Clinical feature of male non-gonorrhoea urethritis and minocycline treatment of Chlamydia or Ureaplasma-infected urethritis

Thirty-nine male patients with urethritis were studied for gonorrhoea or non-gonorrhoea infections. Only 2 patients were infected with N. gonorrhoeae, the other 37 patients were non-gonorrhoea urethritis (NGU). In 9 of these patients, C. trachomatis was identified and in 6 patients, U. urealyticum was isolated. No chlamydial urethritis was combined with ureaplasma. There was no clinical difference between chlamydia and ureaplasma infection, such as serous urethral discharge or mild pyuria. Minocycline was given orally at the dose of 200 mg daily for 7 to 42 days to these patients. Seven of the 9 patients (78%) with C. trachomatis and 7 of the 6 patients (67%) with U. urealyticum infection showed improvement of subjective and objective symptoms after minocycline. In no case, was an adverse reaction noted. Minocycline was effective in the treatment of both C. trachomatis and U. urealyticum urethral infection.     

DETECTION OF MYCOPLASMA GENITALIUM IN PATIENTS WITH URETHRITIS

Purpose

We attempted to detect Mycoplasma genitalium in urethral swab specimens by a polymerase chain reaction based assay to determine the prevalence of M. genitalium in patients with urethritis.

Materials and Methods

We examined a total of 171 Japanese men who presented to our hospital from February 1995 through January 1997. Of these men 150 had symptoms and signs compatible with acute urethritis and 21 had no symptoms or signs of urethritis. Urethral swab specimens were used to culture Neisseria gonorrhoeae, to detect Chlamydia trachomatis by an enzyme immunoassay and to detect M. genitalium by a polymerase chain reaction based assay.

Results

Gonococcal urethritis was diagnosed in 74 symptomatic men, and nongonococcal urethritis was diagnosed in 76 symptomatic men. Of the 74 cases of gonococcal urethritis 3 (4.1%) were positive for M. genitalium, and 14 (18.9%) were positive for C. trachomatis. Of the 76 cases of nongonococcal urethritis 10 (13.2%) were positive for M. genitalium, and 42 (55.2%) were positive for C. trachomatis. While only 1 of the 42 cases with chlamydial nongonococcal urethritis (2.4%) was positive for M. genitalium, 9 of the 34 chlamydia negative nongonococcal urethritis cases (26.5%) were positive for the mycoplasma. In contrast, all 21 cases men were negative for N. gonorrhoeae, M. genitalium, and C. trachomatis.

Conclusions

The prevalences of M. genitalium in patients with gonococcal urethritis and nongonococcal urethritis who attended our clinic were 4.1 and 13.2%, respectively. M. genitalium was detected significantly more often in men with nongonococcal urethritis than in asymptomatic men. In addition, its prevalence in men with chlamydia negative nongonococcal urethritis (26.5%) was significantly greater than in those with chlamydia positive nongonococcal urethritis (2.4%). These findings suggest that M. genitalium may be associated with the development of nongonococcal urethritis independent of C. trachomatis.     

Diagnosis of gonococcal urethritis and chlamydial urethritis by polymerase chain reaction]

A polymerase chain reaction (PCR) method was compared to standard methods (cultures for Neisseria gonorrhoeae and Chlamydia trachomatis and an enzyme-immunoassay for C. trachomatis) in diagnosis of gonococcal and chlamydial urethritis in 40 male patients with urethritis. Gonococcal urethritis was diagnosed by detection of a 206 bp DNA fragment amplified by PCR with N. gonorrhoeae-specific primers. Chlamydial urethritis was diagnosed by detection of a 242 bp DNA fragment amplified by PCR with C. trachomatis-specific primers. Gonococcal and chlamydial urethritis, gonococcal and non-chlamydial urethritis, non-gonococcal and chlamydial urethritis, and non-gonococcal and non-chlamydial urethritis were diagnosed in 8, 10, 14 and 8 patients, respectively, by the PCR method. In 9 patients with gonococcal and chlamydial urethritis, 10 with gonococcal and non-chlamydial urethritis, 12 with non-gonococcal and chlamydial urethritis, and 9 with non-gonococcal and non-chlamydial urethritis, diagnosed by the standard methods, the coincidence rates of the PCR to the standard methods were 78% (7/9), 90% (9/10), 100% (12/12), and 89% (8/9), respectively. The overall coincidence rate between the PCR and the standard methods in diagnosis of urethritis were high (90%). In addition, N.gonorrhoeae and C.trachomatis could be simultaneously detected from one urethral sample in approximately 6 hours by means of the PCR. Thus, the PCR method could clinically be applied and would offer several advantages to diagnosis of urethritis, compared to the standard methods.     

Acute urethritis caused by Neisseria meningitidis and Chlamydia trachomatis

A 16-year-old heterosexual man presented to our hospital with a purulent urethral discharge and pain at voiding. These symptoms began seven days after oral-genital contact (fellatio) with his partner. A Gram-stained smear from the urethral discharge showed Gram-negative diplococci, and the antigen of Chlamydia trachomatis from urine was positive. We initially made a diagnosis of urethritis caused by Neisseria gonorrhoeae and C. trachomatis. However, N. meningitidis was isolated by culture. Clinicians should pay attention to the possibility of N. meningitidis infection in all cases resembling gonococcal urethritis.     

Epidemiologic and therapeutic study on gonococcal infections--clinical efficacy of norfloxacin

We studied the basic and clinical effects of norfloxacin (NFLX) in 120 patients with gonococcal infections (110 men with urethritis and 10 women with cervicitis)--all residents at Sapporo City; and epidemiologically analyzed the sources of their infections. The male patients were between 16 and 67 years old and the female patients were between 20 and 61 years old, with a peak in the early 20s both for sexes. 70.6% of the male patients in their 10s were infected from their girl friends or so-called pick-up friends and 50% of the female patients from their husbands. The other half of the female were workers serving at so-called special massage parlors. The minimum inhibitory concentration (MIC) of NFLX against N. gonorrhoeae distributed was 0.0125 approximately 3.13 micrograms/ml, with a peak at 0.025 micrograms/ml. NFLX inhibited 93.3% of the clinical strains of this species at less than 0.1 microgram/ml and 96.2% at less than 1 microgram/ml, where the inoculation was 10(6) CFU/ml. Twenty one (20.2%) of the 104 N. gonorrhoeae strains were penicillinase-producing one (PPNG). NFLX inhibited 18 of these PPNG (85.7%) at less than 0.1 microgram/ml and the other 3 strains at 1.56 approximately 3.13 micrograms/ml. Oral administration of 200 mg NFLX showed the average peak serum level of 0.72 micrograms/microliter in 2 hours and the average peak level in the urethral secretions of 0.5 micrograms/ml in one hour. These two concentrations of NFLX covered 95.2% of the MIC distribution against N. gonorrhoeae. The clinical efficacy of 600 mg NFLX (peros) was 97.4 and 93.1% for a 3-and 7-day treatment for male urethritis; and 100% for both 3-and 7-day treatment for female cervicitis. Complicated urethritis with C. trachomatis was noticed in 32.7% of the male urethritis and in 20% of the female cervicitis cases. Urethral secretions among about half of these patients were observed even after treatment with NFLX. As a subsequent treatment, another effective chemotherapeutic is required against C. trachomatis. No adverse reactions were detected with NFLX. All the above results demonstrate that NFLX is a highly effective and safe chemotherapeutic agent for treatment of gonorrhoea.     

Efficacy of various single-dose regimens of ceftriaxone in uncomplicated acute gonococcal urethritis in adult males

The therapeutic efficacy of single intramuscular doses of ceftriaxone (Rocephin; Roche) (62.5, 125 and 250 mg), administered without probenecid, was evaluated in 167 adult males with uncomplicated acute gonococcal urethritis. Cure rates of 100% were achieved at 62.5 mg and 250 mg. In the 125 mg dose group, Neisseria gonorrhoeae was isolated from 1 patient at follow-up after therapy. Reinfection was suspected, since this patient returned on day 10 and admitted to sexual contact 2 days previously. Side-effects were minimal, and patient acceptance was better for ceftriaxone dissolved in lignocaine than in sterile water. Chlamydia trachomatis was detected at follow-up in 14.4% patients, confirming that ceftriaxone has no significant effect on chlamydial infection and additional treatment is necessary for patients with coexistent infection.     

PCR检测衣原体及其在男性尿道感染中的意义

应用聚酶链反应（ＰＣＲ）检测６０４例临床已确诊的男性泌尿系感染患者沙眼衣原体（ＣＴ）感染情况，发现ＣＴ阳性率为：急性淋菌性尿道炎（ＡＧＵ）占２６．９％（１１７／４３５），淋菌感染后尿道炎（ＰＧＵ）占４８．５％（３２／６６），非淋菌性尿道炎（ＮＧＵ）占３１．１％（３２／１０３）。认为ＰＣＲ技术是临床快速诊断男性ＣＴ尿道炎的有效方法。     

Treatment of nongonococcal urethritis--studies on clinical effects of ofloxacin

Clinical effects of ofloxacin (OFLX) in the treatment of chlamydial urethritis was compared with those in the treatment of non-chlamydial urethritis. Chlamydia trachomatis was isolated from 33 (39.3%) out of 84 patients with nongonococcal urethritis. OFLX was administered at a dose of 100 mg, three times daily (300 mg) for 14 days. In 31 (93.3%) of the 33 patients with chlamydial urethritis, C. trachomatis was eliminated within 7 to 14 days after the start of administration, and, in two patients, inclusion bodies decreased in number but persisted. The subjective and objective clinical symptoms, urethral discharge, polymorphonuclear leucocyte (PMNL) in smears, and pyuria in VB1 of the patients with chlamydial urethritis, disappeared in 56.0, 57.6, and 63.0% of the cases, and improved in 24.0, 30.0 and 29.6% respectively, whereas those of the patients with non-chlamydial urethritis, urethral discharge, PMNL, and pyuria in VB1 disappeared in 57.6, 56.9 and 32.9%, and improved in 26.9, 13.7 and 37.9%, respectively. There was no significant difference in the clinical effects of OFLX between cases of chlamydial urethritis and those of non-chlamydial urethritis. Marked improvement in clinical symptoms were observed between day 7 and day 14 of medication in cases of both chlamydial and non-chlamydial urethritis. In nine out of 11 cases of non-chlamydial urethritis where OFLX was ineffective, no Ureaplasma nor aerobes, nor C. trachomatis, were isolated. In the remaining two cases where Ureaplasma and S. epidermidis were isolated respectively, these two bacteria were eradicated after medication, but urethral discharge and PMNL remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)     

Detection of penicillinase-producing Neisseria gonorrhoeae from male patients with urethritis

Eighty-nine isolates of Neisseria gonorrhoeae from 89 male urethritis patients were studied for beta-lactamases (penicillinase) production, and their susceptibilities to benzylpenicillin, amoxicillin, piperacillin, clavulanic acid/amoxicillin (Augmentin), cephalexin, cefotaxime, spectinomycin and minocycline were determined by an agar plate-dilution method. Penicillinase activity was tested by a chromogenic cephalosporin method with nitrocefin as substrate (CefinaseTM discs, BBL, USA) and by a paper strip acidimetric method with benzylpenicillin as substrate (beta-Lactamase detection papers, Oxoid, UK). In addition, 60 of the 89 patients were examined for Chlamydia trachomatis, using fluorescein-labeled monoclonal antibodies (Direct specimen test; Micro TrakTM, Syva Co., USA). Penicillinase-producing N. gonorrhoeae (PPNG) were found in 12 of the 89 strains (13.5%). Although all these strains of PPNG were highly resistant to benzylpenicillin and amoxicillin, the minimum inhibitory concentrations (MICs) of Augmentin markedly decreased. Piperacillin was highly active against not only non-PPNG but also PPNG strains. More than half the isolates were resistant to cephalexin (MICs greater than or equal to 12.5 micrograms/ml) while all strains including non-PPNG and PPNG were fully sensitive to cefotaxime (MICs less than or equal to 0.20 microgram/ml). Spectinomycin and minocycline had MIC ranges of 6.25 to 25 micrograms/ml and 0.01 to 3.13 micrograms/ml, respectively; the ranges for non-PPNG and PPNG strains were fairly similar. C. trachomatis was detected in 11 (18.3%) out of 60 patients examined. The increasing incidence of PPNG and coexisting chlamydial infection should be taken into account in the treatment of gonococcal urethritis.     

Clinical studies of male urethritis caused by Chlamydia trachomatis

From January through June 1983, 178 male patients with urethritis were investigated on the etiology and epidemiological and clinical features. By using Chlamydia trachomatis direct specimen test (Micro Trak), C. trachomatis was detected in 60 (47.2%) among 127 patients with non-gonococcal urethritis, while it was detected 8 (15.7%) among 51 patients with gonococcal urethritis. The source of infection was a non-prostitute in 30% of chlamydial urethritis, while in gonorrheal urethritis only one patient was infected from a non-prostitute. Mean incubation period of chlamydial and gonorrheal urethritis was 28.5 and 9.2 days, respectively. In chlamydial urethritis, 33.3% of patients did not complain of urination pain and 20.4% showed no urethral discharge. Symptoms of chlamydial urethritis were milder than those of gonorrheal urethritis.     

Clinical studies of Chlamydia trachomatis in male urethritis

From January through December 1986, the urethral smear specimens from 132 male urethritis patients were examined by using Chlamydia trachomatis direct specimen test (Micro Trak). C. trachomatis was detected in 59 (44.7%) out of 132 male urethritis patients, 8 (30.8%) out of 26 patients with gonococcal urethritis (GU), and 51 (48.1%) out of 106 patients with non-gonococcal urethritis (NGU). In 5 (31.3%) out of 16 cases, already treated in other hospitals, infection of C. trachomatis was revealed. The age distribution of the patients with chlamydial urethritis (NGU-C) was between 19 and 52 years old, and the average was 30.9 years old. The peak incubation periods of GU and NGU-C were seen within 7 days and between 8 and 14 days, respectively. In NGU-C patients, 70.6% of them showed WBC less than or equal to 9/hpf in first voided urine sediment. The source of infection was a non-prostitute in 22.2% and a prostitute in 72.2% of GU, while in NGU-C 23.5% was infected from a non-prostitute, and 62.7% from a prostitute. Ofloxacin (OFLX) was administered in a daily dosage of 600 mg (in 3 divided oral doses) for 5 to 14 days in 38 NGU-C patients, and C. trachomatis was eliminated in all cases after the treatment.     

Epidemiological and therapeutic studies on gonococcal infections--one shot therapy by spectinomycin--[Sapporo Clinical Research Group for STD]

From January through March of 1985, the Sapporo Clinical Research Group for STD treated 69 cases of gonococcal infections (61 cases of male gonococcal urethritis and 8 cases of female gonococcal cervicitis) at its facilities in Sapporo City. The therapeutic efficacy of one shot therapy of Spectinomycin (SPCM) was investigated, and an epidemiological study on the cases and bacteriological studies on the isolated strains of Neisseria gonorrhoeae were made. The male patients were between 19 and 55 years old, with a peak age distribution in the younger half of the twenties. The female patients were between 18 and 40 years old. The major source of infections was a so-called special massage parlor which accounted for 36.1% of male cases. The isolation rate of PPNG were 16.7% (11/66). The MIC (inoculum size; 10(6) CFU/ml) of SPCM ranged from 3.13 to 25 micrograms/ml regardless of beta-lactamase production. In male patients, the eradication rate (efficacy rate) of N. gonorrhoeae by SPCM was 94.7% on the first day, 93.6% on the third day and 100% on the seventh day after 2 g one shot therapy. In female patients, the rate was 100% on the third and seventh day after 2 g one shot therapy, and 75% on the first day, 66.7% on third day and 100% on seventh day after 4 g one shot therapy. We considered that one shot therapy of SPCM was effective for gonococcal infection also in the present time. Especially SPCM was effective for infections by PPNG, since it was not resolved by beta-lactamase of N. gonorrhoeae. Positive rate of Chlamydia trachomatis was 16.3% in male gonococcal urethritis, and the serous discharge tended to remain longer in the positive patients than in the negative patients. There was only one side effect (1.4%), therefore SPCM was recognized to be a safely administrated antimicrobial agent.     

Epidemiologic and therapeutic study on gonococcal infections--clinical efficacy of cefetamet pivoxil

We studied the epidemiology of 109 cases of gonococcal infections (105 males with urethritis and 4 females with cervicitis), together with the basic and clinical effects of cefetamet pivoxil in the cases. The peak of age distribution of the male patients was in the younger half of their twenties, and all of the 4 female cases were between 20 and 39 years old. The major source of infections in the males younger than 25 years old was their girl friends or so-called pick-up friends, and that of the males older than 25 years old workers serving at an amusement center, for example, bars and so-called special massage parlor, which accounted for about three fourths of the male cases between 35 and 44 years old. The distribution of the MIC (inoculum size; 10(6) CFU/ml) of Cefetamet against beta-lactamase non penicillinase producing Neisseria gonorrhoeae (non-PPNG) ranged from 0.025 to 0.1 microgram/ml and that against beta-lactamase producing Neisseria gonorrhoeae ranged from 0.025 to 0.05 microgram/ml. The isolation rate of PPNG was 10.2% (9/88). In male patients with gonococcal urethritis, the efficacy rate was 100% on days 3 and 7 for 1,000 mg single dose and 7-day treatment and 500 mg single dose treatment. One of the cases treated with 250 mg single dose therapy was unchanged at 3, but the efficacy rate of the remaining cases was 100% at day 7. Complicated urethritis with C. trachomatis was noticed in 25.7% (5/105) of the male urethritis and in 25.0% (1/4) of the female cervicitis cases. The only side effect was diarrhea observed in 1 of the 124 case (0.8%).     

Clinical evaluation of norfloxacin in gonococcal urethritis

Norfloxacin, a new quinolinecarboxylic acid derivative, was administered to 30 male patients with gonococcal urethritis at a daily dose of 600 mg for 7-21 days. The clinical response was evaluated after administration of 7 days as excellent; Negative culture of N. gonorrhoeae. WBC less than 3/hpf in first voided urine sediment, good; Negative culture, WBC greater than or equal to 3/hpf, and poor; Positive culture. The result was excellent in 14 cases and good in 16 cases. No subjective side effects were observed. The minimum inhibitory concentration (MIC) distribution against the clinically isolated 30 strains of N. gonorrhoeae ranged from 0.0096 micrograms/ml to 0.34 micrograms/ml. Seven of thirty strains were resistant to ABPC. The MIC of these 7 strains ranged from 0.018 micrograms/ml to 0.18 micrograms/ml. Seven cases with ABPC resistant strains had a similar clinical response to other cases. Twelve patients (40%) developed post gonococcal urethritis for 7-14 days after treatment. Clinical observation of this series suggests that a 7 day therapy of Norfloxacin for the patients with gonococcal urethritis is sufficiently effective and that treatment should be changed to other antibacterial agents in the case of post gonococcal urethritis, since continuous administration for more than 7 days of Norfloxacin is not so effective.     

Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases.

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners.     

Bacteriological and clinical evaluation of norfloxacin in male gonorrheal urethritis

Thirty male patients with gonorrheal urethritis were treated with norfloxacin (NFLX) at our urological ward between May and July, 1984, and clinically evaluated. Thirty-nine strains of Neisseria gonorrhoeae isolated from the clinical specimens of these patients were bacteriologically studied. Of the 39 strains, 3 (7.7%) were PPNG strains and the other 36 strains were non-PPNG strains. The minimum inhibitory concentration (MIC) of penicillin G, PCG to the 3 PPNG strains was 6.25-25 micrograms/ml and that to the 36 non-PPNG strains was 0.05-3.13 micrograms/ml. The MIC of NFLX to the PPNG strains was 0.025-0.1 microgram/ml and that to the non-PPNG strains was less than or equal to 0.0125-0.2 microgram/ml. The patients with gonorrheal urethritis were given NFLX orally for 3 days at a daily dose of 600 mg. The clinical efficacy rate was 100%: excellent in 12 and good in 18 cases. All 3 patients with gonorrheal urethritis caused by PPNGs were cured. No subjective side effects were found.     

Epidemiological survey of sexually transmitted male urethritis in Kyoto Prefecture

The data of sexually transmitted urethritis in males have been collected at 24 institutes in Kyoto Prefecture since October, 2002. The data collected from January to December in 2004 are summarized herein. A total of 1,275 patients were diagnosed with urethritis during this period. Microbiological examinations isolated Neisseria gonorrhoeae alone in 368 (29%), Chlamydia tracomatis alone in 336 (26%), both in 85 (7%), and others in 453 (36%). Male patients under 20 years old tended to have Chlamydial urethritis, alone or combined with gonococcal infection, and had a predominant infectious source, a non-commercial-sexual-worker female partner, suggesting a profound problem in sexual life of adolescents. The urologist preferred to use quinolones as the first therapeutic modality against male urethritis. However, drug resistance of N. gonorrhoeae, especially against quinolones, has rapidly progressed, which was also observed by a sensitivity examination test. Antibiotics should be used adequately against male urethrits according to the recent guidelines.     

Detection of Chlamydia trachomatis with a direct specimen test (MicroTrack) in urethritis patients

The urethral smear specimens from 197 male urethritis patients attending our department and 4 affiliated hospitals were examined for Chlamydia trachomatis between April, 1984 and May, 1985, using fluorescein-labeled monoclonal antibodies (Direct Specimen Test; MicroTrack, Syva Co., USA). C. trachomatis was detected in 7 (25.0%) out of 28 patients with gonococcal urethritis, and 83 (49.1%) out of 169 patients with nongonococcal urethritis. The detection rates were almost comparable to those of other reports that used the cell culture method. The direct test is a time-saving, non-culture method useful for the diagnosis of chlamydial infection.     

Cytodiagnosis of Chlamydia trachomatis by the immunoperoxidase technic

The PAP-immunocytochemistry using a monoclonal antibody against Chlamydia trachomatis was applied to male patients with clinically manifest urethritis and their female sex partners. In addition, serum levels of the antibody were determined by means of an ELISA system. Immunoperoxidase reactions were recognized on urethral scrapes in 53 (33%) out of 160 cases, and on endocervical specimens in 13 (59%) out of 22 sex partners of PAP-positive patients. In patients with gonococcal urethritis, an infection of C. trachomatis was revealed immunocytochemically in 11 (31%) out of 36 cases, and in 29 (46%) out of 62 cases with non-gonococcal urethritis. Following medication with 200 mg of minocycline or doxycycline per day, PAP staining became negative in 23 (66%) out of 35 cases. The levels of serum antibody against C. trachomatis were undetectable in 8 (26%) out of 29 PAP-positive cases, but positive in 7 (15%) out of 44 PAP-negative cases.     

Detection of Chlamydia trachomatis in urethra of patients with urogenital infection

Between January, 1984 and August 1986, we examined 151 male patients with urogenital infections including 114 cases of urethritis, 18 cases of epididymitis, 19 cases of prostatitis at the outpatient clinic of the department of urology, Toho University's Ohmori Hospital. The positive rate for Chlamydia trachomatis from the urethra based on cell cultures was 29.0%, (30.5% for urethritis, 27.8% for epididymitis, and 21.1% for prostatitis). The positive rate for non-gonorrheal urethritis was 33.0% and chlamydia infections were complicated by gonorrheal urethritis in 23.3% of the cases. The mean age of the patients with positive Chlamydia trachomatis was 31.9 years. The route of infection in 77.8% of the cases was sexual intercourse the most common cause of which was infection from a prostitute in 62.1% of the cases. The latent period was in most cases from 2-3 weeks.