High rates of treatment failure for Mycoplasma genitalium among men and women attending a sexual health clinic.

BACKGROUND: Mycoplasma genitalium (Mgen) causes non-gonococcal urethritis (NGU) and is believed to cause pelvic inflammatory disease (PID). High rates of macrolide resistance are well documented globally for Mgen. In Brighton, patients with NGU and PID are tested for Mgen and test of cure (TOC) offered post-treatment. METHODS: Demographic, clinical and treatment history data were collected over a 12-month period for all Mgen-positive patients in a Brighton-based genitourinary clinic. RESULTS: There were 114 patients with Mgen. 18% (61/339) of men with NGU and 9% (15/160) of women with PID had Mgen. 62/114 (54%) returned for first test TOC 4 weeks after treatment. 27/62 (44%) had a positive TOC; 25/27 (92.6%) had received azithromycin first line (500 mg stat then 250 mg OD for 4 days), 1/27 (3.7%) had received moxifloxacin first line (400 mg OD for 14 days) and 1/27 (3.7%) had received doxycycline first line (100 mg BD for 7 days). 20/27 (74%) returned for a second TOC 4 weeks later. 5/20 (25%) patients were positive on second TOC; 3/5 (60%) had received azithromycin second line and 2/5 (40%) had received moxifloxacin second line. Patients were more likely to have a positive TOC if they were at risk of reinfection (9/27 positive TOC vs 3/35 negative TOC; p=0.02). Patients given moxifloxacin were more likely to have a negative TOC (1/27 positive TOC vs 9/35 negative TOC; p=0.03) than those who received other antibiotic regimens. CONCLUSIONS: Treatment failure rates for Mgen following azithromycin use are substantial, raising concerns regarding resistance. However, reinfection risk may contribute, suggesting a requirement for improved public awareness and clinician knowledge.

Sexually transmitted diseases treatment guidelines, 2015.

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.

[Efficacy of combined physiotherapeutic methods in complex treatment of patients with chronic infectious urethroprostatitis].

The study is aimed at investigation of efficacy and safety of a combined effect of laser therapy and vibromagnetotherapy in complex treatment of patients with chronic urethroprostatitis in the presence of sexually transmitted infection (STI). A total of 35 males aged 20 to 51 years entered the study. They were divided into 3 groups. Group 1 received standard basic therapy, group 2 received basic and laser therapy, group 3 - basic treatment and laser plus vibromagnetotherapy. Effectiveness of the treatment was assessed by the evidence obtained from clinical, bacteriological, device and functional examinations. The results of the treatments were evaluated after 2 weeks of the follow-up. It is shown that patients of groups 2 and 3 achieved more pronounced improvement of clinical and laboratory indices, parameters of basal blood flow. Thus, physiotherapy, added to antibacterial treatment, is safe and effective in the treatment of chronic urethroprostatitis and STI.

Subacute fulminant hepatic failure with intermittent fever.

BACKGROUND: Viral hepatitis B accounts for over 80% of acute hepatic failures in China and the patients die mainly of its complications. A patient with hepatic failure and fever is not uncommon, whereas repeated fever is rare. METHODS: A 32-year-old female was diagnosed with subacute hepatic failure and hepatitis B viral infection because of hyperbilirubinemia, coagulopathy, hepatic encephalopathy, serum anti-HBs-positive without hepatitis B vaccination, and typical intrahepatic pathological features of chronic hepatitis B. Plasma exchange was administered twice and she awoke with hyperbilirubinemia and discontinuous fever. RESULTS: Urethritis was confirmed and medication-induced fever and/or spontaneous bacterial peritonitis (Gram-negative bacillus infection) was suspected. The patient was treated with antibiotics, steroids and a Chinese herbal medicine, matrine, for three months and she recovered. CONCLUSION: The survival rate of patients with hepatic failure might be improved with comprehensive supporting measures and appropriate, timely management of complications.

10 plantes de chez nous / 10 domestic plants

Dix cas cliniques succincts presentes a la Societe Royale Belge d'Homeopathie avec une etude repertoriale et de la matiere medicale pour chacun des remedes

Infecciones genitales debidas a Chlamydia trachomatis / Genital infections caused by Chlamydia trachomatis

C. trachomatis es la bacteria más frecuentemente involucrada en la etiología de las enfermedades de transmisión sexual. En la mujer la cervicitis, que se puede complicar con endometritis, salpingitis e infertilidad, es la presentación clínica más común. Sin embargo, la mayoría de las infecciones genitales en la mujer son asintomáticas. En el hombre la uretritis y la epididimitis son formas frecuentes de presentación. El diagnóstico de las infecciones por C. trachomatis se puede hacer por métodos de detección de antígenos incluyendo la amplificación de los ácidos nucleicos. Dependiendo de la presentación clínica diversos protocolos de tratamiento se pueden implementar (AU)

[Urethral electrothermal stimulation in treating patients with chronic non-gonococcal urethro-prostatitis]. / Elektrotermouretrostimuliatsiia v lechenii bol'nykh khronicheskim negonokokkovym uretroprostatitom.

Two groups of patients with chronic urethral electrothermal stimulation [correction of electrothermoureterostimulation] were singled out. Group 1 (50 patients) received traditional treatment plus urethral electrothermal stimulation [correction of electrthermoureterostimulation] while group II only traditional treatment. The ejaculate in these groups receiving different treatment revealed significant qualitative and quantitative differences. Treatment including urethral electrostimulation [correction of electroureterostimulation] stimulates the mucosa and surrounding tissues of the urinary canal, prostatic part of the urethra [correction of ureter] and prostate, increase of its blood flow. This favoured resolution of the inflammatory process, opens the obstructed ducts of the urethral [correction of ureteral] process and alveoli of the prostate.

[Experience in treating chronic urethritis in men by iontophoresis and inductothermy]. / Opyt lecheniia khronicheskikh uretritov u muzhchin ionoforezom i induktotermiei.

A method for therapy of chronic urethritis by exposure to ionized solutions of drugs has been developed (Authors' Certificate of the USSR No. 876138). Active electrode is placed in the flask with the drug, passive one on the external surface of the body as close to the focus of involvement as possible. Ionized solution of the drug (2.5-3.1) is introduced into the urethra via a double-lumen catheter, washes its walls and saturates the mucosa; the solution is aspirated from the urethra through the other lumen of the catheter, thus removing the inflammation products from the urethra. Current density has made up 0.01-0.03 mA/cm2, length of session 12-15 min, 6-8 sessions per course. A device for local therapy of chronic urethritis by a combination of ionophoresis and inductothermy has been suggested (Authors' Certificate of the USSR No. 1084031). This device permits a simultaneous administration of 2 drugs: one from the tube via urethral mucosa, the other from the cuvette outwardly. Current density has made up 0.01-0.03 mA/cm2, with the current of 200 mA in the inductor. Length of inductometry and ionophoresis session is 10-15 min.

[Local hyperthermia in the combined treatment of patients with chronic bacterial urethroprostatitis]. / Lokal'naia gipertermiia v kompleksnom lechenii bol'nykh khronicheskim bakterial'nym uretroprostatitom.

Ninety patients with chronic urethroprostatitis have been followed up. The patients were divided into two groups. Group 1 (50 patients), besides general treatment, have been treated with local hyperthermia: the temperature in the urethra has been gradually increased to reach 40-60 degrees C and maintained so for 20-60 min. The temperature elevation depended on the patient's tolerance. Group 2 patients have been administered local therapy with various instillations. Good results in Group 1 recommend a smooth warming of the urethra to 40-60 degrees C as a rational and effective method of local therapy in combined treatment of patients with chronic urethroprostatitis.