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Matthew R Golden - One of the best experts on this subject based on the ideXlab platform.
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a single arm open label clinical trial of 2g aztreonam for the treatment of n gonorrhoeae
Antimicrobial Agents and Chemotherapy, 2020Co-Authors: Lindley A. Barbee, Negusse Ocbamichael, Olusegun O Soge, Angela Leclair, Matthew R GoldenAbstract:Background: The threat of ceftriaxone-resistant Neisseria gonorrhoeae (NG) necessitates new gonorrhea treatment regimens. Repurposing older antibiotics not routinely used for NG may expeditiously identify new therapies. Ideally, all recommended therapies should eradicate gonorrhea at the pharynx.Methods: Between April and September 2019, we enrolled men in an open-label, one-arm clinical trial of single-dose intramuscular aztreonam (2g). Enrollment criteria included 1) nucleic acid amplification test (NAAT)-positive pharyngeal gonorrhea ≤14 days; or 2) Gram-stain-positive gonococcal Urethritis plus report of performing oral sex in ≤2 months. At enrollment, we collected cultures from NAAT-positive or screening sites, and men returned 3-8 days following treatment for a test of cure (TOC) by culture. The per-protocol analysis required men to be culture-positive at enrollment and to return for TOC. We calculated efficacy as number of subjects with negative culture at TOC divided by the number culture-positive at enrollment by anatomic site.Results: Thirty-two men enrolled in study; 21 were pharyngeal NAAT-positive and 11 had gonococcal Urethritis. The per-protocol analysis included 17 men, 6 with pharyngeal, 9 urethral and 4 rectal gonococcal infections. Aztreonam cured 2 of 6 pharyngeal infections (33%, 95%CI: 4.3%-78%) and 3 of 4 rectal infections (75%, 95%CI: 19%-99%). All 11 men with Urethritis were cured (100%, 95%CI: 66%-100%). The aztreonam MIC90 was 0.5 μg/mL (range: 0.06 - 2.0 μg/mL). All treatment failures occurred at MIC ≥0.25 μg/mL.Conclusions: Single-dose aztreonam is not a reliable treatment for gonorrhea at the pharynx, but may be useful for men with gonococcal Urethritis and beta-lactam allergy.
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primary syphilis in the male urethra a case report
Clinical Infectious Diseases, 2019Co-Authors: Laura C Chambers, Matthew R Golden, Sujatha Srinivasan, Sheila A Lukehart, Negusse Ocbamichael, Jennifer Morgan, Sylvan M Lowens, David N FredricksAbstract:: We documented urethral Treponema pallidum infection in a man with nongonococcal Urethritis and a negative syphilis serology using broad-range bacterial polymerase chain reaction (PCR) and sequencing, targeted PCR, and immunofluorescence microscopy. He subsequently seroconverted for syphilis. Early syphilis may present as Urethritis. Urethral T. pallidum shedding can occur before seroconversion.
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an estimate of the proportion of symptomatic gonococcal chlamydial and non gonococcal non chlamydial Urethritis attributable to oral sex among men who have sex with men a case control study
Sexually Transmitted Infections, 2016Co-Authors: Lindley A. Barbee, Julia C Dombrowski, Christine M Khosropour, Lisa E. Manhart, Matthew R GoldenAbstract:Background Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. Methods We conducted a case–control study of MSM attending Public Health—Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic Urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel–Haenszel OR estimates. Results Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal Urethritis, 31.4% of chlamydial Urethritis and 35.9% non-gonococcal, non-chlamydial Urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal Urethritis, chlamydial Urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. Conclusions The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause Urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.
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an estimate of the proportion of symptomatic gonococcal chlamydial and non gonococcal non chlamydial Urethritis attributable to oral sex among men who have sex with men a case control study
Sexually Transmitted Infections, 2016Co-Authors: Lindley A. Barbee, Julia C Dombrowski, Christine M Khosropour, Lisa E. Manhart, Matthew R GoldenAbstract:Background Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. Methods We conducted a case–control study of MSM attending Public Health—Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic Urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel–Haenszel OR estimates. Results Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal Urethritis, 31.4% of chlamydial Urethritis and 35.9% non-gonococcal, non-chlamydial Urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal Urethritis, chlamydial Urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. Conclusions The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause Urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.
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p3 162 an estimate of the proportion of gonococcal chlamydial and non gonococcal non chlamydial Urethritis ngncu attributable to oral sex among men who have sex with men msm
Sexually Transmitted Infections, 2013Co-Authors: Lindley A. Barbee, Julia C Dombrowski, Lisa E. Manhart, Matthew R GoldenAbstract:Background The proportion of infectious Urethritis associated with oral sex is unknown. Methods We conducted a retrospective study of MSM diagnosed with symptomatic Urethritis attending an STD Clinic between 2001–2010. We categorised men according to their urethral exposures in the previous 60 days: (1) only insertive oral sex and no insertive anal sex (IOS); (2) only protected insertive anal intercourse and insertive oral sex (PIAI); (3) unprotected insertive anal intercourse with or without oral sex (UIAI); (4) no insertive sex (oral or anal). We calculated the proportion of Urethritis cases by groups as a minimum estimate of the proportion of cases attributable to oral sex. Results Between 2001–2010, 4,091 MSM were diagnosed with Urethritis, had complete records for categorization, and were included in this analysis. Men reported the following urethral exposures: 13% IOS, 21% PIAI, 65% UIAI, and Conclusion While usually considered a safer sexual practise, our findings suggest that a large proportion of all cases of Urethritis are attributable to insertive oral sex. These findings highlight the importance of screening the oropharynx and counselling MSM about the risks of oral sex.
Takashi Deguchi - One of the best experts on this subject based on the ideXlab platform.
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Comparative study flow diagram.
2019Co-Authors: Nozomu Hanaoka, Mitsuru Yasuda, Shin Ito, Masami Konagaya, Naomi Nojiri, Tsuguto Fujimoto, Takashi DeguchiAbstract:A total of 650 clinical visitors were enrolled in this study. They were categorized into two groups. The acute Urethritis group included 398 cases, and the no symptoms (asymptomatic) group included 163 individuals. FVU was used for all tests. All specimens underwent screening for the following microorganisms: NG, CT, MG, MH, UP, UU, HI, NM, SP, TV, HAdVs, and HSV. aThe 23 cases in which only HAdV DNA was detected were confirmed as adenoviral Urethritis (AU) cases and bthe nine cases in which HAdV DNA and other pathogens were simultaneously detected were considered as adenovirus-associated Urethritis (AAU) cases. A total of 32 cases were confirmed as Urethritis with adenovirus in the acute Urethritis group. Among the 163 individuals in the asymptomatic group, only one case was positive for HAdV DNA alone and two cases simultaneously had both HAdV DNA and other pathogens. Other pathogens were detected in 37 FVU samples, and 124 patients exhibited no pathogens in urine. Abbreviations: NG, Neisseria gonorrhoeae; CT, Chlamydia trachomatis; MG, Mycoplasma genitalium; MH, Mycoplasma hominis, UP, Ureaplasma parvum; UU, Ureaplasma urealyticum; HI, Haemophilus influenzae; NM, Neisseria meningitidis; SP, Streptococcus pneumoniae; TV, Trichomonas vaginalis; HAdV, Human adenovirus; HV, herpes simplex virus.
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antimicrobial susceptibility of haemophilus influenzae strains isolated from the urethra of men with acute Urethritis and or epididymitis
Journal of Infection and Chemotherapy, 2017Co-Authors: Takashi Deguchi, Mitsuru Yasuda, Nozomu Hanaoka, Tomohiro Tsuchiya, Shigeaki Yokoi, Kyoko Hatazaki, Kengo Horie, Keita Nakane, Kosuke Mizutani, Ken ShimutaAbstract:Abstract We determined minimum inhibitory concentrations (MICs) of 41 antimicrobial agents for 73 clinical strains of Haemophilus influenzae isolated from the urethra of men with acute Urethritis and/or epididymitis and examined the strains for the production of β-lactamase. We also compared their antimicrobial susceptibilities with those of H. influenzae strains from respiratory tract or otorhinolaryngological infections that were reported in Japan. The proportion of β-lactamase-nonproducing ampicillin-resistant strains from acute Urethritis and/or epididymitis appeared to be lower, but that of β-lactamase-producing ampicillin-resistant strains appeared to be higher, compared with those from respiratory tract or otorhinolaryngological infections. However, their antimicrobial susceptibilities to a variety of other antimicrobial agents would be similar to those from respiratory tract or otorhinolaryngological infections. Almost all of the strains of H. influenzae from acute Urethritis and/or epididymitis were susceptible to the agents, including ceftriaxone, quinolones, macrolides, and tetracyclines, commonly prescribed for treatment of acute Urethritis based on the MIC breakpoints recommended by the Clinical and Laboratory Standards Institute. Ceftriaxone and quinolones could be effective on H. influenzae -induced Urethritis. However, azithromycin treatment failures were reported in acute Urethritis caused by H. influenzae strains considered susceptible to azithromycin. Further studies will be needed to determine MIC breakpoints of antimicrobial agents, which are recommended for treatment of urogenital infections, for H. influenzae strains causing these infections. Nevertheless, this study provides useful data regarding antimicrobial susceptibilities of H. influenzae strains isolated from the urogenital tract, which have rarely been studied.
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Male non-gonococcal Urethritis: From microbiological etiologies to demographic and clinical features.
International Journal of Urology, 2016Co-Authors: Shin Ito, Mitsuru Yasuda, Nozomu Hanaoka, Ken Shimuta, Kensaku Seike, Tomohiro Tsuchiya, Shigeaki Yokoi, Masahiro Nakano, Makoto Ohnishi, Takashi DeguchiAbstract:Objectives To detect microorganisms responsible for male acute Urethritis and to define the microbiology of non-gonococcal Urethritis. Methods The present study comprised 424 men with symptoms and signs compatible with acute Urethritis. Their urethral swabs and first-voided urine underwent detection of the microorganisms. Demographic characteristics and clinical features of Mycoplasma genitalium-, Ureaplasma urealyticum-, Haemophilus influenza-, adenovirus- or Herpes simplex virus-positive monomicrobial non-gonococcal Urethritis, or all-examined microorganism-negative Urethritis in heterosexual men were compared with Urethritis positive only for Chlamydia trachomatis. Results Neisseria gonorrhoeae was detected in 127 men (30.0%). In 297 men with non-gonococcal Urethritis, C. trachomatis was detected in 143 (48.1%). In 154 men with non-chlamydial non-gonococcal Urethritis, M. genitalium (22.7%), M. hominis (5.8%), Ureaplasma parvum (9.1%), U. urealyticum (19.5%), H. influenzae (14.3%), Neisseria meningitidis (3.9%), Trichomonas vaginalis (1.3%), human adenovirus (16.2%), and Herpes simplex virus types 1 (7.1%) and 2 (2.6%) were detected. Although some features of monomicrobial non-chlamydial non-gonococcal Urethritis or all-examined microorganism-negative Urethritis were significantly different from those of monomicrobial chlamydial non-gonococcal Urethritis, most features were superimposed. Conclusions Predicting causative microorganisms in men with non-gonococcal Urethritis based on demographic and clinical features is difficult. However, the present study provides useful information to better understand the microbiological diversity in non-gonococcal Urethritis, and to manage patients with non-gonococcal Urethritis appropriately.
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treatment of men with Urethritis negative for neisseria gonorrhoeae chlamydia trachomatis mycoplasma genitalium mycoplasma hominis ureaplasma parvum and ureaplasma urealyticum
International Journal of Urology, 2007Co-Authors: Shinichi Maeda, Phuoc Ba Nguyen, Masayoshi Tamaki, Mitsuru Yasuda, Yasuaki Kubota, Takashi DeguchiAbstract:Objective: Some patients with symptomatic non-gonococcal Urethritis (NGU) are negative for Chlamydia trachomatis, mycoplasmas and ureaplasmas. The optimal antimicrobial chemotherapy for such NGU has not fully been elucidated, though many studies of antimicrobial chemotherapies for C. trachomatis-positive NGU have been performed. We assessed the efficacy of antimicrobial agents that are active against C. trachomatis on non-mycoplasmal, non-ureaplasmal and non-chlamydial NGU (NMNUNCNGU). Methods: One hundred men whose first-pass urine samples were negative for C. trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum were treated with levofloxacin, gatifloxacin, minocycline, or clarithromycin for 7 days. Urethritis symptoms and the presence of polymorphonuclear leukocytes (PMNL) in urethral smears were assessed before and after treatment. Results: Eighty-eight (88.0%) of 100 men with NMNUNCNGU showed no signs of urethral inflammation after treatment, but two men complained of some symptoms of Urethritis. Twelve (12.0%) of 100 men had significant numbers of PMNL in urethral smears, but five of these 12 men had no symptoms of Urethritis. The efficacy for normalization of urethral smears was 90.7% for clarithromycin, 89.7% for levofloxacin, 87.5% for gatifloxacin, and 75.0% for minocycline. The 12 men who showed signs of urethral inflammation were retreated with levofloxacin, gatifloxacin, minocycline or clarithromycin for an additional 7 days. The 10 men who returned after the second treatment had negative urethral smears. Conclusion: Our present findings suggest that antimicrobial agents active against C. trachomatis are effective against NMNUNCNGU and that a 7-day treatment regimen with an appropriate antimicrobial agent may be sufficient to manage patients with NMNUNCNGU.
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polymerase chain reaction based subtyping of ureaplasma parvum and ureaplasma urealyticum in first pass urine samples from men with or without Urethritis
Sexually Transmitted Diseases, 2005Co-Authors: Takashi Yoshida, Yoshito Takahashi, Yuri Nomura, Hiroaki Ishiko, Shinichi Maeda, Masayoshi Tamaki, Mitsuru Yasuda, Yasuaki Kubota, Takashi DeguchiAbstract:Background: Our previous study suggested a significant association between Ureaplasma urealyticum and nongonococcal Urethritis (NGU). However, association of the serovars of U. urealyticum with NGU remains unclear. A polymerase chain reaction (PCR)-based assay can distinguish 4 serovars of Ureaplasma parvum from each other and categorize 10 serovars of U. urealyticum into 3 subtypes: subtype 1 (serovars 2, 5, 8, and 9), subtype 2 (serovars 4, 10, 12, and 13), and subtype 3 (serovars 7 and 11). Goal: The goal of this study was to determine which subtypes of U. urealyticum are associated with NGU as determined by PCR-based assay. Study: The prevalence of U. urealyticum subtypes in 106 ureaplasma-positive men with Urethritis was compared with that in 30 ureaplasma-positive men without Urethritis. Results: In men with nonchlamydial NGU and men with Mycoplasma genitalium-negative nonchlamydial NGU, only U. urealyticum subtype 1 (serovars 2, 5, 8, and 9) was detected significantly more often than in men without Urethritis. Conclusion: This study suggests that subtype 1 of U. urealyticum (serovars 2, 5, 8, and 9) is associated with NGU independently of Chlamydia trachomatis or M. genitalium.
Lisa E. Manhart - One of the best experts on this subject based on the ideXlab platform.
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prevalence of mycoplasma genitalium infection antimicrobial resistance mutations and symptom resolution following treatment of Urethritis
Clinical Infectious Diseases, 2020Co-Authors: Laura H Bachmann, Harold C. Wiesenfeld, Lisa E. Manhart, Arlene C Sena, Robert D Kirkcaldy, William M Geisler, Stephanie N Taylor, Candice J Mcneil, Lori M Newman, Noelle MylerAbstract:BACKGROUND Antimicrobial resistance in Mycoplasma genitalium (MG), a cause of Urethritis, is a growing concern. Yet little is known about the geographic distribution of MG resistance in the United States or about its associated clinical outcomes. We evaluated the frequency of MG among men with Urethritis, resistance mutations, and posttreatment symptom persistence. METHODS We enrolled men presenting with Urethritis symptoms to 6 US sexually transmitted disease (STD) clinics during June 2017-July 2018; men with Urethritis were eligible for follow-up contact and, if they had persistent symptoms or MG, a chart review. Urethral specimens were tested for MG and other bacterial STDs. Mutations in 23S ribosomal ribonucleic acid (rRNA) loci (macrolide resistance-associated mutations [MRMs]) and in parC and gyrA (quinolone-associated mutations) were detected by targeted amplification/Sanger sequencing. RESULTS Among 914 evaluable participants, 28.7% (95% confidence interval [CI], 23.8-33.6) had MG. Men with MG were more often Black (79.8% vs 66%, respectively), <30 years (72.9% vs 56.1%, respectively), and reported only female partners (83.7% vs 74.2%, respectively) than men without MG. Among MG-positive participants, 64.4% (95% CI, 58.2-70.3%) had MRM, 11.5% (95% CI, 7.9-16.0%) had parC mutations, and 0% had gyrA mutations. Among participants treated with azithromycin-based therapy at enrollment and who completed the follow-up survey, persistent symptoms were reported by 25.8% of MG-positive/MRM-positive men, 13% of MG-positive/MRM-negative men, and 17.2% of MG-negative men. CONCLUSIONS MG infection was common among men with Urethritis; the MRM prevalence was high among men with MG. Persistent symptoms following treatment were frequent among men both with and without MG.
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an estimate of the proportion of symptomatic gonococcal chlamydial and non gonococcal non chlamydial Urethritis attributable to oral sex among men who have sex with men a case control study
Sexually Transmitted Infections, 2016Co-Authors: Lindley A. Barbee, Julia C Dombrowski, Christine M Khosropour, Lisa E. Manhart, Matthew R GoldenAbstract:Background Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. Methods We conducted a case–control study of MSM attending Public Health—Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic Urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel–Haenszel OR estimates. Results Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal Urethritis, 31.4% of chlamydial Urethritis and 35.9% non-gonococcal, non-chlamydial Urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal Urethritis, chlamydial Urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. Conclusions The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause Urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.
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an estimate of the proportion of symptomatic gonococcal chlamydial and non gonococcal non chlamydial Urethritis attributable to oral sex among men who have sex with men a case control study
Sexually Transmitted Infections, 2016Co-Authors: Lindley A. Barbee, Julia C Dombrowski, Christine M Khosropour, Lisa E. Manhart, Matthew R GoldenAbstract:Background Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. Methods We conducted a case–control study of MSM attending Public Health—Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic Urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel–Haenszel OR estimates. Results Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal Urethritis, 31.4% of chlamydial Urethritis and 35.9% non-gonococcal, non-chlamydial Urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal Urethritis, chlamydial Urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. Conclusions The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause Urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.
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advances in the understanding and treatment of male Urethritis
Clinical Infectious Diseases, 2015Co-Authors: Laura H Bachmann, Lisa E. Manhart, Jørgen Skov Jensen, David H Martin, Arlene C Sena, Jordan D Dimitrakoff, Charlotte A GaydosAbstract: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.
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bacterial vaginosis associated bacteria in men association of leptotrichia sneathia spp with nongonococcal Urethritis
Sexually Transmitted Diseases, 2013Co-Authors: Lisa E. Manhart, Christine M Khosropour, Catherine W Gillespie, Congzhu Liu, Kevin Depner, Tina L Fiedler, Jeanne M Marrazzo, David N FredricksAbstract:Urethritis is the most common male reproductive tract syndrome and is caused primarily by Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT). However, up to 50% of cases have neither GC nor CT detected1 and are referred to simply as nonchlamydial nongonococcal Urethritis (NGU). Clinically defined as symptoms of urethral irritation (dysuria, pruritis) or visible urethral discharge and 5 or more polymorphonuclear leukocytes per high-power field (PMNs/HPF) in urethral exudates, nonchlamydial NGU has been associated with a number of known pathogens; Mycoplasma genitalium (MG) in 15% to 25%, Trichomonas vaginalis (TV) in 5% to 15%, and, less commonly, herpes simplex virus (HSV) and adenovirus in 2% to 4%.1 The differentiated Ureaplasma urealyticum (UU) has been associated with Urethritis in some2–4 but not all studies.4,5 However, in a recent case-control study, 45% of NGU cases had no known pathogen,4 even after testing for CT, MG, TV, and UU. Although noninfectious causes of male Urethritis exist, most cases are likely caused by sexually transmitted pathogens. Therefore, bacteria involved in female reproductive tract disease are reasonable candidates for involvement in NGU. Bacterial vaginosis (BV) is the most prevalent genital tract syndrome in women, affecting 29% of reproductive-aged women,6 and has been associated with increased risk for perinatal complications,7 pelvic inflammatory disease,8 and HIV acquisition9 and transmission.10 Although there is debate as to whether BV can be sexually transmitted, the protective effect of condoms11 and the concordance of infection in lesbian couples12 support this concept. The syndrome is characterized by a shift in the vaginal microbiota from a predominance of lactobacilli to a predominance of anaerobic bacteria13 and does not seem to be caused by a single organism, but rather represents a change in the vaginal microbiota from one with several predominant Lactobacillus species to one marked by increased species richness and diversity.14–16 Several recently identified bacteria have been highly predictive of and specific for BV, including Leptotrichia/Sneathia spp., Atopobium spp., Megasphaera spp. and BVAB-1, BVAB-2, and BVAB-3 (all Clostridiales order bacteria)17 Most of these organisms, with the exception of BVAB-1, were also more common in women with than in those without cervicitis in a pilot study we conducted (unpublished data), suggesting that their presence in men may be associated with similar inflammation in the male urethra. To assess the role of these newly described bacteria in male Urethritis, we conducted a case-control study of men with and without idiopathic NGU. All men were tested for 5 recently identified bacteria associated with BV in women, and we estimated the risk of Urethritis associated with detection of each bacterial species.
Irving F Hoffman - One of the best experts on this subject based on the ideXlab platform.
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addition of treatment for trichomoniasis to syndromic management of Urethritis in malawi a randomized clinical trial
Sexually Transmitted Diseases, 2003Co-Authors: Matthew Price, Irving F Hoffman, Dickman Zimba, Cornelia S Kaydosdaniels, William C Miller, Francis Martinson, David Chilongozi, Ester Kip, Esnath Msowoya, Marcia M HobbsAbstract:Background: Male Urethritis is generally treated syndromically but failure of empirical treatment is common. Goal: The study goal was to evaluate the addition of metronidazole to the syndromic management of Urethritis in Malawi in a randomized clinical trial. Study Design: Men with Urethritis were randomized to receive either 2 g of metronidazole by mouth or placebo in addition to standard care for Urethritis (i.e. a single intramuscular dose of 240 mg gentamicin and 100 mg doxycycline twice daily for 7 days). The primary endpoints of the study included measurement of the effects of treatment on Trichomonas vaginalis signs and symptoms of Urethritis and the concentration of HIV RNA in semen in dually infected subjects. Results: The overall prevalence of T vaginalis was 17.3% (71/411) and treatment with metronidazole cleared 95% of culture-positive infections compared with 54% clearance among men receiving placebo (P = 0.006). Prevalence of persistent Urethritis was observed in approximately 16% of both groups at the end of 1 week (29/179 of those receiving metronidazole versus 29/187 in the placebo group; P = 0.86). For a subset of HIV-infected men with trichomoniasis the seminal plasma HIV RNA concentration was lower than in a group of HIV-positive control subjects (P = 0.052). Conclusion: In areas with a high prevalence of trichomoniasis the addition of metronidazole to the syndromic management of male Urethritis can eliminate infection with T vaginalis and may help to reduce the transmission of HIV. Such treatment should be strongly considered as part of empirical therapy for Urethritis in men in Malawi and places where T vaginalis infection in men is common. (authors)
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trichomonas vaginalis as a cause of Urethritis in malawian men
Sexually Transmitted Diseases, 1999Co-Authors: Marcia M Hobbs, Myron S Cohen, Peter N Kazembe, Eniffa Nkata, Celine Costello Daly, Dickman Zimba, William C Miller, Andrea W Reed, Hrishikesh Chakraborty, Irving F HoffmanAbstract:This study was conducted to determine the prevalence of trichomoniasis in Malawian men to evaluate a polymerase chain reaction (PCR) detection assay for T. vaginalis in urethral swab samples and to examine the effect of T. vaginalis infection on HIV excretion in the semen. There were 206 men with symptomatic Urethritis in STD clinic and 127 asymptomatic men in the Dermatology Clinic who were enrolled from January to March 1996. Results according to a wet-mount microscopy and urethral swabs culture combination showed that of 293 men only 38 (13%) men were positive for T. vaginalis. The estimated prevalence among symptomatic and asymptomatic cases was 15.7% and 8.7% respectively. The PCR yielded a sensitivity of 0.82 (95% CI: 0.66-0.92) and specificity of 0.95 (95% CI: 0.91-0.97); these were compared to the wet-mount microscopy and culture combination. Overall HIV seroprevalence of men was 51% because gonococcal Urethritis was shown to significantly increase seminal HIV RNA levels. The median HIV RNA concentration in seminal plasma from men with symptomatic Urethritis plus T. vaginalis infection was significantly higher than in seminal plasma from HIV-positive men with symptomatic Urethritis only. Since this study has several important limitations a randomized clinical trial would be useful for determining whether Urethritis cure rates can be significantly improved.
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specificity of dysuria and discharge complaints and presence of Urethritis in male patients attending an std clinic in malawi
Sexually Transmitted Infections, 1998Co-Authors: G Dallabetta, F Behets, G Lule, A M Wangel, S Moeng, Irving F Hoffman, H A Hamilton, Myron S Cohen, G LiombaAbstract:The World Health Organization (WHO) has recommended a syndromic approach to the case management of sexually transmitted diseases (STDs) in areas with inadequate laboratories and trained personnel. This study evaluated the specificity of discharge and dysuria for laboratory confirmed Urethritis among 517 consecutive symptomatic men presenting to an urban STD clinic in Malawi in 1992-93. Patients were randomized to receive one of five antibiotic regimens with an efficacy range of 33-95% and instructed to return for a follow-up visit in 8-10 days. The present analysis was limited to the 330 men with follow-up data. Overall 257 men (70%) had gonococcal Urethritis and 13 (4%) had chlamydia Urethritis. Laboratory evidence of Urethritis was identified in over 90% of symptomatic patients with discharge or dysuria. Men with complaints of dysuria alone were significantly more likely to have sought treatment elsewhere before presenting to the clinic than men with both discharge and dysuria (72% vs. 48%) and were less likely to have had gonorrhea (64% vs. 83%). 92% of those who returned for the follow-up visit had no symptoms of either discharge or dysuria but 22 of these men (9.2%) had gonorrhea and 52 (21.8%) had nongonococcal Urethritis. Among men with symptoms at the time of the follow-up visit 26 (28%) had gonorrhea and 12 (13%) had nongonococcal Urethritis. These findings suggest that the symptom of dysuria should be added to discharge as an entry criterion for evaluation for Urethritis in WHOs treatment recommendations. Moreover given the high prevalence of asymptomatic infection at follow-up in men who received suboptimal antimicrobial therapy it is recommended that the most effective treatment available should be provided at the first clinic visit.
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association of cd4 cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 hiv 1 rna concentrations with genital ulcer disease in hiv 1 infected men in malawi
The Journal of Infectious Diseases, 1998Co-Authors: John R Dyer, Irving F Hoffman, Peter N Kazembe, Joseph J Eron, Pietro Vernazza, Eniffa Nkata, Celine Costello Daly, Susan A Fiscus, Myron S CohenAbstract:CD4 cell counts and blood plasma and seminal plasma HIV-1 concentrations were compared in HIV-1 RNA-seropositive men with Urethritis and with or without genital ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median 258/mcl vs. 348/mcl) and increased blood plasma HIV-1 RNA (median 240 x 10 vs. 79.4 x 10 copies/ml). Men with nongonococcal Urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median 195 x 10 vs. 4.0 x 10 copies/ml) than men with nongonococcal Urethritis without GUD. These levels decreased approximately 4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission thus complicating interpretation of the role of the genital ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determined. (authors)
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association of cd4 cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 hiv 1 rna concentrations with genital ulcer disease in hiv 1 infected men in malawi
The Journal of Infectious Diseases, 1998Co-Authors: John R Dyer, Irving F Hoffman, Peter N Kazembe, Joseph J Eron, Pietro Vernazza, Eniffa Nkata, Celine Costello Daly, Susan A Fiscus, Myron S CohenAbstract:CD4 cell counts and blood plasma and seminal plasma human immunodeficiency virus type 1 (HIV-1) concentrations were compared in HIV-1 RNA-seropositive men with Urethritis and with or without genital ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median, 258 vs. 348/microL) and increased blood plasma HIV-1 RNA (median, 240 x 10[3] vs. 79.4 x 10[3] copies/mL). Men with nongonococcal Urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median, 195 x 10[3] vs. 4.0 x 10[3] copies/mL) than men with nongonococcal Urethritis without GUD. These levels decreased approximately 4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission, thus complicating interpretation of the role of the genital ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determined.
Myron S Cohen - One of the best experts on this subject based on the ideXlab platform.
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methods for detection of trichomonas vaginalis in the male partners of infected women implications for control of trichomoniasis
Journal of Clinical Microbiology, 2006Co-Authors: Marcia M Hobbs, Myron S Cohen, Jane R Schwebke, William C Miller, Dana Lapple, Lisa F Lawing, Heidi Swygard, Julius Atashili, Peter A Leone, Arlene C SenaAbstract:Trichomonas vaginalis infection in men is an important cause of nongonococcal Urethritis. Effective detection of the parasite in men using culture requires examination of multiple specimens. We compared culture and PCR-enzyme-linked immunosorbent assay in urethral swabs, urine, and semen for T. vaginalis detection in male sexual partners of women with trichomoniasis identified by wet mount and culture. Trichomonads were detected by at least one positive test in 205/280 men (73.2%) who submitted at least one specimen for culture and PCR. Whereas InPouch TV culture detected only 46/205 cases (22.5%), PCR detected 201/205 (98.0%). Urethral swab cultures from men with Urethritis were more likely to be positive with shorter incubation than specimens from men without Urethritis. T. vaginalis was detected more often in men with wet-mount-positive partners. Even with a sensitive PCR assay, reliable detection of T. vaginalis in male partners required multiple specimens. The majority of male sexual partners in this study were infected, emphasizing the importance of partner evaluation and treatment.
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trichomonas vaginalis as a cause of Urethritis in malawian men
Sexually Transmitted Diseases, 1999Co-Authors: Marcia M Hobbs, Myron S Cohen, Peter N Kazembe, Eniffa Nkata, Celine Costello Daly, Dickman Zimba, William C Miller, Andrea W Reed, Hrishikesh Chakraborty, Irving F HoffmanAbstract:This study was conducted to determine the prevalence of trichomoniasis in Malawian men to evaluate a polymerase chain reaction (PCR) detection assay for T. vaginalis in urethral swab samples and to examine the effect of T. vaginalis infection on HIV excretion in the semen. There were 206 men with symptomatic Urethritis in STD clinic and 127 asymptomatic men in the Dermatology Clinic who were enrolled from January to March 1996. Results according to a wet-mount microscopy and urethral swabs culture combination showed that of 293 men only 38 (13%) men were positive for T. vaginalis. The estimated prevalence among symptomatic and asymptomatic cases was 15.7% and 8.7% respectively. The PCR yielded a sensitivity of 0.82 (95% CI: 0.66-0.92) and specificity of 0.95 (95% CI: 0.91-0.97); these were compared to the wet-mount microscopy and culture combination. Overall HIV seroprevalence of men was 51% because gonococcal Urethritis was shown to significantly increase seminal HIV RNA levels. The median HIV RNA concentration in seminal plasma from men with symptomatic Urethritis plus T. vaginalis infection was significantly higher than in seminal plasma from HIV-positive men with symptomatic Urethritis only. Since this study has several important limitations a randomized clinical trial would be useful for determining whether Urethritis cure rates can be significantly improved.
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specificity of dysuria and discharge complaints and presence of Urethritis in male patients attending an std clinic in malawi
Sexually Transmitted Infections, 1998Co-Authors: G Dallabetta, F Behets, G Lule, A M Wangel, S Moeng, Irving F Hoffman, H A Hamilton, Myron S Cohen, G LiombaAbstract:The World Health Organization (WHO) has recommended a syndromic approach to the case management of sexually transmitted diseases (STDs) in areas with inadequate laboratories and trained personnel. This study evaluated the specificity of discharge and dysuria for laboratory confirmed Urethritis among 517 consecutive symptomatic men presenting to an urban STD clinic in Malawi in 1992-93. Patients were randomized to receive one of five antibiotic regimens with an efficacy range of 33-95% and instructed to return for a follow-up visit in 8-10 days. The present analysis was limited to the 330 men with follow-up data. Overall 257 men (70%) had gonococcal Urethritis and 13 (4%) had chlamydia Urethritis. Laboratory evidence of Urethritis was identified in over 90% of symptomatic patients with discharge or dysuria. Men with complaints of dysuria alone were significantly more likely to have sought treatment elsewhere before presenting to the clinic than men with both discharge and dysuria (72% vs. 48%) and were less likely to have had gonorrhea (64% vs. 83%). 92% of those who returned for the follow-up visit had no symptoms of either discharge or dysuria but 22 of these men (9.2%) had gonorrhea and 52 (21.8%) had nongonococcal Urethritis. Among men with symptoms at the time of the follow-up visit 26 (28%) had gonorrhea and 12 (13%) had nongonococcal Urethritis. These findings suggest that the symptom of dysuria should be added to discharge as an entry criterion for evaluation for Urethritis in WHOs treatment recommendations. Moreover given the high prevalence of asymptomatic infection at follow-up in men who received suboptimal antimicrobial therapy it is recommended that the most effective treatment available should be provided at the first clinic visit.
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association of cd4 cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 hiv 1 rna concentrations with genital ulcer disease in hiv 1 infected men in malawi
The Journal of Infectious Diseases, 1998Co-Authors: John R Dyer, Irving F Hoffman, Peter N Kazembe, Joseph J Eron, Pietro Vernazza, Eniffa Nkata, Celine Costello Daly, Susan A Fiscus, Myron S CohenAbstract:CD4 cell counts and blood plasma and seminal plasma HIV-1 concentrations were compared in HIV-1 RNA-seropositive men with Urethritis and with or without genital ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median 258/mcl vs. 348/mcl) and increased blood plasma HIV-1 RNA (median 240 x 10 vs. 79.4 x 10 copies/ml). Men with nongonococcal Urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median 195 x 10 vs. 4.0 x 10 copies/ml) than men with nongonococcal Urethritis without GUD. These levels decreased approximately 4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission thus complicating interpretation of the role of the genital ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determined. (authors)
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association of cd4 cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 hiv 1 rna concentrations with genital ulcer disease in hiv 1 infected men in malawi
The Journal of Infectious Diseases, 1998Co-Authors: John R Dyer, Irving F Hoffman, Peter N Kazembe, Joseph J Eron, Pietro Vernazza, Eniffa Nkata, Celine Costello Daly, Susan A Fiscus, Myron S CohenAbstract:CD4 cell counts and blood plasma and seminal plasma human immunodeficiency virus type 1 (HIV-1) concentrations were compared in HIV-1 RNA-seropositive men with Urethritis and with or without genital ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median, 258 vs. 348/microL) and increased blood plasma HIV-1 RNA (median, 240 x 10[3] vs. 79.4 x 10[3] copies/mL). Men with nongonococcal Urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median, 195 x 10[3] vs. 4.0 x 10[3] copies/mL) than men with nongonococcal Urethritis without GUD. These levels decreased approximately 4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission, thus complicating interpretation of the role of the genital ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determined.
