Signs Of Urethritis Research Articles

KORUNMASIZ CİNSEL İLİŞKİ SONUCU ÜRETRİT TANISI ALAN SÜNNETLİ HASTALARDA ASEMPTOMATİK HIV, HEPATİT B, HEPATİT C VE SİFİLİZ GÖRÜLME SIKLIĞI

Aim: In this study, it was aimed to determine the frequency of asymptomatic Human Immunodeficiency Virus (HIV), Hepatitis B, Hepatitis C, and syphilis in circumcised patients diagnosed with urethritis transmitted by sexual intercourse because of unprotected sexual contact. Material and Methods: We retrospectively investigated the serological results of HIV, Hepatitis B, Hepatitis C, and Syphilis diseases in 364 male patients diagnosed with urethritis, all of them were circumcised during childhood. The study included patients who applied to the urology outpatient clinic of secondary state hospital between January 2017 and December 2019 with symptoms or signs of urethritis. In the examination, only urethral discharge could be seen without symptoms. After the patients were examined, first void urine samples were taken. Also at the first examination, peripheral blood samples were tested for HIV, Hepatitis B, Hepatitis C, and syphilis antibodies. Results: As a result of retrospective screening of the serological results of 364 male patients diagnosed with urethritis, Hepatitis B positivity was 1.09% with 4 cases, Hepatitis C positivity was found as 0.27% in 1 case and the Syphilis positivity rate was 1.92% with 7 cases in 364 patients. None of the patients had HIV positivity. Conclusions: The fact that there was not any encounter of HIV-positive patients in patients diagnosed with urethritis because of unprotected sexual contact led to the thought that circumcision had a protective contribution in these patients with urethritis, who were all circumcised. Also, screening tests, especially syphilis, should be performed on all patients diagnosed with STI infection.

Prevalence of Mycoplasma genitalium and other sexually transmitted pathogens in male urethritis in a sexual health centre in New Caledonia.

The prevalence of sexually transmitted infections (STIs) is high in New Caledonia (NC), but there are no data on Mycoplasma genitalium (MG). However, the syndromic treatment of urethritis used in the territory includes a single dose of azithromycin, which could generate resistance in MG. We recruited 217 men referred to the Noumea public medical centre (CMP) with signs of urethritis and meeting the inclusion criteria from May 2016 to March 2018. Each was tested for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and for the first time in NC for MG by polymerase chain reaction (PCR). The prevalence of MG was 10.1% (22/217). Azithromycin resistance of MG (mutation in the 23S rRNA gene) could only be assessed for 10 of the 22 strains. Only one (1/10; 10%) was resistant. The prevalence of other STIs tested was high, as CT, NG and/or TV were associated in 77.3% (17/22) of MG-positive cases. Although co-infections further justify syndromic management, the presence of MG in NC urethritis cases could call treatment guidelines into question.

Mental health consequences of bride kidnapping in the Kyrgyz republic

The consequences of gender-based violence (GBV) in the Kyrgyz Republic have often remained outside of both police officers’ and mental health care specialists’ attention. Statistical data on gender-based violence in the Kyrgyz Republic are underestimated, given that the majority of victims prefer not to seek help at all. One of the types of GBV in the Kyrgyz Republic is bride kidnapping, which is still very popular in rural areas of the state. Brides, that were kidnapped, present common behaviors and symptoms, such as an submissiveness, idealization of a husband, numbing, permanent desire to please a mother-in-law and other relatives of higher status in the family. Problems with the urogenital system, such as signs of urethritis and cystitis, vaginal itching, menstrual irregularities are also very common among daughters-in-law who were brutally kidnapped and had been experiencing violence from members of their families. Authors present an algorithm of dealing with the problem, which has been already implemented as a pilot project in one of the regions of the state.Disclosure of interestThe authors have not supplied their declaration of competing interest.

PD20-06 PRESENCE OF SEROTYPE H EXHIBITS MILDER SYMPTOMATIC CHARACTERISTICS IN AGED MEN THAN OTHER SEROTYPES

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia I1 Apr 2016PD20-06 PRESENCE OF SEROTYPE H EXHIBITS MILDER SYMPTOMATIC CHARACTERISTICS IN AGED MEN THAN OTHER SEROTYPES Yu Seo and Gil Lee Yu SeoYu Seo More articles by this author and Gil LeeGil Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1419AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The rate of Chlamydia trachomatis infection has been steadily increasing over the past decade. Extant research on genital chlamydia screening focuses primarily on women. Furthermore, current clinical practices do not recommend routine chlamydia screening for middle aged heterosexual men showing little or no symptoms. Consequently, these men are often omitted from studies on genital chlamydia infection, resulting in limited availability of their epidemiological data. Chlamydia ompA gene has unique regions for evading host immunity. Therefore, certain ompA genotype may have a selective advantage for its survival. In this study, we evaluated the patterns of urinary chlamydia ompA genotypes in men who visited the clinic with or without symptoms and signs of urethritis and investigated the effects of different genotypes on clinical features. METHODS We routinely collected 685 urine samples from participants from January 2009 to April 2012. In addition, we included four stored urine specimens from four urethritis patients collected in 2008. A multiplex PCR was performed using KL1-KL2 primers for chlamydia infection and HO1-HO3 primers for Neisseria gonorrhoeae, and the amplified ompA products were sent to determine the nucleotide sequences. RESULTS The mean age (Yrs ± SD) is 37.38±11.97. The serotypes, in order of prevalence, are serotype H (69.23%, n=27), followed by E (12.82%, n=5), F (7.69%, n=3), D (7.69%, n=3), and J (2.56%, n=1). We find a substantial difference in age between serotype H and the other serotypes (D, E, F, and J) (p=0.004, nonparametric analysis) (Table 1). In addition, men with serotype H showed milder symptom (urethral discharge, P=0.001) and sign (pyuria, P=0.001) than the other serotypes (Table 1). CONCLUSIONS The presence of serotype H was associated reduced symptomatic characteristics in middle aged men compared to other serotypes. This mild nature of senotype H may facilitate the spread of infection as the infected persons do not visit the clinic and hence clinicians cannot evaluate the infection. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e452-e453 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yu Seo More articles by this author Gil Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin.

BackgroundAzithromycin has been widely used for Mycoplasma genitalium treatment internationally. However, the eradication efficacy has substantially declined recent decade. In Russia, josamycin (another macrolide) is the recommended first-line treatment for M. genitalium infections, however, no data regarding treatment efficacy with josamycin and resistance in M. genitalium infections have been internationally published. We examined the M. genitalium prevalence in males attending an STI clinic in Moscow, Russia from December 2006 to January 2008, investigated treatment efficacy with josamycin in male urethritis, and monitored the M. genitalium DNA eradication dynamics and selection of macrolide resistance in M. genitalium during this treatment.MethodsMicroscopy and real-time PCRs were used to diagnose urethritis and non-viral STIs, respectively, in males (n = 320). M. genitalium positive patients were treated with recommended josamycin regimen and treatment efficacy was monitored using quantitative real-time PCR. Macrolide resistance mutations were identified using sequencing of the 23S rRNA gene.ResultsForty-seven (14.7%) males were positive for M. genitalium only and most (85.1%) of these had symptoms and signs of urethritis. Forty-six (97.9%) males agreed to participate in the treatment efficacy monitoring. All the pre-treatment M. genitalium specimens had wild-type 23S rRNA. The elimination of M. genitalium DNA was substantially faster in patients with lower pre-treatment M. genitalium load, and the total eradication rate was 43/46 (93.5%). Of the six patients with high pre-treatment M. genitalium load, three (50%) remained positive post-treatment and these positive specimens contained macrolide resistance mutations in the 23S rRNA gene, i.e., A2059G (n = 2) and A2062G (n = 1).ConclusionsM. genitalium was a frequent cause of male urethritis in Moscow, Russia. The pre-treatment M. genitalium load might be an effective predictor of eradication efficacy with macrolides (and possibly additional antimicrobials) and selection of macrolide resistance. Additional in vivo and in vitro data are crucial to support the recommendation of using josamycin as first-line treatment for M. genitalium infections in Russia. It would be valuable to develop international M. genitalium management guidelines, and quantitative diagnostic PCRs determining also M. genitalium load and resistance mutations (for macrolides and ideally also moxifloxacin) should ideally be recommended.

P3-S1.23 Mycoplasma genitalium in South African men with and without symptoms of urethritis: diagnosis and bacterial load

ObjectivesTo diagnose causes of urethritis in symptomatic men and evaluate the role of Mycoplasma genitalium by calculating bacterial loads in urine specimens from symptomatic and asymptomatic men.MethodsUrine specimens from 94...

Association of Mycoplasma genitalium with acute non-gonococcal urethritis in Russian men: a comparison with gonococcal and chlamydial urethritis

Urethral specimens from 172 men who attended sexually transmitted disease clinics in the Moscow Oblast were examined for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium by nucleic acid amplification tests. N. gonorrhoeae was detected in the urethra of 41 (24%) of the 172 men and C. trachomatis in 57 (33%). The latter occurred in 15 (36%) of the 41 men who were infected by N. gonorrhoeae and in 42 (32%) of 131 uninfected by gonococci. Of the 42 men uninfected by gonococci but chlamydia infected, 39 (93%) had symptoms and/or signs of urethritis. M. genitalium was detected in 45 (26%) of the 172 men, in nine (22%) of the 41 men infected with N. gonorrhoeae and in 12 (21%) infected with C. trachomatis. M. genitalium was detected alone in 25 (28%) of the 89 men uninfected by either gonococci or C. trachomatis. Of these 25 men, 24 (96%) had urethral symptoms and signs of inflammation, a proportion significantly more than experienced by the 64 men uninfected by any of the microorganisms. Of the 31 men who apparently had no symptoms or signs of urethritis, only three (10%) were infected by M. genitalium. The data provide evidence for the pathogenicity and frequent occurrence of M. genitalium in men in Moscow and presumably elsewhere in Russia.

High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study

Objectives:To measure the prevalence of urethral infections including trichomoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the...

Detecting urethral and prostatic inflammation in patients with chronic prostatitis

Objectives. Diagnosis of urethral and prostatic inflammation can represent a challenge. We compare the accuracy of diagnostic methods for detecting inflammation in lower urinary specimens/samples. Methods. A standardized protocol was used to evaluate urethral smear, first-void urine (VB1), midstream urine (VB2), expressed prostatic secretions (EPS), and postmassage urine (VB3) in urologic patients with no symptoms or signs of urethritis who were attending our prostatitis clinic. Results. Of 235 subjects, 60 (26%) had leukocytes detected by the Gram-stained urethral smear, 44 (18%) by the VB1, and only 14 (6%) by the VB2. Compared with the urethral swab, VB1 had 0% to 22% sensitivity and 81% to 98% specificity, and VB2 had 8% to 11% sensitivity. Of 83 subjects with prostatic inflammation, the EPS detected 63 (76%) and the VB3 detected 68 (82%). Conclusions. VB1 or VB2 examinations had low sensitivity for detecting urethral inflammation. Examining both the EPS and VB3 proved best for detecting prostatic fluid inflammation. Combining the urethral smear with lower urinary tract localization (“four-glass test”) represents an optimal approach for detecting urethral and prostatic inflammation.

DETECTION OF MYCOPLASMA GENITALIUM IN PATIENTS WITH URETHRITIS

Purpose We attempted to detect Mycoplasma genitalium in urethral swab specimens by a polymerase chain reaction based assay to determine the prevalence of M. genitalium in patients with urethritis. Materials and Methods We examined a total of 171 Japanese men who presented to our hospital from February 1995 through January 1997. Of these men 150 had symptoms and signs compatible with acute urethritis and 21 had no symptoms or signs of urethritis. Urethral swab specimens were used to culture Neisseria gonorrhoeae, to detect Chlamydia trachomatis by an enzyme immunoassay and to detect M. genitalium by a polymerase chain reaction based assay. Results Gonococcal urethritis was diagnosed in 74 symptomatic men, and nongonococcal urethritis was diagnosed in 76 symptomatic men. Of the 74 cases of gonococcal urethritis 3 (4.1%) were positive for M. genitalium, and 14 (18.9%) were positive for C. trachomatis. Of the 76 cases of nongonococcal urethritis 10 (13.2%) were positive for M. genitalium, and 42 (55.2%) were positive for C. trachomatis. While only 1 of the 42 cases with chlamydial nongonococcal urethritis (2.4%) was positive for M. genitalium, 9 of the 34 chlamydia negative nongonococcal urethritis cases (26.5%) were positive for the mycoplasma. In contrast, all 21 cases men were negative for N. gonorrhoeae, M. genitalium, and C. trachomatis. Conclusions The prevalences of M. genitalium in patients with gonococcal urethritis and nongonococcal urethritis who attended our clinic were 4.1 and 13.2%, respectively. M. genitalium was detected significantly more often in men with nongonococcal urethritis than in asymptomatic men. In addition, its prevalence in men with chlamydia negative nongonococcal urethritis (26.5%) was significantly greater than in those with chlamydia positive nongonococcal urethritis (2.4%). These findings suggest that M. genitalium may be associated with the development of nongonococcal urethritis independent of C. trachomatis.

STD rapid assessment in Rwandan refugee camps in Tanzania.

OBJECTIVE: To obtain baseline information on sexually transmitted diseases (STDs) in the Rwandan refugees camps in Tanzania, prior to establishment of STD services. SETTING: The largest camps of Rwandan refugees...

Factors affecting urine EIA sensitivity in the detection of Chlamydia trachomatis in men.

This study examined the effects of four variables on the detection of Chlamydia trachomatis in urine from men by enzyme immunoassay (EIA). These variables were: symptoms and signs of urethritis, urine polymorphonuclear leucocytes (PMN), inclusion counts from urethral chlamydia cell cultures and the time between testing and last voiding. Included were patients with and without symptoms and/or signs of urethritis attending the Edmonton Sexually Transmitted Disease Clinic. Men were asked to submit a 20 ml volume urine sample. Urethral swabs were collected for gram stain, chlamydia and gonorrhea culture. A total of 318 men were evaluated of whom 47 had chlamydia. Excluding six men who were coinfected with gonorrhoea, sensitivities and specificities of the Microtrak, Chlamydiazyme and IDEIA systems were 78.1% and 99.6%, 75.6% and 100%, and 80.5% and 97.8% respectively. Last void time did not affect the sensitivity. However, sensitivity was best when applied to men with severe evidence of urethritis. There is evidence that urine EIA could be used to detect chlamydia in men with acute urethritis but not in those without signs of urethritis.

Clinical manifestations of trichomoniasis in men.

To determine the prevalence and clinical manifestations of trichomoniasis among sexually active men. Survey of two groups of men attending a sexually transmitted disease clinic. Subjects had a comprehensive sexual history and clinical examination plus cultures for Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis. The study included 147 sexual partners of women with trichomoniasis and 300 subjects selected randomly from heterosexual men coming to the same clinic for evaluation of new problems. Isolation of T. vaginalis was compared with urogenital signs and symptoms. The prevalence of T. vaginalis was 33 of 147 (22% [95% CI, 16% to 29%]) among sexual contacts of women with trichomoniasis and 17 of 300 (6% [CI, 3% to 9%]) among heterosexual men attending the same clinic. Men with trichomoniasis alone were more likely to complain of urethral discharge (P < 0.01), to have discharge on examination (P < 0.03), and to have inflammatory cells in their urethral secretions (P < 0.01) than were men who did not have T. vaginalis, N. gonorrhoeae, or C. trachomatis. Trichomonas vaginalis remained associated with nongonococcal nonchlamydial urethritis (adjusted odds ratio 3.8; CI, 1.1 to 11.2) after adjustment for race, age, number of sex partners in the previous 6 months, exposure to a partner with trichomoniasis, and history of trichomoniasis, urethritis, or gonorrhea. Trichomoniasis was common among men at risk for sexually transmitted diseases and was associated with symptoms and signs of urethritis.

Efficacy of ofloxacin in the treatment of non-gonococcal urethritis in men and genital infections caused by Chlamydia trachomatis in men and women.

The efficacy of ofloxacin was evaluated in 30 men with non-gonococcal urethritis (NGU) and 17 women with Chlamydia trachomatis infection of the cervix. All were treated with ofloxacin 200 mg twice daily for seven days. Before treatment, Ch. trachomatis was isolated from 11 (37%) of the 30 men with NGU. Of these 30 men, the symptoms and signs of urethritis were eliminated in 20 (67%) two weeks after completion of ofloxacin therapy. Ch. trachomatis was not re-isolated from any of the 11 men with positive isolation before treatment. All of the group of 17 women with Ch. trachomatis infection of the cervix had complete cure two weeks after completion of ofloxacin treatment. Ofloxacin appears to be an effective treatment for lower genital tract infections with Ch. trachomatis in men and women and its efficacy in NGU appears to be comparable to standard tetracycline therapy.

Isolation of Neisseria gonorrhea from the Urethra of Asymptomatic Adolescent Males

Symptomatic infection with Neisseria gonorrhea (NG) has become a major health problem in the adolescent population. While sexually active adults, who carry Neisseria gonorrhea may serve as a reservoir of infection even when asymptomatic, there are few data documenting the frequency of the asymptomatic carrier state in adolescent males. The purpose of this study was to determine the frequency of NG isolates in a sample of asymptomatic adolescent males (ages 13-18 years). Urethral cultures and gram stains were performed on 249 males (95% black) from a lower socioeconomic background presenting to an adolescent clinic for routine health care. Of the 249 males cultured, 177 were without symptoms or signs of urethritis. NG were isolated from four (2.26%) patients (Z = 2.03, p less than or equal to 0.043). They were also isolated from 65 (90.3%) of the remaining 72 who had either symptoms or signs of urethritis. Although 26% of the patients had documented gonococcal disease, only 8% offered a genitourinary complaint at the time of initial evaluation. Our data indicate a low but statistically significant incidence of NG colonization comparable to that found in adult males in this population of asymptomatic adolescent males.

Diagnosis ofChlamydia trachomatisInfections by Direct Immunofluorescence Staining of Genital Secretions

Because few clinicians have access to laboratories offering cell culture confirmation of suspected Chlamydia trachomatis genital infections, we evaluated a diagnostic method in which fluorescein-conjugated monoclonal antibodies were used to directly identify C. trachomatis elementary bodies in slides made from genital secretions. Compared with culture results, the direct smear had a sensitivity of 92% and a specificity of 96% in 576 men, most of whom had symptoms and signs of urethritis. Among 595 women attending the same clinics, sensitivity of the direct smear for cervical infection was 89% and specificity was 99%. In 225 pregnant women screened in a prenatal or abortion clinic, the sensitivity and specificity of the test were 86% and 99% respectively. Direct detection of elementary bodies in genital smears offers an alternative diagnostic approach for C. trachomatis infections.

Chlamydia trachomatis urethral infections in men. Prevalence, risk factors, and clinical manifestations.

Twelve percent of 596 men presenting to a sexually transmitted disease clinic had positive urethral cultures for Chlamydia trachomatis, and 53% had microimmunofluorescent antibody to chlamydia. Prevalence of C. trachomatis urethral infection was greater in heterosexual than homosexual men (14% versus 5%; p less than 0.01), in men under 20 years of age, and in blacks. Only 10% of men with gonococcal urethral infection lacked symptoms or signs of urethritis, whereas nearly 25% of men with C. trachomatis urethral infection had no signs and symptoms, 33% lacked abnormal numbers of leukocytes on urethral Gram stain, and 50% were identified and treated solely on the basis of a screening culture. The number of newly diagnosed cases found by screening cultures was 1.3 per 100 cultures for gonorrhea but 5.5 per 100 for chlamydial infection. Clinicians appropriately treated 91% of men with gonococcal urethritis on their initial visit before culture results were available versus only 51% of men with chlamydial urethral infection. Asymptomatic urethral infections in men eventually contribute to chlamydial infections in women, and culture screening for their detection appears warranted in high-risk populations.

Anaerobes in men with urethritis.

Sixty-four men with non-gonococcal urethritis (NGU), seven with gonococcal urethritis (GU), and 30 who had no symptoms or signs of urethritis were studied. Chlamydia trachomatis was isolated from urethral specimens taken from 22% of the men with NGU, and 18% with GU, but not from those who did not have urethritis even though 20 (67%) of them had a history of NGU, GU, or both. The chlamydial isolation rate for men having NGU for the first time was 30%. Ureaplasma urealyticum was isolated from 42% of the men with NGU, 43% of men with GU, and 27% of those without urethritis.In addition to aerobes anaerobes were isolated frequently from men whether or not they had urethritis, the most common being anaerobic Corynebacteria, peptococci, and micro-organisms of the Bacteroides-Fusobacteria group. There was no appreciable difference in the overall isolation of anaerobes from men with NGU (89%) or from those without disease (80%). The rate of isolation of a Gram-negative anaerobic bacillus from men with NGU (50%) was, however, strikingly different to that from men with GU (14%) or from those without disease (13%). Furthermore, this bacillus was recovered from 28 (56%) of 50 men with NGU who were considered chlamydia-negative and from 19 (61%) of 31 men who were both chlamydia-negative and ureaplasma-negative. The effect of antibiotic treatment was evaluated in a few patients only, so that although those from whom the Gram-negative bacillus was eliminated by tetracycline recovered clinically there is a need for a prospective therapeutic trial to evaluate further the importance of the bacillus.

One-week treatment of chlamydia-positive urethritis with doxycycline and tetracycline chloride in males

65 patients with chlamydia-positive urethritis were treated with doxycycline and 59 with tetracycline chloride 1 g/day for one week. All steady sexual partners of these patients were treated with the same regimen during the same period. At control visits 2 and 3 weeks after the beginning of the treatment, all re-examined doxycycline-treated patients and all except 4 tetracycline-treated patients showed clinical cure and were free from signs of urethritis in the microscopical examination of Gram-stained smears from the urethra. Isolation of C. trachomatis was positive in 7 of the doxycycline-treated and 10 of the tetracycline-treated patients at the first control visit and in one more tetracycline-treated patient at the second control visit. The study stresses the importance of attempts to isolate C. trachomatis in cases without clinical or microscopical evidence of nongonococcal urethritis at control visits after short-term treatment with tetracyclines. The present investigation indicates that this is true also in cases in which all steady sexual partners are treated simultaneously.

Evaluation of urethral culture for Neisseria gonorrhoeae in the routine investigation of men attending a STD clinic.

Urethral gonorrhoea was diagnosed by culture in 957 (18.8%) of 5076 new male patients attending a sexually transmitted diseases clinic; the infection was asymptomatic in 38 (4%) of these patients. The diagnosis in only six (0.3%) out of 2159 men with urethral gonorrhoea but with no symptoms or signs of urethritis would have been missed if urethral cultures had not been performed.