Search

This review is devoted to specific features of diagnosis and treatment of non-gonococcal urethritis caused by intracellular microorganisms. Using modern literature data and the up-to-date clinical guidelines, an analysis of changes in the epidemiological structure and resistance of intracellular pathogens in non-gonococcal urethritis has been carried out. The current principles of diagnosis and treatment of non-gonococcal urethritis are reviewed, with a discussion of the place of new molecular genetic methods for detecting the resistance of some intracellular pathogens (Mycoplasma genitalium) in routine clinical practice. Treatment regimens proposed by various clinical guidelines are compared and critically appraised in the review. Both clinical data and the results of in vitro studies on the efficiency of various drugs against certain intracellular pathogens of urethritis are presented.

Objective: The purpose of this review was to summarize the current literature on the assessment and treatment of radiation urethritis and cystitis (RUC) for the development of an evidenced-based management algorithm., Material and Methods: The PubMed/MEDLINE database was searched by a multidisciplinary group of experts in January 2021., Results: In total, 48 publications were identified. Three different types of RUC can be observed in clinical practice: inflammation-predominant, bleeding-predominant, and the combination of inflammation- and bleeding-RUC. There is no consensus on the optimal treatment of RUC. Inflammation-predominant RUC should be treated symptomatically based on the existence of bothersome storage or voiding lower urinary tract symptom as well as on pain. When bleeding-predominant RUC has occurred, hydration and hyperbaric oxygen therapy (HOT) should be used first and, if HOT is not available, oral drugs instead (sodium pentosane polysulfate, aminocaproic acid, immunokine WF 10, conjugated estrogene, or pentoxifylline + vitamin E). If local bleeding persists, focal therapy of bleeding vessels with a laser or electrocoagulation is indicated. In case of generalized bleeding, intravesical installation should be initiated (formalin, aluminium salts, and hyaluronic acid/chondroitin). Vessel embolization is a less invasive treatment with potentially less complications and good clinical outcomes. Open- or robot-assisted surgery is indicated in patients with permanent, life-threatening bleeding, or fistulae., Conclusions: Treatment of RUC, if not self-limiting, should be done according to the type of RUC and in a stepwise approach. Conservative/medical treatment (oral and topic agents) should primarily be used before invasive (transurethral) treatments., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

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., (© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.)

Introduction: idiopathic hemorrhagic urethritis of childhood (IHU) is uncommon. Data about the disease are limited. There are no available protocols for diagnosis, treatment, or follow-up and prognostic factors are unknown., Objective: We aim to review the available data about IHU, to organize and to synthesize information, to facilitate clinical choices and the establishment of future research protocols., Study Design: Descriptive review of the literature., Results: The disease typically affects peri-pubertal boys. A third evolve to chronic disease and circa 15% develop urethral stenoses. Voiding dysfunction is frequent. Acute scrotum secondary to orchiepididymitis may occur. Meatal stenosis and hypospadias are more frequent than in the general population. Diagnosis is clinical (urethrorrhagia ± dysuria). Complementary exams are mostly used for differential diagnosis. Indications for cystoscopy are controversial. Bulbar urethral inflammation with fibrinous "membranes" are typical. Treatment is controversial and mostly expectant. Topical steroids and indwelling catheterization are the most successful for severe or recalcitrant cases (summary table)., Conclusion: IHU turns into a chronic condition in a significant proportion of the cases and associates to a low quality of life. Urethral stenosis is the most common complication. Indications for diagnostic cystoscopy, prolonged catheterization, and steroid prescription need to be better defined. Clinical protocols are deeply needed., Competing Interests: Conflict of interest None., (Copyright © 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Mycoplasma genitalium (Mgen) causes non-gonococcal urethritis (NGU) and is believed to cause pelvic inflammatory disease (PID). High rates of macrolide resistance are well documented globally for Mgen. In Brighton, patients with NGU and PID are tested for Mgen and test of cure (TOC) offered post-treatment., Methods: Demographic, clinical and treatment history data were collected over a 12-month period for all Mgen-positive patients in a Brighton-based genitourinary clinic., Results: There were 114 patients with Mgen. 18% (61/339) of men with NGU and 9% (15/160) of women with PID had Mgen. 62/114 (54%) returned for first test TOC 4 weeks after treatment. 27/62 (44%) had a positive TOC; 25/27 (92.6%) had received azithromycin first line (500 mg stat then 250 mg OD for 4 days), 1/27 (3.7%) had received moxifloxacin first line (400 mg OD for 14 days) and 1/27 (3.7%) had received doxycycline first line (100 mg BD for 7 days). 20/27 (74%) returned for a second TOC 4 weeks later. 5/20 (25%) patients were positive on second TOC; 3/5 (60%) had received azithromycin second line and 2/5 (40%) had received moxifloxacin second line. Patients were more likely to have a positive TOC if they were at risk of reinfection (9/27 positive TOC vs 3/35 negative TOC; p=0.02). Patients given moxifloxacin were more likely to have a negative TOC (1/27 positive TOC vs 9/35 negative TOC; p=0.03) than those who received other antibiotic regimens., Conclusions: Treatment failure rates for Mgen following azithromycin use are substantial, raising concerns regarding resistance. However, reinfection risk may contribute, suggesting a requirement for improved public awareness and clinician knowledge., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: We have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

Objective: To investigate the status quo of the diagnosis and treatment of male urethritis (MU) in urology and andrology., Methods: According to The Guidelines for Clinical Diagnosis and Treatment of Sexually Transmitted Diseases (2017), we designed 27 questions on the prevalence, diagnosis, treatment, and prognosis of MU. Using these questions, we conducted a questionnaire investigation among urological, andrological and other relevant clinicians with different professional titles, followed by an analysis of the compliance of the doctors to the Guidelines., Results: Totally, 116 valid questionnaires were collected from 86 urological, 28 andrological and 2 other relevant doctors, including 22 professors, 36 associate professors, 40 attending doctors and 16 resident doctors. MU was found mostly in those aged 20－40 years and more than half of the patients had a history of unclean sex, gonococcal urethritis significantly less prevalent than non-gonococcal, with Ureaplasma urealyticum as the most common pathogen of non-gonococcal urethritis. As for the compliance to the Guidelines in the diagnosis of MU, 22.73% of the professors, 16.67% of the associate professors, 15.00% of the attending doctors and 12.50% of the resident doctors examined the eyes, mouth and perianus (P > 0.05), 40.91% of the professors, 58.33% of the associate professors, 40.00% of the attending doctors and 37.50% of the resident doctors conducted HIV and syphilis screening (P > 0.05), and 86.36% of the professors, 77.78% of the associate professors, 70.00% of the attending doctors and 75.00% of the resident doctors performed genital mycoplasma screening (P > 0.05). Concerning the treatment of MU, 50.00% of the professors, 47.22% of the associate professors, 22.50% of the attending doctors and 43.75% of the resident doctors used anti-Chlamydia trachomatis drugs for gonococcal urethritis (P > 0.05), 0.00% of the professors, 11.11% of the associate professors, 5.00% of the attending doctors and 31.25% of the resident doctors prescribed 1g single-dose oral azithromycin for non-gonococcal urethritis (P < 0.05), 13.64% of the professors, 33.33% of the associate professors, 17.50% of the attending doctors and 6.25% of the resident doctors medicated persistent or recurrent non-gonococcal urethritis for >4 weeks (P > 0.05), 63.64% of the professors, 83.33% of the associate professors, 57.50% of the attending doctors and 62.50% of the resident doctors treated asymptomatic trachomatis and mycoplasma infections according to the proposed medication in the Guidelines (P > 0.05). As regards the results of treatment, the cure rate of gonococcal urethritis was 100.00% by professors, 97.22% by associate professors, 95.00% by attending doctors and 81.25% by resident doctors (P > 0.05), and that of non-gonococcal urethritis was 86.36% by professors, 61.11% by associate professors, 62.50% by attending doctors and 37.50% by resident doctors (P < 0.05)., Conclusions: Urological and andrological clinicians do not strictly follow the Guidelines in the diagnosis and treatment of male urethritis. There are significant differences in the dosing of azithromycin and results of treatment of non-gonococcal urethritis among doctors with different professional titles, but not in the other aspects.

Naphthalene is commonly used in Ghana as an insecticide and there have been occasional ingestion unintentionally ingestion in children. Naphthalene use has been associated with intravascular haemolysis especially in patients with glucose-6-phoshate dehydrogenase (G6PD) deficiency but its unorthodox use for the treatment of urethritis in a young man and its associated acute kidney injury has not been described in Ghana. This case report bring to fore the indiscriminate use of complementary medicines and the multiple adverse effects on the kidneys after the ingestion of a combination of naphthalene, alcohol and aluminium sulphate (Alum) as a treatment for urethritis upon a friend's suggestion requiring intermittent haemodialysis but recovered completely of his renal functions. Naphthalene ingestion can cause acute tubular necrosis from haemoglobinuria and timely interventions are necessary to restore renal and maintain good renal functions., Competing Interests: The authors declare no competing interests.

Background: Men who have sex with men (MSM) are a key population, particularly vulnerable to sexually transmitted infections (STIs) and HIV, but there are limited data on health programs targeting MSM in Africa. This study aims to describe the utilization of nongovernmental organization-supported sexual health services for MSM at 2 public sector health facilities in Johannesburg, South Africa., Methods: We retrospectively analyzed routine data over the period of January 2014 to June 2016. We report on service utilization for STI syndromes, HIV testing, and the antiretroviral therapy (ART) program., Results: Some 5796 men visited the facilities. Seven thousand one hundred eighty-eight STI episodes were managed, 68.2% (4903 episodes) of which were classified as male urethritis and 9.8% (704 episodes) as genital ulcers. Positivity yield for first-time HIV tests was 38.0% (205 positive test results) in MSM, compared with 14.1% (471 positive test results) in other men. At the end of the study, there were 1090 clients on ART, and 2-year retention was 82% (95% confidence interval, 78%-85%). There was no difference in retention between MSM and other men (P = 0.49)., Conclusions: This study is the first to show that sexual health services targeting MSM in Africa have managed to attract MSM and other men in need of STI and HIV care. The observed high HIV testing yield among MSM illustrates the relevance of MSM-focused services in the South African public health sector, and the good retention on ART demonstrates that high-quality care can be provided to MSM in our setting.

Urethritis posterior is a possible cause of asymptomatic haematuria in prepubescent boys. It is a benign lesion of the posterior urethra and its cardinal symptoms are blood spots in the underwear without any laboratory or radiologic findings. Urethrocystoscopy is the only way to confirm the diagnosis, but has been subject to criticism as it is associated with a high risk of strictures. It is advisable to adopt a "wait and see" strategy because urethritis posterior usually heals spontaneously over time. This condition is most likely caused by detrusor-sphincter dyssynergia, since behavioural intervention with biofeedback therapy offers good treatment results., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: To determine if female partners of men with pathogen-negative non-gonococcal urethritis (NGU) are at risk of genital infection., Methods: Secondary data analysis using health records from a large sexually transmitted disease clinic in Melbourne of 1710 men and their female partners attending on the same day from January 2006 to April 2015. Proportions of female partners with symptoms suggesting genital infection or pelvic inflammatory disease (PID) were determined for: (1) men with NGU and no Chlamydia trachomatis or Mycoplasma genitalium (referred to as pathogen-negative NGU) (n = 91); 2) men with urethral C. trachomatis (n = 176); 3) men with urethral M. genitalium (n = 26); and 4) asymptomatic men (n = 652)., Results: Female partners of men with pathogen-negative NGU experienced deep pelvic pain (adjusted odds ratio [AOR], 2.2; 95% confidence interval [CI], 1.1-4.4), post coital bleeding (AOR, 2.4; 95% CI, 1.2-4.9), and dysuria (AOR, 3.7; 95% CI, 1.6-8.6) more commonly and were diagnosed with PID more commonly (AOR, 4.8; 95% CI, 2.1-11.3) than the female partners of asymptomatic men. Pelvic inflammatory disease was not more likely to be diagnosed in the female partners of men with genital warts (AOR, 1.4; 95% CI, 0.5-4.4) or candidiasis (AOR, 1.2; 95% CI, 0.4-3.5) than the female partners of asymptomatic men. The female partners of men with chlamydia experienced post coital bleeding more (AOR, 1.9; 95% CI, 1.0-3.6) and were more likely to be diagnosed with PID (AOR, 3.6; 95% CI, 1.6-8.0)., Conclusions: The female partners of men with pathogen-negative NGU may be at increased risk of genital infection, even if a recognised pathogen is not identified in the man.

Introduction: Williams and Mikhael (1971) described idiopathic urethritis (IU) as a self-limiting condition that affects boys aged 5-15 years, with symptoms of urethrorrhagia, dysuria and haematuria. However, a proportion of boys will remain symptomatic for several years, and may develop urethral stricture (Poch et al., 2007; Palagiri et al., 2003). There is no universally effective treatment for IU, although various strategies have been employed., Objective: To review the presentation and long-term outcomes of boys with IU, and present the efficacy of management strategies that have been utilised., Study Design: A retrospective review was performed of all boys with IU. It was based on clinical and cystoscopic findings for presentation, medical history, management and clinical progress., Results: Fifty-four boys were included, with a median age of 11 years (range 5-15 years) at presentation. The median duration of symptoms was 18 months (range 2-132 months). The median follow-up was 18.5 months (range 1-120 months). Seven (13.0%) boys had early urethral stricture at initial cystourethroscopy, and one (1.9%) developed stricture during follow-up. Thirty-six boys (66.7%) had previous circumcision and four (7.4%) had meatal stenosis. Eight (14.8%) had previous hypospadias repair., Conclusion: Whilst 50% of boys with IU do not require any specific treatment, those with severe/unremitting symptoms may benefit from a trial of urethral steroids or short-term urethral catheterisation. The mechanisms of benefit from these modalities are unclear and they require further evaluation., (Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

In April 2013, the Centers for Disease Control and Prevention (CDC) convened an advisory group to assist in development of the 2015 CDC sexually transmitted diseases (STDs) treatment guidelines. The advisory group examined recent abstracts and published literature addressing the diagnosis and management of sexually transmitted infections. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of epididymitis that were considered in preparation of the 2015 CDC STD treatment guidelines., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Neisseria gonorrhoeae and Chlamydia trachomatis are well-documented urethral pathogens, and the literature supporting Mycoplasma genitalium as an etiology of urethritis is growing. Trichomonas vaginalis and viral pathogens (herpes simplex virus types 1 and 2 and adenovirus) can cause urethritis, particularly in specific subpopulations. New data are emerging regarding the potential role of bacterial vaginosis-associated bacteria in urethritis, although results are inconsistent regarding the pathogenic role of Ureaplasma urealyticum in men. Mycoplasma hominis and Ureaplasma parvum do not appear to be pathogens. Men with suspected urethritis should undergo evaluation to confirm urethral inflammation and etiologic cause. Although nucleic acid amplification testing would detect N. gonorrhoeae and C. trachomatis (or T. vaginalis if utilized), there is no US Food and Drug Administration-approved clinical test for M. genitalium available in the United States at this time. The varied etiologies of urethritis and lack of diagnostic options for some organisms present treatment challenges in the clinical setting., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

The article shows the high efficacy of the additional local use of the drug Miramistin in combination therapy of chronic urethritis, associated with sexually transmitted infections (STIs). In accordance with the principles of evidence-based medicine, patients were assigned to the study group (n=110) treated with conventional therapy and Miramistin, and the comparison group (n=40) treated with conventional therapy only. The between-group comparison of treatment effectiveness was carried out by matching results of the etiological healing, the changes of the endoscopic picture of the urethra, and basic clinical manifestations of STI: the degree of inflammatory reaction of urethral mucous membrane, dysuria, pain and sexual syndrome.

The aim of this study was to describe the clinical features and long-term outcome of the patients who were treated at our institution for idiopathic urethrorrhagia. The data of 10 male patients, who underwent cystoscopy between October 2010 and March 2013 due to urethrorrhagia, were evaluated retrospectively. Ten male patients aged between 8 and 16 years at first submission. Four patients (40%) had low voiding frequency (2-3 per day). Three of the four patients had abnormal uroflowmetry/EMG findings. Cystoscopy was done in all patients which revealed bulbar urethral inflammation and hemorrhage in all. Symptoms were not resolved on three of the patients who were under observation, having symptoms on average for 29.6±10.5 months. Complete resolution developed in the other seven patients. Six of the patients` symptoms were resolved soon after cystoscopy. In the patients' with or without normal uroflowmetry/EMG findings urethrorrhagia resolution rates were 86% and 33%, respectively. In the evaluation of urethrorrhagia; detailed history taking, basic laboratory investigation and cystoscopy are enough. The typical patients may be treated expectantly. In our opinion, it seems that dysfunctional voiding and infrequent voiding might cause delayed remission and/or recurrence of urethrorrhagia. Even though, it does not effect the treatment, in the persistent cases, confirmation of diagnosis by cystoscopy helps to lessen the anxiety of the family and might decrease the use of many unnecessary diagnostic tools in the long term follow ups.

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.

For many years an increase in cases of urethritis has been observed in western Europe. In order to be able to combat this continuous rise, the perception of sexually transmitted diseases must be promoted, the clarification and screening must be intensified and therapy must be rapidly and correctly carried out. In addition to the commonest pathogens causing urethritis, namely chlamydia and gonococci, many other pathogenic microbes must be taken into consideration in the diagnostics. With respect to therapy, apart from the increasing resistance formation of Mycoplasma genitalium, the decreasing effectiveness of standard forms of treatment of other microbes must be emphasized. For chronic and recurrent urethritis in particular a broad clarification of the pathogen should be carried out to enable targeted treatment and also partner treatment. Priority must again be given to primary prevention.

Background: While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya., Methods: In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines., Results: Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2-10) at pharmacies, 3 (1-3) at private clinics and 5 (2-17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews., Conclusions: In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes.

Background: Partner notification (PN) is the process whereby sexual partners of an index patient are informed of their exposure to a sexually transmitted infection (STI) and the need to obtain treatment. For the person (index patient) with a curable STI, PN aims to eradicate infection and prevent re-infection. For sexual partners, PN aims to identify and treat undiagnosed STIs. At the level of sexual networks and populations, the aim of PN is to interrupt chains of STI transmission. For people with viral STI, PN aims to identify undiagnosed infections, which can facilitate access for their sexual partners to treatment and help prevent transmission., Objectives: To assess the effects of different PN strategies in people with STI, including human immunodeficiency virus (HIV) infection., Search Methods: We searched electronic databases (the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE) without language restrictions. We scanned reference lists of potential studies and previous reviews and contacted experts in the field. We searched three trial registries. We conducted the most recent search on 31 August 2012., Selection Criteria: Published or unpublished randomised controlled trials (RCTs) or quasi-RCTs comparing two or more PN strategies. Four main PN strategies were included: patient referral, expedited partner therapy, provider referral and contract referral. Patient referral means that the patient notifies their sexual partners, either with (enhanced patient referral) or without (simple patient referral) additional verbal or written support. In expedited partner therapy, the patient delivers medication or a prescription for medication to their partner(s) without the need for a medical examination of the partner. In provider referral, health service personnel notify the partners. In contract referral, the index patient is encouraged to notify partner, with the understanding that the partners will be contacted if they do not visit the health service by a certain date., Data Collection and Analysis: We analysed data according to paired partner referral strategies. We organised the comparisons first according to four main PN strategies (1. enhanced patient referral, 2. expedited partner therapy, 3. contract referral, 4. provider referral). We compared each main strategy with simple patient referral and then with each other, if trials were available. For continuous outcome measures, we calculated the mean difference (MD) with 95% confidence intervals (CI). For dichotomous variables, we calculated the risk ratio (RR) with 95% CI. We performed meta-analyses where appropriate. We performed a sensitivity analysis for the primary outcome re-infection rate of the index patient by excluding studies with attrition of greater than 20%. Two review authors independently assessed the risk of bias and extracted data. We contacted study authors for additional information., Main Results: We included 26 trials (17,578 participants, 9015 women and 8563 men). Five trials were conducted in developing countries. Only two trials were conducted among HIV-positive patients. There was potential for selection bias, owing to the methods of allocation used and of performance bias, owing to the lack of blinding in most included studies. Seven trials had attrition of greater than 20%, increasing the risk of bias.The review found moderate-quality evidence that expedited partner therapy is better than simple patient referral for preventing re-infection of index patients when combining trials of STIs that caused urethritis or cervicitis (6 trials; RR 0.71, 95% CI 0.56 to 0.89, I(2) = 39%). When studies with attrition greater than 20% were excluded, the effect of expedited partner therapy was attenuated (2 trials; RR 0.8, 95% CI 0.62 to 1.04, I(2) = 0%). In trials restricted to index patients with chlamydia, the effect was attenuated (2 trials; RR 0.90, 95% CI 0.60 to 1.35, I(2) = 22%). Expedited partner therapy also increased the number of partners treated per index patient (three trials) when compared with simple patient referral in people with chlamydia or gonorrhoea (MD 0.43, 95% CI 0.28 to 0.58) or trichomonas (MD 0.51, 95% CI 0.35 to 0.67), and people with any STI syndrome (MD 0.5, 95% CI 0.34 to 0.67). Expedited partner therapy was not superior to enhanced patient referral in preventing re-infection (3 trials; RR 0.96, 95% CI 0.60 to 1.53, I(2) = 33%, low-quality evidence). Home sampling kits for partners (four trials) did not result in lower rates of re-infection in the index case (measured in one trial), or higher numbers of partners elicited (three trials), notified (two trials) or treated (one trial) when compared with simple patient referral. There was no consistent evidence for the relative effects of provider, contract or other patient referral methods. In one trial among men with non-gonococcal urethritis, more partners were treated with provider referral than with simple patient referral (MD 0.5, 95% CI 0.37 to 0.63). In one study among people with syphilis, contract referral elicited treatment of more partners than provider referral (MD 2.2, 95% CI 1.95 to 2.45), but the number of partners receiving treatment was the same in both groups. Where measured, there was no statistical evidence of differences in the incidence of adverse effects between PN strategies., Authors' Conclusions: The evidence assessed in this review does not identify a single optimal strategy for PN for any particular STI. When combining trials of STI causing urethritis or cervicitis, expedited partner therapy was more successful than simple patient referral for preventing re-infection of the index patient but was not superior to enhanced patient referral. Expedited partner therapy interventions should include all components that were part of the trial intervention package. There was insufficient evidence to determine the most effective components of an enhanced patient referral strategy. There are too few trials to allow consistent conclusions about the relative effects of provider, contract or other patient referral methods for different STIs. More high-quality RCTs of PN strategies for HIV and syphilis, using biological outcomes, are needed.

Background/aim: This study aimed to determine the prevalence of Mycoplasma genitalium infection among male patients with dysuria and/or urethral discharge. An analysis of the clinical, demographic and microbiological factors associated with M. genitalium infection was also conducted., Method: From May 2007 to June 2011, men presenting to the clinic with self-reported symptoms of dysuria and/or urethral discharge were identified and underwent urethral swab, which was microscopically assessed for objective non-gonococcal urethritis. A first-void urine sample was tested for Chlamydia trachomatis and Neisseria gonorrhoeae using the Aptima Combo-2 assay. A portion of the urine sample was sent for polymerase chain reaction analysis for M. genitalium., Results: One thousand, one hundred and eighty-two men with dysuria and/or urethral discharge were tested for M. genitalium. Of those, 96 men (8.1%) were positive for M. genitalium. Men identifying as solely MSM (men who have sex with men) constituted 16.3% (n = 193) of the sample. Their infection rate was 3.1% (n = 6). The infection rate for heterosexual and bisexual men was 9.1%. For all men, the M. genitalium co-infection rate was 14.6% (n = 14) with C. trachomatis and 3.1% (n = 3) with N. gonorrhoeae. Factors associated with M. genitalium infection were analysed by univariate analysis. We determined that five investigated predictors were significantly associated with M. genitalium infection, urethral discharge, non-gonococcal urethritis on Gram stain of urethral smears, identification as heterosexual or bisexual, and absence of co-infection with C. trachomatis or N. gonorrhoeae., Conclusion: In Adelaide, M. genitalium is an important sexually transmitted infection among men with dysuria and/or urethral discharge, and is primarily an infection of heterosexual and bisexual men., (© 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.)

Background: Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious consequences for the entire urinary tract. Its prevalence among men in industrial countries is estimated at 0.9%. It produces obstructive and irritative urinary symptoms and can ultimately impair renal function. Urethral strictures can be caused by diagnostic or therapeutic urological procedures. These procedures are being performed ever more commonly, because the population is aging; thus, urethral strictures will probably become more common as well., Methods: We selectively reviewed pertinent original articles and meta-analyses (1995-2012) on the causes, diagnostic evaluation, and treatment of urethral strictures, which were retrieved by a search in the PubMed database., Results: Most of the relevant publications are reports of retrospective studies from single centers. Only a few prospective randomized trials and structured reviews are available. The overall level of the scientific evidence is low. 45% of urethral strictures are iatrogenic, 30% idiopathic, and 20% due to bacterial urethritis. Strictures are diagnosed with a flow test and a retrograde urethrogram. Short bulbar strictures can be treated endoscopically. For recurrent and complex strictures, only open urethral surgery can reliably and permanently remove the infravesical obstruction., Conclusion: Urethral strictures must be recognized and treated so that their most serious long-term complication, impaired renal function, can be prevented. The clinical utility of urethrotomy is limited by a high recurrence rate.

The study is aimed at investigation of efficacy and safety of a combined effect of laser therapy and vibromagnetotherapy in complex treatment of patients with chronic urethroprostatitis in the presence of sexually transmitted infection (STI). A total of 35 males aged 20 to 51 years entered the study. They were divided into 3 groups. Group 1 received standard basic therapy, group 2 received basic and laser therapy, group 3 - basic treatment and laser plus vibromagnetotherapy. Effectiveness of the treatment was assessed by the evidence obtained from clinical, bacteriological, device and functional examinations. The results of the treatments were evaluated after 2 weeks of the follow-up. It is shown that patients of groups 2 and 3 achieved more pronounced improvement of clinical and laboratory indices, parameters of basal blood flow. Thus, physiotherapy, added to antibacterial treatment, is safe and effective in the treatment of chronic urethroprostatitis and STI.

Background: Viral hepatitis B accounts for over 80% of acute hepatic failures in China and the patients die mainly of its complications. A patient with hepatic failure and fever is not uncommon, whereas repeated fever is rare., Methods: A 32-year-old female was diagnosed with subacute hepatic failure and hepatitis B viral infection because of hyperbilirubinemia, coagulopathy, hepatic encephalopathy, serum anti-HBs-positive without hepatitis B vaccination, and typical intrahepatic pathological features of chronic hepatitis B. Plasma exchange was administered twice and she awoke with hyperbilirubinemia and discontinuous fever., Results: Urethritis was confirmed and medication-induced fever and/or spontaneous bacterial peritonitis (Gram-negative bacillus infection) was suspected. The patient was treated with antibiotics, steroids and a Chinese herbal medicine, matrine, for three months and she recovered., Conclusion: The survival rate of patients with hepatic failure might be improved with comprehensive supporting measures and appropriate, timely management of complications.

Objective: To assess the cost-effectiveness of syndromic management for the treatment of sexually transmitted diseases (STD) in comparison with the strategies currently used in STD clinics in Taiwan., Methods: Between July 2004 and June 2005, all male patients with genitourinary symptoms attending two hospitals were included in this study. Current clinical procedures (presumptive treatment and laboratory tests), aetiological diagnosis and syndromic management were compared in terms of diagnostic accuracy, treatment appropriateness, costs and effectiveness., Results: 473 patients met the inclusion criteria and were enrolled in the study. 335 patients (71%) had urethral symptoms (discharge, dysuria or painful urination) and 138 (29%) had genital ulcers, sores and skin rashes. For the current approach, the sensitivity, specificity and positive predictive value (PPV) for the detection of chlamydial, gonococcal and combined forms of infection were 100%, 40.0% and 60.4%, respectively. In contrast, the sensitivity, specificity and PPV for the detection of syphilis were 100%, 86.7% and 70.2%, respectively. For syndromic management, the sensitivity, specificity and PPV detection of chlamydial, gonococcal and combined forms of infection were 85.0%, 40.0% and 56.4%, respectively. In contrast, the sensitivity, specificity and PPV for the detection of syphilis were 78.8%, 18.1% and 23.2%, respectively. The average cost of implementing a correct treatment using the current approach was US$54.27 and US$30.74 for urethritis and syphilis, respectively. For the aetiological approach, the average cost of implementing a correct treatment was US$32.83 and US$21.58 for urethritis and syphilis, respectively. For the syndromic approach, the average cost for a correct treatment was US$3.86 and US$14.30 for urethritis and syphilis, respectively., Conclusions: In this sample of patients attending STD clinics in Taiwan, syndromic management was found to be a more cost-effective protocol in terms of cost per treated STD patient compared with the current and aetiological protocols for STD.

Background: Urinary tract infections are the most common infections seen in hospitalized patients and the second most common, after respiratory tract infections, seen in the general population. The World Wide Web can now assist healthcare professionals in finding up-to-date information on different medical conditions., Methods: We sought to identify websites that contain information on urogenital infections by using popular search engines, such as Google and Yahoo. We also reviewed the sites of major institutions, and international healthcare associations. Only those sites that were written in English, were open access, and developed by a government, academic institution or a national or international healthcare professionals association were included., Results: We selected 114 sites that provide healthcare professionals with useful information on urogenital infections based on the criteria described above., Conclusions: There are several free websites that contain worthy information on urogenital infections. The compilation of a list of Internet resources on these common types of infections may be useful to practitioners and medical students.

Objectives: We can say that in military hospitals, pioneer institutions in health-care in our country, approximately 25% of the pathology over the second half of the 19th century would correspond to sexually transmitted diseases (STD), with hospital wards dedicated to these diseases, initially associated with genitourinary diseases. The "military drip" or blennorrhagic urethritis was a venereal disease with great incidence and prevalence in the pre-antibiotic era. This article reviews the diagnostic and therapeutic methods employed by Spanish military doctors during such period., Methods: In the introduction we state the relationship between the knowledge of the time and the environment in which military doctors developed their professional activity. We make reference to military health-care journals, vehicle for their worries and demonstration of the level of theoretical and practical knowledge they were distinguished for. Based on their service records and publications we refer the urologists from the military health-care system that showed a greater interest in the field of urethral diseases, talking about the methodology they used for diagnosis and treatment of blennorrhagic urethritis., Results and Conclusions: Military health-care at the end of 18th century and the beginning of the 19th century joined a group of professionals who demonstrated talent and perseverance in the treatment of "military drip". To know the concepts for the diagnosis and treatment of urethritis improves our perspective in the knowledge of these pathologies, and confirms us in the evaluation of the advances available for us today, thanks to the addition of efforts of our predecessors.

Our study has shown that the same set of physical factors in combination with local drug therapy when used endourethrally has a higher effect in therapy of chronic bacterial urethroprostatitis (CBUP). Mean subjective indices (pain, dysuria, questionnaire data) in the urethral technique are 1.33 times higher than those in the rectal technique. The objective indices (leukocytes, licetine granulations) - 1.4, uroflowmetry parameters - 1.51, hemodynamic parameters - 1.4 times higher. The complex AMUS-01-Intramag has some advantages over the other complexes, the main advantage being the ability to provide local drug therapy and accumulation of the drug in the affected focus.

Objectives: To determine the adequacy of care received from general practitioners by patients with sexually transmitted diseases or genitourinary symptoms., Design: Prospective study., Setting: Hong Kong., Participants: Diagnoses and drug data obtained from logbooks submitted by doctors studying for the Diploma in Family Medicine and candidates for Fellowship examinations between 1999 and 2002., Main Outcome Measures: Diagnosis or symptom of a sexually transmitted disease and prescribed treatment., Results: Sexually transmitted diseases and genitourinary symptoms accounted for 1.1% of the workload of these community doctors in Hong Kong. The majority of patients were young adult males. The overall standard of treatment was inadequate: both multi-pharmacy and inappropriate treatment was common; in up to 30% of cases, doctors ignored local or international guidelines., Conclusion: Primary care doctors play an important role in the diagnosis and management of sexually transmitted diseases or genitourinary symptoms in Hong Kong. A high index of suspicion should be maintained and continuing education made available if doctors are to provide an equally high standard of care.

Unlabelled: Little is known about gaps in quality and the extent to which clinical standards are used in emergency department (ED) practice., Objectives: To determine whether ED practitioners comply with the Centers for Disease Control and Prevention (CDC) recommendations for diagnosing and treating sexually transmitted diseases (STDs)., Methods: A retrospective chart review of ED visits was conducted at an urban teaching hospital. Using ICD-9 codes, urethritis, cervicitis, pelvic inflammatory disease (PID), gonorrhea, and chlamydia cases seen from May 1, 2000, to February 28, 2001, were identified. Documentation of components of the history, physical examination, diagnostic testing, prescribed antibiotics, and discharge instructions necessary to comply with the CDC guidelines were abstracted. This set of comprehensive criteria was compared with a less stringent subset of selected criteria., Results: Two hundred forty-six patient visits were identified, and 203 (83%) were included. Forty-eight men and 155 women were included: 48 (24%) with urethritis, 34 (17%) with cervicitis, and 121 (60%) with PID. For urethritis, cervicitis, and PID, respectively, there was documentation of compliance with indicators related to the following: history 73%, 15%, and 14%; physical examinations 63%, 15%, and 22%; diagnostic testing 79%, 71%, and 71%; antibiotic use 33%, 32%, and 32%; and safe sex instructions 50%, 18%, and 15% of the time. Men were more likely to receive safe sex instructions (p < or = 0.01). Total (100%) compliance in all five domains occurred 8% of the time for urethritis, 3% for cervicitis, and never for PID. The rates of 100% compliance were not significantly different when a subset of selected criteria was used., Conclusions: Deficits in adherence to recommended guidelines for the diagnosis and treatment of STDs exist in ED practice.

Urogenital infections may often have a major effect on fertility. For the most part, however, the pathogenetic aspects of such cases have not yet been clarified. In the future, the integration of functional and molecular parameters will be decisive for defining an interaction between urogenital infection and male fertility. As a rule, infection-related alterations to the ejaculate require antimicrobial treatment, although the effect of the latter on fertility remains uncertain.

Purpose: To describe current knowledge about diagnosis, screening, and treatment of sexually transmitted urethritis among adolescent and young adult males., Data Sources: Current research, systematic reviews, consensus guidelines and the author's clinical experience., Conclusions: Urethritis, the most common sexually transmitted syndrome in young males, is most frequently caused by Chlamydia trachomatis and/or Neisseria gonorrhea. Symptoms include dysuria and penile discharge, although up to 50% of males are asymptomatic. Risky sexual behaviors and lack of access to healthcare increase incidence of this infection. Transmission to female partners can lead to pelvic inflammatory disease, infertility, and neonatal infection., Implications for Practice: Young males with urethritis must be treated as soon as diagnosis is established. Consensus guidelines exist for diagnosis and treatment of gonococcal and non-gonococcal urethritis. Careful patient education is necessary to ensure successful treatment. Prevention of repeat infections requires partner treatment and detailed education about safer sexual practices. Improved access to preventive services for young males should be a healthcare priority.

The diagnosis and treatment of STDs is a common problem in primary care practice; however, newer diagnostic and therapeutic alternatives require physicians to be aware of evidence-based guidelines that are continuing to evolve. The treatment of STDs in men, in particular, is an area of evolving evidence because much of what is known is based on the treatment of STDs in women. Men represent unique challenges in diagnosis, evaluation, and follow-up that need to be considered in the treatment of urethritis, epididymitis, herpes genitalis, condyloma, prostatitis, and other syndromes. Screening for asymptomatic STDs is currently not recommended in the general population, but selected criteria can be used to identify a target population for screening in high-risk areas.

Objective: To evaluate sexual behaviour (including abstinence), sex partner change, and condom use during the 3 month period following treatment for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, or non-gonococcal urethritis., Methods: 251 14-21 year old participants (83% female; 83% African-American) diagnosed with gonorrhoea, chlamydia, trichomonas, or non-gonococcal urethritis or sexual contacts of infected partners. Participants were clients of a public sexually transmitted diseases clinic or primary care adolescent clinics. Data were collected by structured interview at treatment, 1 month post-treatment, and 3 months post-treatment. At each visit, participants were asked about coital frequency and condom use for each recent partner. At 1 month, participants were asked when coitus occurred following treatment. At each follow up visit, sex partners were compared to partners named at treatment and classified as "same partner(s)," "new partner(s)," or both "same and new partner(s).", Results: Post-treatment abstinence was reported by 26% and 19% for the 1 month and 3 month visits, respectively. Abstinence was associated with greater likelihood of infection at enrolment although abstainers reported fewer lifetime STI and fewer lifetime sex partners. A substantial proportion of participants reported additional sexual contact with a previous partner. The average proportion of condom protected coital events increased from about 45% at enrolment to 64% at 1 month and 58% at 3 months (p<0.05). Higher levels were sustained for the 3 months following treatment., Conclusions: Many adolescents adopt, at least temporarily, risk reduction behaviours such as abstinence or increased condom use. Sexual re-exposure to potentially untreated previous partners may increase risk of subsequent reinfection.

These guidelines for the treatment of patients who have sexually transmitted diseases (STDs) were developed by the Centers for Disease Control and Prevention (CDC) after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on September 26-28, 2000. The information in this report updates the 1998 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 1998;47 [No. RR-1]). Included in these updated guidelines are new alternative regimens for scabies, bacterial vaginosis, early syphilis, and granuloma inguinale; an expanded section on the diagnosis of genital herpes (including type-specific serologic tests); new recommendations for treatment of recurrent genital herpes among persons infected with human immunodeficiency virus (HIV); a revised approach to the management of victims of sexual assault; expanded regimens for the treatment of urethral meatal warts; and inclusion of hepatitis C as a sexually transmitted infection. In addition, these guidelines emphasize education and counseling for persons infected with human papillomavirus, clarify the diagnostic evaluation of congenital syphilis, and present information regarding the emergence of quinolone-resistant Neisseria gonorrhoeae and implications for treatment. Recommendations also are provided for vaccine-preventable STDs, including hepatitis A and hepatitis B.

Sexually transmitted infections (STIs) are considered a major public health problem, globally. In particular, increasing STI rates have been documented throughout eastern Europe and central Asia. The Russian Federation and adjacent countries have, traditionally, managed STIs on an aetiological basis. This approach is expensive in terms of laboratory costs and it may lead to delayed diagnosis and treatment. To overcome the limitations of the aetiological management of STIs, the World Health Organization (WHO) has placed an increased emphasis on integrated care using syndromic management at the primary care level, especially in developing countries. This article reviews the current aetiology of STIs in Estonia, an eastern European country bordering the Baltic Sea and formerly a part of the Soviet Union, with the aim of defining whether infection with Trichomonas vaginalis is common enough to include its management in a syndromic management protocol. The use of syndromic management, in general, is also discussed.

Effective management for sexually transmitted diseases (STDs) depends on appropriate testing, treatment, partner management, and complete and timely reporting of positive STD tests (1). Testing can ensure appropriate treatment of initial or recurrent infections and identification of drug-resistant pathogens, appropriate treatment can reduce risk for complications and development of drug resistance, and complete and timely reporting of positive test results by laboratories and STD cases by health-care providers to health departments can facilitate rapid sex partner notification and outbreak detection. By 1998, private providers, including those affiliated with commercial or Medicaid managed care organizations (MCOs) (2,3) were caring for approximately 70% of persons with chlamydia and 55% of persons with gonorrhea. To assess the quality of STD care at a MCO-affiliated multisite facility, the testing, treatment, and reporting practices of gonorrhea- and chlamydia-associated urethritis in male patients were evaluated. This report summarizes the evaluation, which indicated that the providers tested most men with urethritis symptoms, prescribed CDC-recommended therapy to all patients, and reported most laboratory-confirmed chlamydia and gonorrhea cases of urethritis to the state health department. Several interventions introduced at this large group practice may have encouraged these favorable STD practices.

The goal of this study was to determine whether a urine two-glass test or a leucocyte esterase (LE) test of first-void urine (FVU) improve the sensitivity or specificity of the World Health Organization (WHO) algorithm for the syndromic management of men with urethritis in southern Thailand. A secondary aim was to determine whether infection with Trichomonas vaginalis was sufficiently common to include treatment for it in a syndromic management protocol. One hundred and twenty-nine men with symptoms of urethritis seen at 2 STD clinics in Songkla Province, Thailand were enrolled. Symptoms and signs of each man were recorded and a urethral swab collected for microscopy and culture for Neisseria gonorrhoeae. A two-glass urine test and an LE test of an FVU specimen were performed. The FVU was tested by polymerase chain reaction (PCR) for N. gonorrhoeae, Chlamydia trachomatis and T. vaginalis. Dysuria was a symptom in 78% of men. A urethral discharge was a symptom in 68% but was evident on examination in 95% of the men. The prevalences of infection were 32.6% for N. gonorrhoeae, 23.3% for C. trachomatis, 1.6% for T. vaginalis and 51.9% for any infection. The sensitivities and specificities of urethral discharge on examination, two-glass test and LE test of FVU as indicators of infection with either or both of N. gonorrhoeae or C. trachomatis were 97% and 8%; 57% and 83%; and 59% and 78% respectively. Combinations of urethral discharge on examination and one of the other indicators were more specific but much less sensitive than the presence of discharge alone. Culture for N. gonorrhoeae was found to be only 43% sensitive compared with an expanded gold standard involving a PCR test. Our analysis demonstrates that neither the two-glass test nor the LE test of FVU were useful in improving on the WHO algorithm for management of men with urethritis. T. vaginalis was not common enough to include in a first-line syndromic management protocol for male urethritis. We recommend that, in southern Thailand, men with symptoms of urethritis in whom a urethral discharge is present on examination be offered immediate treatment for both N. gonorrhoeae and C. trachomatis as per the WHO algorithm.