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

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

Sexual behaviors and results of bacterial sexually transmitted infections testing among frail HIV-infected individuals.

BACKGROUND: The impact of premature frailty in HIV-infected individuals on the prevalence of sexual behaviors and sexually transmitted infections (STIs) is unknown. METHODS: We compared these factors among individuals aged ≥ 18 years, who had prior determination of a frailty phenotype at the Washington University HIV Clinic between June and December 2008. All P values were 2-tailed and considered significant at <.05. RESULTS: Of 445 individuals (71% male, 30% Caucasian, median age 43 years) assessed, the prevalence of frailty was 9%. Reports of recent sexual activity (44%) did not differ by frailty status. Consistent condom use (69% overall) was similar between sexually active frail and nonfrail individuals, and there was no significant difference in STI prevalence between groups (0 vs 32 [9%], P = .08). CONCLUSION: In this relatively young population, frailty did not affect reports of recent sexual activity or consistent condom use and no significant difference in STI prevalence was observed.

The impact of discontinuation of male STD screening services at a large urban county jail: Chicago, 2002-2004.

BACKGROUND: Before April 2003, all male detainees were offered chlamydia (CT) and gonorrhea (GC) screening tests, after which services were limited to symptom-based testing. In 2003, male screening was discontinued at a large urban county jail. OBJECTIVE: To evaluate the impact of discontinuing universal male sexually transmitted disease screening in a large county jail. METHODS: We compared the number of male CT/GC cases during the periods of universal screening (April 2002 to March 2003) with symptom-based testing (April 2003 to March 2004). RESULTS: The number of reported CT/GC cases among male detainees declined by -91.7% (3329-277) and -90.5% (1133-108), respectively after universal screening was discontinued. Citywide, CT/GC cases among males and females declined by -9.3% (24,885-22,563) and -12.9% (13,249-11,541), respectively. CONCLUSIONS: Discontinuation of universal male CT/GC screening services at a large county jail represents a missed opportunity to screen a high-risk population and was associated with substantial declines in reported morbidity.

Lymphogranuloma venereum in the United kingdom.

BACKGROUND: Over the past 2 years, lymphogranuloma venereum (LGV), caused by L serovars of Chlamydia trachomatis, has emerged as a significant problem among men who have sex with men (MSM). We report on, to our knowledge, the largest case series of LGV to date, with detailed epidemiological and clinical characteristics of the epidemic in the United Kingdom. METHODS: A national diagnostic service and surveillance system was established in October 2004. Cases were confirmed by the presence of C. trachomatis and an LGV serovar (L1, L2, or L3) from genotyping. For confirmed cases, an enhanced surveillance questionnaire was sent to the clinician. RESULTS: Through February 2006, a total of 327 cases of LGV were confirmed. Cases were diagnosed across the United Kingdom, with the majority from London (71%) and Brighton (13%). Case reports were received for 282 MSM. The majority (96%) had proctitis, many with severe local and systemic symptoms. There was a high level of coinfection with human immunodeficiency virus (76%), hepatitis C (19%), and other sexually transmitted infections (39%). Nine cases of human immunodeficiency virus infection were diagnosed around the same time as LGV. Most cases were acquired within the United Kingdom, although patients with early cases were more likely to report contacts in The Netherlands. CONCLUSIONS: We found a significant burden of this once-rare sexually transmitted infection among MSM in the United Kingdom. LGV may be contributing to the epidemic of human immunodeficiency virus infection by facilitating transmission. Further control efforts are required, including awareness campaigns, continued detailed surveillance, and expanded chlamydia testing among MSM.

[Efficacy of low-intensity laser radiation and antibacterial therapy in the treatment of chronic prostatitis in the presence of sexually transmitted infections].

We studied 94 patients with chronic prostatitis (CP) in combination with urogenital chlamydiasis. The patients were divided into three groups. Group 1 consisted of 32 patients with bacterial prostatitis and sexually transmitted infection (STI). They were treated with fromilid in a dose 500 mg twice a day. Group 2 (n = 27) received also low-intensity laser radiation (LILR) on the prostatic gland. Group 3 patients (n = 35) with abacterial prostatitis were given fromilid (500 mg twice a day). We studied prostatic hemodynamics with color doppler mapping. A specific feature of prostatic vascularisation in CP and STI versus healthy subjects is heterogeneous decline of vessels density in ischemic zones with parallel decrease in these vessels diameter. A peripheral prostatic zone in CP patients with STI was characterized by lower vascularisation than central one. This deteriorates the course of the disease. The results of the study show that adjuvant LILR in CP patients with STI raises efficacy of therapy by 11%. Investigation of prostate vascularisation and hemodynamics of its vessels in CP patients with STI using transrectal ultrasonography and dopplerography provide detailed information about prostatic structure allowing for lesion zones. This facilitates choice of an optimal complex treatment with application of LELR in peripheral inflammation of the prostate.

Prevalence of chlamydial genital infection and associated risk factors in adolescent females at an urban reproductive health care center in Croatia.

The study was undertaken to determine the prevalence of chlamydial genital infection in sexually active, urban adolescent females 15-19 years; to identify behavioral, demographic, and clinical factors associated with chlamydial infections; and to develop criteria for potential screening strategies. 500 adolescent women, median age 17.7 years, who visited gynecological outpatient clinic in Children's Hospital Zagreb for different reasons were enrolled in this study. Gynecological exam, colposcopy, detection of chlamydial infection by the rapid direct immunoassay of endocervical swab (Clearview Chlamydia-Unipath), endocervical cytological examination--Papanicolaou smear, and questionnaire to obtain demographic, social, behavioral and presence of symptoms data were performed. Positive Chlamydia trachomatis test were found in 16.4% of participants, cytologic cervical abnormalities--cervical intraepithelial neoplasia (CIN I-CIN III) were found in 25.2% and cytological signs of Human papilloma virus were found in 11.4%. Stepwise multivariate logistic regression analysis identified five factors associated with infection: the age of menarche < or =13 years, > or =4 lifetime sexual partners, non-use of contraception (rare or never), cervical friability, and abnormal Papanicolaou test. Urban adolescent sexually active women are at high risk for chlamydial infection and other sexually transmitted diseases including HIV infection. Association between chlamydial genital infection and risk-taking sexual and contraceptive behavior was found. Routine Chlamydia trachomatis testing for this population is recommended as well as implementation of school based sexual health education because of their risk-taking sexual behavior.

Infection in 2015: HIV protection with PrEP - implications for controlling other STIs.

HIV and bacterial sexually transmitted infection incidence remains persistently high for men who have sex with men. Results of new studies show that clinicians might be able to address this challenge by providing oral HIV pre-exposure prophylaxis and by intensifying efforts to diagnose and treat other sexually transmitted infections.

Pelvic inflammatory disease: education for maintaining fertility.

PID is a serious health problem that affects the reproductive potential of women. Education regarding risk factors and prevention of PID are primary prevention strategies that can minimize loss of future fertility potential. Acute episodes of PID can be successfully managed by clinicians using a high index of suspicion and initiating prompt, aggressive treatment for patients and partners. Ongoing follow-up and counseling can minimize repetitive threats to reproductive loss and circumvent the need for reparative fertility surgery.

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

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

Impact of T. vaginalis infection on innate immune responses and reproductive outcome.

Trichomonas vaginalis is the most common non-viral sexually transmitted pathogen. The infection is prevalent in reproductive age women and is associated with vaginitis, endometritis, adnexitis, pyosalpinx, infertility, preterm birth, low birth weight, bacterial vaginosis, and increased risk of cervical cancer, HPV, and HIV infection. In men, its complications include urethritis, prostatitis, epididymitis, and infertility through inflammatory damage or interference with the sperm function. The infection is often asymptomatic and recurrent despite the presence of specific antibodies, suggesting the importance of the innate immune defense. T. vaginalis adhesion proteins, cysteine proteases, and the major parasite lipophosphoglycan (LPG) play distinct roles in the pathogenesis and evasion of host immunity. LPG plays a key role in the parasite adherence and signaling to human vaginal and cervical epithelial cells, which is at least in part mediated by galectins. The epithelial cells respond to T. vaginalis infection and purified LPG by selective upregulation of proinflammatory mediators. At the same time, T. vaginalis triggers an immunosuppressive response in monocytes, macrophages, and dendritic cells. The molecular mechanisms underlying reproductive complications and epidemiologic risks associated with T. vaginalis infection remain to be elucidated.

Asymptomatic sexually transmitted infections in HIV-infected men who have sex with men: prevalence, incidence, predictors, and screening strategies.

Sexually transmitted infections (STIs) have increased among men who have sex with men (MSM) and are associated with unsafe sex practices, intrinsic morbidity, and enhanced genital shedding and transmission of HIV. Screening for asymptomatic STIs is recommended as part of the HIV prevention efforts, however, optimal screening strategies among HIV-infected MSM have not been well defined. In this study, conducted from April 2004 to September 2006, 212 HIV-infected MSM from two urban HIV clinics were screened for asymptomatic STIs. Testing for Neisseria gonorrhea and Chlamydia trachomatis from pharynx, rectum, and urine, as well as serologic testing for syphilis were performed initially, and then after 6 and 12 months. A self-administered questionnaire was used to assess possible predictors of incident asymptomatic STIs. A cost analysis was performed to assess different screening strategies for detecting incident STIs. The baseline prevalence of STIs was 14% (n = 29; 95% confidence interval [CI] 9%-19%) and the incidence of new infections was 20.8 cases per 100 person years (95% CI 14.8-28.4 cases per 100 person years). Younger age, higher CD4 cell count, and marijuana use were associated with increased risk of acquiring an asymptomatic STI. The laboratory cost to detect one positive STI did not significantly differ between once- and twice-yearly screening. However, almost half of all incident STIs were detected at the 6-month screening visit, potentially resulting in an increased duration of infectivity if these cases remained undiagnosed. In conclusion, prevalent and incident asymptomatic STIs are common among HIV-infected MSM. Our data support current Center for Disease Control and Prevention STI guidelines that recommend routine screening at increased frequency for HIV-infected MSM.

Cumulative experience with Haemophilus ducreyi 35000 in the human model of experimental infection.

BACKGROUND AND OBJECTIVES: To study Haemophilus ducreyi pathogenesis, the authors developed an experimental model of infection in human volunteers. The authors analyze their cumulative experience with strain 35000 in the model and calculate the papule and pustule formation rates for estimated delivered doses (EDDs) ranging from 1 cfu to 100 cfu. STUDY DESIGN: Sixty-five volunteers were included in the analysis. A total of 139 sites were available for calculation of the papule formation rate, and 117 sites were available for calculation of the pustule formation rates. RESULTS: The effect of EDDs and probabilities of papule formation and the pustule formation were dose-dependent. Increasing the EDD resulted in a higher probability of papule and pustule formation. CONCLUSION: H ducreyi is highly infectious for humans. Inoculation of an EDD of 1 cfu causes a papule formation rate of 50%. Pustule formation rates are approximately 50% for 27 cfu and 90% for 100 cfu.

The clinical manifestations and treatment of sexually transmitted diseases in human immunodeficiency virus-positive men.

Sexually transmitted diseases (STDs) occur commonly in sexually active human immunodeficiency virus (HIV)-positive men. STDs may have atypical presentations, can cause significant morbidity in persons with HIV infection, and may increase the risk of HIV transmission. Thus, the appropriate diagnosis and treatment of STDs in this population are extremely important. The clinical manifestations and treatment of several common STDs in HIV-positive men are reviewed. Further research is needed to define effective management and screening strategies for STDs in men with HIV infection.

Donovanose / Granuloma inguinale

A donovanose é uma infecção causada pela Calymmatobacterium granulomatosis, que afeta principalmente a região genital. De caráter progressivo e destrutivo, vem aumentando sua incidência nos últimos anos, despertando grande interesse pela necessidade de diagnóstico precoce, com a finalidade de evitar estádios avançados que limitam a vida do indivíduo. Os autores, após algumas considerações sobre os antecedentes da enfermidade e seus aspectos clínico-patológicos, relatam o case de um paciente do sexo feminino, 33 anos, com donovanose de caráter insidioso, progressivo e evolução de 10 anos. No momento da admissão, a paciente apresentava lesões ulcerovegetantes nas regiões vulvar, crural e abdominal baixa, que após manejo terapêutico adequado, obteve melhora satisfatória do quadro clínico. Nos comentários fazemos breve referência às complicações e terapêutica atual realizada para cura da patologia e das infecções secundárias, dando melhoria de condições vitais dos pacientes