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Samra RS, Plummer EL, Vodstrcil L, Bradshaw CS. Case of Haemophilus influenzae urethritis in a male patient. Sex Transm Infect 2024; 100:189. [PMID: 38365450 DOI: 10.1136/sextrans-2023-055926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Affiliation(s)
- Ranjit S Samra
- Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lenka Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Ljubin-Sternak S, Meštrović T, Marijan T, Anušić M, Šuto S, Vraneš J. Detection of Macrolide and/or Fluoroquinolone Resistance Genes in Mycoplasma genitalium Strains Isolated from Men in the Northwest Region of Croatia in 2018-2023. Genes (Basel) 2024; 15:470. [PMID: 38674404 DOI: 10.3390/genes15040470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Mycoplasma genitalium (M. genitalium) poses a significant public health challenge due to its association with non-gonococcal urethritis (particularly in men) and antimicrobial resistance. However, despite the prevalence of M. genitalium infections and the rise in resistance rates, routine testing and surveillance remain limited. This is the first study from Croatia that aimed to assess the prevalence and trends of resistance in M. genitalium strains isolated from male individuals by detecting macrolide and fluoroquinolone resistance genes. The study also aimed to explore the factors associated with resistance and changes in resistance patterns over time. Urine samples collected from male individuals in the Zagreb County and northwest region of Croatia between 2018 and 2023 were tested for M. genitalium with the use of molecular methods. Positive samples were subjected to DNA extraction and multiplex tandem polymerase chain reaction (MT-PCR) targeting genetic mutations associated with macrolide (23S rRNA gene) and fluoroquinolone (parC gene) resistance. Of the 8073 urine samples tested from 6480 male individuals (and following the exclusion of repeated specimens), we found that the prevalence of M. genitalium infection was 2.2%. Macrolide resistance was observed in 60.4% of strains, while fluoroquinolone resistance was found in 19.2%. Co-resistance to both antibiotics was present in 18.2% of cases. A statistically significant increase in fluoroquinolone resistance was noted over the study period (p = 0.010), but this was not evident for azithromycin resistance (p = 0.165). There were no statistically significant differences in resistance patterns between age groups, whereas re-testing of patients revealed dynamic changes in resistance profiles over time. The high burden of macrolide resistance and increasing fluoroquinolone resistance underscore the urgent need for comprehensive resistance testing and surveillance programs. The implementation of resistance-guided treatment strategies, along with enhanced access to molecular diagnostics, is pivotal for effectively managing M. genitalium infections.
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Affiliation(s)
- Sunčanica Ljubin-Sternak
- Clinical Microbiology Department, Teaching Institute of Public Health "Dr Andrija Štampar", 10000 Zagreb, Croatia
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Meštrović
- University Centre Varaždin, University North, 42000 Varaždin, Croatia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Tatjana Marijan
- Clinical Microbiology Department, Teaching Institute of Public Health "Dr Andrija Štampar", 10000 Zagreb, Croatia
| | - Maja Anušić
- Clinical Microbiology Department, Teaching Institute of Public Health "Dr Andrija Štampar", 10000 Zagreb, Croatia
| | - Sandra Šuto
- Clinical Microbiology Department, Teaching Institute of Public Health "Dr Andrija Štampar", 10000 Zagreb, Croatia
| | - Jasmina Vraneš
- Clinical Microbiology Department, Teaching Institute of Public Health "Dr Andrija Štampar", 10000 Zagreb, Croatia
- Medical Microbiology Department, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Obafemi OA, Rowan SE, Nishiyama M, Wendel KA. Mycoplasma genitalium: Key Information for the Primary Care Clinician. Med Clin North Am 2024; 108:297-310. [PMID: 38331481 DOI: 10.1016/j.mcna.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission. Three Food and Drug Administration (FDA) approved tests are available. Testing should be focused to avoid inappropriate antibiotic use. The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis and state that testing should be considered in cases of PID. Testing is also recommended for sexual contacts of patients with MG. Testing is not recommended in asymptomatic patients, including pregnant patients, who do not have a history of MG exposure. Although resistance-guided therapy is recommended, there are currently no FDA approved tests for MG macrolide resistance, and tests are not widely available in the United States. The CDC recommends 2-step treatment with doxycycline followed by azithromycin or moxifloxacin. Moxifloxacin is recommended if resistance testing is unavailable or testing demonstrates macrolide resistance..
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Affiliation(s)
- Oluyomi A Obafemi
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Department of Family Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Sarah E Rowan
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Masayo Nishiyama
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA
| | - Karen A Wendel
- Public Health Institute at Denver Health, 601 Broadway, 8th Floor, MC 2800, Denver, CO 80203-3407, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
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Mullis CE, Marlow KA, Maity A, Fazzari M, Zingman BS, Keller MJ, Meyerowitz EA. Clinical Presentations and Treatment Outcomes of Mycoplasma genitalium Infections at a Large New York City Health Care System. Sex Transm Dis 2024; 51:199-205. [PMID: 38100794 PMCID: PMC10922512 DOI: 10.1097/olq.0000000000001911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Mycoplasma genitalium (MG) is an emerging sexually transmitted infection. Treatment of MG is complicated by increasing resistance to primary treatment regimens, including macrolides and fluoroquinolones. Understanding the various clinical presentations and relative effectiveness of treatments for MG is crucial to optimizing care. METHODS Patients with a positive MG nucleic acid amplification test between July 1, 2019, and June 30, 2021, at a large health system in New York City were included in a retrospective cohort. Demographics, clinical presentations, coinfections, treatment, and follow-up microbiologic tests were obtained from the electronic medical record. Associations with microbiologic cure were evaluated in bivariate and multivariable logistic regression models. RESULTS Five hundred two unique patients had a positive MG nucleic acid amplification test result during the study period. Male individuals presented predominantly with urethritis (117 of 187 [63%]) and female individuals with vaginal symptoms (142 of 315 [45%]). Among patients with follow-up testing who received a single antibiotic at the time of treatment, 43% (90 of 210) had persistent infection and 57% (120 of 210) had microbiologic cure. Eighty-two percent of patients treated with moxifloxacin had microbiologic cure compared with 41% of patients receiving azithromycin regimens ( P < 0.001). In multivariable analysis, treatment with moxifloxacin was associated with 4 times the odds of microbiologic cure relative to low-dose azithromycin (adjusted odds ratio [aOR], 4.18; 95% confidence interval, 1.73-10.13; P < 0.01). CONCLUSIONS Clinical presentations of MG vary, with urethritis or vaginal symptoms in most cases. Among patients who received a single antibiotic, only treatment with moxifloxacin was significantly associated with microbiologic cure relative to low-dose azithromycin.
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Affiliation(s)
- Caroline E. Mullis
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Kerry A. Marlow
- Albert Einstein College of Medicine, Bronx, New York, United States
| | - Aloke Maity
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Melissa Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Barry S. Zingman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Marla J. Keller
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Eric A. Meyerowitz
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
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Müller EE, Gumede LYE, Maseko DV, Mahlangu MP, Venter JME, Da Costa Dias B, Nhlapho D, Kularatne RS. Emergence of high-level azithromycin-resistant Neisseria gonorrhoeae causing male urethritis in Johannesburg, South Africa, 2021. Sex Health 2024; 21:NULL. [PMID: 38029797 DOI: 10.1071/sh23143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In South Africa, Neisseria gonorrhoeae , which is the predominant cause of male urethritis, is treated syndromically using dual ceftriaxone and azithromycin therapy. We determined antimicrobial susceptibilities of N. gonorrhoeae isolates from urethral discharge specimens, and genetically characterised those with elevated minimum inhibitory concentrations (MICs) for first-line antimicrobials. METHODS Routine antimicrobial susceptibility testing (AST) of N. gonorrhoeae isolates included E-test for ceftriaxone, cefixime and gentamicin and agar dilution for azithromycin and spectinomycin. Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance (NG-STAR) was performed for isolates with elevated MICs to identify antimicrobial resistance (AMR) determinants, and Neisseria gonorrhoeae Multi-Antigen Sequence Typing (NG-MAST) was used to determine strain relatedness. RESULTS N. gonorrhoeae was cultured from urethral discharge swab specimens obtained from 196 of 238 (82.4%) men presenting to a primary healthcare facility in Johannesburg in 2021. All viable isolates were susceptible to extended-spectrum cephalosporins. Four isolates had high azithromycin MICs ranging from 32mg/L to >256mg/L and grouped into two novel NG-MAST and NG-STAR groups. Two isolates from Group 1 (NG-MAST ST20366, NG-STAR ST4322) contained mutated mtrR (G45D) and 23S rRNA (A2059G) alleles, while the two isolates from Group 2 (NG-MAST ST20367, NG-STAR ST4323) had different mutations in mtrR (A39T) and 23S rRNA (C2611T). CONCLUSIONS We report the first cases of high-level azithromycin resistance in N. gonorrhoeae from South Africa. Continued AMR surveillance is critical to detect increasing azithromycin resistance prevalence in N. gonorrhoeae , which may justify future modifications to the STI syndromic management guidelines.
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Affiliation(s)
- Etienne E Müller
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Lindy Y E Gumede
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Dumisile V Maseko
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Mahlape P Mahlangu
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Johanna M E Venter
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Bianca Da Costa Dias
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Duduzile Nhlapho
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Ranmini S Kularatne
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; and Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Present address: Labtests Auckland and Northland Pathology, Mt Wellington, Auckland, New Zealand
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6
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Vallejo-Ruiz MDLS, Sandoval-Garcés M, Bru-Gorraiz FJ, Martín-Gorgojo A. Nongonococcal tysonitis. Int J STD AIDS 2024; 35:155-157. [PMID: 37852285 DOI: 10.1177/09564624231208241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Tyson's glands are sebaceous glands located on each side of the frenulum that communicate with the preputial sac, and their inflammation can be an infrequent complication of urethritis. We describe a rare case that presented with urethral discharge and parafrenular swelling with mucopurulent discharge a week after an unprotected sexual encounter. The patient was empirically treated with 500 mg of ceftriaxone intramuscularly and 100 mg of doxycycline every 12 h for 14 days with symptomatic resolution. The urethral swab culture and the urine polymerase chain reaction (PCR) were negative for Neisseria gonorrhoeae and Chlamydia trachomatis, therefore, and given the response to treatment, nongonococcal tysonitis was diagnosed.
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Affiliation(s)
- María de la Soledad Vallejo-Ruiz
- STI/Dermatology Department, Centro de Diagnóstico Médico, Madrid City Council, Madrid, Spain
- Dermatology Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | - Matías Sandoval-Garcés
- STI/Dermatology Department, Centro de Diagnóstico Médico, Madrid City Council, Madrid, Spain
- Department of Dermatology, School of Medicine. University of Chile, Santiago de Chile, Chile
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Pérez-Bertólez S, Casal-Beloy I, Martín-Solé O, Carbonell M, Capdevila B, Tarrado X, García-Aparicio L. A novel therapy for idiopathic urethritis in children: Local steroid injection. J Pediatr Urol 2024; 20:134-137. [PMID: 37827922 DOI: 10.1016/j.jpurol.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
Idiopathic urethritis (IU) is difficult to manage and there is no standarized therapy. The technique of local steroid injection (LSI) for the treatment of IU in children and the results of the patients undergoing LSI from 2020 to 2021 in a single center are presented. Seven patients with IU underwent LSI. An internal urethrotomy was also performed in two patients with stricture. Complete resolution of symptoms and signs occurred in six patients. The remaining patient did not achieve total remission but did substantially improve symptoms. LSI seems to be an effective alternative for treatment of IU in children.
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Affiliation(s)
- Sonia Pérez-Bertólez
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
| | - Isabel Casal-Beloy
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Oriol Martín-Solé
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Mar Carbonell
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Blanca Capdevila
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Xavier Tarrado
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Luis García-Aparicio
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
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8
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Rossotti R, Travi G, Bana NB, Orcese C, Puoti M. A case of chronic bacterial prostatitis due to Mycoplasma genitalium. Sex Transm Infect 2023; 99:571-573. [PMID: 37963760 DOI: 10.1136/sextrans-2023-055935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
Mycoplasma genitalium (MG) is a common cause of non-gonococcal urethritis, but a role in acute or chronic prostatitis has not been described. We describe the case of a 42-year-old man with recurrent urinary tract infections since 2018 who developed chronic prostatitis despite several and prolonged antibiotic courses. Multiparametric prostatic magnetic resonance showed peripheral inflammatory alterations. A 4-glass Meares-Stamey test detected MG in the third voided bladder (VB3) sample. Moxifloxacin 400 mg daily for 28 days resulted in sustained clinical and microbiological cure.
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Affiliation(s)
- Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Giovanna Travi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Nicholas Brian Bana
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Carloandrea Orcese
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
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Manhart LE, Leipertz G, Soge OO, Jordan SJ, McNeil C, Pathela P, Reno H, Wendel K, Parker A, Geisler WM, Getman D, Golden MR. Mycoplasma genitalium in the US (MyGeniUS): Surveillance Data From Sexual Health Clinics in 4 US Regions. Clin Infect Dis 2023; 77:1449-1459. [PMID: 37402645 PMCID: PMC10654846 DOI: 10.1093/cid/ciad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) is on the CDC Watch List of Antimicrobial Resistance Threats, yet there is no systematic surveillance to monitor change. METHODS We initiated surveillance in sexual health clinics in 6 cities, selecting a quota sample of urogenital specimens tested for gonorrhea and/or chlamydia. We abstracted patient data from medical records and detected MG and macrolide-resistance mutations (MRMs) by nucleic acid amplification testing. We used Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% CIs, adjusting for sampling criteria (site, birth sex, symptom status). RESULTS From October-December 2020 we tested 1743 urogenital specimens: 57.0% from males, 46.1% from non-Hispanic Black persons, and 43.8% from symptomatic patients. MG prevalence was 16.6% (95% CI: 14.9-18.5%; site-specific range: 9.9-23.5%) and higher in St Louis (aPR: 1.9; 1.27-2.85), Greensboro (aPR: 1.8; 1.18-2.79), and Denver (aPR: 1.7; 1.12-2.44) than Seattle. Prevalence was highest in persons <18 years (30.4%) and declined 3% per each additional year of age (aPR: .97; .955-.982). MG was detected in 26.8%, 21.1%, 11.8%, and 15.4% of urethritis, vaginitis, cervicitis, and pelvic inflammatory disease (PID), respectively. It was present in 9% of asymptomatic males and 15.4% of asymptomatic females, and associated with male urethritis (aPR: 1.7; 1.22-2.50) and chlamydia (aPR: 1.7; 1.13-2.53). MRM prevalence was 59.1% (95% CI: 53.1-64.8%; site-specific range: 51.3-70.6%). MRMs were associated with vaginitis (aPR: 1.8; 1.14-2.85), cervicitis (aPR: 3.5; 1.69-7.30), and PID cervicitis (aPR: 1.8; 1.09-3.08). CONCLUSIONS MG infection is common in persons at high risk of sexually transmitted infections; testing symptomatic patients would facilitate appropriate therapy. Macrolide resistance is high and azithromycin should not be used without resistance testing.
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Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology and Center for AIDS and STD, University of Washington, Seattle, Washington, USA
| | - Gina Leipertz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Olusegun O Soge
- Department of Global Health, and Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Stephen J Jordan
- Division of Infectious Diseases, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Candice McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Preeti Pathela
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Hilary Reno
- Division of Infectious Diseases, Washington University, St Louis, Missouri, USA
| | - Karen Wendel
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Anika Parker
- Department of Epidemiology and Center for AIDS and STD, University of Washington, Seattle, Washington, USA
| | - William M Geisler
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Matthew R Golden
- Center for AIDS and STD, University of Washington, Seattle, Washington, USA
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10
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Matoga M, Chen JS, Massa C, Thengolose I, Tegha G, Ndalama B, Bonongwe N, Mathiya E, Jere E, Banda G, Khan S, Loftis AJ, Kashuba A, Cottrell ML, Schauer AP, Van Horne B, Tompkins LA, Lancaster KE, Miller WC, Eron JJ, Hoffman IF, Cohen MS. HIV and urethritis: time required for antiretroviral therapy to suppress HIV in semen. AIDS 2023; 37:2233-2238. [PMID: 37534689 PMCID: PMC10621634 DOI: 10.1097/qad.0000000000003679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To examine the time required to suppress HIV in the genital tract with antiretroviral therapy (ART) in men with urethritis. DESIGN An observational cohort study. METHODS Men with HIV and urethritis not on ART were enrolled at an STI clinic in Malawi and offered to initiate ART. Blood and semen samples were collected pretreatment and at 1, 2, 4, 8, 12 and 24 weeks posturethritis treatment. Median viral loads (VLs) were calculated by ART initiation groups: 'within 1 week', 'between 1 and 4 weeks' and 'no ART before 4 weeks', based on the men's choice about whether or not to initiate ART. The presence of ART at each visit was confirmed by bioanalytical methods. FINDINGS Between January 2017 and November 2018, 74 men presented with urethritis and HIV and were confirmed ART naive. The median age was 32 years. Forty-one (55% of men) initiated ART within 1 week; 12 (16%) between 1 and 4 weeks; and 21 (28%) did not initiate ART by week 4. Within the 1 week group, median VL was suppressed within 4 weeks in both semen and blood. Among the 1-4 weeks group, VL was suppressed within 4 weeks in semen and 5 weeks in blood. Among the no ART before 4 weeks group, VL in semen declined within the first 4 weeks but remained unsuppressed through week 24, and there was no significant decline in blood HIV. CONCLUSION Treatment of urethritis and prompt initiation of ART with counseling for safer sex for at least one month is a critical measure to reduce transmission of HIV.
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Affiliation(s)
- Mitch Matoga
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Jane S. Chen
- Institute for Global Health and Infectious Diseases
| | - Cecilia Massa
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Gerald Tegha
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Naomi Bonongwe
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Esther Mathiya
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Edward Jere
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Gabriel Banda
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Shiraz Khan
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Angela Kashuba
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | | | - Amanda P. Schauer
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Brian Van Horne
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Lauren A. Tompkins
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | | | - William C. Miller
- The Ohio State University College of Public Health, Columbus, OH, USA
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Saiz-Escobedo L, Cadenas-Jiménez I, Olmos R, Carrera-Salinas A, Berbel D, Càmara J, Tubau F, Domínguez MA, Ardanuy C, González-Díaz A, Marti S. Detection of bla CTX-M-15 in an integrative and conjugative element in four extensively drug-resistant Haemophilus parainfluenzae strains causing urethritis. Int J Antimicrob Agents 2023; 62:106991. [PMID: 37774891 DOI: 10.1016/j.ijantimicag.2023.106991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
Haemophilus parainfluenzae is a commensal organism with rising numbers of multidrug-resistant (MDR) strains. This pathogen is of increasing clinical relevance in urogenital infection. The aim of this work was to identify and characterise the molecular mechanisms of resistance associated with four cephalosporin-resistant H. parainfluenzae strains collected from patients with urethritis. Antimicrobial resistance was determined by microdilution following European Committee on Antimicrobial Susceptibility Testing criteria. Strains were then analysed by whole-genome sequencing to determine clonal relationship and the molecular basis of antimicrobial resistance. Finally, a phylogenetic analysis was performed on all urogenital MDR strains of H. parainfluenzae previously isolated in our hospital. All strains were resistant to β-lactams, macrolides, tetracycline, fluoroquinolones, chloramphenicol, cotrimoxazole, and aminoglycosides. The resistance profile was compatible with the presence of an extended-spectrum β-lactamase (ESBL). Whole-genome sequencing detected blaCTX-M-15 that conferred high minimum inhibitory concentrations to cephalosporins in two novel integrative and conjugative elements (ICEHpaHUB6 and ICEHpaHUB7) that also harboured a blaTEM-1 β-lactamase. This study shows a novel blaCTX-M-15 ESBL carried in an integrative conjugative element in four extensively drug-resistant H. parainfluenzae strains. This resistance determinant could be transmitted to other sexually transmitted pathogens and this is a cause for concern.
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Affiliation(s)
- L Saiz-Escobedo
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
| | - I Cadenas-Jiménez
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - R Olmos
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
| | - A Carrera-Salinas
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
| | - D Berbel
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - J Càmara
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - F Tubau
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - M A Domínguez
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Infectious Diseases (CIBERINFEC), ISCIII, Madrid, Spain; Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - C Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain; Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - A González-Díaz
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain.
| | - S Marti
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain; Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Spain.
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12
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Yasuda M, Takahashi S, Miyazaki J, Wada K, Kobayashi K, Matsumoto M, Hayami H, Yamamoto S, Kiyota H, Sato J, Matsumoto T, Yotsuyanagi H, Hanaki H, Masumori N, Hiyama Y, Nishiyama H, Kimura T, Yamada H, Matsumoto K, Ishikawa K, Togo Y, Tanaka K, Sadahira T, Inokuchi J, Hamasuna R, Ito K, Hirayama H, Hayashi K, Kurimura Y, Kadena H, Ito S, Shiono Y, Maruyama T, Ito M, Hatano K, Chokyu H, Ihara H, Uno S, Monden K, Yokoyama T, Kano M, Kaji S, Kawahara M, Sumii T, Tojo T, Hosobe T, Naito K, Kawai S, Nishimura H, Izumitani M, Yoh M, Matsumura M, Fujita R, Takayama K, Hara M, Nishi S. The third nationwide surveillance of antimicrobial susceptibility against Neisseria gonorrhoeae from male urethritis in Japan, 2016-2017. J Infect Chemother 2023; 29:1011-1016. [PMID: 37553046 DOI: 10.1016/j.jiac.2023.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023]
Abstract
Neisseria gonorrhoeae is one of the important pathogens of sexually transmitted infections. N. gonorrhoeae is rapidly becoming antimicrobial resistant, and there are few drugs that are effective in the initial treatment of gonorrhea. To understand the trends of antimicrobial susceptibility of N. gonorrhoeae, the Surveillance Committee of the Japanese Society of Infectious Diseases, the Japanese Society for Chemotherapy, and the Japanese Society of Clinical Microbiology conducted the third nationwide antimicrobial susceptibility surveillance of N. gonorrhoeae isolated from male urethritis. The specimens were collected from male patients with urethritis at 30 facilities from May 2016 to July 2017. From the 159 specimens collected, 87 N. gonorrhoeae strains were isolated, and 85 were tested for susceptibility to 21 antimicrobial agents. All strains were non-susceptible to penicillin G. Seven strains (8.2%) were β-lactamase-producing strains. The rates of susceptibility to cefixime and cefpodoxime were 96.5% and 52.9%, respectively. Three strains were non-susceptible with a minimum inhibitory concentration (MIC) of 0.5 mg/L for cefixime. None of the strains were resistant to ceftriaxone or spectinomycin. The susceptibility rate for ciprofloxacin was 23.5% (20 strains), and no strains showed intermediate susceptibility. The susceptibility rate against azithromycin was 81.2%, with one strain isolated with a MIC of 8 mg/L against azithromycin. The results of this surveillance indicate that ceftriaxone and spectinomycin, which are currently recommended for gonococcal infections in Japan, appear to be effective. It will be necessary to further expand the scale of the next surveillance to understand the current status of drug-resistant N. gonorrhoeae in Japan.
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Affiliation(s)
- Mitsuru Yasuda
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Satoshi Takahashi
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jun Miyazaki
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan; Department of Urology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koichiro Wada
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, Faculty of Medicine, Shimane University, Izumo, Japan; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kanao Kobayashi
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Masahiro Matsumoto
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Hiroshi Hayami
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Shingo Yamamoto
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroshi Kiyota
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan; Department of Urology, School of Medicine, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Junko Sato
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan
| | | | | | - Hideaki Hanaki
- Research Center for Anti-infectious Drugs, Kitasato Institute for Life Science, Kitasato University, Tokyo, Japan
| | - Naoya Masumori
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yoshiki Hiyama
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Yamada
- Department of Urology, School of Medicine, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kiyohito Ishikawa
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yoshikazu Togo
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryoichi Hamasuna
- Department of Urology, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Kenji Ito
- Ito Urology Clinic, Kitakyushu, Japan
| | | | - Kenji Hayashi
- Department of Urology, Tomakomai Urological Clinic, Hokkaido, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Motonori Kano
- Department of Urology, Kano Hospital, Kasuya-gun, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Ryuji Fujita
- Nephrology and Urology Nishigawara Clinic, Okayama, Japan
| | - Kazuo Takayama
- Department of Urology, Takayama Hospital, Chikushino, Japan
| | - Makoto Hara
- Department of Urology, Tsujinaka Hospital, Kashiwa, Japan
| | - Shohei Nishi
- Nishi Urology and Dermatology Clinic, Kitakyushu, Japan
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Hsu YT, Chuang TY, Hsiao JC, Cheng W. Diagnosis and treatment outcomes of urethritis-like symptoms in young males: a retrospective cohort study. Sci Rep 2023; 13:17469. [PMID: 37838817 PMCID: PMC10576823 DOI: 10.1038/s41598-023-44733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
The study evaluated the prevalence of gonorrhoea and chlamydia infections and find out other non-infectious diseases in sexually active young males with urethritis-like symptoms and their treatment outcomes. We retrospectively reviewed the young adult males (aged 20-50 years) who visited our clinic with urethritis symptoms from March 2019 to April 2022. All patients underwent urinalysis, urine culture, and urinary polymerase chain reaction (PCR) testing for gonorrhoea and chlamydia. Student's t-test and Pearson's chi-square test were used to compare the differences between the triple-negative group (i.e., negative results in urinalysis, urine culture, and urinary PCR) and the any-positive group. Logistic regression analyses were used to evaluate the predictive factors for positive PCR results for gonorrhoea or chlamydia in patients with negative urinalysis and urine culture. Of the 365 participants with urethritis-like symptoms, 139 patients were diagnosed of gonococcal or chlamydia urethritis. Among the 202 patients with negative urinalysis and urine culture, 60 patients were diagnosed with gonorrhoea or chlamydia using PCR. Urethral discharge was an independent predictor. 142 patients with triple negative results were attributed to other non-infectious diseases. Empirical antibiotic treatment is recommended for patients with urethritis symptoms showing positive or negative urinalysis results but with urethral discharge.
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Affiliation(s)
- Yi-Ting Hsu
- Division of Urology, Department of Surgery, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Tzu-Yu Chuang
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jui Chang Hsiao
- Department of Clinical Laboratory, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Weiming Cheng
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.
- Department of Urology, Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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14
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Ruiz Del Pino M, Rosales-Castillo A, Hidalgo-Tenorio C, Expósito-Ruiz M, Navarro-Marí JM, Gutiérrez-Fernández J. [Isolation of Haemophilus no ducreyi in samples from the genital tract of men: Its clinical relationship]. Rev Int Androl 2023; 21:100374. [PMID: 37413940 DOI: 10.1016/j.androl.2023.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION With the advancement of microbiological methods, the isolation of less typical pathogens in cases of urethral and rectal infection is more frequent, apart from the classic etiological agents. One of them is formed by species of Haemophilus no ducreyi (HND). The objective of this work is to describe frequency, susceptibility to antibiotics, and clinical features of HDN urethritis and proctitis in adult males. PATIENTS AND METHODS This is an observational retrospective descriptive study of the results obtained by the Microbiology laboratory of the Virgen de las Nieves University Hospital on the isolates of HND in genital and rectal samples from males between 2016 and 2019. RESULTS HND was isolated in 135 (7%) of the genital infection episodes diagnosed in men. H. parainfluenzae was the most commonly isolated (34/45; 75.6%). The most frequent symptoms in men with proctitis were rectal tenesmus (31.6%) and lymphadenopathy (10.5%); in those with urethritis, dysuria (71.6%), urethral suppuration (46.7%) and gland lesions (27%), so differentiating it from infections caused by other genitopathogens is difficult. 43% of patients were HIV positive. Antibiotic resistance rates for H. parainfluenzae were high to quinolons, ampicillin, tetracycline and macrolides. CONCLUSION HND species should be considered as possible etiologic agents in episodes of urethral and rectal infection in men, especially in cases with negative screening tests for agents that cause sexually transmitted infections (STIs). Its microbiological identification is essential for the establishment of an effective targeted treatment.
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Affiliation(s)
- Marta Ruiz Del Pino
- Departamento de Microbiología, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - Antonio Rosales-Castillo
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves-IBS, Granada, España; Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España.
| | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - Manuela Expósito-Ruiz
- Departamento de Bioestadística de FIBAO, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - José María Navarro-Marí
- Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España
| | - José Gutiérrez-Fernández
- Departamento de Microbiología, Hospital Universitario Virgen de las Nieves-IBS, Granada, España; Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España
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15
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Braam JF, Zondag HCA, van Dam AP, de Vries HJC, Vergunst C, Hetem D, Schim van der Loeff MF, Bruisten SM. Prevalence of fluoroquinolone resistance-associated mutations in Mycoplasma genitalium among clients of two sexual health centres in the Netherlands: a cross-sectional study. BMJ Open 2022; 12:e066368. [PMID: 36600371 PMCID: PMC9730358 DOI: 10.1136/bmjopen-2022-066368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to determine the prevalence of fluoroquinolone resistance-associated mutations (QRAMs) in Mycoplasma genitalium (MG) among clients of two sexual health centres (SHCs) in the Netherlands. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS Between 2018 and 2019, 669 clients with MG were included from two previous studies: 375 male clients with urethritis from the SHC in Amsterdam; and 294 clients (male and female) from the SHC in Amsterdam and The Hague. Urogenital and anal samples (705 in total) that tested positive for MG by nucleic acid amplification tests were selected. OUTCOME MEASURES The presence of QRAM was detected by an MG-QRAM PCR targeting four mutations in the parC gene and investigated by sequence analysis of relevant regions of the gyrA and parC genes. Possible risk factors for the presence of QRAM were investigated. RESULTS We found QRAM in 58 of 669 (9%) clients with an MG infection: 36 of 375 (10%) in the study population of men with urethritis and 22 of 294 (7%) in the study population of other clients (including both men and women; p=0.334). Most prevalent mutations in the parC gene were S83I and D87N, occurring in 31 of 60 (52%) and 20 of 60 (33%) samples, respectively. Factors associated with the presence of QRAM were: men who have sex with men (adjusted OR (aOR) 3.4, 95% CI 1.7 to 6.9) and Asian origin (aOR 2.5, 95% CI 1.2 to 5.6). Multidrug resistance (QRAM plus macrolide resistance-associated mutations) was found in 46 of 669 (7%) clients. CONCLUSIONS Nine per cent of MG-positive clients from two Dutch SHCs had QRAM. New treatment strategies and antibiotics are needed to treat symptomatic patients with multidrug-resistant MG.
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Affiliation(s)
- Joyce F Braam
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Helene C A Zondag
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Alje P van Dam
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Clarissa Vergunst
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Noordwest Ziekenhuisgroep-Locatie Den Helder, Den Helder, The Netherlands
| | - David Hetem
- Department of Medical Microbiology, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Sylvia M Bruisten
- Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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16
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Meštrović T, Neuberg M, Sviben M, Ribić R, Drenjančević D, Škrlec I, Talapko J, Kozina G, Profozić Z. Corynebacterium glucuronolyticum in men with and without urethritis syndrome: An underrecognized pathogen or a bona fide commensal? Infect Dis Now 2022; 52:441-446. [PMID: 36030041 DOI: 10.1016/j.idnow.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND By analysing the largest collection of Corynebacterium glucuronolyticum (C. glucuronolyticum) isolates from a single centre thus far, we aimed to appraise a potential causal link between an infrequently isolated species and the urethritis syndrome in men. METHODS A total of 1055 Caucasian male individuals with or without urethritis syndrome were included in this single-centre case-control study. Group-wise comparisons were pursued by analysing sociodemographic, behavioural and microbiological specificities between the two groups. C. glucuronolyticum isolates from urethral specimens were identified using the analytical profile index biotyping system (API Coryne) and additionally confirmed by MALDI-TOF mass-spectrometry, with subsequent determination of their antimicrobial sensitivity profiles. Statistical significance was set at p < 0.05 (two-tailed). RESULTS C. glucuronolyticum was isolated in 5.08% of study participants with urethritis syndrome and 3.60% of those without it (p = 0.303). In the urethritis group, the species was more frequently found as a sole isolate (p = 0.041) and after prior infection with Chlamydia trachomatis (p = 0.025). The most frequent presentation of urethritis included a clear discharge in small or moderate amounts, without any pathognomonic findings. The resistance rates were 62.22% for clindamycin, 42.22% for tetracycline and 26.67% for ciprofloxacin. CONCLUSIONS Our study provides major insights on the relevance of urethral C. glucuronolyticum in non-gonococcal urethritis, with significant implications for further aetiological research and management approaches.
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Affiliation(s)
- T Meštrović
- Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington, USA; University Centre Varaždin, University North, Varaždin, Croatia; Clinical Microbiology and Parasitology Unit, Dr. Zora Profozić Polyclinic, Zagreb, Croatia.
| | - M Neuberg
- University Centre Varaždin, University North, Varaždin, Croatia
| | - M Sviben
- Microbiology Service, Croatian National Institute of Public Health, Zagreb, Croatia; Medical Microbiology Department, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - R Ribić
- University Centre Varaždin, University North, Varaždin, Croatia
| | - D Drenjančević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; University Hospital Centre Osijek, Osijek, Croatia
| | - I Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - J Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - G Kozina
- University Centre Varaždin, University North, Varaždin, Croatia
| | - Z Profozić
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozić Polyclinic, Zagreb, Croatia
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17
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Melendez JH, Hardick J, Onzia A, Yu T, Kyambadde P, Parkes-Ratanshi R, Nakku-Joloba E, Kiragga A, Manabe YC, Hamill MM. Retrospective Analysis of Ugandan Men with Urethritis Reveals Mycoplasma genitalium and Associated Macrolide Resistance. Microbiol Spectr 2022; 10:e0230421. [PMID: 35412392 PMCID: PMC9045240 DOI: 10.1128/spectrum.02304-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/14/2022] [Indexed: 01/22/2023] Open
Abstract
The rising rates of antimicrobial resistance (AMR) in Mycoplasma genitalium globally and the association of this sexually transmitted infection (STI) with cervicitis, urethritis, and HIV are potentially of great public health concern. Data on the epidemiology of M. genitalium in men in sub-Saharan Africa are limited. We sought to determine the prevalence of M. genitalium and macrolide resistance in men with urethritis in Kampala, Uganda. Self-collected penile-meatal swabs and/or urine samples from men with symptomatic urethritis (n = 250) were retrospectively analyzed for the presence of M. genitalium and macrolide resistance markers with the Aptima M. genitalium and ResistancePlus M. genitalium assays. Additionally, demographic and STI coinfection data were used to investigate associations with M. genitalium infection. M. genitalium was detected in 12.8% (32/250) of individuals; 40.6% (n = 13) had M. genitalium monoinfection. Mutations associated with macrolide resistance were detected in 10.7% (3/28) of participants. Coinfection with Neisseria gonorrhoeae was common (41.0%), but M. genitalium was more prevalent in participants without N. gonorrhoeae coinfection (P = 0.001). M. genitalium is common in Ugandan men with urethritis both as a monoinfection and as a coinfection with other curable STIs. Macrolide resistance was present and warrants further research on treatment outcomes and the association between untreated M. genitalium and subsequent morbidity. IMPORTANCE Mycoplasma genitalium is a common sexually transmitted infection associated with urethritis in men. Little is known about M. genitalium infection in men with urethritis in Uganda. We report that 12% of participants in this study were positive for M. genitalium and that resistance to azithromycin, a macrolide antibiotic, is present. Furthermore, we show that either self-collected penile-meatal swabs or urine can be used for detection of M. genitalium.
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Affiliation(s)
- Johan H. Melendez
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Justin Hardick
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Annet Onzia
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tong Yu
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Peter Kyambadde
- Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda
| | | | - Edith Nakku-Joloba
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yukari C. Manabe
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Shepherd R, Crossland A, Turo R, Christodoulidou M. Unusual presentation of a periurethral abscess following infection with Neisseria gonorrhoea. BMJ Case Rep 2022; 15:e246494. [PMID: 34983811 PMCID: PMC8728418 DOI: 10.1136/bcr-2021-246494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/04/2022] Open
Abstract
We describe an unusual case of a male patient presenting with penile and testicular swelling following an unprotected and traumatic sexual encounter. It was suspected that an isolated penile injury occurred during intercourse; however, ultrasound imaging identified an intact tunical layer and right-sided epididymo-orchitis. Following screening for sexually transmitted infections (STIs), he was discharged with antibiotics and advice to attend the Sexual Health Centre for contact tracing. He represented with a periurethral abscess and an antimicrobial-resistant (AMR) strain of Neisseria gonorrhoea was identified. Appropriate antibiotic treatment was initiated. Examination-under-anaesthesia, following abscess drainage, revealed a contained collection with no urethral fistula; however, a flat urethral lesion was seen during urethroscopy. Repeat urethroscopy and biopsy of the lesion indicated polypoid urethritis. Periurethral abscess secondary to gonococcal urethritis is a rare complication, but one that we should be suspicious of, especially with the growing incidence of AMR-STIs.
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Affiliation(s)
- Robin Shepherd
- Urology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | | | - Rafal Turo
- Urology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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Toh E, Gao X, Williams JA, Batteiger TA, Coss LA, LaPradd M, Ren J, Geisler WM, Xing Y, Dong Q, Nelson DE, Jordan SJ. Evaluation of Clinical, Gram Stain, and Microbiological Cure Outcomes in Men Receiving Azithromycin for Acute Nongonococcal Urethritis: Discordant Cures Are Associated With Mycoplasma genitalium Infection. Sex Transm Dis 2022; 49:67-75. [PMID: 34618416 PMCID: PMC8665015 DOI: 10.1097/olq.0000000000001509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In men with nongonococcal urethritis (NGU), clinicians and patients rely on clinical cure to guide the need for additional testing/treatment and when to resume sex, respectively; however, discordant clinical and microbiological cure outcomes do occur. How accurately clinical cure reflects microbiological cure in specific sexually transmitted infections (STIs) is unclear. METHODS Men with NGU were tested for Neisseria gonorrhoeae, Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis, urethrotropic Neisseria meningitidis ST-11 clade strains, and Ureaplasma urealyticum (UU). Men received azithromycin 1 g and returned for a 1-month test-of-cure visit. In MG infections, we evaluated for the presence of macrolide resistance-mediating mutations (MRMs) and investigated alternate hypotheses for microbiological treatment failure using in situ shotgun metagenomic sequencing, phylogenetic analysis, multilocus sequence typing analyses, and quantitative PCR. RESULTS Of 280 men with NGU, 121 were included in this analysis. In the monoinfection group, 52 had CT, 16 had MG, 7 had UU, 10 had mixed infection, and 36 men had idiopathic NGU. Clinical cure rates were 85% for CT, 100% for UU, 50% for MG, and 67% for idiopathic NGU. Clinical cure accurately predicted microbiological cure for all STIs, except MG. Discordant results were significantly associated with MG-NGU and predominantly reflected microbiological failure in men with clinical cure. Mycoplasma genitalium MRMs, but not MG load or strain, were strongly associated with microbiological failure. CONCLUSIONS In azithromycin-treated NGU, clinical cure predicts microbiological cure for all STIs, except MG. Nongonococcal urethritis management should include MG testing and confirmation of microbiological cure in azithromycin-treated MG-NGU when MRM testing is unavailable.
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Affiliation(s)
- Evelyn Toh
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Xiang Gao
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - James A. Williams
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Teresa A. Batteiger
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lisa A. Coss
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michelle LaPradd
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jie Ren
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - William M. Geisler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yue Xing
- Center for Biomedical Informatics, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Qunfeng Dong
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
- Center for Biomedical Informatics, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - David E. Nelson
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen J. Jordan
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Palich R, Gardette M, Bébéar C, Caumes É, Pereyre S, Monsel G. Initial Failure of Pristinamycin Treatment in a Case of Multidrug-Resistant Mycoplasma genitalium Urethritis Eventually Treated by Sequential Therapy. Sex Transm Dis 2021; 48:e163-e164. [PMID: 34110731 DOI: 10.1097/olq.0000000000001415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We present a case of persistent Mycoplasma genitalium urethritis with documented macrolide and fluoroquinolone resistance, and we describe the A2062T mutation in the 23S rRNA gene, possibly associated with pristinamycin resistance. After several treatment failures and loss of the A2062T mutation, M. genitalium urethritis was finally cured by a sequential antibiotic treatment including minocycline.
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Affiliation(s)
- Romain Palich
- From the Sorbonne University, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, Paris
| | - Marie Gardette
- CHU Bordeaux, Bacteriology Department, National Reference Center for Bacterial Sexually Transmitted Infections
| | | | - Éric Caumes
- From the Sorbonne University, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, Paris
| | | | - Gentiane Monsel
- From the Sorbonne University, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, Paris
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21
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Takahashi S, Yasuda M, Wada K, Matsumoto M, Hayami H, Kobayashi K, Miyazaki J, Kiyota H, Matsumoto T, Yotsuyanagi H, Tateda K, Sato J, Hanaki H, Masumori N, Hiyama Y, Egawa S, Yamada H, Matsumoto K, Ishikawa K, Yamamoto S, Togo Y, Tanaka K, Shigemura K, Uehara S, Kitano H, Kiyoshima K, Hamasuna R, Ito K, Hirayama H, Kawai S, Shiono Y, Maruyama T, Ito S, Yoh M, Ito M, Hatano K, Ihara H, Uno S, Monden K, Yokoyama T, Takayama K, Sumii T, Kadena H, Kawahara M, Hosobe T, Izumitani M, Kano M, Nishimura H, Fujita R, Kaji S, Hayashi K, Tojo T, Matumura M. Nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis from male urethritis in Japan: Comparison with the first surveillance report. J Infect Chemother 2021; 28:1-5. [PMID: 34580009 DOI: 10.1016/j.jiac.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 01/23/2023]
Abstract
The Urogenital Sub-committee and the Surveillance Committee of the Japanese Society of Chemotherapy, The Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology conducted the second nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis. In this second surveillance study, clinical urethral discharge specimens were collected from patients with urethritis in 26 hospitals and clinics from May 2016 to July 2017. Based on serial cultures, the minimum inhibitory concentration (MIC) could be determined for 41 isolates; the MICs (MIC90) of ciprofloxacin, levofloxacin, tosufloxacin, sitafloxacin, doxycycline, minocycline, erythromycin, clarithromycin, azithromycin and solithromycin were 2 μg/ml (2 μg/ml), 1 μg/ml (0.5 μg/ml), 0.25 μg/ml (0.25 μg/ml), 0.125 μg/ml (0.063 μg/ml), 0.125 μg/ml (0.125 μg/ml), 0.25 μg/ml (0.25 μg/ml), 0.031 μg/ml (0.031 μg/ml), 0.25 μg/ml (0.125 μg/ml), and 0.016 μg/ml (0.008 μg/ml), respectively. In summary, this surveillance project did not identify any strains resistant to fluoroquinolone, tetracycline, or macrolide agents in Japan. In addition, the MIC of solithromycin was favorable and lower than that of other antimicrobial agents. However, the MIC of azithromycin had a slightly higher value than that reported in the first surveillance report, though this might be within the acceptable margin of error. Therefore, the susceptibility of azithromycin, especially, should be monitored henceforth.
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Affiliation(s)
- Satoshi Takahashi
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Mitsuru Yasuda
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Koichiro Wada
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masahiro Matsumoto
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroshi Hayami
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Kanao Kobayashi
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan
| | - Jun Miyazaki
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan
| | - Hiroshi Kiyota
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Kazuhiro Tateda
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan
| | - Junko Sato
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan
| | - Hideaki Hanaki
- Infection Control Research Center, Kitasato University, Tokyo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Yamada
- Department of Urology, The Jikei University Katsushika MedicalCenter, Tokyo, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | | | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshikazu Togo
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazushi Tanaka
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumi Shigemura
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Uehara
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Kitano
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keijiro Kiyoshima
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryoichi Hamasuna
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kenji Ito
- Ito Urology Clinic, Kitakyushu, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kazuo Takayama
- Department of Urology, Takayama Hospital, Chikushino, Japan
| | | | | | | | | | | | - Motonori Kano
- Department of Urology, Kano Hospital, Fukuoka, Japan
| | | | - Ryuji Fujita
- Jin-Hinyokika Nishikawahara Clinic, Okaayama, Japan
| | | | - Kenji Hayashi
- Tomakomai Urology and Cardiology Clinic, Tomakomai, Japan
| | - Takanori Tojo
- Department of Urology, Tomeiatsugi Hospital, Atsugi, Japan
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de Lannoy LH, da Silva RJDC, Nahn EP, de Oliveira EC, Gaspar PC. Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause urethral discharge. Rev Soc Bras Med Trop 2021; 54:e2020633. [PMID: 34008729 PMCID: PMC8210486 DOI: 10.1590/0037-8682-633-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
This article approaches infections that cause urethral discharge. This theme is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. Urethritis can cause severe and even irreversible health damage when not properly treated, or when the microorganism develops antimicrobial resistance. It is noteworthy that the high levels of antimicrobial resistance grown by pathogens that cause urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention, and control actions for infections that cause urethral discharge, to contribute to managers' and health professionals' care qualification. Associated factors with urethritis are: young age, low socioeconomic level, multiple partnerships or new sexual partnership, history of STI, irregular use of condoms, and lack of access to adequate diagnosis and treatment.
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Affiliation(s)
- Leonor Henriette de Lannoy
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Infectologia, Vitória, ES, Brasil
| | - Roberto José de Carvalho da Silva
- Faculdade das Américas, Centro Universitário, São Paulo, SP, Brasil
- Secretaria de Estado da Saúde de São Paulo, Programa Estadual de DST/Aids, São Paulo, SP, Brasil
| | - Edilbert Pellegrini Nahn
- Universidade Federal do Estado do Rio de Janeiro, Campus Macaé, RJ, Brasil
- Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brasil
| | - Eduardo Campos de Oliveira
- Secretaria de Estado da Saúde de Santa Catarina, Gestão Estadual de DST/Aids/HIV de Santa Catarina, Florianópolis, SC, Brasil
| | - Pâmela Cristina Gaspar
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
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23
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Sell J, Nasir M, Courchesne C. Urethritis: Rapid Evidence Review. Am Fam Physician 2021; 103:553-558. [PMID: 33929174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Urethritis refers to inflammation of the urethra and is classified as gonococcal (caused by Neisseria gonorrhoeae) or nongonococcal in origin (most commonly caused by Chlamydia trachomatis, Mycoplasma genitalium, or Trichomonas vaginalis). The most common signs and symptoms include dysuria, mucopurulent urethral discharge, urethral discomfort, and erythema. Diagnostic criteria include typical signs, symptoms, or history of exposure in addition to mucopurulent discharge, Gram stain of urethral secretions showing at least two white blood cells per oil immersion field, first-void urinalysis showing at least 10 white blood cells per high-power field, or a positive leukocyte esterase result with first-void urine. First-line empiric treatment consists of ceftriaxone and doxycycline; however, the antibiotic regimen may be targeted to the isolated organism. Repeat testing is not recommended less than three weeks after treatment because false-positive results are possible during this time. Patients treated for a sexually transmitted infection should have repeat screening in three months, with shared decision-making about future screening intervals. Patients treated for urethritis should abstain from sex for seven days after the start of treatment, until their partners have been adequately treated, and until their symptoms have fully resolved.
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Affiliation(s)
- Jarrett Sell
- Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Munima Nasir
- Penn State Health Hershey Medical Center, Hershey, PA, USA
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24
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Urethritis. Am Fam Physician 2021; 103:Online. [PMID: 33929176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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25
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Kovalyeva YS, Neymark AI, Zheltikova YD, Subbotin EA. [The efficiency of combination therapy of non-gonococcal urethritis in men]. Urologiia 2020:5-9. [PMID: 33185339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM To carry out a comparative assessment of the efficiency of combination therapy for non-gonococcal urethritis (NGU) in men. MATERIALS AND METHODS a total of 124 patients with NGU and laboratory-confirmed urogenital infection were included in the study. The diagnostic methods included microscopy of urethral smear, real-time polymerase chain reaction (PCR) for the detection of uropathogens and laser Doppler flowmetry for evaluating the urethral microcirculation. All patients were randomized into three groups matched for age, clinical manifestations, and disease duration. Patients of the group 1 received targeted antibiotic therapy. In the group 2, local peloid therapy was added, while patients in group 3 additionally received vibromagnetotherapy. The control group consisted of 22 patients aged 18 to 55 years. The study included 2 visits, at the baseline and 4 weeks after the end of treatment. RESULTS After the treatment, the frequency of microbiological cure was 89%. In the group 3, more pronounced improvement in main symptoms of NGU was observed. The analysis of microcirculation after treatment in the groups 2 and 3 showed a significant increase in perfusion and modulation of urethral blood flow and a decrease in venous congestion after combined therapy. CONCLUSION The combined treatment, including antibiotic, peloid therapy, and vibromagnetotherapy, promotes more pronounced clinical improvement, restoration of urethral microcirculation and relief of inflammatory process in patients with NGU and can be recommended for routine clinical practice.
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Affiliation(s)
- Y S Kovalyeva
- Department of Dermatology and Venerology, Cosmetology and Immunology of Altai State Medical University of the Ministry of Health of Russia, Barnaul, Russia
| | - A I Neymark
- Department of Urology and Andrology with a course of Specialized Surgery of Altai State Medical University of the Ministry of Health of Russia, Barnaul, Russia
| | - Ya D Zheltikova
- Department of Dermatology and Venerology, Cosmetology and Immunology of Altai State Medical University of the Ministry of Health of Russia, Barnaul, Russia
| | - E A Subbotin
- Department of Physics and Informatics of Altai State Medical University of the Ministry of Health of Russia, Barnaul, Russia
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26
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Singh AE, Manhart L. Is It Time for the United States and Canada to Reconsider Macrolides as the First-line Empiric Treatment for Males With Symptomatic Urethritis? Clin Infect Dis 2020; 70:811-813. [PMID: 30972414 PMCID: PMC8344297 DOI: 10.1093/cid/ciz297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/04/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lisa Manhart
- Department of Epidemiology and Center for AIDS and STD, University of Washington, Seattle, Washington
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27
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Li Y, Su X, Le W, Li S, Yang Z, Chaisson C, Madico G, Gong X, Reed GW, Wang B, Rice PA. Mycoplasma genitalium in Symptomatic Male Urethritis: Macrolide Use Is Associated With Increased Resistance. Clin Infect Dis 2020; 70:805-810. [PMID: 30972419 PMCID: PMC7390511 DOI: 10.1093/cid/ciz294] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/04/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) causes symptomatic urethritis in men, and can infect alone or together with other sexually transmitted infection (STI) agents. METHODS The prevalence of MG and other STIs was determined in 1816 men with symptomatic urethritis. Resistance of MG to macrolides and fluoroquinolones was determined by sequencing; the impact of recent antimicrobial usage on the distribution of MG single or mixed infections was determined. RESULTS Overall, prevalence of MG infection was 19.7% (358/1816). Fifty-four percent (166/307) of MG infections occurred alone in the absence of other STI agents. Men with single MG infection self-administered or were prescribed antibiotics more often in the 30 days prior to enrollment than subjects with urethritis caused by MG coinfection (P < .0001). Higher rates (96.7%) of infection with macrolide resistance in MG were identified in men who had taken macrolides prior to enrollment (P < .03). Overall, 88.9% (303/341) of 23S ribosomal RNA (rRNA) genes contained mutations responsible for macrolide resistance; 89.5% (308/344) of parC and 12.4% (42/339) of gyrA genes had mutations responsible for fluoroquinolone resistance. Approximately 88% (270/308) of MG had combined mutations in 23S rRNA and parC genes; 10.4% (32/308) had mutations in all 3 genes. CONCLUSIONS MG was the single pathogen identified in 11% of men with symptomatic urethritis. Overall, nearly 90% of MG infections were resistant to macrolides and fluoroquinolones. Men who took macrolides in the 30 days prior to enrollment had higher rates (97%) of macrolide-resistant MG. Resistance was associated with numerous mutations in 23SrRNA, parC, and gyrA genes.
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Affiliation(s)
- Yang Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
- Affiliated Qingdao Municipal Hospital of Qingdao University, China
| | - Xiaohong Su
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Wenjing Le
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Sai Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - Zhaoyan Yang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health
| | - Christine Chaisson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health
| | - Guillermo Madico
- National Emerging Infectious Diseases Laboratories, Boston University
| | - Xiangdong Gong
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
| | - George W Reed
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester
- Corrona Research Foundation, Albany, New York
| | - Baoxi Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peter A Rice
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester
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28
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Zhou CF, Wu ZG, Li CD, Xiao YB, Cai J. [Diagnosis and treatment of male urethritis in urology and andrology: A status survey]. Zhonghua Nan Ke Xue 2019; 25:802-810. [PMID: 32233207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the status quo of the diagnosis and treatment of male urethritis (MU) in urology and andrology. METHODS According to The Guidelines for Clinical Diagnosis and Treatment of Sexually Transmitted Diseases (2017), we designed 27 questions on the prevalence, diagnosis, treatment, and prognosis of MU. Using these questions, we conducted a questionnaire investigation among urological, andrological and other relevant clinicians with different professional titles, followed by an analysis of the compliance of the doctors to the Guidelines. RESULTS Totally, 116 valid questionnaires were collected from 86 urological, 28 andrological and 2 other relevant doctors, including 22 professors, 36 associate professors, 40 attending doctors and 16 resident doctors. MU was found mostly in those aged 20-40 years and more than half of the patients had a history of unclean sex, gonococcal urethritis significantly less prevalent than non-gonococcal, with Ureaplasma urealyticum as the most common pathogen of non-gonococcal urethritis. As for the compliance to the Guidelines in the diagnosis of MU, 22.73% of the professors, 16.67% of the associate professors, 15.00% of the attending doctors and 12.50% of the resident doctors examined the eyes, mouth and perianus (P > 0.05), 40.91% of the professors, 58.33% of the associate professors, 40.00% of the attending doctors and 37.50% of the resident doctors conducted HIV and syphilis screening (P > 0.05), and 86.36% of the professors, 77.78% of the associate professors, 70.00% of the attending doctors and 75.00% of the resident doctors performed genital mycoplasma screening (P > 0.05). Concerning the treatment of MU, 50.00% of the professors, 47.22% of the associate professors, 22.50% of the attending doctors and 43.75% of the resident doctors used anti-Chlamydia trachomatis drugs for gonococcal urethritis (P > 0.05), 0.00% of the professors, 11.11% of the associate professors, 5.00% of the attending doctors and 31.25% of the resident doctors prescribed 1g single-dose oral azithromycin for non-gonococcal urethritis (P < 0.05), 13.64% of the professors, 33.33% of the associate professors, 17.50% of the attending doctors and 6.25% of the resident doctors medicated persistent or recurrent non-gonococcal urethritis for >4 weeks (P > 0.05), 63.64% of the professors, 83.33% of the associate professors, 57.50% of the attending doctors and 62.50% of the resident doctors treated asymptomatic trachomatis and mycoplasma infections according to the proposed medication in the Guidelines (P > 0.05). As regards the results of treatment, the cure rate of gonococcal urethritis was 100.00% by professors, 97.22% by associate professors, 95.00% by attending doctors and 81.25% by resident doctors (P > 0.05), and that of non-gonococcal urethritis was 86.36% by professors, 61.11% by associate professors, 62.50% by attending doctors and 37.50% by resident doctors (P < 0.05). CONCLUSIONS Urological and andrological clinicians do not strictly follow the Guidelines in the diagnosis and treatment of male urethritis. There are significant differences in the dosing of azithromycin and results of treatment of non-gonococcal urethritis among doctors with different professional titles, but not in the other aspects.
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Affiliation(s)
- Chao-Feng Zhou
- Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zhi-Gang Wu
- Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Cheng-di Li
- Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yun-Bei Xiao
- Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jian Cai
- Department of Urology and Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
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McIver R, Jalocon D, McNulty A, Jeoffreys NJ, Chen SCA, Power M, Couldwell DL. Men Who Have Sex With Men With Mycoplasma genitalium-Positive Nongonococcal Urethritis Are More Likely to Have Macrolide-Resistant Strains Than Men With Only Female Partners: A Prospective Study. Sex Transm Dis 2019; 46:513-517. [PMID: 31295218 DOI: 10.1097/olq.0000000000001009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycoplasma genitalium was previously less common among men who have sex with men (MSM) compared with men with only female partners (MSW) in men with nongonococcal urethritis (NGU) in Sydney, Australia. We aimed to determine the prevalence of M. genitalium and of macrolide-resistant M. genitalium in men with NGU and to compare differences between prevalence and resistance rates between MSM and MSW. METHODS We enrolled 588 men with NGU in a prospective study at two urban sexual health services. The ResistancePlus MG assay (SpeeDx, Australia) was used to detect both M. genitalium, and macrolide resistance-associated mutations in first-void urine samples. Demographic, behavioral and clinical data were analyzed to investigate associations with M. genitalium infection or the presence of macrolide resistance. RESULTS Mycoplasma genitalium prevalence was 12.8% (75 of 588) overall and among MSM (12.8% [39 of 306]) and MSW (12.8% [36 of 282]; risk ratio [RR], 1.00; 95% confidence interval [CI], 0.65-1.52). Overall, 70.7% (53 of 75) of M. genitalium strains were macrolide-resistant, with significantly more resistance among MSM (89.7%, 35 of 39) than MSW (50%, 18 of 36) (RR, 1.80; 95% CI, 1.27-2.54; P = 0.001). On multivariate analysis, the presence of M. genitalium macrolide resistance mutations was independently associated with having male sexual partners compared with having only female partners (RR, 1.55; 95% CI, 1.02-2.38; P = 0.042). CONCLUSIONS Prevalence of M. genitalium among men with NGU is now similar for MSW and MSM and has increased locally from 5.2% to 12.8% within the last 10 years. Men who have sex with men are significantly more likely than MSW to harbor macrolide-resistant M. genitalium infections. This has treatment implications.
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Affiliation(s)
| | - Dean Jalocon
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-NSW Health Pathology, Westmead
| | | | - Neisha J Jeoffreys
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-NSW Health Pathology, Westmead
| | - Sharon Chih-Ann Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-NSW Health Pathology, Westmead
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Jannic A, Mammeri H, Larcher L, Descamps V, Tosini W, Phung B, Yazdanpanah Y, Bouscarat F. Orogenital Transmission of Neisseria meningitidis Causing Acute Urethritis in Men Who Have Sex with Men. Emerg Infect Dis 2019; 25:175-176. [PMID: 30561300 PMCID: PMC6302579 DOI: 10.3201/eid2501.171102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neisseria meningitidis sequence type 11 is an emerging cause of urethritis. We demonstrate by using whole-genome sequencing orogenital transmission of a N. meningitidis sequence type 11 isolate causing urethritis in a monogamous couple of men who have sex with men. These results suggest dissemination of this clonal complex among low-risk patients.
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Tshokey T, Tshering T, Pradhan AR, Adhikari D, Sharma R, Gurung K, Dorji T, Wangmo S, Dorji U, Wangdi K. Antibiotic resistance in Neisseria gonorrhoea and treatment outcomes of gonococcal urethritis suspected patients in two large hospitals in Bhutan, 2015. PLoS One 2018; 13:e0201721. [PMID: 30067836 PMCID: PMC6070275 DOI: 10.1371/journal.pone.0201721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/20/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Gonorrhea is a major sexually transmitted infection (STI) globally with increasing trends. Despite limited data, gonorrhea remains an important public health problem in Bhutan. Methods A descriptive study was carried out in two Bhutanese hospitals; Jigme Dorji Wangchuck National Referral Hospital and Phuentsholing General Hospital in 2015. Patients suspected of gonococcal urethritis were sampled, treated and followed up at two weeks. Gonococcal isolates were identified and tested for antibiotic susceptibility by the Calibrated Dichotomous Sensitivity Test (CDS) method. Results Of the 524 patients, 2.3% (12) were females. Most (46.6%) patients belonged to the 26–35 years age group. About 58% were lost to follow up; 62% (277) of males and all (12) females. N. gonorrhoea was positive in 76% (398) of microscopy and 73.1% (383) by culture. Resistance against ciprofloxacin, penicillin, tetracycline and nalidixic acid were 85.1%, 99.2%, 84.8% and 99.7% respectively. Nearly all the isolates were sensitive to cefpodoxime, ceftriaxone and azithromycin. Sixty-seven percent (350) were treated with injection ceftriaxone alone, 32% (169) with ceftriaxone and oral doxycycline and 1% (5) with ceftriaxone, doxycycline and metronidazole. Probable treatment failure was seen only in one patient (0.5%). Conclusions Gonococcal resistance to currently used antibiotics was low and there was a high clinical cure rate. Compliance to treatment guidelines need reinforcement addressing antibiotic regimen, tracing sexual partners and addressing the social stigma. National STI programs should be more women-friendly for effective management, prevention and control of STIs. Laboratories must adopt more reliable susceptibility testing methods, the Minimum Inhibition Concentration method.
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Affiliation(s)
- Tshokey Tshokey
- Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan
- * E-mail:
| | | | | | - Deepika Adhikari
- Essential Medicine and Technology Division, Ministry of Health, Thimphu, Bhutan
| | - Ragunath Sharma
- Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan
| | - Kiran Gurung
- Phuentsholing General Hospital, Phuentsholing, Bhutan
| | | | | | - Ugen Dorji
- Department of Pharmacy, JDWNRH, Thimphu, Bhutan
| | - Kinley Wangdi
- Phuentsholing General Hospital, Phuentsholing, Bhutan
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Rietmeijer CA, Mungati M, Machiha A, Mugurungi O, Kupara V, Rodgers L, Kilmarx PH, Roloff AH, Gonese E, Tippett-Barr BA, Shambira G, Lewis DA, Handsfield HH, Tshimanga M. The Etiology of Male Urethral Discharge in Zimbabwe: Results from the Zimbabwe STI Etiology Study. Sex Transm Dis 2018; 45:56-60. [PMID: 29240635 PMCID: PMC10719555 DOI: 10.1097/olq.0000000000000696] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are managed syndromically in most developing countries. In Zimbabwe, men presenting with urethral discharge are treated with a single intramuscular dose of kanamycin or ceftriaxone in combination with a week's course of oral doxycycline. This study was designed to assess the current etiology of urethral discharge and other STIs to inform current syndromic management regimens. METHODS We conducted a study among 200 men with urethral discharge presenting at 6 regionally diverse STI clinics in Zimbabwe. Urethral specimens were tested by multiplex polymerase chain reaction testing for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. In addition, serologic testing for syphilis and HIV was performed. RESULTS Among the 200 studied men, one or more pathogens were identified in 163 (81.5%) men, including N. gonorrhoeae in 147 (73.5%), C. trachomatis in 45 (22.5%), T. vaginalis in 8 (4.0%), and M. genitalium in 7 (3.5%). Among all men, 121 (60%) had a single infection, 40 (20%) had dual infections, and 2 (1%) had 3 infections. Among the 45 men with C. trachomatis, 36 (80%) were coinfected with N. gonorrhoeae. Overall, 156 (78%) men had either N. gonorrhoeae or C. trachomatis identified. Of 151 men who consented to HIV testing, 43 (28.5%) tested positive. There were no differences in HIV status by study site or by urethral pathogen detected. CONCLUSIONS Among men presenting at Zimbabwe STI clinics with urethral discharge, N. gonorrhoeae and C. trachomatis are the most commonly associated pathogens. Current syndromic management guidelines seem to be adequate for the treatment for symptomatic men, but future guidelines must be informed by ongoing monitoring of gonococcal resistance.
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Affiliation(s)
- Cornelis A. Rietmeijer
- Surveillance, Evaluation, Assessment, and Monitoring (SEAM) Project, Department of Community Medicine, College of Medicine, University of Zimbabwe, Harare, Zimbabwe
- Colorado School of Public Health, University of Colorado Denver
- Rietmeijer Consulting, Denver, CO
| | | | | | | | - Vitalis Kupara
- Zimbabwe Community Health Intervention Research (ZiCHIRe) Project
| | - Luanne Rodgers
- Zimbabwe Community Health Intervention Research (ZiCHIRe) Project
| | - Peter H. Kilmarx
- US Centers for Disease Control and Prevention, Harare, Zimbabwe, Zimbabwe
| | - Amy Herman Roloff
- US Centers for Disease Control and Prevention, Harare, Zimbabwe, Zimbabwe
| | - Elizabeth Gonese
- US Centers for Disease Control and Prevention, Harare, Zimbabwe, Zimbabwe
| | | | - Gerald Shambira
- Surveillance, Evaluation, Assessment, and Monitoring (SEAM) Project, Department of Community Medicine, College of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Mufuta Tshimanga
- Surveillance, Evaluation, Assessment, and Monitoring (SEAM) Project, Department of Community Medicine, College of Medicine, University of Zimbabwe, Harare, Zimbabwe
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Bazan JA, Turner AN, Kirkcaldy RD, Retchless AC, Kretz CB, Briere E, Tzeng YL, Stephens DS, Maierhofer C, Del Rio C, Abrams AJ, Trees DL, Ervin M, Licon DB, Fields KS, Roberts MW, Dennison A, Wang X. Large Cluster of Neisseria meningitidis Urethritis in Columbus, Ohio, 2015. Clin Infect Dis 2017; 65:92-99. [PMID: 28481980 PMCID: PMC5848337 DOI: 10.1093/cid/cix215] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Neisseria meningitidis (Nm) is a Gram-negative diplococcus that normally colonizes the nasopharynx and rarely infects the urogenital tract. On Gram stain of urethral exudates, Nm can be misidentified as the more common sexually transmitted pathogen Neisseria gonorrhoeae. Methods In response to a large increase in cases of Nm urethritis identified among men presenting for screening at a sexually transmitted disease clinic in Columbus, Ohio, we investigated the epidemiologic characteristics of men with Nm urethritis and the molecular and phylogenetic characteristics of their Nm isolates. The study was conducted between 1 January and 18 November 2015. Results Seventy-five Nm urethritis cases were confirmed by biochemical and polymerase chain reaction testing. Men with Nm urethritis were a median age of 31 years (interquartile range [IQR] = 24-38) and had a median of 2 sex partners in the last 3 months (IQR = 1-3). Nm cases were predominantly black (81%) and heterosexual (99%). Most had urethral discharge (91%), reported oral sex with a female in the last 12 months (96%), and were treated with a ceftriaxone-based regimen (95%). A minority (15%) also had urethral chlamydia coinfection. All urethral Nm isolates were nongroupable, ST-11 clonal complex (cc11), ET-15, and clustered together phylogenetically. Urethral Nm isolates were similar by fine typing (PorA P1.5-1,10-8, PorB 2-2, FetA F3-6), except 2, which had different PorB types (2-78 and 2-52). Conclusions Between January and November 2015, 75 urethritis cases due to a distinct Nm clade occurred among primarily black, heterosexual men in Columbus, Ohio. Future urogenital Nm infection studies should focus on pathogenesis and modes of sexual transmission.
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Affiliation(s)
- Jose A Bazan
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
- Sexual Health Clinic, Columbus Public Health, Ohio
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Cecilia B Kretz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Elizabeth Briere
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Yih-Ling Tzeng
- Division of Infectious Diseases, Departments of Medicine and
| | - David S Stephens
- Division of Infectious Diseases, Departments of Medicine and
- Microbiology and Immunology, Emory University School of Medicine, and
| | - Courtney Maierhofer
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Carlos Del Rio
- Division of Infectious Diseases, Departments of Medicine and
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - A Jeanine Abrams
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
| | - David L Trees
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
| | | | | | | | | | - Amanda Dennison
- STD & Hepatitis Prevention Program, Bureau of Infectious Diseases, Ohio Department of Health, Columbus
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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Zanella MC, Schoofs F, Huttner B, Huttner A. [Lower urinary tract infections in men. Urethritis, cystitis and prostatitis]. Rev Med Suisse 2017; 13:808-814. [PMID: 28727330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recommendations for the treatment of lower non-catheter-related urinary tract infection (UTI) in men are rarely evidence-based. Their management requires the localization of the site of infection, whether it be the urethra, bladder or prostate, and includes antibiotic therapy and in most cases urological assessment. They are often associated with urinary tract procedures or anatomical or functional abnormalities. Nearly 80 % of male UTIs are caused by Enterobacteriaceae. The prevalence of broad-spectrum beta-lactamase-producing strains (ESBL) and quinolone-resistant strains is increasing. The aim of this article is to define three types of lower, non-catheter-related UTI in men - urethritis, cystitis and prostatitis - their microbiology and management in Switzerland.
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Affiliation(s)
| | | | - Benedikt Huttner
- Service des maladies infectieuses, HUG, 1211 Genève 14
- Service du contrôle et prévention des infections, HUG, 1211 Genève 14
| | - Angela Huttner
- Service des maladies infectieuses, HUG, 1211 Genève 14
- Service du contrôle et prévention des infections, HUG, 1211 Genève 14
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Yasuda M, Ito S, Hatazaki K, Deguchi T. Remarkable increase of Neisseria gonorrhoeae with decreased susceptibility of azithromycin and increase in the failure of azithromycin therapy in male gonococcal urethritis in Sendai in 2015. J Infect Chemother 2016; 22:841-843. [PMID: 27578029 DOI: 10.1016/j.jiac.2016.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/23/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022]
Abstract
The antimicrobial resistance of Neisseria gonorrhoeae is a serious problem worldwide. In this study, we examined the susceptibility of N. gonorrhoeae isolated from male gonococcal urethritis in Sendai in 2014 and 2015. Furthermore, of all cases, we investigated the clinical efficacy of a single 2-g dose of extended-release azithromycin (AZM-SR) in the treatment of male gonococcal urethritis retrospectively. Sixty N. gonorrhoeae strains in 2014 and 54 strains in 2015 were isolated from male gonococcal urethritis and stored each year. The MIC of AZM was ≥1 mg/L in 4 strains (6.7%) in 2014 and in 13 strains (24.1%) in 2015 and the number of strains having ≥1 mg/L MIC increased significantly (P = 0.016). Microbiological efficacy was evaluated in 32 and 29 of these patients, and the rates of treatment success were 93.8% and 79.3%, respectively. All of the treatment failures were caused by strains having a MIC of AZM of ≥0.5 mg/L. In particular, the increase in the isolates having a MIC of AZM of ≥1 mg/L was remarkable. Therefore, it was thought that the increase in these strains was the reason for the increase in treatment failures in 2015. Because no other drug is effective, it is currently necessary to use AZM-SR to treat gonococcal infections caused by ceftriaxone-resistant strains or patients allergic to ceftriaxone. To prevent a further increase in resistance to AZM, we should not use AZM-SR to treat normal cases of gonococcal infection.
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Affiliation(s)
- Mitsuru Yasuda
- Department of Urology, Gifu University Hospital, Gifu, Japan.
| | | | - Kyoko Hatazaki
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takashi Deguchi
- Department of Urology, Gifu University Hospital, Gifu, Japan; Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
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Abstract
Seventy-eight men with a history of chronic urethritis were referred for investigation. Of 52 men diagnosed as having persistent or recurrent non-gonococcal urethritis (NGU) at the time of referral, 11 (21%) were infected with Mycoplasma genitalium and three with Chlamydia trachomatis. Men who were M. genitalium-positive had not previously received less antibiotic, in terms of treatment duration, than those who were M. genitalium-negative, suggesting a possible resistance to the antibiotics given. In the current investigation, of 11 M. genitalium-positive men with persistent or recurrent NGU who were treated for four to six weeks with erythromycin, 500mg four times daily, nine (82%) responded clinically and microbiologically, but later six relapsed without M. genitalium being detected. The results of observing and investigating a patient for about one year, the only one to have concurrent chlamydial and mycoplasmal infections, is presented, a feature being the intermittent persistence of the mycoplasma.
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Affiliation(s)
- D Taylor-Robinson
- Division of Medicine, Imperial College London, St Mary's Hospital, London W2 1NY, UK
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Tabrizi SN, Tan LY, Walker S, Twin J, Poljak M, Bradshaw CS, Fairley CK, Bissessor M, Mokany E, Todd AV, Garland SM. Multiplex Assay for Simultaneous Detection of Mycoplasma genitalium and Macrolide Resistance Using PlexZyme and PlexPrime Technology. PLoS One 2016; 11:e0156740. [PMID: 27271704 PMCID: PMC4894623 DOI: 10.1371/journal.pone.0156740] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022] Open
Abstract
Mycoplasma genitalium is a cause of non-gonoccocal urethritis (NGU) in men and cervicitis and pelvic inflammatory disease in women. Recent international data also indicated that the first line treatment, 1 gram stat azithromycin therapy, for M. genitalium is becoming less effective, with the corresponding emergence of macrolide resistant strains. Increasing failure rates of azithromycin for M. genitalium has significant implications for the presumptive treatment of NGU and international clinical treatment guidelines. Assays able to predict macrolide resistance along with detection of M. genitalium will be useful to enable appropriate selection of antimicrobials to which the organism is susceptible and facilitate high levels of rapid cure. One such assay recently developed is the MG 23S assay, which employs novel PlexZyme™ and PlexPrime™ technology. It is a multiplex assay for detection of M. genitalium and 5 mutations associated with macrolide resistance. The assay was evaluated in 400 samples from 254 (186 males and 68 females) consecutively infected participants, undergoing tests of cure. Using the MG 23S assay, 83% (331/440) of samples were positive, with 56% of positives carrying a macrolide resistance mutation. Comparison of the MG 23S assay to a reference qPCR method for M. genitalium detection and high resolution melt analysis (HRMA) and sequencing for detection of macrolide resistance mutations, resulted in a sensitivity and specificity for M. genitalium detection and for macrolide resistance of 99.1/98.5% and 97.4/100%, respectively. The MG 23S assay provides a considerable advantage in clinical settings through combined diagnosis and detection of macrolide resistance.
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Affiliation(s)
- Sepehr N. Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- * E-mail:
| | | | | | - Jimmy Twin
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
| | - Marin Poljak
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Victoria, Australia
| | | | | | | | - Suzanne M. Garland
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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Abstract
Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. Other causes are Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV) and adenovirus. Up to half of the cases are non-specific. Urethritis is characterized by discharge, dysuria and/or urethral discomfort but may be asymptomatic. The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. An excess of mononuclear leucocytes in the smear indicates a viral etiology. In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. Nucleid acid amplifications tests (NAAT) for Neisseria gonorrhoeae, C. trachomatis and for M. genitalium. If viral or protozoan aetiology is suspected, NAAT for HSV, adenovirus and T. vaginalis, if available. If marked symptoms and urethritis is confirmed, syndromic treatment should be given at the first appointment without waiting for the laboratory results. Treatment options are doxycycline 100 mg x 2 for one week or azithromycin 1 gram single dose or 1,5 gram distributed in five days. However, azithromycin as first line treatment without test of cure for M. genitalium and subsequent Moxifloxacin treatment of macrolide resistant strains will select and increase the macrolide resistant strains in the population. If positive for M. genitalium, test of cure samples should be collected no earlier than three weeks after start of treatment. If positive in test of cure, moxifloxacin 400 mg 7-14 days is indicated. Current partner(s) should be tested and treated with the same regimen. They should abstain from intercourse until both have completed treatment. Persistent or recurrent NGU must be confirmed with microscopy. Reinfection and compliance must be considered. Evidence for the following recommendations is limited, and is based on clinical experience and guidelines. If doxycycline was given as first therapy, azithromycin five days plus metronidazole 4-500 mg twice daily for 5-7 days should be given. If azithromycin was prescribed as first therapy, doxycycline 100 mg x 2 for one week plus metronidazole, or moxifloxacin 400 mg orally once daily for 7-14 days should be given.
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Affiliation(s)
- Harald Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway.
| | - Karla Blee
- Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Patrick J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Hayakawa K, Itoda I, Shimuta K, Takahashi H, Ohnishi M. Urethritis caused by novel Neisseria meningitidis serogroup W in man who has sex with men, Japan. Emerg Infect Dis 2015; 20:1585-7. [PMID: 25154021 PMCID: PMC4178410 DOI: 10.3201/eid2009.140349] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Johnson RB. Azithromycin. Curr Probl Dermatol 2015; 24:184-93. [PMID: 8743269 DOI: 10.1159/000424899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Gaunavinaka L, Balak D, Varman S, Ram S, Graham SM. A descriptive study of urethral discharge among men in Fiji. N Z Med J 2014; 127:48-52. [PMID: 25331311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Urethral discharge is a common presentation of sexually transmitted infection (STI) in men and known pathogens include Neisseria gonorrhoeae and Chlamydia trachomatis. There are no published data of the burden of urethral discharge among men in Fiji. OBJECTIVE To evaluate urethral discharge among men to determine the incidence, the frequency of recurrence and reported at-risk behaviour. METHODS We conducted a retrospective, descriptive study of clinical records of all men presenting with urethral discharge to two major reproductive health clinics. Data collected included self-reported at-risk behaviours, results of abnormal syphilis serology and antibiotics prescribed. The frequency of recurrence in the following 1-2 years of initial presentation was determined along with microbiological findings from urethral swab in this group. RESULTS A total of 748 males presented with urethral discharge to the clinic in one year. This represents an incidence rate of at least 295 per 100,000 adult males per year in the study population. Within the next 1-2 years of the initial presentation, 102 (14%) of these re-presented out of which 42 had urethral swab taken for etiological diagnosis. The commonest isolate was Neisseria gonorrhoeae. Results of syphilis tests were available for 560 (75%) of patients and 29 (5%) were positive. Recurrence was not associated with self-reported at-risk behaviours. CONCLUSION The incidence of urethral discharge among males in Fiji is very high and prevention strategies are urgently needed.
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Affiliation(s)
- Lavenia Gaunavinaka
- Naviti Street Sexual and Reproductive Health Clinic, PO Box 45, Naviti Street, Lautoka, Fiji.
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Ninan GK, Pringle K, Patel R. Upper urinary tract inflammation and dilatation secondary to idiopathic urethritis: a plea for steroid treatment. Int J Urol 2014; 21:348-9. [PMID: 24000904 DOI: 10.1111/iju.12241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- George K Ninan
- Department of Pediatric Urology, Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.
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Yamashita H, Araki I, Kageyama S, Baba M, Nakano E, Okada Y. [Questionnaire survey on medical care for male urethritis in community clinics in Shiga prefecture]. Hinyokika Kiyo 2014; 60:7-12. [PMID: 24594766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Six regional medical associations in Shiga prefecture agreed to cooperate in an investigation of medical care for male gonococcal and chlamydial urethritis. In June 2011, we sent a questionnaire to 372 medical offices in Shiga prefecture, and analyzed replies of respondents. Ten urologists and 175 non-urologists responded to the survey (response rate 49.7%). Among 185 physicians, 52 (10 urologists and 42 nonurologists) have treated male patients with gonococcal and chlamydial urethritis. More than 20% (42/175) of non-urological clinics are involved in the medical management. At initial diagnosis for sexually transmitted male urethritis, all urologists select the nucleic acid amplification method (100%), whereas many non-urologists do not (35%). For the treatment of chlamydial urethritis, non-urologists select levofloxacin (LVFX, 52.8%) rather than azithromycin (AZM, 22.0%), whereas urologists use AZM (78.0%) mostly but do not use LVFX (0%) (p = 0.023). For the treatment of gonococcal urethritis, non-urologists prefer oral new quinolones (53.1%) compared to urologists (25.0%) (p = 0. 74). For cure judgment of gonoccocal and chlamydial urethritis, many non-urologists rely on the improvement of subjective symptoms (50 and 47%), but urologists do not (10 and 0%) (p = 0.022 and 0.026, respectively). As for recognition of the clinical guideline for sexually transmitted disease, most urologists (90%) know it, but few non-urologists (13%) do (p < 0.001). We found that non-urological clinics make a great contribution to the medical treatment for male gonococcal and chlamydial urethritis in Shiga prefecture. It is important to standardize the medical care for sexually transmitted male urethritis by familiarizing non-urological practitioners with the clinical guideline.
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Affiliation(s)
| | - Isao Araki
- The Department of Urology, Shiga University of Medical Science
| | - Susumu Kageyama
- The Department of Urology, Shiga University of Medical Science
| | - Masato Baba
- The Department of Urology, Shiga University of Medical Science
| | | | - Yusaku Okada
- The Department of Urology, Shiga University of Medical Science
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Abdrakhmanov RM, Khalilov BV, Abdrakhmanov AR. [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]. Urologiia 2013:59-63. [PMID: 24437243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
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.
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Onodera S, Onoe Y, Hosobe T, Kato T, Yoshida M. [Efficacy and safety of levofloxacin to non-gonorrheal urethritis]. Jpn J Antibiot 2012; 65:399-409. [PMID: 23593735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We investigated the efficacy and safety of levofloxacin (LVFX) 500mg once a day in patients with non-gonorrheal urethritis. Men, aged 20 years or older, with urethritis symptoms, and detection of Chlamydia trachomatis (C. trachomatis) or Mycoplasma genitalium (M. genitalium) by a microbiological examination were eligible for this study. Patients were administered LVFX 500mg, orally, once a day and the dosage period was seven days. We assumed 22 patients for a safety and efficacy analysis. In 22 patients, 17 patients had urethritis with C. trachomatis, 4 patients urethritis with M. genitalium, and one patient mixed infection of C. trachomatis and M. genitalium. In the clinial study, the primary endpoint was set as the bacteriological eradication rate at two to four weeks after completion of treatment. The bacterial eradication rate in the urethritis was 86.4% (19/22). The bacterial eradication rate in the urethritis with C. trachomatis, M. genitalium, and mixed infection of C. trachomatis and M. genitalium were 94.1% (16/17), 50.0% (2/4), 100% (1/1), respectively. A significant difference was not recognized among the three groups. The clinical efficacy at two to four weeks after completion of treatment was 90.9% (20/22). The clinical efficacy rates in the urethritis with C. trachomatis, M. genitalium, and mixed infection of C. trachomatis and M. genitalium were 100% (17/17), 50.0% (2/4), 100% (1/1), respectively. The efficacy rate of urethritis with M. genitalium was significantly low. No adverse drug reactions were observed. These results suggest that once-a-day levofloxacin (500mg) is effective and safe treatment for non-gonorrheal urethritis.
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Hamasuna R. Identification of treatment strategies for Mycoplasma genitalium-related urethritis in male patients by culturing and antimicrobial susceptibility testing. J Infect Chemother 2012; 19:1-11. [PMID: 23076335 DOI: 10.1007/s10156-012-0487-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Indexed: 11/25/2022]
Abstract
Mycoplasma genitalium was first isolated from urethral swab specimens of male patients with non-gonococcal urethritis. However, the isolation of M. genitalium strains from clinical specimens has been difficult. Co-cultivation with Vero cells is one available technique for the isolation of M. genitalium. The strains that can be used for antimicrobial susceptibility testing by broth dilution or agar dilution methods are limited. Macrolides, such as azithromycin (AZM), have the strongest activity against M. genitalium. However, AZM-resistant strains have emerged and spread. Mutations in the 23S rRNA gene contribute to the organism's macrolide resistance, which is similar to the effects of the mutations in macrolide-resistant Mycoplasma pneumoniae. Of the fluoroquinolones, moxifloxacin (MFLX) and sitafloxacin have the strongest activities against M. genitalium, while levofloxacin and ciprofloxacin are not as effective. Some clinical trials on the treatment of M. genitalium-related urethritis are available in the literature. A doxycycline regimen was microbiologically inferior to an AZM regimen. For cases of treatment failure with AZM regimens, MFLX regimens were effective.
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Affiliation(s)
- Ryoichi Hamasuna
- Department of Urology, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
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Neĭmark AI, Shelkovnikova NV, Neĭmark BA, Sizovv KA. [The role of human papilloma virus in development of chronic urethritis and vulvodynia in females: perspectives of immunomodulating therapy]. Urologiia 2012:35-38. [PMID: 22876631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article is devoted to combined affection of the lower urinary tracts and genitalia in women with human papilloma virus (HPV) infection which manifests with persistent recurrent urethritis, pelvic pain syndrome. The colposcopic and urethrocystoscopic features, disturbed microcirculation of urethral and vaginal mucosa in virus infection promoting recurrences and persistence of HPV are discussed. Immunomodulators (inosin pranobex-groprinosin) are recommended for more effective treatment.
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Andreeva IV, Kozlov SN, Korolev SV, Belikov AN, Grinev AV, Evstaf'ev VV, Kirpicheva NN, Serdiutskaia MV, Stetsiuk OU, Fokin AA, Khrianin AA. [Diagnostic and treatment patterns in management of male patients with nongonococcal urethritis: results of Russian multicentral cross-sectional study]. Antibiot Khimioter 2012; 57:32-40. [PMID: 23156042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of the study was to estimate the diagnostic and treatment patterns in the management of acute nongonococcal urethritis (NGU) in males in some cities of Russia. Retrospective cross-sectional study was conducted in 2009 in 5 centers of 4 cities in the Central Part of Russia (Kaluga, Pskov, Smolensk - 2 centres and Tula). The data on the diagnostic and treatment approaches to the management of NGU in male subjects >16 years old were collected and analyzed with the use of specially designed case report forms. 556 cases of acute urethritis were analyzed during the study. The diagnosis of NGU was confirmed in 401 cases. The average age of the patients was 29.8 years (16-68 years). The following diagnostic methods were used in 95% of the cases: urethral smear microscopy (314/82.4%), C. trachomatis - PCR (113/29.7%), ELISA (155/40.7%); T. vaginalis - PCR (106/27.8%); U. urealyricum and M. hominis, respectively - bacteriology (140/36.7% and 126/33.1%), PCR (110/28.9% and 108/28.3%); M. genitalium - PCR (110/28.9%). The treatment patterns included antimicrobials AMs alone in 60.3, and AMs + non-AMs in 37.8% of the cases. The most frequently prescribed AMs were azithromycin (27.5%), fluconazole (16.4%), doxycycline (13.6%), metronidazole (11.2%), ofloxacine (7.3%), ceftriaxone (4.4%), josamycin (4.2). According to the results use of the standard methods for NGU diagnosis was rather rare. The use of PCR for atypical pathogens was the following: C. trachomatis 29.7%, U. urealyticum 36.7%, M. hominis 28.9%, M. genitalium 28.3%. Doubtful culture methods were used for detection of U. urealyticum and M. hominis (36.7% and 33.1%). The AMs treatment in some cases was not in compliance with the up-to-date practical guidelines for STD and NGU.
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Chlamydia trachomatis and pregnancy. Prescrire Int 2011; 20:302. [PMID: 22216551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chlamydia trachomatis infection seems to have little impact on the outcome of pregnancy. If transmitted to the newborn during delivery, this pathogen can cause conjunctivitis or, occasionally, neonatal pneumonia. Amoxicillin (a 7-day course) is the antibiotic of choice for pregnant women with C. trachomatis cervicitis or urethritis. There is no evidence that other antibiotics are safer or more effective. Doxycycline and fluoroquinolones are contraindicated during pregnancy. The possible benefits of treating asymptomatic C. trachomatis infection in pregnant women are uncertain.
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