clinicopathological study of urethritis in males

To determine the etiology and frequency of different types of urethritis in adult males. A case series. The Dermatology Department of PNS Shifa Hospital, Karachi, from June 2004 to December 2007. One hundred male patients having complaints of urethral discharge and dysuria reporting in the skin OPD were included in the study. Patients who had received systemic treatment for their complaints and those who had other systemic infections were excluded. A detailed history including history of sexual contact was taken. Dermatological examination including examination of external genitalia was also performed. All these patients were subjected to complete physical examination, complete urine examination, urethral pus for gram staining and culture, endo-urethral swab with urethral loop for seeing Chlamydia antigen by fluorescent microscopy, cultures for ureaplasma and Wet mount specimen microscopy for trichomonas along with HIV [serum ELISA] test. Non-gonococcal urethritis was diagnosed on the presence of more than five polymorphonuclear leucocytes per high power field in at least five fields of Gram stained urethral smear, in the absence of Gram negative diplococci. The mean age was 29.2 +/- 5.8 years. Seventy [70%] cases were diagnosed as gonococcal urethritis and 30 [30%] cases as non-gonococcal urethritis [NGU]. History of illicit sexual exposure was available in 25 [25%] patients. The interval period between initiation of symptoms and reporting of patient in gonococcal urethritis was 4 to 30 days [mean 12.8 days] and 4 days to 2 months [mean 20.7 days] in non-gonococcal urethritis. The patients with gonococcal urethritis presented with purulent discharge in 66 [84%] cases, and dysuria in 49 [70%] cases. In the NGU group, 25 [80%] cases had mucoid discharge and 18 [65%] had dysuria. in 70%, Neisseria gonorrhoeae was isolated, Chlamydia trachomatis in 16%, ureaplasma in 8%, and Trichomonas vaginalis in 4%. No organism could be detected in 2% cases. HIV test was negative in all cases. Gonococcal urethritis was the commonest urethritis seen followed by Chlamydia infection in the studied group of adult males

Simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis by PCR in genitourinary specimens from men and women attending an STD clinic.

Neisseria gonorrhoeae and Chlamydia trachomatis are the two most common bacterial sexually transmitted infections that manifest primarily as urethritis in males and endocervicitis in females, though the infection may be asymptomatic especially in women. Since complications may occur in untreated symptomatic and asymptomatic infected individuals, early diagnosis and treatment of infected individuals is required to prevent severe sequelae and spread of these diseases. Recently molecular amplification assays like Polymerase Chain Reaction (PCR) and Ligase Chain Reaction (LCR) have been found to be highly sensitive and specific methods for detection of N. gonorrhoeae and C. trachonmatis not only in urethral and cervical specimens but also in urine. The objective of this study was to screen male and female Sexually Transmitted Disease (STD) clinic attenders, with and without symptoms suggestive of urethritis and cervicitis for presence of N. gonorrhoeae and C. trachomatis using a multiplex PCR based assay, to compare its performance with culture for N. gonorrhoeae and Direct Fluorescent Antibody (DFA) staining for C. trachomatis and also to compare the efficacy of PCR test performed on urine and genital swab specimens collected from this high risk group. Genital specimens and urine was collected from STD clinic attenders. N. gonorrhoeae and C. trachomatis was detected in genital specimens by culture and DFA respectively. Multiplex PCR was used to detect N. gonorrhoeae and C. trachomatis infection in both genital and urine specimens. Among men with urethritis, N. gonorrhoeae was detected in 70% by culture and 77% by PCR, while C. trachomatis as detected in 7.5% by DFA and 17.5% by PCR. Among females with endocervicitis, N. gonorrhoeae was detected in 7.7% by culture and 30.7% by PCR, while C. trachomatis was detected in 7.7% by DFA and in 15.4% by PCR. None of the asymptomatic males were positive for N. gonorrhoeae and C. trachomatis by conventional methods, while 43.9% were positive for N. gonorrhoeae and 7.5% for C. trachomatis by PCR. Fifty per cent of asymptomatic women were positive for C. trachomatis by PCR alone. We encountered PCR positive but culture/DFA negative results and also PCR negative but culture/DFA positive results. In view of this a single PCR test cannot be used for diagnosis and treatment of N. gonorrhoeae and C. trachomatis infection unless confirmed by a second test.

Microbiological study of male's urethral discharge

To evaluate male patients complaining of urethritis clinically according to the isolated organisms. A total of 100 male patients attending to of Dermatological and Venereal private clinics for the period April 2003 to November 2003 were included in the study. Urethral swab was obtained from each male for culture and direct immunofluorescence examination was done. Demographic data was obtained, also. N. gonorrhoea was the predominate cause of infection in 22%. A peak of infection was reported in the second decade of age. Highest rate reported among single males. A significant association was noticed between profuse discharge and infection with gonorrhoea. This study demonstrated that peak of infection in the second decade of age and among singles. A broad range of causative agents was reported

Trichomonas vaginalis is not a rare sexually-transmitted disease among Egyptian men

The objective of this work was to determine the etiological role of Trichomonas vaginalis in urethritis among Egyptian men. Urethral swabs were obtained from 90 male patients presenting with urethritis and from 60 patients presenting with sexual dysfunction or infertility as controls. The swabs were examined by wet mount examination, culture on CPLM medium and polymerase chain reaction [PCR] to detect the presence of Trichomonas vaginalis. The results revealed that Trichomonas vaginalis was found in 16.7% of patients with urethritis and in 8.3% among the controls. In conclusion, Trichomonas vaginalis is an important consideration in urethritis among Egyptian men

Chlamydia and fertility

Chlamydia trachomatis infection is the most common sexually transmitted disease all around the world. For a long time, Chlamydia trachomatis has been recognized as the common cause of urethritis, cervicitis, and other complications such as pelvic inflammatory disease [PID], ectopic pregnancy, etc. However, today there is more concern on its role in male and female fertility and infertility and many studies have concentrated on this issue all over the world. There is good evidence based on seroepidemiologic studies on relationship between serum Chlamydial antibodies and infertility due to tubal factor in women with or without PID. However, there are many questions about Chlamydia trachomatis and its influence on IVF outcome and the exsisting information is controversial. The impact of Chlamydia trachomatis on male infetility is under investigation and it seems able to cause destruction of different parts of male genital tract in addition to high rate of transmission to women. With regard to these data, it seems that prevention, early diagnosis and treatment of Chlamydial infections are importart and cost effective

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

Eficacia de una monodosis de azitromicina para el tratamiento de la uretritis aguda masculina / Efficacy of azithromycin monodose for treatment of male acute urethritis

La uretritis aguda es causa frecuente de consulta en nuestro medio en centros de enfermedades de transmisión sexual y los principales agentes etiológicos son Neisseria gonorrhoeae y Chlamydia trachomatis. Un problema para el manejo de esta patología, es la emergencia de resistencia en N. gonorrhoeae; datos de 1991 mostraban una resistencia en cepas chilenas de N. gonorrhoeae de 30,3 por ciento a penicilina y 39,8 por ciento a tetraciclina, los antibióticos que se utilizaban empíricamente. Estas cifras se mantienen con tendencia al ascenso en algunas regiones. En estas situaciones, la OMS recomienda usar ceftriaxona intramuscular, una dosis de 125 mg, lo cual resulta costoso y poco práctico para nuestra realidad y no cubre a C. trachomatis. Para evaluar otras alternativas terapéuticas con un enfoque sindromático, se estudió la eficacia y seguridad de una dosis de 1 gramo oral de azitromicina en 61 pacientes masculinos que consultaron por uretritis aguda. A cada paciente que accedió a ingresar al estudio se le efectuaron tres controles clínicos y bacteriológicos: el día 1, entre 7 a 10 y 21 a 38 días, después del tratamiento. En estos pacientes, la etiología de la uretritis correspondió a N. gonorrohoeae en 67 por ciento, a C. trachomatis en 3 por ciento, en 11,5 por ciento a una coinfección por estos dos agentes y en 18 por ciento no se detectó el agente causal. Se observó curación clínica en 85,2 por ciento a los 7-10 días y 91,5 por ciento a los 21-28 días. La erradicación bacteriológica fue del 95 por ciento. Dos pacientes (3,2 por ciento) presentaron efectos adversos y de corta duración que se manifestaron por vómitos, hipotermia y epigastralgia. En conclusión, azitromicina resultó una alternativa eficaz, segura y práctica para el tratamiento de pacientes con uretritis aguda; la eficacia fue excelente para los dos agentes más frecuentemente observados

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

Cryptococcal urethritis. a case report

A unique case of cryptoccal urethritis showing symptoms of chronic urethritis and apparently without other organ involvement is reported. The infection was successfully treated with amophotericin B and 5-fluorocytosine

Incidence of Trichomonas vaginalis among women having vaginal discharge, in Manisa, Turkey

In the present study, vaginal discharge samples obtained from 207 patients with vaginal discharge complaints were examined by utilizing wet mount preparations, Giemsa staining method and CPLM cultivation method. In 27 of them [13.1%], T. vaginalis was detected by both saline wet mount preparation and Giemsa staining method. But as a result of the cultivation in CPLM media of the vaginal discharge materials collected from infected samples, reproduction was observed in only 21 of them [10.2%]. A treatment of secnidazole by 2 g unique dose was applied to infected patients and their spouses and a complete recovery was followed up both microscopically and clinically

Infección por chlamydia / Chlamydia infection

La Chlamydia trachomatis en la actualidad es la infección sexualmente transmitida más frecuente en el mundo. Las manifestaciones pueden pasar desapercibidas, producir uretritis en ambos sexos, enfermedad inflamatoria pélvica en mujeres y epididimitis en hombres. El linfogranuloma venéreo es una infección que invade vasos linfáticos causada por este microorganismo. La infección por Chlamydia puede producir infertilidad, embarazos ectópicos y durante el embarazo causar abortos, ruptura prematura de membrana y partos prematuros. Durante el periodo neonatal puede ocasionar queratoconjuntivitis y/o neumonía. El diagnóstico de esta infección previene problemas de la gestación y enfermedades neonatales. "Si no lo buscas, no lo encuentras"

Uretritis por Haemophilus influenzae serotipo b. Reporte de un caso / Urethritis due to serotype B Haemophilus influenzae. Report of one case

Se presenta un caso de un paciente con antecedentes de esquistosomiasis haematobium, procedente de Mozambique, que ingresa en el Instituto de Medicina Tropical "Pedro Kouri" por presentar molestias al orinar y secresion uretral purulenta. Se aislo Haemophilus influenzae serotipo b, biotipo IV, de la uretra. La cepa resulto ser sensible a la ampicillina, cloranfenicol, ceftriaxona y norfloxacina y resistente a la tetraciclina y eritromicina. El paciente evoluciono hacia la curacion luego de recibir tratamiento con norfloxacina. Se realiza un comentario sobre el papel de este microorganismo como patogeno de transmision sexual

Etiología, tratamiento y conducta epidemiológica en pacientes con uretritis / Etiolgy, treatment and epidemiologic approach in patients with urethritis

Trabajo retrospectivo de revisión de 40 Historias Clínicas con diagnóstico de Uretritis, cuyo exámen bacteriológico identificó Neisseria Gonorrhoae en 76,3, otras bacterias como Estafilococos Albus, Estreptococo en 23,7. En 55,3 fueron tratados con PenicilinaProcáinica en dósis de 4,8 U.I. con resultados óptimops, el segundo antibiótico utilizado en 10,5, también con buenos resultados fué la tetraciclina en dósis de 2 gr/d. por siete días, en 10,5 se utilizaron otros antibióticos como ser Eritromicina, Gentamicina. El Estudio de contactos, y localización de los mismos no se efectuo en ninguno de los casos.

Tratamiento de la uretritis por Chlamydia trachomatis con dosis única de azitromicina / Treatment of clamydia trachomatis urethritis with a single dose of azithromicin

En el presente estudio se evaluó la eficacia de 1 g de azitromicina por vía oral, en dosis única, como tratamiento de la uretritis por Chlamydia trachomatis en 31 varones. La edad promedio fue 35.6 ñ 8.5 años. La visita 2 tuvo lugar entre los día 5 y 7, y la visita 3, entre los días 12 y 16 después de tomar el medicamento. En la visita 1, juntando los casos moderados y severos, 90 por ciento presentaba secreción uretral y disuria, mientras 52 por ciento tuvieron prurito y 45 por ciento eritema del meato. Para las visitas 2 y 3, todas esta alteraciones habían desaparecido o eran leves. Al inicio del estudio, los 3 casos eran positivos al examen microbiológico de Clamydia, mientras que los 30 que acudieron a las visitas 2 y 3 eran negativos. No se observaron efectos secundarios adversos atribuibles al medicamento en estudio. Este trabajo confirma la eficacia y tolerancia de una dosis única de 1 g de azitromicina como tratmiento de uretritis por C. trachomatis

Balanite circinada erosiva em síndrome de Reiter oligossintomática / Erosive circinate balanitis in Reiter's syndrome

A balanite circinada erosiva é uma das manifestaçöes cutâneas da síndrome de reiter. Descriçäo do caso de paciente de 38 anos que, após uretrite nä--gonocócica, apresentou lesöes na glande, artrite sacroilíaca e entesopatia aquiliana

Carriage of Gardnerella vaginalis in the urethra of Indian men.

A total of 310 consecutive sexually active men attending sexually transmitted disease clinic of the Nehru Hospital, Chandigarh, were studied to assess the prevalence of G vaginalis. Non-gonococcal urethritis (NGU) was diagnosed in 53, acute gonococcal urethritis (AGU) in 20, psychosomatic disorders in 50 and genital ulcer disease in 187 patients. G. vaginalis was isolated in 11 patients (3.5%) only. Of these 11 isolates, 4(7.5%) were from patients with NGU, 2(10.0%) from men diagnosed to have AGU, 3(6%) from the patients with psychosomatic disorders and 2 isolates (1.7%) from patients with genital ulcer disease.

prevalence of chlamydia trachomatis among pregnant women

A total of 100 pregnant women were included in this study; 70 of them were symptomatic, complajning mainly of dysuria and/or vaginal discharge, and 30 of them were asymptomatic and were considered as a control group. Cervical samples were taken from 45 women and urethral samples were taken from 55 women and all samples were examined by direct immunofluorescence test and then subjected to culture technique on Hela cells which was taken as a reference method. The prevalence rate for Chlamydia trachomatis was 24.3% among symptomatic women while in the asymptomatic women, it was 10%. This prevalence was significantly related to the presence of dysuria and vaginal discharge together for more than 2 weeks [52.9%], to the presence of endocervical mucopurulent discharge [35.3%], and to the presence of cervicitis and ectopy [75%]. Also the incidence of Chlamydia trachomatis was significantly higher in cervical samples compared to urethral samples. The relations between the chlamydial isolation rate and age, parity, dysuria, vaginal discharge, urethritis and urethral discharge were insignificant. Direct immunofluorescence test had a sensitivity, specifity, positive and negative predictive values of 88.9%, 95.1%, 80% and 97.5%, respectivity

Estudio clínico microbiológico de uretritis gonococcicas tratadas con amoxicilina-sulbactama / Microbiological clinic study of gonococci infection of genital tract treated with amoxycillin-sulbactam

Se trataron 49 pacientes ambulatorios, de sexo masculino, de edades comprendidas entre 13 y 60 años, con diagnóstico de uretritis gonocóccica, provenientes del Hospital "J. R. Vidal" del Centro Dermatológico de la Ciudad de Corrientes y de consultorios externos del Instituto de Patología Regional de la Universidad Nacional del Nordeste de Resistencia (Argentina). En todos los casos se aisló Neisseria gonorrhoeae en el cultivo, siendo el 35 por ciento de las cepas estudiadas productoras deÿß-lactamasas, cifra similar a la obtenida en otros estudios nacionales. Todos los pacientes fueron tratados con una dosis única de amoxicilina-sulbactama de 3 grs. cada componente. Se confirmó curación clínica en el 94 por ciento de los pacientes mientras que en 3 (6 por ciento) hubo mejoría clínica. Presentaron erradicación bacteriológica el 98 por ciento y solo un fracaso bacteriológico. La administración de la asociación fué muy bien tolerada, solo dos pacientes presentaron síntomas digestivos. En conclusión la asociación amoxicilina-sulbactama ha demostrado ser efectiva "in vitro" e "in vivo", y constituye una opción terapéutica válida y útil para el tratamiento de las uretritis gonocóccicas