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International Journal of STD & AIDS Sep 2019HIV infection may increase the risk of persistent infection and complications. Perinatally HIV-infected (PHIV) and HIV-uninfected male adolescents and young adults (AYA)... (Observational Study)
Observational Study
HIV infection may increase the risk of persistent infection and complications. Perinatally HIV-infected (PHIV) and HIV-uninfected male adolescents and young adults (AYA) in Thailand were matched by age and number of lifetime sexual partners. HPV infection at oral, anal, penile, and scrotal sites was detected by polymerase chain reaction. A total of 49 PHIV and 47 HIV-uninfected male AYA (median age 18 [17–20] years) were enrolled (June 2013– September 2014). Overall, 18 were men who had sex with men (MSM) (12% of PHIV and 26% of HIV-uninfected AYA; =0.12). Among the PHIV, the median (IQR) CD4 cell count was 573 (434–747) cells/mm and 69% had HIV RNA load <40 copies/mL. The prevalence of any HPV infection was 61% in PHIV and 49% in HIV-uninfected AYA (=0.23); and that of high-risk HPV infection was 33% in PHIV and 28% in HIV-uninfected AYA (=0.59). Among those with HPV, 55% were infected with any high-risk HPV type and 28% had HPV-16 and/or HPV-18. In multivariate models, smoking (OR 6.10, 95% CI, 1.19–31.35, =0.01) and prior history of STI symptoms (OR 5.01, 95% CI, 1.63–15.40, =0.004) were associated with high-risk HPV infection. HPV vaccination in early adolescence presents a valuable but missed prevention opportunity.
Topics: Adolescent; Antiretroviral Therapy, Highly Active; Case-Control Studies; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Male; Papillomaviridae; Papillomavirus Infections; Penis; Polymerase Chain Reaction; Prevalence; Prospective Studies; Rectum; Scrotum; Thailand; Young Adult
PubMed: 31284841
DOI: 10.1177/0956462419853384 -
Nature Reviews. Urology May 2023Since 2006, five penis transplants have been performed worldwide. Mixed outcomes have been reported, and two of the five penile transplants have required explantation.... (Review)
Review
Since 2006, five penis transplants have been performed worldwide. Mixed outcomes have been reported, and two of the five penile transplants have required explantation. However, the long-term outcomes have been encouraging when compliance is implemented, whether standard induction and triple therapy maintenance, or single therapy maintenance. Follow-up monitoring of transplant recipients has enabled a synthesis of technical considerations for surgical success and has shown stable leukocyte counts and renal function after a donor bone-marrow-based immunomodulatory regimen followed by tacrolimus monotherapy as long as 3 years post-transplant, as well as continuous nerve regeneration of penile allografts 3 years post-transplant. Areas of uncertainty include the ethics of donor-recipient colour mismatch, surveillance for sexually transmitted infections and how to optimize patient compliance. Questions also remain with respect to the long-term immunological sequelae of penile tissue, functional outcomes, psychosocial implications and patient selection. Patient counselling should be modified to mention the possibility of long-term improvement in nerve regeneration and sufficient renal function with single-therapy maintenance, and to build a longitudinal dialogue and partnership between the patient and the multidisciplinary care team regarding the risks of sexually transmitted infection instead of surveillance.
Topics: Male; Humans; Penile Transplantation; Baltimore; Tacrolimus; Tissue Donors; Penis
PubMed: 36627487
DOI: 10.1038/s41585-022-00699-7 -
Veterinary Medicine and Science Mar 2022To describe a novel technique for partial anatomic penile amputation using a thoracoabdominal stapler in dogs and to report any associated short-term peri-operative...
OBJECTIVES
To describe a novel technique for partial anatomic penile amputation using a thoracoabdominal stapler in dogs and to report any associated short-term peri-operative complications and clinical outcomes associated with the procedure.
MATERIALS AND METHODS
Medical records from a tertiary referral hospital were reviewed for dogs undergoing penile amputation and scrotal urethrostomy between October 2007 and December 2019. Data collected included patient signalment, clinical signs on presentation, indication for penile amputation, surgical technique, duration of surgery, post-operative complications, and short-term outcome.
RESULTS
Nine dogs were included in the study. Indications for surgery were for treatment of chronic paraphimosis and priapism (n = 3), recurrent urethral prolapse (n = 2), balanoposthitis (n = 1), masses arising from the penis, prepuce, and/or urethra (n = 2), and penile trauma (n = 1). All dogs underwent a scrotal urethrostomy followed by a partial penile amputation with a thoracoabdominal stapler. All dogs suffered mild post-operative haemorrhage from the urethrostomy stoma. On recovery from general anaesthesia, 2/9 dogs were painful and another 2/9 dogs were dysphoric. Two dogs experienced incisional complications with mild swelling around the urethrostomy stoma. One dog experienced an infection of the penile amputation site 21 days after surgery. The short-term outcomes for this procedure were excellent in 8/9 dogs. These outcomes were based on owner assessment of comfort and monitoring throughout the recovery period, manual palpation of the surgical site at the time re-evaluation, and surgeon visualization of successful voluntary urination 14-35 days after surgery.
CLINICAL SIGNIFICANCE
Use of a thoracoabdominal stapler is effective in achieving partial anatomic penile amputation in dogs.
Topics: Amputation, Surgical; Animals; Dog Diseases; Dogs; Male; Penis; Postoperative Complications
PubMed: 35146966
DOI: 10.1002/vms3.723 -
Archivio Italiano Di Urologia,... Mar 2022Plaque incision and grafting is indicated for patients with Peyronie's Disease [PD] and severe curvature, complex deformities or for patients with significant penile...
OBJECTIVE
Plaque incision and grafting is indicated for patients with Peyronie's Disease [PD] and severe curvature, complex deformities or for patients with significant penile shortening. To date, no graft studied has been considered ideal. The aim of this study is to conduct a descriptive analysis about functional results with the use of a bioabsorbable graft for PD treatment.
MATERIALS AND METHODS
A single-center, retrospective evaluation of a cohort of patients who were treated by plaque incision and grafting with a polyglycolic acid polymer graft (Gore® Bio-A®) between 2018 and 2021 was conducted. Correction of penile curvature was the main outcome. Loss of penile sensitivity, de novo erectile dysfunction and any other adverse event were the secondary endpoints.
RESULTS
14 patients were included in this study (mean age 59.5 ± 7.2 years). The median follow-up time was 12 months (range 3-12). The curvature correction rate was 78.5%. Glans hypoesthesia was present in one of 14 patients (7.1%) and refractory erectile dysfunction was reported in 64.2%. None of the patients presented any major adverse event based on Clavien-Dindo classification.
CONCLUSIONS
Curvature correction and changes in penile sensitivity rates were similar to those found in the literature. No major surgical complications, such as graft rejection, infection, and extrusion, occurred in this sample. Although a population with a higher prevalence of erectile dysfunction was included in this sample, higher rates of refractory erectile dysfunction were observed and these findings should be confirmed in further studies.
Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Penile Induration; Penis; Polyglycolic Acid; Retrospective Studies
PubMed: 35352532
DOI: 10.4081/aiua.2022.1.87 -
MBio Oct 2021Up to 50% of women receiving first-line antibiotics for bacterial vaginosis (BV) experience recurrence within 12 weeks. Evidence suggests that reinfection from an... (Clinical Trial)
Clinical Trial
Up to 50% of women receiving first-line antibiotics for bacterial vaginosis (BV) experience recurrence within 12 weeks. Evidence suggests that reinfection from an untreated regular sexual partner contributes to recurrence. We conducted a pilot study of 34 heterosexual couples to describe the impact of concurrent partner treatment on the composition of the genital microbiota over a 12-week period. We also determined the acceptability and tolerability of concurrent partner treatment and obtained preliminary estimates of the efficacy of the intervention to inform a randomized controlled trial (RCT). Women received first-line antibiotic treatment for BV (i.e., oral metronidazole or intravaginal clindamycin), and their male partner received oral metronidazole, 400 mg, and 2% clindamycin cream applied topically to penile skin, both twice daily for 7 days. The genital microbiota was characterized at three anatomical sites (women, vaginal; men, cutaneous penile and first-pass urine [representing the urethra]) using 16S rRNA gene sequencing. Immediately posttreatment, concurrent partner treatment significantly reduced the abundance of BV-associated bacteria (false-discovery rate [FDR] corrected value < 0.05) and altered the overall microbiota composition of all three anatomical sites ( = 0.001). Suppression of BV-associated bacteria was sustained in the majority (81%) of women over the 12-week period (FDR value < 0.05), despite BV-associated bacteria reemerging at both genital sites in men. In this cohort of women at high risk for recurrence, five recurred within 12 weeks of treatment (17%; 95% confidence interval [CI], 6 to 34%). Importantly, men tolerated and adhered to combination therapy. Our findings provide support for an RCT of combined oral and topical male partner treatment for BV. Recurrence of BV following standard treatment is unacceptably high. Posttreatment recurrence is distressing for women, and it imposes a considerable burden on the health care system. Recurrences result in multiple presentations to clinical services and repeated antibiotic use, and the associated obstetric and gynecological sequelae are significant. New treatments to improve long-term BV cure are urgently needed. Here, we used 16S rRNA gene sequencing to investigate changes in the microbiota composition at three genital sites (vagina, penile skin, and male urethra) of heterosexual couples undergoing concurrent partner treatment for bacterial vaginosis (BV). We found that concurrent partner treatment immediately and significantly altered the composition of the genital microbiota of both partners, with a reduction in BV-associated bacteria seen at all three sites. BV cure at 12 weeks posttreatment was higher than expected. These microbiological data provide evidence for continued investigation of partner treatment as a strategy to improve BV cure.
Topics: Adult; Anti-Bacterial Agents; Bacteria; Clindamycin; Female; Heterosexuality; Humans; Male; Metronidazole; Penis; Pilot Projects; Prospective Studies; Sexual Partners; Vagina; Vaginosis, Bacterial
PubMed: 34663095
DOI: 10.1128/mBio.02323-21 -
MBio Jul 2017Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4 T cells or dendritic cells. The foreskin is a... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4 T cells or dendritic cells. The foreskin is a major site of viral entry in heterosexual transmission of HIV. Although the probability of acquiring HIV from a sexual encounter is low, the risk varies even after adjusting for known HIV risk factors. The genital microbiome may account for some of the variability in risk by interacting with the host immune system to trigger inflammatory responses that mediate the infection of mucosal immune cells. We conducted a case-control study of uncircumcised participants nested within a randomized-controlled trial of male circumcision in Rakai, Uganda. Using penile (coronal sulcus) swabs collected by study personnel at trial enrollment, we characterized the penile microbiome by sequencing and real-time PCR and cytokine levels by electrochemiluminescence assays. The absolute abundances of penile anaerobes at enrollment were associated with later risk of HIV seroconversion, with a 10-fold increase in , , , and increasing the odds of HIV acquisition by 54 to 63%, after controlling for other known HIV risk factors. Increased abundances of anaerobic bacteria were also correlated with increased cytokines, including interleukin-8, which can trigger an inflammatory response that recruits susceptible immune cells, suggesting a mechanism underlying the increased risk. These same anaerobic genera can be shared between heterosexual partners and are associated with increased HIV acquisition in women, pointing to anaerobic dysbiosis in the genital microbiome and an accompanying inflammatory response as a novel, independent, and transmissible risk factor for HIV infection. We found that uncircumcised men who became infected by HIV during a 2-year clinical trial had higher levels of penile anaerobes than uncircumcised men who remained HIV negative. We also found that having higher levels of penile anaerobes was also associated with higher production of immune factors that recruit HIV target cells to the foreskin, suggesting that anaerobes may modify HIV risk by triggering inflammation. These anaerobes are known to be shared by heterosexual partners and are associated with HIV risk in women. Therefore, penile anaerobes may be a sexually transmissible risk factor for HIV, and modifying the penile microbiome could potentially reduce HIV acquisition in both men and women.
Topics: Adolescent; Adult; Anaerobiosis; Bacteria, Anaerobic; Case-Control Studies; Circumcision, Male; Dysbiosis; Female; Foreskin; HIV Infections; HIV Seropositivity; Heterosexuality; Humans; Interleukin-8; Male; Microbiota; Middle Aged; Mucous Membrane; Penis; Prevotella; Real-Time Polymerase Chain Reaction; Risk Factors; Sexual Partners; Uganda; Young Adult
PubMed: 28743816
DOI: 10.1128/mBio.00996-17 -
BMC Urology Apr 2022Penile Mondor disease is a superficial dorsal vein thrombophlebitis of the penis, which mainly affects young and middle-aged men. It generally manifests as a visible...
BACKGROUND
Penile Mondor disease is a superficial dorsal vein thrombophlebitis of the penis, which mainly affects young and middle-aged men. It generally manifests as a visible painful cord located along the dorsal surface of the penis with signs of skin inflammation. The condition is usually self-limiting, but in severe cases a surgical procedure may be necessary in addition to pharmacological treatment. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is associated with a frequent incidence of thrombophilia; therefore, such a prothrombotic state during infection may be a significant risk factor for penile Mondor disease.
CASE PRESENTATION
The 34-year-old patient reported moderate pain felt on the surface of the penis. During the medical interview, the patient did not admit significant risk factors for Mondor Disease, apart from the previous, a month earlier COVID-19 disease. Examination revealed swelling erythema and a thick indurated cord on the surface of the penis. Color Doppler ultrasound was performed to confirm assumptions and exclude thrombosis of other penile vessels. Based on visible clots in the course of the superficial penile vein and after exclusion of vasculitis due to autoimmune disease the diagnosis of penile Mondor disease was made. Pharmacological therapy was implemented to further break down the clot and prevent rethrombosis in the penile vessels. The patient did not report any treatment complications and returned for a control visit, which revealed complete clot dissolution on ultrasound; therefore, complete recovery was stated.
CONCLUSIONS
This case report presents the correlation between SARS-Cov-2 infection and penile Mondor disease, based on the confirmed influence of COVID-19 on the pathophysiology of thrombosis. It can be concluded that COVID- 19 is a risk factor for Mondor disease, as in the presented case the virus was the only prothrombotic risk factor for the patient. Consequently, the possibility of developing thrombosis in the form of penile Mondor disease should be taken into account among patients with post-COVID-19 and active SARS-Cov-2 infection.
Topics: Adult; COVID-19; Humans; Male; Middle Aged; Penis; Risk Factors; SARS-CoV-2; Thrombosis
PubMed: 35413893
DOI: 10.1186/s12894-022-01002-x -
Journal of Acquired Immune Deficiency... Aug 2020Men who have sex with men (MSM) have a high prevalence of anal and penile human papillomavirus (HPV) infections with MSM living with HIV (MSMLH) bearing the highest...
BACKGROUND
Men who have sex with men (MSM) have a high prevalence of anal and penile human papillomavirus (HPV) infections with MSM living with HIV (MSMLH) bearing the highest rates. Data on anogenital high-risk HPV (hrHPV) among MSM in Rwanda and the associated risk factors are scant.
METHODS
We recruited 350 self-identified MSM aged 18 years living in Kigali, Rwanda, with 300 recruited from the community and 50 from partner clinics. Anal and penile specimens from all participants were analyzed for hrHPV using the AmpFire platform. Logistic regression was used to calculate crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (95% CIs) as a measure of association between various factors and anal and penile hrHPV infection prevalence.
RESULTS
Anal hrHPV prevalence was 20.1%, was positively associated with having receptive anal sex with more partners (aOR: 9.21, 95% CI: 3.66 to 23.14), and was negatively associated with having insertive anal sex with more partners (aOR: 0.28, 95% CI: 0.12 to 0.66). Penile hrHPV prevalence was 35.0%, was negatively associated with having receptive anal sex with more partners (aOR: 0.29, 95% CI: 0.13 to 0.66), and differed significantly by HIV status, with 55.2% and 29.7% for MSMLH and HIV-negative MSM, respectively (P < 0.01).
CONCLUSION
Penile hrHPV prevalence was higher than that of anal hrHPV and it was significantly higher in Rwandan MSMLH than in HIV-negative MSM. The prevalence of anal and penile HPV infections is likely variable at different locations in Africa, according to a number of factors including HIV status and sexual practices.
Topics: Adolescent; Adult; Anus Diseases; Coinfection; HIV Infections; Homosexuality, Male; Humans; Male; Papillomaviridae; Papillomavirus Infections; Penile Diseases; Penis; Prevalence; Rwanda; Urban Population; Young Adult
PubMed: 32692104
DOI: 10.1097/QAI.0000000000002376 -
Postgraduate Medical Journal Aug 1994This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier's gangrene) and a review of previous publications. Even... (Review)
Review
This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier's gangrene) and a review of previous publications. Even though found mostly in elderly male patients, the disease spares no age group and can involve the external genitalia in neonates and women as well. The disease is a necrotising fasciitis of infective origin and always has a portal of entry of the infecting organisms even though it may be so trivial as to be undetected. The commonest portals of entry of infection are periurethral sepsis, groin wound sepsis, anorectal sepsis, prostatic sepsis and trauma. The infecting organisms comprise both aerobic and anaerobic organisms such as Escherichia coli, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, enterococci, Bacteroides fragilis and anaerobic streptococcus. Fournier's gangrene is probably the same disease as necrotizing fasciitis occurring in other parts of the body, but modified by the peculiar anatomy of the genitoperineum.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Fasciitis; Gangrene; Genital Diseases, Male; Humans; Infant; Infant, Newborn; Male; Middle Aged; Necrosis; Penile Diseases; Penis; Prospective Studies; Scrotum
PubMed: 7937450
DOI: 10.1136/pgmj.70.826.568 -
Archivio Italiano Di Urologia,... Jul 2023To report the clinical presentation of circumcision complications encountered at our center and evaluate their management and outcomes. (Review)
Review
OBJECTIVE
To report the clinical presentation of circumcision complications encountered at our center and evaluate their management and outcomes.
PATIENTS AND METHODS
A retrospective and descriptive study was conducted at Souro Sanou University Hospital between January 1, 2014, and December 31, 2018. All patients presenting with circumcision complications were included. Parameters related to clinical aspects of circumcision complication, their management and outcomes were studied.
RESULTS
During the study period, 23 cases of circumcision complications were reported. The average age of patients with circumcision complications was 8.3 years ± 3.5 years, with ages ranging from 18 months to 65 years old. Circumcision was performed by nurses in 12 cases and traditional practitioners in 11 cases. Observed complications included post-circumcision bleeding and hematoma (n = 8), leading to surgical exploration and hemostasis; total or partial amputation of the glans (n = 4), requiring regularization and meatoplasty; infectious complications (n = 3), managed with combined resuscitation, antibiotic administration, and penile debridement; penile urethra-cutaneous fistulas (n = 2), which were repaired; and stenosis of the external urethral meatus (n = 2), treated by meatoplasty. No deaths were reported.
CONCLUSIONS
Circumcision complications presented various clinical manifestations, including hemorrhagic complications, glans amputation, infection, penile fistulas, and meatal stenosis. These complications were effectively managed from a functional perspective; however, aesthetic issues may persist. Emphasis should be placed on preventing these complications by ensuring circumcisions are performed by appropriately trained medical professionals.
Topics: Male; Humans; Child; Constriction, Pathologic; Retrospective Studies; Burkina Faso; Circumcision, Male; Penis
PubMed: 37491935
DOI: 10.4081/aiua.2023.11494