Aetiology of male urethritis in patients recruited from a population with a high HIV prevalence
University of KwaZulu-Natal, Port Natal, KwaZulu-Natal, South AfricaInternational Journal of Antimicrobial Agents (Impact Factor: 4.3). 10/2004; 24 Suppl 1:S8-14. DOI: 10.1016/j.ijantimicag.2004.02.004
The aetiology of urethritis, the significance of potential pathogens and the relation of urethritis to HIV infection were determined in 335 men (cases) with and 100 men (controls) without urethral symptoms. Urethral swab specimens were tested for different organisms by PCR or by culture for Neisseria gonorrhoeae. The prevalence of N. gonorrhoeae and Chlamydia trachomatis was 52 and 16%, respectively. The potential pathogens: Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis and herpes simplex virus (HSV), were present in 5, 36, 6 and 6% of the cases respectively. M. genitalium was the only potential pathogen associated with microscopic urethritis. After excluding gonococcal infections, U. urealyticum was more frequent in symptomatic patients, while the prevalence of T. vaginalis was similar among cases and controls. These results strongly suggest an a etiological role for M. genitalium in male urethritis, a possible role for U. urealyticum, but not for T. vaginalis. The control group, with 97% genital ulcer disease patients, was not suitable for the investigation of the role of HSV. The sero-prevalence of HIV was 45%. Current infections were not associated with HIV. However, a history of previous urethral discharge was associated with HIV in a multivariate analysis and supported the hypothesis that non-ulcerative sexually transmitted diseases facilitate HIV transmission.
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ABSTRACT: Mycoplasmas, the common denomination of the Mycoplasma and Ureaplasma genera, represent a unique and complex group of microorganisms that has been ignored by the majority of diagnostic laboratories, not only because of its fastidious growth, absence of commercial media and of procedures for a rapid diagnosis, but most of all due to a clinical perception established for many years that these microorganisms are of minor importance. Recently, this situation has changed, because there s a better understanding of mycoplasmas clinical importance, they have been recently associated with Human Immunodeficiency Virus (HIV), complications in pregnant women and their neonates and with rheumatological disorders, resulting in a need to cure infected persons. The development of laboratory techniques that allows their culture and identification has contributed for a clarification of the role of these microorganisms as etiological agents or as co-factor of specific diseases. This article wishes to be, not only a revision of the main characteristics of the human mycoplasmas, but also to contribute for a better understanding of the diseases to which these fascinating microorganisms are associated and of the available diagnostic methods by the health professionals.
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ABSTRACT: Although Mycoplasma genitalium was described 20 years ago, the knowledge concerning it is still limited. The publications in the area are surprisingly few in number, especially considering that the pathogen is rather common and has been connected with a number of different urogenital diseases. The PCR technique has made it possible to perform investigations on a large scale, which might elucidate the pathogenic role of M. genitalium in the urogenital tract. However, it seems well established that M. genitalium causes non-gonococcal urethritis (NGU). The mycoplasma behaves almost identically to Chlamydia trachomatis with respect to routes of infection and inflammatory response, but no further relationship between the two organisms seems obvious. M. genitalium is believed to produce urethritis with almost the same frequency as C. trachomatis. In the female genital tract, M. genitalium is strongly incriminated as a primary cause of cervicitis, endometritis and salpingitis, the latter complicated by tubal damage. The role of the organisms in epididymitis, prostatitis and neonatal infections is unclear. In the case of urethritis and upper genital tract infections in the female, it is recommended to test for M. genitalium using molecular biological assays and in the event of a positive result institute antimicrobial therapy.
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ABSTRACT: To describe the prevalence and characteristics of subpreputial penile wetness and to investigate the association between current levels of penile wetness and HIV infection. Male attenders at a sexually transmitted infections clinic in Durban, South Africa were enrolled and treated for their presenting sexually transmitted infection complaint. They were asked to return after 14 days when a structured questionnaire was administered, and the degree of wetness of the glans penis and coronal sulcus was assessed clinically. Six hundred and fifty men were enrolled, and 488 (75%) returned. Three hundred eighty-six uncircumcised men were included for statistical analysis of whom 215 (56%) were HIV positive. One hundred ninety-six (50.8%) had no penile wetness, and 190 (49.2%) had penile wetness. In the adjusted analysis, penile wetness was associated with younger age, low level of attained education, low income, higher lifetime numbers of sexual partners, and not washing after sex. The prevalence of HIV was greater in those with penile wetness 126 of 190 (66.3%) compared with 90 of 196 (45.9%) with no penile wetness, crude prevalence odds ratio 2.32 (95% confidence interval [CI], 1.54-3.50, P=or<0.001), crude prevalence relative risk 1.44 (95% CI, 1.23-1.63, P=or<0.001), and adjusted for predictors of HIV, confounders and herpes type 2 antibodies, odds ratio 2.38 (95% CI, 1.42-3.97, P=or<0.001), and relative risk 1.46 (95% CI, 1.19-1.68, P=or<0.001). This is the first study to show an association between subpreputial penile wetness and HIV. Consideration should be given to providing advice about improving penile hygiene in uncircumcised men in areas where HIV is a significant problem. Good penile hygiene should also be promoted at the community level to become a desirable social norm.
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