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1.
J Virol ; 94(12)2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32269129

RESUMO

Concurrent sexually transmitted infections (STI) can increase the probability of HIV-1 transmission primarily by increasing the viral load present in semen. In this study, we explored the relationship of HIV-1 in blood and seminal plasma in the presence and absence of urethritis and after treatment of the concurrent STI. Primer ID deep sequencing of the V1/V3 region of the HIV-1 env gene was done for paired blood and semen samples from antiretroviral therapy (ART)-naive men living in Malawi with (n = 19) and without (n = 5) STI-associated urethritis; for a subset of samples, full-length env genes were generated for sequence analysis and to test entry phenotype. Cytokine concentrations in the blood and semen were also measured, and a reduction in the levels of proinflammatory cytokines was observed following STI treatment. We observed no difference in the prevalence of diverse compartmentalized semen-derived lineages in men with or without STI-associated urethritis, and these viral populations were largely stable during STI treatment. Clonal amplification of one or a few viral sequences accounted for nearly 50% of the viral population, indicating a recent bottleneck followed by limited viral replication. We conclude that the male genital tract is a site where virus can be brought in from the blood, where localized sustained replication can occur, and where specific genotypes can be amplified, perhaps initially by cellular proliferation but further by limited viral replication.IMPORTANCE HIV-1 infection is a sexually transmitted infection that coexists with other STI. Here, we examined the impact of a concurrent STI resulting in urethritis on the HIV-1 population within the male genital tract. We found that viral populations remain largely stable even with treatment of the STI. These results show that viral populations within the male genital tract are defined by factors beyond transient inflammation associated with a concurrent STI.


Assuntos
Infecções por HIV/virologia , HIV-1/genética , Sêmen/virologia , Doenças Sexualmente Transmissíveis/virologia , Uretrite/virologia , Produtos do Gene env do Vírus da Imunodeficiência Humana/genética , Adulto , Sequência de Bases , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/virologia , Estudos de Coortes , Citocinas/genética , Citocinas/imunologia , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/transmissão , HIV-1/classificação , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Filogenia , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/imunologia , Doenças Sexualmente Transmissíveis/transmissão , Uretrite/epidemiologia , Replicação Viral , Produtos do Gene env do Vírus da Imunodeficiência Humana/sangue , Produtos do Gene env do Vírus da Imunodeficiência Humana/classificação
2.
Euro Surveill ; 25(15)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32317054

RESUMO

Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US_NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its 'parent' strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US_NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci.


Assuntos
Neisseria meningitidis/isolamento & purificação , Uretrite/diagnóstico , Adulto , Surtos de Doenças , Resistência Microbiana a Medicamentos , Feminino , Humanos , Masculino , Neisseria meningitidis/classificação , Filogenia , Polimorfismo de Nucleotídeo Único , Reino Unido/epidemiologia , Estados Unidos , Uretrite/tratamento farmacológico , Uretrite/epidemiologia
3.
Sex Transm Infect ; 96(4): 306-311, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31515293

RESUMO

OBJECTIVES: Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) cause the majority of non-gonococcal urethritis (NGU). The role of Ureaplasma urealyticum (UU) in NGU is unclear. Prior case-control studies that examined the association of UU and NGU may have been confounded by mixed infections and less stringent criteria for controls. The objective of this case-control study was to determine the prevalence and aetiology of mixed infections in men and assess if UU monoinfection is associated with NGU. METHODS: We identified 155 men with NGU and 103 controls. Behavioural and clinical information was obtained and men were tested for Neisseria gonorrhoeae and CT, MG, UU and Trichomonas vaginalis (TV). Men who were five-pathogen negative were classified as idiopathic urethritis (IU). RESULTS: Twelve per cent of NGU cases in which a pathogen was identified had mixed infections, mostly UU coinfections with MG or CT; 27% had IU. In monoinfected NGU cases, 34% had CT, 17% had MG, 11% had UU and 2% had TV. In controls, pathogens were rarely identified, except for UU, which was present in 20%. Comparing cases and controls, NGU was associated with CT and MG monoinfections and mixed infections. UU monoinfection was not associated with NGU and was almost twice as prevalent in controls. Men in both the case and control groups who were younger and who reported no prior NGU diagnosis were more likely to have UU (OR 0.97 per year of age, 95% CI 0.94 to 0.998 and OR 6.3, 95% CI 1.4 to 28.5, respectively). CONCLUSIONS: Mixed infections are common in men with NGU and most of these are UU coinfections with other pathogens that are well-established causes of NGU. UU monoinfections are not associated with NGU and are common in younger men and men who have never previously had NGU. Almost half of NGU cases are idiopathic.


Assuntos
Chlamydia trachomatis/isolamento & purificação , Coinfecção/epidemiologia , Mycoplasma genitalium/isolamento & purificação , Trichomonas vaginalis/isolamento & purificação , Ureaplasma urealyticum/isolamento & purificação , Uretrite/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Coinfecção/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Prevalência , Uretrite/etiologia , Adulto Jovem
4.
BMJ Sex Reprod Health ; 46(2): 132-138, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31722934

RESUMO

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.


Assuntos
Infecções por Mycoplasma/tratamento farmacológico , Mycoplasma genitalium/efeitos dos fármacos , Resultado do Tratamento , Uretrite/etiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Doxiciclina/uso terapêutico , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium/patogenicidade , Serviços de Saúde Reprodutiva/normas , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Uretrite/epidemiologia , Uretrite/terapia
5.
Eur J Clin Microbiol Infect Dis ; 39(4): 703-710, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31828685

RESUMO

Haemophilus parainfluenzae (HPAR) is a Gram-negative bacterium that can become an opportunistic urogenital pathogen. Recently, multidrug resistant (MDR) strains have emerged. We aim to analyse the epidemiology of HPAR at Hospital Universitari de Bellvitge between 2013 and 2017 to determine its putative role in sexually transmitted infections (STI). Strains were classified by sample origin, and antimicrobial susceptibility was performed by disk-diffusion tested on Mueller-Hinton Fastidious. MDR was defined as the resistance of the antimicrobial to three or more antibiotic class. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) after restriction with SmaI and Cfr9I. We classified 944 HPAR isolates as being of urogenital (n = 175; 18.5%), respiratory (n = 719; 76.2%), or other (n = 50; 5.3%) origins. Among the urogenital isolates, 50 (28.6%) were MDR, which was significantly higher than that found in respiratory samples (40/719; 5.6%; p < 0.01). The frequency of MDR increased progressively among urogenital samples from 13.3% (2013) to 33.3% (2017) (r = 0.8; p = 0.035). The resistance rates for all 944 episodes were significantly higher for cotrimoxazole (51.4%), tetracycline (46.3%), chloramphenicol (28.0%), ciprofloxacin (21.1%), and ampicillin (20.6%). After PFGE, no clonal relationship was found. Clinical charts were available for 40 symptomatic patients with MDR HPAR infections presenting mostly urethritis (n = 26; 65.0%). In all cases, symptoms were treated effectively with combination therapy. Furthermore, in 10 of those patients with urethritis, MDR HPAR was the only potential pathogen to be identified. The emergence of MDR HPAR is a matter of concern, and the detection as a single pathogen highlights its putative role as cause of STI.


Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções por Haemophilus/epidemiologia , Haemophilus parainfluenzae/efeitos dos fármacos , Haemophilus parainfluenzae/genética , Sistema Respiratório/microbiologia , Sistema Urogenital/microbiologia , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Feminino , Infecções por Haemophilus/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem Molecular , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Espanha/epidemiologia , Uretrite/epidemiologia , Uretrite/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adulto Jovem
6.
BMC Infect Dis ; 19(1): 991, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752720

RESUMO

BACKGROUND: Male urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU). METHODS: A retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls. RESULTS: Among n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predictors of GU were any abnormalities on genital examination (aOR 10.4, 95% CI 2.1 to 50.8) and a history of urethral discharge (aOR 5.7, 95% CI 1.4 to 22.6). Aboriginal patients (aOR 3.0, 95% CI 0.9 to 9.6) and those over 30 years of age (aOR 1.4, 95% CI 0.3 to 7.0) were more likely to have GU in the unadjusted analysis, but not in the adjusted model. CONCLUSION: This is the first study looking at patterns of male urethritis in urban NT and the results support a move towards adopting national guidelines to use ceftriaxone for empiric management of syndromic urethritis only in high-risk patients. In addition to traditional demographic risk factors, clinical features remain an important component of risk stratification.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Uretrite/epidemiologia , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Azitromicina/uso terapêutico , Estudos de Casos e Controles , Ceftriaxona/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Gonorreia/tratamento farmacológico , Gonorreia/microbiologia , Humanos , Masculino , Neisseria gonorrhoeae/efeitos dos fármacos , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Northern Territory/epidemiologia , Estudos Retrospectivos , Uretrite/diagnóstico , Uretrite/tratamento farmacológico , Uretrite/microbiologia
7.
Pan Afr Med J ; 33: 328, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692786

RESUMO

Urethral stricture is a disease whose cause and management vary according to the context. This study aims to analyze the epidemiological etiological and therapeutic features of urethral stricture in our department. We conducted a longitudinal cross-sectional study of patients with acquired urethral stricture admitted to our department between March 2014 and February 2016. The average age of our patients was 24.5 years (10 and 81years). The diagnosis was confirmed by retrograde and voiding Urethro-Cystography (UCG). The average stricture length was 2.28cm (0.5-5cm). The therapeutic approaches included: resection with termino-terminal anastomosis; retrograde dilatation etc. Outcome assessment performed 6-15 months after surgery was satisfactory with absence of recidivism, PMR ≤30cc and strong urine flow and weak in the case of recurrence of dysuria or PMR ≥100cc. Urethral stricture accounted for 7.14% of our urologic treatments. Most of our patients were farmers from the rural area. A history of recurrent urethritis was most often reported by our patients and 78,57% of them were married men, among whom 91% were polygamous). The main reason for consultation was dysuria (50% of the study population) and 50.01% of our patients had secondary urinary tract infection, most commonly caused by Escherichia coli. The main cause of urethral stricture was an infection (56.52%). The most affected area was the bulbar urethra (45.60% of cases). UCG was the most used technique (39.13%). Overall outcomes were good (85,65%) and failure rate reached 13.04%; the highest success rate was achieved with resection with anastomosis (94.44% respectively). Urethral stricture is common among young people. Infection is the main cause in our department. Prevention is essential as well as an efficient and effective management of sexually transmitted infections.


Assuntos
Anastomose Cirúrgica/métodos , Disuria/etiologia , Estreitamento Uretral/cirurgia , Uretrite/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Cistografia/métodos , Disuria/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estreitamento Uretral/diagnóstico , Uretrite/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
9.
Sex Transm Dis ; 46(10): e101-e104, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31517808

RESUMO

We evaluated the prevalence of Mycoplasma genitalium coinfection in 302 chlamydia-infected women seen at a sexually transmitted disease clinic in Birmingham, AL. M genitalium coinfection was detected in 22 (7.3%). No participant characteristics predicted coinfection. Among coinfected women, M genitalium was detected again in 6 (28.6%) of 21 women returning for a 3-month follow-up visit after azithromycin treatment.


Assuntos
Colo do Útero/microbiologia , Infecções por Chlamydia/epidemiologia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Infecções por Mycoplasma/epidemiologia , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Estudos de Coortes , Coinfecção/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycoplasma/tratamento farmacológico , Mycoplasma genitalium , Prevalência , Parceiros Sexuais , Uretrite/epidemiologia , Uretrite/microbiologia , Adulto Jovem
11.
BMC Infect Dis ; 19(1): 561, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248368

RESUMO

BACKGROUND: In a context of increasing use of Nucleic Acid Amplification Test, diagnoses of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men increased in Europe and USA since 2007. We aimed to describe trends in the incidence of male urethritis in France between 2007 and 2017. METHODS: We analysed male urethritis clinical cases reported by the French GPs' Sentinelles network. RESULTS: GPs reported 1944 cases of male urethritis during the study period. The estimated annual incidence rates in men aged 15 years and older remained stable between 226 cases per 100,000 seen in 2007 and 196 in 2017 (P value = 0.9). A third-generation cephalosporin with macrolide or tetracycline was prescribed in 17.5% of cases in 2009 (27/154) and 32.4% in 2017 (47/145) (P value = 0.0327). CONCLUSIONS: The incidence rates for adult male urethritis diagnosed in primary care have remained stable since 2007 in France in contrast with the increasing trend of Neisseria gonorrhoeae and Chlamydia trachomatis infections based on microbiological surveillance. Using stable clinical definition for male urethritis seems essential to follow correctly epidemiological dynamic.


Assuntos
Chlamydia trachomatis/genética , Neisseria gonorrhoeae/genética , Trichomonas vaginalis/genética , Uretrite/diagnóstico , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Chlamydia trachomatis/isolamento & purificação , DNA Bacteriano/isolamento & purificação , DNA Bacteriano/metabolismo , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico , Trichomonas vaginalis/isolamento & purificação , Uretrite/tratamento farmacológico , Uretrite/epidemiologia , Uretrite/microbiologia , Adulto Jovem
12.
Investig Clin Urol ; 60(3): 202-209, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31098428

RESUMO

Purpose: To study the sexual behavior and status of sexually transmitted urethritis (STU) in the elderly population of South Korea. Materials and Methods: Congregating places for elderly population, which were selected on the expected risk of sexually transmitted infections, were visited to study their sexual behavior, awareness on sexually transmitted diseases (STDs), and STU status using a specially developed survey and urine polymerase chain reaction (PCR) test. In addition, analysis of the Health Insurance Review & Assessment Service (HIRA) database was done to study the nationwide status and trends of STU of the elderly population. Results: The study found that approximately 42% of elderly South Koreans were sexually active. Elderlies in the high-risk group showed a higher percentage of multiple sexual partners and prostitution than elderlies in the low-risk group. Only 3% and 14% in the low-risk group and high-risk group used condoms, showing a very low rate of condom use. Both the urine PCR results and HIRA database analysis showed that the prevalence of STU was not high and it remained stable in recent years, implying that currently, STU is not a significant burden on public health in the elderly population of South Korea. Conclusions: The current study presented the sexual behavior in the elderly population of South Korea, as well as the recent prevalence and trend of STU in the elderly population. These results may be used as baseline data for future study, education, prevention and public campaign plan for STDs in the elderly population.


Assuntos
Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Uretrite/epidemiologia , Uretrite/microbiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Medição de Risco
13.
J Urol ; 202(4): 748-756, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31091176

RESUMO

PURPOSE: Histopathology can provide insights into disease mechanisms but to date it has been poorly described for urethral stricture. The purpose of this study was to comprehensively describe histopathological findings of stricture specimens obtained at the time of anterior urethroplasty. MATERIALS AND METHODS: All pathological specimens of men who underwent anterior urethroplasty of urethral stricture disease from 2010 to 2017 at a single institution were rereviewed by a single blinded pathologist directed to rule out lichen sclerosus and then describe inflammatory cell type and severity when present. Cohorts comprising strictures with no inflammation, minimal to mild inflammation or moderate to severe inflammation were developed and stricture, patient and surgical outcome characteristics were compared. RESULTS: Histopathology slides from 100 anterior urethroplasty cases were reviewed. Two or more lichen sclerosus characteristics were present in 21% of specimens and 44% of specimens showed chronic inflammation, which was minimal in 20%, mild in 39%, moderate in 39% and severe in 2%. Lymphocytes in 86% of specimens and plasma cells in 12% were the predominant cell types. Patients with inflammatory stricture reported worse overall health. Inflammation was largely absent from isolated bulbomembranous strictures (9%) and more common in lichen sclerosus strictures (100%). The 11% overall failure rate was not affected by the presence (7%) or absence (14%) of inflammation. CONCLUSIONS: Chronic inflammation is prevalent in a significant percent of urethral stricture disease specimens. Associations with worse overall health suggest systemic mediators. Absent inflammation in bulbomembranous strictures suggests a unique pathophysiology in this region. The presence of inflammation did not affect surgical outcomes at mid-term followup.


Assuntos
Líquen Escleroso e Atrófico/epidemiologia , Uretra/patologia , Estreitamento Uretral/etiologia , Uretrite/epidemiologia , Adulto , Seguimentos , Humanos , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/patologia , Estreitamento Uretral/cirurgia , Uretrite/complicações , Uretrite/patologia , Procedimentos Cirúrgicos Urológicos Masculinos
15.
World J Urol ; 37(4): 661-666, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30810832

RESUMO

PURPOSE: Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil. METHODS: This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient. RESULTS: The mean age was 52.13 ± 16.9 years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39 years old group (42.8%), idiopathic in the 40-59 years old group (32.4%) and iatrogenic in patients over 60 years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%). CONCLUSION: In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.


Assuntos
Países em Desenvolvimento , Doença Iatrogênica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estreitamento Uretral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Fraturas Ósseas/complicações , Humanos , Hipospadia/cirurgia , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/epidemiologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estreitamento Uretral/etiologia , Uretrite/complicações , Uretrite/epidemiologia , Cateterismo Urinário/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto Jovem
16.
Enferm Infecc Microbiol Clin ; 37(7): 458-466, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30732970

RESUMO

Gonococcal infection is a current public health problem worldwide, being the second most prevalent bacterial sexually transmitted infection. The etiologic agent is Neisseria gonorrhoeae, a gram-negative diplococcus, and mainly causes urethritis in men. In women up to 50% of infections can be asymptomatic. N. gonorrhoeae has a great ability to develop antibiotic resistance, so the last remaining therapeutic option are extended spectrum cephalosporins. Many guides recommend dual therapy with ceftriaxone and azithromycin, but in recent years the resistance to azithromycin is also increasing, so that dual treatment is being questioned by scientific societies.


Assuntos
Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/efeitos dos fármacos , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Abuso Sexual na Infância , Busca de Comunicante , Transmissão de Doença Infecciosa/prevenção & controle , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Feminino , Saúde Global , Gonorreia/congênito , Gonorreia/epidemiologia , Gonorreia/transmissão , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Oftalmia Neonatal/tratamento farmacológico , Oftalmia Neonatal/epidemiologia , Oftalmia Neonatal/microbiologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Comportamento Sexual , Uretrite/tratamento farmacológico , Uretrite/epidemiologia , Uretrite/microbiologia , Cervicite Uterina/tratamento farmacológico , Cervicite Uterina/epidemiologia , Cervicite Uterina/microbiologia
17.
Sex Transm Infect ; 95(3): 212-218, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30181326

RESUMO

OBJECTIVE: Although Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are major causes of non-gonococcal urethritis (NGU), up to 50% of cases are of unknown aetiology. We sought to identify urethral exposures at last sexual episode associated with NGU and non-CT/non-MG NGU to identify anatomical sites from which aetiologically relevant micro-organisms may be acquired. METHODS: We enrolled STD clinic patients with and without NGU assigned male sex at birth and age ≥16 into a cross-sectional study. NGU was urethral symptoms or visible discharge plus ≥5 polymorphonuclear leucocytes without Neisseria gonorrhoeae. Urine was tested for CT and MG (Aptima). We used logistic regression to estimate the association between urethral exposures at last sex and NGU separately among cisgender men and transgender women who have sex with men (MSM/TGWSM) and cisgender men who have sex with women (MSW). RESULTS: Between 8 August 2014 and 1 November 2017, we enrolled 432 patients, including 183 MSM/TGWSM (118 NGU+, 65 NGU-) and 249 MSW (126 NGU+, 123 NGU-). The mean age was 34; 59% were white. CT and MG were detected in 72 (30%) and 49 (20%) NGU+ participants, respectively. Compared with MSM/TGWSM reporting only non-urethral exposures at last sex, those reporting insertive anal intercourse (IAI) only (adjusted OR (AOR)=4.46, 95% CI 1.09 to 18.19) and IAI with insertive oral sex (IOS) (AOR=7.88, 95% CI 2.67 to 23.26) had higher odds of NGU. MSM/TGWSM reporting IOS only had no significant increased odds (AOR=1.67, 95% CI 0.58 to 4.85). Compared with MSW whose only urethral exposure at last sex was vaginal sex (VS), MSW reporting IOS and VS had similar odds of NGU (OR=0.84, 95% CI 0.50 to 1.41). The results were similar for non-CT/non-MG NGU. CONCLUSIONS: Among MSM/TGWSM, IAI may lead to transmission of yet-unidentified rectal micro-organisms that cause non-CT/non-MG NGU, in addition to transmission of known pathogens. Sites of urethral exposure appear less important for understanding NGU risk among MSW due to minimal variation in behaviour.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium , Pacientes Ambulatoriais , Comportamento Sexual , Pessoas Transgênero , Uretrite/epidemiologia , Adulto , Idoso , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/etiologia , Infecções por Chlamydia/microbiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycoplasma/etiologia , Infecções por Mycoplasma/microbiologia , Uretrite/etiologia , Uretrite/microbiologia , Washington/epidemiologia , Adulto Jovem
18.
Eur Urol Focus ; 5(1): 29-35, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30318465

RESUMO

CONTEXT: Urethritis prevalence in Europe changed in the last years due to both the increase of migratory streams from North Africa and the more frequent exposition of males to relevant risk factors. Owing to these reasons, urethritis treatment should be optimized by accurate microbiological investigations to avoid the risk of persistence, recurrence, or reinfection. OBJECTIVE: The aim of this systematic review is to optimize the treatments for urethritis and investigate the applicability of nucleic acid amplification test (NAAT) as the primary microbiological investigation. EVIDENCE ACQUISITION: A literature search in Medline, Cochrane, and Google Scholar databases was conducted up to June 2018. Subject headings were selected as follows: Urethritis OR gonococcal urethritis OR non-gonococcal urethritis AND Antibiotics OR Recurrence. A total of 528 abstracts were identified and selected. Finally, 12 full-text articles were selected for a qualitative synthesis. The Preferred Reported Items for Systematic Reviews and Meta-Analyses statement was used to perform an accurate research checklist and report. EVIDENCE SYNTHESIS: Empirical treatments are no more recommended, although a broad spectrum of antibiotic therapy may be initiated while awaiting the results from pathogens' microbiological characterization. First-line treatment for gonococcal urethritis consists of a single dose of ceftriaxone/azithromycin combined therapy. Specific therapies should be initiated for nongonococcal urethritis according to each single pathogen involved in the infection process. Owing to this reason, NAAT is mandatory in the clinical approach to the disease, although the Gram stain of urethral discharge or smear remains applicable for some less frequent nongonococcal urethritis. Moreover, the urethritis "modern view" also includes noninfectious etiologies that occurred after traumas or injection of irritating compounds. Sexual abstinence of at least 7 d should be observed from the start of treatment to avoid reinfection, while sexual partners should evenly be treated. CONCLUSIONS: The treatment of urethritis implies accurate determination of pathogens involved in the infection process by NAAT with subsequent appropriate antibiotic therapy, thus avoiding the risk of antibiotic resistance and overuse of antibiotics indicated for empirical treatments. The population exposed to relevant risk factors should be adequately informed about the increased risk of developing infections and motivated toward the intensive use of condoms during sexual intercourses. PATIENT SUMMARY: Urethritis is a sexually transmitted disease generally characterized by urethral discharge or other symptoms such as itching, tingling, and apparent difficulties in having a regular urinary flow. Microbiological investigations are mandatory to obtain satisfactory results from the treatment. Multiple antibiotic treatments are often necessary due to the high risk of multiple pathogens responsible for the disease. Similarly, sexual partners should be investigated and treated in the same way. Several risk factors such as immunodeficiency, multiple sexual partners, homo- and bisexuality, and alcohol abuse may be related to the disease. In these cases, the use of condom is strongly recommended.


Assuntos
Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Técnicas de Amplificação de Ácido Nucleico/métodos , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Uretrite/tratamento farmacológico , África do Norte/epidemiologia , Antibacterianos/uso terapêutico , Azitromicina/administração & dosagem , Ceftriaxona/administração & dosagem , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/efeitos dos fármacos , Preservativos/normas , Quimioterapia Combinada/métodos , Europa (Continente)/epidemiologia , Feminino , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Masculino , Neisseria gonorrhoeae/efeitos dos fármacos , Prevalência , Fatores de Risco , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Uretrite/diagnóstico , Uretrite/epidemiologia , Uretrite/microbiologia
19.
Rev Inst Med Trop Sao Paulo ; 60: e65, 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30379232

RESUMO

A prevalence of 3.47% of asymptomatic Chlamydia trachomatis urethritis has been previously reported among males living with HIV infection in Brazil. This study aims to assess the recurrence of C. trachomatis urethritis three years later in the same cohort of patients and analyze associated risk factors. A total of 115 male patients diagnosed with HIV infection, with no symptoms of urethritis and observed since May of 2015 in followup visits were enrolled. They had urine samplers tested by PCR for C. trachomatis and N. gonorrhoeae between February and March 2018. Results: Three of the four patients who had asymptomatic C. trachomatis urethritis three years before were recurrently positive for C. trachomatis urethritis. Two new patients were diagnosed as positives, accounting for a total asymptomatic C. trachomatis urethritis prevalence of 4.34%. The prevalence during the whole study was 5.21%. The relative risk for a new urethritis episode among those previously diagnosed with urethritis is RR=41.62 (95% CI: 9.42-183.84), p < 0.01. Patients who presented asymptomatic urethritis anytime and who were recurrently positive for C. trachomatis had a lower mean age (p<0.01). Married individuals were protected regarding asymptomatic urethritis [p<0.01, OR = 0.04 (0.005-0.4)] and had lower risk to develop recurrence [p<0.01, RR = 0.86 (0.74-0.99)]. Illicit drugs users had risk associated to asymptomatic urethritis [p=0.02, OR= 5.9 (1.03-34)] and higher risk to develop recurrence [p<0.01, RR=1.1 (1-1.22)]. Conclusion: The recurrence of asymptomatic C. trachomatis urethritis after treatment among males living with HIV infection in Brazil can be considered high and should not be neglected.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Uretrite/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Infecções Assintomáticas/epidemiologia , Infecções por Chlamydia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Recidiva , Fatores de Risco , Uretrite/diagnóstico , Uretrite/microbiologia
20.
PLoS One ; 13(4): e0196217, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29698421

RESUMO

BACKGROUND: Mycoplasma genitalium (MG) is a cause of urethritis. While resistance to azithromycin is increasing, routine detection of MG is not performed in Belgium, where its prevalence is unknown. The aim of this study is to determine prevalence of MG in men with urethritis. METHOD AND FINDINGS: An "in-house" amplification assay detecting MG was performed on urine of men with complaints of urethritis who consulted the emergency unit or the Sexually Transmitted Infection clinic of our public hospital in Brussels. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were tested on the same sample. A total of 187 men were tested. Prevalence of MG was 9% (95% Confidence Interval: 5 to 13.2%). CT was detected in 20%, NG in 22% and 56% of samples were negative for these three pathogens. Neither age, ethnic origin, sexual orientation nor HIV infection were associated with MG urethritis. CONCLUSION: M. genitalium was identified in 9% of men with complaints of urethritis indicating that amplification assay detecting MG should be implemented in routine testing for those patients.


Assuntos
Mycoplasma genitalium/isolamento & purificação , Uretrite/diagnóstico , Bélgica/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Estudos Transversais , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Hospitais Públicos , Humanos , Masculino , Mycoplasma genitalium/genética , Neisseria gonorrhoeae/isolamento & purificação , Reação em Cadeia da Polimerase , Prevalência , Uretrite/epidemiologia , Uretrite/microbiologia
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