Comparison of self-obtained penile-meatal swabs to urine for the detection of C. trachomatis, N. gonorrhoeae and T. vaginalis

BACKGROUND

Self-obtained penile-meatal swabs and urine specimens have been used for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) for outreach screening in men.

OBJECTIVE

To compare the sensitivity of self-collected male penile-meatal swabs and urine for the detection of CT, NG and TV.

METHODS

Matching penile-meatal swabs and urines were collected at home after recruitment to the study; via the internet programme, http://www.iwantthekit.org. The instructions directed the participant to place the tip of a Copan flocked swab at the meatal opening of the urethra to collect the penile-meatal sample. Two ml of urine was collected after the swab onto a Copan sponge-on-a-shaft collection device. Both swab and urine were placed into individual Aptima transport media tubes and mailed to the laboratory for testing. All specimens were tested for CT and NG using the GenProbe Aptima Combo2 Assay and for TV using GenProbe Aptima Analyte Specific Reagents with TV oligonucleotides.

RESULTS

Of 634 men, 86 (13.6%) were positive for CT, 9 (1.4%) were positive for NG and 56 (9.3%) positive for TV. For CT, swab sensitivity was 81/86 (94.2%), and urine sensitivity was 66/86 (76.7%). For NG, swab sensitivity was 9/9 (100%) and urine sensitivity was 8/9 (88.9%). For TV, swab sensitivity was 45/56 (80.4%) and urine sensitivity was 22/56 (39.3%).

CONCLUSIONS

Self-obtained penile-meatal swabs provided for the detection of more CT, NG and TV, than urine specimens.

[The influence of the degree of infestation with trematode parthenites on the structure of penial glands in the mollusks Littorina saxatilis of different age]

Histological and confocal microscopy studies of the structure of penial glands in the Littorina saxatilis males were carried out. The examined mollusks belong to two age groups and were at different stages of spontaneous infection with a trematode from the pygmaeus species group (Microphallus piriformes). Based on comparative analysis of microscopic sections of copulative organs in infested and non-infested mollusks, data on the modifications in histological structure ofpenial glands were obtained. From these data we can suggest that the infestation have an influence on all parts of the gland. Decrease of secret production and reduction of muscular capsule (down to its disappearance) were observed. We suppose that changes in the penial glands structure prevent their normal functioning. In the mollusks infested on reaching the sexual maturity, gradual reduction of distal part of reproductive system was observed, while in the mollusks infested before the sexual maturity, development of ancillary part of reproductive system was blocked.

Urgent penectomy in a patient presenting with epidermoid carcinoma of the penis associated to myiasis

The objective of this study is to describe the case of a patient presenting advanced epidermoid carcinoma of the penis associated to myiasis. A 41-year-old patient presenting with a necrotic lesion of the distal third of the penis infested with myiasis was attended in the emergency room of our hospital and was submitted to an urgent penectomy. This is the first case of penile cancer associated to myiasis described in the literature. This case reinforces the need for educative campaigns to reduce the incidence of this disease in developing countries.

Giant penoscrotal filariasis

A 42 year old male individual having a hugely distended scrotum and barely perceptible penis, unable to maintain his livelihood on account of his handicap and socially withdrawn for the fear of humiliation, got admitted into the Surgery department of Mymensingh Medical College Hospital in August 5, 2007. The person had been carrying the so called curse for the last four years. On the basis of clinical, serological and haematological examinations, diagnosis was established as lymphatic filariasis causing elephantiasis of the scrotum. After assessment for operative feasibility, the patient underwent an operation in August 20, 2007 during which, ligation of both the spermatic cords, excision of the scrotum along with the testicles and reposition of the penile shaft into the anterior pelvic wall in the subcutaneous plane (Fleying procedure) was performed. The scrotum measured about 36 inches in diameter and weighed 40 kgs after excision. Histopathological examination of the scrotal skin confirmed the diagnosis. The patient was released without any complication, on the 11th post operative day after removal of stitches, with indwelling urethral catheter. He was prescribed Doxicycline for the next 8 weeks, a drug which has been found to be effective in treating filariasis in a number of studies, and acts by killing a symbiotic bacteria necessary for the survival of the worm. Follow up after 3 months was uneventful.

Genital lesions associated with visceral leishmaniasis and shedding of Leishmania sp. in the semen of naturally infected dogs

Although visceral leishmaniasis is primarily transmitted by a biological invertebrate vector, transmission in the absence of the vector has been reported, including venereal transmission in humans. Considering the possibility of venereal transmission, we studied genital lesions in dogs naturally infected with visceral leishmaniasis and shedding of Leishmania sp. in the semen. Approximately 200 dogs were serologically tested for anti-Leishmania antibodies and divided into three groups: 1) serologically negative dogs (n = 20), 2) asymptomatic serologically positive dogs (n = 20), and 3) symptomatic serologically positive dogs (n = 20). Samples from both testes, all segments of both epididymes, prostate gland, glans penis, and prepuce were histologically evaluated and processed for immunodetection of Leishmania sp. Semen samples were obtained from 22 symptomatic serologically positive dogs and processed for detecting Leishmania DNA by polymerase chain reaction. A significantly higher frequency of inflammation was observed in the epididymes, glans penis, and prepuce of dogs with visceral leishmaniasis, which was associated with a high frequency of immunohistochemically positive tissues (up to 95% of tissues from symptomatic dogs were positive by immunohistochemistry). Leishmania DNA was detected in eight of 22 semen samples from symptomatic dogs. Together these findings indicate that genital lesions and shedding of Leishmania sp. (donovani complex) in the semen are associated with visceral leishmaniasis. Additional studies should address the possibility of venereal transmission of the disease in the dog.

Difficulties in achieving vs maintaining erection: organic, psychogenic and relational determinants

Achieving and maintaining a penile erection are two essential components of the male sexual response. It has recently been suggested that distinct molecular mechanism could underlie the two disturbances. The aim of the present study is to verify possible clinical differences on pathogenetic factors underlying difficulties of achieving and maintaining an erection. We studied a consecutive series of 560 patients (aged 51.9+/-12.8 y old) reporting erectile dysfunction (ED), using SIEDY structured interview. Patients were classified into two distinct categories: those with difficulties in maintaining, rather than achieving, an erection (sample A) and those with main problems in achieving an erection (sample B). A complete physical examination and a series of metabolic, biochemical, hormonal, psychometric, penile vascular tests and nocturnal penile tumescence and rigidity evaluations (NPT) were also performed. Sample B patients showed a higher prevalence of organic conditions related to ED, when compared with sample A as confirmed by higher SIEDY scale 1 scores (3[1-5] vs 1[0.1-3] for sample B vs sample A, respectively; P < 0.0001) which explores organic component of ED and higher prevalence of pathological instrumental parameters. No difference among groups was observed for SIEDY scale 2 (relational component) and SIEDY scale 3 (intrapsychic component) of ED. In conclusion, this study shows for the first time that patients with difficulties in maintaining erection are less likely to be affected by organic disturbances interfering with sexual function, when compared with those unable to achieve a valid erection.

Intrahost distribution and transmission of a new species of cyclopoid copepod endosymbiotic to a freshwater snail, Pomacea canaliculata (Caenogastropoda, Ampullariidae), from Argentina

A new species of cyclopoid copepod, Ozmana huarpium, is described as a symbiont to Pomacea canaliculata (Lamarck 1822) (Caenogastropoda, Ampullariidae). Rather large numbers (about one hundred copepods per snail) were found, although there was no evidence of harm to the host. To our knowledge, O. haemophila (symbiont to P. maculata), and the currently described species, O. huarpium, are the only copepod species ever recorded as endosymbionts to freshwater invertebrates. While O. haemophila is restricted to the haemocoel of its host, O. huarpium predominate in the penis sheath, the ctenidium and the mantle cavity, figuring in these pallial organs 63-65% of total mature forms. The sex ratio of the symbiont is skewed to the female side in these organs, specially in male hosts. The hypothesis that a special female tropism for the male host's pallial organs might ensure interindividual transmission of the symbiont was tested, with indications that the symbiont is mainly transmitted during copulation.

Ultrastructural study of a tetratrichomonad species isolated from prepucial smegma of virgin bulls

We present observations on an unusual tetratrichomonad species isolated from preputial smegma of virgin bulls. Ultrastructural studies were performed using scanning and electron microscopy techniques. This protozoan presents four anterior flagella of unequal length and a recurrent one forming the undulating membrane. It shows one anterior nucleus, a Golgi complex, an axostyle, and a costa. The hydrogenosomes are rather elongated, seen in groups, and presenting different electron densities. Vacuoles of different sizes containing bacteria and material in process of digestion were frequently found. PCR was also used in order to compare the species herein described with other trichomonad species. The amplification products were seen only with primers TFR1 and TFR2 (specific to trichomonads), but not with TFR3 and TFR4 (specific to Tritrichomonas foetus), suggesting that although collected from the genital tract of the bull, this protist was not T. foetus. We propose that the appearance of these tetratrichomonads were probably due to the sodomy practiced among bulls. Concomitant contamination of preputial cavity with feces could explain the presence of the opportunistic organism. The observations presented here show the importance of the correct diagnostic when investigating samples obtained from the urogenital tract of cattle. We also suggest that this flagellate belongs to the species Tetratrichomonas buttreyi.

Evaluation of a PCR test for the diagnosis of Tritrichomonas foetus infection in bulls: effects of sample collection method, storage and transport medium on the test

The objectives of this study were to determine the detection limit of a PCR test for Tritrichomonas foetus, to investigate the effect of sampling method, guanidinium thiocyanate (GuSCN), and sample storage, and to confirm the accuracy of the test on field samples. Serial 10-fold dilutions of culture material were used to determine the detection limit. For the sample handling trial, five positive bulls were sampled by sheath washing and scraping on six occasions over a period of 18 days (n=29 samples) and eight control bulls were sampled three, four or six times (n=28 samples). Samples were cultured, while portions with and without GuSCN were subjected to DNA extraction within 6h, after 30 h and after 5 days at 4 degrees C. PCR and agarose gel electrophoresis was performed. A two-tailed chi-square test was used to test for differences between treatments. The PCR assay showed a specificity of 98%. Its sensitivity declined with storage time, from 90% at 6h to 31% at 5 days. Sampling method and GuSCN had no effect on test sensitivity. The detection limit of the assay was 100 organisms. Parallel testing of 193 field samples gave complete agreement between culture and PCR results.

Sample collection factors affect the sensitivity of the diagnostic test for Tritrichomonas foetus in bulls

The current diagnostic test for Tritrichomonas foetus involves the culture of collected preputial or vaginal samples. In an earlier study, which evaluated sampling tools for use with bulls, it was observed that the sensitivity of the diagnostic test was higher for 2nd samples collected from the right side of the prepuce than it was for samples collected 1st from the left side. The study described in this paper was conducted to evaluate which of these factors was responsible for the effect on diagnostic sensitivity. Twenty-nine bulls infected with T. foetus were repeatedly sampled in a 2-factor cross-over design. Samples taken from the right side of the prepuce were 4 times as likely to be positive as samples taken from the left side (P = 0.03). Other factors did not have a significant effect on the outcome of the diagnostic test. Unexpected factors may affect the sensitivity of the diagnostic test for T. foetus.

Collection of preputial material by scraping and aspiration for the diagnosis of Tritrichomonas foetus in bulls

Two trials were carried out to assess the diagnostic sensitivity and practicability of preputial scraping as a method of collecting preputial material from bulls infected with Tritrichomonas foetus. In the 1st trial, preputial material was collected by simultaneous scraping and aspiration from 3 infected and 1 uninfected bull 10 times over a 5-week period. In the 2nd trial, samples from 5 infected bulls were collected by both sheath washing and scraping on 6 occasions, while 8 uninfected animals were sampled 3 times. Samples were cultured using a modified Trichomonas culture medium (Oxoid). In the first trial, 29 of 30 samples from infected bulls were found to be positive. In the second trial, 83 % of samples collected by both methods tested positive. In neither trial were any samples from the control bulls found to be positive. Scraping was found to be quick and safe, and offered advantages over preputial washing in that urine contamination was easily avoided, samples were smaller and more concentrated and contamination was reduced. It may, however, be subject to greater operator variability than sheath washing. It is concluded that preputial scraping is as effective as washing and represents a suitable alternative for the collection of material for direct examination and culture of Tritrichomonas foetus.

Experimental transmission of Trypanosoma cruzi through the genitalia of albino mice

Trypanosoma cruzi is usually transmitted by contact with the excreta of infected Triatominae; among non-vectorial infections, direct transmission through coitus has been proposed. We investigated this possibility by instilling, through the external meatus of the vagina and the penis of previously anesthetized NMRI albino mice, blood of mice infected with strains isolated from Didelphis marsupialis (opossum, strain CO57), Rattus rattus (rat, strain CO22) and human (strain EP). Some animals were allowed to copulate the same day of the instillation. In other experiments, the strains were inoculated in the scrotum. To determine the effect of immunosuppression, some mice were treated with cyclophosphamide 30 days post-instillation. Controls were instilled orally and ocularly. Vaginal instillation with strain CO22 produced systemic infection with tropism to the heart, skeletal muscle, skin, duodenum, pancreas, ovary and sternum. Scrotal inoculation with strain EP likewise invaded liver, spleen, lung, lymph nodes and urogenital organs; while strain CO57 invaded skeletal and cardiac muscle, pancreas, testis, and vas deferens. Penile infection with strain CO22 was detected by xenodiagnosis. Immunosuppression did not increase parasitemia of vaginally infected mice or controls. Mating did not produce infection. Our results show that contact of blood trypomastigotes of T. cruzi with genital mucosa can produce blood and tissue infections. These results are discussed in relation to reports of frequent experimental tropism of T. cruzi toward urogenital organs.

Demonstration of Tritrichomonas foetus in the external genitalia and of specific antibodies in preputial secretions of naturally infected bulls

Portions of penis and prepuce were collected from 24 bulls with current or recent Tritrichomonas foetus infection. Epididymides were collected from seven of the bulls, and seminal vesicles and prostate were collected from four. Following immunohistochemical staining with two monoclonal antibodies (34.7C4.4 and TF1.15) prepared against T. foetus surface antigens, trichomonads were identified in sections from 15 of the bulls. Organisms were most often located in penile crypts in the midshaft and caudal regions and less often in preputial crypts. Trichomonads were not observed in sections from other genitalia or in subepithelial tissue. T. foetus antigen, however, was present in the cytoplasm of some epithelial cells and the cytoplasm of some mononuclear cells in subepithelial lymphoid aggregates and follicles. Preputial smegma was collected from 16 T. foetus-infected bulls and from 16 control bulls with negative T. foetus cultures. Preputial antibody levels to TF1.17, a surface antigen of T. foetus, were determined by an enzyme-linked immunosorbent assay. Preputial secretions from infected bulls contained specific antibody of each isotype and subisotype tested. IgG1 responses were the greatest, IgM and IgA responses were approximately equal, and IgG2 responses were low. Each isotype and subisotype response in infected bulls was significantly greater than that in the controls. These results confirm previous speculation concerning anatomical sites of infection and suggest that parasite antigen can be taken up and processed locally, resulting in deposition of specific IgG1, IgG2, IgA, and IgM antibodies in the preputial cavity.

Comparison of two sampling tools for diagnosis of Tritrichomonas foetus in bulls and clinical interpretation of culture results

OBJECTIVE

To compare sensitivity for diagnosing Tritrichomonas foetus infection in bulls using 2 sampling tools and to calculate negative predictive values for infection.

DESIGN

Randomized clinical trial.

ANIMALS

30 Bos taurus bulls naturally or experimentally infected with T foetus.

PROCEDURE

Preputial scrapings were obtained once/wk for 6 weeks using an artificial insemination pipette and a metal brush; which tool was used first for each bull was randomly determined. Samples were collected first from the left side of the prepuce and then from the right side and placed in commercially available transport media chi 2 Values and confidence limits were adjusted for effect of clustering of results by bull.

RESULTS

Significant differences in sensitivity of results were not found between samples collected using the brush or pipette. Using the pipette, sensitivity was estimated to be 91.6% (95% confidence interval, 84.3 to 95.7%); negative predictive values ranged from 41 to 99% for prevalence of infection of 90 to 5%, respectively. Sensitivity was 88.8% for first sample obtained and 96.1% for second sample obtained.

CONCLUSIONS AND CLINICAL RELEVANCE

Collection of preputial scrapings with an artificial insemination pipette or a metal brush and use of a commercially available culture system can provide a sensitive diagnostic test for T foetus infection in bulls. Calculated negative predictive values indicated that 1 or 2 tests would suffice in most clinical situations. For bulls from herds in which T foetus is endemic, 2 to 4 tests/bull may be required to ensure that each bull is not infected.

Prevalence of Tritrichomonas fetus in a bull population and effect on production in a large cow-calf enterprise

OBJECTIVE

To determine prevalence of infection with tritrichomonas fetus in a bull population; assess influence of age, breed, and grouping; assess effects on measures of cow performance (pregnancy rate, weaning percentage, weaning weight); and estimate test sensitivity.

DESIGN

Epidemiologic study.

ANIMALS

1,383 bulls and records for 28,471 cows bred by these bulls in the immediate past breeding season.

PROCEDURE

Bulls in 11 cattle units on a large ranch were tested for T fetus colonization by vigorous preputial scraping and protozoologic culture until no newly infected bulls were identified. Bull infection prevalence within units was calculated and correlated to production measurements reported for each cattle unit.

RESULTS

Mean prevalence of T fetus-infected bulls was 11.9% (range, 0 to 35.9%). Significant difference was detected between mean age of infected bulls (5.5 years) and noninfected bulls (3.9 years). Difference in prevalence among breeds was found, although other factors may have influenced this finding. Cow performance measurements (weaning percentage, mean weaning weight, and adjusted mean weaning weight/exposed cow) for cows exposed by breeding to bull groups with the highest prevalence of infection (35.9%) were significantly different from mean values for the entire study population. Test sensitivity for this study (73%) was less than that reported in other studies.

CLINICAL IMPLICATIONS

T fetus infection in a natural service beef herd has an adverse impact on several production measures: Severity of impact is related to prevalence of infection in the bull population, where prevalence is bull age and population dependent.

Aberrant migration of Ancylostoma caninum to the os penis of a dog

A male pitbull terrier was presented with a history of stranguria and depression. On clinical and radiological examination a suspected necrogranuloma of the caudal os penis, which obstructed the urethra, was found. The necrogranuloma was removed surgically and contained blood and necrotic tissue as well as several adult male and female Ancylostoma caninum worms. The urethral obstruction resulted in post-renal azotaemia, hydronephrosis and eventually bladder rupture. A rare case of aberrant migration of A. caninum to the os penis of a dog is described.

Canine mucosal leishmaniasis

Four dogs infected with Leishmania had proliferative lesions on the mucosae of the penis, tongue, oral cavity, prepuce, or nose. These mucosal, nodular lesions produced by parasites of the genus Leishmania have not been described previously in the dog. Leishmaniasis should be considered in the differential diagnosis of tumor-like lesions of mucous membranes.

Morphological differentiation of Tritrichomonas foetus from other protozoa of the bovine reproductive tract

Tritrichomonas foetus is a protozoan parasite associated with reproductive failure in the bovine. Its incidence has effectively been controlled in the UK, as in many other countries, through a policy of testing of breeding animals and the widespread use of artificial insemination (AI). As a result there have been only two cases of bovine trichomoniasis in the UK over the past 20 years. Despite the virtual absence of T. foetus in bovine preputial and vaginal samples, routine examinations have occasionally revealed the presence of motile protozoa which require careful identification. In this paper, the morphological characteristics of T. foetus, and other protozoa isolated from the bovine reproductive tract, are presented.

Risk assessment and laboratory diagnosis of trichomoniasis in men

Control of Trichomonas vaginalis is assuming higher priority because recent studies have suggested that trichomoniasis enhances susceptibility to human immunodeficiency virus infection and the risk for delivery of low-birth weight infants. In a cross-sectional study, 50 cases were identified among 447 men attending a sexually transmitted disease clinic. As previously reported, trichomoniasis was associated with nonchlamydial nongonococcal urethritis. Other risk factors included sexual contact with an infected woman or prior treatment for trichomoniasis or nongonococcal urethritis. Urethral and first-void urine cultures were positive in 80% and 68% of positive cases, respectively. When combined, these two cultures diagnosed 49 (98%) of 50 cases. These data suggest that criteria for selection of men for culture should include presence of nonchlamydial nongonococcal urethritis, recent exposure to trichomoniasis, or a history of trichomoniasis or nongonococcal urethritis. In addition, combining urethral and urine sediment cultures may prove accurate for evaluating T. vaginalis infection.