High treatment failure rate is better explained by resistance gene detection than by minimum inhibitory concentration in patients with urogenital Chlamydia trachomatis infection.

OBJECTIVE: The aim of this study was to investigate the relationships between treatment outcomes of patients with urogenital Chlamydia trachomatis infections and minimum inhibitory concentrations (MICs) and drug resistance genes. METHODS: The clinical data of 92 patients diagnosed with Chlamydia trachomatis (C. trachomatis) infections were collected. Of these patients, 28 received regular treatment with azithromycin and 64 received minocycline. All patients underwent three monthly follow-ups after the completion of treatment. The microdilution method was used for the in vitro susceptibility tests. The acquisition of 23S rRNA mutations and presence of the tet(M) gene were detected by gene amplification and sequencing. RESULTS: The MICs of azithromycin, clarithromycin, erythromycin, tetracycline, doxycycline, and minocycline were comparable for isolates from the treatment failure and treatment success groups. Higher detection rates of 23S rRNA gene mutations and tet(M) were found in the treatment failure group (57.14% and 71.43%, respectively) than in the treatment success group (14.29% and 30.23%, respectively) (p < 0.05). The A2057G, C2452A, and T2611C gene mutations of 23S rRNA were detected in eight clinical isolates from the azithromycin treatment failure group, while the T2611C gene mutation was detected in one clinical strain from the treatment success group. CONCLUSIONS: The detection of resistance genes could better explain the high treatment failure rate than the MIC results in patients with urogenital C. trachomatis infections, highlighting the need for genetic antimicrobial resistance testing in infected patients.

Prevalence of genital Mycoplasma and response to eradication treatment in patients undergoing assisted reproductive techniques.

OBJECTIVE: Several studies have reported greater success of fertilisation by ART in couples who were not infected by Ureaplasma. Increased semen quality and better results have also been observed in couples who were treated with antibiotics to eradicate the infection. The aim of this study was to determine the prevalence of genital mycoplasmas in urine samples from male partners enrolled in the Assisted Reproduction Program (ARP) in our healthcare area so that, positive cases can be treated prior to the use of ART in order to increase the quality of semen, improve the embryo implantation rates and minimize the risk of adverse effects during pregnancy. METHODS: This study included couples enrolled in the ARP during 2016. Mycoplasma detection was made using real-time PCR. In positive cases, both members of the couple were treated with antibiotics until eradication of the microorganism. The antibiotics used were: azithromycin, doxycycline, levofloxacin, moxifloxacin, and clindamycin. RESULTS: Of the 205 men studied, 33 were positive: Ureaplasma urealyticum 15.1%, Mycoplasma hominis 3.9%. Eradication treatment with azithromycin failed in 50% compared to 10.2% for doxycycline. Of the 5 cases treated with levofloxacin, only 2 achieved elimination of U. urealyticum. CONCLUSIONS: We consider that genital mycoplasma routine screening could be useful in order to increase the quality of semen which could simplify the in vitro fertilisation procedures and raise the success rate of embryo implantation and pregnancy, especially when fast, sensitive and specific technics as real time PCR are used.

Brucellosis, genital campylobacteriosis and other factors affecting calving rate of cattle in three states of Northern Nigeria.

BACKGROUND: Reproductive diseases limit the productivity of cattle worldwide and represent an important obstacle to profitable cattle enterprise. In this study, herd brucellosis and bovine genital campylobacteriosis (BGC) status, and demographic and management variables were determined and related to predicted calving rate (PrCR) of cattle herds in Adamawa, Kaduna and Kano states, Nigeria. Serum samples, preputial scrapings, questionnaire data, trans-rectal palpation and farm records were used from 271 herds. The Rose-Bengal plate test and competitive enzyme-linked immunosorbent assay were used for Brucella serology and culture and identification from preputial samples for BGC. A herd was classified as positive if one or more animals tested positive. The PrCR was determined as the number of calvings expected during the previous 6 and next 6 months as a percentage of the number of postpubertal heifers and cows in the herd. A multilevel linear regression model was used to estimate the herd-level effect of Brucella abortus seropositivity, Campylobacter fetus infection and other factors on calculated PrCR. RESULTS: The reproductive performance of the cattle herds was generally poor: Only 6.5% of the nursing cows were pregnant and 51.1% were non-pregnant and acyclic; the mean annual PrCR was 51.4%. Brucella abortus and C. fetus infection of herds were independently associated with absolute reduction in PrCR of 14.9% and 8.4%, respectively. There was also a strong negative association between within-herd Brucella seroprevalence and PrCR. Presence of small ruminants, animal introduction without quarantine and the presence of handling facilities were associated with lower PrCR, whereas larger herd size, supplementary feeding, routine mineral supplementation and care during parturition were associated with higher PrCR. CONCLUSIONS: Brucellosis and BGC may be largely responsible for the poor reproductive performance of indigenous Nigerian cattle. Farmer education and measures to improve the fertility of cattle herds are suggested.

Is there a reservoir of sub-clinical lymphogranuloma venereum and non-LGV Chlamydia trachomatis infection in men who have sex with men?

SUMMARY: The aim of this study was to determine if a reservoir of sub-clinical LGV infection exists in men who have sex with men (MSM), as this finding might account for the recent rise in lymphogranuloma venereum (LGV) Chlamydia trachomatis infections among MSM in Canada. MSM without proctitis were enrolled between January and August 2006 in a cross-sectional study. Rectal, urine, serology and pharyngeal specimens were tested for specific C. trachomatis serovars. The median age of the 253 participants was 43 years; 53% were HIV+. We found no active cases of LGV infection; but 20 (8%) participants had positive serology. Thirteen participants (5%) had non-LGV C. trachomatis infections. Unprotected anopenetrative intercourse, rectal enema and drug use were associated with non-LGV C. trachomatis infection. Sub-clinical rectal non-LGV C. trachomatis infection was relatively common but LGV was not identified in our sample. Further studies of screening for non-LGV chlamydia infection in MSM are needed.

[Genital bacterial infections associated with papillomavirus: value of screening and basis for treatment]. / Infections bactériennes génitales associées aux papillomavirus: intérêt du dépistage et base du traitement.

Genital bacterial and viral infections may be responsible of couple infertility and may be potentially oncogenic for genital lesions. Genital bacterial infection is associated with human papillomavirus infection in as much as 48% for men and 64% for women. The bacterias most frequently found are intracellular species (29%) and Gram-negative bacilli (14%). Treatment with specific antibiotics can reduce the frequency of infertility in both men and women. This treatment can also prevent therapeutic complications during treatment for papillomavirus infection.

[The use of ampicillin/sulbactam (Unasyn) in treating inflammatory urological diseases]. / Ispol'zovanie ampitsillin/sul'baktama (unazina) pri lechenii vospalitel'nykh urologicheskikh zabolevanii.

Unasyn is a combination of ampicillin, a bactericidal antibiotic, and sulbactam, an inhibitor of beta-lactamases. It was used in treatment of 36 patients with urogenital infections. The combination was administered intravenously and in the main intramuscularly. The treatment course amounted to 7-10 days. The average daily dose was 6 to 9 g. 22 patients with acute nonocclusive pyelonephritis were treated with the combination and its clinical and bacteriological efficacy was stated in 95 per cent of the cases. An excellent clinical effect of the combination was observed in 6 patients with acute epididymitis. A clinical improvement was also observed in the treatment of the patients with acute prostatitis and chronic renal infections. Unasyn proved to be a highly efficient antibacterial combination with regard to gram-positive flora and colon bacilli as representatives of gram-negative organisms. Satisfactory results were also stated in the treatment of infections caused by Proteus spp. Complete elimination of the pathogen was achieved in 57.7 per cent of the cases. No adverse reactions to Unasyn except pain in the site of the injection were recorded.

Dose-ranging study of fleroxacin for treatment of uncomplicated Chlamydia trachomatis genital infections.

Men and women with suspected or proven genital infections caused by Chlamydia trachomatis were enrolled in a double-blind study to evaluate the efficacy and tolerability of fleroxacin. Patients received either 400, 600, or 800 mg once daily for 7 days and were monitored approximately 2, 4, and 7 weeks after initiation of therapy. In men monitored for at least 6 weeks or until failure of the therapy, fleroxacin failed to eradicate C. trachomatis in three of eight on the 400-mg regimen, in one of four on the 600-mg regimen, and in four of seven on the 800-mg regimen. All five women monitored for at least 6 weeks became culture negative. There was no association between in vitro susceptibility of C. trachomatis to fleroxacin and outcome, with MICs being 4 to 8 migrograms/ml for almost all isolates tested. Among those with positive cultures for Ureaplasma urealyticum initially, the first follow-up cultures remained positive in 8 (29%) of 28 men and 8 (50%) of 16 women. Independent of culture results, men with nongonococcal urethritis receiving 800 mg of fleroxacin were significantly more likely to show a clinical response than men receiving 400 or 600 mg (93 versus 54%). Adverse events were frequent, often severe, and dose related. Insomnia and photosensitivity reactions were the most important. The adverse reactions and unacceptably high rates of microbiologic failure resulted in premature termination of the study.

The role of hyperbaric oxygen in the management of Fournier's gangrene.

Fournier's gangrene of the external genitals is a complex entity characterized by acute onset, rapid progress to gangrene, toxemia and high mortality rate. The disease may be primary as described by Fournier or secondary with a detectable cause in the colo-rectal area, the lower urogenital tract or in the perineum. The disease may affect healthy young males (originally described by Fournier) or elderly subjects especially with general ill health, cancer, diabetes, liver or renal failure, immunosuppression, etc. The microbiology is as complex as the etiology. The nosiology is likewise complex. Because the mortality is high, it is important to be aggressive in therapy. Triple attack is necessary, viz.: antibiotic coverage for aerobes and anaerobes, general supportive measures and adequate surgical debridement. We, recommend Hyperbaric Oxygen Therapy (HBO) treatment in specialized centers as an adjunctive measure since we had no mortality in the cases we treated. In expert centers, HBO has very few complications which are outweighed by the benefit the patient gets. The one-man chamber is the commonest in use, but for a compromised patient the multiplace may be more appropriate. In the very early stage, HBO may avert gangrene or reduce it. It is important to have a high index of awareness of this disease amongst the medical profession. More work is needed for the more precise definition, classification and management of the complex syndrome of Fournier.

Studies on bovine herpesviruses. Part 1. Isolation and characterization of viruses isolated from the genital tract of cattle.

Herpesviruses, previously isolated from cattle (Theodoridis, 1978), were further studied and provisionally placed in the bovid herpesvirus 4 (BHV-4) group. Major differences were found between IBR-IPV (BHV-1) and BHV-4 virus strains. In MDBK cells, all BHV-4 strains started growing at the edges of the culture, the process progressing slowly until destruction of the cells was complete by the 10th day. BHV-4 strains failed to induce neutralizing antibodies in cattle, goats and rabbits. Only the addition of mineral oil adjuvant induced neutralizing and complement fixing antibodies in goats. BHV-1 strains, in contrast, produced very potent antisera in all these systems. Cross-neutralization tests indicated the existence of 2 distinct serological groups representing BHV-1 and BHV-4. The BHV-4 strains appear to be interrelated and they could not be grouped. A BHV-1 strain showed fixation of complement with the antisera of 6 BHV-4 strains. Electron micrographs showed an accumulation of nucleocapsids in the cytoplasm and an early release of virus particles due to cell destruction. Variation in incubation temperature had a significant effect on the particle formation. At lower temperatures, the number of enveloped particles in the cytoplasm increased. On the basis of the characteristics uncovered in this study, it is possible that all the BHV-4 strains represent one and the same virus which has undergone certain biological changes, thus illustrating a phenomenon which appears to be a characteristic of the herpesviruses.

Fournier's gangrene of the scrotum. A poorly defined syndrome or a misnomer?

Fournier's gangrene is defined classically as a fulminant, rapidly spreading infection of the scrotum that also involves the perineum, penis, and abdominal wall. The pathologic findings are described as synergistic gangrene secondary to a polymicrobial flora with a poorly defined portal of entry. In our experience with 12 cases, the portal of entry was well defined and the causative organisms were those typically found in the lower bowel. Portals of entry were perirectal abscesses in five patients, urethral infections in three, and surgical procedures in four patients. All patients required aggressive surgical debridement, broad-spectrum antibiotics, and adjunctive measures. The fact that four patients died in spite of aggressive treatment demonstrates the lethal nature of this disease. This study suggests that this syndrome is no longer "idiopathic" but is primarily a necrotizing cellulitis of the perineum with subsequent involvement of the genitalia and surrounding tissues.