Utilidad de las técnicas de biología molecular en el diagnóstico de las infecciones de transmisión sexual y otras infecciones genitales / Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections

Históricamente, el diagnóstico de las infecciones detransmisión sexual ha sido difícil. La introducción en eldiagnóstico microbiológico de las técnicas de biologíamolecular y su aplicación a muestras no invasivas hapermitido importantes avances en su diagnóstico. Engeneral, la detección de Neisseria gonorrhoeae mediantetécnicas de biología molecular proporciona un diagnósticopresuntivo y requiere confirmación por cultivo en zonas de baja prevalencia. Para Chlamydia trachomatis, estastécnicas se consideran como las más sensibles yespecíficas, tanto para estudios de cribado poblacional,como para el diagnóstico de pacientes sintomáticos. Eldiagnóstico de Mycoplasma genitalium por cultivo es muylento, por ello, las técnicas moleculares son las únicas que pueden aportar información diagnóstica relevante. Para Treponema pallidum, las técnicas moleculares puedenaportar ventajas en el diagnóstico directo de la infección. Respecto a la donovaniosis, las técnicas moleculares no están establecidas para el diagnóstico sistemático, aunque se recomiendan en manos expertas. En el caso de Haemophilus ducreyi, las dificultades del cultivo y su baja sensibilidad aconsejan el uso de métodos moleculares. En el herpes genital, las técnicas moleculares han comenzado a recomendarse para el diagnóstico sistemático y pueden convertirse en la técnica de referencia en poco tiempo. Para otras infecciones genitales, como vaginosis bacteriana, vulvovaginitis candidiásica y tricomoniasis, losmétodos moleculares para el diagnóstico están pocoestablecidos. Respecto a las verrugas genitales, lastécnicas de cribado y genotipado disponibles paramuestras endocervicales podrían utilizarse para ciertaspoblaciones, aunque no se han validado para estecometido

Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose

Infecciones asociadas a dispositivos para drenaje de las vías urinarias. Infecciones del tracto genital relacionadas con los dispositivos protésicos / Infections associated with the use of indwelling urinary catheters. Infections related to intrauterine devices_š

La infección urinaria (IU) nosocomial se relaciona fundamentalmente con la utilización de la sonda urinaria(SU). En este capítulo se repasan los mecanismos patogénicos por los cuales los microorganismos alcanzan el tracto urinario, así como la capacidad de adhesión y de formación de biopelículas, lo cual depende tanto del microorganismo como del tipo de SU. En la etiología de la IU del paciente sondado intervienen múltiples microorganismos, lo cual dificulta la elección de un tratamiento empírico adecuado, especialmente si se sospecha infección por microorganismos multirresistentes. En el sondado las manifestaciones clínicas son menos características y el diagnóstico, a menudo, difícil. La terapia deberá estratificarse según el tipo de IU; mientras la bacteriuria asintomática no requiere habitualmente de tratamiento, en el paciente con shock séptico la cobertura deberá ser amplia. Se efectúa, asimismo, un amplio repaso de las medidas preventivas. Las infecciones del tracto genital relacionadas con dispositivos protésicos se han asociado fundamentalmente a la utilización de dispositivos intrauterinos (DIU). En este apartado se repasa la epidemiología, la etiología, el tratamiento y la prevención de las infecciones asociadas a la utilización de DIU (AU)

Hospital-acquired urinary tract infections (UTI) are mainly associated with indwelling urinary catheter use. In this chapter, the pathogenesis of hospital-acquired UTI in catheterized patients, the mechanisms by which microorganisms reach the urinary tract and are able to adhere and form biofilms, and the influence of other riskfactors, such as time since catheter insertion and catheter composition, are reviewed. A wide variety of infecting microorganisms can affect patients with urinary catheters, making the choice of an adequate empirical antimicrobial course complex, particularly in cases of suspected multiresistant microorganisms. Moreover, the clinical symptoms are less characteristic in catheter infection and the diagnosis may be difficult. Treatment should best ratified according to the clinical features, which canvary from asymptomatic bacteriuria that may not require treatment, to severe septic episodes that need wide antibiotic coverage. The prevention measures for UTI in permanently catheterized patients are reviewed. Infections of the female genital tract associated with foreign bodies are mainly related to the use of intrauterine devices (IUDs). The epidemiology, microbiology profile, antimicrobial treatment, and prophylaxis of pelvic inflammatory disease related to IUD use in women are also reviewed (AU)

Association of Ureaplasma urealyticum infection with varicocele-related infertility.

BACKGROUND: The role of seminal colonization of Ureaplasma urealyticum in varicocele-related infertility was investigated. METHODOLOGY: Semen samples were obtained from infertile patients with or without varicocele and healthy controls and were subjected to routine semen analysis and PCR. DNA was extracted by Cadieux method and analyzed by PCR protocol with species-specific primers for U. urealyticum (urease gene). RESULTS: U. urealyticum was detected by PCR in 23 of 146 (15.75%) semen specimens from infertile patients and in 3 of 100(3%) healthy men (P<0.001). Infertile patients with varicocele had higher U. urealyticum colonization [17/81(20.98%)] than those without varicocele [6/65(9.23%), P=0.086] or healthy controls [3/100 (3%), P<0.001].The percentage of sperm cells with motility, volume of semen fluid, concentration of sperm cells, and sperm cell with normal morphology were significantly decreased in infertile men (P<0.001). In the group of varicocele patients with PCR positive for U. urealyticum the volume, count and morphology of semen samples were lower than those in the varicocele patients with PCR negative results, but the differences were not significant (P>0.05). CONCLUSION: Although the colonization of U. urealyticum does not affect the semen quality, the high prevalence of this microorganism in varicocele patients may be an additional negative factor affecting varicocele status and worsening reproductive potential.

Genital Ureaplasma urealyticum infection in varicocele-related infertility.

OBJECTIVE: To assess the existence of a possible infectious factor in varicocele-related infertility. METHODS: A total of 925 seminal plasmas from 590 infertile men with varicocele and 335 infertile patients without palpable varicocele were cultured for Ureaplasma urealyticum infection, and routine semen analysis was made. RESULTS: The infection rate of Ureaplasma urealyticum in seminal plasmas was 48.22%. The asymptomatic genital infection of Ureaplasma urealyticum was traced in 329 (55.76%) varicocele men and 117 (34.93%) infertile patients without varicocele (control group). A significant quantitative difference in the incidence of genital Ureaplasma urealyticum infection between the varicocele and control group was observed (P < 0.005) and asthenozoospermia was significantly more prevalent in the patients with varicocele than in the other patients (P < 0.05). CONCLUSIONS: Genital Ureaplasma urealyticum infection may play a role in varicocele-related infertility. To prevent future infertility, men with both varicocele and genital Ureaplasma urealyticum infection may benefit from early evaluation and treatment.

Seminal biochemistry and sperm characteristics in infertile men with bacteria in ejaculate.

Sperm examination, quantitative sperm culture, citric acid, acid phosphatase, and fructose were assayed in three groups of men: fertile controls without significant bacteriospermia (group I), infertile men with significant bacteriospermia; idiopathic infertile men (group II), and infertile men with varicocele (group III). Level of significance of bacteriospermia was greater than or equal to 10(4) germs/ml of ejaculate. In group II, motility and typical morphology percentages were lower, independently of the degree and the nature of bacteriospermia. Incidence of pathogenic bacteria was higher than in group III and linked to the degree of bacteriospermia. Fructose was unaltered in the two groups of infected men. No modification of prostatic markers was observed in any groups, except in group II, where they decreased when bacteriospermia was lower than 10(5) germs/ml and when biological pattern of semen evoked chronic prostatitis. Thus, the presence of germs in ejaculate alters the motility and the typical morphology percentages but does not result in any obvious modifications of biochemical markers of prostate and seminal vesicles. For idiopathic infertile men, it is suggested that the quantitative criterion of pathogenic bacteriospermia is a germ count greater than or equal to 10(5)/ml.