Trichomonas vaginalis Associated with Chronic Penile Ulcers and Multiple Urethral Fistulas.

The case of a 29-year-old, HIV-infected man presenting with Trichomonas vaginalis (TV)-associated chronic penile ulcers and multiple urethral fistulas is described. To our knowledge, this is the first description of chronic TV infection being implicated as the probable cause of a destructive lesion leading to sinus drainage and fistula formation.

Cystoscopic removal of leeches in the lower urinary tract: our experience.

INTRODUCTION: The purpose of this study is to describe the experience of managing leech infestation in lower urinary tract from a tropical country. MATERIALS AND METHODS: Medical records (January 2002 to December 2010) of children with history of leech infestation in the urinary system, admitted in the Department of Pediatric Surgery, Chittagong Medical College & Hospital, Chittagong, Bangladesh were reviewed. All patients underwent saline irrigation through urethral catheter. When saline irrigation failed, cystoscopic examination was done with removal of leeches by flexible graspers. Follow-up was done 2 weeks later. RESULT: The study included 117 patients. Age ranged from 4 to 12 years. Male and female ratio was 3.7:1. All patients had per urethral bleeding. 51 (43.6%) patients had suprapubic pain. All children underwent saline irrigation through urethral catheter. Spontaneous expulsion occurred after saline irrigation in 57 (48.7%) patients. The expelled leeches were alive in 11 cases; dead in 46 patients. Cystoscopic removal of leeches was done in 60 patients (51.3%). In the cystoscopic group, 54 of the removed leeches were dead and 6 were alive. CONCLUSION: Cystoscopic removal can be a useful technique for the removal of leeches from the urinary tract when saline irrigation fails.

An unusual case of urethral hiriduniasis.

Bleeding as the result of a leech in the male urethra is very rare. We describe a 13-year-old boy who had a leech in his urethra. In the emergency department he persistently squeezed his penis in an attempt to prevent the leech from going deeper into his urethra. Manual removal by forcep failed and cystoscopic removal was recommended. Penile block with lidocaine 1% relieved the pain and enabled him to squeeze his penis harder until the leech was pushed out making forcep removal easier. Post-removal he had hematuria and penile pain for 2 days. A description of his presentation and management, along with a review of the literature is presented.

Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic.

OBJECTIVE: Although established in women as a common cause of vaginal discharge, the prevalence of Trichomonas vaginalis (TV) in men compared with other classic urethral pathogens has not been well characterized. To assess this issue, the authors compared the prevalence of Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and TV in consecutive men attending a sexually transmitted diseases (STD) clinic. METHODS: From June 1, 1998 to July 27, 1998, 454 consecutive men presenting to the Denver Metro Health Clinic with a new problem were tested for GC by urethral swab culture, for CT by polymerase chain reaction of urine, and for TV by urine sediment culture. RESULTS: GC, CT, and TV were detected in 23 (5.1%), 34 (7.5%), and 13 (2.8%) of men, respectively. There were significant differences by age for both CT (11.3% in men younger than 30 years versus 3.3% in men 30 years and older, P < 0.05) and TV (0.8% in men younger than 30 years versus 5.1% in men 30 years and older, P < 0.05). In 50 men 30 years or older with symptoms of urethral discharge, TV prevalence (12.0%) rivalled that of GC (12.0%) and CT (14.0%). In 45 men 30 years and older with nongonococcal urethritis, the prevalence of TV and CT were each 13.3%. Multivariate logistical regression analysis showed the presence of discharge and nongonococcal urethritis in men 30 years and older to be an independent predictor of TV. CONCLUSIONS: TV is common in men attending sexually transmitted disease clinics, especially in those 30 years or older, in whom it may account for as much urethritis as GC or CT. These findings suggest that in older men with nongonococcal urethritis, diagnostic evaluation, empiric treatment, and partner management should include the possibility of TV infection.

Patterns of Schistosoma haematobium egg distribution in the human lower urinary tract. II. Obstructive uropathy.

In a series of 32 unselected consecutive autopsies of Egyptian male adults, we found a significant prevalence of schistosomal obstructive uropathy (SOU) and of precursor lesions of stenosis, fibrosis and induration of the ureters (62.5%). Lower urinary tracts with obstructive uropathy had a significantly higher total egg burden (TEB) than did lower urinary tracts with any other type of gross lesion (i.e., benign prostatic hypertrophy, other urethral outlet obstruction, or SOU precursor lesions). In turn, lower urinary tracts with any type of gross change had higher egg burdens than did tracts which appeared grossly normal. Lower urinary tracts with any type of gross lesion had significantly larger seminal vesicles than did tracts which were grossly normal. Moreover, relative weight of seminal vesicles could be correlated with the S. haematobium egg burdens in the seminal vesicles. In a series of lower urinary tracts taken from unselected consecutive American autopsies, seminal vesicle weight could be correlated with increase in prostatic weight in those tracts with prostatic hypertrophy; the same correlation could not be found in tracts without prostatic hypertrophy. Thus, seminal vesicle hypertrophy appears to correlate with obstructive uropathy in general, not solely obstructive uropathy of schistosomal origin. Digital evaluation of seminal vesicle size may be useful in the clinical evaluation of such patients.

Post coital pin-worm infection.

In Ibadan, Nigeria, an Enterobius vermicularis worm was found in the urine of a soldier complaining of urethral irritation that had started 4 hours after coitus. After his first post-coital micturition, which yielded the worm, the irritation stopped. There was convincing evidence that the worm had entered the soldier's urethra from his partner's perianal region (rear-entry coital position, no ejaculation because of partner's complaint of painful coitus, the partner was a school girl of 15, enterobiasis is common in young school girls in the city, etc.).

Urogenital myiasis caused by Chrysomya bezziana (Diptera: Calliphoridae) in peninsular Malaysia.

A case of urogenital myiasis caused by Chrysomya bezziana (Diptera: Calliphoridae) was diagnosed in a 76-year old patient who had carcinoma of the rectum. A total of 35 larvae were obtained from ulcers near the external genitalia and urethra opening. Larvae pupated within 1 to 2 days and 6 days later emerged as adult males. These were identified as Chrysomya bezziana. Female flies possibly attracted by the fetid odour, laid eggs in the existing lesions in the urogenital area, the larvae invading and feeding on living tissue. Lack of personal hygiene was the contributing factor for the cause of urogenital myiasis in this patient.

[Human myiasis in middle Europe]. / Myiasis beim Menschen in Mitteleuropa

A report is given on 4 cases of myiasis of the mucous membrane of different localisation and etiology observed in the GDR (vaginal myiasis by Lucilia sericata, urethral and vesicular myiasis by Calliphora vicina, rectal myiasis by Sarcophaga haemorrhoidalis and ophthalmomyiasis by Oestrus ovis). Biological peculiarities and habits of life of the causative organisms, pathogenesis of the different forms of parasitosis in man and clinical pictures are described. The cases mentioned show that occasionally is to reckoned with autochthonic myiasis - above all due to larve of blue-bottles, meat and bot-flies - not only in tropic countries, but also in Middle Europe (especially during the warm seasons and when a considerable quantity of flies is present). Among the predisposing factors for furunculous and migrating skin myiasis as well as wound, urogenital, intestinal and other myiases of the mucous membrane comatous conditions due to severe basic diseases play a special part. On unhygienic conditions, however, the parasitic invasion of the maggots of certain, in general harmless species of flies into the integumentum and into various hollow organs of man is just possible also in primarily healthy persons with good general condition. In an adequate anamnesis and suspicious clinical symptomatology, therefore, a myiasis should be included into differential-diagnostic considerations.