Infecciones bacterianas del tracto reproductivo masculino y su papel en la fertilidad / Bacterial infections of the male reproductive tract and their role in fertility

Antecedentes: El espermatozoide es una célula altamente especializada encargada de llevar el material genético paterno hasta el tracto reproductivo femenino en búsqueda del oocito, no obstante durante su desplazamiento puede interactuar con sustancias, otras células e incluso microorganismos que puede transportar desencadenando procesos infecciosos que alteran el éxito reproductivo. Objetivo: Describir las bacterias involucradas en la alteración de la función reproductiva y sus efectos sobre calidad espermática, así como la capacidad de los espermatozoides para transportar infecciones y diseminarlas al tracto reproductivo femenino. Resultados: Las infecciones bacterianas que afectan el tracto reproductivo masculino se clasifican en infecciones de transmisión sexual, del tracto urinario y las asociadas a la microbiota bacteriana, donde están implicadas una gran variedad de agentes etiológicos como Chlamydia trachomatis, Ureoplasma urealyticum, Mycoplasma hominis, Escherichia coli y los Staphyloccoccus coagulasa negativos. Aún es controversial el efecto de estos gérmenes sobre los parámetros seminales así como la presencia de microbiota en el semen; su diagnóstico depende de la calidad de la muestra, de la sensibilidad de la técnica de detección y de los factores de riesgo que presente el individuo. Conclusión: Los procesos inflamatorios e infecciosos en el trato reproductivo masculino influyen en la fertilidad, por lo que se requiere profundizar en el estudio de estos procesos, establecer más y mejores métodos diagnósticos y pautas para el autocuidado que disminuyan la propagación de estos agentes patógenos.

Introduction: Spermatozoon is a highly specialized cell responsible for carrying the paternal genetic material toward the oocyte. During its journey in the female reproductive tract, the sperm cell interacts with substances, cells and also microorganisms that can be transported, thus triggering infectious processes that could alter reproductive success. Objective: Describe the species of bacteria involved in the alteration of sperm cells reproductive function and their effect on the sperm quality. In addition, evaluate the ability of the sperm cell to carry infections and disseminate them in the female reproductive tract. Results: Bacterial infections that affect the male reproductive tract are classified as sexually transmitted infections, urinary tract infections, and infections associated with bacterial microbiome. Chlamydia trachomatis, Ureoplasma urealyticum, Mycoplasma hominis, Escherichia coli and coagulase-negative Staphylococcus are the main etiologic agents of these infections. The presence of bacteria in semen and their effect of in semen parameters are still controversial. To probe that bacteria are present in semen depends on the quality of the sample, the sensitivity and specificity of the detection technique and the patient risk factors. Conclusion: Inflammatory and infectious processes in the male reproductive treatment affect fertility; therefore, further study of the role of thoseprocesses, establishment of more and better diagnostic methods and guidelines for self-care to decrease the spread of these pathogens will be necessary.

Feo-hifomicose subcutânea por Exophiala jeanselmei localizada na bolsa escrotal: relato de caso / Subcutaneous phaeohyphomycosis on the scrotum caused by Exophiala jeanselmei: case report

A feo-hifomicose subcutânea é uma doença causada por fungos demáceos que acomete principalmente indivíduos imunocomprometidos e geralmente cursa com lesões localizadas nos membros inferiores. Os autores relatam um caso de feo-hifomicose subcutânea em um paciente imunocompetente, com localização atípica - na hemibolsa escrotal esquerda -, tratado com sucesso com fluconazol sistêmico associado à excisão cirúrgica.

Subcutaneous phaeohyphomycosis is a disease caused by dematiaceous fungi that develops mainly in immunocompromised patients. Lesions are generally located on the lower limbs. The present report describes a case of phaeohyphomycosis in an immunocompetent patient in whom a subcutaneous abscess was located in an unusual site, on the left hemiscrotum. The abscess was treated successfully with oral fluconazole associated with surgical excision.

Impact of infection on the secretory capacity of the male accessory glands

INTRODUCTION: Studies that compare the impact of different infectious entities of the male reproductive tract (MRT) on the male accessory gland function are controversial. MATERIAL AND METHODS: Semen analyses of 71 patients with proven infections of the MRT were compared with the results of 40 healthy non-infected volunteers. Patients were divided into 3 groups according to their diagnosis: chronic prostatitis NIH type II (n = 38), chronic epididymitis (n = 12), and chronic urethritis (n = 21). RESULTS: The bacteriological analysis revealed 9 different types of microorganisms, considered to be the etiological agents, isolated in different secretions, including: urine, expressed prostatic secretions, semen and urethral smears: E. Coli (n = 20), Klebsiella (n = 2), Proteus spp. (n = 1), Enterococcus (n = 20), Staphylococcus spp. (n = 1), M. tuberculosis (n = 2), N. gonorrhea (n = 8), Chlamydia tr. (n = 16) and, Ureaplasma urealyticum (n = 1). The infection group had significantly (p < 0.05) lower: semen volume, alpha-glucosidase, fructose, and zinc in seminal plasma and, higher pH than the control group. None of these parameters was sufficiently accurate in the ROC analysis to discriminate between infected and non-infected men. CONCLUSION: Proven bacterial infections of the MRT impact negatively on all the accessory gland function parameters evaluated in semen, suggesting impairment of the secretory capacity of the epididymis, seminal vesicles and prostate. These findings were associated with an infectious related significant increase of semen pH. None of the semen parameters evaluated can be suggested as a diagnostic tool for infection.

Aplicación de método molecular en la detección de Mycoplasma genitalium en hombres y en mujeres embarazadas / Molecular detection of Mycoplasma genitalium in men and pregnant women

Mycoplasma genitalium es un patógeno oportunista del tracto genital. En el hombre es causa de uretritis, en tanto que en mujeres ha sido implicado en la etiología de cervicitis y de enfermedad inflamatoria pelviana (EIP). El objetivo de este estudio fue determinar la prevalencia de M. genitalium en pacientes masculinos con uretritis y en muestras vaginales de mujeres embarazadas. Se obtuvo muestras de secreción uretral en 37 pacientes con uretritis y de muestras vaginales de 50 consecutivas mujeres embarazadas, determinándose la presencia de M. genitalium mediante reacción de polimerasa en cadena (RPC). Las muestras de secreción uretral fueron también evaluadas en busca de Chlamydia trachomatis, Neisseria gonorrhoeae y Ureaplasma sp en tanto que en las de origen vaginal se investigó la microbiota y presencia de micoplasmas de tipo genital. Veintitrés casos fueron clasificados como uretritis no gonocóccica (UNG) y 14 como enfermedad gonocóccica. M. genitalium fue detectado en 3 de 23 (13,04 por ciento) varones con UNG; en dos casos asociado a Ureaplasma sp, y en un paciente como agente único. C. trachomatis fue detectado en 7 pacientes con UNG y en uno con gonorrea. Ureaplasma sp fue aislado en 13 (35,1 por ciento) pacientes, 8 casos de UNG y en 5 con gonorrea. El microorganismo fue detectado también en 6 (15 por ciento) de 40 mujeres; en 5 casos en presencia de microbiota normal (score de Nugent 0-3), y en un caso en presencia de vaginosis bacteriana. Ureaplasma spp fue aislado en las seis muestras positivas. En conclusión, este estudio demuestra que M. genitalium debe ser también considerado en la etiología de la UNG así como en el tracto genital inferior en la mujer embarazada, en presencia de una microbiota vaginal normal.

Chlamydia in pelvic inflammatory disease

Pelvic inflammatory disease is one of the major public health problems in the world, both in the developing as well as developed countries. Genitourinary tract infections caused by Chlamydia trachomatis are most common sexually transmitted diseases. Fifty to seventy per cent of women suffering from chlamydial infection of the genital are symptom free and 25-30% of chlamydial urethritis is silent. Clinical presentation is varied. Laparoscopy is the gold standard in the diagnosis of Chlamydia associated pelvic infections. Treatment depends on the severity of the disease. Early diagnosis, prompt, accurate, aggressive and appropriate chemotherapy is essential to prevent its sequelae

Identificación de DNA de papilomavirus humano en condilomas anogenitales de una población masculina / DNA identification of human papillomavirus in anogenital condyloma of a male population

Human Papillomaviruses (HPV) are the cause of benign human anogenital lesions where HPV 6 and HPV 11 are most commonly found. Conversely, HPV 16, 18, 31 and 33 are frequently detected in genital carcinomas and are thus considered as oncogenic types. In order to analyze the prevalence of specific HPV types in an Argentine male population, 43 anogenital lesions from different patients with diagnosis of condyloma acuminata were analyzed. These lesions were localized in different regions of the male genitalia comprising the corona glandis, urethral meatus, skin of the penis, scrotum and anus. The biopsies were screened for the presence of HPV 6, 11, 16, 18, 30, 31 and 33 by Southern blot at different stringent conditions of hybridization (Tm -48 degrees C and Tm -20 degrees C). HPV DNA was found in 41 examined cases (95.3) with a clear prevalence of HPV 6 and HPV 11 types (51.2 and 23.3 respectively). Six samples (14.0) were positive only under nonstringent conditions of hybridization. Mixed infections between HPV 16, 18, 30, 31, 33 or a HPV 30 related type with HPV 6 or HPV 11 were detected in 8 specimens (18.6). Only one case was between HPV 16 and HPV 30. Two additional samples were only positive for HPV 30. Experiments in progress about the prevalence of HPV types in female lesions as well as in normal subjects will contribute to complete the description of the epidemiology of these infections in Argentina.

Influência da infecçäo genital por germes aeróbios sobre os parâmetros do sêmen humano em indivíduos com fertilidade comprovada / Influence of genital infection by aerobic germens on the parameters of human semen of subjects with confirmed fertility

Foi estudada a influência da infecçäo nos parâmetros do ejaculado, em 131 amostras de sêmen de homens clinicamente normais, cujas esposas estavam grávidas. Foram realizadas culturas para pesquisa de germes aeróbios, demonstrando-se a presença de infecçäo em 62,6% dos casos. Dos parâmetros analisados: viscosidade, tempo de liquefaçäo, volume, pH, número de espermatozóides (total e por mililitro de ejaculado), percentagem de formas móveis na primeira hora e percentagem de formas normais, somente a motilidade esteve alterada quando a espermocultura demonstrou a presença de germes considerados saprófitas