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OBJECTIVES: To investigate semen quality in HIV patients under stable antiretroviral therapy (ART) compared with WHO 2010 reference values and on the sperm proteome level. DESIGN: Between 2011 and 2013, we prospectively enrolled 116 HIV-positive men without hepatitis B or C co-infections from our outpatient department for infectious diseases. METHODS: Patients received a comprehensive andrological work-up. Complete semen analysis was performed according to WHO 2010 recommendations, with each semen variable of the study population being compared with the WHO reference group (n~2000). Correlation analysis was done to investigate the influence of HIV surrogate parameters on semen quality. Two-dimensional gel electrophoresis and subsequent protein identification was performed to determine any differences in the sperm protein composition of the 15 HIV-positive patients and that of 15 age-matched healthy men. RESULTS: Median values of all assessed semen parameters were within a normal range. However, for each semen variable, about 25% of patients had values below the fifth percentile of the WHO 2010 reference group. Disease-related parameters (CD4þ cell count, viral load, CDC stage, duration of disease, duration of ART, number and type of antiretroviral drugs) were not significantly correlated with any sperm parameter. Sperm proteome analysis identified 14 downregulated proteins associated with sperm motility and fertility. CONCLUSION: This is the first study that compares all standard semen parameters in HIV positive patients under ART to WHO 2010 reference values. It provides evidence of impaired conventional semen parameters and altered sperm protein composition. Finally, HIV surrogate parameters are not suitable for predicting semen quality.

We report a case of a pregnant 21-year-old woman with pulmonary tuberculosis in which magnetic resonance imaging of the lung was used to assess the extent and characteristics of the pathological changes. Although the lung has been mostly ignored in magnetic resonance imaging for many decades, today technical development enables detailed examinations of the lung. The technique is now entering the clinical arena and its indications are increasing. Magnetic resonance imaging of the lung is not only an alternative method without radiation exposure, it can provide additional information in pulmonary imaging compared to other modalities including computed tomography. We describe a successful application of magnetic resonance imaging of the lung and the imaging appearance of post-primary tuberculosis. This case report indicates that magnetic resonance imaging of the lung can potentially be the first choice imaging technique in pregnant women with suspected pulmonary tuberculosis.

Sexually transmitted infections are caused by a wide variety of bacteria, viruses, and parasites that are communicated from one human being to another primarily by vaginal, anal, or oral sexual contact. Different sexually transmitted infections (STIs) can be present or be transmitted simultaneously, and the presence of any such infection increases the risk of contracting other types of STI. Sexually transmitted infections are often oligo- or asymptomatic. According to the World Health Organization (WHO), sexually transmitted infections are one of the five types of disease for which adults around the world most commonly seek medical help (1). The current state of the data on the prevalence of sexually transmitted infections in Germany does not permit any reliable conclusions about infection rates, except for those of two diseases: human immunodeficiency virus (HIV) and syphilis (2). Sexually transmitted infections can cause severe fetal and neonatal damage, genital neoplasia, and infertility. A number of diagnostic strategies and tests, of variable quality, are available for the individual pathogens. Definition According to the WHO, sexually transmitted infections are one of the five types of disease for which adults around the world most commonly seek medical help. The diagnostic and therapeutic algorithms can generally be tailored to the leading clinical manifestations (if the patient is symptomatic). Thus, sexually transmitted infections can usefully be classified by their presenting features, as follows: Genital, anal, perianal, or oral ulcers Urethral or vaginal discharge Genital warts HIV or hepatitis C virus (HCV) infection. If the availability of diagnostic tests is limited, effective treatment can also be initiated without any testing on the basis of the clinical findings alone, if these are clearly typical of a particular sexually transmitted disease. Asymptomatic infections are common, however, and only detectable by testing. Up to 90% of sexually transmitted infections are asymptomatic. The likelihood that an infection will be asymptomatic depends both on the site of infection and on the responsible pathogen. For example, the probability of asymptomatic rectal infection with C. trachomatis and N. gonorrhoeae is 85% in men who have sex with men (MSM) (e1). 30% of pregnant girls in Tanzania have an asymptomatic type 2 herpes simplex virus (HSV-2) infection (3). In the United States, about 85% of T. vaginalis infections in women are asymptomatic; so are 77% in men (4). The treatment of sexually transmitted infections has the following objectives: To cure the infection in the individual patient as rapidly as possible, and to eliminate contagiousness as rapidly as possible in order to interrupt the chain of transmission; To prevent reinfection and recurrent infection. The treatment of sexual partners is important as well. Bacterial infections and trichomoniasis can now be cured with systemic treatment (1, 5, 6). Viral infections due to HIV, HSV, and human papillomaviruses cannot be cured, but they can be weakened or modulated with systemic treatment (1, 5, 6).

Quantification of hepatitis C virus (HCV) core antigen and RNA in serum samples leads to a highly variable ratio of both. It is not clear whether this is due to the inaccuracy of RNA quantification or whether both are independent parameters in a certain range. We established a real-time reverse transcription (RT)-PCR for HCV RNA that combines very high sensitivity with a large dynamic range and minimal standard deviations. The assay was calibrated with the first international standard, 96/790, and the international genotype panel for HCV from the National Institute of Biological Standardisation and Control. A linear readout was obtained between 200 and 5 × 10 7 IU/ml. The detection limit was 80 IU/ml, the reproducibility was

Alterations of bone metabolism have been observed in numerous studies of HIV-infected patients. Sex steroids are known to profoundly influence bone mass and bone turnover. Hypogonadism is common in HIV-infection. Therefore, we performed a cross sectional study of 80 male HIV-infected patients without wasting syndrome, and 20 healthy male controls, in whom we analyzed urine and serum samples for both calciotropic hormones and markers of bone metabolism and of endocrine testicular function. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry both in the lumbar spine and Ward's triangle of the left hip. None of the patients received highly-active-antiretroviral-therapy (HAART). Compared to eugonadal HIV-infected patients, subjects with hypogonadism (n = 32; 40%) showed statistically significant decrease of serum osteocalcin (p < 0.05) and elevated urinary excretion of crosslinks (p < 0.05). However, we found 13 and 15, respectively, patients with osteopenia (t-score -1.0 to -2.5 SD below normal) of the lumbar spine. The dissociation between bone formation and resorption and the reduction of of BMD (p < 0.05) is stronger expressed in patients with hypogonadism. Habitual hypogonadism appears to be of additional relevance for bone metabolism of male HIV-positive patients prior to HAART.

Background Syphilis is called the chameleon of the diseases due to its variety of its clinical presentations, potentially affecting every organ of the body. Incidence of this ancient disease is once again on the increase worldwide. Case presentation We here report an unusual case of neurosyphilis manifesting with unilateral visual loss and hyponatremia. The patient also had primary syphilitic lesions and was concomitantly diagnosed with Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Treatment with ceftriaxone and prednisolone, completely resolved the hyponatremia and visual acuity was partially restored. Conclusion Awareness of syphilis as a differential diagnosis is important as previously unreported presentations of neurosyphilis can arise, especially in HIV infected patients.