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.     

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.     

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 study of male urethritis in Oogaki Municipal Hospital

We studied 181 patients diagnosed with male urethritis at Oogaki Municipal Hospital from April 2002 to March 2004. Twenty-two out of 92 patients diagnosed with gonococcal urethritis (GU) and 52 out of 89 patients diagnosed with non-gonococcal urethritis (NGU) were positive for Chlamidia trichomatis by polymerase chain reaction (PCR). Most patients of male urethritis were in their twenties. Of GU patients, 39 (67%) were infected from commercial sex workers (CSWs). Of NGU patients, 12 (30%) were infected from CSWs, 24 (40%) from girl friends and 4 (10%) from their Twenty-eight (48%) out of GU patients were infected through oral sex. spouse. Eighty-three GU patients were treated with SPCM (2 g, one shot). Fifty-five patients could be evaluated for the efficacy of treatment. Elimination rate of Neisseria gonorrhoeae was 100% and 14 out of 18 patients with persisting urethritis had C. trichomatis. Eighty-two NGU patients were treated with minocycline, tosufloxacin, levofloxacin, gatiflixacin or clarithromycine. Sixty-six patients could be evaluated for the efficacy of treatment. Forty-one patients were diagnosed with non-gonococcal chlamydial urethritis (NGCU) and 25 patients were diagnosed with non-gonococcal, non-chlamydial urethritis (NGNCU). The clinical curative rate of NGCU and NGNCU was 93% (38/41) and 80% (20/25), respectively.     

Ureaplasma urealyticum and mycoplasma hominis in male urethritis]

We conducted a multi-center clinical study to evaluate the role of Ureaplasma urealyticum and Mycoplasma hominis in male urethritis. The incidence of each organism in first-voided urine samples of 160 male urethritis patients, including 28 with gonococcal and 126 with non-gonococcal urethritis, was investigated. U. urealyticum and M. hominis were isolated from 13.6% and 6.5%, respectively, of the urine samples, and the concentration of each mycoplasma exceeded 10(3) ccu/ml (color changing units/ml) in 5.2% and 3.9%, respectively. Among 64 patients with non-gonococcal non-chlamydial urethritis, U. urealyticum and M. hominis concentration exceeding more than 10(3) ccu/ml were detected in only two and one samples, respectively. The incidence among urethritis patients with a concentration of either mycoplasma exceeding 10(3) ccu/ml was not significantly greater than that among subfertile males without urethritis. The findings of the present study suggest that, although mycoplasmas may cause urethritis in some patients, the incidence of urethritis due to U. urealyticum or M. hominis is low among patients with non-gonococcal, non-chlamydial urethritis.     

Bacteriological and clinical studies on levofloxacin in male gonococcal urethritis]

We performed basic and clinical studies in male gonococcal urethritis on a new oral antimicrobial agent, levofloxacin (LVFX, DR-3355), a new quinolone derivative. The antibacterial activity of LVFX against clinical strains of Neisseria gonorrhoeae was roughly comparable to that of ofloxacin, and ciprofloxacin. LVFX was administered to 10 males with gonococcal urethritis, 200 mg twice a day (8 cases) or 100 mg twice a day for 3 days (2 cases). Clinical evaluation was made according to the criteria of the Japanese UTI Committee. Overall efficacy rate was 100% (10/10). In the complication of chlamydia trachomatis (2 cases), efficacy rate was 100% (2/2). No subjective or objective adverse reactions occurred.     

Clinical observation of non-gonococcal urethritis

Sixty-one male urethritis cases, 28 gonococcal urethritis and 33 nongonococcal urethritis (NGU), were out-patients at the Department of Urology, Asahi General Hospital, during the 4 months, Oct. 1, 1984-Jan. 31, 1985. Thirteen of the 33 NGU patients (39.4%) were infected with C. trachomatis (CT). The efficacy of Doxycycline and the route of infection was studied in the cases of CT-positive CT-negative-NGU. CT infection from prostitutes was not so frequent as in the other pathogen infection of NGU. The efficacy of Doxycycline (100 mg b.i.d. for 2 weeks) against CT infection was excellent in the disappearance of subjective complaints and that of white blood cells in the urethral discharge in the CT positive-NGU group (13/13), in comparison with CT negative-NGU group (7/18). The efficacy of Doxycycline against CT was also confirmed from the follow-up study by the isolation of CT and by detection of CT antigen from urethral swabs using FITC conjugated monoclonal antibody against CT antigen.     

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.     

The clinical evaluation of 414 cases of male urethritis

PURPOSE: We reviewed the clinical data of male urethritis diagnosed as sexually transmitted disease with the aim of revealing its clinical features. PATIENTS AND METHODS: In a total number of 414 males diagnosed as having acute urethritis transmitted by sexual activities between January and December in 2000, clinical data were collected and analyzed. In addition, questionnaire concerning the awareness of pharyngeal infection was obtained. RESULTS: Their ages ranged from 16 to 60 years with a mean of 31 years. The source of infection was a commercial sexual worker (CSW) in 288 (69.6%) out of 414 cases. In 241 cases in whom an infection route was determined, 199 cases (82.6%) were considered to have an infection through oral sex. Microbiological examinations isolated Neisseria gonorrhea alone in 206 (49.8%), Chlamydia tracomatis alone in 47 (11.3%) and both in 46 (11.1%) cases. In our study, 57.5% and 20.8% of Neisseria gonorrhea strains were resistant to penicillin and new quinolones, respectively. Based on questionnaire, 174 (57.8%) out of 301 cases were not aware of possible infection from the pharynx through oral sex. CONCLUSION: The remarkable prevalence of gonococcal urethritis might be in part due to the lacking of awareness of infection through oral sex and sexual activities without a condom. Instruction on the prevention as well as the actual situation of urethritis is needed for general population with a broad age spectrum. The appropriate use of antimicrobial agents with sufficient susceptibility and less inductivity of drug-resistance is also of clinical importance.     

用聚合酶链反应诊断男性淋菌性尿道炎

采用聚合酶反应（ＰＣＲ），对１５０例男性淋菌性尿道炎病人进行检测。与直接涂片检查的结果相比较，ＰＣＲ具有快速、特异和敏感的特点。     

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.     

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.     

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.     

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.     

Bacteriological and clinical studies on fleroxacin in male gonococcal urethritis

We performed basic and clinical studies on the effects of a new oral antimicrobial agent, fleroxacin (FLRX), a new quinolone derivative in male gonococcal urethritis. The antibacterial activity of FLRX against clinical strains of Neisseria gonorrhoeae was roughly comparable to that of norfloxacin and ofloxacin. FLRX was administered to 58 males with gonococcal urethritis. Two different schedules of administration were adopted. One was a single-dose of 300 mg given orally (17 cases) and the other was the oral administration of 200 mg once a day for 3 to 10 days (41 cases). Clinical evaluation was made according to the criteria of the Japanese UTI Committee. The overall efficacy rate was 98% (49/50). For complications of Chlamydia trachomatis (11 cases), the efficacy rate was 90.9% (10/11). No subjective or objective adverse reaction occurred.     

Clinical effectiveness of pipemidic acid on gonorrhoeal urethritis

Twenty cases of gonorrhoeal urethritis were orally treated with pipemidic acid (PPA). The results are as follows. The clinical effect of PPA was excellent in 9 cases and good in 6 cases, the efficacy rate being 75%. The usefulness of PPA was satisfactory in 12 cases (60%). No side effects were observed. The minimal inhibitory concentrations against 14 isolated Neisseria gonorrhoeal strains ranged from 0.78 to 3.13 micrograms/ml with a median value of 1.56 micrograms/ml. A beta-lactamase-producing strain was observed among the 14 strains and the case infected by this strain was successfully treated with PPA. These results indicate that PPA is a useful drug for the treatment of gonorrhoeal urethritis.     

Mycoplasma genitalium in male urethritis: Diagnosis and treatment in Japan

Male urethritis is a common disease for urologists, with the most common pathogens being, Chlamydia trachomatis and Neisseria gonorrhoeae. When the tests fail to detect these pathogens, the presented urethritis is called non‐chlamydial non‐gonococcal urethritis. Mycoplasma genitalium is one of the pathogens for non‐chlamydial non‐gonococcal urethritis. The test for detecting M. genitalium, which is commercially available in Japan, is not accepted by the Japanese insurance system now. The detection rate of M. genitalium from patients with non‐gonococcal urethritis is 10–20% in Japan. Antimicrobial susceptibility testing for M. genitalium showed that macrolide has the strongest activity and the minimum inhibitory concentrations of tetracyclines were not substantially lower. Some kinds of fluoroquinolones, such as sitafloxacin and moxifloxacin, have stronger activities against M. genitalium. For non‐gonococcal urethritis, macrolides and tetracycline are recommended in some guidelines. In clinical studies, tetracyclines are less effective against M. genitalium than azithromycin, and azithromycin regimens including 1 g stat or 2 g stat are now recommended for urethritis with M. genitalium. However, macrolide‐resistant M. genitalium strains have recently emerged and are spreading worldwide. This macrolide‐resistance is closely related to mutations on the 23S rRNA gene. Sitafloxacin and moxifloxacin have shown good efficacies for M. genitalium in some clinical studies. If the azithromycin regimens fail, we must consider the use of fluoroquinolones, such as sitafloxacin, in Japan. The most important issues include the acceptance of M. genitalium examinations by the national insurance system and the individual treatment of C. trachomatis and M. genitalium in the not‐too‐distant future.     

男性乳腺癌23例临床分析

目的探讨男性乳腺癌的临床特征及合理的临床治疗。方法对1986年至1999年间收治的23例男性乳腺癌进行回顾性分析,其中行乳腺癌根治术16例(69.6%),改良根治术4例(17.4%),3例因为心脏原因仅行局部切除术(13.0%);2例Ⅱ期、3例Ⅲ期患者行术前化疗,23例行术后化疗;14例行术后放疗;3例行术后内分泌治疗。结果经过4~216个月的随访,5年总生存率为73.9%,无瘤生存率为60.9%;10年总生存率63.6%,无瘤生存率为45.5%。在预后相关指标单因素分析中,未能发现年龄、肿瘤大小、临床分期、腋淋巴结转移等因素对预后产生影响。结论男性乳腺癌的治疗应采取手术治疗、化疗、内分泌治疗、放疗相结合的综合治疗措施。