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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 (MIC90) 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.

Background Gentamicin has been used for the treatment of gonorrhea in Malawi since 1993. However, declining clinical cure rates have been suspected. We evaluated current Neisseria gonorrhoeae susceptibility to gentamicin in vitro and clinically. Methods Men with acute urethritis were recruited at the Bwaila District Hospital STI Clinic in Lilongwe, Malawi, between January 2017 and August 2019. All men provided urethral swabs for etiological testing at enrollment and test of cure (TOC), one week later, using Gram-stained microscopy and culture. We used Etest to determine minimum inhibitory concentrations (MICs) of gentamicin, azithromycin, cefixime, ceftriaxone, ciprofloxacin, and spectinomycin, disc diffusion for tetracycline susceptibility and whole genome sequencing (WGS) to verify/refute treatment failure. Results Among 183 N. gonorrhoeae culture-positive men enrolled, 151 (82.5%) had a swab taken for TOC. Of these 151 men, 16 (10.6%) had a positive culture at TOC. 141 baseline isolates were tested for gentamicin susceptibility using Etest; 2 (1.4%) MIC = 2 μg/mL; 111 (78.7%) MIC = 4 μg/mL; and 28 (19.9%) MIC = 8 μg/mL. All isolates were susceptible to azithromycin, cefixime, ceftriaxone, and spectinomycin while 63.1% had intermediate susceptibility or resistance to ciprofloxacin. Almost all (96.1%) isolates were resistant to tetracycline. All examined isolates cultured at TOC (n = 13) had gentamicin MICs ≤8 μg/mL. Ten men had pre- and post-treatment isolates examined by WGS, 2 (20%) were verified new infections (4119 and 1272 single-nucleotide polymorphisms (SNPs)), while 8 (80%) were confirmed treatment failures (0-1 SNP). Conclusions Gentamicin MICs poorly predict gonorrhea treatment outcome with gentamicin, and treatment failures are verified with gonococcal strains with in vitro susceptibility to gentamicin. The first-line treatment for gonorrhea in Malawi should be reassessed.

Objectives Gonococcal infections with a higher bacterial load may pose a higher risk of transmission. We assessed the association between gonococcal bacterial load and coinfection with Mycoplasma genitalium. Methods From September 2015 until May 2018, 200 men and transgender women who have sex with men participated in an HIV pre-exposure prophylaxis (PrEP) demonstration trial in Antwerp, Belgium. They underwent 3-monthly 3-site (anus, urine, and pharynx) molecular testing for N. gonorrhoeae and C. trachomatis and M. genitalium, irrespective of symptoms. Gonococcal bacterial load was determined on remnant DNA extracts using an in-house quantitative PCR. Results were expressed as log10 transformed copies/mL and analyzed with a linear regression model. Results Gonococcal bacterial load could be determined for 82 (80.4%) of 102 anal, 17 (73.9%) of 23 urine, and 64 (90.1%) of 71 pharyngeal samples. M. genitalium was detected in five of these anal, two urine, and two pharyngeal samples and C. trachomatis was detected in 16 anal, one urine, and two pharyngeal samples. Gonococcal bacterial load was significantly higher in the presence of M. genitalium (difference 0.92 log copies/mL, 95% CI 0.16–1.67). Conclusions Gonococcal bacterial load was higher with M. genitalium coinfection. M. genitalium may thus be a cofactor in gonococcal transmission.

Recently, culture-independent molecular methods, such as DNA sequencing techniques targeting the 16S-ribosomal RNA (rRNA) gene and/or other housekeeping genes with Sanger method-based technologies, next generation sequencing (NGS), and metagenomic analysis, have been developed for detecting microorganisms in the human body; these can provide information on microbiomes of samples from individuals with or without infectious diseases. Determining the bacterial species is crucial in identifying causative bacteria of upper and lower respiratory tract infections, especially for Streptococcus species, but NGS analysis is often not precise enough to identify bacteria at the species level. This review briefly introduces previous observations of the microbiome of samples from various respiratory and other infections assessed using the clone library method with Sanger sequencing of the 16S-rRNA gene. On analysis of 16S-rRNA gene-sequence data of bronchoalveolar lavage fluid obtained from pneumonia lesions in patients with bacterial pneumonia and lung abscess, anaerobes are often detected in non-elderly patients with pneumonia, and the detection rate of Staphylococcus aureus in patients with hospital-acquired pneumonia is lower than that previously reported. Analysis of pleural effusion samples from patients with pleurisy indicated a more important role of anaerobes than previous believed. The other topics reviewed include microbiomes of nontuberculous mycobacteriosis and lower respiratory tract infections in children with permanent tracheostomy due to neuromuscular disorders, in nasal discharge, in bacterial vaginosis, in the intracystic fluid of postoperative maxillary cyst, and in bacterial conjunctivitis; urine microbiota in urethritis; fecal microbiota; and newly detected infectious organisms in the human respiratory tract.

This review highlights recent changes to the CDC recommendations for sexually transmitted infections. Neisseria gonorrhoea has developed resistance to multiple antibiotics. A total of 500 mg intramuscular ceftriaxone (1000 mg in patients weighing greater than 150 kg) is required to achieve the mean inhibitory concentration to eradicate infection reliably. Mycoplasma genitalium has also been found to develop antibiotic resistance and is implicated in cases of recurrent urethritis and cervicitis. The CDC has published a 2021 update to their sexually transmitted infection management guidelines. These guidelines include new first-line regimens for managing gonorrhea and chlamydia as well as for pelvic inflammatory disease. This review provides a succinct summary of the new treatment guidelines with an emphasis on updates pertinent to management of sexually transmitted infections in the emergency department.

Urethritis is simply defined as inflammation of the urethra. In the majority of cases, urethritis is caused by a sexually transmitted infection. Urethritis is the most common condition diagnosed and treated among men attending genito-urinary medicine (GUM) clinics in the UK. This article aims to outline the assessment and management of urethritis in both primary care and GUM clinics.

Sexually transmitted infections are a public health problem worldwide. Their inadequate antimicrobial management has been associated with a higher risk of recurrence.To characterize the main sexually transmitted infections, the adherence to clinical practice guidelines, and the factors associated with recurrence in Colombia.We conducted an observational study to identify the main sexually transmitted infections, the sociodemographic variables, and the pharmacological management in a patient cohort from a population database of 6.5 million people affiliated with the Colombian health system. We made a multivariate analysis to identify the variables associated with recurrence.We detected 3,158 patients with a mean age of 41.8 ± 14.5 years, of whom 63.1% were men. We found 4.030 episodes of sexually transmitted infections, predominantly urethral syndrome (27.5%). Only 13.6% of patients with urethral syndrome, ulcerative syndrome, or genital warts were managed in compliance with clinical practice guidelines and 20.6% were dispensed condoms; 16.7% of patients had recurrences and being male (OR=1.32; 95%CI 1.08-1.63),30 years old (OR=1.72; 95%CI 1.40-2.13), being treated in municipalities other than capital cities (OR=1.43; 95%CI 1.06-1.94), and having received inadequate treatment for the first episode (OR=1.93; 95%CI 1.52-2.39) were associated with recurrence.The majority of patients with sexually transmitted infections were not treated in compliance with clinical practice guidelines and those who did not have adequate management had a higher risk of recurrence.Introducción. Las infecciones de transmisión sexual constituyen actualmente un problema de salud pública en el mundo. Su inadecuado tratamiento antimicrobiano se ha relacionado con un mayor riesgo de recurrencias. Objetivo. Caracterizar las principales infecciones de transmisión sexual, el cumplimiento de las guías de práctica clínica de Colombia y los factores asociados con las recurrencias. Materiales y métodos. Se hizo un estudio observacional para determinar las principales infecciones de transmisión sexual, las variables sociodemográficas y el tratamiento farmacológico en una cohorte de pacientes registrados en una base de datos poblacional de 6,5 millones de personas afiliadas al Sistema de Salud de Colombia. Se hizo un análisis multivariado para establecer las variables asociadas con las recurrencias. Resultados. Se detectaron 3.158 pacientes; su edad media era de 41,8 ±14,5 años y 63,1 % de ellos correspondía a hombres; se encontraron 4.030 episodios de infecciones de transmisión sexual con predominio del síndrome uretral (27,5 %). El 13,6 % de los pacientes con síndrome uretral, ulceroso o con verrugas genitales se manejó según las guías de práctica clínica. El 20,6 % tenía acceso a condones y el 16,7 % presentó recurrencias. Ser hombre (OR=1,32; IC95% 1,08-1,63), tener30 años (OR=1,72; IC95% 1,40-2,13), ser tratado en municipios distintos a ciudades capitales (OR=1,43; IC95% 1,06-1,94) y haber recibido un tratamiento inadecuado en el primer episodio (OR=1,93; IC95% 1,52-2,39) fueron factores asociados con las recurrencias. Conclusiones. La mayoría de los pacientes con infecciones de transmisión sexual no fueron tratados según las guías de práctica clínica y quienes no tuvieron un manejo adecuado presentaban mayor riesgo de recurrencias.

The literature review provides data on tuberculosis of the urethra in men. This disease is rarely recorded, as a rule, at the stage of formation of the urethral stricture, which can develop many years after the onset of the disease. Urethral tuberculosis is usually secondary to other localizations of extrapulmonary tuberculosis, such as tuberculosis of the prostate, penis, kidney, and bladder, but there are also isolated forms of this disease. The most common symptoms of urethral tuberculosis are the presence of strictures, skin-urethral and recto-prostatic fistulas, and purulent urethritis. Almost always, with this disease, conservative specific therapy was carried out, which in some cases made it possible to completely eliminate the symptoms and ensure the patient’s clinical recovery. Tuberculous urethral strictures are operated on according to generally accepted rules, but there is no single algorithm for the surgical treatment of strictures of this etiology, often limiting itself only to urine diversion or urethral dilation. Of the urethroplasty, the most commonly used end-to-end urethral anastomosis. In our opinion, a promising direction is the use of various grafts for the surgical treatment of this disease.

Many serious and fatal infections with urogenital mycoplasmas in immunocompromised patients have been reported. M. genitalium is recognized as a cause of male urethritis and other common genitourinary diseases. The aim of the study was to estimate prevalence of urogenital mycoplasmas which can cause complications in men with common genitourinary diseases. Study included 85 men with genitourinary tract carcinoma (n = 35), urolithiasis (n = 36), and BPH (benign prostatic hyperplasia) (n = 14). The control group consisted of 50 healthy men. FVU (first void urine) samples were examined by PCR for the presence of urogenital mycoplasmas DNA. Occurrence of urogenital mycoplasmas was significantly more common in study group compared with control 24/85 (28.2%) and 7/50 (14%), respectively (p = 0.05). In men with urolithiasis, positive results for mycoplasmas DNA were significantly more frequent than in control: 33.3% vs. 14% (p U. urealyticum was most often found, while in the genitourinary carcinoma and BPH groups, U. parvum was more frequent. Incidence of M. fermentans was also significantly higher in the urolithiasis group vs. control (p = 0.03). A higher percentage of positive results for urogenital mycoplasma DNA in study group has been found. Further studies are required to confirm the role of urogenital mycoplasmas in the development of infectious complications among patients with urolithiasis, genitourinary carcinoma, and BPH.

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.

The study in Teheran, Islamic Republic of Iran, investigated the prevalence of Ureaplasma urealyticum and Mycoplasma species in men with non-gonococcal urethritis. Urethral swab samples were collected from 125 cases and 125 healthy men as a control group. The samples were then investigated by culture methods. The rates of detected bacteria in case and control groups were 19.2% and 7.2% for U. urealyticum, 7.2% and 0.8% for M. genitalium, and 2.4% and 1.6% for M. hominis respectively. Statistical analysis showed a significant difference between case and control groups in the prevalence of U. urealyticum and M. genitalium but not M. hominis. It is concluded that in men, U. urealyticum and M. genitalium may have an etiologic role in non-gonococcal urethritis

Background As one of the causes of urethral symptoms, female chronic posterior urethritis is a common and distressing disease; however, it is often neglected and misdiagnosed as overactive bladder (OAB) or interstitial cystitis/bladder pain syndrome (IC/BPS). Currently, little is known about the urothelium and lamina propria of the bladder neck and proximal urethra. Thus, identifying urethral lesions is necessary for the diagnosis and treatment of female chronic posterior urethritis. Transurethral electroresection is an effective and safe approach for treating female chronic posterior urethritis. This study sought to determine if urethral lesions are necessary for the diagnosis and treatment of female chronic posterior urethritis, and evaluate the efficacy and safety of the transurethral electroresection of mucosa and submucosa in treating female chronic posterior urethritis. Methods A single-center, retrospective, observational study was conducted at a teaching and referral hospital. A total of 147 female patients who had been diagnosed with chronic papillary urethritis underwent transurethral electroresection between 2015 and 2018. Each patient underwent a follow-up examination. A chart review was also performed. Results Patients had a mean age of 54 years (range, 23-82 years), and the average follow-up period was 54.8 months (range, 6-600 months). Urinary frequency and urgency (51.7%) were the most common clinical manifestations of chronic posterior urethritis. Forty-two-point two percent of patients had positive urine culture results, most commonly with Mycoplasma genitalium. The cystoscopic findings revealed that chronic posterior urethritis has tuft-like, pseudopodia-like, finger-like, and follicular-like polyps and villi, and a pebble-like appearance with mucosal hyperemia. The success rate of the transurethral electroresection was 88.6%, and patients showed no apparent or serious complications. Conclusions This study showed that female chronic posterior urethritis is a cause that contributes to LUT symptoms. Its characteristic cystoscopic appearance and biopsy play a vital role in its diagnosis. The transurethral electroresection of urethral lesions is simple, effective, and minimally invasive without any apparent complications.

For patients with persistent irritative lower urinary tract symptoms, such as dysuria and urinary frequency, evaluation for the atypical organisms Ureaplasma and Mycoplasma has been a common part of care. However, these species are genitourinary colonizers and have not been established as causative pathogens in chronic lower urinary tract symptoms. We therefore sought to evaluate diagnostic testing patterns for Ureaplasma and Mycoplasma and characterize the associations of these bacteria with irritative lower urinary tract symptoms using molecular detection techniques.Ureaplasma/Mycoplasma testing patterns for 2019 were assessed using an anonymized data repository. Clean catch urine specimens (179) were collected prospectively from female and male patients with and without irritative lower urinary tract symptoms. Quantitative polymerase chain reaction evaluated urinary Ureaplasma and Mycoplasma DNA concentrations, while next-generation sequencing assessed the relative abundance of Ureaplasma and Mycoplasma within the urinary bacterial population.Ureaplasma/Mycoplasma testing was common, with 575 tests performed in 2019 in our community hospital system. In our cohort, Ureaplasma and Mycoplasma were identified in similar proportions in symptomatic and asymptomatic subjects: 25% of female controls and 27% of females with lower urinary tract symptoms and 9.5% of asymptomatic males and 3.3% of men with symptoms (p=0.87 and p=0.91 for females and males, respectively). Regression analysis revealed that both abundance and concentrations of Mycoplasmataceae correlated negatively with a range of irritative lower urinary tract symptoms, including dysuria and urethral pain.A statistically significant negative correlation of Ureaplasma/Mycoplasma levels with a variety of lower urinary tract symptoms suggests that polymerase chain reaction-based Mycoplasmataceae detection has little diagnostic benefit in assessment of chronic irritative urinary symptoms.

Currently, infections caused by Mycoplasma genitalium are ones the most common sexually transmitted infections. Their prevalence is varied from 1.3% to 15.9%. Infections caused by M.genitalium may lead to urethritis in men and a wide spectrum of diseases in women. Antibiotic resistance now is one of the most emerging problems both in the scientific and in the healthcare fields. The usage of antimicrobials inhibiting cell wall synthesis for the treatment of M.genitalium is ineffective, and resistance to macrolides and fluoroquinolones is increasing rapidly. M.genitalium infections diagnostics is complicated due to specific conditions and duration of culture methods. The usage of nucleic acid amplification techniques is the most relevant for laboratory diagnostics, and is used in existing assays. This review compiles current data on the prevalence, molecular mechanisms of pathogenesis and antibiotic resistance, as well as diagnostics methods of M.genitalium.

In men with nongonococcal urethritis (NGU), clinicians and patients rely on clinical cure to guide the need for additional testing/treatment and when to resume sex, respectively; however, discordant clinical and microbiological cure outcomes do occur. How accurately clinical cure reflects microbiological cure in specific sexually transmitted infections (STIs) is unclear.Men with NGU were tested for Neisseria gonorrhoeae, Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis, urethrotropic Neisseria meningitidis ST-11 clade strains, and Ureaplasma urealyticum (UU). Men received azithromycin 1 g and returned for a 1-month test-of-cure visit. In MG infections, we evaluated for the presence of macrolide resistance-mediating mutations (MRMs) and investigated alternate hypotheses for microbiological treatment failure using in situ shotgun metagenomic sequencing, phylogenetic analysis, multilocus sequence typing analyses, and quantitative PCR.Of 280 men with NGU, 121 were included in this analysis. In the monoinfection group, 52 had CT, 16 had MG, 7 had UU, 10 had mixed infection, and 36 men had idiopathic NGU. Clinical cure rates were 85% for CT, 100% for UU, 50% for MG, and 67% for idiopathic NGU. Clinical cure accurately predicted microbiological cure for all STIs, except MG. Discordant results were significantly associated with MG-NGU and predominantly reflected microbiological failure in men with clinical cure. Mycoplasma genitalium MRMs, but not MG load or strain, were strongly associated with microbiological failure.In azithromycin-treated NGU, clinical cure predicts microbiological cure for all STIs, except MG. Nongonococcal urethritis management should include MG testing and confirmation of microbiological cure in azithromycin-treated MG-NGU when MRM testing is unavailable.

Trichomonas vaginalis infections in men are traditionally considered to be benign and consequently have been overlooked. However, men with this common sexually transmitted infection can experience urethritis, prostatitis, reduced fertility, and amplified human immunodeficiency virus risk. In addition, men are often asymptomatic and can unknowingly spread the infection to their female sexual partners. With advances in T. vaginalis diagnostics, more men are being diagnosed, yet the optimal method of treatment in men remains unknown. The purpose of this review is to discuss the epidemiology, natural history, diagnosis, and treatment of T. vaginalis among men.

Objective: To systematically review the available literature on the long-term effects of sexually transmitted diseases (STIs) on male reproductive functions. Methods: A PubMed search was conducted on 3 January 2021, and as a result, 952 articles were retrieved. Exclusion of irrelevant articles resulted in 36 articles, dating from 1998 to 2020, which were analysed. Results: Only 52.8% of these articles described original research, while the rest were reviews. The majority (26) of the articles dealt with bacterial infections, of which 20 described Chlamydia trachomatis. There were 11 articles that described research on viruses, with five on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The analysis of the articles showed further that not much new knowledge on the long-term effects on male reproductive functions has been added. The existing knowledge that ascending infections can cause epididymo-orchitis, prostatitis or urethritis was confirmed. Due to epithelial inflammatory responses these infections can result in scarring with resulting infertility due to obstruction. These effects were described for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium or Treponema pallidum, as well as for the Zika and SARS-CoV-2 viruses. Even trichomoniasis can lead to long-term compromised male fertility if not treated. Conclusion: In conclusion, problem awareness needs to be raised and more research on this important topic needs to be conducted.

Mycoplasma genitalium ( M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians’ adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive ( p = 0.30) or macrolide-resistant M.genitalium ( p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.

Aim: Development of a routine screening technique for Chlamydia trachomatis infection. The proposed approach involves the CRISPR RNA (crRNA). In the presence of the target sequence, the RNase activity of the Cas13a protein is activated, and it cleaves RNA fluorescent probe so that fluorescence will be emitted. Results: The sensitivity of the detection based on CRISPR-Cas13a was 10 fM. The results obtained by CRISPR-Cas13a and quantitative polymerase chain reaction were closely correlated: χ2 = 81.798 (p < 0.001). Conclusion: The method can be carried out at room temperature and yields results within 2 h. The developed technique does not require expensive instruments and, thus, can meet the needs of community hospitals and other institutions for screening.

Recurrent urinary tract infections (RUTI) are one of the most common manifestations of the genitourinary menopausal syndrome and occur in more than 20% of peri- and post-menopausal women. The most common risk factor for RUTI in peri- and post-menopausal women is sex steroid deficiency. The urinary and genital tracts share a common embryonic origin due to the presence of α- and β-estrogen receptors, progesterone and androgen receptors in all structures of the urogenital tract: lower third of the ureters, urinary bladder, vascular plexus, urothelium, pelvic floor muscles, pelvic ligamentous apparatus. Patients with RUTI are treated in two stages: treatment of exacerbations and prevention of relapses. During exacerbations, short courses of antibiotic therapy are administered according to the sensitivity of the bacterial agent. If microbiological testing of urine samples is not possible, antibiotics are selected empirically, taking into account the most common pathogens of a UTI. Vaccine prophylaxis is the leading method of preventing a UTI recurrence. The efficacy and safety of E. coli bacterial extracts have been proven in numerous RCTs. The Uro-Vaxom vaccine reliably reduces the incidence of cystitis recurrence, reduces the need for antibacterial drugs, and therefore improves the quality of life of menopausal women with RUTIs. Vaccine prophylaxis in menopause can be administered as monotherapy or in combination with topical estrogen therapy, which also plays a positive role in the treatment of urinary tract infections.

Non-gonococcal urethritis (NGU) is one of the most common diseases of the male genital tract. The results of the researches show that the main pathogens are Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum. With the introduction of advanced molecular diagnostic techniques, Mycoplasma hominis, Ureaplasma parvum, Gardnerella vaginalis, and other opportunistic microorganisms are often found in the urethral microflora, the role of which in the etiopathogenesis of urethritis is controversial and not fully elucidated. Untreated male urethritis can produce problems related to reproductive and sexual function and it is one of the leading causes of infertility. The aim of this paper is to analyze the epidemiology, causes, diagnostic and treatment options of male NGU after a review of scientific literature.

Mycoplasma genitalium is a well-known cause of urethritis in men and has been associated with cervicitis, pelvic inflammatory disease, and adverse obstetric outcomes in women. In this cross-sectional study, we determined the current prevalence of M. genitalium infection and the rate of macrolide resistance in M. genitalium isolates, in patients visiting two large Dutch sexually transmitted infection (STI) clinics, to evaluate whether the recommendations in Dutch guidelines should be revised. In addition, risk factors for M. genitalium were identified. In total, 3225 patients were included. M. genitalium prevalence rates were 13.8% for all patients; 20.1% for men who have sex with men, 8.2% for men who have sex with women, and 12.6% for women. Macrolide resistance-associated mutations were detected in 66% of the patients infected with M. genitalium. Age, educational level, country of origin, number of sexual partners, HIV-positivity, infection with Neisseria gonorrhoeae, and urethral symptoms in men were independently associated with M. genitalium infection. In conclusion, we found very high prevalence rates and macrolide resistance rates of M. genitalium in patients visiting STI clinics.

Mycoplasma genitalium is an emerging agent of sexually transmitted infections, associated with urethritis, cervicitis, and pelvic inflammatory disease. Over the past decade, a remarkable increase in macrolide-resistant M. genitalium, the first-line treatment, is observed all over the world. In some regions, an increase in fluoroquinolone-resistance, the second-line treatment, is also noticed. It therefore seems important to have a knowledge of the local epidemiology as well as the means of detecting these resistances in order to best adapt the treatment. Our study aimed to determine the prevalence of macrolide and fluoroquinolone-resistant Mycoplasma genitalium at the University Hospital of Tours in 2018, using a real-time PCR technique followed by Sanger sequencing. The prevalence of macrolide resistance in our population was 15.4 %. No FQ resistance-conferring mutations were observed in our study. Furthermore, we evaluated the performance of the commercial kit S-DiaMGRes® (Diagenode Diagnostics, Belgium), allowing the detection of 23S rRNA mutations conferring resistance to macrolides.

International audience; Objective: To characterize the current profile of gonococcal infections in France, and to describe their management. Patients and method: A population-based retrospective study of all gonococcal infections documented by PCR in two French departments (Île-et-Vilaine, Morbihan), in 2014–2016. Cases were identified through hospital databases and the Rénago sentinel network. Results: We enrolled 245 patients (96 females, 149 males), with a median age of 25 years [interquartile range, 21–33]. The incidence rate was estimated at 4.54 per 100,000 inhabitants-year. Cases were diagnosed mostly by a general practitioner (n = 122, 49.8%) or a gynecologist (n = 45, 18.4%). The main clinical presentations included urethritis (n = 59), pelvic inflammatory disease (n = 40), cervicitis (n = 12), and anorectitis (n = 11). The main coinfections were Chlamydia trachomatis (n = 40) and HIV (n = 8). Ceftriaxone MIC was ≤ 0.12 mg/L in 146/147 patients with positive culture. Treatment was appropriate in 52/74 (70.2%) patients with available data. Conclusions: In France, general practitioners are at the front line in management of gonococcal infections. © 2020 Elsevier Masson SAS

BACKGROUND Mycoplasma genitalium is an important emerging sexually transmitted pathogen commonly causing urethritis in men, cervicitis, and pelvic inflammatory disease in women with potential of infertility. Accumulating evidence identifies the prevalence of M. genitalium similar to long recognized pathogens, Chlamydia trachomatis and Neisseria gonorrhoeae. The purpose of this study was to establish the prevalence and epidemiology of M. genitalium in a mid-Pacific military population. METHODS A prospective analysis was conducted from routine specimens collected as standard of care for sexually transmitted infection (STI) testing at Tripler Army Medical Center on Oahu, HI. The prevalence of M. genitalium was determined using the Aptima M. genitalium assay, a transcription-mediated amplification test. A multivariate analysis was performed to assess the associations for this infection with other STIs and demographic factors. RESULTS A total of 1876 specimens were tested in a 6-month period including 6 sample types from 1158 females and 718 males. Subject ages ranged from 18 to 76 years, with a median of 24 years (interquartile range, 21-29 years). The prevalence of M. genitalium was 8.8% overall (n = 165), 7.1% in females and 11.6% in males. Coinfection with M. genitalium occurred with another sexually-transmitted pathogen in 43 patients (18.3%), with C. trachomatis as the most common organism (n = 38). CONCLUSIONS These data contribute to the evidence base for M. genitalium and STI screening in an active-duty military.

Reactive arthritis (ReA) is an immune-mediated aseptic synovitis resulting either from genitourinary or gastrointestinal tract, commonly presenting as oligoarthritis of the lower limbs and rarely urethritis and conjunctivitis. The treatment options include nonsteroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic drugs, and biologics in severe cases. We report successful use of secukinumab in two cases of chronic severe ReA who initially failed to treatment with tumour necrosis factor inhibitor.

The role of fungi as causative agents of infections is growing. In in-patients, especially at intensive care units, fungal infections might cause serious problems. Studies conducted over recent years shows an increase of fungi detection in urine in in-patients from 5,01 up to 10,63%. Most often, the appearance of fungi in the urine connected with contamination or colonization of the urinary tract. However, in immunocompromised patients, this could be the part of urinary tract infection and even of disseminated fungal process. Candida is the most common cause of fungal urinary tract infections. At the same time, the presence of Candida in urine (candiduria) not always comes with clinical signs of urethritis, cystitis and pyelonephritis. Detection of noCandida albicans agents in urine is increasing, new Candida species revealed are resistant to antifungal drugs so risk of complications is increasing. Recent researches reveal new mechanisms of how Candida interacts with the bacteria that cause urinary infections. The main mechanisms of Candida virulence factors are dimorphism, adhesion proteins — Als1-7,9 and Gls, invasion enzymes — phospholipase, Als3 and Ssa1, as well as enzymes that neutralize reactive oxygen species. The most significant risk factors of fungal urinary tract infection are the presence of a urinary catheter, diabetes mellitus, immunosuppression and previous antibiotic intake. The study of the formation process of the cellular and immune response to Candida makes it possible to identify the main links in the pathogenesis of urinary tract candidiasis, as well as the main role of immunosuppression in the development of the disease.

"Introduction: Despite advances in the diagnosis and treatment of urethritis, they remain a global public health problem worldwide. Patients with urethritis have a higher risk sexual behavior than the general population. Aim: The aim of the study was to evaluate the risk factors and the etiological pathogens of urethritis in men among Brașov county. Patients and methods: A retrospective study was conducted in Medlife-PDR Clinic from Brașov, România, from Jan 2016 to Nov, 2020. 111 male patients aged from 17 to 78 years (mean age 34.5±10.26) presenting with dysuria, micturition discomfort and/or urethral discharge were included in the study. Results: The highest incidence of urethritis was among men aged 21-40 years. The acquisition of urethral infection was related to their young age, low educational level, multiple sexual partners and lack of condom use, most having extramarital relations including commercial sex. N. gonorrhoeae was identified as a causative agent in 18 (16.22%) patients with urethritis, C. trachomatis in 39 (35.14%) patients, Mycoplasma spp. in 5 (4.5%) patients, Ureaplasma spp. in 30 (27.03%) patients, Trichomonas vaginalis in 6 (5.4%) patients. A concurrent infection with N. gonorrhoeae and C. trachomatis was identified in one patient (0.01%). In 12 patients (9.9%) other infectious agents were identified and in one case the aetiological agent could not be identified (0.01%). Conclusion: By identifying risky sexual behaviors, clinicians may be able to provide educational counseling as well as assistance in the diagnosis and treatment of urethritis. "

AIM To study the efficiency of using alfuzosin 10 mg (Alfuprost MR, SUN Pharma) in routine clinical practice in order to predict its feasibility for treating acute urinary retention. MATERIALS AND METHODS A total of 47 patients, aged from 54 to 88 years old (mean 68.5+/-5.6) with acute urinary retention due to benign prostatic hyperplasia were treated at the urology department of City clinical hospital named after D.D. Pletnev from September to December 2019. 14 patients were excluded from the study since they had chronic urinary retention. In all cases, urethral catheter was put and left in place for 24-72 hours (mean 44+/-12). All 33 patients were prescribed alfuzosin 10 mg. After removal of the urethral catheter, spontaneous voiding was restored in 19 patients. Transurethral resection of the prostate was consequently performed in three patients. In one patient, the urethral catheter was changed to cystostomy tube due to the urethritis. Recurrent urinary retention occurred in 10 men, and 8 patients underwent cystostomy. In other two cases, spontaneous voiding was restored after repeated removal of the urethral catheter. RESULTS the efficiency of conservative therapy was 63.6% (21/33). According to our results, history of severe lower urinary tract symptoms, the prostate volume more than 50 cc and intravesical protrusion of more than 1 cm have a significant influence on the outcome of conservative therapy in patients with acute urinary retention. CONCLUSIONS Based on a prospective study, a high efficiency and safety of the Alfuprost MP 10 mg/day in patients with acute urinary retention was established.

Background Proliferative urethritis (PU) is an uncommon inflammatory and infiltrative disease of the urethra in female dogs, often associated with urinary tract infection (UTI). It typically presents with evidence of urethral obstruction (UO). Objectives Identify clinical features in dogs with PU and determine outcome after different treatment modalities. Animals Eleven client-owned dogs. Methods Medical records of dogs with histopathologic diagnosis of PU from 2011 to 2020 were retrospectively evaluated, including information on clinical pathology, imaging, and histopathology. Outcomes of various treatment modalities were recorded and compared. Long-term urethral patency (>6 months) was considered treatment success. Results All dogs were female and presented with UO. Eight (73%) had a history of UTI. Ten of 11 survived to discharge and were used for long-term data collection. Seven of 10 (70%) were treated using an effacement procedure (balloon dilatation [BD], stent, or both) and 6/7 (86%) achieved long-term urethral patency (>6 months). Seven of 10 had UO recurrence after their first procedure, including 3/3 (100%) that did not have effacement and 4/7 that did (57%), at a median of 101 days and 687 days, respectively. After effacement, the duration of patency was longer for those treated using a stent than BD alone (median, 843 days and 452 days, respectively). Conclusions and clinical importance Proliferative urethritis is a recurrent disease often associated with UTI. The best outcome of long-term urethral patency occurred after lesion effacement, either by BD or stenting. Future prospective studies should determine the impact of immunosuppressive treatment.

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.

Aim To carry out a comparative assessment of the efficiency of combination therapy for non-gonococcal urethritis (NGU) in men. Materials and methods a total of 124 patients with NGU and laboratory-confirmed urogenital infection were included in the study. The diagnostic methods included microscopy of urethral smear, real-time polymerase chain reaction (PCR) for the detection of uropathogens and laser Doppler flowmetry for evaluating the urethral microcirculation. All patients were randomized into three groups matched for age, clinical manifestations, and disease duration. Patients of the group 1 received targeted antibiotic therapy. In the group 2, local peloid therapy was added, while patients in group 3 additionally received vibromagnetotherapy. The control group consisted of 22 patients aged 18 to 55 years. The study included 2 visits, at the baseline and 4 weeks after the end of treatment. Results After the treatment, the frequency of microbiological cure was 89%. In the group 3, more pronounced improvement in main symptoms of NGU was observed. The analysis of microcirculation after treatment in the groups 2 and 3 showed a significant increase in perfusion and modulation of urethral blood flow and a decrease in venous congestion after combined therapy. Conclusion The combined treatment, including antibiotic, peloid therapy, and vibromagnetotherapy, promotes more pronounced clinical improvement, restoration of urethral microcirculation and relief of inflammatory process in patients with NGU and can be recommended for routine clinical practice.

Objectives To describe the characteristics of patients with a positive urethral sample for Haemophilus spp. Material and methods We performed a retrospective study from January 2018 to July 2019 at the Bordeaux university hospital (France) of all urethral samples positive for Haemophilus spp. Results Haemophilus spp. was isolated in 10 urethral samples from nine patients. The mean age was 33.8 years. Most patients reported having unprotected sex. Haemophilus parainfluenzae was isolated in nine samples, and Haemophilus influenzae in one sample. Antibiotic susceptibility tests were performed in five samples; Haemophilus spp. was always resistant to amoxicillin and tetracycline. One patient had persistent symptoms after treatment for a multidrug-resistant Haemophilus parainfluenzae strain. Conclusion Haemophilus spp. is a rare pathogen of urethritis. Its responsibility should be considered in case of persistent symptoms. The emergence of multidrug-resistant Haemophilus spp. is becoming problematic.

Mycoplasma genitalium (MG) causes frequently asymptomatic STIs. MG prevalence figures are lacking and management is complicated by the lack of etiological diagnostics and high antimicrobial resista...

The article presents a review of Russian and international literature dedicated to the problem of painful ejaculation. Mentions of this type of disorders are quite rare. Its real incidence remains unknown. Connections between painful ejaculation and infectious and inflammatory diseases (orchitis, epididymitis, prostatitis, vesiculitis, urethritis), previous surgeries (in particular, transurethral resection of the prostate), administration of certain drugs (for example, antidepressants), rare congenital developmental anomalies are considered. Data on the effectiveness of conservative and surgical treatment are presented.

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 ( 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.

Outbreaks of acute respiratory disease associated with human adenovirus (HAdV) B7d have been reported, including fatal cases in the United States. In 2018, we detected HAdV-B7d in a patient with urethritis, probably transmitted through sexual contact. Infectious HAdV-B7d was excreted in urine and gargle for >10 days after the disappearance of symptoms.

ObjectivesInternational guidelines recommend Mycoplasma genitalium testing, preferably using an assay to detect macrolide resistance-associated mutations, for men presenting with non-gonococcal urethritis, but there is no specific guidance on such testing for men with gonococcal urethritis.MethodsThis study aimed to estimate the proportion of men with gonococcal urethritis who have coinfection with M. genitalium through a retrospective analysis of cases of symptomatic urethral gonorrhoea at Western Sydney Sexual Health Centre in 2017 and 2018.ResultsFourteen of 184 (7.6%, 95% CI 3.7 to 11.5) men with gonococcal urethritis had M. genitalium detected in the urine at the time of presentation. No demographic or behavioural factors predicted M. genitalium coinfection. Coinfection with urethral Chlamydia trachomatis was detected in 29 of 184 (15.8%, 95% CI 10.5 to 21.1). All five men with macrolide-resistant M. genitalium detected returned for treatment with moxifloxacin at a median of 8 days (range 5–16 days) after presentation and treatment of gonorrhoea; three of five were documented to remain symptomatic at this visit.ConclusionAlthough M. genitalium coinfection is less common than chlamydia among men with symptomatic gonococcal urethritis, M. genitalium testing, using an assay to detect macrolide resistance, will potentially reduce symptom duration particularly for men with macrolide-resistant infections, but may not be justifiable on cost-benefit analysis.

Purpose: In this study our aim was to investigate the current etiology of posterior urethral stricture disease in our department and to observe if there have been any differences in the major causes of urethral strictures. Patients and Methods: We analysed 116 male patients between March 2009 and September 2019 to evaluate the etiology of posterior urethral strictures. All patients had been assesed preoperatively,including detailed medical history,physical examination,retrograde urethrogram and uroflowmetry. We examined all patients in terms of age, stricture site,the most probable cause of the stricture and stricture length. We classified the location of posterior stricture into three anatomic parts: membranous urethra,prostatic urethra and bladder neck and stricture etiologies were subcategorized into idiopathic,inflammatory,iatrogenic and traumatic. Results: The most common site of the strictures was the membranous urethra (67 patients, 57.8%) followed by the prostatic urethra ( 27 patients, 23.3%) and bladder neck (22 patients, 18.9%). The two main overall posterior urethral stricture causes were iatrogenic (79 patients,68.1%) and traumatic (24 patients,20.7%).The less common causes were idiopathic (11 patients,9.5%) and urethritis(2 patients,1.7%). Of the patients in iatrogenic group, TUR-P and TUR-BT were the most common etiologic factors. ( 42 patients,36.2%) All urethral strictures were short(

We report a case of Mycoplasma genitalium-positive non-gonococcal urethritis who failed to respond to multiple different courses of antibiotics including azithromycin, minocycline, moxifloxacin and spectinomycin. Extracted M. genitalium DNA from urethral swabs obtained from the patient harbored mutations of 23S rRNA, parC and gyrA. Microbiological cure was eventually achieved by a 14-day course of doxycycline.

I hope that my comrades will not condemn me for such an apparently insignificant topic, which I have chosen for today's report; I chose her because they paid and pay little attention to the urethritis of women and, in general, to the diseases of their urinary canal, - and very little about the diseases of this canal comes across in the manuals; a more extensive treatise we find in the surgery of Pitha-Billroth T. XI, processed by Winckel. In gynecology of various authors about diseases of urinary organs, it is said in passing and, in general, very little. And it is very understandable that gynecologists, busy with a more important organ - the organ of support of the human race, pay little or no attention to this small vessel - the urethra; but this short water supply of the female body does not easily cause not a little suffering, which is often attributed to uterine suffering, between which he is the cause of all suffering.

The genital mycoplasmas are a unique group of inherently antibiotic-resistant sexually transmitted bacteria, often associated with non-gonococcal urethritis and bacterial vaginosis. The MYCO WELL D-ONE is a culture-based assay that aims to detect these organisms whilst concurrently screening them for antibiotic resistance. Urine and/or swabs from 856 informed and consented participants attending Welsh sexual health clinics were subjected to MYCO WELL D-ONE analysis, alongside qPCR and culture titration methodologies to determine sensitivity, specificity, PPV, NPV and accuracy. Resistance was confirmed by CLSI-compliant susceptibility testing and genetic mechanisms determined. The MYCO WELL D-ONE displayed a sensitivity and specificity of 91.98% and 96.44% for the detection of Ureaplasma spp., with sensitivity and specificity values of 78.23% and 98.84% for Mycoplasma hominis, compared with qPCR. Swabs harboured significantly greater bacterial loads than urine samples for both Ureaplasma spp. and M. hominis. Levofloxacin resistance rates, mediated by Ser83Leu mutation in ParC, for Ureaplasma spp. were 0.54%. Tetracycline resistance rates, mediated by tet(M), were 0.54% and 2% for Ureaplasma spp. and M. hominis, respectively; sequence analysis of tet(M)-positive Ureaplasma spp. and M. hominis strains isolated from a single individual confirmed separate resistance gene origins. The MYCO WELL D-ONE is a sensitive and specific assay for the detection of Ureaplasma spp. and M. hominis in genitourinary medicine samples, facilitating the accurate detection of these organisms within low-technology environments. While good for antibiotic resistance screening, accurate confirmation by MIC determination or molecular methods are required, and more optimally performed on urine samples.

Background: Herpes simplex virus infections are prevalent worldwide. They are caused by Herpes simplex virus Type-1 (HSV-1) and type-2 (HSV-2). HSV-1 causes orolabial disease. Genital herpes may be caused by either HSV-2 or HSV-1, large majority of cases being caused by HSV-2. HSV-1 is acquired during early childhood by most of the individuals. The acquisition of HSV-2 starts around puberty or thereafter. The ability of the virus to successfully avoid clearance by the immune system by entering a non-replicating state known as latency leads to life long persistence of infection with unpredictable reactivation and transmission. Detecting antibodies plays an important role in identifying those infected. Type specific tests have been developed that are based on the protein Glycoprotein G from HSV-2 (gG2) or Glycoprotein G from HSV-1 (gG1). As very limited sequence homology exists between gG1 and gG2, assays based on detecting these type specific epitopes using ELISA can reliably differentiate between antibodies to HSV-1 and HSV-2. Objectives 1. To study the Seroprevalence of Herpes simplex virus infection in patients attending the STI clinic.2. To study the risk factors and other socioepidemiological factors associated with HSV-2 seropositivity.3. To study the seroprevalence of HSV infection in HIV positive individuals.4. To study the proportion of subclinical seropositives for HSV infection. Material and methods: The study was carried out from July 2017 to June 2019. All patients reporting to DVL OPD at GITAM institute of Medical sciences & Research, Visakhapatnam, Andhra Pradesh were examined and evaluated. 82 consecutive patients of both sexes with STI complaints, in the age group of 15-70 years were studied. Patients with genital herpes as well as patients with other STI complaints including both HIV positive and HIV negative patients were included in the study.With prior permission from ethical committee and consent from patients, blood samples were collected and tested for HSV-1 IgG and IgM antibodies and HSV-2 IgG and IgM antibodies.Results: Out of 82 patients 42 (51%) were females and 40 (49%) were males; 41 (50%) were HIV positive and the other 41(50%) were HIV negative.Out of 82 patients, 39(47.6%) had genital herpes and 43 (52.5%) had other STDs which include genital candidiasis (18.3%), non specific urethritis (13.4%), Condyloma acuminate (14.6%) and genital molluscum contagiosum (6.1%).Out of 82 patients, 2(2.4%) were seropositive for HSV-1 IgM and 68 (82.9%) were seropositive for HSV-1 IgG.Out of 82 patients, 4(5%) were seropositive for HSV-2 IgM and 40(48.8%) are seropositive for HSV-2 IgG.Out of 39 patients with genital herpes 21(53.8%) were seropositive for HSV-2 and out of 43 patients with other STDs without genital herpes 19 (44.2%) were seropositive for HSV-2, indicating that the proportion of subclinical seropositivity was 44.2% in our studyConclusion: From our study we conclude that Herpes simplex virus infection is common in STI clinic attendees in our hospital. Prevalence of HSV-1 and HSV-2 serum antibodies provide an epidemiological measure of population burden of these infections. The high seroprevalence of HSV-2 in HIV patients potentiates the need for regular HSV-2 screening in HIV positive individuals and proper counselling and treatment of HSV-2 seropositives during outbreaks will efficiently lower the frequency of recurrences and decrease the transmission of both HSV and HIV infections.

Background . Beginning with the middle of the XX century some observations about cases of meningococcal urethritis have appeared. The number of articles for such subjects has promptly increased in the last decade of XXI. The epidemiological features of meningococcal urethritis are slightly understood. Aims . A review of the latest publications on meningococcal urethritis is presented. Particular attention is given to outbreaks of meningococcal urethritis caused by the new genetic clade USNmCU of N.meningitidis, which occurred in several US states in 2013-2016. Conclusions . The isolates from patients were non-capsulated and belonged to the CC-11 clonal complex, the most virulent among N.meningitidis strains of serogroups B, C, Y, W. The orogenital transmission of clade strains has been proven. It is assumed that N.meningitidis acquired genes for anaerobic growth as a result of genetic recombination during co-presence with N. gonorrhea on the mucous membranes and became to be able to colonize the urogenital tract. The urethritogenic meningococcal clade is the result of the adaptation of the capsular strain of meningococcus serogroup C of the clonal complex CC-11, which is responsible for outbreaks of generalized meningococcal infection in MSM communities. The urethritogenic strains are considered as representatives of the emergent clade of N. gonorhoeae. Their ability to be transmitted through direct sexual contact is unknown. The epidemiological role of the clade in the spread of meningococcal infection is discussed. It is necessary to develop the researches concerning the epidemiological features of meningococcal urethritis and its additional role as the source of meningococcal disease.

Introduction: Ureaplasma urealyticum and Mycoplasma genitalium are infectious pathogens resulting in non-gonococcal urethritis and complications such as pelvic inflammatory disease (PID) and infertility. This study aimed to determine the prevalence of U. urealyticum and M. genitalium in women with secondary infertility and the related factors to these infections. Methods: This cross-sectional descriptive study was carried out from July 2017 to June 2018. Cervical specimens were collected from women with secondary infertility at the Center for Reproductive Endocrinology and Infertility, Hue University Hospital, Vietnam. PCR was applied for detection of U. urealyticum and M. genitalium. Tubal patency was assessed by hysterosalpingography. Results: Prevalence of U. urealyticum and M. genitalium were 37.9% and 2.1%, respectively. The association was not statistically significant among infection and the following factors like age, educational level, occupation, history of miscarriage, history of genital infection and abdominal surgery, or infertility duration (p > 0.05). There was a statistically significant correlation between U. urealyticum infection and tubal damage according to hysterosalpingography (p < 0.05). Conclusion: In the case of women with secondary infertility, genital infection with M. genitalium was rare, whereas that with U. urealyticum infection was high and appeared to be associated with tubal damage.

Introduction Idiopathic urethritis (IU) is a known entity in the childhood and adolescent age groups and is described as blood spotting of the underwear in these populations. Typically, IU presents clinically as terminal void haematuria or blood spotting, accompanied with dysuria, occasional suprapubic pain and rarely constitutional symptoms. Sometimes IU may progress to formation of urethral strictures. It carries a high morbidity because of its chronicity and recurrent course, which often persists to puberty. In spite of no single aetiology being confirmed, several treatment approaches have shown some efficacy. Although no consensus has yet been established, the consideration of previous authors' experience and expertise may contribute to the development of a possible unified algorithm. Aim This article considers IU, collecting pertinent data and case series from the literature. The authors attempt to describe all presumptive aetiologies, endoscopic findings with established grading classifications and finally the various treatment modalities proposed. In addition, highlights from the senior's author experience regarding this entity including endoscopic, radiographic and histological images are mentioned. Methods Retrospective review and analysis of all relevant articles present on PubMed, SCOPUS and Cochrane Library from the time of inception to the date of first submission. Results A total of 19 series concerning IU have been reported since year 1971 to present time (Table 1). Many aetiologies have been postulated, but some have been refuted, including infectious pathogens. Children with dysfunctional voiding and meatal stenosis are more prone to exhibit IU. A variation in the urethral milieu during the prepubertal period, secondary to systematic hormonal alteration, may lead to squamous cell metaplasia resulting in IU and possible urethral strictures. Grading classifications for IU are described. Up to 20% of IU may develop urethral strictures. Various treatment approaches are discussed. Conclusion A summary of current understanding of the pathogenesis and spectrum of IU has been achieved. Successful treatment can be achieved with steroids and dysfunctional voiding protocols. It may be possible to develop a consensus unified management algorithm.

The sexually transmitted infection gonorrhea, caused by the Gram-negative bacterium Neisseria gonorrhoeae, can cause urethritis, cervicitis, and systemic disease, among other manifestations. N. gonorrhoeae has rapidly rising incidence along with increasing levels of antibiotic resistance to a broad range of drugs including first-line treatments. The rise in resistance has led to fears of untreatable gonorrhea causing substantial disease globally. In this review, we will describe multiple approaches being undertaken to slow and control this spread of resistance. First, a number of old drugs have been repurposed and new drugs are being developed with activity against Neisseria gonorrhoeae. Second, vaccine development, long an important goal, is advancing. Third, new diagnostics promise rapid detection of antibiotic resistance and a shift from empiric to tailored treatment. The deployment of these new tools for addressing the challenge of antibiotic resistance will require careful consideration to provide optimal care for all patients while extending the lifespan of treatment regimens.

A 10-year-old male mixed-breed dog was admitted for recurrent signs of urinary tract infection (UTI). Urinary bladder ultrasonography revealed decreased thickness of its wall with floating hyperopic particles within its lumen. Ultrasonography revealed a structure invading the dorsal wall of the penile urethral lumen, located in a segment distal to the bladder. Radiographies showed bone resorption with proliferation at the caudal aspect of the penile bone, stricture of the final aspect of the penile urethra, and no radiopaque images compatible with a urethrolith. Computed tomography showed bone proliferation causing stricture of the urethral lumen at two different sites. Presumptive diagnosis of penile neoplasia was considered more likely and the dog underwent penectomy along with orchiectomy and scrotal urethrostomy. Enterobacter spp. was cultured from the urine sample and antibiotic sensitivity tests revealed that the bacterium was susceptible to amikacin, imipenem, and meropenem. Histopathology revealed severe suppurative urethritis, bone resorption, and hyperostosis, suggestive of osteomyelitis of the penile bone. Neoplastic cells were not observed at any part of the examined tissue. The findings in the present case suggest that osteomyelitis of the penile bone should be included in differential diagnosis for partial and complete urethral obstruction in dogs with recurrent UTI.