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.

PCR for Diagnosis of Male Trichomonas vaginalis Infection with Chronic Prostatitis and Urethritis

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.

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.

Diagnóstico de Mycoplasma genitalium por amplificación de los genes MgPa y ARN ribosomal 16S / Diagnosis of Mycoplasma genitalium by MgPa and rRNA 16S gene amplification

OBJETIVO: El microorganismo Mycoplasma genitalium se ha relacionado con la uretritis no gonocócica (UNG). La técnica de PCR se ha convertido en el principal método de detección de este patógeno. En consecuencia, debe aplicarse un método de diagnóstico mediante la amplificación de fragmentos de ADN por la técnica PCR. MATERIAL Y MÉTODOS: Se seleccionaron los cebadores MGF-MGR y MgPaF-MgPaR, complementarios de los genes de ARNr 16S y MgPa de M. genitalium, respectivamente. Se efectuaron ensayos de especificidad y sensibilidad y se estudiaron muestras clínicas. RESULTADOS: La PCR con cada grupo de cebadores utilizado fue específica sólo para M. genitalium y la sensibilidad fue mayor con el grupo de cebadores MGF-MGR. En el estudio de 34 muestras clínicas, 18.5 por ciento fue positivo a M. genitalium y se encontró un mayor número de muestras positivas al utilizar los cebadores MgPaF-MgPaR. CONCLUSIONES: Debe aplicarse en la práctica clínica el diagnóstico de M. genitalium mediante la amplificación del ADN por PCR en los pacientes con UNG.

OBJECTIVE: Mycoplasma genitalium has been associated with nongonococcal urethritis (NGU). Diagnosis by PCR has become the primary detection method for this organism. Thus, diagnosis by DNA amplification using the PCR technique should be utilized. MATERIAL AND METHODS: GMF/GMR and MgpF/MgpR primer pairs, complementary to the M. genitalium 16S rRNA and MgPa genes, respectively, were selected. Specificity and sensibility assays were conducted and clinical samples were studied. RESULTS: The PCR with each primer pair was specific only for M. genitalium, and the sensibility was higher with the GMF/GMR primers. In the study of 34 clinical samples, 18,5 percent were positive for M. genitalium, with more positive samples when the MgpF/MgpR primers were used. CONCLUSIONS: DNA amplification by PCR should be applied in clinical practice to the diagnosis of M. genitalium in patients with NGU should using.

Urethral trichomoniasis in Iraqi females

Trichomonas vaginalis has long been recognized as a cause of infectious vaginitis in women. Different studies have demonstrated a significant burden of the parasite to cause urethritis as well. It has been assumed that the localization of parasite in the urethra may be responsible for the recurrence of vaginal infection. To evaluate the infection rate of urethral trichomoniasis and to evaluate two different laboratory methods used in the diagnosis. The present study consisted of 420 female patients presented with vaginal discharge with or without itching or disorient, investigated for urethral trichomoniasis who were compared to 50 females represented the control group. Each female was asked to collect first 10-20 ml of urine in a sterile screw capped bottle; the deposits were examined microscopically by: 1. Wet mount method for Trichomonas vaginalis. 2. Culture in a specific ready made culture media. At the same time high vaginal swabs were taken and examined by both wet mount and culture methods for vaginal trichomoniasis. Among 420 female patients examined for both urine sediments and vaginal swabs, 80 [19.04%] females were found to be positive for T. vaginalis by vaginal swabs. The parasite was seen either in the vagina alone in 39 [9.28%] or in the vagina and urethra in 41[9.76%], but it was never isolated from urethra alone. Trichomonas vaginalis is a common parasite of female urethra as well as of the vagina, the localization of this flagellate in the urethra may be responsible for the recurrence of vaginal infection, since it may survive in the urethra, possibly in the paraurethral glands [skene's] so when the treatment is limited to the vagina, this will often fail to reach the urethra and the trichomonads may contaminate the vagina following urination or serial intercourse, that is why systemic rather than local treatment is indicated

Tamizaje serológico y con PCR para determinar la prevalencia de Chlamydia trachomatis en pacientes con vaginosis y vaginitis inespecífica que asisten a hospitales de la Secretaría de Salud de Bogotá / Serologic and PCR screening to determine the prevalence of Chlamydia trachomatis in patients with vaginitis and inespecific vaginitis in two public hospitals in Bogotá

Chlamydia trachomatis (CT) es uno de los agentes etiológicos más importantes en las infecciones de transmisión sexual. En la mujer CT causa patologías tales como cervicitis, uretritis y enfermedad pélvica inflamatoria, entre otras. Los objetivos de este trabajo fueron determinar la prevalencia de la infección y la concordancia de las pruebas diagnósticas para CT en pacientes sintomáticas de vaginitis o leucorrea inespecífica, que asistieron al hospital Pablo VI de Bosa y al Hospital del Sur de Bogotá, durante los meses de junio y julio de 2004. Se obtuvieron 180 muestras simultáneas de suero y de orina para la determinación de IgG, IgM e IgA anticlamidia y para PCR, respectivamente. La detección de los anticuerpos para CT en suero se realizó mediante el método ELISA (VIRCEL) y la detección del DNA en orina se hizo con la prueba AMPLICOR CT PCR (ROCHE). La prevalencia de la infección fue del 31 porciento (56 casos). La mediana de edad en mujeres con evidencia de infección reciente o activa fue de 23 años; 37 pacientes (66)porciento positivas para algún marcador tenían infección activa. En 24 participantes (42.8)porciento con infección activa, de acuerdo con los resultados serológicos, no se detectó el DNA en orina; en 14 pacientes (25 porciento de las pacientes positivas en las pruebas serológicas) se encontró el PCR positivo en las muestras de orina. Una prevalencia del 31 porciento en mujeres sintomáticas indica que la infección por Chlamydia es un problema para la salud pública. Implantar un programa de tamizaje para la búsqueda activa de casos, así como la búsqueda activa de contactos sexuales, reducirá el peso socioeconómico de la infección. La prueba ideal para diagnóstico tanto de cervicitis como de uretritis en el mismo procedimiento deberá utilizar muestra de orina y de cepillado cervical.

Correlation between asymptomatic urethritis with bacteriospermia in seminal plasma of fertile and infertile men

Urogenital infection can influence the fertilization potential of the spermatozoa, which may lead to male infertility. The symptomatic urethiritis can change the semen parameters, however the role of asymptomatic urethirtis in fertility is still obscure. In this descriptive investigation, a total of 148 samples from urethra and semen of fertile as well as 146 samples from urethra and semen of infertiles men were examined for the presence of 5 bacterial species including streptococcus group A., Entercoccus, E.coli, coagulase positive and negative Staphylococcus. The rate of infection of urethra and semen of fertile men were 49.22% and 29.05%, respectively. The aforementioned rates were 34.9% and 60.27% for infertile men. The seminal infection was significantly different between two groups of fertile and infertile [p < 0.01]. The results showed that the most common pathogen in semen of fertile and infertile men was Entrococcus with prevalence of 32.60% [14 cases], and 42% [37 cases], respectively. A total of 90 out of 131 samples contaminated with bacteria showed high rate of Leuckocytes [pyospermia]. The remaining 41 infected samples lacked or had low number of leuckocytes. In conclusion, bacteriospermia is significantly higher in seminal samples of infertile than fertile men [p < 0.01]. Therefore, the pathogens involved in urethritis may be involved in male infertility. In addition, seminal culture is necessary for detection of bacteria presence in the semen, and thus it is important to note that presence or absence of Leukocyte in semen may not represent the urogenital infection

Chlamydia trachomatis y ureaplasma urealyticum / Chlamydia trachomatis and ureaplasma urealyticum

La etiología de la uretitis no gonocóccica trasciende las infecciones por chlamydia trachomatis y ureaplasma urealyticum. otros agentes etiológicos comunes son responsables de aproximadamente 20 por ciento de los casos y en un tercio no se precisa una etiología. Por esta situación se requiere de una nueva terminología para caracterizar mejor esta entidad. Test de amplificación genómica aplicados a la secreción uretral u orina son nuevas herramientas para un diagnóstico precoz de chlamydia trachomatis. El diagnóstico precoz es muy importante para evitar complicaciones y secuelas, especialmente infertilidad en mujeres, mediante un tratamiento oportuno y adecuado. Azitromicina, 1g oral, en dosis única es un avance significativo en el tratamiento de la uretritis causada por clamidias

Complicaciones urológicas del transplante riñon-pancreas / Urologic complications of the kidney-pancreas transplantation

Se analizan las complicaciones precoces ocurridas en los primeros 3 transplantes efectuados y que coinciden con las habitualmente publicadas I.T.U. hamaturia, uretritis, etc. Se presentan estas complicaciones y se analiza su manejo en cada caso. Se presentan estudios urodinámicos de los casos ya que vejigas de alta presión pueden ocacionar desde I.T.U. a pancreatitis del injerto. Se concluye que la mayoría de las complicaciones son precoces y con el transcurso del tiempo disminuye en frecuencia e intensidad

Uretritis y vulvovaginitis en pacientes en control en policlínicos de control sanitario y ETS / Urethritis and vulvovaginitis in patients at sanitary control and sexual transmission diseases clinics

Se analizan retrospectivamente 466 casos de uretritis y vulvovaginitis en pacientes de policlínico de control sanitario y de enfermedades de transmisión sexual en Concepción, entre mayo y octubre de 1995. Los hallazgos diagnósticos y microbiológicos son discutidos con una referencia especial a gonorrea, tricomonas, cándida y gardnerella. Se enfatiza la necesidad de experiencia y entrenamiento en este campo clínico, junto con una conceptualización adecuada para efectuar una diferenciación entre organismos patógenos y otros organismos presentes. Clamidias y micoplasmas no fueron estudiados y ameritan una investigación de rutina

mycofast [MF] as a means of diagnosing and determining the incidence of urogenital mycoplasma implicated in persistent and/or recurrent nongonococcal uretheritis in men

The current work was designed to test the value of Mycofast [MF], a new repid method of urogenital mycoplasma [UGM] detection, in the diagnosis of Ureaplasma urealyticum and Mycoplasma hominis implicated in persistent or recurrent nongonococcal uretheritis in male patients. We aimed also at determinig the incidence of these pathogens in such clinical condition. Three samples either uretheral discharge or first voided urine were collected from each of 66 patients attending the Venereology Clinic, Armed Forces Hospital, Kuwait, between January- June, 1990 and suffering from persistent or recurrent NGU. The first sample was used for N. gonorrhea isolation, the second for UGM isolation by conventional methods and the third for inoculation of the MF kit. No N. gonorrhea was isolated. 26 samples grew U. urealyticum by conventional methods. Those 26 samples in addition to one conventional methods negative sample showed U. urealyticum picture on M. F after 24-72 hours. The number of growth ranged between 10[3]-10[6]CCU/ml. All strains except one were sensitive to cyclines and all except one were resistant to ciprofloxacin. M. hominis was detected neither by conventional method nor by MF. The incidence of U. urealyticum in the cases studied was 39% by conventional methods and 43% by MF. We conclude that MF is an ideal method for the diagnosis of UGM. Due to its high incidence, U. urealyticum should be considered in the empirical antibiotic regimen for patients with persistent or recurrent NGU

Role of chlamydia and mycoplasma in the etiology of nongonococcal urethritis [NGU] in men

A total of 70 men [patients and controls] were included in the present study. 50 patients complained either of spontaneous urethral discharge or a discharge was demonstrable on penile stripping with >/= 4 PMNs/HPF in urethral smear and with negative smear and culture for Neisseria gonorrhoeae; these men were designated as the NGU group. The remaining 20 men were completely asymptomatic; they were designated as the control group. By passage of urethral swabs specimens were obtained for smear and culture for Neisseria gonorrhoeae, culture for mycoplasma, and smear for chlamydia [for immunofluorescence staining]. Chlamydia tracomatis was identified from significantly more NGU patients [23 [46%] of 50] than from men with no-urethitis [1 [5%] of 20]. Ureaplasma urealyticum was isolated from 14 [28%] of 50 NGU, this agent was found to be significantly associated with chlamydia-negative NGU patients [11 [41%] of 27 patients] than either chlamydia-positive NGU [3 [13%] of 23 patients] or men with no-urethritis [3 [15%] of 20 men]. On the other hand, there was no statistically significant difference in the rate of isolation of Mycoplasma hominis between NGU patients and controls. Clinically there were no prominant differences observed between the NGU group and the control group

Sonography in evaluation of male anterior urethra

Ultrasonography offers advantages over conventional urethrography in terms of abnormalities detected, convenience of the study and lack of ionizing radiation. Our study favours sonography to be the examination of choice for both follow up of postoperative patients and for the evaluation of patients with new symptoms. The urologist may require a "road map" before surgery and for this purpose contrast urethra-gram may be more helpful

Trichomoniasis in non-gonococcic urethritis among male patients

Urethral discharge of 415 male patients [age 18-50 years] were examined for Trichomonas vaginalis by direct examination of fresh and Giemsa-stained slides and cultivation in CPLM media. In this study, 85 [20.7%] specimens out of 415, were found to be positive for trichomoniasis. Three groups consisting of 30, 29 and 26 patients, each was treated with secnidazole, metronidazole and ornidazole, respectively. In the follow up controls, all patients were found to be negative for trichomoniasis and all complaints were disappeared totally without a significant difference between all groups

Evaluation of a locally developed direct immunofluorescence test for chlamydial infections.

The high cost of diagnostic tests for chlamydial infections limits their use which may result in under estimation of the incidence of chlamydial infections. This study was an attempt to reduce the cost of the test by developing an immunofluorescence test for C. trachomatis using monoclonal antibody to major outer membrane protein of C. trachomatis. Urethral swabs were obtained from patients with symptoms of urethritis. The developed immunofluorescence test was compared with culture method and a commercial immunofluorescence test kit (BioMerieux). Compared with the culture method, the sensitivity, specificity, predictive value of positive and predictive value of negative of the developed test were 79, 85, 61 and 93 per cent respectively. The results obtained from the comparison with commercial test kit showed an agreement of 88 per cent. The developed test was positive in 32 per cent of specimens while the commercial test was positive in 24 per cent. The commercial test kit showed excellent reactions and it contained monoclonal antibody to lipopolysaccharide of Chlamydiae in addition to monoclonal antibody to major outer membrane protein which can lead to stronger immunofluorescence staining. The locally developed test, however, costs much less without compromising the results.