purulent urethral discharge with or without dysuria, due to an increased number of polymorphonuclear leukocytes in the anterior urethra. Antimicrobial therapy and preventive measures are essential in the management of bacterial urethritis. However, these drugs may cause antimicrobial resistance, resulting in unsuccessful treatment and complications of urethritis. Resistance of Neisseria gonorrhoeae to antibiotics is well known for decades, and in recent years there are more cases of resistance of Chlamydia trachomatis and Mycoplasma genitalium to different antibiotics. There is a danger that in the future certain strains of N. gonorrhoeae will be resistant to all available antimicrobial agents, unless new antibiotics to which resistance will not develop rapidly or an effective vaccine are developed.

A 34-year-old man with urethral discharge

A 34-year-old man who has sex with men and has a remote history of primary syphilis presents to his primary care physician with painful urination and a purulent urethral discharge. He received unprotected oral sex from a new sexual partner 3 weeks ago. Two weeks before his current visit, he

Neisseria Meningitidis Urethritis: A Case Report Highlighting Clinical Similarities to and Epidemiological Differences From Gonococcal Urethritis

An adult male presented to the Hawaii Health Department with a purulent urethral discharge. Urethral Gram stain examination led to a presumptive gonorrhea diagnosis even though his sexual history was nonsupportive. Culture results identified Neisseria meningitidis. This case report highlights the clinical similarities and differing epidemiology of these Neisseria urethritides.

Surprises in the urinary bladder

Surprises in the urinary bladder Bhushan Wani1, Suhas Jajoo1, Navinchandra Wani2, Anil Bhole11Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, India; 2Department of Surgery, Annasaheb Chudaman Patil Memorial Medical College, Dhule, IndiaAbstract: Foreign bodies of the urinary bladder may occur by self insertion, iatrogenic means or migration from the neighbouring organs. The variety of objects found self-inserted is impressive. The patient usually presents with dysuria, poor urinary stream or retention, bloody or purulent urethral discharge, ascending urinary tract infection, urgency, and/or pelvic pain. Management should be tailored according to the nature and dimensions of the foreign body. In the following paper, we report three cases with different presentations that were managed successfully.Keywords: urinary, bladder, foreign bodies

Soap induced urethral pain in boys.

To describe the cause, possible pathogenesis and management of "idiopathic" urethral pain in boys. Eighteen boys presenting with distal urethral pains over a period of 12 years were reviewed and their responses to the application of bland petroleum jelly to the external urethral meatus before each soap bath was noted. The symptoms started suddenly while bathing with soap. Penile erections at onset occurred in 14 (78%). Two (11%) had purulent urethral discharge and 1 (5.5%) had meatal stenosis. Application of bland petroleum jelly to the external urethral meatus before each soap bath satisfactorily controlled the urethral pains. "Idiopathic urethral pain in boys" may be due to soap induced chemical urethritis and responds well to application of bland petroleum jelly to the external urethral meatus before each soap bath with appropriate antibiotics when there is associated purulent urethral discharge.

Immunoreceptor tyrosine-based activation motif phosphorylation during engulfment of Neisseria gonorrhoeae by the neutrophil-restricted CEACAM3 (CD66d) receptor.

Gonorrhea is characterized by a purulent urethral or cervical discharge consisting primarily of neutrophils associated with Neisseria gonorrhoeae. These interactions are facilitated by gonococcal colony opacity-associated (Opa) protein binding to host cellular CEACAM receptors. Of these, CEACAM3 is restricted to neutrophils and contains an immunoreceptor tyrosine-based activation motif (ITAM) reminiscent of that found within certain phagocytic Fc receptors. CEACAM3 was tyrosine phosphorylated by a Src family kinase-dependent process upon infection by gonococci expressing CEACAM-specific Opa proteins. This phosphorylation was necessary for efficient bacterial uptake; however, a less efficient uptake process became evident when kinase inhibitors or mutagenesis of the ITAM were used to prevent phosphorylation. Ligated CEACAM3 was recruited to a cytoskeleton-containing fraction, intense foci of polymerized actin were evident where bacteria attached to HeLa-CEACAM3, and disruption of polymerized actin by cytochalasin D blocked all bacterial uptake by these cells. These data support a model whereby CEACAM3 can mediate the Opa-dependent uptake of N. gonorrhoeae via either an efficient, ITAM phosphorylation-dependent process that resembles phagocytosis or a less efficient, tyrosine phosphorylation-independent mechanism.

FAILURE OF CIPROFLOXACIN PROPHYLAXIS FOR ULTRASOUND GUIDED TRANSRECTAL PROSTATIC BIOPSY IN THE ERA OF MULTIRESISTANT ENTEROBACTERIACEAE

No AccessJournal of UrologyClinical Urology: Case Reports1 Jan 1999FAILURE OF CIPROFLOXACIN PROPHYLAXIS FOR ULTRASOUND GUIDED TRANSRECTAL PROSTATIC BIOPSY IN THE ERA OF MULTIRESISTANT ENTEROBACTERIACEAE JACOB GILAD, ABRAHAM BORER, NIMROD MAIMON, KLARIS RIESENBERG, MOTI KLEIN, and FRANCISC SCHLAEFFER JACOB GILADJACOB GILAD More articles by this author , ABRAHAM BORERABRAHAM BORER More articles by this author , NIMROD MAIMONNIMROD MAIMON More articles by this author , KLARIS RIESENBERGKLARIS RIESENBERG More articles by this author , MOTI KLEINMOTI KLEIN More articles by this author , and FRANCISC SCHLAEFFERFRANCISC SCHLAEFFER More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62107-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "FAILURE OF CIPROFLOXACIN PROPHYLAXIS FOR ULTRASOUND GUIDED TRANSRECTAL PROSTATIC BIOPSY IN THE ERA OF MULTIRESISTANT ENTEROBACTERIACEAE." The Journal of Urology, 161(1), p. 222 References 1 : Antibiotic prophylaxis for transrectal prostate biopsy. J. Antimicrob. Chemother.1997; 39: 115. Google Scholar 2 : Tumors of the prostate. In: Management of Urologic Disorders. Edited by . London: Mosby-Year Book Europe, Ltd.1994: 55. Google Scholar 3 : Ultrasound-guided techniques. In: Prostate Outflow Obstruction: Investigation and Treatment. Edited by . Oxford: Blackwell Sciences1995: 39. Google Scholar Infectious Disease Institute, Department of Internal Medicine E and Division of Anesthesiology and Critical Care Medicine, Soroka Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byTerris M (2018) Re: Transrectal Ultrasound Guided Biopsy of the Prostate. Do Enemas Decrease Clinically Significant Complications?Journal of Urology, VOL. 167, NO. 5, (2145-2146), Online publication date: 1-May-2002. Volume 161Issue 1January 1999Page: 222 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information JACOB GILAD More articles by this author ABRAHAM BORER More articles by this author NIMROD MAIMON More articles by this author KLARIS RIESENBERG More articles by this author MOTI KLEIN More articles by this author FRANCISC SCHLAEFFER More articles by this author Expand All Advertisement PDF downloadLoading ...