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Is Human Mpox a New Sexually Transmitted Infection in Korea That Should Be Monitored?
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Gilho Lee
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Urogenit Tract Infect 2023;18(2):35-44. Published online August 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.2.35
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- Human monkeypox (mpox) outbreaks have been reported in more than 110 countries, with more than 86,930 confirmed cases. The World Health Organization has realized the seriousness of personal transmission and has declared a global health emergency against the infection. Traditionally, contact with infected animals in a few endemic countries has been a major transmission route of the mpox virus. On the other hand, the global mpox outbreak in 2022 has been primarily associated with sexual networks of men who have sex with men (MSM) and bisexual men exhibiting high-risk behaviors. Their common symptoms are initial fever, headache, swollen lymph nodes, and subsequent skin rashes. These presentations did not consistently occur in the 2022 outbreak. Many patients presented with skin lesions on the anogenital areas without prodromal symptoms. In addition, the atypical characteristics of the recent outbreak may result in a misdiagnosis of other skin lesions, such as chickenpox. Furthermore, infected persons are frequently co-infected with sexually transmitted infections (STIs) with similar skin lesions. The newly confirmed cases in Korea on April 2023 must have been infected through community transmission because these new patients had not traveled overseas in the past three months. Therefore, mpox is something that everybody should be concerned about in Korea. Medical practitioners must know the characteristics of the infection because patients with mpox may visit their offices with some genital lesions or other STIs. The clinical information from this paper may broaden and deepen the understanding of human mpox and curb the early transmission of the infection.
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Syphilis Notification Systems in Korea over the Last 20 Years
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Yumi Seo, Gilho Lee
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Urogenit Tract Infect 2021;16(1):16-23. Published online April 30, 2021
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DOI: https://doi.org/10.14777/uti.2021.16.1.16
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- Purpose: The syphilis notification system has been revised three times in Korea during the last 20 years. Accordingly, we evaluated the performance of the three systems by analyzing data from the Korea Disease Control and Prevention Agency (KDCA).
Materials and Methods: We analyzed trends of stage 1, 2, and congenital syphilis cases reported in the KDCA from 2001 to 2010 in the 1st sentinel (S1), from 2011 to 2019 in the 1st universal (U1), and 2020 in the 2nd sentinel (S2) notification system.
Results: A total of 21,820 syphilis cases were reported, 9,177 cases in S1, 12,321 in U1, and 322 in S2, respectively. The reported cases can be presented in the form of four expanding waves across the time period. Although the most commonly reported age group with infection was 20-29 years in all three reporting systems, the pattern of infections was different; the number of older patients was relatively high in the S1 group while the number of syphilis cases declined sharply in the older than 20-29 old age group in the U1 and S2 systems. Also, there was a sex-based difference in the three groups; the data from S1 were female-dominant but the data in U1 and S2 were male-dominant.
Conclusions: Our results showed that the universal notification system (U1) is superior in both the quantity and quality of data to the previous sentinel system (S1). The results from the new system, S2, are similar to those from U1.
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Association between an Interleukin 4 Gene Polymorphism, rs2243268, and Urogenital Tuberculosis
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Bongsuk Shim, Sang Don Lee, Tae-Hyoung Kim, Seung Il Jung, Won Yeol Cho, Gilho Lee
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Urogenit Tract Infect 2018;13(2):35-39. Published online August 31, 2018
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- Purpose: Urogenital tuberculosis (UGT) is rarely reported in developed countries. This study evaluated the genetic susceptibility of Korean patients to UGT.
Materials and Methods: A total of 35 UGT patients who were confirmed pathologically, 44 intrapulmonary tuberculosis (IPT) patients who were confirmed radiologically, and 102 controls over a 6 year period were enrolled in this study. The region of rs2243268 in interleukin-4 (IL-4) gene was amplified from whole blood samples, and the DNA sequences were read using the Sanger method.
Results: Twenty women and 15 men were diagnosed with UGT. The occurrence of the CC, AC, and AA genotypes of rs2243268 were 26 (74.3%), 8 (22.9%), and 1 (2.9%), respectively, in UGT; 28 (63.6%), 15 (34.1%), and 1 (2.3%), respectively, in IPT; and 51 (50.0%), 45 (44.1%), and 6 (5.9%), respectively, in the control groups (p=0.115). The bivariate data of CC and AC/AA were 74.3% and 25.7% in UGT, 63.6% and 36.4% in IPT, and 50.0% and 50.0% in the control groups, respectively (p=0.029). The UGT was significantly different from the control group among the three genotypes (p=0.038, Fisher’s exact test) and bivariate genotypes (p=0.017, Fisher’s exact test). In addition, people carrying the CC genotype had a higher risk of UGT (odds ratios, 2.889; 95% confidence intervals, 1.233-6.770; p=0.015).
Conclusions: A single nucleotide polymorphism in the IL-4 gene, rs2243268, is associated with the development of clinical tuberculosis. The CC type of rs2243268 increases the risk of UGT significantly compared to the CA/AA type.
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Genetic Variation in Mycoplasma genitalium
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Gilho Lee
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Urogenit Tract Infect 2017;12(2):65-76. Published online August 31, 2017
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- Mycoplasma genitalium (MG) is the smallest self-replicating bacterium. Although small in size, unique MG genome induces distinctive and often serious characteristics in the infected cells. Due to its small genome and chronic symptomatic characteristics in the infected host, it first appears as a weak, insignificant, and easily controllable microbe. However, it is not a monotonous chrysalis, but rather a multicolored butterfly with various capabilities. Repetitive DNA sequence in MG’s immunodominant MgPa operon has been considered as an efficient strategy to evade the host immune surveillance and mediate MG’s genetic flexibility. Because of MG’s pathogenicity in multiple organs, various antimicrobials are prescribed, further exerting selection pressure on microbes. Consequently, a rapidly increasing drug resistance in macrolide and moxifloxacin has been frequently reported globally, radically decreasing the overall cure rate of infection. Re-infection can be defined as a new MG infection through antigenic variation, while persistent infection refers to recurrent infections caused by the same MG isolate through acquisition of antimicrobial resistance. Therefore, we must differentiate between re-infection and persistent MG infection, and approach them accordingly. The genetic mechanisms of DNA variation in the MgPa operon and antibiotic resistance must be considered for the management of multicolored infection. In this respect, the unique genetic characteristics of MG will be described in detail. We hope that with this manuscript, clinicians can expand their understanding of recurrent MG infections and better choose an appropriate treatment for the infection in clinical setting.
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Acute Bacterial Prostatitis by Salmonella Infection
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Yu Mi Seo, Pil Won Seo, Gilho Lee
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Urogenit Tract Infect 2016;11(2):69-72. Published online August 31, 2016
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- Acute Salmonella prostatitis is a very rare disease. Herein, we report on a healthy 37-year-old man presented with recently developed lower abdominal pain, fever, dysuria, frequency, and perineal pain. Clinical symptoms and signs, as well as abdominal computed tomography scan suggested acute bacterial prostatitis. The initial urine culture revealed significant colonies of Salmonella species. We could not, however, find Salmonella species from subsequent specimens from blood and stool. Three days after admission, we examined his prostate and performed prostatic massage. While we could not find Salmonella species in the follow-up urine specimen, we found Salmonella species in his expressed prostatic secretion. His symptoms and signs were improved with ciprofloxacin treatments.
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Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study
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Eu Chang Hwang, Ho Song Yu, Seung Il Jung, Dong Deuk Kwon, Sun Ju Lee, Tae-Hyoung Kim, In Ho Chang, Hana Yoon, Bongsuk Shim, Kwang Hyun Kim, Donghyun Lee, Jung-Sik Huh, Dong Hoon Lim, Won Jin Jo, Seung Ki Min, Gilho Lee, Ki Ho Kim, Tae Hwan Kim, Seo Yeon Lee, Seung Ok Yang, Jae Min Chung, Sang Don Lee, Chang Hee Han, Sang Rak Bae, Hyun Sop Choe, Seung-Ju Lee, Hong Chung, Yong Gil Na, Seung Woo Yang, Sung Woon Park, Young Ho Kim, Tae Hyo Kim, Won Yeol Cho, June Hyun Han, Yong-Hyun Cho, U-Syn Ha, Heung Jae Park, The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII)
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Urogenit Tract Infect 2016;11(1):17-24. Published online April 30, 2016
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- Purpose: Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis.
Materials and Methods: A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidoneiodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications.
Results: The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004).
Conclusions: The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy.
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Two Different Coagulopathy Episodes in a Single Patient with Metastatic Prostate Cancer
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Insoo Rheem, Gilho Lee
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Korean J Urogenit Tract Infect Inflamm 2015;10(1):53-56. Published online April 30, 2015
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- We reported a case of two different episodes of critical coagulopathy in a single patient with metastatic prostate cancer (mPC). The patient initially visited the emergency room with a huge left retroperitoneal hematoma, high serum prostate-specific antigen level, and signs of acute disseminated intravenous coagulation (DIC) from mPC. With blood product replacement and anti-androgen therapy, the DIC-related symptoms and signs were relieved. During the follow-up, he was treated with docetaxel chemotherapy for hormone refractory PC. Four years later, he visited the emergency room again with relapsed coagulopathy and severe anemia that were not replaced with blood products. The laboratory findings were consistent with thrombotic thrombocytopenic purpura rather than DIC. A satisfactory recovery was achieved with a new cycle of docetaxel chemotherapy. Differentiation of the coagulopathies in PC is difficult; therefore, we describe the different features of two overlapping coagulopathies, which will be helpful in deciding on urgent treatment.
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Swedish Variant of Chlamydia trachomatis in Korea
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Jae Kyung Kim, Gilho Lee
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Korean J Urogenit Tract Infect Inflamm 2013;8(2):98-101. Published online October 31, 2013
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Purpose: Today, many urologists use nucleic acid amplification tests (NAAT) in diagnosis of Chlamydia trachomatis infection in Korea. A new variant of C. trachomatis with a deletion in the cryptic plasmid, which cannot be detected using commercial tests targeting the deleted DNA sequences, has been found in Sweden. Therefore, the partial deletion of cryptic plasmid DNA means that the diagnostic standards cannot detect chlamydial infection any more in cases of new mutants. The mutant type has been prevalent in Sweden, however, its incidence was not high in other countries such as France, Holland, and Denmark. In or to study the existence of this mutant C. trachomatis in Korea, we developed new primer sets for detection of this mutation. Materials and Methods: We collected the first voided urine from male urethritis patient from April 2012 to August 2013 (Dankook University Hospital, Cheonan, Korea). We used the 25 confirmed C. trachomatis-positive specimens by using KL1 and KL2 primers for C. trachomatis and tested the existence of mutant chlamydial infection with the newly developed primer sets. Results: We could not detect any new variant in the samples. Conclusions: Although this mutant C. trachomatis is not seen in Korea, we should watch for the occurrence of the type in the future. I would like to briefly report on implications of the surging mutant forms and how we might attain an understanding of this phenomenon.
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Extended-spectrum β-lactamases Producing Bacteria in Urinary Tract Infection
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Gilho Lee
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):32-41. Published online April 30, 2011
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- Multi-drug-resistant Enterobacteriaceae that produce extended-spectrum β-lactamases (ESBLs) have emerged in the communities and hospitals. Because β-lactamases are bacterial enzymes that hydrolyze β-lactamring in antibiotics, cephalosporins are not usually effective. Most ESBLs can be divided into three groups: TEM, SHV, and CTX-M. Recently, AmpC β-lactamase is included in this category. The clinical significance of ESBL bacteria is well known. Initially, ESBL bacteria exhibitmulti-drug resistance, such as co-trimoxazole, tetracycline, gentamicin, and fluroquinolone, as well as broad-spectrum cephalosporins. In addition, they can be transmitted to other places andother people. Moreover, inappropriate empirical therapy to urinary tract infection secondary to ESBL bacteria is usually associated with higher mortality. For these reasons, gram-negative pathogens that produce ESBLs remain an important cause oftherapy failure with newly developed cephalosporins, and incur serious complications and have consequences in infection control in the community. Consequently, it is an urgent issue to understand the characteristics of ESBL bacteria to minimize their spread and to treat ESBL associated urinary tract infection. We herein review the clinical significances of ESBL bacteria in urinary tract infection.
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Detection of Mycoplasma genitalium and Ureaplasma urealyticum Infection in Female Commercial Sex Workers
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Gilho Lee, Hee Yoon Park
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):182-187. Published online October 31, 2010
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- "Purpose: To detect Ureaplasma urealyticum (U. urealyticum) and Mycoplasma genitalium (M. genitalium) infections in female commercial sex workers (FCSW) in Korea. Materials and Methods: Total 127 samples from FCSWs were randomly collected. Endo-cervical swab was obtained and DNA was extracted from the samples. Gene amplification was performed with specific primers for U. urealyticum and M. genitalium from the patients’ DNA. Results: Of the 127 samples, 49 samples were positive by amplification of U. urealyticum and 7 samples were positive by amplification of M. genitalium. In this study, the prevalence of U. urealyticum and M. genitalium in FCSW were 38.5% and 5.51%, respectively. Conclusions: Detection of U. urealyticum was relatively high, whereas detection of M. genitalium was relatively low in FCSW in Korea. Further studies should be performed to characterize the mycoplasma infections in sexually transmitted infectious core groups."
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Aminoglycosides Resistance of Escherichia coli Isolates from Acute Uncomplicated Cystitis
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Gilho Lee, Min Eui Kim, Yong-Hyun Cho, Chul Sung Kim, Young Ho Kim, Seung Ju Lee
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):51-56. Published online April 30, 2010
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- "Purpose: The aim of the study was to determine the aminoglycosides resistance of Escherichia coli (E. coli) strains isolated from acute uncomplicated cystitis. Materials and Methods: All 219 female patients who presented with symptoms of acute cystitis by E. coli infection were included in this study. We used gentamicin, tobramycin, and amikacin for detecting the resistance to aminoglycosides. The prevalence of gentamicin, tobramycin, and amikacin resistance of E. coli was 25.1%, 24%, and 0.4%, respectively. Results: The resistant isolates to tobramycin or gentamicin definitively showed an associated resistance to other antibiotics such as ciprofloxacin and trimethoprin-sulfamethoxazole, while the resistance to amikacin was not. In addition, 3 aminoglycosides resistant E. coli isolates did not associated with the history of recurrent cystitis. Conclusions: We recommend the clinical use of amikacin for the ciprofloxacin or trimethoprim- sulfamethoxazole resistant E. coli isolates from urinary tract infection, instead of gentamicin or tobramycin."
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The Usefulness and Limitation of Bacterial Genetic Amplification Method for Diagnosis of Chronic Prostatitis
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Gilho Lee
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Korean J Urogenit Tract Infect Inflamm 2008;3(1):37-42. Published online April 30, 2008
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- Some urologists have insisted that fastidious and nonculturable microorganisms may be important in the etiology of idiopathic chronic prostatitis. The bottom-line is that the diagnosis of infectious causes which only detected by genetic amplification methods have theoretically serious defects and incurs determinant misinterpretations if not used by an appropriated method. In Korea, the amplification method to detect fastidious bacteria has been widely used in out-patient clinics without criticism, which phenomenon is unusual or can not understand in the eyes of foreign scientists. Moreover, many urologists who care the patients, even patients, can not believe the PCR results. Under some situations, because the amplification results from some commercial companies make the situations in a mess or more complicating to understand idiopathic chronic prostatitis, so many people have a question that “Is it a right result or is our approach right?”. Herein, I will discuss what the real problems are, and why the results are contradictious in Korea. Finally I will give a suggestion about “we are on the right way”.
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Bacterial Interference, an Alternative Treatment for Patients with Recurrent Cystitis
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Gilho Lee
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Korean J Urogenit Tract Infect Inflamm 2007;2(2):167-172. Published online October 31, 2007
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- Urinary tract infections (UTIs) cause significant morbidity, and in some patients recurrent cystitis severely impacts quality of life. Antibiotic treatment is, in most cases, effective but when repeated courses or long-term prophylactics are needed. However, the long term therapy may develop side effects of drug such as ecological disturbance in bowel or antibiotics resistance. Bacterial interference has attracted interest as a possible alternative treatment option for recurrent UTI or persistence infection patients. The strain used for colonization, the ABU isolate Escherichia coli 83972, has been shown to cause symptom-free colonizations for long periods of time. Patients on long-term colonization report a subjective benefit, and UTI treatments are rare in colonized patients. I present an update on bacterial interference theory in mainly research point of view, and describe some clinical results of the E. coli 83972 colonization trials.
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Urachal Abscess Caused by a Swallowed Fish Bone
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Inho Sohng, Gilho Lee
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Korean J Urogenit Tract Infect Inflamm 2007;2(2):238-241. Published online October 31, 2007
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- A 64-year-old man visited our hospital with a 2 weeks history of lower abdominal pain and palpable mass. Physical examination revealed a tender mass in the suprapubic area. Abdominal ultrasonography and abdominal computerized tomography of the patient showed a cystic mass and adhesion of the bowel with a foreign body which fortunately found out to be a fish bone. An urachal abscess was suspected, and we first drained the cystic mass and debrided the necrotic tissues. We then performed a complete resection of the urachal remnant, a fistulectomy, a partial resection of adhesive ileum and a partial resection of the bladder. Urachal abscess by a swallowed fish bone is rare, and it was only reported in Japan. A preoperative diagnosis with ultrasonography or CT scan may be helpful to evaluate patients and make a treatment plan.
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Uropathogenic Escherichia coli Infection and Host Response
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Gilho Lee
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Korean J Urogenit Tract Infect Inflamm 2007;2(1):48-52. Published online May 31, 2007
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- Urinary tract infections are a result of interactions between the uropathogen and the host. Successful infection of the urinary tract is determined in part by the virulence factors of the bacteria such as type 1 fimbriae and/or P fimbriae, the inoculum size, and the inadequacy of host defense mechanisms. Detection of microorganisms through microbe-associated molecular patterns by Toll-like receptors is crucial to trigger protective innate immunity. A rapid cytokine response was observed when Escherichia coli bacteria infected the epithelial cells with production of interleukin-1ß (IL-1ß), IL-6, and IL-8. These factors play a role in determining the damage to the urinary tract.
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