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Background: Mycoplasma genitalium is an emerging pathogen, which has been linked to cervicitis, urethritis and pelvic inflammatory disease (PID). With the advent of multiplex polymerase chain reaction (PCR) panels for sexually transmitted infections, it is increasingly being identified in pregnant women. Objectives: The aim was to review international guidelines, which had explicit recommendations for treatment of M. genitalium infection in pregnancy and breastfeeding. Search Strategy: PubMed, EMBASE and Cochrane databases were reviewed with no age, species, language or date restrictions. Selection Criteria: Studies were included if they had an explicit recommendation for treatment of M. genitalium in pregnancy. Studies were excluded if there was no recommendation in pregnancy, if they referred to other international guideline recommendations or were historical versions of guidelines. Data Collection and Analysis: References were manually reviewed and 50 papers were selected for review. Only four guidelines were included in the final analysis and they were from Europe, UK, Australia and Aotearoa New Zealand. Main Results: All studies recommended azithromycin as first‐line treatment, and advised against moxifloxacin use. The dosing schedule of azithromycin, varied between guidelines, as did the utility/safety of pristinamycin for macrolide resistant infections. Safety data was generally reassuring for azithromycin but inconsistent for pristinamycin. Conclusions: Azithromycin is the first‐line treatment for macrolide susceptible or unknown resistance infections, but there is a lack of consistency regarding dosing of azithromycin or the utility/safety of pristinamycin for macrolide resistant infections in pregnancy/lactation. Synopsis: While international guidelines recommend azithromycin as first‐line treatment for M. genitalium infections in pregnancy, there are inconsistencies around second‐line treatment options and azithromycin dosing. [ABSTRACT FROM AUTHOR]

Introduction: Urinary Tract Infections (UTIs) are caused by microbial invasion of the urinary tract, extending from the renal cortex of the kidney to the urethral meatus. Over the past years, resistance levels to the traditional drugs used for the treatment of UTIs have been gradually increasing. Therefore, a therapy based on the individual culture report and antibiotic sensitivity test is highly encouraged. Aim: To determine the age-wise and sex-wise prevalence of UTI, as well as to determine the bacteriological profile and antimicrobial sensitivity pattern of isolated uropathogens. Materials and Methods: This retrospective record-based study was conducted in the Department of Microbiology at Travancore Medical College in Kollam, Kerala, India. Samples were collected from patients with clinically suspected UTI attending the Outpatient Department (OPD) and Inpatient Department (IPD) of Travancore Medical College, Kollam, Kerela, India over a period of six months from July 2022 to December 2022. Both male and female patients with clinically suspected UTI were included in the study. The clinical diagnostic criteria included dysuria, frequency, urgency, and fever. Data were retrieved from the culture register maintained in the Microbiology laboratory, LIS (ELLIDER), and the WHONET software system. Urine culture was performed using a semiquantative technique. A growth of >105 Colony Forming Units (CFU)/mL was considered indicative of an active UTI with significant bacteriuria. Organisms were identified using Gram stain, motility testing, and biochemical reactions following standard microbiological techniques. Antimicrobial sensitivity testing was conducted using the Kirby-Bauer Disc diffusion method. The data were entered into a Microsoft Excel worksheet, and the results were analysed using simple descriptive statistics involving percentages and proportions using Statistical Package for Social Sciences (SPSS) software version 16.0. Results: Of the total 2,794 samples, 319 (11.4%) samples yielded significant bacteriuria. Among the positive samples, 204 (64%) were from females and 115 (36%) were from males. UTIs were most commonly seen in the age group of 61-80 years. Escherichia coli (E.coli), with 148 isolates (46.4%), was the predominant organism, followed by Klebsiella pneumoniae with 72 isolates (22.6%). E. coli showed the highest susceptibility to meropenem, with 137 isolates (92.6%), and imipenem, with 136 isolates (91.9%), followed by cefoperazone/sulbactam with 129 isolates (87.2%), and piperacillin/tazobactam with 128 isolates (86.5%). Klebsiella pneumoniae was most susceptible to imipenem, with 42 isolates (60%), followed by meropenem, with 29 isolates (41.4%). Most non fermenters were highly susceptible to carbapenems, cefoperazone/sulbactam, and piperacillin/tazobactam. Among the gram-positive organisms, Enterococcus spp. was the most frequently isolated, showing 100% sensitivity to vancomycin and linezolid. Conclusion: In this study, UTI was found to be more prevalent among elderly females. Gram-negative organisms were the most commonly isolated pathogens in UTI, with E. coli being the most frequent agent. Urinary pathogens exhibited resistance to commonly used antibiotics such as ampicillin, cephalosporins, quinolones, and cotrimoxazole. Based on this study, it can be concluded that the resistance to commonly used antibiotics is very high. Due to the changing trends in the sensitivity patterns of various antibiotics, it is important to understand the antibiogram of common isolates in a specific area or hospital to ensure better empirical treatment. [ABSTRACT FROM AUTHOR]

The urinary system, primarily responsible for the filtration of blood and waste, is affected by several infectious and inflammatory conditions. Focusing on the lower tract, this review outlines the physiological and immune landscape of the urethra and bladder, addressing key immunological and microbiological aspects of important infectious/inflammatory conditions. The conditions addressed include urethritis, interstitial cystitis/bladder pain syndrome, urinary tract infections, and urosepsis. Key aspects of each condition are addressed, including epidemiology, pathophysiology, and clinical considerations. Finally, therapeutic options are outlined, highlighting gaps in the knowledge and novel therapeutic approaches. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical efficacy and safety of Shuangshi Tonglin capsules combined with doxycycline hydrochloride in treating male non-gonococcal urethritis (Damp-Heat Pouring Downward type). Methods From March 2022 to March 2023, 104 patients with non-gonococcal urethritis (Damp-Heat Pouring Downward type) were randomly divided into two groups based on block randomization, including the treatment group (n =52) and the control group ( n = 52) . The patients in the control group were orally administrated with doxycycline hydrochloride for 7 days, and the treatment group with Shuangshi Tonglin capsules in combination with doxycycline hydrochloride for 7 days. Both groups of patients were re-examined at the 7th day after stopping the medication. The clinical efficacy of the two groups was observed and compared, as well as the traditional Chinese medicine symptom scores, the time of clinical symptom regression, laboratory test results for the pathogen, and the incidence of adverse reactions. Results The total efficacy rate for the treatment group and the control group was 96. 15% and 84. 62%, respectively, with a significant difference (P <0. 05) . Symptom regression times of the treatment group for frequent urination, urgency, pain, redness and swelling of the urethral opening, itching, and urethral discharge[ (3.12 ±0.38), (3.34 +0.44), (4.12 ±0.68), (4.03 ±0.59), (3.36 ±0.32), and (3.56 ±0.52) days] were all better than those of the control group[ (4.26 ± 0.76), (4.76 ±0.83), (4.89 ±0.89), (5.12 ±0.92), (4.56 ± 0.82), and (4.64 ±0.78) days], with statistical significance (P <0. 05) . Symptom scores of both groups after treatment showed an obvious decrease (P <0.05), and the scores for the treatment group for each symptom [(0.86 ±0.18), (0.94 ± 0.23), (0.79 ±0. 6), (1.01 ±0.27), (0.83 ± 0.20), and (0.97 ±0.25)] were all notably lower than those of the control group[ (1.38 ±0.46), (1.54 ± 0.52), (1.46 ±0.49), (1.50 ± 0.51), (1.44 ± 0.43), and (1.32 ± 0.36)], with a significant difference (P <0. 05) . The pathogen clearance rate of the treatment group was 96. 15%, which was higher than that of in the control group (82. 69%, P <0.05) . The cases with gastrointestinal reactions, headaches, maculopapular rash, and dry mouth in the treatment group were 1, 1, 0, and 1 and the cases in the control group were 1, 2, 2, and 0 cases. The incidence of adverse reactions in the treatment group was 5.77%, which was lower than that in the control group. However, the difference was not statistically significant (P >0.05). Conclusions The combined treatment of Shuangshi Tonglin capsules and doxycycline hydrochloride for male non-gonocoecal urethritis of the Damp-Heat Pouring Downward type can significantly enhance the clinical pathogen clearance rate, effectively improve clinical symptoms and the life quality of patients. [ABSTRACT FROM AUTHOR]

Objective: Urethritis is a common sexually transmitted disease (STD) in developing countries; however, up to 40% of cases have no determined etiology. The characteristics of STDs vary geographically. This study aimed to define the demographic, clinical, and microbiological features of men with urethritis in Cyprus, where current data in the literature are lacking. Methods: We included 138 patients who sought care at a university hospital in Cyprus from 2017 to 2021 and had symptoms suggestive of urethritis or a history of a recent sexual partner with STD. Urethral swab samples of the patients were tested for seven pathogens (Trichomonas vaginalis, Neisseria gonorrhoeae (N. gonorrhoeae), Chlamydia trachomatis (C. trachomatis), Ureaplasma urealyticum (U. urealyticum), Ureaplasma parvum (U. parvum), Mycoplasma genitalium (M. genitalium), Mycoplasma hominis (M. hominis) by multiplex polymerase chain reaction assay. In addition, demographic, clinical, and microbiological data were obtained from the hospital program and analyzed. Results: Pathogens were detected in 59.4% of the cases: U. urealyticum in 26.8%, C. trachomatis in 13%, N. gonorrhoeae in 9.4%, U. parvum in 10.1%, M. genitalium in 10.1%, and M. hominis in 10.9%, with multiple microorganisms detected in 18.1%. Overall, 80.4% of the cases were symptomatic at presentation, and pathogen detection was associated with a history of STD, multiple sexual partners, and unprotected sexual intercourse. Conclusions: Urethritis is a common and heterogeneous clinical condition. U. urealyticum dominates male urethritis in Cyprus, yet many individuals have no detectable microorganisms. Future studies should focus on developing more comprehensive quantitative molecular diagnostic methods with determined cycle threshold values to shed light on the pathogenic roles of commensal microorganisms. [ABSTRACT FROM AUTHOR]

Neisseria gonorrhoeae is one of the important pathogens of sexually transmitted infections. N. gonorrhoeae is rapidly becoming antimicrobial resistant, and there are few drugs that are effective in the initial treatment of gonorrhea. To understand the trends of antimicrobial susceptibility of N. gonorrhoeae , the Surveillance Committee of the Japanese Society of Infectious Diseases, the Japanese Society for Chemotherapy, and the Japanese Society of Clinical Microbiology conducted the third nationwide antimicrobial susceptibility surveillance of N. gonorrhoeae isolated from male urethritis. The specimens were collected from male patients with urethritis at 30 facilities from May 2016 to July 2017. From the 159 specimens collected, 87 N. gonorrhoeae strains were isolated, and 85 were tested for susceptibility to 21 antimicrobial agents. All strains were non-susceptible to penicillin G. Seven strains (8.2%) were β-lactamase-producing strains. The rates of susceptibility to cefixime and cefpodoxime were 96.5% and 52.9%, respectively. Three strains were non-susceptible with a minimum inhibitory concentration (MIC) of 0.5 mg/L for cefixime. None of the strains were resistant to ceftriaxone or spectinomycin. The susceptibility rate for ciprofloxacin was 23.5% (20 strains), and no strains showed intermediate susceptibility. The susceptibility rate against azithromycin was 81.2%, with one strain isolated with a MIC of 8 mg/L against azithromycin. The results of this surveillance indicate that ceftriaxone and spectinomycin, which are currently recommended for gonococcal infections in Japan, appear to be effective. It will be necessary to further expand the scale of the next surveillance to understand the current status of drug-resistant N. gonorrhoeae in Japan. [ABSTRACT FROM AUTHOR]

Neisseria meningitidis causes invasive meningococcal diseases and has also been identified as a causative agent of sexually transmitted infections, including urethritis. Unencapsulated sequence type 11 meningococci containing the gonococcal aniA-norB locus and belonging to the United States N. meningitidis urethritis clade (US_NmUC) are causative agents of urethral infections in the United States, predominantly among men who have sex with men. We identified 2 subtypes of unencapsulated sequence type 11 meningococci in Japan that were phylogenetically close to US_NmUC, designated as the Japan N. meningitidis urethritis clade (J_NmUC). The subtypes were characterized by PCR, serologic testing, and whole-genome sequencing. Our study suggests that an ancestor of US_NmUC and J_ NmUS urethritis-associated meningococci is disseminated worldwide. Global monitoring of urethritis-associated N. meningitidis isolates should be performed to further characterize microbiologic and epidemiologic characteristics of urethritis clade meningococci. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives. Illustration of a case of systemic mastocytosis mimicking reactive arthritis in the absence of an infectious etiology. Methods. Review of the patient's medical records. Results. We report a case of systemic mastocytosis relapse, presenting with pancytopenia accompanied by knee monoarthritis, cystitis, and bilateral conjunctivitis occurring simultaneously at the same time interval within 2–4 days, mimicking reactive arthritis in the absence of an infectious etiology. Conclusion. Our case demonstrated reactive arthritis features (triad of urethritis, conjunctivitis, and arthritis) without an infectious trigger but rather a relapse of mastocytosis. We should think outside the box when faced with such a clinical scenario in the absence of an infectious etiology. Paraneoplastic reactive arthritis is to be considered after excluding an underlying infection. [ABSTRACT FROM AUTHOR]

Mycoplasma genitalium (MG) is a bacterium that can be spread through sexual contact with another person who is infected. If misdiagnosed and left untreated, this newer, emerging sexually transmitted infection (STI) can cause complications such as urethritis and pelvic inflammatory disease (PID) in bothmen andwomen. In males, MGcan be asymptomatic and undetectable. In females, MGmay present with nonspecific symptoms, such as dysuria, vaginal discharge, and/or pelvic pain. In addition to chlamydia and gonorrhea, MG may result in PID. Due to the complications of MG, health care providers in the emergency department setting need to consider this as a differential diagnosis when performing STI and vaginitis screenings on sexually active patients who may present with urinary or vaginal complaints. As patients with pelvic pain are frequently seen in the emergency department, providers need to be aware of the role that MG may play in STIs and the subsequent sequelae if not treated properly. [ABSTRACT FROM AUTHOR]

Introduction: Gonococcal infection of the penile raphe is rarely encountered in the clinical setting. The study aimed to understand the incidence, sites, clinical manifestations, and treatment of gonococcal infection of the penile raphe. Methods: We enrolled men with gonococcal infection of the penile raphe and men with urethral gonorrhea from January 2010 to December 2021. All patients' demographic data and clinical characteristics were recorded. All patients were treated with ceftriaxone. Incision and drainage were performed in patients with non-ruptured abscesses. Nodules and sinus tract-like lesions that did not resolve after 1 month of treatment were excised. Results: Among 2,736 men who presented with urethral gonorrhea from January 2010 to December 2021, 5 (0.18%) had accompanying gonococcal infection of the penile raphe. An additional two men presented with gonococcal infection of the penile raphe without urethritis. Thus, 7 (0.26%; confidence interval, 0.11–0.56%) of 2,738 men had urethral gonorrhea or gonococcal infection of the penile raphe confirmed both clinically and by laboratory testing. Lesions were present in the frenulum of the prepuce and at the median aspect, proximal end, distal end, and both the proximal and distal ends of the penile raphe. The lesions manifested as abscesses, ulcers, a nodule, and a nodule with a sinus-like lesion. All lesions exhibited tenderness. All seven patients were cured after treatment. Conclusion: Gonococcal infection of the penile raphe is a rare, atypical type of involvement of the male urogenital tract by Neisseria gonorrhoeae. It may be a local complication of urethral gonorrhea or an independent primary infection. The proximal end, distal end, and median aspect of the penile raphe can be infected by N. gonorrhoeae. Cutaneous lesions present as abscesses, ulcers, nodules, and sinus-like lesions. Ceftriaxone is effective, but sinus-like lesions require surgery. [ABSTRACT FROM AUTHOR]

Background: Male urethritis is primarily sexually transmitted in India and has also shown a high rate. Urethritis or inflammation of the urethra is a multifactorial condition. It is called gonococcal urethritis (GU) when Neisseria gonorrhoeae is detected in a urethral smear of the patient and non-gonococcal urethritis (NGU) when this organism cannot be visualized. Aims and Objectives: To study the demographic profile and management pattern of NGU retrospectively in male patients. Materials and Methods: Urethritis cases were identified from the dermatology outpatient record. A retrospective study of data of patients diagnosed with NGU was done for 5 years from August 2015 to July 2020. We included only male patients more than 10 years of age. Results: Chlamydia trachomatis (CT, 48%) was the most common causative organism found. The diagnosis was confirmed by demonstrating ≥5 polymorphonuclear lymphocytes (PMNLs) from the anterior urethra using a Gram-stained urethral smear followed by the polymerase chain reaction (PCR.) of urine. The most common age group affected was 21–30, (30, 46%) years with a mean ± standard deviation (SD) of 30.32 ± 10.80. Most patients were from low socioeconomic status, labourers (36, 55%). A history of heterosexual behaviour, (57, 88%) was the most common and it had been seen that sexual exposure was more common in unmarried patients (38, 59%). Associated features were seen in 18 patients. Among recommended initial therapies for NGU, doxycycline and azithromycin might be improved by the addition of antimicrobial coverage for Trichomonas vaginalis (T. vaginalis). Further, it was seen that response to doxycycline therapy was better than azithromycin. Conclusions: Though there is an increased incidence of Herpes infections, we found Chlamydia infection to be the most common cause of NGU. Doxycycline showed better results in NGU due to Chlamydia infection. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Mycoplasma penetrans is an emerging pathogen with a reduced genome. This bacterium has only previously been cultured from individuals with chronic immunodeficiencies. Here we report the characteristics of 4 M. penetrans isolates from the urine of immunocompetent males with nongonococcal urethritis, in comparison with strain HF-2 from an immunocompromised patient. Several features exhibited distinct differences between these isolates and HF-2. Unlike HF-2, all 4 were resistant to azithromycin. They exhibited greater sialic acid-dependent binding to erythrocytes, gliding motility speed, and H2O2 production than HF-2. All new isolates produced thinner capsules than HF-2. Invasiveness varied, with some isolates being more invasive than HF-2 and some less invasive. Cytotoxicity to HeLa cells was similar to HF-2, and all strains could clear extracellular traps produced by innate immune cells. We conclude that subtle differences among M. penetrans strains may be critical for this organism to establish an infection in an otherwise healthy individual. [ABSTRACT FROM AUTHOR]

Diseases which are passed on through any kinds of sexual behaviors are called sexually transmitted infections (STI). Recently, antibiotic resistance of causative bacteria for STI has advanced and it is important that urologists as specialists have sufficient knowledge about appropriate diagnostic methods and the appropriate selection of antibiotics. Under the pandemic of COVID-19, patients with STI, especially those with syphilis, have been increasing in number. For a diagnosis of syphilis, an understanding of the results of serological tests for syphilis is necessary. In Japan, oral amoxicillin was previously used for the treatment of syphilis and benzylpenicillin benzathine hydrate has now become available since 2022. Early-stage syphilis is treatable by a single dose of this injectable drug. Male urethritis is classified as gonococcal urethritis or non-gonococcal urethritis dependent upon whether it is with or without the detection of Neisseria gonorrhoeae. Several microorganisms are related to non-gonococcal urethritis and urethritis with the detection of Chlamydia trachomatis is called chlamydial urethritis. The pathogenicity of Mycoplasma genitalium for male urethritis has been confirmed and the nucleic acid amplification test detecting M. genitalium became accepted by the Japanese national insurance system in 2022. The intravenous injection of 1g of ceftriaxone as a single dose is the first line of treatment for gonococcal urethritis. For chlamydial urethritis, macrolide, tetracycline and fluoroquinolone are effective. However, the antibiotic resistance of M. genitalium has advanced and macrolide is now poorly effective against M. genitalium infection. Doxycycline, minocycline or sitafloxacin are available, but multidrug-resistant M. genitalium strains are spreading worldwide. [ABSTRACT FROM AUTHOR]

Objectives: Sexually transmitted infections are a prevalent global health care problem. Treatment guidelines have recently been updated as a result of antimicrobial resistance and public health trends. The aim of the study was to assess the appropriateness of empirical antibiotic therapy prescribed for cervicitis and urethritis in the emergency department. Methods: We designed a retrospective observational cohort study. We included adult patients with suspected cervicitis or urethritis who attended the emergency department of a tertiary hospital in 2020. We excluded patients with suspected pelvic inflammatory disease, pregnancy or prostatitis and those requiring admission to hospital. Appropriateness of empirical antibiotic therapy was evaluated taking into account 4 aspects: indication, dosing, duration of therapy, and route of administration. Data were obtained from the electronic medical record, the electronic prescription program, and the discharge summary. Results: The study population comprised 176 patients; mean age was 28.9 years (SD = 7.7), and 90.9% were men. The most prescribed treatment was the combination of ceftriaxone and azithromycin (83.0%). Treatment was inappropriate in 71.6% of patients. A total of 159 drug errors were recorded. The most frequent cause was undertreatment (36.4%) related to underdosing (46.5%), particularly with regard to ceftriaxone. The percentage of errors was 11.9% for indication, 84.9% for dosing, 3.1% for duration, and 0% for route of administration. Conclusions: A high percentage of patients who attended the emergency department for suspected cervicitis or urethritis received an inappropriate empirical antibiotic regimen. The main reason was undertreatment due to underdosing. [ABSTRACT FROM AUTHOR]

The US Neisseria meningitidis urethritis clade (US_NmUC) harbors gonococcal deoxyribonucleic acid alleles and causes gonorrhea-like urogenital tract disease. A large convenience sample of US_NmUC isolates (N = 122) collected between January 2015 and December 2019 in Columbus, Ohio demonstrated uniform susceptibility to antibiotics recommended for gonorrhea treatment and meningococcal chemoprophylaxis. [ABSTRACT FROM AUTHOR]

Background: Accessing care for sexual health has always been a challenge in our Indian context. The primary reason is a lack of awareness of modes of transmission of sexually transmitted diseases (STD), appropriate testing, and treatment options. The second is taboo associated with the morality of the individual. The third is the accessibility and availability of Quality STD care by allopathic specialists in comparison to the demand. This has paved way for lots of myths and misconceptions among the general public regarding STDs and HIV disease. Compounding it is the mushrooming of nonqualified practitioners and healers who claim to cure all STDs and HIV has led to poor treatment outcomes. Several methods of partnership with qualified allopathic practitioners have been tried for the provision of quality STD care by various donor-funded, HIV and STD prevention programs in the country. The key reasons for the nonsustainability of these clinics were the lack of technical capability to handle the sexual health and STD clinical cases and the huge cost involved in the advertisement and maintenance of the clinics. Methodology: Seven clinicians from different geographical locations in Tamil Nadu, who were exclusively qualified in Venereology, conceived the idea of provision of comprehensive clinical care cum counseling and testing services through a networking model from December 01, 2020. The model comprised the following: (1) Dedicated YouTube channel (Nakshatra Health) to provide scientific information on STD and HIV, modes of transmission, clinical symptoms, lab testing, interpretation of results, clinical treatment options, and counseling on prevention, (2) Dedicated telephone helpline was established with WhatsApp to answer the queries of clients by the network venereologists, (3) Dedicated website (www.nakshatra.health) was developed to provide information on STD and HIV and options to clarify doubts and fix appointments online, (4) Clinical consultations were done in a hybrid mode with an option for direct clinic and online consultation. Prescriptions were provided using dedicated software instantly, (5) Networking was done with NABL-accredited labs and collection centers for performing STD and HIV tests with e-test request forms, (6) Networking was done with pharma companies to provide pre- and postexposure prophylaxis (PEP) services to clients through e-prescriptions. Cross referrals were made across the network members to facilitate easy access to clinical services by clients from different parts of Tamil Nadu. The entire concept was branded as "Nakshatra health" with a tagline - "Your sparkling solution for safe sexual health care." Quality STD care and ethical practice were the underlying motos of this concept. Results: During the 20 months (December 2020 to July 2022), 6442 phone calls and 9328 WhatsApp messages were received. 82.3% of the calls and messages were queries from clients related to their sexual exposures, and 16.4% were general information seekers. During this period, the Nakshatra Health YouTube channel had 1590 subscribers and nearly 2.4 lakh views of all its 24 videos. Among the viewers, 92.4% were male. 52.29% of viewers were between the ages of 25 and 34 years, 28.25% were between the ages of 18 and 24 years, and 17.25% viewers were between the ages of 35 and 44 years. 86% of the viewers were from India and 13% were Tamil-speaking viewers from Middle East, Southeast Asian countries and 1% were from European, African, and American countries. The most commonly watched videos were related to HIV symptoms and lab tests for STD and HIV. 16% of the viewers repeatedly watched the various videos in the series. The network laboratories provided testing services for 1082 clients with 2423 various STD/HIV tests. Totally 3328 clients availed of online consultation and 924 clients accessed clinic-based services across the network members. Among these cases, 18 cases of Syphilis (primary and secondary) and 12 cases of acute gonococcal urethritis, and 10 cases of genital warts were diagnosed and treated. 12 cases of phimosis and 4 cases of anal warts were surgically treated in collaboration with a surgeon. Through this initiative, PEP and PreP services were provided to 228 and 8 individuals. Conclusion: Designing a comprehensive sexual health service package is crucial to ensure the availability and ease of access to services to the general public. Provision of correct scientific information, networking and cross-referral of cases with like-minded dermatovenereologists/clinicians interested in venereology sexually transmitted infections, easily accessible clinical, laboratory, and treatment services including PreP and PEP medications, and ethical practice are the key factors for scaling this concept. [ABSTRACT FROM AUTHOR]

Despite developing surgical techniques in urethral surgery, the outcome and complications are still unsatisfactory. Alternative treatment modality has been coming up, particularly in patients with longer stricture, under revision surgery, and penile stricture. Tissue engineering grafts are a promising approach for substituting urethral reconstruction. Over the decades, numerous preclinical studies have been published to show the efficacy and safety of different origins of materials, the presence of autologous cells (acellular matrices or autologous cell-seeded matrices), and the construction of engineered tissue (patch or tubularized constructs) on animal models. However, the results of these studies have not yet reached the intended level for daily clinical practice. A PubMed database search was performed for articles, using specific keywords, published between 1998 and 2022, with a selection on using tissue-engineered grafts for urethroplasty. Many materials have been used as a graft, such as acellular bladder matrix, small intestinal submucosa, acellular dermal matrix, and polyglycolic acid with or without cells, and were evaluated according to the functional and anatomical outcomes comprising complications. According to current literature, tubularized scaffolds constructed from co-cultured cells have promising results for the future. However, high-quality evidence through randomized controlled studies with larger sample sizes, with a long-term follow-up is required to determine accurate outcomes. [ABSTRACT FROM AUTHOR]

Mycoplasma genitalium (M. genitalium) has emerged as a sexually transmitted infection (STI) all over the world in the last three decades. It has been identified as a cause of male urethritis, and there is now evidence that it also causes cervicitis and pelvic inflammatory disease in women. However, the precise role of M. genitalium in diseases such as pelvic inflammatory disease, and infertility is unknown, and more research is required. It is a slow-growing organism, and with the advent of the nucleic acid amplification test (NAAT), more studies are being conducted and knowledge about the pathogenicity of this organism is being elucidated. The accumulation of data has improved our understanding of the pathogen and its role in disease transmission. Despite the widespread use of single-dose azithromycin in the sexual health field, M. genitalium is known to rapidly develop antibiotic resistance. As a result, the media frequently refer to this pathogen as the "new STI superbug." Despite their rarity, antibiotics available today have serious side effects. As the cure rates for first-line antimicrobials have decreased, it is now a challenge to determine the effective antimicrobial therapy. In this review, we summarise recent M. genitalium research and investigate potential therapeutic targets for combating this pathogen. [ABSTRACT FROM AUTHOR]

Background: Mycoplasma genitalium is a gram negative, parasitic pathogenic bacterium, usually transmitted sexually into human and frequently causing urethritis in men and women as well as cervicitis and pelvic inflammation in women. This is an extremely small selfreplicating entity whose genome has been sequenced. This genome sequencing is advantageous in understanding pathogenesis and identifying therapeutic targets. In this study different bioinformatics tools and databases were adopted to analyze the functions of different hypothetical proteins from M. genitalium G37. Methodology: A total of 75 hypothetical proteins (HPs) were retrieved from KEGG database, while CDD-BLAST, Pfam, and InterProScan servers were used for conserved domains analysis. After that, those HPs were broadly analyzed for physicochemical properties, subcellular localization, GO annotation, and virulence factors. Results: Based on best score, hypothetical protein MG_476 was selected for homology modelling which produced a fairly good quality 3D model. The active site within MG_476 was predicted using CASTp server that helps to explore the surface features of the protein. Other approaches include the use of NetCTL, IEDB, Bcepred, and ABCpred servers to predict the location of B and T cell epitopes. Among the CD8+ T cell epitopes tested, ILQIIMFIL scored highest (0.23718) in terms of immunogenicity. Conclusion: Moreover, this analysis recommended MG_476 as a non-homologous protein and the data generated in this study may facilitate the experimental designing of novel drug and vaccines against M. genitalium. [ABSTRACT FROM AUTHOR]

To explore the microbial etiology of urethritis in Vietnamese men and the association with patients' characteristics, especially their sexual behaviors. This study was conducted on 349 men who presented with symptomatic urethritis and evidence of STIs (determined by multiplex PCR tests) at the Department of Andrology and Sexual Medicine—Hanoi Medical University Hospital. All information regarding medical history, sexual activities, and symptoms of urethritis was documented. C. trachomatis and N. gonorrhoea remained the two most common causative pathogens, followed by an unexpectedly high prevalence of Mycoplasma and Ureaplasma species. Coinfection was significant with a rate of 40.7%. Men who had sex with female sex workers (FSWs) were more likely to be positive with N. gonorrhoea but less likely to be positive with C. trachomatis and M. genitalium than those having sex with only one romantic partner. Our findings suggested the important role of other microorganisms, especially M. genitalium, in the etiology of urethritis in men besides the previously well-known causes of STIs. Since the coinfection rate is quite high, targeted treatment with clear microbial evidence should be considered rather than empiric antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Reactive arthritis is a rare form of spondyloarthropathies occurring after genital or enteric infection. It is most often self‐limited but can progress to chronic spondylarthritis. We report the case of a 30‐year‐old man who presented with acute arthritis occurring 2 months after an episode of urethral discharge. Physical examination revealed polyarthritis, dactylitis, sacroiliac joint involvement, and plantar papulosquamous plaques. The human leukocyte antigen B27 was positive. Detection of Chlamydia trachomatis and Gonococcus in the first catch urine specimen was negative. Hepatitis B and C, Chlamydia trachomatis, human immunodeficiency virus, and syphilis serologic test results were negative. Pelvic magnetic resonance imaging revealed left sacroiliitis. The patient was treated with antibiotics, diclofenac, and sulfasalazine. After 6 months of follow‐up, a significant clinical improvement was obtained without remission, suggesting an evolution to chronic spondylarthritis. Diagnosis of Reactive arthritis is difficult since microbiologic examinations are commonly negative. This disease should be considered in patients with rheumatologic manifestations occurring after a urogenital or enteric infection, mainly when associated with skin manifestations and human leukocyte antigen B27. [ABSTRACT FROM AUTHOR]

Background. Male urethritis is one of the most common genital tract syndromes. Though the number of patients with urethritis is increasing worldwide, the cause of many cases of non-gonococcal urethritis (NGU) is still unknown. Objectives. This study aimed to delineate the association between Trichomonas vaginalis (T. vaginalis) infection and male urethritis. Methods. The literature was searched in PubMed, Scopus, and Web of Science databases using the search terms "urethritis," "Trichomonas vaginalis," "trichomoniasis," and "male urethritis" up to February 2020. Overall risk difference(RD) was applied to assess the relationship between T. vaginalis infection and male urethritis. Results. In total, seven articles were included in this systematic review and meta-analysis study. Our meta-analysis involved the review of case-control studies, including 2,242 urethritis cases and 929 individuals as controls. Among subjects examined for trichomoniasis, in the case group, 211 males were infected, and in the control group, 32 individuals were infected. The overall risk difference (RD) was 0.06, and the total reported p value was 0.00001. Although the result of our meta-analysis was not significant, it was shown that the risk of urethritis is 0.06 more in trichomoniasis patients than in the non-exposed group. Conclusion. Findings from the included papers showed that trichomoniasis is not a risk factor for male urethritis. Although trichomoniasis alone is not the main cause of urethritis, it can be considered one of the risk factors in male urethritis. Therefore, in the future, it is necessary to perform further studies to clarify the detailed association between T. vaginalis infection and urethritis risk in male patients. [ABSTRACT FROM AUTHOR]

Introduction: Neisseria gonorrhoeae and Chlamydia trachomatis are the primary pathogens causing urethritis. A cross-sectional study was carried out in the Department of Microbiology in conjunction with the Department of Dermatology and STD of our hospital. The aim of the study was to detect N. gonorrhoeae and C. trachomatis among men with urethritis and to determine the anti-microbial susceptibility of the N. gonorrhoeae isolates. Material and Methods: All cases were subjected to direct Gram's smear examination and culture of urethral discharge (N. gonorrhoeae), real-time polymerase chain reaction and direct fluorescent antibody test (C. trachomatis). All N. gonorrhoeae isolates were subjected to anti-microbial susceptibility testing and were tested for ß-lactamase production by chromogenic cephalosporin test. Statistical Analysis Used: Data were expressed as percentages. Fisher's exact test was used to evaluate statistical significance in the case of unpaired categorical data. Agreement between the methods was assessed by using kappa statistics. Results: Gonococcal infection was detected in 58.1% cases, and C. trachomatis was detected in 14% cases. However, both were detected in 12% cases. The sensitivity, specificity, positive predictive value, and negative predictive value of direct Gram's smear examination and culture of urethral discharge were found to be 100% when compared to culture for N. gonorrhoeae. Direct fluorescent antibody (DFA) test proved to be a valuable test aiding in the diagnosis of chlamydial urethritis with a majority of positive cases showing 20–30 elementary bodies. We detected our first gonococcal isolate with decreased susceptibility to third-generation cephalosporins, ceftriaxone, cefixime, and cefpodoxime (MIC for ceftriaxone = 0.19 μg/ml). Conclusions: Optimal management of urethritis and strategies to prevent its transmission depend on accurate detection of infected persons. Our study demonstrates the utility and limitations of different laboratory tests including anti-microbial sensitivity testing for N. gonorrhoeae and C. trachomatis. [ABSTRACT FROM AUTHOR]

The article describes the case of a 14-year old boy with gross hematuria. It refers to blood sports on underwear after urination and urine discoloration as additional complementary findings on exam for terminal hematuria. It identifies differential diagnosis of terminal hematuria including infections, disorders in the posterior urethra, bladder neck or trigone area, as well as causes of terminal hematuria. Treatment options for gross hematuria include oral antihistamine and optical steroids.

Background Cross-protective immunity between Neisseria meningitidis (Nm) and Neisseria gonorrhoeae (Ng) may inform gonococcal vaccine development. Meningococcal serogroup B (MenB) outer membrane vesicle (OMV) vaccines confer modest protection against gonorrhea. However, whether urethral Nm infection protects against gonorrhea is unknown. We examined gonorrhea risk among men with US Nm urethritis clade (US_NmUC) infections. Methods We conducted a retrospective cohort study of men with urethral US_NmUC (n = 128) between January 2015 and April 2018. Using diagnosis date as the baseline visit, we examined Ng status at return visits to compute urethral Ng risk. We compared these data to 3 referent populations: men with urethral Ng (n = 253), urethral chlamydia (Ct) (n = 251), and no urethral Ng or Ct (n = 255). We conducted sensitivity analyses to assess varied approaches to censoring, missing data, and anatomical site of infection. We also compared sequences of protein antigens in the OMV-based MenB-4C vaccine, US_NmUC, and Ng. Results Participants were primarily Black (65%) and heterosexual (82%). Over follow-up, 91 men acquired urethral Ng. Men with urethral US_NmUC had similar Ng risk to men with prior urethral Ng (adjusted hazard ratio [aHR]: 1.27; 95% CI:.65–2.48). Men with urethral US_NmUC had nonsignificantly increased Ng risk compared with men with urethral Ct (aHR: 1.51; 95% CI:.79–2.88), and significantly increased Ng risk compared with men without urethral Ng or Ct (aHR: 3.55; 95% CI: 1.27–9.91). Most of the protein antigens analyzed shared high sequence similarity. Conclusions Urethral US_NmUC infection did not protect against gonorrhea despite substantial sequence similarities in shared protein antigens. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis (CT) is the agent of the most common bacterial sexually transmitted infection worldwide. Until now, little information is available about the microbial composition of urine samples during CT urethritis. Therefore, in this study, we characterized the microbiome and metabolome profiles of first-void urines in a cohort of women with CT urethral infection attending an STI clinic. Methods: Based on CT positivity by nucleic acid amplification techniques on urine samples, the enrolled women were divided into two groups, i.e., "CT-negative" (n = 21) and "CT-positive" (n = 11). Urine samples were employed for (i) the microbiome profile analysis by means of 16s rRNA gene sequencing and (ii) the metabolome analysis by 1H-NMR. Results: Irrespective of CT infection, the microbiome of first-void urines was mainly dominated by Lactobacillus, L. iners and L. crispatus being the most represented species. CT-positive samples were characterized by reduced microbial biodiversity compared to the controls. Moreover, a significant reduction of the Mycoplasmataceae family—in particular, of the Ureaplasma parvum species—was observed during CT infection. The Chlamydia genus was positively correlated with urine hippurate and lactulose. Conclusions: These data can help elucidate the pathogenesis of chlamydial urogenital infections, as well as to set up innovative diagnostic and therapeutic approaches. [ABSTRACT FROM AUTHOR]

Background: Mycoplasma genitalium (MG) is associated with urethritis in men and could play a role in clinical outcome. We examined clinical improvement of symptoms in men receiving empirical treatment for urethritis and correlated the outcome with Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), MG, and MG macrolide resistance-associated mutations (MRAM) status.Methods: At the sexually transmitted infection clinic in Amsterdam, the Netherlands, empirical treatment for gonococcal urethritis is 1 g ceftriaxone and for nongonococcal urethritis 1 g azithromycin. In 2018 to 2019, we tested urine samples of men with urethritis for CT, NG, and MG using transcription-mediated amplification assays. Mycoplasma genitalium-positive samples were tested for MRAM using quantitative polymerase chain reaction. Two weeks after receiving therapy, men were sent a text message inquiring after clinical improvement.Results: We evaluated 2505 cases of urethritis. The positivity rates of NG, CT, and MG were 26% (648 of 2489), 29% (726 of 2489), and 23% (522 of 2288), respectively. In 768 of 2288 of the cases (34%), no causative agent was detected. Most cases were infected with a single pathogen: NG, 417 of 2288 (18%); CT, 486 of 2288 (21%); and MG, 320 of 2288 (14%). The prevalence of MRAM among MG-positives was 74% (327 of 439). For 642 (25.6%) cases, we could evaluate clinical improvement after treatment of whom 127 (20%) indicated no improvement; 9% (15 of 174) in NG cases, 18% (35 of 195) in CT cases, 14% (4 of 28) in MG wild-type cases, and 40% (38 of 94) in MG-MRAM cases. Clinical improvement in MG-MRAM cases was significantly lower compared with all other groups (P < 0.001).Conclusions: Presence of MG-MRAM is associated with lack of clinical improvement in azithromycin-treated nongonococcal urethritis. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of the A.F. Genital System (Liofilchem®, Italy) in detecting pathogens compared with multiplex real‐time polymerase chain reaction (PCR) in men with acute urethritis. Men diagnosed as having acute urethritis between 1 April 2021 and 31 December 2021 were included. Urethral swab samples were obtained for A.F. Genital System and PCR testing in a randomly determined order. The efficacy of the A.F. Genital System was analysed by comparing the results of the two tests. The study included 83 patients (mean age 34.1 ± 11.3 years). A urethritis pathogen was detected in 69 patients (83.1%) by PCR and only 15 patients (18.1%) with the A.F. Genital System. The sensitivity of the A.F. Genital System in detecting acute urethritis pathogens was 21.7% (95% confidence interval [CI]: 13.6–32.8), and the specificity was 100% (95% CI: 78.5–100). Its sensitivity was 20% (95% CI: 7.1–45.2) in the diagnosis of gonococcal urethritis and 19.1% (95% CI: 11.2–30.4) in the diagnosis of non‐gonococcal urethritis. PCR detected two or more urethritis pathogens in 9 patients (13.0%), while no polymicrobial infection was detected with the A.F. Genital System. Based on the results of multiplex real‐time PCR, the A.F. Genital System had very low sensitivity in the detection of pathogens in acute male urethritis. It should be kept in mind that using this test in patients with acute urethritis may result in a high missed diagnosis rate for urethritis pathogens. [ABSTRACT FROM AUTHOR]

To investigate the incidence, clinical manifestations, and treatments of gonococcal tysonitis in men. We enrolled men with gonococcal tysonitis and men with gonococcal urethritis from January 2000 to December 2020. Demographic data, interval from non-marital sexual contact to the onset of symptoms of gonococcal tysonitis, occurrence sites, and manifestations were recorded for all patients. Ceftriaxone (1 g) was injected intramuscularly once daily for 5 days in patients with lesions comprising abscesses or nodules. A single dose of ceftriaxone (1 g) was injected intramuscularly in patients with sinus-like lesions. Incision and drainage were performed in patients with non-ruptured abscesses. Fifteen patients with gonococcal tysonitis (0.29%; 95% confidence interval: 0.15–0.44%) were observed among 5087 patients with gonococcal urethritis. The mean age was 38.64 years (range, 17–74 years). The mean gonococcal tysonitis incubation period was 6.02 ± 1.37 days (range, 2–11 days). Lesions were present in the right side of the preputial frenulum in seven patients (46.67%), in the left side of the preputial frenulum in six patients (40%), and in both sides of preputial frenulum in two patients (13.33%). The lesions manifested as abscesses in 7 patients (46.67%), nodules in six patients (40%), and sinus-like lesions in two patients (13.33%); all lesions exhibited tenderness. All 15 patients were cured after treatment. Gonococcal tysonitis is a rare local complication of gonorrhea. Gonococcal urethritis with concurrent gonococcal tysonitis was less common than gonococcal urethritis with concurrent paraurethral gonococcal infection or gonococcal urethritis with concurrent gonococcal epididymitis. Gonococcal tysonitis lesions manifest as abscesses, nodules, and sinus-like lesions. Treatment with ceftriaxone is effective for gonococcal tysonitis. [ABSTRACT FROM AUTHOR]

Design: A descriptive cross-sectional study. Aim: The current study aims to assess the knowledge, attitude and practice of urinary tract infection among female in Aseer region. Methods: A descriptive cross-sectional study was conducted targeting all women in Aseer region aging 18 years or more. All accessible women in general population were invited to fill the uploaded questionnaire consecutively during the period from April-2021 to October 2021 The questionnaire included women personal data, women knowledge of UTI, attitude and perception and practice regarding UTI. Questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends. Results: A total of 855 females fulfilling the inclusion criteria completed the study questionnaire. Female ages ranged from 18 to more than 40 years with mean age of 31.6 ± 9.7 years old. Exact of 615 71.9% females were married and 205 24% were single. Exact of 80.5% of the study participants know what is UTI. A total of 14.6% defined UTI as inflammation of the balder, 9.9% defined it as inflammation of the urethra, and 74.3% defined as inflammation of bladder, kidney and urethra. As for causes of UTI, only 108 12.6% correctly reported for personal hygiene while 73.3% told about bacteria. A total of 569 66.5% participants reported experiencing UTI which was for only once per year among 58.3% of them, and for 2 times per year among 18.6%. Ad for symptoms experienced, 76.1% had pain in urination, 71.2% complained of abdominal pain, 56.6% had urge, 50.4% experienced frequent urination, while 41.5% had fever. Conclusion: The study revealed that nearly two out of each three women were knowledgeable regarding UTIs and about one out of each two showed good perception and attitude. Women practice regarding UTIs was also satisfactory especially for seeking for medical consultation and fluid intake. [ABSTRACT FROM AUTHOR]

Objective: Sexually transmitted diseases are one of the most important health issues that cause economic and social problems. Urethritis is one of the most common clinical manifestations. Patients who are especially asemptomatically infected with resistant microorganisms continue to infect others; thus, surveillance is important. Our study retrospectively evaluated urethritis cases in males over 10 years for causative agents and their antibiotic susceptibilities. Methods: This study included 748 male patients with urethritis. Urethral discharge swab and ejaculation samples were examined for isolation and antibiotic susceptibilities of N. gonorrhoeae (Biomerieux, France), M. hominis, and U. urealyticum (Mycoplasma IES, Autobio). Additionally, rapid chromatographic immunoassay (Ultimed) was used for C. trachomatis antigen detection. Results: Of 748 patients, 166 (22.2%) were positive for at least one microorganism, whereas 28 showed a mixed infection. The most prevalent microorganism was U. urealyticum (114 patients, 58.8%), followed by N. gonorrhoeae (43 patients, 21.6%), M. hominis (24 patients, 12.4%), and C. trachomatis (10 patients, 5.2%). Most of the N. gonorrhoeae strains were susceptible (92.3-100%) to cefuroxime, ceftriaxone, penicillin, levofloxacin, ciprofloxacin, and tetracycline. The great majority of U. urealyticum strains were resistant to clindamycin (89.6%) and ciprofloxacin (78.5%). M. hominis strains were resistant to erythromycin (100%), clarithromycin (90%), clindamycin (70%), and ciprofloxacin (43.8%). Conclusion: This study revealed that these microorganisms and their antibiotic resistance patterns remain a major public health concern for the last decade. [ABSTRACT FROM AUTHOR]

Urogenital chlamydial infection is the most common sexually transmitted infection. Many cases of chlamydial infection are reported worldwide every year. Genital chlamydial infection in women can also cause obstetric issues, including infertility and miscarriage. For that purpose, appropriate care should be conducted with the latest knowledge. Only few guidelines come from Asian countries. The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding chlamydial urethritis. We have collected the feedback and updated the guidelines which is now submitted for consideration of publication. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for chlamydial urethritis. [ABSTRACT FROM AUTHOR]

Mucinous adenocarcinoma of the urethra is rare. Here we performed a contemporary clinicopathologic analysis of this entity in both male and female patients. All cases with secondary tumors involving the urethra were excluded. Clinicopathologic parameters and follow up was obtained. Seventeen patients were included in the study, 9/17 (53 %) male and 8/17 (47 %) female. The mean patient age was 68 years (range: 53–88 years). The majority (11/17, 65 %) of patients were African American, with an even greater incidence (7/8, 87 %) in female patients. In male patients, prostatic urethra was the most common part of the urethra (6/9, 67 %) where the tumor arose from. Immunohistochemical stains were performed in 11/17 (65 %) tumors and were positive for CK20 (11/11, 100 %), CDX2 (11/12, 92 %), CK7 (8/9, 88 %), GATA3 (3/8, 37 %) and negative for NKX3.1, PSA, p63, PAX8, and Beta-Catenin. In resection specimens, tumors were categorized as pT2 (3/11, 27 %), pT3 (1/11, 9 %), and pT4 (7/11, 64 %). Lymph node status was categorized as pN0 (6/9, 67 %), pN1 (1/9, 11 %), and pN2 (2/9, 22 %). Available follow up data showed 7/13 (54 %) patients developed recurrence after surgical resection and chemotherapy, of which 3/7 (43 %) died of widespread metastatic disease. It is critical for pathologists and urologic oncologists to be aware of this entity in both male and female patients in view of potential diagnostic pitfalls, prognosis, and therapeutic implications. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this review was to summarize the current literature on the assessment and treatment of radiation urethritis and cystitis (RUC) for the development of an evidenced-based management algorithm. Material and Methods: The PubMed/MEDLINE database was searched by a multidisciplinary group of experts in January 2021. Results: In total, 48 publications were identified. Three different types of RUC can be observed in clinical practice: inflammation-predominant, bleeding-predominant, and the combination of inflammation- and bleeding-RUC. There is no consensus on the optimal treatment of RUC. Inflammation-predominant RUC should be treated symptomatically based on the existence of bothersome storage or voiding lower urinary tract symptom as well as on pain. When bleeding-predominant RUC has occurred, hydration and hyperbaric oxygen therapy (HOT) should be used first and, if HOT is not available, oral drugs instead (sodium pentosane polysulfate, aminocaproic acid, immunokine WF 10, conjugated estrogene, or pentoxifylline + vitamin E). If local bleeding persists, focal therapy of bleeding vessels with a laser or electrocoagulation is indicated. In case of generalized bleeding, intravesical installation should be initiated (formalin, aluminium salts, and hyaluronic acid/chondroitin). Vessel embolization is a less invasive treatment with potentially less complications and good clinical outcomes. Open- or robot-assisted surgery is indicated in patients with permanent, life-threatening bleeding, or fistulae. Conclusions: Treatment of RUC, if not self-limiting, should be done according to the type of RUC and in a stepwise approach. Conservative/medical treatment (oral and topic agents) should primarily be used before invasive (transurethral) treatments. [ABSTRACT FROM AUTHOR]

Objective: Sexually transmitted diseases are one of the most important health issues that cause economic and social problems. Urethritis is one of the most common clinical manifestations. Patients who are especially asemptomatically infected with resistant microorganisms continue to infect others; thus, surveillance is important. Our study retrospectively evaluated urethritis cases in males over 10 years for causative agents and their antibiotic susceptibilities. Methods: This study included 748 male patients with urethritis. Urethral discharge swab and ejaculation samples were examined for isolation and antibiotic susceptibilities of N. gonorrhoeae (Biomerieux, France), M. hominis, and U. urealyticum (Mycoplasma IES, Autobio). Additionally, rapid chromatographic immunoassay (Ultimed) was used for C. trachomatis antigen detection. Results: Of 748 patients, 166 (22.2%) were positive for at least one microorganism, whereas 28 showed a mixed infection. The most prevalent microorganism was U. urealyticum (114 patients, 58.8%), followed by N. gonorrhoeae (43 patients, 21.6%), M. hominis (24 patients, 12.4%), and C. trachomatis (10 patients, 5.2%). Most of the N. gonorrhoeae strains were susceptible (92.3-100%) to cefuroxime, ceftriaxone, penicillin, levofloxacin, ciprofloxacin, and tetracycline. The great majority of U. urealyticum strains were resistant to clindamycin (89.6%) and ciprofloxacin (78.5%). M. hominis strains were resistant to erythromycin (100%), clarithromycin (90%), clindamycin (70%), and ciprofloxacin (43.8%). Conclusion: This study revealed that these microorganisms and their antibiotic resistance patterns remain a major public health concern for the last decade. [ABSTRACT FROM AUTHOR]

The Urogenital Sub-committee and the Surveillance Committee of the Japanese Society of Chemotherapy, The Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology conducted the second nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis. In this second surveillance study, clinical urethral discharge specimens were collected from patients with urethritis in 26 hospitals and clinics from May 2016 to July 2017. Based on serial cultures, the minimum inhibitory concentration (MIC) could be determined for 41 isolates; the MICs (MIC 90) of ciprofloxacin, levofloxacin, tosufloxacin, sitafloxacin, doxycycline, minocycline, erythromycin, clarithromycin, azithromycin and solithromycin were 2 μg/ml (2 μg/ml), 1 μg/ml (0.5 μg/ml), 0.25 μg/ml (0.25 μg/ml), 0.125 μg/ml (0.063 μg/ml), 0.125 μg/ml (0.125 μg/ml), 0.25 μg/ml (0.25 μg/ml), 0.031 μg/ml (0.031 μg/ml), 0.25 μg/ml (0.125 μg/ml), and 0.016 μg/ml (0.008 μg/ml), respectively. In summary, this surveillance project did not identify any strains resistant to fluoroquinolone, tetracycline, or macrolide agents in Japan. In addition, the MIC of solithromycin was favorable and lower than that of other antimicrobial agents. However, the MIC of azithromycin had a slightly higher value than that reported in the first surveillance report, though this might be within the acceptable margin of error. Therefore, the susceptibility of azithromycin, especially, should be monitored henceforth. [ABSTRACT FROM AUTHOR]

Background: Neisseria gonorrhoeae culture is required for antimicrobial susceptibility testing, but recovering isolates from clinical specimens is challenging. Although many variables influence culture recovery, studies evaluating the impact of culture specimen collection timing and patient symptom status are limited. This study analyzed urogenital and extragenital culture recovery data from Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG) program, a multisite project, which enhances local N. gonorrhoeae culture and antimicrobial susceptibility testing capacity.Methods: Eight SURRG jurisdictions collected gonococcal cultures from patients with N. gonorrhoeae-positive nucleic acid amplification test (NAAT) results attending sexually transmitted disease and community clinics. Matched NAAT and culture specimens from the same anatomic site were collected, and culture recovery was assessed. Time between NAAT and culture specimen collection was categorized as same day, 1 to 7 days, 8 to 14 days, or ≥15 days, and patient symptoms were matched to the anatomic site where culture specimens were collected.Results: From 2018 to 2019, among persons with N. gonorrhoeae-positive NAAT, urethral infections resulted in the highest culture recovery (5927 of 6515 [91.0%]), followed by endocervical (222 of 363 [61.2%]), vaginal (63 of 133 [47.4%]), rectal (1117 of 2805 [39.8%]), and pharyngeal (1019 of 3678 [27.7%]) infections. Culture recovery was highest when specimens were collected on the same day as NAAT specimens and significantly decreased after 7 days. Symptoms were significantly associated with culture recovery at urethral (P = <0.0001) and rectal (P = <0.0001) sites of infection but not endocervical, vaginal, or pharyngeal sites.Conclusions: Culture specimen collection timing and patient symptomatic status can impact culture recovery. These findings can guide decisions about culture collection protocols to maximize culture recovery and strengthen detection of antimicrobial-resistant infections. [ABSTRACT FROM AUTHOR]

Design: A descriptive cross-sectional study. Aim: The current study aims to assess the knowledge, attitude and practice of urinary tract infection among female in Aseer region. Methods: A descriptive cross-sectional study was conducted targeting all women in Aseer region aging 18 years or more. All accessible women in general population were invited to fill the uploaded questionnaire consecutively during the period from April-2021 to October 2021 The questionnaire included women personal data, women knowledge of UTI, attitude and perception and practice regarding UTI. Questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends. Results: A total of 855 females fulfilling the inclusion criteria completed the study questionnaire. Female ages ranged from 18 to more than 40 years with mean age of 31.6 ± 9.7 years old. Exact of 615 71.9% females were married and 205 24% were single. Exact of 80.5% of the study participants know what is UTI. A total of 14.6% defined UTI as inflammation of the balder, 9.9% defined it as inflammation of the urethra, and 74.3% defined as inflammation of bladder, kidney and urethra. As for causes of UTI, only 108 12.6% correctly reported for personal hygiene while 73.3% told about bacteria. A total of 569 66.5% participants reported experiencing UTI which was for only once per year among 58.3% of them, and for 2 times per year among 18.6%. Ad for symptoms experienced, 76.1% had pain in urination, 71.2% complained of abdominal pain, 56.6% had urge, 50.4% experienced frequent urination, while 41.5% had fever. Conclusion: The study revealed that nearly two out of each three women were knowledgeable regarding UTIs and about one out of each two showed good perception and attitude. Women practice regarding UTIs was also satisfactory especially for seeking for medical consultation and fluid intake. [ABSTRACT FROM AUTHOR]

Gonococcal urethritis (GU) is the second most common sexually transmitted infection (STI). Epidemiologic studies of the situation of GU reinfection and its related risk factors among patients with a history of GU in Thailand remain somewhat limited. A hospital-based retrospective cohort study was conducted between January 1, 2010 and December 31, 2020 to determine the incidence and risk factors of GU reinfection among male patients visiting in Royal Thai Army (RTA) Hospitals. A total of 2,465 male patients presenting a history of GU was included in this study. In all, 147 (6.0%; 95% CI 5.1–6.9) male patients presented GU reinfection, representing an incidence rate of 1.3 (95% CI 1.1–1.5) per 100 person-years. The independent risk factors for GU reinfection were age < 30 years (AHR 1.7; 95% CI 1.0–2.8), number of sexual partners equal to 2 (AHR 3.4; 95% CI 1.0–11.2), ≥ 3 (AHR 5.6; 95% CI 2.7–11.6), and participants residing in the north (AHR 4.1; 95% CI 2.3–7.5) and northeast regions (AHR 2.1; 95% CI 1.1–3.9). Incidence of GU reinfection among male patients visiting RTA Hospitals was significantly high among younger aged patients, especially in the north and northeast regions. Multiple sex partners played a major role in GU reinfection. Effective STI prevention programs should be provided to alleviate reinfection and its complications. [ABSTRACT FROM AUTHOR]

Background Prior to the widespread availability of antiretroviral therapy (ART), men living with human immunodeficiency virus (HIV) with urethritis had increased concentrations of HIV in semen. This study aims to better evaluate HIV shedding in men with urethritis receiving ART, and its implications for the cure of HIV. Methods Men living with HIV with urethritis taking ART ≥12 weeks were enrolled at a sexually transmitted infections clinic in Lilongwe, Malawi. Study follow-up included visits at 1, 2, 4, 8, 12, 24, 36, and 48 weeks after urethritis diagnosis and treatment. Matched blood and semen samples were collected at all visits, and all additional episodes of urethritis were followed with extra visits 1, 2, and 4 weeks after treatment. Results There were 111 men enrolled in the study between January 2017–March 2019, and 77 (69%) were suppressed in the blood (<400 copies/mL). Among the 77 men, 87 episodes of urethritis were evaluated during follow-up. Of the 87 episodes, 15 episodes (17%) had instances of seminal viral shedding ≥400 copies/mL despite viral suppression in the blood. During nonurethritis follow-up, ≤6% of men at each visit had a viral load ≥400 copies/mL in the semen while maintaining viral suppression in the blood. Conclusions An HIV cure requires the elimination of HIV from every body compartment, but available ART does not currently accomplish this. Our study highlights the male genital tract as a local source of HIV that can be reversibly activated. A better understanding of this phenomenon is important to advance the HIV cure field. [ABSTRACT FROM AUTHOR]

Background Nongonococcal urethritis (NGU) is a common syndrome with no known etiology in ≤50% of cases. We estimated associations between urethral bacteria and NGU in men who have sex with men (MSM) and men who have sex with women (MSW). Methods Urine was collected from NGU cases (129 MSM, 121 MSW) and controls (70 MSM, 114 MSW) attending a Seattle STD clinic. Cases had ≥5 polymorphonuclear leukocytes on Gram stain plus symptoms or discharge; controls had <5 PMNs, no symptoms, no discharge. NGU was considered idiopathic when Neisseria gonorrhoeae , Chlamydia trachomatis , Mycoplasma genitalium , Trichomonas vaginalis , adenovirus, and herpes simplex virus were absent. The urethral microbiota was characterized using 16S rRNA gene sequencing. Compositional lasso analysis was conducted to identify associations between bacterial taxa and NGU and to select bacteria for targeted qPCR. Results Among NGU cases, 45.2% were idiopathic. Based on compositional lasso analysis, we selected Haemophilus influenzae (HI) and Mycoplasma penetrans (MP) for targeted qPCR. Compared with 182 men without NGU, the 249 men with NGU were more likely to have HI (14% vs 2%) and MP (21% vs 1%) (both P ≤.001). In stratified analyses, detection of HI was associated with NGU among MSM (12% vs 3%, P =.036) and MSW (17% vs 1%, P <.001), but MP was associated with NGU only among MSM (13% vs 1%, P =.004). Associations were stronger in men with idiopathic NGU. Conclusions HI and MP are potential causes of male urethritis. MP was more often detected among MSM than MSW with urethritis. [ABSTRACT FROM AUTHOR]

Non-chlamydial non-gonococcal urethritis (NCNGU) is defined as urethritis with neither Neisseria gonorrhoeae nor Chlamydia trachomatis. Possible causative agents of NCNGU include Mycoplasma genitalium , Ureaplasma urealyticum , Ureaplasma parvum , Mycoplasma hominis , Trichomonas vaginalis , and so on. Among these microorganisms, the pathogenicity of M. genitalium and T. vaginalis to the male urethra has been confirmed so far. The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding NCNGU and the present guidelines were updated from previous edition. Relevant references were meticulously reviewed again and latest studies were collected. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for M. genitalium and non-chlamydial non-gonococcal urethritis. [ABSTRACT FROM AUTHOR]

We aimed to estimate how often urethral gonorrhoea is symptomatic among men in the Pre-Exposure Prophylaxis Expanded Victoria study. Eighty-seven percent of 213 cases of urethral gonorrhoea were symptomatic. Ensuring men with urethral gonorrhoea both recognize and present early for treatment is critical to reduce transmission. [ABSTRACT FROM AUTHOR]

Introduction: Urinary tract infection (UTI) is a common disorder in childhood. Early identification and appropriate antibiotic use are essential to avoid long-term sequels. The trial objective was to identify the prevalence of URI in children, and the risk factors. Methods: This is an analytical cross-sectional study conducted in the Saudi Arabia, from April 4th 2020 till July 30th 2020. The sample was randomly selected from children who presented to the ministry of health tertiary hospitals. People answered a questionnaire of 10 items. Results: 1083 people participated in the current trial. The prevalence of UTI was 25.8%. The mean age was 4.5-5 years. UTI was commoner in females than males. Urethritis was the main presenting complaint. Western region was the commonest identified area. Those with multivitamin deficiency had the highest prevalence. Conclusion: UTI is not a very common problem for children in Saudi Arabia. Western region had the highest prevalence and the peak age ranged from 4.5 to 5 years. Additionally, nearly a sixth of children could develop severe/complicated UTI. [ABSTRACT FROM AUTHOR]

6 Non-chlamydial non-gonococcal urethritis [Executive summary] • Male urethritis in which neither N. gonorrhoeae nor C. trachomatis is detected is called non-chlamydial non-gonococcal urethritis (I, B). Non-gonococcal urethritis in which chlamydia is detected is called chlamydial urethritis, and urethritis in which neither gonococcus nor chlamydia is detected is called non-chlamydial non-gonococcal urethritis (I, B). Urethritis and cervicitis are frequently caused by Neisseria gonorrhoeae and Chlamydia trachomatis, and gonococcal urethritis and cervicitis and chlamydial urethritis and cervicitis have been used as terms to indicate these conditions. 4 Non-gonococcal urethritis • Urethritis in which gonococci are not detected is called non-gonococcal urethritis (I, A). Urethritis is classified into gonococcal and non-gonococcal urethritis depending on detection or no detection of gonococcus. [Extracted from the article]

Male guinea pigs (Cavia porcellus), especially older animals, are prone to urethritis and posthitis. Severe, chronic balanoposthitis/posthitis can result in fibrosis, localised infection and the deposition of mineralised plaques in the prepuce. Severe cases may require surgical intervention, such as penile amputation and urethrostomy, to achieve resolution. [ABSTRACT FROM AUTHOR]

The article discusses several studies related to infectious diseases. Topics include cases of urethral infection with human adenovirus (HAdV) in over 9.5 years at a single hospital in Spain, the presence of additional adhesions in Candida (C.) auris using a model of surface association that measured adhesion between fungal cells and polymer substrates, and herpes simplex encephalitis and subsequent neurological complications.

• First description of extended-spectrum β-lactamase CTX-M-15 in Haemophilus parainfluenzae. • H. parainfluenzae is a potential reservoir of resistance genes. • Increasing prevalence of urogenital infections caused by H. parainfluenzae. • H. parainfluenzae may be a causative agent of sexually-transmitted infections (STIs). • H. parainfluenzae might transmit resistance determinants to other STI-associated pathogens. Haemophilus parainfluenzae is a commensal organism with rising numbers of multidrug-resistant (MDR) strains. This pathogen is of increasing clinical relevance in urogenital infection. The aim of this work was to identify and characterise the molecular mechanisms of resistance associated with four cephalosporin-resistant H. parainfluenzae strains collected from patients with urethritis. Antimicrobial resistance was determined by microdilution following European Committee on Antimicrobial Susceptibility Testing criteria. Strains were then analysed by whole-genome sequencing to determine clonal relationship and the molecular basis of antimicrobial resistance. Finally, a phylogenetic analysis was performed on all urogenital MDR strains of H. parainfluenzae previously isolated in our hospital. All strains were resistant to β-lactams, macrolides, tetracycline, fluoroquinolones, chloramphenicol, cotrimoxazole, and aminoglycosides. The resistance profile was compatible with the presence of an extended-spectrum β-lactamase (ESBL). Whole-genome sequencing detected bla CTX-M-15 that conferred high minimum inhibitory concentrations to cephalosporins in two novel integrative and conjugative elements (ICE HpaHUB6 and ICE HpaHUB7) that also harboured a bla TEM-1 β-lactamase. This study shows a novel bla CTX-M-15 ESBL carried in an integrative conjugative element in four extensively drug-resistant H. parainfluenzae strains. This resistance determinant could be transmitted to other sexually transmitted pathogens and this is a cause for concern. [ABSTRACT FROM AUTHOR]