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Introduction: The association between sodium-glucose cotransporter-2 (SGLT2) inhibitors and the risk of urogenital infections remains controversial. This study aimed to investigate the association between SGLT2 inhibitors and the incidence of perineal soft tissue infections, including Fournier's gangrene (FG), genital bacterial infections, and urinary tract infections (UTIs), using administrative claims data in Japan. Methods: In this retrospective cohort study, we utilized the JMDC Claims Database. The study included patients aged 18 years or older diagnosed with type 2 diabetes mellitus, identified by a diagnostic code, who received new prescriptions for SGLT2 inhibitors or dipeptidyl peptidase 4 (DPP-4) inhibitors between April 2014 and August 2020. Using one-to-one propensity score (PS) matching, we compared the incidence of perineal soft tissue infections, including FG, genital bacterial infection, and UTIs between groups treated with SGLT2 and DPP-4 inhibitors. Hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using the Cox proportional hazards model. Results: We identified 34,897 patients in the SGLT2 inhibitor group and 135,311 patients in the DPP-4 inhibitor group. After one-to-one PS matching, 31,665 pairs were generated. The mean age of the patients was 51 years, with approximately 70% being male. The use of SGLT2 inhibitors was associated with a decreased risk of UTI (HR 0.90, 95% CI 0.83–0.98) and an increased risk of genital bacterial infection (HR 1.23, 95% CI 1.03–1.46) compared to DPP-4 inhibitors. However, no significant association was observed with perineal soft tissue infection (HR 1.05, 95% CI 0.61–1.81). Conclusions: SGLT2 inhibitors were associated with a reduced risk of UTI and an increased risk of genital bacterial infection. They showed no significant association with perineal soft tissue infection when compared to DPP-4 inhibitors. Future research should explore broader demographics, focusing on the elderly and achieving gender balance, to gain a comprehensive understanding of infection risks. [ABSTRACT FROM AUTHOR]

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to reduce adverse cardiovascular events in patients with type 2 diabetes mellitus, all-cause mortality, and heart failure hospitalization in patients with heart failure, as well as adverse renal outcomes. However, concerns regarding the heightened risk of genitourinary (GU) infections, particularly urinary tract infections, remain a significant barrier to their wider adoption. Addressing these misconceptions using existing evidence is needed to ensure proper risk-benefit assessment and optimal utilization of this efficacious therapy. This review aims to provide a balanced perspective on the evidence-based cardiovascular and renal benefits of SGLT2is and the associated risk of GU infections. We also summarize and propose clinical practice considerations for SGLT2i-associated GU infections focusing on patients with cardiovascular disease. [Display omitted] • Treatment with SGLT2is is associated with an increased risk of GMI but not UTI or necrotizing fasciitis of the perineum (Fournier's gangrene). • The benefits of SGLT2is usually outweigh the risk of treatment-associated GU infections. • In most cases, patients developing mild-moderate or stable severe GU infections can continue SGLT2is. [ABSTRACT FROM AUTHOR]

The development of new approaches and drugs for effective control of the chronic and complicated forms of urogenital chlamydia caused by Chlamydia trachomatis, which is suspected to be one of the main causes of infertility in both women and men, is an urgent task. We used the technology of single-domain antibody (nanobody) generation both for the production of targeting anti-chlamydia molecules and for the subsequent acquisition of anti-idiotypic nanobodies (ai-Nbs) mimicking the structure of a given epitope of the pathogen (the epitope of the Chlamydial Type III Secretion System Needle Protein). In a mouse model, we have shown that the obtained ai-Nbs are able to induce a narrowly specific humoral immune response in the host, leading to the generation of intrinsic anti-Chlamydia antibodies, potentially therapeutic, specifically recognizing a given antigenic epitope of Chlamydia. The immune sera derived from mice immunized with ai-Nbs are able to suppress chlamydial infection in vitro. We hypothesize that the proposed method of the creation and use of ai-Nbs, which mimic and present to the host immune system exactly the desired region of the antigen, create a fundamentally new universal approach to generating molecular structures as a part of specific vaccine for the targeted induction of immune response, especially useful in cases where it is difficult to prepare an antigen preserving the desired epitope in its native conformation. [ABSTRACT FROM AUTHOR]

Background This study evaluated the distribution of macrolide-resistant Mycoplasma genitalium in multiple urogenital specimens collected from women enrolled in a prospective multicenter US clinical study. Methods Four female urogenital specimens (vaginal swab, urine, endocervical swab, ectocervical brush/spatula) collected from each subject were tested using a transcription-mediated amplification (TMA) assay for M. genitalium. TMA-positive specimens were evaluated by reverse transcription–polymerase chain reaction and bidirectional Sanger sequencing of M. genitalium 23S rRNA to identify the presence of macrolide-resistance–mediating mutations (MRMs) at base positions 2058/2059. Results Of 140 women with ≥1 TMA-positive specimens, 128 (91.4%) yielded M. genitalium 23S rRNA sequence. MRMs were found in 52% of vaginal specimens, 46.3% of urine specimens, 37.8% of endocervical specimens, and 46% of ectocervical specimens. There were 44 unique specimen type/sequence phenotype combinations of M. genitalium infection. Most (81; 63.3%) women had single specimen-sequence phenotype (macrolide-susceptible, MRM, or both) infections, while 24 (18.8%) women had multiple specimen-sequence phenotype concordant infections, and 23 (17.9%) women had multiple specimen-sequence phenotype discordant infections. The sensitivity for any single specimen type to detect overall urogenital tract macrolide-resistant M. genitalium infection status was 96.3% for vaginal swab samples, 82.6% for urine samples, 70.8% for endocervical swab samples, and 82.1% for ectocervical brush/spatula liquid Pap samples. Conclusions The distribution of M. genitalium infections in female urogenital tract specimens is highly complex, with multiple phenotypic combinations of the organism infecting a significant proportion of women at different anatomic specimen collection sites. Vaginal swab sampling yielded the highest sensitivity for identifying women with macrolide-resistant M. genitalium urogenital tract infections. [ABSTRACT FROM AUTHOR]

Testicular tuberculosis (TB) is a rare disease, and it tends to mimic other testicular diseases which are more common. We highlight the case of a 37-year-old male who presented to the emergency department with testicular torsion. Further investigations revealed evidence of TB. [ABSTRACT FROM AUTHOR]

This article presents biochemical markers and clinical laboratory reasons for predicting preterm labor in urogenital infections. Premature birth (PB) is one of the main pathologies in obstetrics and neonatology. Perinatal mortality and morbidity rates depend on preterm birth. According to numerous studies, almost half of the causes of preterm birth are due to infection, especially with urogenital infections. Prematurity, which affects almost 10% of pregnancies worldwide, is the most significant cause of perinatal mortality or morbidity, predicting their causes using biochemical markers and timely antibiotic therapy started, prevents purulent septic complications in the postpartum period, both in women and in newborns. [ABSTRACT FROM AUTHOR]

We performed an electron microscopic study of samples of urethral polyps obtained from 90 women (mean age 52.5±4.9 years). According to PCR and culture studies, the most common infectious agent in patients with urethral polyps is U. urealyticum (100% cases). In 70% cases, this infectious agent was present as monoinfection, of these, clinically significant concentration (>106 CFU/ml) were found in 53.3% cases. In 30% cases, associations with C. trachomatis, T. vaginalis, and M. genitalium were found. We observed significant ultrastructural heterogeneity of the epithelial cells in urethral polyps, which manifested in a combination of hyperplastic and metaplastic changes and signs of cytodestruction. Detection of mycoplasma-like bodies in connective tissue mononuclear cells and viral particles in epithelial cells during ultrastructural study, including cases with negative PCR results, indicates the pathogenetic role of latent infection in the formation of urethral polyps. [ABSTRACT FROM AUTHOR]

We performed an electron microscopic study of samples of urethral polyps obtained from 90 women (mean age 52.5±4.9 years). According to PCR and culture studies, the most common infectious agent in patients with urethral polyps is U. urealyticum (100% cases). In 70% cases, this infectious agent was present as monoinfection, of these, clinically significant concentration (>106 CFU/ml) were found in 53.3% cases. In 30% cases, associations with C. trachomatis, T. vaginalis, and M. genitalium were found. We observed significant ultrastructural heterogeneity of the epithelial cells in urethral polyps, which manifested in a combination of hyperplastic and metaplastic changes and signs of cytodestruction. Detection of mycoplasma-like bodies in connective tissue mononuclear cells and viral particles in epithelial cells during ultrastructural study, including cases with negative PCR results, indicates the pathogenetic role of latent infection in the formation of urethral polyps. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted infections play a great role in formation of inflammatory diseases of female urogenital system. These diseases can cause a decrease in the level of female sex hormones, as well as the ratio of estrogens and androgens. Objective: To determine changes in the state of sex hormones in women with inflammatory diseases of ovaries associated with opportunistic urogenital flora. Materials and Methods: 136 women aged 18-39 yr participated in this crosssectional clinical study. They were examined with the use of a complex of clinical, laboratory and instrumental methods of examination. The patients with confirmed diagnosis of inflammatory disease of reproductive system associated with opportunistic urogenital infection have been under blood analysis to reveal the concentration of follicle-stimulating hormone, luteinizing hormone, and estrogens. Results: After the treatment the functional capacity of ovary significantly increased, proved by a corresponding increase in the concentration of estradiol hormone in blood serum in all phases of menstrual cycle. According to estradiol in follicular phase its concentration was increased from 421.8±10.8 nmol/L to 581.3±10.2 nmol/L. The elevation in the ratio of estradiol/testosterone hormones in blood serum also is demonstrated. Conclusion: Inflammatory diseases associated with opportunistic urogenital infection is responsible for a decrease of female sex hormones and the ratio of estrogens and androgens. [ABSTRACT FROM AUTHOR]

We isolated a cryptic genospecies of Haemophilus influenzae referred to as ‘ Haemophilus quentini ’ in the urethra of 3 men complaining of urethritis symptoms. H. influenzae strains, which had been isolated from the urethra in 77 of 1518 men complaining of urethritis symptoms, identified by the conventional test, and stored, were re-cultured for this study. Sixty-seven strains surviving storage were screened by a PCR-based assay specific for the cryptic genital Haemophilus genospecies. Three strains (HI09003, HI11006, and HI14016) were screened by PCR and identified as ‘ H. quentini ’ by 16S rRNA sequencing. The men positive for HI09003 and HI11006 were diagnosed as having non-chlamydial non-gonococcal urethritis (NGU), and their demographic and clinical features were similar to those of NGU caused by other pathogens. The man positive for HI14016 was ultimately diagnosed as having condyloma acuminatum on the glans. The 3 strains of ‘ H. quentini ’ produced no β-lactamase and were susceptible to ampicillin and other antimicrobial agents, including cephalosporins, fluoroquinolones, tetracyclines, and macrolides, recommended for treatment for urethritis. ‘ H. quentini ’ would be an uncommon pathogen in men with urogenital infections. Based on the clinical features of the two patients with ‘ H. quentini ’-positive NGU, it would be difficult to predict the presence of ‘ H. quentini ’ in the urethra. The 3 strains of ‘ H. quentini ’ were susceptible to a variety of antimicrobial agents. Further accumulation of data regarding ‘ H. quentini ’ infections is needed to characterize the pathogenic roles of this genospecies in urogenital infections and to establish appropriate management of ‘ H. quentini ’ infections. [ABSTRACT FROM AUTHOR]

Objective: To determine whether interactions between coital frequency, cervical length, and urogenital infection affect obstetric outcomes. Materials and Methods: A total of 268 unselected pregnant women were recruited in the study. The study population consisted of four groups of women: group 1 (n=203) screened negative for bacterial vaginosis (BV) both in the first and second trimesters; group 2 (n=18) screened negative for BV in the first trimester but positive in the second trimester; group 3 (n=33) screened positive for BV in the first trimester but negative in the second trimester; and group 4 (n=14) screened positive for BV both in the first and second trimesters. Urine culture, cervico-vaginal cultures, and bacterial vaginosis were screened between 11-14 weeks and 20-24 weeks. Results: Two hundred fifty women were eligible for analysis in the study after lost-to-follow up patients were excluded. Previous abortion ≥1 and previous preterm delivery at 24-34 weeks ≥1 were statistically significantly higher in group 2. The number of patients who were diagnosed as having preterm premature rupture of membranes (PPROM) was statistically significantly higher in group 4. Sexual intercourse during the first trimester, cervical length during the second trimester, and history of preterm birth (PTB) were statistically significant risk factors for preterm birth <37 weeks (1.27; (1.12-1.44); 5.33; (1.84-15.41); 6.95; (1.58-30.54), respectively). Conclusion: Presence or treatment of BV did not influence rates of PTB. The probability of PPROM would be higher in patients who are BV positive both in the first and second trimesters. [ABSTRACT FROM AUTHOR]

Background: The role of Mycoplasma hominis and M. genitalium in urogenital tract infections remains unknown. Furthermore these mollicutes present a complex relationship with the host immune response. The role of inflammatory cytokines in infections also makes them good candidates to investigate bacterial vaginosis and mycoplasma genital infections. Therefore, the aim of this study was to detect the above-mentioned mollicutes by quantitative Polymerase Chain Reaction (qPCR) methodologies in vaginal swabs and dosage of cytokines. Methods: Vaginal swabs and peripheral blood were collected from 302 women, including healthy individuals. The molecular findings were correlated with some individual behavioral variables, clinical and demographic characteristics, presence of other important microorganisms in vaginal swabs, and levels of interleukin (IL)-1β and IL-6. Results: M. hominis and M. genitalium were detected in 31.8% and 28.1% of samples, respectively. The qPCR results were associated with clinical signs and symptoms of the infections studied. The frequency of Trichomonas vaginalis, Gardnerella vaginalis, Neisseria gonorrhoeae and Chlamydia trachomatis was 3.0%, 21.5%, 42.4%, and 1.7% respectively. Increased levels of IL-1β were associated with the presence of M. hominis and signs and/or symptoms of the genital infection of women studied. Conclusion: IL-1β production was associated with the detection of M. hominis by qPCR. The sexual behavior of women studied was associated with the detection of mycoplasma and other agents of genital infections. [ABSTRACT FROM AUTHOR]

Problem Interleukin (IL)-18 is a novel cytokine, previously known as interferon (IFN)- γ inducing factor. We evaluated the levels of IL-18 and IFN- γ in seminal plasma (SP) of fertile and infertile men. Method of study Semen samples were obtained by masturbation from 80 men, and were examined for the levels of IL-18 and IFN- γ by enzyme-linked immunosorbent assay. Seven groups were included: (i) fertile men ( n = 18), (i) infertile men with genital tract infections ( n = 17), (iii) with varicocele ( n = 15), (iv) with Klinefelter syndrome ( n = 6), (v) with cryptorchidism ( n = 7), (vi) with mumps orchitis ( n = 7), and (vii) with idiopathic testicular lesions ( n = 10). Results Mean levels of IL-18 were higher in SP from infertile men with genital tract infections compared with SP from other groups except Klinefelter syndrome ( P < 0.05). However, no significant differences could be detected for IFN- γ. A significant positive correlations was found between IL-18 and IFN- γ in total patient population ( P < 0.001). Moreover, a negative correlation was observed between IL-18 and sperm concentrations, and motility ( P < 0.01 and <0.03, respectively). Furthermore, there was a positive and statistically significant association between IL-18 and IFN- γ levels in SP of infertile men with genital tract infections ( P < 0.0001). However, there was no relationship between IL-18 and IFN- γ, and semen parameters in the same group. Conclusion SP IL-18 levels were increased in men with urogenital infections. Thus, the elevated expression of IL-18 in SP may be used as a diagnostic marker in the male genital tract infections. [ABSTRACT FROM AUTHOR]

In recent years there has been a significant upsurge in research on the characterisation and verification of the potential health benefits associated with the use of probiotics. In addition, the market for probiotics continues to expand exponentially as consumers (mostly healthy individuals) rely on health claims made by manufacturers to make their choices. This review appraises the available evidence for and against the health claims associated with probiotics. The use of probiotics in promoting gastrointestinal health and immunity, and their use in the prevention of urogenital infections, allergies and cancer are reviewed. Furthermore, issues surrounding the use of probiotics in healthy individuals, the safety of probiotics and regulatory concerns are addressed. There is scientific evidence that specific strains of probiotic microorganisms confer health benefits on the host and are safe for human use. However, this evidence cannot be extrapolated to other strains, as these effects are strain-specific. Probiotics have potential health benefits for conditions such as gastrointestinal infections, genitourinary infections, allergies and certain bowel disorders, all of which afflict a considerable proportion of the global population. However, considerable work is still needed to confirm these potential health benefits. [ABSTRACT FROM AUTHOR]

A total of 196 patients attending the Center of Dermatology and Andrology, Giessen, Germany, were examined for fertility problems. Polymorphonuclear elastase, reactive oxygen species (ROS and the number of round and peroxidase-positive cells were investigated in addition to routine semen analysis. The ejaculates were also analysed before and after sperm separation by means of swim-up or glass wool filtration. In 20 cases of leukocvtospermia, sperm concentration, motility, viability, production of reactive oxygen species. and the number of peroxidase- positive cells were evaluated before and after glass wool filtration. The results show that ROS production by viable spermatozoa is highly correlated with the concentration of PMN elastase and the number of both peroxidase-positive and round cells. Multiple regression analysis with motility as dependent parameter showed the number of round cells (n=91; r= -0.332; P=0.0030) to be the most important parameter affecting motility, while ROS mainly affects the viability of spermatozoa (n=69; r=0.250; P=0.0107). In the ease of leukocytospermia, glass wool filtration significantly reduced the number of peroxidase-positive cells and ROS production (P=0.0098 and P=0.0005, respectively). Receiver operating characteristic (ROC) curve analysis for ROS production in the ejaculate using a concentration of 1.000 ng ml -1 PMN elastase as decisive parameter resulted in a rut-off value of 49,489.9 counts 10-7 viable spermatozoa. The statistical parameters were: Sensitivity: 63.2%, specificity: 100%, positive predictive value: 100%, negative predictive value: 36.1%. [ABSTRACT FROM AUTHOR]

Prostatic inflammation is associated with infections penetrating through the urethra. This inflammation is treated by long courses of wide-spectrum antibiotics. However, the most frequent cause of prostatitis is Escherichia coli and other enteric flora. Electron microscopy of biopsy specimens from the prostate detected gaps in the prostatic epithelium basement membrane, their size explaining the penetration of enteric flora into the prostate. These data suggest another view on the pathogenesis of prostatitis and approaches to improvement of therapy for this disease. [ABSTRACT FROM AUTHOR]

Urogenital infections with Chlamydia trachomatis belong to the most prevalent sexually-transmitted bacterial diseases. In women, they can cause chronic salpingitis with subsequent tubal infertility and ectopic pregnancies. In men, C. trachomatis can cause urethritis, prostatitis and epididymitis. Urogenital infections can be symptomatic or asymptomatic. Symptomatic urogenital infections might impair male fertility. In vitro, C. trachomatis affects sperm motility and viability. However, there is no clear evidence that asymptomatic urogenital infections have an adverse effect on male fertility. Because C. trachomatis can be sexually transmitted and lead to female infertility, it is also of significance in male infertility work-up. Because of their high sensitivity, nucleic acid amplification tests should be used to examine first-void urine specimens. Both partners should be treated. The role of Ureaplasma urealyticum in reproductive medicine has been discussed controversially. There is no evidence that U. urealyticum has a significant impact on female or male infertility. [ABSTRACT FROM AUTHOR]

Objective This study is to investigate the functions of newly discovered genes in Chlamydia muridarum (C. muridarum) strains with single gene differences. Methods Using whole genome sequencing and plaque formation assays, C. muridarum parental and passaging strains were established, and the isogenic clones expressing certain genotypes were isolated. Strains with single gene differences were obtained. Based on prediction, the valuable strains with single gene differences of tc0412, tc0668 or tc0237 were subjected to the in vitro and in vivo experiments for biological characterization and virulence analysis. Results Insertional -472840T mutation of the tc0412 gene (T28T/B3 type) matching with the nonmutant tc0668 gene and tc0237 gene with point mutations G797659T (Q117E) might slow the growth of Chlamydia due to the lack of a plasmid. The nonmutant tc0668 in the strain might induce a high incidence of hydrosalpinx in mice, while tc0668 with a G797659T point mutation was significantly attenuated. Compared with the nonmutant tc0237, the strains containing mutant tc0237 were characterized by reduced centrifugation dependence during infection. Conclusion The identification and characterization of these genes might contribute to the comprehensive understanding of the pathogenic mechanism of Chlamydia. [ABSTRACT FROM AUTHOR]