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Male urethritis is an inflammation of the urethra and the periurethral glands; it is widely classified as gonococcal or non-gonococcal. The most frequent microorganisms responsible are Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum. In the last three decades, the diagnosis of sexually transmitted diseases depended almost exclusively on traditional methods, such as culture, enzyme immunoassay, fluorescent antibody staining, and hybridization, until the appearance of molecular techniques. Clinical syndromes such as urethritis are rarely specific for a single microorganism, so screening strategies should allow multiple agents to be considered. Multiplex PCR is the fastest and most sensitive technique for the diagnosis of gonococcal and non-gonococcal urethritis. Male urethritis without treatment is one of the main health problems related to reproductive and sexual function, constituting one of the main causes of infertility. The objective of this mini-review was to analyze the epidemiology, causes, diagnosis, and complications of male urethritis., (Copyright © 2020 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Gonococcal infection is a current public health problem worldwide, being the second most prevalent bacterial sexually transmitted infection. The etiologic agent is Neisseria gonorrhoeae, a gram-negative diplococcus, and mainly causes urethritis in men. In women up to 50% of infections can be asymptomatic. N. gonorrhoeae has a great ability to develop antibiotic resistance, so the last remaining therapeutic option are extended spectrum cephalosporins. Many guides recommend dual therapy with ceftriaxone and azithromycin, but in recent years the resistance to azithromycin is also increasing, so that dual treatment is being questioned by scientific societies., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Introduction: The incidence of urethritis due to Haemophilus species is increasing. The main aim of this study was to describe the clinical and microbiological characteristics of patients with this form of urethritis. A secondary aim was to discuss the adequacy of treatments in patients with different types of antibiotic resistance., Material and Methods: We studied patients with a microbiologically confirmed diagnosis of urethritis seen at the Sexually Transmitted Infections Unit of our hospital between July 2015 and July 2018. We selected all patients in whom Haemophilus species were isolated on chocolate agar. Antibiotic resistance was tested using the disk-diffusion method. Cross-sectional data were collected prospectively during outpatient visits., Results: Haemophilus species were isolated in 33.6% of cases. The most common clinical manifestation was urethral discharge (57.6%); 60% of the patients were men who have sex with men and in this subgroup Haemophilus species were significantly more common than either Neisseria or Chlamydia species. Haemophilus species were found in isolation in 39.5% of patients and the most common one was Haemophilus parainfluenzae (isolated in 84.2% of cases). In total, 34.2% of patients were resistant to azithromycin and 26.3% were resistant to both azithromycin and tetracycline. Empirical treatment achieved clinical and microbiologic cure in 11 of the patients who were not lost to follow-up (n=17; 44.7%). The remaining 6 patients required treatment with a new antibiotic., Conclusions: Haemophilus species are a new cause of nongonococcal urethritis, whose incidence is rising, particularly in men who have sex with men who engage in unprotected oral sex. The clinical manifestations are similar to those seen in gonococcal urethritis. Eradication of infection must be confirmed due to the high rate of antibiotic resistance associated with Haemophilus species., (Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To know the best empirical treatment of urethritis in patients at the City Center of Madrid., Methods: 2.021 urethral exudates were analyzed in men between January 2003-December 2007. In addition to the traditional cultures, it was determined the presence of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis and Herpes simplex. The susceptibility of N.gonorrhoeae and Haemophilus spp was performed by disk diffusion method and U. urealyticum by Mycoplasma IST., Results: The percentage of positive samples was: 30.6%. The most frequently isolated microorganisms were: U. urealyticum 9.9%, N. gonorrhoeae 7.4%, C. trachomatis 5.1% and Haemophilus spp 3.8%. The resistance of N. gonorrhoeae in the first period was: penicillin 11.8%, tetracycline 5.9%, ciprofloxacin 8.8% and presence of betalactamase 11.8%. In the second period: penicillin 9.7%, amoxicillin/clavulanic acid 1.4%, tetracycline 8.3%, ciprofloxacin 23.6% and presence of betalactamase 10.5%. Resistance to ciprofloxacin in non-MSM (men having sex with men) was 20% and in MSM 56.2%. Resistance of Haemophilus spp in the first period was: 38.2% ampicillin, amoxicillin/clavulanic acid 8.8%, clarithromycin 35.3%, cotrimoxazole 64.7%, cefuroxime 5.9%, ciprofloxacin 8.8%, tetracycline 12.1% and presence of betalactamase 26.5%. In the second period:presence of betalactamase 41.9%, ampicillin 53.1%, amoxicillin/clavulanic acid 9.4%, cefuroxime 9.4%, clarithromycin 18.7%, tetracycline 34.4%, ciprofloxacin 15.6%, and cotrimoxazole 68.7%. Resistance of U. urealyticum was: ciprofloxacin 80.7%, ofloxacin 32.4%, erythromycin 17.5%, azithromycin 9.6%, tetracycline 3.5% and doxycycline 0.8%., Conclusions: N. gonorrhoeae showed a level of resistance to tetracycline and ciprofloxacin higher in the second period, being significant for ciprofloxacin. Quinolone resistance was higher in MSM. Haemophilus spp showed a level of resistance to ampicillin, ciprofloxacin and tetracycline higher in the second period, being significant for tetracycline. U.urealyticum showed high level of resistance to ciprofloxacin (80.7%)and ofloxacin (32.4%) and low level of resistance to doxycycline (0.8%) and tetracycline (3.5%).

Objective: To determine the prevalence of Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonhorroeae) infections and the risk factors for acquiring them in individuals under 35 years-old attending sexual health clinics in Barcelona province in 2006., Methods: Cross-sectional study of a convenience sample of 500 adolescents and young adults aged between 16 and 35 years. A total of 423 samples were analysed using real-time PCR. A standardised questionnaire was used to collect clinical, epidemiological, and behavioural data on the participants. Significant differences were analysed in the descriptive study using Pearson's ((2). The association between C. trachomatis infection and its determining factors was analysed using the Mantel-Haenszel test and a multivariate logistic regression model., Results: The overall prevalence of C. trachomatis was 4%, and was significantly higher in those under 25 years of age. The overall prevalence of N. gonhorroeae was 0.2%. The independent risk factors for infection by C. trachomatis were as follows: foreign origin (OR: 3.74; CI 95%: 1.10-12.72), having had a sexual partner in the last 3 months (OR 3.91; CI 95%: 1.30-11.81), and tobacco use the last 12 months (OR: 4.99; CI 95%: 1.34-18.59)., Conclusions: This is the first study performed in Catalonia that shows high prevalence of C. trachomatis in young people, thus confirming trends in the rest of Europe. Systematic monitoring of C. trachomatis infection in sentinel populations will provide valid information allowing us to assess the relevance of proposing targeted screening programs in our setting., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Objectives: The aim of this study is to know the prevalence and tendency of microorganisms producing urethritis, in men, in the City Centre of Madrid., Methods: Cross-sectional study. The urethral samples of 1.248 men were analyzed, for 3 years. The samples were studied for: GRAM stain, when secretion exists; culture in habitual plates; detection of C. trachomatis, U. urealyticum and M. hominis, when there was suspicious, study of T. vaginalis and when suspicious injuries exist, study of virus Herpes simplex., Results: The percentage of positive samples was 22.60%. The isolated microorganisms were: U. urealyticum 7.61%, N. gonorrhoeae 6.33%, C. trachomatis 4.81%, M. hominis 0.24%, H. parainfluenzae 1.76%, H. influenzae 1.12%, Candida spp 0.48%, S. pyogenes 0.16% and Herpes virus simplex (2) 0.08%. Two or more microorganisms were isolated in 1.68%. The percentage of positive samples in 2003 was 17.41% and N. gonorrhoeae the most frequent microorganism (6.22%). In 2004 was 25.57% and the most frequent U. urealyticum (10.18%). In 2005 the 24.50% of the samples were positive and U. urealyticum the most frequent (7.92%). The 79.41% of N. gonorrhoeae were susceptible to all antibiotics tested. It is not found resistance to ceftriaxone, claritromicine and amoxicilline/clavulanic acid. The 11.76% were betalactamase- producing. The 26.47% of Haemophilus spp. were betalactamase- producing and all strains were susceptible to cefotaxime., Conclusions: The isolated microorganisms most frequently were: U. urealyticum, N. gonorrhoeae and C. trachomatis. There is an increase of 7% of prevalence between the years 2003 and 2005. Ceftriaxone, claritromicine and amoxicilline/clavulanic acid were susceptible to all the strains studied and cefotaxime to all Haemophilus spp.

Objective: Mycoplasma genitalium has been associated with nongonococcal urethritis (NGU). Diagnosis by PCR has become the primary detection method for this organism. Thus, diagnosis by DNA amplification using the PCR technique should be utilized., Material and Methods: GMF/GMR and MgpF/MgpR primer pairs, complementary to the M. genitalium 16S rRNA and MgPa genes, respectively, were selected. Specificity and sensibility assays were conducted and clinical samples were studied., Results: The PCR with each primer pair was specific only for M. genitalium, and the sensibility was higher with the GMF/GMR primers. In the study of 34 clinical samples, 18,5% were positive for M. genitalium, with more positive samples when the MgpF/MgpR primers were used., Conclusions: DNA amplification by PCR should be applied in clinical practice to the diagnosis of M. genitalium in patients with NGU should using.

Introduction: The aim of this study is to analyze the clinical and epidemiological characteristics of Chlamydia trachomatis infection in patients attended in a clinic for sexually transmitted disease in Seville (Spain). Microbiological diagnosis was performed in various types of samples., Material and Methods: The study included 3854 patients (50.8% women and 49.2% men, mean age 30.1 years) seen from 2002 to 2004. Among the total, 50% belonged to groups engaging in high risk sexual practices: female commercial sex workers (CSWs) (47%), men who maintain sexual relationships with other men (MSM) (45%), users of prostitution (4%), promiscuous heterosexual men (4%), those with a risk partner (2.7%) and injection drug users (IDU) (2.2%). We analyzed a total of 5978 samples (2384 cervical exudates, 2645 urethral exudates and 949 rectal exudates), for the detection of C. trachomatis by PCR technique with the COBAS Amplicor CT System., Results: Prevalence of C. trachomatis infection was 6% (4.3% in women and 7.8% in men). Among the total in women, 51.2% of positive samples were from women with high-risk sex factors and 73.8% of the women were asymptomatic. In men, the proportions were 70.5% and 36.9%, respectively. Cervical, urethral and rectal exudates yielded positive results in 4%, 4.9% and 4.3%, respectively., Conclusions: Systematic sampling for C. trachomatis detection is necessary in symptomatic and asymptomatic patients practicing high-risk sex; periodic follow-up studies are also needed for early detection of sexually transmitted infection. Rectal sample collection is important for detecting this infection in MSM and in patients whose sexual habits make it advisable.

Mycoplasma genitalium is an opportunistic pathogen of the genital tract. It has been implicated as an etiological agent of urethritis in men and cervicitis and pelvic inflammatory disease (PID) in women. The aim of this study was to determine the prevalence of Mycoplasma genitalium in male urethritis and in vaginal specimens of pregnant women. Urethral specimens obtained from 37 men presenting with urethritis and vaginal specimens from 50 consecutive pregnant women were tested for the presence of M. genitalium by polymerase chain reaction (PCR). The urethral specimens were also examined for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma sp whereas the vaginal microbiota and the presence of genital mycoplasma were investigated in the vaginal specimens. Twenty three cases were classified as nongonococcal urethritis (NGU) and 14 as gonorrheal disease. M. genitalium was detected in 3 of 23 (13.04%) men with NGU; in two cases with Ureaplasma sp, and in one patient as the unique agent. C. trachomatis was found in 7 patients with NGU and in one patient with gonorrhea. Ureaplasma sp was isolated in 13 (35.1%) patients, 8 cases of NGU and in 5 patients with gonorrhea. The organism was also detected in 6 (15%) of 40 women; in 5 cases in the presence of a normal microbiota (Nugent score 0-3), and an in one case in the presence of bacterial vaginosis. Ureaplasma spp was isolated in the 6 positive specimens. This study indicates that M. genitalium can be detected in urethral specimens of some cases of NGU as well as in the lower genital tract of pregnant women in the presence of a normal vaginal microbiota.

Objective: To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatología, as well as to compare the clinical data and lifestyle between C. trachomatis-infected and uninfected men to establish a possible association with gynecological damage in their sexual female partners., Methods: An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatología between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hybridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analyze clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05., Results: C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation of Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR = 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR = 2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5)., Conclusion: A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C. trachomatis.

Sexual pathogens, cell types and morphologic alterations of urethral epithelial cells were investigated by means of the Papanicolaou smear in 110 heterosexual men. Seventy-five patients with urethritis were included: 17 (22.6%) with gonococcal urethritis (GU) and 58 (77.3%) with non-gonococcal urethritis (NGU). Thirty-five males without symptoms or signs of urethritis comprised the control group. An increase in epithelial cell dissociation was observed in patients with urethritis. Non-specific inflammatory changes were statistically more common in patients with urethritis than in controls, and more severe in GU (65%) than in NGU (15.5%). Nuclear atypia was a common finding (43.5%) in infections due to C. trachomatis. Mucus was associated with the presence of urethritis although no differences regarding etiology were found. No polimorphonuclear neutrophils were observed in the exudate of three patients (5%) with NGU. There was a statistically significant presence of lymphocytes in patients with urethritis, particularly in GU (45%), more frequent than in NGU (15.5%). Erythrocytes were also significantly more frequent in urethritis, with a greater proportion in GU (94%) than in NGU (64%). Plasma cells, eosinophils, and histiocytes were only observed in a few patients with urethritis. The Papanicolaou smear had a sensitivity of 47% and a specificity of 90% in Chlamydia trachomatis infections.

Mycoplasma hominis and Ureaplasma urealyticum are species closely related to urogenital diseases such as pyelonephritis, nongonococcal urethritis, urinary calculi, epididymitis, pelvic inflammation, infertility, abortions and post-delivery fever. They can also cause pneumonia and meningitis in newborn infants. In this paper we used nucleic acid hybridization and polymerase chain reaction to analyze 22 samples from patients with different urogenital symptoms in order to detect mycoplasmas and ureaplasmas. We obtained 10 positive samples and 12 were negative. From positive samples we identified two with Mycoplasma hominis, two with Ureaplasma and six with both species. The results obtained by these molecular techniques were compared with reference methods and we found coincident results in 18 samples, while in four the results were discordant. These discordant findings were not statistically significant.

Background: Chlamydia trachomatis is responsible for 30 to 50% of genital tract infections and is present, without symptoms, in 20% of men and 60% of women. We have little information in Chile about the prevalence of this infection., Aim: To assess the prevalence of Chlamydia trachomatis in men, using first catch urine samples., Subjects and Methods: Three hundred and fifty one first catch urine samples of asymptomatic men and 50 samples coming from men with a primary urethritis, were analyzed. Urethral discharge samples from the latter were simultaneously studied. Analysis was performed using an enzyme immuno analysis (MicroTrak Chlamydia EIA, Syva Co.) and a nested polymerase chain reaction towards the gene that codifies MOMP (PCR/OMP)., Results: Among asymptomatic men, two of 154 teenagers aged 18 to 19 years old (1.3%), 10 of 100 university students (10%) and eight of 97 adults over 30 years old (8.2%), were infected. The global prevalence of infection in these men was 5.7%. The prevalence of infection in men with urethritis was 12%. Urine EIA had a higher detection frequency than PCR/OMP, but according to another PCR assay, these results were false positives. EIA in first catch urine, had a sensitivity, specificity, positive and negative predictive value of 83.3, 75, 31.3 and 97% respectively, for the detection of Chlamydia trachomatis. The figures for PCR/OMP were 100% for all these parameters., Conclusions: The prevalence of Chlamydia trachomatis infection in Chilean men is similar to that reported in developed countries. Enzyme immuno assay in first catch urine had a good diagnostic accuracy and could be used in epidemiological studies in asymptomatic men.

Background: In this report we inform laboratory results accumulated over ten years (1986-1995). The number of cases, and the geographic distribution, allow us to present a very reliable data about the dimension of Chlamydia trachomatis urogenital infections in Buenos Aires city and we also compare this profile with the prevalence of Neisseria gonorrhoeae in the same area and period of time., Methods: Patients were females and males (aged from 15 to 49 years old) attending clinics not specialize in Sexually Transmitted Diseases (STD). Intent to isolation of C. trachomatis was done in McCoy cells culture. Patients for Neisseria gonorrhoeae investigation were a population assisted at the Clinic for STD of an University Hospital (aged from 15 to 75 years old). Study for detection of N. gonorrhoeae was developed by direct and conventional culture technics., Results: 4128 endocervical samples from women with lower genital tract pathology were studied and C. trachomatis infection was detected in 25.6 +/- 4.8%. Over 1206 male urethral samples 29.5 +/- 4.47% shows positive cultures. Except for years 1989 and 1990 in which annual percentage of infected women showed slightly higher percentage over the global average, the results shows a very stable annual values, as it was also found in male patients. Infection in males shows a discrete tendency to be higher compare with values obtained in women. Global results of the evolution of prevalence of N. gonorrhoeae infection shows a very different pattern. Since 1992 we demonstrate a very significant decrease in the number of confirmed cases., Conclusions: We concluded that patients not attending a STD clinic, reveal a high and very stable endemic level of C. trachomatis lower tract urogenital infections. N. gonorrhoeae in this population is a very sporadic or null finding. Prevalence of Chlamydial infection in STD centers is even higher and also shows an stable profile. In people attending STD clinics N. gonorrhoeae shows a very different kinetics, with an important decrease in prevalence in the last five years.

Background: Haemophilus spp. had been previously suggested as a potential pathogen in genitourinary infections that could be sexually transmitted. In order to check that suggestions we have determined the incidence, pathogenic role, possible sexual transmission and susceptibility to antibiotics in isolates of Haemophilus parainfluenzae and Haemophilus influenzae from genital tract infections. The microbiological samples were taken during a period of four years from patients attended in a Service of Sexual Transmission Diseases and the data were further reviewed., Methods: The study included 5,572 genital specimens from 2,182 women prostitutes with different genitourinary infections and from 825 men with urethritis. Microbiological samples were cultured in a non-specific media for genital pathogens and species of Haemophilus spp. and clinical circumstances of isolation were evaluated. Susceptibility tests were performed by using a standard microdilution test., Results: Haemophilus spp. was isolated in 155 samples (2.8%) using a non-selective culture method. H. parainfluenzae was isolated in 100 cases (64.5%), Haemophilus influenzae in 45 cases (29%) and Haemophilus spp. in 10 strains (6.4%). Haemophilus spp. was isolated as a sole pathogen in men with urethritis (8 cases), epididymo-orchitis (2 cases), cervicitis and/or vaginitis (9 cases) and Bartholin's Abscess (2 cases). The most frequent biotypes were H. parainfluenzae biotype II (43%) and III (19%), and H. influenzae biotype IV (35.5%). Beta lactamase activity and ampicillin resistance were present in 29% of the H. parainfluenzae strains and in the 26.7% of clinical isolates of H. influenzae., Conclusions: 1) Haemophilus spp. was isolated from genitourinary infections at a low frequency in the studied group. 2) The pathogenic role of Haemophilus spp. was suggested when was isolated as a sole pathogen present from some infections of the genitourinary tract such as urethritis in men and Bartholin's abscess in women. 3) The susceptibility to antibiotics in the clinical isolates of Haemophilus spp. from genitourinary infections was similar previously reported studies performed in Spain.

A case of a patient with schistosomiasis haematobium history, from Mozambique, is presented. This patient was admitted in the Institute of Tropical Medicine for having urination troubles and purulent urethral secretion. Serotype B Haemophilus influenzae, biotype i.v. of the urethra, was isolated. The strain was sensitive to ampicillin, chloramphenicol, ceftraxione, and norfloxacin, and resistant to tetracycline and erythromycin. The patient got better after receiving treatment with norfloxacin. A comment is made on the role of this microorganism as a sexual transmission pathogen.

Background: To compare and evaluate two commercial methods for Mycoplasma hominis and Ureaplasma urealyticum with the isolation in agar A7 medium., Method: One hundred and twenty three vaginal and cervical swabs in women prostitutes, and urethral swabs in men, were studied for Mycoplasma hominis and Ureaplasma urealyticum isolation in agar A7 medium (BioMérieux; France), Mycoplasma IST (BioMérieux, France) and MycoFast ALL-IN (Unipath, U.K.)., Results: Of all 123 samples studied, it was isolated 24 Mycoplasma hominis (19.5%) and 56 Ureaplasma urealyticum (45.5%) in agar A7. The sensitivity was 100% for Mycoplasma hominis and Ureaplasma urealyticum in Mycoplasma IST versus 29.2% and 50% in MycoFast ALL-IN, both respectively. Specificity was lower for Ureaplasma urealyticum (59.7%) in Mycoplasma IST than in MycoFast ALL-IN (100%). It was found a tetracycline resistance of 15% and 12.5% for Ureaplasma urealyticum and Mycoplasma hominis, both respectively., Conclusions: The use of commercial methods permits to count the genital mycoplasmas, being Mycoplasma IST better than MycoFast ALL-IN for Mycoplasma hominis isolation. Both methods have limitations for Ureaplasma urealyticum and they require the use of agar A7. Mycoplasma IST could be a good method to survey tetracycline resistance.

Nine hundred thirty four samples of urethral secretion proceeding from male subjects without previous treatment were analyzed with Gram stain. These subjects consulted in Santiago Western area, and belong to medium and low socioeconomical status. In 82.5% of samples, intracellular gram-negative diplococci were found, that made the presumptive diagnosis of gonococcal urethritis. The importance of direct examination of urethral secretion for the diagnosis and immediate treatment of gonococcal urethritis is emphasized.

From 1985 to 1987 we obtained urethral samples from 453 patients with a clinical diagnosis of urethritis. N gonorrhoeae was isolated in 55%, a rate that increased along the study period. The most common other agent was U urealyticum alone or in combination with other organisms. Among 82 patients, the incidence of chlamydia trachomatis was 19%. The proportion of Beta-lactamase producing strains among N gonorrhoeae varied form 7% in 1985 to 13% in 87 and 3% in 1988.

247 strains of N gonorrhoeae were isolated from 453 patients with acute urethritis from 1985 to 1987. 19 strains produced beta-lactamase for a 7, 13 and 3% incidence in each of the 3 years. MIC between 1 and 8 micrograms/ml or between 65 and 256 micrograms/ml were found in 2 groups of beta lactamase producing strains. An increase in the sensitivity rate (81%) to penicillin of non beta-lactamase producing strains was observed in this period. The sensitivity to erythromycin and chloramphenicol remained constant while a slight increase in resistance to tetracycline was observed.

A retrospective study to investigate the relationship between the isolation of Chlamydia trachomatis and other factors occurring in 146 patients suffering of non-gonococcal urethritis, has been released 39 being positive for C. trachomatis. The relationship between the isolation of C. trachomatis and previous antibiotic treatment, age, sexual different contacts in the last month and year has been studied. The main feature affecting the isolation is the absence of antimicrobial therapy a previously to the specimen collection and being performed after four days post-contact.

A study of 280 male patients with urethritis is presented. The frequency of infections caused by Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans and Mycoplasma "T" is reported. Some clinical characteristics of patients regarding the type of urethritis are described. Literature on non-gonoccal urethritis is reviewed.

A prospective study was carried out in 103/863 obstetric patients with cystitis characterized by urinary urgency and frequency, dysuria, pyuria and suprapubic discomfort in the absence of systemic symptoms such as fever and costovertebral angle tenderness. The association of symptomatic lower urinary tract infection with low-count bacteriuria (10(2)-10(5) UFC/mL of urine) was present in all the patients. The incidence of cystourethritis was about 12%, most of the infections occurred at the first trimester. To learn whether a multiple-dose of nitrofurantoin or ampicillin is safe and effective therapy for acute uncomplicated urinary tract infections, 103 symptomatic pregnant women were randomly grouped to receive oral nitrofurantoin (100 mg t.i.d.) or ampicillin (500 mg t.i.d.) for five days. Seventeen patient were excluded since they did not return for follow-up. Escherichia coli was isolated in 67% of infections. Overall cure varied from 87% to 89%, without any great differences between the regimens. Nine patients had asymptomatic bacteriuria in the course of pregnancy, four developed acute pyelonephritis and one of them had abnormal intravenous pyelogram.

The presence of Chlamydia trachomatis was studied by the direct immunofluorescence test, as also was that of Neisseria gonorrhoeae, Mycoplasma and Ureaplasma by the standard methods, in 82 patients with urethral discharge. Ch. trachomatis was found in 19.5% (16) of the cases and in 11 of them (68.8%) there was association with the other bacteria investigated. This eleven patients presented a scanty gelatinous discharge.