Mycoplasma genitalium: Key Information for the Primary Care Clinician.

Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, which appears to be a cause of urethritis and cervicitis and has been associated with pelvic inflammatory disease (PID), epididymitis, proctitis, infertility, complications during pregnancy, and human immunodeficiency virus (HIV) transmission. Three Food and Drug Administration (FDA) approved tests are available. Testing should be focused to avoid inappropriate antibiotic use. The Center of Disease Control and Prevention (CDC) guidelines recommend testing for persistent male urethritis, cervicitis, and proctitis and state that testing should be considered in cases of PID. Testing is also recommended for sexual contacts of patients with MG. Testing is not recommended in asymptomatic patients, including pregnant patients, who do not have a history of MG exposure. Although resistance-guided therapy is recommended, there are currently no FDA approved tests for MG macrolide resistance, and tests are not widely available in the United States. The CDC recommends 2-step treatment with doxycycline followed by azithromycin or moxifloxacin. Moxifloxacin is recommended if resistance testing is unavailable or testing demonstrates macrolide resistance..

Nongonococcal tysonitis.

Tyson's glands are sebaceous glands located on each side of the frenulum that communicate with the preputial sac, and their inflammation can be an infrequent complication of urethritis. We describe a rare case that presented with urethral discharge and parafrenular swelling with mucopurulent discharge a week after an unprotected sexual encounter. The patient was empirically treated with 500 mg of ceftriaxone intramuscularly and 100 mg of doxycycline every 12 h for 14 days with symptomatic resolution. The urethral swab culture and the urine polymerase chain reaction (PCR) were negative for Neisseria gonorrhoeae and Chlamydia trachomatis, therefore, and given the response to treatment, nongonococcal tysonitis was diagnosed.

[New Sk2 guideline idiopathic posterior urethritis : Discussion of the current guideline using a case study]. / Neue Sk2-Leitlinie Urethritis posterior : Diskussion der aktuellen neuen Leitlinie anhand eines Fallbeispiels.

Posterior urethritis is diagnosed in prepubertal or pubertal boys mainly with terminal asymptomatic haematuria or postmicturition blood spotting on the meatus or in the underwear. It presents with typical changes in the bulbar urethra (hyperaemia, oedema and denuded mucosa) without laboratory or radiological findings. The pathology is self-limiting with a very good prognosis. This condition is most likely caused by dysfunctional voiding and urotherapy with biofeedback therapy offers good treatment results. Although urethrocystoscopy is the only way to confirm the diagnosis, the patient should be prevented from having a (usually unnecessary) urethrocystoscopy and the relatives should be reassured.

A novel therapy for idiopathic urethritis in children: Local steroid injection.

Idiopathic urethritis (IU) is difficult to manage and there is no standarized therapy. The technique of local steroid injection (LSI) for the treatment of IU in children and the results of the patients undergoing LSI from 2020 to 2021 in a single center are presented. Seven patients with IU underwent LSI. An internal urethrotomy was also performed in two patients with stricture. Complete resolution of symptoms and signs occurred in six patients. The remaining patient did not achieve total remission but did substantially improve symptoms. LSI seems to be an effective alternative for treatment of IU in children.

Clinical Presentations and Treatment Outcomes of Mycoplasma genitalium Infections at a Large New York City Health Care System.

BACKGROUND: Mycoplasma genitalium (MG) is an emerging sexually transmitted infection. Treatment of MG is complicated by increasing resistance to primary treatment regimens, including macrolides and fluoroquinolones. Understanding the various clinical presentations and relative effectiveness of treatments for MG is crucial to optimizing care. METHODS: Patients with a positive MG nucleic acid amplification test between July 1, 2019, and June 30, 2021, at a large health system in New York City were included in a retrospective cohort. Demographics, clinical presentations, coinfections, treatment, and follow-up microbiologic tests were obtained from the electronic medical record. Associations with microbiologic cure were evaluated in bivariate and multivariable logistic regression models. RESULTS: Five hundred two unique patients had a positive MG nucleic acid amplification test result during the study period. Male individuals presented predominantly with urethritis (117 of 187 [63%]) and female individuals with vaginal symptoms (142 of 315 [45%]). Among patients with follow-up testing who received a single antibiotic at the time of treatment, 43% (90 of 210) had persistent infection and 57% (120 of 210) had microbiologic cure. Eighty-two percent of patients treated with moxifloxacin had microbiologic cure compared with 41% of patients receiving azithromycin regimens ( P < 0.001). In multivariable analysis, treatment with moxifloxacin was associated with 4 times the odds of microbiologic cure relative to low-dose azithromycin (adjusted odds ratio [aOR], 4.18; 95% confidence interval, 1.73-10.13; P < 0.01). CONCLUSIONS: Clinical presentations of MG vary, with urethritis or vaginal symptoms in most cases. Among patients who received a single antibiotic, only treatment with moxifloxacin was significantly associated with microbiologic cure relative to low-dose azithromycin.

[A 19-year-old male migrant with urethritis and vesicular rash]. / Un migrant de 19 ans consulte pour une urétrite et une éruption vésiculeuse.

We report the case of a 19-year-old Malian patient, who presented with urethritis and a vesicular rash during the summer of 2022, following a probable heterosexual intercourse. The epidemic context among the male homosexual population and the clinical picture without genital lesions or lymphadenopathy allowed us to discuss both chickenpox and mpox, the latter being finally confirmed by the detection of Monkeypox virus DNA from vesicular fluid.

A case of chronic bacterial prostatitis due to Mycoplasma genitalium.

Mycoplasma genitalium (MG) is a common cause of non-gonococcal urethritis, but a role in acute or chronic prostatitis has not been described. We describe the case of a 42-year-old man with recurrent urinary tract infections since 2018 who developed chronic prostatitis despite several and prolonged antibiotic courses. Multiparametric prostatic magnetic resonance showed peripheral inflammatory alterations. A 4-glass Meares-Stamey test detected MG in the third voided bladder (VB3) sample. Moxifloxacin 400 mg daily for 28 days resulted in sustained clinical and microbiological cure.

[Urethritis-spectrum of pathogens, diagnostics and treatment]. / Urethritis ­ Erregerspektrum, Diagnostik und Therapie.

A broad spectrum of bacteria, fungi, protozoa and viruses can cause urethritis. In particular, N. gonorrhoeae, C. trachomatis, M. genitalium and T. vaginalis are the focus of diagnostic considerations as classic pathogens associated with sexually transmitted infections (STI). A step-by-step procedure is needed to make a definitive diagnosis. Microscopy with a staining preparation provides an initial differentiation between gonoccocal and non-gonococcal urethritis in symptomatic men as a point-of-care (POC) test. Nucleic acid amplification technology (NAAT) is used for specific and sensitive pathogen detection and, as a multiplex diagnostic test, offers the possibility of detecting several organisms from the same sample. In addition, compared to culture, no vital organisms are required, which allows the collection and use of more diverse and less invasive biological samples (e.g. first stream urine in men or vaginal swabs). Susceptibility testing by culture remains essential for N. gonorrhoeae as resistance is emerging. The treatment of urethritis depends on the suspected or proven pathogen according to the current guidelines. Treatment failure can be caused by many factors (coinfection, lack of therapy adherence, reinfection or resistance of the pathogen) and requires a repeated diagnostic and therapeutic procedure and differentiated approach.

Brazilian Clinical Practice Guidelines for Sexually Transmitted Infections That Cause Urethral Discharge: Assessment According to the AGREE II and Critical Analysis Based on the WHO Recommendations.

BACKGROUND: Sexually transmitted infections (STI) can have severe consequences. In Brazil, case management is recommended by the Clinical Protocol and Therapeutical Guidelines for Comprehensive Care for People with STIs (PCDT-IST). This study assessed the quality of PCDT-IST (2021) and reviewed the main recommendations for the management of STI that cause urethral discharge compared with the World Health Organization (WHO) STI Guidelines. METHODS: The PCDT-IST (2021) quality was independently assessed by 4 appraisers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). The PCDT-IST (2021) and the WHO Guidelines for the Management of Symptomatic STI (2021) were compared considering 14 different assessment domains. RESULTS: The PCDT-IST (2021) scores in the AGREE II domains were: Rigor of Development (58%), Applicability (35%), Editorial Independence (38%), Scope and Purpose (78%), Stakeholder Involvement (74%), and Clarity and Presentation (82%). The overall score was 67%, and all appraisers recommended the Brazilian guideline. Regarding the PCDT-IST (2021) and the WHO STI Guidelines (2021) comparation, 10 domains would be relevant for further reviewing the Brazilian recommendations: Diagnostic tests; Etiological approach; Treatment for recurrent urethral discharge; Treatment for urethritis without etiological agent identification; Treatment for gonococcal urethritis; Treatment for chlamydial urethritis; Retreatment for gonococcal infections; Treatment for Mycoplasma genitalium urethritis; Treatment for Trichomonas vaginalis urethritis; 10. Flowcharts. CONCLUSIONS: The PCDT-IST (2021) has a reasonable degree of quality. However, the domains of Applicability, Rigor of Development, and Editorial Independence must be better ensured. The guidelines comparison will help to select key topics that should be addressed with priority in the following national STI guidelines updates.

Diagnosis and treatment outcomes of urethritis-like symptoms in young males: a retrospective cohort study.

The study evaluated the prevalence of gonorrhoea and chlamydia infections and find out other non-infectious diseases in sexually active young males with urethritis-like symptoms and their treatment outcomes. We retrospectively reviewed the young adult males (aged 20-50 years) who visited our clinic with urethritis symptoms from March 2019 to April 2022. All patients underwent urinalysis, urine culture, and urinary polymerase chain reaction (PCR) testing for gonorrhoea and chlamydia. Student's t-test and Pearson's chi-square test were used to compare the differences between the triple-negative group (i.e., negative results in urinalysis, urine culture, and urinary PCR) and the any-positive group. Logistic regression analyses were used to evaluate the predictive factors for positive PCR results for gonorrhoea or chlamydia in patients with negative urinalysis and urine culture. Of the 365 participants with urethritis-like symptoms, 139 patients were diagnosed of gonococcal or chlamydia urethritis. Among the 202 patients with negative urinalysis and urine culture, 60 patients were diagnosed with gonorrhoea or chlamydia using PCR. Urethral discharge was an independent predictor. 142 patients with triple negative results were attributed to other non-infectious diseases. Empirical antibiotic treatment is recommended for patients with urethritis symptoms showing positive or negative urinalysis results but with urethral discharge.

Outbreak of Sexually Transmitted Nongroupable Neisseria meningitidis-Associated Urethritis, Vietnam.

We report on an outbreak of nongroupable Neisseria meningitidis-associated urethritis, primarily among men who have sex with men in southern Vietnam. Nearly 50% of N. meningitidis isolates were resistant to ciprofloxacin. This emerging pathogen should be considered in the differential diagnosis and management of urethritis.

A successful treatment with ALA-PDT: A case-report on erythroplasia of Queyrat misdiagnosed as urethritis.

Queyrat erythroplasia is an intraepidermal squamous cell carcinoma localized on the glans penis or the inner side of the foreskin. It accounts for about 10% of all penile malignancies and up to 33% cases may lead to invasive squamous cell carcinoma and the intraurethral erythroplasia of Queyrat is relatively rare. Treatment of Queyrat erythroplasia present a challenge especially if the proximal urethra is involved. Here, we report a case of intractable Queyrat erythroplasia involving the urethral meatus. This case suggested that 5-aminolaevulinic acid photodynamic therapy is effective and safe in the treatment of Queyrat erythroplasia, which provides a new choice for the patients with Queyrat erythroplasia with poor therapeutic effect.

Neisseria meningitidis y el aumento del sexo oral. A propósito de un caso / Neisseria meningitidis and the increase of oral sex. A case report

La uretritis es una entidad caracterizada por disuria y secreción uretral purulenta, generalmente adquirida por vía sexual. Neisseria gonorrhoeae es uno de los microorganismos más frecuentemente responsables. Neisseria meningitidis es un diplococo gramnegativo aislado habitualmente en la faringe, que causa en ocasiones meningitis meningocócica, siendo poco común aislarlo en el área anogenital, donde podría ser patógeno genitourinario. Presentamos el caso de un hombre heterosexual de 25 años que tras una relación heterosexual con una pareja ocasional no profesional que incluyó sexo oral y vaginal presenta clínica de uretritis, orientándose como infección de transmisión sexual. El cultivo bacteriológico convencional para N. gonorrhoeae fue negativo, siendo la PCR para Chlamydia trachomatis positiva. Posteriormente, el laboratorio informó de un cultivo bacteriológico positivo para N. meningitidis serogrupo C, sensible a ceftriaxona, y PCR negativa para N. gonorrhoeae. N. meningitidis es la principal causa de meningitis bacteriana, pero estudios genómicos evidencian que alelos de la nitrato reductasa, la proteína ligadora del factor-H y la cápsula están asociados con aislamientos de N. meningitidis en infecciones genitourinarias. La transmisión desde orofaringe a uretra a través del contacto orogenital en el sexo oral desprotegido ha sido ampliamente demostrada. La prevalencia de N. meningitidis como causante de uretritis es baja, siendo los portadores asintomáticos en uretra muy raros. La PCR es un método para el diagnóstico de N. gonorrhoeae y C.trachomatis, pero no detecta N. meningitidis. El diagnóstico de gonorrea se basa en un número aumentado de polimorfonucleares con diplococos gramnegativos intracelulares en tinción de Gram de secreción uretral. En nuestro caso, el diplococo gramnegativo visualizado en la tinción fue meningococo. (AU)

Urethritis is an entity characterized by dysuria and purulent urethral discharge, generally acquired sexually. Neisseria gonorrhoeae is one of the most frequently responsible microorganisms. Neisseria meningitidis is a gram-negative diplococcus usually isolated in the pharynx, that occasionally causes meningococcal meningitis, being unusual it's isolation in the anogenital area where it could be a genitourinary pathogen. We present the case of a 25-years-old heterosexual male who, after a heterosexual intercourse with an occasional non-professional partner, including oral and vaginal sex, presented with symptoms of urethritis, orienting to a sexually transmitted infection. The bacteriological culture for N. gonorrhoeae was negative and the PCR for Chlamydia trachomatis was positive. Subsequently, the lab reported a positive bacteriological culture for sero-group C N. meningitidis, sensitive to ceftriaxone and a negative PCR for N. gonorrhoeae. N. meningitidis is the main cause of bacterial meningitis, but genomic studies have suggested that alleles of nitrate reductase, factor-H biding protein and capsule are associated with N. meningitidis isolation in genitourinary infections. Transmission from the oropharynx to the urethra through orogenital contact in unprotected oral sex has been widely proven. N. meningitidis prevalence as the cause of the urethritis is low, and the asymptomatic carriers in the urethra are extremely rare. PCR is a method for the N. gonorrhoeae and C.trachomatis diagnoses, but it does not detect N. meningitidis. The gonorrhoea diagnosis is based on an increased number of polymorphonuclear cells, with intracellular gram-negative diplococci in Gram’ stain of urethral discharge. In our case, the gram-negative diplococcus seen in the stain was a meningococcus. (AU)

[Neisseria meningitidis and the increase of oral sex. A case report]. / Neisseria meningitidis y el aumento del sexo oral. A propósito de un caso.

Urethritis is an entity characterized by dysuria and purulent urethral discharge, generally acquired sexually. Neisseria gonorrhoeae is one of the most frequently responsible microorganisms. Neisseria meningitidis is a gram-negative diplococcus usually isolated in the pharynx, that occasionally causes meningococcal meningitis, being unusual it's isolation in the anogenital area where it could be a genitourinary pathogen. We present the case of a 25-years-old heterosexual male who, after a heterosexual intercourse with an occasional non-professional partner, including oral and vaginal sex, presented with symptoms of urethritis, orienting to a sexually transmitted infection. The bacteriological culture for N. gonorrhoeae was negative and the PCR for Chlamydia trachomatis was positive. Subsequently, the lab reported a positive bacteriological culture for sero-group C N. meningitidis, sensitive to ceftriaxone and a negative PCR for N. gonorrhoeae. N. meningitidis is the main cause of bacterial meningitis, but genomic studies have suggested that alleles of nitrate reductase, factor-H biding protein and capsule are associated with N. meningitidis isolation in genitourinary infections. Transmission from the oropharynx to the urethra through orogenital contact in unprotected oral sex has been widely proven. N. meningitidis prevalence as the cause of the urethritis is low, and the asymptomatic carriers in the urethra are extremely rare. PCR is a method for the N. gonorrhoeae and C.trachomatis diagnoses, but it does not detect N. meningitidis. The gonorrhoea diagnosis is based on an increased number of polymorphonuclear cells, with intracellular gram-negative diplococci in Gram' stain of urethral discharge. In our case, the gram-negative diplococcus seen in the stain was a meningococcus. Urethritis due to N. meningitidis is indistinguishable from the secondary to N. gonorrhoeae, mimicking it even microscopically, only the epidemiology varies. The conventional bacteriological culture continues to be essential for a correct diagnosis.

Testing for Mycoplasma genitalium and Using Doxycycline as First-Line Therapy at Initial Presentations for Non-Gonococcal Urethritis (NGU) Correlate With Reductions in Persistent NGU.

We found that the odds of return clinic visits for persistent non-gonococcal urethritis (NGU) were significantly lower (odds ratio: .4; 95% confidence interval: .3-.6; P < .0001) after implementing (1) testing for Mycoplasma genitalium during initial evaluations for NGU and (2) switching from azithromycin to doxycycline as first-line NGU treatment.

[Urethritis due to coinfection with Neisseria gonorrhoeae and Enterobius vermicularis in a 27-year-old man]. / Urethritis durch Koinfektion mit Neisseria gonorrhoeae und Enterobius vermicularis bei einem 27-jährigen Patienten.

Urethritis is mainly caused by sexually transmitted pathogens, such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) [1]. Close to 90 million adults are infected annually with NG [2]. Treatment shall be performed according to national guidelines and resistance profiles [2, 3]. Enterobius vermicularis (EV) is the most common helminth in humans with 1 billion people globally infected [4-6]. Symptoms include anal pruritus; however, many infections are asymptomatic [4-7]. A case of urethritis due to simultaneous infection with NG and EV is reported.

Sexuality Transmitted Infection in the COVID-19 Pandemic and Non-Pandemic Time.

On March 11, 2020, the World Health Organization recognized the SARS-CoV-2 infection as a pandemic. The pandemic itself in addition to its containment measures affects individuals' lifestyles and welfare including their sexual behaviors. Thus, we hypothesized that sexually transmitted infection (STI) incidence may be changed and so we evaluate urethritis incidence as the most common STI in men and some other related factors. Two cross-sectional surveys during the first 6 months of 2019 and 2020 were undertaken and data were collected from 11 urology offices located in different parts of the capital city. In total, 34,611 male participants were included in our study, and 191 (.55%) patients' clinical diagnoses were urethritis. The urethritis incidence significantly decreased from 149 of 17,950 (.83%) to 42 of 16,661 (.25%) individuals in the same period of the years 2019 and 2020, respectively (p-value < .001). There was a higher percentage of single (p-value = .049) and older (p-value < .001) urethritis patients in the first 6 months of the year 2020 compared with 2019. Our survey provided urethritis incidence, demographics, symptoms, and treatment characterization. As our results show, the proportion of urethritis patients in all populations admitted to urologist offices had dramatically decreased during the COVID-19 pandemic compared with prior. The indirect effects of the pandemic and its containment measures on people's sexual health should be noticed and an appropriate reaction and policy-making are recommended to manage issues properly in different aspects of sexual health.