[A toddler with a lump on his penis]. / Een peuter met een zwelling op de penis.

A father consulted his general practitioner with his 3-years-old son who had swelling on his penis for several months. He experienced no miction problems. The swelling appeared to be a retention of smegma. This is harmless and will disappear spontaneously as the process of separation of the preputium continues.

Microorganisms and Antibiotic Profile of the Subpreputial Space in Uncircumcised Boys.

PURPOSE: This study investigates the frequency of isolated microorganisms and the antimicrobial resistant pattern of inner foreskin and smegma in prepubertal children. MATERIALS AND METHODS: This comparative cross-sectional study was conducted between March and November 2019, where 132 prepubertal boys, who were scheduled to receive religious circumcisions at our outpatient clinic, were examined. The patients were divided into the following groups based on the presence of smegma in their subpreputial space: Group I (with smegma, n=58) and Group II (without smegma, n=74). Sterile stuart transport swabs (Advanced Diagnostic Research, Mediko Kimya, Turkey) were taken from the smegma or the subpreputial space (glans surface and inner foreskin) using aseptic techniques and then the swab samples were immediately transported by sterile stuart transportation for microscopy, culture identification, and antibiographic resistance testing by conventional test methods and automated systems (VITEK II, Biomerieux, France) to the Microbiological Laboratory of our hospital. RESULTS: 48 bacteria isolated from 39 boys in Group I comprised 28 gram-positive species (58.3%) and 20 gram-negative species (41.7%). The most commonly isolated gram-negative bacterium was Proteus mirabilis (45%) while most positive was Staphylococcus hominis (42.9%). In Group II, 68 boys had 103 bacterial isolates in the glans comprising 81 gram-positive species (78.6%) and 22 gram-negative species (21.4%). The most commonly isolated gram-negative bacterium was Proteus mirabilis (42.9%) while the most positive were Enterococcus faecalis (40.7%) and S. hominis (42.9%) Conclusion: The subpreputial space of uncircumcised boys is colonized by various types of uropathogens resistant to multidrug drugs. Smegma does not pose additional risks to microbiological colonization in children.

Microbiology of smegma: Prospective comparative control study.

Purpose: The aim of the study was to investigate the common bacteria found in the smegma in the subpreputial space of asymptomatic boys prospectively, and to determine the difference of those bacteria according to the presence of smegma. Materials and Methods: In our institution, 40 boys who performed penoplasty were recruited into the study. Swab was done using aseptic techniques on smegma and glans in the operation room. According to the presence of smegma in the subpreputial space, we classified glans as a group S (with smegma, n=20) and group C (without smegma, n=20). The swabs were immediately sent to microbiology laboratory for microscopy, culture, and sensitivity tests. Results: The mean age was 30.4±26.4 months. Thirty-one bacteria were isolated from smegma, comprising 15 gram-positive species (48.4%) and 16 gram-negative species (51.6%). The most commonly isolated gram-negative bacterium was Escherichia coli (25.8%), while the commonly isolated gram-positive bacteria were Enterococcus faecalis (19.4%) and Enterococcus avium (12.9%). Most of the bacterial isolates were multi-drug-resistant (61.3%). In group S, 12 boys had 22 bacterial isolates in the glans. The commonly isolated bacteria were E. coli (27.3%), E. avium (22.7%) and E. faecalis (18.2%). In group C, 13 boys had 21 bacterial isolates in the glans. The most commonly isolated bacterium was E. faecalis (28.6%). Conclusions: Smegma in the subpreputial space of children was colonized by many kinds of uropathogen.

Lack of Bovine leukemia virus transmission during natural breeding of cattle.

Bovine leukosis is a chronic lymphoproliferative disorder that leads to significant economic losses in the beef and dairy industries. The major route of virus transmission is believed to be iatrogenic through the transfer of blood containing infected lymphocytes. In addition, BLV proviral DNA has been identified in nasal secretions, saliva, milk, colostrum, semen and smegma; however, natural transmission of BLV through these secretions has not been clearly demonstrated. The use of bulls for natural breeding has been identified as a risk factor in BLV infected dairy herds. However, the risk of BLV-infected bulls transmitting the virus is unknown. The objective of this study was to evaluate the potential for BLV transmission during natural breeding between a BLV-infected bull and uninfected heifers. Forty healthy, BLV seronegative, and proviral-negative beef heifers were randomly assigned to one of two groups: control heifers (n = 20) exposed to a BLV seronegative and proviral negative bull and challenged heifers (n = 20) exposed to a BLV seropositive and proviral-positive bull. Each group was housed with the bull for a period of 38 days in a 5-acre pasture to replicate the housing of commercial beef cattle during the breeding season. Blood samples were collected from heifers at -60, -30 and 0 days prior to breeding and day 30, 60 and 90 after the breeding period ended. Blood samples were tested for BLV antibodies by ELISA and BLV proviral DNA by CoCoMo-qPCR. New infection was not detected by ELISA or CoCoMo-qPCR in any of the challenge or control heifers at any time point during the study. Based on these results, BLV infected bulls that are healthy and aleukemic may not be a significant risk of BLV transmission during a defined breeding season.

Direct detection of Tritrichomonas foetus in cattle genital fluid trough loop mediated isothermal amplification of elongation factor 1 alpha 1.

Testing for Tritrichomonas foetus and exclusion of infected animals is an effective way of improving the reproductive efficiency in a herd. Conventional PCR is inherently more specific than the culture method and quantitative PCR can significantly increase the detection limit. Loop Mediated Isothermal DNA Amplification (LAMP) is gaining interest because the method does not require expensive equipment, specificity and sensitivity can be as high as quantitative PCR. The object of this study was to develop a sensitive and friendly test for point-of-care detection of T. foetus. The LAMP test that targeted T. foetus elongation factor 1 alpha 1 sequences showed high specificity. Sensitivity was 100-1000 times higher than that reached through culture, polymerase chain reaction or with a previously developed LAMP for 5.8 ribosomal sequences. Moreover, T. foetus detection could be performed without DNA purification from infected cervical vaginal mucus (CVM) or smegma samples. The tf-ef1a1 LAMP method was tested for field detection with paper strips soaked in CVM from infected cows and the results were observed 90 min later. Direct detection of T. foetus in CVM with the tf-ef1a1 LAMP showed high sensitivity and specificity, and an overall diagnostic odds ratio of 56 (CI: 13.3-235.0). The tf-ef1a1 LAMP showed great potential for diagnosis and control of T. foetus in resource-challenged regions.

Improvements in Tritrichomonas foetus molecular testing.

Bovine trichomoniasis is a sexually transmitted disease that results in infertility, abortion, and calf age variability. To date, management strategies include testing for Tritrichomonas foetus and culling of infected males. Challenges associated with testing include cost of culture medium, time and labor burden of sample incubation and processing, and adverse effects of bacterial growth on detection sensitivity. To overcome these challenges, we developed a direct reverse-transcription quantitative real-time PCR (direct RT-qPCR) utilizing smegma, eliminating the use of culture medium. In an analysis of 166 field samples (56 positives and 110 negatives as determined using microscopic reading of cultures as the reference test), the direct RT-qPCR exhibited 100% diagnostic sensitivity and 100% specificity, whereas the currently employed qPCR (culture qPCR), which utilizes cultured samples, exhibited 95% diagnostic sensitivity and 100% specificity. Agreement between direct RT-qPCR and culture qPCR was 98%. Moreover, direct RT-qPCR identified 3 more positive samples and exhibited lower quantification cycle (Cq) values among positives by culture reading than did culture qPCR (direct RT-qPCR Cq range = 14.6-32.3 vs. culture qPCR Cq range = 18.7-37.4). The direct RT-qPCR enables simplified sample collection, elimination of culture medium, faster results, applicability in cows, and lower cost than culture qPCR.

Prevalence and risk factors associated with Tritrichomonas foetus infection in cattle in the state of Paraíba, Brazil.

The objective of this study was to determine the prevalence of Tritrichomonas foetus infection and to evaluate risk factors associated with this infection among cattle in the state of Paraíba in northeastern Brazil. Samples of cervicovaginal mucus from 290 females and smegma from 59 males [beef, 31; mixed aptitude (beef and dairy), 10; and dairy, 18] from 31 farms were collected. Modified Diamond's medium and polymerase chain reaction (PCR) were used for the laboratory diagnosis of T. foetus infection. Univariate analysis and logistic regression were performed to test for potential risk factors in addition to prevalence mapping. No sample was positive for T. foetus in culture, and the prevalence of T. foetus infection using PCR was 3.7% (13/349) [confidence interval (CI) 95%, 2.1%-6.4%]. In total, 19.3% (6/31) of the farms had at least one animal positive for T. foetus. The contact of females with males from other farms [Odds ratio, 5.9; 95% CI, 1.5-22.4; p = 0.009] was identified as a risk factor for T. foetus infection. This study demonstrates that T. foetus infection is prevalent among dairy cows in the state of Paraíba, Brazil. Sexual resting, removal of positive females, and avoiding contact of females with males from other farms are recommended to reduce the risk of infection.

Equine papillomavirus type 2: An equine equivalent to human papillomavirus 16?

In horses, squamous cell carcinomas (SCC) commonly affect the external genitals. There is growing evidence that equine papillomavirus type 2 (EcPV2) infection promotes disease development. To assess the possible association of EcPV2 with equine SCCs of the head (HSCC), 15 HSCC DNA samples were screened by E6/E7, E2, and LCR PCR and amplicons were analysed for sequence variations. The physical form of EcPV2 in HSCC, genital lesions, and smegma from horses with SCC was then addressed using EcPV2 immunocapture PCR (IC/PCR) for detection of virion, and E6 vs. E2 qPCR to investigate possible integration events. Four of 15 HSCC tested positive for EcPV2 DNA and harboured known or novel genetic variants of E6, E7, E2 and the LCR. Eighteen of 35 sample extracts including 3/4 smegma samples scored positive by IC/PCR, suggesting that about 51% of tested extracts harboured virions. E6/E2 qPCR from tumour DNA revealed E2/E6 copies/cell ranging between <1 (E2; E6) and 797 (E2) or 1434 (E6). IC/PCR-positive smegma samples contained higher E2 and E6 copy numbers, ranging between 1490 and 4.95×105 (E2) or 2227 and 8.54×105 (E6) copies/cell. Together with IC/PCR results, this finding suggests that smegma can serve as a rich EcPV2 reservoir. HSCCs harboured significantly lower viral DNA amounts (<1-25 copies/cell) than most genital tumour and smegma DNA isolates. The majority of samples contained more E6 than E2 DNA, with E6:E2 ratios ranging between 0.88 and 4.12. Although not statistically significant (P>0.05), this finding suggests that EcPV2 can integrate into the equine host cell genome.

[A toddler with a swelling of his penis]. / Een kleuter met een zwelling aan zijn penis.

A 4-year-old boy presented with a subcutaneous, yellowish swelling of 0.8 by 1.5 cm on his penis. We made the diagnosis of a smegma retention cyst. This cyst is the result of a physiologic phenomenon that originates from the separation of the foreskin.

High-risk Oncogenic Human Papilloma Virus Infection of the Foreskin and Microbiology of Smegma in Prepubertal Boys.

OBJECTIVE: To evaluate the prevalence and genotypes of human papillomavirus (HPV) infection and microbiological status of the foreskin in asymptomatic prepubertal boys. METHODS: A total of 100 prepubertal healthy boys who underwent a standard circumcision procedure were included in the study. High-risk HPV status was determined by real-time polymerase chain reaction for the genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The swabs were immediately sent to microbiology laboratory for culture and sensitivity tests. RESULTS: The median age at the time of surgery was 5.7 years (range, 2 months-9 years). High-risk HPV was detected in 9 foreskins (9%). Positive samples showed are HPV16 (n = 3), 31 (n = 2), 39 (n = 3), and 51 (n = 1). There were a total of 72 organism isolates: 54 gram-positive (75%) and 17 gram-negative (23.6%) bacteria and 1 (1.4%) Candida. The most commonly isolated gram-negative bacterium was Escherichia coli (41.2%), whereas the commonly isolated gram-positive bacterium was Enterecoccus sp. (57.4%). CONCLUSION: Our results showed that subclinical high-risk HPV infections are found in the foreskin, which could be a reservoir for HPV-associated diseases, and smegma seems not to be a risk factor for drug-resistant infection in children.

Diagnostic sensitivity of ultrasound, radiography and computed tomography for gender determination in four species of lizards.

Gender determination is frequently requested by reptile breeders, especially for species with poor or absent sexual dimorphism. The aims of the current study were to describe techniques and diagnostic sensitivities of ultrasound, radiography, and computed tomography for gender determination (identification of hemipenes) in four species of lizards. Nineteen lizards of known sex, belonging to four different species (Pogona vitticeps, Uromastyx aegyptia, Tiliqua scincoides, Gerrhosaurus major) were prospectively enrolled. With informed owner consent, ultrasound, noncontrast CT, contrast radiography, and contrast CT (with contrast medium administered into the cloaca) were performed in conscious animals. Imaging studies were reviewed by three different operators, each unaware of the gender of the animals and of the results of the other techniques. The lizard was classified as a male when hemipenes were identified. Nineteen lizards were included in the study, 10 females and nine males. The hemipenes were seen on ultrasound in only two male lizards, and appeared as oval hypoechoic structures. Radiographically, hemipenes filled with contrast medium appeared as spindle-shaped opacities. Noncontrast CT identified hemipenes in only two lizards, and these appeared as spindle-shaped kinked structures with hyperattenuating content consistent with smegma. Hemipenes were correctly identified in all nine males using contrast CT (accuracy of 100%). Accuracy of contrast radiography was excellent (94.7%). Accuracy of ultrasound and of noncontrast CT was poor (64.3% and 63.1%, respectively). Findings from the current study supported the use of contrast CT or contrast radiography for gender determination in lizards.

Detection of Leishmania infantum in the smegma of infected dogs / Detecção de Leishmania infantum no esmegma de cães infectados

Considering the venereal transmission of visceral leishmaniasis from dogs to bitches, the aim of this study was to verify if the penile surface and smegma from infected dogs can be the source of parasites in bitches. Twelve Leishmania infantum infected dogs had semen and smegma samples collected for submission to PCR identification of the DNA of the parasite. Semen (41.7 percent) and smegma (50.0 percent) have similar positive incidence (P>0.05; Fisher's exact test), with 58.3 percent of the dogs positive for semen and/or smegma samples. The proportion of positivity for both semen and smegma was 33.3 percent, but 8.3 percent was positive only for semen, and 16.7 percent only for smegma, revealing a moderate agreement between tests (K=0.5; Kappa index). It was concluded that Leishmania infantum is present in the smegma of contaminated dogs and it can be a source of parasites for the semen and the bitch...

Tendo em vista a transmissão venérea da leishmaniose visceral do cão para a cadela, o objetivo deste estudo foi verificar se a superfície peniana e o esmegma de cães infectados poderiam ser a fonte de parasitas para a fêmea. Amostras de sêmen e esmegma de 12 cães infectados com Leishmania infantum foram submetidas à identificação do DNA do parasita por PCR. As incidências de positividade no sêmen (41,7 por cento) e no esmegma (50,0 por cento) foram semelhantes (P>0,05; teste exato de Fisher), sendo 58,3 por cento dos cães positivos para sêmen e/ou esmegma. A positividade para sêmen e esmegma juntos ocorreu em 33,3 por cento, mas em 8,3 por cento dos casos apenas no sêmen, e em 16,7 por cento apenas no esmegma, o que revela uma concordância moderada entre os testes (K=0,5; índice Kappa). Conclui-se que a Leishmania infantum está presente no esmegma de cães contaminados, podendo ser a fonte de parasitas para o sêmen e a cadela...

Pooling of cultured samples and comparison of multistate laboratory workflows with the MagMAX sample preparation system and VetMAX quantitative polymerase chain reaction reagents for detection of Tritrichomonas foetus-colonized bulls.

The objectives of the current study were 1) to compare sample preparation workflows and quantitative real-time polymerase chain reaction assays (qPCR) as currently used in veterinary diagnostic laboratories with a study protocol utilizing commercially available reagents for individual Tritrichomonas foetus testing, 2) to assess the accuracy of pooling cultured smegma samples followed by extraction and qPCR testing as used in the study laboratory, and 3) to assess the specificity of the currently used primers and probes by sequencing all positive and presumptive positive samples identified in the study laboratory in an attempt to capture any nucleotide variability between T. foetus isolates and to rule out false-positive results possibly due to Simplicimonas moskowitzi. Eight hundred three cultured smegma samples were collected from different regions of the United States with the collaboration of 5 veterinary testing laboratories. The samples were processed individually by the respective laboratories, and then sent to the study laboratory and retested using the study protocol. Comparison testing showed an overall agreement of 95.89% between the veterinary testing laboratories and the study laboratory. One hundred seventy-six positive or presumptive positive samples plus 625 negative qPCR samples were combined and retested using a pooling protocol. Pools consisted of 1 positive sample and 4 negative samples (1/5). These pools were processed using the same study laboratory protocols, and 96% of the positive samples were detected in these pools. Nested PCR followed by sequencing confirmed 175 of the 178 samples classified as positive or presumptive positive in the study laboratory as containing T. foetus-specific DNA.

Spatial and temporal epidemiology of bovine trichomoniasis and bovine genital campylobacteriosis in La Pampa province (Argentina).

The venereal diseases bovine trichomoniasis (BT) and bovine genital campylobacteriosis (BCG) cause economic losses in endemic areas like La Pampa province in Argentina, where beef cattle are usually managed extensively. This study used data compiled under a Provincial Programme for the Control and Eradication of BT and BGC (PCE) to determine the spatio-temporal distribution of these diseases and identify spatial clusters. The study population comprised 29,178 non-virgin bulls drawn from 3766 herds, tested for BT and BGC in 2010. Preputial smegma samples were cultured for BT detection, while BGC was diagnosed by direct immunofluorescence testing of these samples. Campylobacter fetus infection was detected in 1.5% of bulls and 2.3% of herds, and Tritrichomonas foetus infection was found in 1.1% of bulls and 5.1% of herds. The proportion of positive tests was highest in February for BT, while in April it was highest for BCG, and was inversely related to the number of tests, which was greatest during the breeding season (spring). An elliptical spatial cluster of high risk for BGC and a circular cluster for BT were both identified in the south of La Pampa province, which could not be explained by cattle herd density. The spatial and temporal patterns identified in this study provide baseline data for monitoring the success of BT and BGC control activities in La Pampa.

Loop mediated isothermal amplification of 5.8S rDNA for specific detection of Tritrichomonas foetus.

Tritrichomonas foetus is the causative agent of bovine trichomonosis, a sexually transmitted disease leading to infertility and abortion. A test based on loop mediated isothermal amplification (LAMP) targeting the 5.8S rDNA subunit was designed for the specific identification of T. foetus. The LAMP assay was validated using 28 T. foetus and 35 non-T. foetus trichomonads strains. It did not exhibit cross-reaction with closely related parasites commonly found in smegma cultures like Tetratrichomonas spp. and Pentatrichomonas hominis. Bovine smegma did not show interferences for the detection of the parasite and, the sensitivity of the method (4×10(3) CFU/mL, approximately 10 cells/reaction) was slightly higher than that found for PCR amplification with TFR3 and TFR4 primers. The LAMP approach has potential applications for diagnosis and control of T. foetus and, practical use for low skill operators in rural areas.

Effect of Topical Steroid (0.05% Clobetasol Propionate) Treatment in Children With Severe Phimosis

PURPOSE: We report our experience with the use of a topical steroid, 0.05% clobetasol propionate, for the treatment of phimosis with clinical complications. MATERIALS AND METHODS: This was a retrospective analysis of the clinical outcomes of all patients presenting with phimosis to a single institution during the time period from October 2008 to May 2012. A total of 88 patients who had a Kikiros retractability grade of 4 or 5 and phimosis-associated clinical complications, such as ballooning of the prepuce, balanoposthitis, or a history of urinary tract infection (UTI), were instructed to apply 0.05% clobetasol propionate cream to the slightly retracted foreskin and to massage gently while retracting the foreskin. The efficacy of treatment was evaluated at 4 weeks from the initiation of therapy. RESULTS: A total of 60 of the 88 patients (68.2%) showed a complete response (i.e., full retraction of the foreskin) to the therapy. The phimotic ring disappeared in 25 of the 88 patients (28.4%) after treatment. Patients who had a history of balanoposthitis, smegma, ballooning of the prepuce, or UTI showed significantly poorer improvement in preputial retraction (p<0.001, p<0.001, p<0.001, and p=0.02, respectively) and phimotic ring disappearance (p<0.001, p=0.001, p<0.001, and p=0.001, respectively) after treatment. No significant local or systemic side effects were associated with the administration of topical steroids. CONCLUSIONS: Topical application of 0.05% clobetasol propionate cream and skin stretching is a safe, simple, and effective procedure with no significant side effects for severe phimosis in prepubertal boys.

High prevalence of Tritrichomonas foetus infection in Asturiana de la Montaña beef cattle kept in extensive conditions in Northern Spain.

Bovine trichomonosis (BT) and bovine genital campylobacteriosis (BGC) are sexually transmitted diseases that can be important infectious causes of reproductive failure in extensively managed beef cattle where natural mating is a common practice. However, their prevalence in Europe was thought to be insignificant or very low. The purpose of this study was to investigate the prevalence and risk factors associated with BT and BCG in a representative beef cattle breed, Asturiana de la Montaña (AM), which is usually managed extensively in the mountain areas of Northern Spain and putative risk factors associated with the two diseases are present on most farms holding AM cattle. Preputial smegma samples were collected from 103 bulls belonging to 65 herds. Pathogen detection was undertaken using culture and PCR. Two scraping methods for sample collection (AI pipette and plastic scraper), as well as different culture media and DNA extraction methods were evaluated on field samples. Campylobacter fetus veneralis infection was not detected in any animal in any herd. However, Tritrichomonas foetus infection was demonstrated in 32% (33/103) and 41.5% (27/65) of bulls and herds tested, respectively. AM bulls older than 3 years (39.7%) were more likely to be infected than young bulls (16%) (OR=3.45, CI=1.07-11.19). An increase in repeat breeder cows was reported in herds from which T. foetus was detected (OR=5.2, CI=1.5-17.18). These findings highlight the re-emergence of this disease in extensively managed beef cattle in Spain. For routine diagnosis, the use of a culture technique and PCR in combination is advisable for testing smegma samples under field conditions.

Microbiology of smegma in boys in Kano, Nigeria.

BACKGROUND: The objective of this study is to document the common bacteria found in the smegma in the subpreputial space of asymptomatic boys in our environment, their antimicrobial susceptibility pattern, and to determine if they differ from those commonly isolated from children with established urinary tract infections in our sub-region. MATERIALS AND METHODS: Between May 2009 and January 2010, smegma swabs were collected from asymptomatic boys who presented for circumcision in our institution. This was done using aseptic techniques in the theatre, following retraction of the prepuce. The swabs were immediately sent to our microbiology laboratory for microscopy, culture, and sensitivity tests. Bacteria were isolated, identified, and confirmed by standard bacteriological techniques, and antimicrobial sensitivity pattern was determined using the disc diffusion method. A total of 52 boys, with an age range of 7 d to 11 y (median 138.7d), were recruited into the study. RESULTS: A total of 50 bacterial isolates were made. There were 29 gram-positive bacteria (58%) and 21 gram-negative ones (42%). A single isolate was found in 34 boys (65.4%), eight had a mixed isolate (15.4%), while no bacteria was isolated in 10 boys (19.2%). The most commonly isolated gram-negative bacteria was Escherichia coli (90.5%), while the commonly isolated gram-positive bacteria were Staphylococcus epidermidis (44.8%) and Staphylococcus aureus (41.4%). Most of the bacterial isolates were multi-drug-resistant. CONCLUSION: Smegma in the preputial space of children may be colonized by drug-resistant organisms, the antimicrobial sensitivity pattern of which must be determined for an effective treatment of any infection arising in the region.