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Mycoplasma genitaliumは性感染症である男子尿道炎の原因微生物である．我が国では非淋菌性尿道炎患者の15-25%の尿から検出される．世界的にマクロライド耐性，キノロン耐性M. genitaliumの出現が，尿道炎治療を行う上で問題となっている．しかし，わが国ではM. genitaliumを検出するための保険適用を有する検査キットがない．今回，Seegene社の性感染症関連微生物7種同時検出キット（AnyplexTM II STI-7 Detection; Neisseria gonorrhoeae，Chlamydia trachomatis，M. genitalium，Mycoplasma hominis，Ureaplasma urealyticum，Ureaplasma parvum，Trichomonas vaginalisを検出）を用いて，M. genitaliumの検出に関する検討を行った．本キットの検出限界を検討するため，保存するM. genitalium 17株を用いた．SP4 mycoplasma mediumで増殖したM. genitalium培養液から，M. genitaliumのDNAを抽出し，M. genitaliumのDNAコピー数を測定した．M. genitaliumのDNA抽出液を101～108倍に希釈した希釈液を作成した．それぞれの希釈液をAnyplexTM II STI-7 Detectionで反応させ，もっとも希釈した液でM. genitaliumが検出されたものを検出限界とした．17株中14株で，希釈限界におけるDNAコピー数は10 genome equivalent（ geq）/reaction未満で，3株で10 geq/reaction以上であった．その中でもっとも高いDNAコピー数は48.4 geq/reactionであり，約50 geq/reactionがAnyplexTM II STI-7 Detectionにより保証されるM. genitaliumのDNAコピー数と考えられた．また，保存する尿検体からDNAを抽出し，MgPa geneの一部を増幅させるPCR法とAnyplexTM II STI-7 Detectionとで，M. genitaliumの検出率を比較した．両方法での陽性一致率は96.4%（27/28），陰性一致率は98.6%（ 71/72）であった．両方法との間に1例ずつの不一致があったものの，陽性，陰性一致率とも高かった．Seegene社の性感染症関連微生物7種同時検出キット，AnyplexTM II STI-7 Detectionを培養液，尿検体の面から検証し，M. genitalium検出に関して有用性が高いことが分かった．, Mycoplasma genitalium is one of the pathogenic microorganisms in male urethritis as a sexually transmitted infection (STI). M. genitalium is detected in the urine specimens of 15-25% male patients with urethritis. The emergence of macrolide- or fluoroquinolone-resistant M. genitalium has become a serious problem in the treatment of male urethritis worldwide, but there is no commercial-based detecting kits accepted by the national insurance in Japan. In this study, we tested the validity of a molecular kit for detecting seven microorganisms related to STI (AnyplexTM II STI-7 Detection which detects Neisseria gonorrhoeae, Chlamydia trachomatis, M. genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, Trichomonas vaginalis) produced by Seegene company in Korea. Seventeen M. genitalium strains were used to determine the detection limit of M. genitalium. M. genitalium DNA samples were extracted from M. genitalium strains and the diluted DNA samples were reacted to detect M. genitalium by the AnyplexTM II STI-7 Detection. The detection limit was determined as the maximum dilution of DNA samples and the number of M. genitalium DNA copies calculated. In this study, the minimum DNA copies to detect M. genitalium by the AnyplexTM II STI-7 Detection was determined to be around 50 per reaction. The detection rates of M. genitalium in urine specimens were compared between MgPa gene PCR and the AnyplexTM II STI-7 Detection. The positive and negative concordant rates were high as 96.4% (27/28) and 98.6% (71/72), respectively. The validity of the kit for detecting seven microorganisms related to STI (AnyplexTM II STI-7 Detection) was high and thought to be useful for clinical uses.

16歳男。主訴は排尿痛, 尿道分泌物であった。7日前に女性パートナーと咽頭を介した性行為を行っていた。尿道分泌物塗抹染色ではグラム陰性双球菌を検出し, 尿中クラミジア・トラコマチス抗原が陽性であったことから, 当初は淋菌およびクラミジア・トラコマチス混合感染による尿道炎と診断したが, 尿道分泌物培養結果は髄膜炎菌B群であった。スペクチノマイシンおよびアジスロシン投与により21日後には自覚症状が改善し, 尿中クラミジア・トラコマチス抗原および尿培養検査も陰性となった。, A 16-year-old heterosexual man presented to our hospital with a purulent urethral discharge and pain at voiding. These symptoms began seven days after oral-genital contact (fellatio) with his partner. A Gram-stained smear from the urethral discharge showed Gram-negative diplococci, and the antigen of Chlamydia trachomatis from urine was positive. We initially made a diagnosis of urethritis caused by Neisseria gonorrhoeae and C. trachomatis. However, N. meningitidis was isolated by culture. Clinicians should pay attention to the possibility of N. meningitidis infection in all cases resembling gonococcal urethritis.

各種カテーテルを実際に患者に使用して, その表面への細菌の付着性と, 尿道粘膜への刺激性を比較した。親水性素材でcoatingしたカテーテルが従来から使われているテフロンやシリコン製と比べて, 最も細菌が付着しがたく, 局所刺激も少ない, To prevent the occurrence of nosocomial urinary tract infections among patients with indwelling urinary catheters, we compared commercially available catheters for the degree of irritation to surrounding mucosa and bacterial adherence. The hydrogel-coated catheter was found to be superior to the teflon-coated or silicone-coated catheters, since it had the lowest degree of bacterial adherence and mucosal irritation among these products. These findings suggest that the incidence of catheter-induced urinary tract infection would be lowered by the use of hydrogel-coated catheter, and recommend their use for patients requiring long-term urinary catheterization.

GU 205例(47.7%), NGU 225例(52.3%), 平均年齢32.5歳は両群で大差なし.感染源はホステス76.3%, 以下ソープランド, ガールフレンド, 海外, 妻の順であった.尿道分泌は87.7%に認められ, 排尿時痛, 尿道不快感がこれにつづいた.検尿, 尿道分泌物塗抹染色陽性は両群で72.7%, 100%と50.9%, 92.2%で, GUのペニシリン抵抗性は29.4%;25.6%にクラミジア混合感染あり, NGUのクラミジア陽性は71.8%となった.GUのNQ, PC治療1週間後の有効は80.6%, 83.8%で, NQによる淋菌消失は89.7%である.NGUではNQ, MINO治療1週間後の有効は70.4%, 85.3%, クラミジア消失は70.0%, 100%であった.NQのOFLX有効は84.3%で最高, 両群共治療は2週間の方が再燃が少なかった, We reviewed 497 patients with male urethritis diagnosed between January, 1986 and March, 1989 at the Asama General Hospital. The incidence of gonococcal urethritis (GU) was 47.7%, and that of non-gonococcal urethritis (NGU) 52.3%. There was no difference in the age distribution between GU and NGU. Prostitutes were the most common source of the infection in both GU and NGU. Incubation periods were longer in NGU than in GU, statistically. Urethral discharge was the most common symptom. Purulent urethral discharge was seen more commonly than serous urethral discharge in GU. On the contrary, serous urethral discharge was more common in NGU. Penicillin-resistant gonococcus comprised 29.4% and mixed infection of the C. trachomatis existed 25.6% in GU. C. trachomatis was detected in 71.8% in NGU. In GU, new quinolones and penicillins were administered frequently. The effective rates 1 week after the administration were 80.6% and 83.3%, respectively. In NGU, new quinolones and minocycline were administered frequently. The effective rates were 70.4% and 85.3%, respectively. Ofloxacin (OFLX) showed the highest effective rate to NGU among the four new quinolones. The relapse rate for the two-week administration group was lower than that for the one-week-administration group, but the difference was not statistically significant.

1977年から1984年までの8年間に経験した尿道炎患者について, 臨床的観察を行った.1)尿道炎新患数は徐々に増加し, 8年間で約2.5倍の増加がみられた.1981年を除いて, NGU(非淋菌性尿道炎)がGU(淋菌性尿道炎)よりも若干多くみられた.2)陰部ヘルペスと尖形コンジローマの増加傾向が認められた.3) GU, NGUとも20, 30歳代に最も多くみられた.4) GU, NGUとも特殊浴場からの感染が最も多かった.5)潜伏期間はGUでは1週間以内が60%以上と最も多く, 全例が1ヵ月以内であった.NGUでも1週間以内が最も多かったが, GUより潜伏期間の長い傾向がみられた.6) GUに対して, 1979年以前では主にPCGの投与が, 1980年以降ではMINOあるいはDOXYとSPCMの併用投与が最も多く行なわれ, 治癒成績はそれぞれ94%, 99%であった.7) NGUに対して, 1979年以前にはMINOあるいはDOXYは7例(10%)に投与されたにすぎなかったが, 1980年以降では152例(89%)に投与され, その成績はそれぞれ43%, 97%の治癒率であった, Clinical observations were made on patients with urethritis, syphilis, chancroid, genital herpes and venereal warts for the last eight years at Gifu City Hospital. The patients with urethritis, genital herpes and venereal warts tended to increase yearly, and the number of the cases with urethritis increased about 2.5 times in the eight years. Slightly more patients had nongonococcal urethritis than gonococcal urethritis excluding 1981. Of the patients with gonococcal urethritis seen between 1977 and 1979, 58% were treated with benzylpenicillin intramuscularly, and 43% of the patients seen between 1980 and 1984 were treated with a concomitant therapy of spectinomycin intramuscularly and minocycline or doxycycline orally. The cure rate for each treatment was 94% and 97%, respectively. Of the patients with nongonococcal urethritis seen between 1980 and 1984, 89% were treated with minocycline or doxycycline orally, and the cure rate was 97%. On the other hand, the cure rate was 43% for the treatment between 1977 and 1979, only 10% of whom had received treatment with minocycline or doxycycline.

Thirty patients with acute urethritis were treated with short-term administration of norfloxacin. The drug was administered randomly in two regimens: Two 400 mg oral doses for a single day or three 200 mg oral doses for three days. For gonorrheal urethritis, the efficacy rates of one and three-day administrations were 75 and 90%, respectively. For non-gonorrheal urethritis, they were 75% each. No adverse effects were observed. The results indicate that short-term administration of norfloxacin is useful in the treatment of acute urethritis, especially for gonorrheal urethritis.