Corymbiform syphilis associated with three other sexually transmitted infections

Abstract: Secondary syphilis can have different clinical presentations, with corymbiform rash as its rarest manifestation. The disease is characterized by a central papule surrounded by smaller ones. We report the case of a man who has sex with man with corymbiform syphilis. The patient was subsequently diagnosed with HIV infection, hepatitis B, non-gonococcal urethritis, as well as infection of the central nervous system by treponema. This case not only illustrates a rare presentation of secondary syphilis, but also demonstrates the importance of further investigation of sexually transmitted infections, particularly among at-risk patients.

Prevalence and risk factors for scrotal lesions/anomalies in a cohort of Brazilian men ? 40 years of age / Prevalência e fatores de risco de lesões escrotais em uma população de brasileiros com idade ? 40 anos

OBJECTIVE: To estimate the prevalence of and risk factors for cutaneous lesions of the scrotum and intrascrotal lesions/anomalies among men included in a prostatic cancer screening program in a Brazilian metropolitan city. DESIGN AND SETTING: Cross-sectional study, private outpatient healthcare service. METHODS: 1731 men aged 40 years or over, participating in a prostate cancer screening program conducted by the municipal public employees' healthcare system, underwent systematic urological assessment by a single examiner. RESULTS: The prevalence of scrotal diseases in our sample was 44.7% (773/1731). Tinea cruris occurred in 203 (11.7%) of the participants, with higher risk among diabetics and lower prevalence among nonwhite individuals; scrotal tinea in eight (0.5%), with higher risk among hypertensive men; subcutaneous nodules in 12 (0.7%), especially in individuals with low schooling level; hydrocele in 283 (16.4%), with higher frequency among participants over the age of 60 years, diabetics or individuals with previous histories of nonspecific urethritis; spermatoceles in 174 (10.1%), with greater prevalence among individuals over the age of 60 years or diabetics, and lower frequency among individuals who underwent vasectomy; unilateral testicular hypotrophy/atrophy in 167 (9.7%) and bilateral hypotrophy/atrophy in 93 (5.4%), both occurring more frequently in individuals over the age of 60 years; absence of palpable testicles due to cryptorchidism in 7 (0.4%); and epididymitis/orchitis in 5 (0.3%), with higher prevalence among diabetics. No cases of cancer were identified in this sample. CONCLUSIONS: Scrotal diseases were highly prevalent in this population of Brazilian men. .

OBJETIVO: Estimar a prevalência e fatores de risco de lesões cutâneas do escroto e de lesões/anomalias intraescrotais entre participantes de programa de rastreamento para câncer de próstata em uma cidade metropolitana brasileira. TIPO DE ESTUDO E LOCAL: Estudo transversal, serviço privado de atendimento ambulatorial à saúde. MÉTODOS: 1.731 homens com idade igual ou superior a 40 anos, participantes do programa de rastreamento de câncer de próstata conduzido pelo sistema de saúde dos funcionários públicos municipais, foram submetidos à avaliação urológica sistemática por um único examinador. RESULTADOS: A prevalência de doenças escrotais nossa amostra foi de 44.7% (773/1731). Tinea cruris ocorreu em 203 (11,7%) dos participantes, com maior risco em diabéticos e menor prevalência em indivíduos não brancos; tinea escrotal em oito (0,5%), com maior risco em homens hipertensos; nódulos subcutâneos em 12 (0,7%), especialmente em indivíduos com baixa escolaridade; hidrocele em 283 (16,4%), com maior frequência nos participantes com mais de 60 anos, diabetes ou história prévia de uretrite inespecífica; espermatoceles em 174 (10,1%), com maior prevalência acima dos 60 anos de idade ou com diabetes, e menor frequência naqueles submetidos a vasectomia; hipotrofia/atrofia testicular unilateral em 167 (9,7%) e hipotrofia/atrofia bilateral em 93 (5,4%), ambas ocorrendo mais frequentemente nos indivíduos com mais de 60 anos; ausência de testículos palpáveis devido à criptorquidia em 7 (0,4%); e epididimite/orquite em 5 (0,3%), com prevalência aumentada em diabéticos. Não foram identificados casos de câncer nesta amostra. CONCLUSÕES: As doenças escrotais foram altamente prevalentes nesta população ...

Comprehensive analysis of etiology on the prognosis of urethral strictures

INTRODUCTION: Urethral strictures remain a reconstructive dilemma, due to high incidence of recurrence and less than satisfactory outcomes. Even experienced surgeons following strict surgical principles have not achieved optimal results, leading us to think whether the etiology of strictures dictate the outcome . We evaluated this "cause-effect" relationship highlighting the significance of the etiology on the overall prognosis of urethral strictures. MATERIALS AND METHODS: A total of 302 males with urethral strictures were assessed (both retrospectively and prospectively) over a period of ten years. The preoperative evaluation was performed by retrograde urethrogram, urethrosonogram, and uroflowmetry and categorized, based on etiology: a) as post traumatic, b) post infective, c) iatrogenic or d) unknown. Traumatic strictures were subjected to pelvic X-ray and sub-categorized into grades A, B and C, following the TILE classification. Patients were operated; with tunica albuginea urethroplasty for anterior strictures and U shape prostato-bulbar anastomosis for posterior strictures. RESULTS: Traumatic strictures accounted for 54 percent of cases. 127 of the 302 patients were treated using Tunica Albuginea Urethroplasty, while U shaped Prostatobulbar Anastomosis was performed on others. Post traumatic strictures had best outcome whereas post infective strictures had the worse outcome. Among strictures following pelvic fractures, TILE grades A and B had a better post operative course as compared to TILE C. Overall complication rate was 13.24 percent. CONCLUSION: Our study demonstrated that etiology of urethral strictures may play a vital role for the overall prognosis of urethral strictures.

Infección por Chlamydia trachomatis en varones y su asociación con las alteraciones ginecológicas de su compañera sexual / Chlamydia trachomatis infection in men and its association to gynecologic alterations of his sexual mate

Objective.To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatologia, as well as to compare the clinical data and lifestyle between C. trachomatis-inifected and uninfected men to establish a possible association with gynecological damage in their sexual female partners. Methods. An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatologia between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hibridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analize clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05. Results. C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation o/Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR= 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR =2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5). Conclusion. A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C trachomatis.

Objetivo. Determinar la frecuencia de infección por Chlamydia trachomatis y comparar la información clínica y el estilo de vida de varones con y sin infección por este patógeno, así como su asociación con las alteraciones ginecológicas que presenta su compañera sexual en un grupo de parejas que asisten a la Clínica de Infertilidad del Instituto Nacional de Perinatologia de la Ciudad de México. Métodos. Se realizó un estudio abierto, longitudinal y prospectivo en un grupo de parejas con diagnóstico de infertilidad, que fueron tratadas en el Instituto Nacional de Perinatologia durante el periodo de junio del 2000 a abril del 2001. Se recolectaron muestras uretrales y cervicales de cada pareja para el diagnóstico de C. trachomatis mediante la prueba de hibridación en fase líquida (PACE-2). También se recolectaron muestras de semen para el análisis de espermatobioscopia y se hicieron cultivos microbiológicos de rutina a las muestras cervicales y de semen. Los datos microbiológicos, clínicos y ginecológicos de los participantes fueron comparados por %z, el análisis de tendencia para proporciones fue usado para establecer el nivel de riesgo en las variables (RR). Las diferencias fueron consideradas estadísticamente significativas si p < 0.05. Resultados. Se analizaron un total de 384 muestras uretrales de varones, 14 presentaron infección activa por C. trachomatis (3.6%), Los datos de espermatobioscopia de los individuos positivos a C. trachomatis no mostraron alteraciones significativas con respecto al de varones no infectados con esta bacteria. El análisis microbiológico del semen mostró un número de aislamientos significativos de infección por Mycoplasma sp. (RR = 5.87, IC95% 1.40-24.70). En cuanto a las muestras cervicovaginales de mujeres con compañero sexual infectado por C. trachomatis, los patógenos aislados con mayor frecuencia fueron: Candida albicans en ocho de 14 (RR = 1.89, IC95% 1.17-3.05) y C. trachomatis en ocho de 14 (RR = 10.57, IC95% 5.67-19.7). Las asociaciones ginecológicas y obstétricas de la compañera sexual de varones positivos a C. trachomatis fueron adherencias tubáricas en 10 de 14 (RR = 1.54, IC95% 1.08-2.18), salpingitis en dos de 14 (RR = 2.2), antecedentes de embarazos ectópicos en 11 de 14 casos (RR = 2.94, IC95% 1.01-8.53) y abortos previos en nueve de 14 (RR = 1.5). Conclusión. Se observó una baja prevalencia de infección por C. trachomatis en los varones de mujeres infértiles en comparación con lo reportado por otros autores, esta diferencia puede estar dada por el método de diagnóstico y la toma del producto. Estos resultados sugieren que el estímulo constante del patógeno produce un aumento de adherencias tubáricas y embarazos ectópicos en las compañeras sexuales de los varones infectados con C. trachomatis. Por lo que una evaluación diagnóstica y de laboratorio deberá ser llevada a cabo en el varón como una medida de prevención y control para la infección por este patógeno, ya que estos individuos actúan como reservónos importantes de infección.

Chlamydia trachomatis como factor de esterilidad en la pareja: proyeccion inicial / Chlamydia trachomatis as a factor in sterility of the couple

El diagnostico y tratamiento de la Chlamydia trachomatis como factor de esterilidad en la pareja humana y como causa de infertilidad en la mujer gestante, es algo mas o menos raro en la nosografia publicada y se constituia, hasta hace unos años, en un poco frecuente hallazgo en la practica de la especialidad. Sin embargo, recientemente con los medios biotecnologicos a nuestro alcance, su frecuencia, investigacion y tratamiento se han convertido en una necesidad en la metodologia de diagnostico, tanto de la pareja que no logra gestaciones, como de aquella en la que el embarazo no culmina afortunadamente. La comunicacion es una proyeccion inicial de un trabajo mayor de proxima publicacion.

Rosoxacin in the treatment of uncomplicated acute gonococcal urethritis.

A total of 112 male patients presenting with acute gonococcal urethritis were admitted to the hospital. The diagnosis was confirmed by smear, culture, oxidase reaction and sugar fermentation tests. The patients were treated with a single 300 mg capsule of rosoxacin. All patients except one showed adequate response to rosoxacin.

Prevalence of chlamydial infection in patients with gonococcal urethritis.

Using a fluorescein labelled monoclonal antibody ("Microtrak") to identify Chalmydia elementary bodies in urethral smears, we detected Chlamydia trachomatis in 32 (26.67%) of 120 male patients after treatment of their gonococcal urethritis. Sixteen of these 32 patients (50%) had normal urethral smear. Only 16 (50%) of the patients yielding chlamydia would have received treatment in the absence of diagnostic service for chlamydial infection.

Uretrite nao gonococica: atualizacao clinica e terapeutica / Nongonococcal urethritis: clinical and therapeutic updating

A uretrite nao gonococica pode ser produzida em 60 a 80% dos casos por Chlamydia trachomatis ou Ureaplasma urealyticum. Nos demais pacientes quase sempre nenhum micro-organismo e encontrado. A doenca produz secrecao uretral nao muito intensa e sintomas uretrais mais discretos mas o seu indice de recidiva pode ser tao alto quanto 30%. O tratamento recomendado e o uso de tetraciclina tendo como alternativa a eritromicina por 7 dias. As recorrencias causam as vezes grande sofrimento emocional e sao de dificill manejo clinico. A epididimite e talvez a sindrome de Reiter sao complicacoes desta doenca

Uretritis masculina: importancia de la chlamydia trachomatis y de otros agentes

Se estudiaron 100 hombres para definir la etiología de su uretritis mediante exámenes directos y cultivos para Neisseria gonorrhoeae e inmunofluorescencia directa para Chlamydia trachomatis. Se halló infección por Chlamydia en 31 pacientes y por Neisseria en 16; había infección mixta en siete individuos y TRICHOMONAS VAGINALIS en uno; no se demostró ninguno de estos agentes en 45 casos. La evolución fue significativamente más larga en los pacientes con chlamydiasis y en los de uretritis de etiología desconocida. En la uretritis por Chlamydia la secreción uretral fue escasa y de características acuosa, mucoide o mixta; asimismo fue frecuente la ausencia de secrecion en los pacientes con uretritis no goncóccica. Se llama la atención hacia la necesidad de estudiar la importancia de la infección por Chlamydia trachomatis