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BMC Infectious Diseases Jul 2023Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common notifiable sexually transmitted infections (STIs) in the United States. Because symptoms of...
BACKGROUND
Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common notifiable sexually transmitted infections (STIs) in the United States. Because symptoms of these infections often overlap with other urogenital infections, misdiagnosis and incorrect treatment can occur unless appropriate STI diagnostic testing is performed in clinical settings. The objective of this study was to describe STI diagnostic testing and antimicrobial treatment patterns and trends among adolescent and adult men and women with lower genitourinary tract symptoms (LGUTS).
METHODS
We analyzed insurance claims data from the IBM® MarketScan® Research Databases. Patients included were between 14 and 64 years old with LGUTS as determined by selected International Classification of Diseases codes between January 2010 and December 2019. Testing of STIs and relevant drug claims were captured, and distribution of testing patterns and drug claims were described.
RESULTS
In total, 23,537,812 episodes with LGUTS (87.4% from women; 12.6% from men) were analyzed from 12,341,154 patients. CT/NG testing occurred in only 17.6% of all episodes. For episodes where patients received treatment within 2 weeks of the visit date, 89.3% received treatment within the first 3 days (likely indicating presumptive treatment), and 77.7% received it on the first day. For women with pelvic inflammatory disease and men with orchitis/epididymitis and acute prostatitis, ≤ 15% received CT/NG testing, and around one-half received antibiotic treatment within 3 days.
CONCLUSIONS
Our study revealed low CT/NG testing rates, even in patients diagnosed with complications commonly associated with these STIs, along with high levels of potentially inappropriate presumptive treatment. This highlights the need for timely and accurate STI diagnosis in patients with LGUTS to inform appropriate treatment recommendations.
Topics: Adult; Adolescent; Male; Humans; Female; United States; Young Adult; Middle Aged; Gonorrhea; Outpatients; Chlamydia Infections; Sexually Transmitted Diseases; Chlamydia trachomatis; Neisseria gonorrhoeae; Prevalence
PubMed: 37442964
DOI: 10.1186/s12879-023-08434-2 -
Acta Radiologica (Stockholm, Sweden :... Mar 2022Diffusion-weighted imaging (DWI) can quantitatively reflect the diffusion characteristics of tissues, providing a theoretical basis for qualitative diagnosis and...
BACKGROUND
Diffusion-weighted imaging (DWI) can quantitatively reflect the diffusion characteristics of tissues, providing a theoretical basis for qualitative diagnosis and quantitative analysis of a disease.
PURPOSE
To characterize testicular lesions that present as a hypointense signal on magnetic resonance imaging (MRI) T2-weighted images using DWI.
MATERIAL AND METHODS
Study participants were divided into three groups. Group A were healthy controls (n = 35), group B included patients with mumps orchitis (n = 20), and group C included patients with seminoma (n = 15). DWI sequences used b-values of 0, 1000, and 2000 s/mm. Apparent diffusion coefficient (ADC) values between 1000 and 2000 s/mm were calculated by MRI postprocessing software. The Kruskal-Wallis test and receiver operating characteristic analysis were performed to evaluate how well ADC values distinguished between mumps orchitis and seminoma.
RESULTS
Normal testicular tissue showed a hyperintense signal on DWI and hypointensity on the ADC map: mean ADC value was 0.77 (0.69-0.85) ± 0.08 ×10 mm/s. Mumps orchitis and seminoma showed slight hyperintensity on DWI: mean ADC values were 0.85 (0.71-0.99) ± 0.15 ×10 mm/s and 0.43 (0.39-0.47) ± 0.04 × 10 mm/s, respectively. There were statistically significant differences in mean ADC values between normal testicular tissue and seminoma and between mumps orchitis and seminoma. The cutoff ADC value for differentiating seminoma from mumps orchitis was 0.54 × 10 mm/s. The sensitivity, specificity, and Youden Index for diagnosing seminoma were 99%, 31%, and 30%, respectively.
CONCLUSION
High b-value DWI has potential utility for differentiating mumps orchitis from seminoma in the clinical setting.
Topics: Adult; Case-Control Studies; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Humans; Male; Mumps; Orchitis; ROC Curve; Retrospective Studies; Seminoma; Sensitivity and Specificity; Statistics, Nonparametric; Testicular Neoplasms; Testis; Young Adult
PubMed: 33557577
DOI: 10.1177/0284185121991980 -
Reproduction in Domestic Animals =... Oct 2022Ultrasound technology has led to new lines of research in equine reproduction, and it has helped to greatly improve clinical diagnosis and reproductive outcomes in... (Review)
Review
Ultrasound technology has led to new lines of research in equine reproduction, and it has helped to greatly improve clinical diagnosis and reproductive outcomes in equine practice. This review aims to discuss the potential clinical uses and new approaches of ultrasonography in equine reproduction. Doppler modalities are usually used to evaluate the vascularization of the follicles, corpus luteum (CL), and the uterus in the mare for diagnostic purposes. Inclusion of Doppler ultrasound in artificial insemination and embryo transfer programs could improve the reproductive outcome of these techniques. Better selection of recipients based on CL functionality, early pregnancy diagnosis 7-8 days postovulation of the donor before flushing or diagnosis of mares with endometritis with pathological increases of blood flow are examples of clinical applications in the mare. In the stallion, colour Doppler ultrasound has improved the diagnostic potential of B-mode ultrasound, improving the differential diagnosis of pathologies such as testicular torsion (decrease or absence of blood flow in the cord) and orchitis (increased blood flow in the cord). The incorporation of pulsed Doppler ultrasound into the reproductive evaluation of the stallion has enabled early identification of stallions with testicular dysfunction, thus allowing administration of timely treatment and subsequent improvements of the fertility prognosis for these animals. In addition, this technique has been used in the monitoring of patients undergoing medical and surgical treatments, thus verifying their efficacy. Recently, computer-assisted pixel analysis using specific software has been performed in research work in order to semi-quantitatively evaluate the vascularization (colour and power Doppler) and echotexture of different organs. These softwares are now being developed for clinical purposes, as is the case with Ecotext, a computer program developed for the evaluation of testicular echotexture, providing information on testicular functionality.
Topics: Animals; Corpus Luteum; Female; Horses; Insemination, Artificial; Male; Pregnancy; Reproductive Medicine; Ultrasonography; Ultrasonography, Doppler, Color
PubMed: 35748405
DOI: 10.1111/rda.14192 -
Journal of Community Hospital Internal... Aug 2020Epididymo-orchitis (EO) is inflammation of the epididymis and testicles. In patients older than thirty-five years, it is commonly due to coliform or uropathogenic...
Epididymo-orchitis (EO) is inflammation of the epididymis and testicles. In patients older than thirty-five years, it is commonly due to coliform or uropathogenic organisms, whereas younger adults are prone to sexually transmitted infections. We present a relatively infrequent case of gonococcal EO in an octogenarian. This case describes a geriatric male who presented to the emergency department in septic shock. His history was notable for prostate cancer, urinary incontinence and multiple sexual partners. He endorsed perineal pain, localized tenderness with chills and dysuria, and was eventually diagnosed with bilateral EO and hydroceles on repeat ultrasound. PCR was positive for N. gonorrhea. His symptoms responded well to fluid resuscitation and antimicrobial therapy. This case demonstrates that EO secondary to sexually transmitted infections is an important consideration in even the oldest old. It is therefore imperative to obtain a detailed sexual history and identify high-risk sexual behaviors in this population.
PubMed: 32850096
DOI: 10.1080/20009666.2020.1774253 -
Ultrasonography (Seoul, Korea) Jul 2020The purpose of this study was to describe the ultrasonographic findings of testicular atrophy after mumps orchitis.
PURPOSE
The purpose of this study was to describe the ultrasonographic findings of testicular atrophy after mumps orchitis.
METHODS
We retrospectively reviewed the case files of eight patients (14 to 24 years old; mean, 17 years) with mumps orchitis and testicular atrophy who were treated between January 2011 and September 2017. On gray-scale and color Doppler, the ultrasonographic features of volume, shape, echogenicity, and degree of blood flow in the testes were analyzed as part of both initial and follow-up ultrasonography. The duration between the initial diagnosis of mumps orchitis and the ultrasonographic diagnosis of testicular atrophy after mumps orchitis ranged from 25 to 230 days (mean, 95.9 days).
RESULTS
Of the eight patients with testicular atrophy after mumps orchitis, the testes were affected unilaterally in seven patients (6 right-sided and 1 left-sided) and bilaterally in one patient. The affected testes (n=9) were 23%-55% (mean, 44.7%) smaller in volume (mean, 6.3±2.0 mL) than the contralateral normal testes (n=7) (mean, 10.8±2.3 mL) on follow-up ultrasonography (P=0.001). The shape of the atrophic testes was oblong in seven cases and elliptical in two cases. The atrophic testes were either heterogeneously hypoechoic with multiple hyperechoic islands (n=7) or heterogeneously hyperechoic (n=2). On follow-up color Doppler ultrasonography, the degree of vascularity of the atrophic testis was either similar to (n=3) or lower than (n=6) that of the contralateral testis.
CONCLUSION
On ultrasonography, atrophic testes after mumps orchitis tended to exhibit an oblong shape, heterogeneous low echogenicity with multiple hyperechoic islands, and decreased vascularity.
PubMed: 32299198
DOI: 10.14366/usg.19097 -
Case Reports in Urology 2022Epididymo-orchitis is an infection of the epididymis and testis, one of the most common urogenital infections. It can be seen at any age. It is caused by sexually...
Epididymo-orchitis is an infection of the epididymis and testis, one of the most common urogenital infections. It can be seen at any age. It is caused by sexually transmitted microorganisms and nonsexual transmitted pathogens. Viruses such as mumps and cytomegalovirus can also cause epididymo-orchitis. During the COVID-19 pandemic, in case of abnormal clinical manifestations of COVID infection and inadequate therapeutic response to the routine therapies, this disease with unusual manifestations should be considered. The case introduced in this paper is a 55-year-old man referred to a urology clinic with typical clinical presentations of epididymo-orchitis. Diagnosis by color Doppler examination and ultrasound also confirmed epididymo-orchitis. The patient underwent appropriate and routine treatment for epididymo-orchitis. Because of the lack of adequate clinical response and the continuation of fever and the development of scrotal lesions and the results of the control ultrasound, which suggested rupture of the tunica albuginea capsule, he underwent surgical exploration and subsequent orchiectomy. Due to the unconventional conditions and the usual culture and pathology, COVID-19 PCR was also performed on the tissues. The PCR showed tissue infection with COVID-19. The patient's clinical condition improved with an orchiectomy, the fever stopped, and he was discharged in a good general condition. It should be noted that before referral to the urology clinic and during hospitalization, evaluation, and treatment, the patient had no evidence in favor of respiratory tract infection with the coronavirus.
PubMed: 35795005
DOI: 10.1155/2022/1891429 -
Frontiers in Immunology 2022
Topics: Male; Humans; Orchitis; Epididymitis; Genitalia, Male
PubMed: 36325325
DOI: 10.3389/fimmu.2022.1042468 -
Frontiers in Immunology 2022Continuous exposure of tissue antigen (Ag) to the autoantigen-specific regulatory T cells (Treg) is required to maintain Treg-dependent systemic tolerance. Thus, testis... (Review)
Review
Continuous exposure of tissue antigen (Ag) to the autoantigen-specific regulatory T cells (Treg) is required to maintain Treg-dependent systemic tolerance. Thus, testis autoantigens, previously considered as sequestered, may not be protected by systemic tolerance. We now document that the complete testis antigen sequestration is not valid. The haploid sperm Ag lactate dehydrogenase 3 (LDH3) is continuously exposed and not sequestered. It enters the residual body (RB) to egress from the seminiferous tubules and interact with circulating antibody (Ab). Some LDH3 also remains inside the sperm cytoplasmic droplets (CD). Treg-depletion in the DEREG mice that express diphtheria toxin receptor on the Foxp3 promoter results in spontaneous experimental autoimmune orchitis (EAO) and Ab to LDH3. Unlike the wild-type male mice, mice deficient in LDH3 (wild-type female or LDH3 males) respond vigorously to LDH3 immunization. However, partial Treg depletion elevated the wild-type male LDH3 responses to the level of normal females. In contrast to LDH3, zonadhesin (ZAN) in the sperm acrosome displays properties of a sequestered Ag. However, when ZAN and other sperm Ag are exposed by vasectomy, they rapidly induce testis Ag-specific tolerance, which is terminated by partial Treg-depletion, leading to bilateral EAO and ZAN Ab response. We conclude that some testis/sperm Ag are normally exposed because of the unique testicular anatomy and physiology. The exposed Ag: 1) maintain normal Treg-dependent systemic tolerance, and 2) are pathogenic and serve as target Ag to initiate EAO. Unexpectedly, the sequestered Ags, normally non-tolerogenic, can orchestrate Treg-dependent, systemic tolerance when exposed in vasectomy.
Topics: Animals; Autoantigens; Female; Humans; Immune Tolerance; Male; Mice; Orchitis; T-Lymphocytes, Regulatory; Vasectomy
PubMed: 35693780
DOI: 10.3389/fimmu.2022.809247 -
Medical Ultrasonography Aug 2019In brucellosis the male genitourinary system can be affected in a small number of patients. In this study we aimed to identify, discuss and compare the radiologic... (Comparative Study)
Comparative Study
AIM
In brucellosis the male genitourinary system can be affected in a small number of patients. In this study we aimed to identify, discuss and compare the radiologic findings of 24 cases with Brucella epididymo-orchitis (BEO) and 285 cases with non-Brucella epididymis orchitis (NBEO).
MATERIAL AND METHODS
The study had a retrospective design. The area of involvement, side of involvement (left, right or bilateral), presence of abscess, hydrocele and testicular involvement pattern were analyzed and compared between the BEO and NBEO cases.
RESULTS
The median age of the included cases was 33 years, with a minimum of 0 and maximum of 89. Epididymo-orchitis and isolated orchitis were more frequent in BEO cases while isolated epididymis involvement was more common in patients with non-BEO (p=0.0117). Bilateral involvement was present in 20.8% and 4.6% cases in the BEO and non-BEO groups, respectively (p=0.008). The frequency of abscess was significantly higher in BEO cases (p=0.003).
CONCLUSION
Although the radiological indications of BEO are similar to those of other types of epididymo-orchitis, abscess formation, bilateral involvement and testicular involvement contribute significantly to diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brucella; Brucellosis; Child; Child, Preschool; Epididymis; Epididymitis; Humans; Infant; Male; Middle Aged; Orchitis; Retrospective Studies; Testis; Ultrasonography; Young Adult
PubMed: 31476203
DOI: 10.11152/mu-1871 -
Tropical Animal Health and Production Oct 2022This study investigated outbreaks of seemingly related abortions and orchitis which occurred in the Khomas, Omaheke and Otjozondjupa regions of Namibia from 2016 to...
This study investigated outbreaks of seemingly related abortions and orchitis which occurred in the Khomas, Omaheke and Otjozondjupa regions of Namibia from 2016 to 2018, affecting cattle, sheep and goats. Fifty-nine questionnaires were administered, and 48 were completed giving an 81.4% return. The outbreaks were limited to Namibia's east and central regions, mainly on farms rearing cattle, sheep and goats and on farms with a mixture of these species. There was no significant difference between Khomas and other regions on abortion reporting at the farm level [X (1, N = 48) = 0.0002, p = 0.987851]. However, there was a significant difference in the abortions at the animal level among the three regions [X (2, N = 6246) = 239.8339, p = .00001]. In addition, the proportions of abortions calculated at the animal level at each farm were significantly different when the Khomas region was compared to the other regions. Seventeen cattle sera, 35 sheep sera, 52 caprine sera, 18 bovine liver samples, one caprine liver, five aborted cattle foetuses, two cattle placentas, 18 testes (one bull, eight bucks and nine rams) and ten bull sheath scrapings were collected and tested. Histopathology, microbiology, serology, immunohistochemistry, real-time PCR and mineral analytical techniques were used to establish the aetiology of the abortion and orchitis outbreaks. The gross and histopathological findings on the 18 testicles were characteristic of chronic orchitis. In aborted foetuses, significant histopathological findings included meconium aspiration, funisitis and cardiomyopathy. Placentitis and endometritis were the primary pathologies observed in cows. The bacteria isolated from microbiological samples included Enterococcus spp. (65.5% [19/29]), Enterobacter spp. (6.9% [2/29]) and Streptococcus spp. (10.3% [3/29]), Trueperella pyogenes (3.4% [1/29]), Stenotrophomonas maltophilia (3.4% [1/29]), Staphylococcus epidermidis (3.4% [1/29]), Providencia rettgeri (3.4% [1/29]) and Acinetobacter lwoffii (3.4% [1/29]), mostly opportunistic bacteria. On mineral analysis, 28%, 33%, 83%, 33% and 17% (n = 18) of cattle livers were low in copper, zinc, manganese, selenium and iron, respectively. Twenty-three percent (12/52) of the caprine sera were positive for Brucella melitensis on the Rose Bengal and complement fixation tests. Thirty-five ovine sera were tested for B. melitensis, B. ovis and Coxiella burnetii, and the prevalence for each was 2.9% (1/35). PCR tests on foetuses were all negative for Brucella spp., Coxiella burnetii, Chlamydia spp., Listeria monocytogenes, Salmonella spp., Campylobacter fetus spp., Leptospira pathogenic strains, bovine viral diarrhoea virus, Rift Valley fever virus, Anaplasma phagocytophilum and bovine herpes virus 4 Campylobacter fetus spp. and Trichomonas foetus spp. The authors concluded that Brucella spp., Enterococcus spp., Escherichia coli, Streptococcus spp., Trueperella pyogenes and Coxiella burnetii could have contributed to this outbreak. Micronutrient imbalances and pathogenic abiotic nanoparticles were also identified as possible contributors to the abortion outbreaks.
Topics: Animals; Cattle; Female; Male; Pregnancy; Abortion, Veterinary; Brucella; Cattle Diseases; Copper; Coxiella burnetii; Disease Outbreaks; Goat Diseases; Goats; Iron; Livestock; Manganese; Meconium Aspiration Syndrome; Micronutrients; Namibia; Orchitis; Q Fever; Real-Time Polymerase Chain Reaction; Rose Bengal; Selenium; Sheep; Zinc
PubMed: 36242679
DOI: 10.1007/s11250-022-03342-0