Incidence of sexually transmitted diseases in Hokkaido, Japan, 1998 to 2001.

The objective of this study was to provide precise data on the incidence of sexually transmitted diseases (STDs) in Hokkaido. The goal of this prospective surveillance, study was to clarify the STD incidence between 1998 and 2001 in Hokkaido, Japan. The incidence of gonococcal infection in men was found to be 127-199 per 100000 people per year, which was three or four times higher than that for women. Female genital chlamydial infection had an incidence of 300-400 with a female to male ratio of two or three to one. Younger adults had higher incidences of gonococcal and chlamydial infections than older people. In conclusion, the current study of STDs revealed high incidences of gonococcal and chlamydial infections in the Hokkaido area, and there was no decreasing trend in STD incidence during these 4 years.

Time courses of bacterial density in urine during antibacterial chemotherapy and influential factors in patients having positive bacteriuria with a complicated urinary tract.

A series of consecutive urine cultures was performed to determine the time points of elimination of bacteria from urine and the factors influencing these time points in patients receiving antimicrobial chemotherapy for positive bacteriuria. Between 1988 and 2000, 110 patients who had positive bacteriuria and received a 5-day regimen of parenteral antibacterials were included in this study. Quantitative urine cultures were performed every 24 h throughout the therapy. Bacteria were identified; minimum inhibitory concentrations of antibacterial agents for causative bacteria were determined, and the bacteria were categorized as susceptible or nonsusceptible. The complexity of the urinary tract was graded as high or low. A multivariate Cox proportional hazards model was utilized to identify the factors that determined the time course of bacterial density in urine. Two penicillins, seven cephalosporins, five carbapenems and one fluoroquinolone were administered to 110 patients. The overall bacteriurial elimination rate at the end of treatment was 73% (80/110), and the most frequent day of elimination was day 1 (54%; 43/80), followed by day 2 (20%; 16/80). The significant factors for persistence of bacteriuria after chemotherapy were the presence of an indwelling catheter, a nonsusceptible pathogen, and high complexity of the urinary tract; risk ratios were: 2.398 (P = 0.0009), 2.227 (P = 0.0020), and 2.113 (P = 0.0455), respectively, which also influenced the day of elimination. In conclusion, the efficacy of treatment and the time point of bacteriurial elimination were determined by the presence of a urinary catheter, drug susceptibility, and urinary complexity in patients with positive bacteriuria undergoing antibacterial chemotherapy.

Bacterial colonization on intraluminal surface of urethral catheter.

OBJECTIVES: To determine the relationship between catheter-colonizing bacteria and urinary planktonic bacteria. The significance of catheter-colonizing bacteria for the pathogenesis of urinary tract infection remains unclear, although they are involved in the development of catheter-associated urinary tract infection refractory to antimicrobial chemotherapy. METHODS: The subjects were 86 inpatients with urethral catheters. Urinary culture and catheter culture were performed simultaneously. The intraluminal catheter surface was swabbed to prepare a suspension. The suspension and a urine specimen from each patient were quantitatively cultured with the dip slide method and the microorganisms identified. RESULTS: The catheters had been mainly placed to monitor urine output after urologic surgery, and their median indwelling period was 3.0 days (range 1 to 35). The overall positive rate of catheter culture was significantly greater than that of urine culture (53.5% and 30.2%, respectively, P <0.01), even in patients without a recent antibacterial agent history. The difference was observed at day 2 (60% and 13.3%, catheter versus urine culture, respectively, P = 0.011) and days 3 to 6 (52.4% and 14.3%, respectively, P = 0.010) of the indwelling period, but was indistinguishable at day 14 and thereafter. The percentage of patients who had the same bacterial species isolated from both specimens increased in a time-dependent manner. CONCLUSIONS: The present results revealed considerable differences in the positive rates and bacterial species isolated from urine and catheter cultures, indicating that not all species of bacteria colonizing the intraluminal surface of the urethral catheter are detected as urinary bacteria. These results also suggest that bacterial colonization on the intraluminal catheter surface can precede the emergence of bacteriuria.

Multidrug-resistant Pseudomonas aeruginosa isolated from the urine of patients with urinary tract infection.

We report the clinical courses of 3 patients with urinary obstruction who developed acute pyelonephritis caused by multidrug-resistant (MDR) Pseudomonas aeruginosa. Genome fingerprinting was performed to clarify the route of cross-infection, and an imipenem-resistance gene was detected by the polymerase chain reaction (PCR) method. The study included 17 patients at our institute who had urinary tract infections caused by P. aeruginosa between January and December 1997. MDR was defined as that when all the minimum inhibitory concentrations (MICs) were determined to show resistance according to the breakpoints recommended by the National Committee for Clinical Laboratory Standards (NCCLS) for P. aeruginosa. Pulse-field gel electrophoresis (PFGE) was carried out for genome fingerprinting. PCR was used to detect the metallo-beta-lactamase gene ( bla(IMP)). Three strains were revealed for MDR. The strains were isolated from the 3 patients with urinary tract obstruction who developed acute pyelonephritis. The treatment consisted of urinary drainage for the obstructed urinary tract and parenterally administered antimicrobials. Although none of the strains was susceptible to any antimicrobials, all patients had favorable outcomes. PFGE revealed that two strains had an identical genotype, implying cross-infection between the patients. The bla(IMP) gene was not detected in any of the three strains. In febrile patients with urinary tract infection caused by MDR P. aeruginosa, treatment for urinary obstruction is strongly recommended. Initial empirical chemotherapy with antimicrobials to which the organism is not susceptible is often inevitable. Because there was epidemiological evidence of cross-infection with MDR P. aeruginosa, countermeasures against nosocominal infection are warranted.

Incidence of sexually transmitted diseases in Hokkaido, Japan, 1998 to 2001.

The objective of this study was to provide precise data on the incidence of sexually transmitted diseases (STDs) in Hokkaido. The goal of this prospective surveillance, study was to clarify the STD incidence between 1998 and 2001 in Hokkaido, Japan. The incidence of gonococcal infection in men was found to be 127-199 per 100 000 people per year, which was three or four times higher than that for women. Female genital chlamydial infection had an incidence of 300-400 with a female to male ratio of two or three to one. Younger adults had higher incidences of gonococcal and chlamydial infections than older people. In conclusion, the current study of STDs revealed high incidences of gonococcal and chlamydial infections in the Hokkaido area, and there was no decreasing trend in STD incidence during these 4 years.

Efficacy of an RNA detection test kit in the diagnosis of genital chlamydial infection.

A nucleic acid amplification method based on DNA detection, the current standard method for the diagnosis of genital infection by Chlamydia trachomatis, has been shown to potentially yield false-positive results after treatment in the clinical setting. RNA detection methods are more appropriate because viable organisms have multiple RNA copies that are surely detected by the method. In this study, we evaluated the efficacy of a new RNA detection test kit, the VIDAS PROBE CT test, in the diagnosis of genital chlamydial infection. For comparison, the standard DNA detection method, Amplicor STD-I, was also used in the study. First voided-urine samples and urethral smears from male patients with urethritis, and first voided-urine samples and cervical smears from female patients with cervicitis served as samples for the detection of C. trachomatis. Of the 60 first voided-urine samples from male patients, 21 were positive and 39 negative with the VIDAS PROBE CT test. Amplicor STD-I achieved exactly the same result. In female patients with cervicitis, the two test kits produced the same result, with 2 positive cervical smears and 38 negative. These results suggest that the VIDAS PROBE CT test is as efficient as Amplicor STD-I in the detection of C. trachomatis. While studies including a greater number of patients will be needed for revealing the unique advantages of the new RNA detection test kit, VIDAS PROBE CT, we concluded from the current study that the test may be clinically useful in the diagnosis of genital chlamydial infection.

Detection of human papillomavirus DNA on the external genitalia of healthy men and male patients with urethritis.

BACKGROUND: Only a few studies have been done involving detection of human papillomavirus (HPV) DNA on the external genitalia of men without genital warts, although many have been done for women. We conducted HPV DNA detection among healthy male volunteers and men with urethritis, both having no visible lesions on their external genitalia. GOAL: The goal of the study was to determine the detection rate of HPV DNA in volunteers and patients with urethritis and to determine risk factor(s) for positive DNA. STUDY DESIGN: This was a prospective clinical study. RESULTS: HPV DNA was found in 1.3% of 75 volunteers and in 18.5% of 130 patients with urethritis. DNA of a high-intermediate oncogenic risk was more predominant than the low-risk type. Among various risk factors, only a history of STD was a significant factor for the positive detection of HPV DNA in multiple regression analysis. CONCLUSION: HPV DNA was found in patients with urethritis more frequently than in volunteers, probably because the former had higher sexual activity.