Reactive arthritis: images.

Reactive arthritis is an extremely rare spondyloarthritis that affects the peripheral joints and spine, resulting in common symptoms such as arthritis, urethritis, conjunctivitis, and mucocutaneous lesions. On rare occasions, oral lesions such as circinate erosions on the hard and soft palate, gums, tongue, and cheeks may occur. Reactive arthritis may develop during or after genitourinary or gastrointestinal bacterial infections such as Shigella, Salmonella, Yersinia, and Chlamydia. A 36-year-old man presented with circinate balanitis, urethral discharge, oligoarthralgia, conjunctivitis, lymphadenopathy, pharyngitis, and erythematous lesions on the palate. Culture examination showed presence of Neisseria gonorrhoeae and antibiotic treatment resulted in improvement of conjunctivitis and the lesions on the penis. However, severe oligoarthralgia, palatal erosions that increased in severity and size, and depilated areas on the tongue were observed. The definitive diagnosis was reactive arthritis. The prevalence of sexually transmitted infections is increasing, highlighting the need to increase awareness of associated risks such as reactive arthritis. Moreover, consideration of non-specific oral manifestations in a systemic context may aid in effective diagnosis and treatment, suggesting the need for multidisciplinary teams.

Genital bovine leptospirosis: A new look for an old disease.

Bovine leptospirosis is often associated with host-adapted leptospires infections, such as strains belonging to the Sejroe serogroup. Although bovine leptospirosis by adapted strains may result in abortions, fetal death, premature births and the birth of weak and/or low-weight calves, this infection is more closely associated with subtler syndromes, such as subfertility and early embryonic death. In this way, this silent disease can go unnoticed and undiagnosed, compromising reproductive efficiency with a consequent decrease in the productivity of herds over long periods. For many years, genital tract infection has been considered a secondary effect of renal infection with the assumption being that leptospires are found in the genital tract due to bacteremia caused by renal colonization. In contrast to this hypothesis, there is some evidence in the literature that suggests that genital leptospirosis should be considered a specific syndrome dissociated from renal/systemic disease. Therefore, this paper aims to gather and critically analyze information about genital leptospirosis in cattle, considering the disease a distinct syndrome, herein denominated bovine genital leptospirosis (BGL), that requires a unique approach to diagnosis and treatment.

Vaccination with MIP or Pgp3 induces cross-serovar protection against chlamydial genital tract infection in mice.

Previously we reported that recombinant Chlamydia muridarum macrophage infectivity potentiator (MIP) provided partial protection against C. muridarum genital tract infection in mice. On the other hand, Chlamydia trachomatis plasmid encoded Pgp3could induce the protection against C. muridarum air way infection. This study aimed to evaluate the immunogenicity of MIP and Pgp3 from C. trachomatis serovar D and further investigate whether MIP and Pgp3 provide cross-serovar protection against C. muridarum genital tract infection in mice. Our results showed that vaccination by any regimen, including MIP alone, Pgp3 alone or MIP plus Pgp3, induced specific serum antibody production and Th1-dominant cellular responses in mice. Live chlamydial shedding from the vaginal and inflammatory pathologies in the oviduct markedly reduced. However, MIP + Pgp3 vaccination did not provide better protection than the single immunization. In conclusion, this study demonstrated that both MIP and Pgp3 can induce cross-serovar protective against chlamydial genital tract infection, and provided the guide for the development of optimal multisubunit vaccines against C. trachomatis infection.

Impact of the Levonorgestrel-Releasing Intrauterine System on the Progression of Chlamydia trachomatis Infection to Pelvic Inflammatory Disease in a Baboon Model.

Background: Understanding the relationship between the levonorgestrel (LNG)-releasing intrauterine system (IUS) and sexually transmitted infections (STIs) is increasingly important as use of the LNG-IUS grows to include women at higher risk for STIs. This study assessed the impact of the LNG-IUS on development of Chlamydia trachomatis pelvic inflammatory disease, using a baboon model. Methods: Baboons with and those without the LNG-IUS were cervically inoculated with C. trachomatis and monitored daily, and cervical and fallopian tube swab specimens were collected weekly for C. trachomatis quantitation by nucleic acid amplification testing and culture. Vaginal swab specimens were collected for cytokine analysis, and serum samples were obtained for detection of C. trachomatis antibodies. Results: The LNG-IUS resulted in an increased C. trachomatis burden in the cervix, with the bacterial burden in the LNG-IUS group diverging from that in the non-LNG-IUS group by 6 weeks after infection. One of 7 baboons in the non-LNG-IUS group and 2 of 6 in the LNG-IUS group developed pelvic inflammatory disease, while 3 animals in each group met criteria suggestive of pelvic inflammatory disease. LNG-IUS increased baseline interleukin 8 levels but failed to further upregulate interleukin 8 during infection. In LNG-IUS recipients, early perturbations in the interleukin 1ß axis corresponded to decreased C. trachomatis clearance and increased T-helper type 2 immune responses. Conclusion: LNG-IUS use results in delayed clearance of C. trachomatis and might alter the reproductive tract immune environment.

[CLINICO-MORPHOLOGICAL FEATURES OF FEMALE URETHRAL MEATUS POLYPS].

The aim of the study was to establish the clinical and morphological characteristics of female urethral polyps including cases with concomitant sexually transmitted infections. A total of 150 women were enrolled in the study. The evaluation of microcirculatory changes, morphological parameters and immunogram indices of urethral polyps were carried out. The most common infectious agent in patients with urethral polyps was Ureaplasma urealyticum. In those cases predominance of inflammatory symptoms and elevated levels of serum proinflammatory cytokines were identified. It is found that the pronounced inflammatory reaction leads to an increase in the relative area of the subepithelial microvascular bed and the cellular elements population of lamina mucosa propria, as well as to the relative predominance of congestive forms of microcirculation disturbances according to the laser Doppler flowmetry.

[Sexually transmitted infections as a cause for solid rectal pseudo tumors]. / Sexuell übertragbare Infektionen als Ursache von solide imponierenden Pseudotumoren des Rektums.

Two cases of symptomatic proctitis with rectal tumors suspicious for malignancy are presented. A florid regenerative proctitis was shown in the histological examination. In both cases a sexually transmitted infection (STI) was causing the symptoms. In rare cases STIs present as pseudo tumors mimicking malignancy in clinical examination and endoscopic/radiological analysis. A close collaboration between gastroenterologist and pathologist is necessary for a correct diagnosis and to prevent unnecessary surgical treatment.

Immunity, immunopathology, and human vaccine development against sexually transmitted Chlamydia trachomatis.

This review examines the immunity, immunopathology, and contemporary problems of vaccine development against sexually transmitted Chlamydia trachomatis. Despite improved surveillance and treatment initiatives, the incidence of C. trachomatis infection has increased dramatically over the past 30 years in both the developed and developing world. Studies in animal models have shown that protective immunity to C. trachomatis is largely mediated by Th1 T cells producing IFN-γ which is needed to prevent dissemination of infection. Similar protection appears to develop in humans but in contrast to mice, immunity in humans may take years to develop. Animal studies and evidence from human infection indicate that immunity to C. trachomatis is accompanied by significant pathology in the upper genital tract. Although no credible evidence is currently available to indicate that autoimmunity plays a role, nevertheless, this underscores the necessity to design vaccines strictly based on chlamydial-specific antigens and to avoid those displaying even minimal sequence homologies with host molecules. Current advances in C. trachomatis vaccine development as well as alternatives for designing new vaccines for this disease are discussed. A novel approach for chlamydia vaccine development, based on targeting endogenous dendritic cells, is described.

Sex, lies, and gastrointestinal tract biopsies: a review of selected sexually transmitted proctocolitides.

There are many insults that result in gastrointestinal tract inflammation. Infections can be particularly challenging because (1) only a limited number of organisms provoke a specific endoscopic and/or histologic appearance; and (2) although some organisms may be present on biopsies, the findings may be so subtle or organisms so few that they are easily missed if the reviewer is not performing a specific search for the offender. Sexually transmitted infections (STI) are rarely a consideration at the time of GI biopsy examination and clinicians rarely inquire about sexual behavior at the time of initial patient interview. Although establishing a definitive STI diagnosis is not possible on histology alone, these infections are associated with inflammatory patterns that may help raise this diagnostic possibility. Becoming familiar with these patterns is necessary as worldwide outbreaks of these infections are being reported. This review aims to provide the pathologist with histologic clues associated with the most frequently encountered bacterial pathogens in the setting of STI proctitis, namely, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum.

Animal models for studying female genital tract infection with Chlamydia trachomatis.

Chlamydia trachomatis is a Gram-negative obligate intracellular bacterial pathogen. It is the leading cause of bacterial sexually transmitted disease in the world, with more than 100 million new cases of genital tract infections with C. trachomatis occurring each year. Animal models are indispensable for the study of C. trachomatis infections and the development and evaluation of candidate vaccines. In this paper, the most commonly used animal models to study female genital tract infections with C. trachomatis will be reviewed, namely, the mouse, guinea pig, and nonhuman primate models. Additionally, we will focus on the more recently developed pig model.

Sexually transmitted diphtheria.

Diphtheria is caused by diphtheria toxin-producing Corynebacterium species. While classical respiratory diphtheria is transmitted by droplets, cutaneous diphtheria often results from minor trauma. This report concerns the first case of sexually transmitted diphtheria in a patient with non-gonococcal urethritis after orogenital contact.

[Clinical, laboratory and uretroscopic evaluation of the effectiveness of Safocid in the complex treatment of urethritis associated with sexually transmitted infections by using endoscopic techniques].

The study included 110 men suffering from sexually transmitted infections. Clinical diagnosis was made using modern hardware and instrumental methods of examination. It is shown that the combined preparation "Safocid" is a high-effective drug for the etiotropic treatment of specific and non-specific urethritis, with elimination of causative microorganisms of sexually transmitted infections in 96.4% of cases.

Chlamydial infection in female lower genital tract and its correlation with cervical smear abnormalities.

BACKGROUND: It is widely known that infection by Chlamydia trachomatis (CT) is the most common curable sexually transmitted infection (STI) among the young population.Chlamydial cervicitis has been suspected in the past to be a risk factor for squamous intraepithelial neoplasia (SIL) and cervical cancer on the basis of case-control comparisons of serological tests. METHODS: A total of 110 women with symptomatic cervicitis were examined and samples for microbiologic detection of Chlamydia trachomatis antigen were obtained. Colposcopic, cytologic and microbiologic analyses were performed. All results were statistically analysed and correlated. RESULTS: 41 patients (37.2 %) were found positive for Chlamydia trachomatis antigen (Group I) and 69 patients (62.8 %) were negative for Chlamydia trachomatis antigen (Group II). When compared to group II, the chlamydia-infected group I of women presented a larger percentage of dyspareunia (60 %), and the dysuric complaints were more common. The chlamydia-positive group revealed a higher incidence of atypical squamous metaplasia (52.5 % vs 27.9 %). Among the women with positive ELISA for chlamydia, a higher percentage of low-grade SIL was observed (6.3 % vs 3.6 %). CONCLUSIONS: Chlamydial infection, especially chlamydial cervicitis occurs often among young women of reproductive age. In these women, a good clinical assessment is necessitated including previous clinical history record, as well as detailed microbiologic, cytologic and colposcopic evaluations (Tab. 5, Ref. 19).

The overall agreement of proposed definitions of mucopurulent cervicitis in women at high risk of Chlamydia infection.

The overall agreement between different criteria for cervicitis in women infected with Chlamydia trachomatis and/or Mycoplasma genitalium, and in women who tested negative was examined. Women attending a clinic for sexually transmitted diseases were enrolled because of sexual partners' suspected chlamydia infection. M. genitalium was tested in a sample of first-catch urine and an endocervical specimen, whereas specimens from four different sites were used for detection of C. trachomatis. Signs of friability and purulent endocervical discharge were documented at gynaecological examination. Specimens for microscopy were taken from the endocervix and urethra as well as the vaginal discharge, and bacterial vaginosis was examined for. The criteria being evaluated included cervical friability and/or pus; polymorphonuclear leukocytes (PMNL)/epithelium cell ratio in the vaginal discharge; and more than 30 PMNL per high-power field in the endocervical smear. The overall agreement of the indicators of cervicitis in women infected with C. trachomatis and/or M. genitalium was 40.5% (15/37), and for those women with negative tests 35.3% (12/34). The criteria for cervicitis require further evaluation, including study of a control group of women at low risk of having a sexually transmitted infection.

HtrA, RseP, and Tsp proteins do not elicit a pathology-related serum IgG response during sexually transmitted infection with Chlamydia trachomatis.

Chlamydia trachomatis sexually transmitted infection can cause serious reproductive morbidities. This study determined the prevalence of a serum IgG response to C. trachomatis putative stress response proteins in women, to test for an association with genital tract pathology. There was no significant association of serum IgG reactive with C. trachomatis HtrA, Tsp, or RseP with infection or pathology. cHSP60 serum IgG prevalence was significantly associated with infection compared to IgG negative infertile controls, but not with upper genital tract pathology. Serum IgG(1-4) antibody subclasses reactive with these antigens was not significantly different between cohorts, although different responses to each antigen were detected.

[Prostatic inflammation and prostate cancer]. / Prostatitis und Prostatakarzinom.

Chronic inflammation seems of importance in multiple types of cancer. Numerous reports have revealed a potential link between chronic prostatatic inflammation and prostate cancer. The aim of this paper is to review the epidemiological, moprphological, molecular and clinical aspects of prostattic inflammation and prostate cancer.

[Approaches to raising efficacy of treatment of patients with chronic prostatitis associated with intracellular infections].

The efficacy of indigal plus containing indol-3-carbinol, epigallocatexin-3-gallat and Serenoa repens extract in combination with sparfloxacin was studied in a trial with participation of 30 patients with chronic infectious prostatitis associated with intracellular agents. Group 1 (n=15) received indigal plus (2 capsules twice a day for 3 months) and sparfloxacin (200 mg twice a day for 1 month). Group 2 including 15 matched controls received sparfloxacin alone according to the same schedule. The examination included questionnaire survey (IPSS, QoL, NIH-CPSI), blood count, urinalysis, PSA test, microscopy, bacteriological study of prostatic secretion, uroflowmetry, transrectal ultrasound investigation of the prostate with residual urine assay, laser doppleroflowmetry. The examinations were performed on the treatment day 30, 60 and 90. After the antibacterial treatment chlamidia, ureaplasma and E.coli were detected in 13.3, 6.7 and 26.7% patients of the control group, in 6.7, 6.7 and 6.7% patients of the study group, respectively. Thus, the addition of a pathogenetic drug indigal plus to sparfloxacin treatment promoted normalization of apoptosis of the infected cells, led to more effective bacterial eradication, enhanced regression of the symptoms. It is recommended to include indigal plus in a basic scheme of treatment of patients with chronic infectious prostatitis.

Ulcerative vulvitis and balanitis in sheep flocks.

Outbreaks of ulcerative vulvitis and balanitis occurred in three commercial sheep flocks in England and Wales. Between 29 and 44 per cent of the ewes were affected; most of the lesions resolved in three weeks. Pathogens such as mycoplasmas, which have previously been associated with these conditions, were not detected despite using improved laboratory techniques. In one of the flocks, ovine herpesvirus type 2 was detected by pcr in the blood of two acutely affected ewes, from the vulval ulcers of one of them, and from the penis of an affected ram.

Brucella ceti associated pathology in the testicle of a harbour porpoise (Phocoena phocoena).

Brucellosis is reported increasingly in marine mammals and the marine species of Brucella are capable of causing community acquired zoonotic infections in humans as well as abortion in cattle as a result of experimental infection. This case report describes pathology associated with an isolate of Brucella ceti that was successfully cultured from, and immunolabelled in, the testis and epididymis of an adult sexually mature free-living harbour porpoise (Phocoena phocoena). This is the first report of such pathology in any species of cetacean, and suggests the potential for sexual transmission and/or sterility as sequelae to infection similar to those reported in terrestrial animals.

The differing profiles of symptomatic and asymptomatic Chlamydia trachomatis-infected men in a clinical setting.

The objectives of this study were to determine whether the risk profiles of chlamydia-infected men in a clinical setting differ based on their symptom status. In all, 363 heterosexual, chlamydia-infected men attending a Sydney sexual health service were compared with controls. The 172 asymptomatically infected men and the 183 symptomatically infected men were also compared with the controls, and with each other. Compared with symptomatic men, asymptomatically infected men were younger (P = 0.03), and more likely to be overseas-born (adjusted odds ratio (AOR) 2.0, 95% confidence interval [CI] [1.1-3.5]), to be in a relationship (AOR 2.4, 95% CI [1.4-4.0]), to report contact with a chlamydia-infected woman (AOR 3.7, 95% CI [2.0-7.1]) and to have had contact with a partner with a non-chlamydial infection (AOR 10.7, 95% CI [1.3-89.7]). Infected men with a history of chlamydia were more likely to have current symptoms and a shorter duration of those symptoms. In conclusion, in a clinical setting, there appear to be differences in the profiles of symptomatic and asymptomatic chlamydia-infected men.