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A New Strategy for Elimination of Human Paplloma Virus-related Disease after Human Papillomavirus Vaccines Introduction
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Yoo-Jin Park, Tae-Hee Kim, Hae-Hyeog Lee, Jun-Mo Kim
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Urogenit Tract Infect 2020;15(3):63-70. Published online December 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.3.63
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- Human papillomavirus (HPV) infections are the most common sexually transmitted diseases in male and female. The most common HPV types include HPV 6/11/16/18/31/33/45/52/58. Bivalent (bHPV), quadrivalent (qHPV), and nonavalent (nHPV) vaccines, have been developed worldwide to protect against HPV infections. This paper describes the worldwide trends in HPV infections after HPV vaccination and shows the progressive changes in national HPV vaccination programs toward gender-neutral vaccination (GNV). This review article is based on original and review articles on the HPV-associated disease burden and nationwide vaccination trends. In Korea, epidemiology studies have shown a decline in the incidence of cervical cancer from 16.3% (in 1999) to 9.1% (in 2015). Interestingly, based on the 2019 annual report from Korean Center for Disease Control, the incidence of anogenital warts increased in both sexes during 2014-2018 and was 2.6 times higher in male than female in 2018. These results indicate the good efficacy of HPV vaccinations against both diseases in female. Other studies suggest that GNV would almost eliminate the risks of HPV-associated diseases in most countries, compared to female-only vaccination. HPV vaccine coverage remains lower in male in Korea despite the vaccine efficacy in both sexes and the worldwide GNV trend. Scaling up HPV vaccination in both sexes should be encouraged. Furthermore, removing the HPV-attributable burden through nHPV vaccination could be considered, showing that HPV 31, 33, 45, 52, 58, which are not covered by bHPV and qHPV, are as prevalent as HPV 6, 11, 16, 18.
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Lactobacillus and Urine Microbiome in Association with Urinary Tract Infections and Bacterial Vaginosis
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Jun-Mo Kim, Yoo-Jin Park
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Urogenit Tract Infect 2018;13(1):7-13. Published online April 30, 2018
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- The traditional concept of “urine is sterile if urine culture and urinalysis are negative” has been overcome by new approaches using 16S ribosomal ribonucleic acid (rRNA) that demonstrated the presence of urinary microbiota. This mini-review article provides updated information of the human urinary microbiome related to urogenital tract infections (UTIs) and describes Lactobacillus in the maintenance of urogenital health and prevention of UTIs. The following keywords were used in combination with “Urinary tract symptoms”, “Urogenital symptoms”, and “Probiotics” in a search: “Bacterial Vaginosis”, “Human Microbiome Project”, “Lactobacillus”, “Microbiome”, and “Urinary Tract Infections.” Here, changes in the urinary microbiome and differences in the abundance of Lactobacillus were identified in patients with UTI. Further development of key characteristics of urinary microbiomes that utilize 16S rRNA gene sequencing will play a key role in improving our understanding of urinary health diseases, such as UTIs.
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Risk Factors for Elevation of Prostate-Specific Antigen in Acute Prostatitis
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Jun-Mo Kim, Eui-Sang Lee, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2012;7(1):56-62. Published online April 30, 2012
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- "Purpose: To evaluate the influence of risk factors for elevation of prostate-specific antigen (PSA) in acute prostatitis. Materials and Methods: This retrospective study examined the records of 93 patients with acute prostatitis from March 2002 to July 2011. These patients were divided into two groups into high PSA group (77 patients, 82.8%) and normal PSA group (16 patients, 17.2%). We evaluated clinical factors, including voiding symptoms, co-morbidity, laboratory test for general and local inflammation, prostate size and result of urine culture. Results: The positive culture rate was 38.7%, and E. coli was the most common organism (66.7%). The only significant risk factor correlated with the elevation of PSA was the size of the prostate (40.0±21.7gm Vs 26.2±7.2gm)(p=0.003). The other clinical factors were not significantly correlated with the elevation of serum PSA. Conclusions: The only clinical factor for elevation of PSA was the prostate size. However, because the prostate size in acute inflammatory period would reflect both the usual prostate size and acute swelling by edema, influence of local inflammation could not be clearly excluded."
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Clinical Outcomes According to Prostatic Abscess in Acute Prostatitis
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Woon-Bin Kim, Kwang-Woo Lee, Jun-Mo Kim, Young-Ho Kim, Min-Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):199-205. Published online October 31, 2011
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- "Purpose: To evaluate differentiation of clinical course and outcomes between patients with acute prostatitis only and acute prostatitis with prostatic abscess. Materials and Methods: This retrospective study examined the records of 68 patients with acute prostatitis from January 2006 to June 2010. These patients were divided into two groups according to the presence of the prostate abscess: group 1 (prostate abcess; 18 patients, mean age 59.1±13.3 years) and group 2 (acute prostatitis without prostatic abscess; 50 patients, mean age 57.7±14.6 years)-. We evaluated clinical parameters including degree and duration of fever, admission period, transrectal ultrasonographic findings, and laboratory test including prostate specific antigen (PSA), white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urinalysis, urine culture, and antibiotic sensitivity. Results: The degree of fever in group 1 (38.4±1.3℃) was higher than group 2 (37.7±0.9℃) (p=0.024), and duration of fever and admission period (3.2±3.0 days vs 1.5±1.6 days, respectively; p=0.006) (22.2±12.6 days vs 6.7±2.9 days, respectively; p<0.001) were longer in group 1. Total prostate volume in group 1 (46.6±20.3ml) was larger than group 2 (32.9±13.9ml) (p=0.002). The results of laboratory tests indicating inflammation in group 1 were higher than group 2 (WBC; 20,592±13258/uL vs 14,577±9097/uL, p=0.040, ESR; 65.1±22.3mm/hr vs 34.3±11.9mm/hr, p=0.001, CRP; 19.4±10.7mg/dL vs 12.1±9.4mg/dL, p=0.023). The causative organisms in group 1 were more resistant to quinolone than group 2 (p=0.019). Conclusions: The clinical course of prostate abscess is more severe and longer than acute prostiaitis. We propose that early imaging study for diagnosis of prostatic abscess in acute prostatitis patients with low response to initial empirical conservative treatment for 2 days. Because antibiotic resistant rate was higher, careful choice of antibiotics and different therapeutic plans including abscess drainage will be needed in patients with prostatic abscess."
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Penile Necrosis in Thromboangitis Obliterans (Buerger's Disease)
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Jun-Mo Kim, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):206-208. Published online October 31, 2011
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- Thromboangiitis obliterans is also known as Buerger’s disease, and it usually affects small-to-medium-sized arteries and veins of the upper and lower extremities. Although as an atypical course of this disease, bilateral renal artery thrombosis and affection of spermatic cord were reported, there has been no report of penile necrosis due to Buerger’s disease in Korea. We present a case of a 47-year-old man with voiding difficulty and urinary retention due to severely atrophic penis and urethra. The patient’s medical history revealed smoking as much as 50 pack/years, and heavy alcohol consumption. Although the patient had been taking anti-coagulant medication for 2 years after diagnosis of thromboangiitis obliterans, penile necrosis was advanced. The patient could self-void after diversion of the urethra into the perineum.
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Update of Prophylactic Antibiotics in Vesicoureteral Reflux
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Jun-Mo Kim
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):18-24. Published online April 30, 2011
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- Antibiotic prophylaxis has been administered to prevent acute pyelonephritis and renal scar development in children with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTI) since the 1960s. However, randomized clinical trials, systematic reviews and meta-analyses on antibiotic prophylaxis after UTI has been published in the last 5 years demonstrate not only ineffective routine antimicrobial prophylaxis in patients with low-grade VUR is ineffective in reducing recurrent UTI, but also antimicrobial resistant rate actually increased. Because children with high-grade VUR were excluded in most of these studies, these findings cannot be applied to grade IV-V VUR. Furthermore, debatable results regarding benefits of antimicrobial prophylaxis in grade III reflux has been reported. The on-going Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) study will provide useful data to address this problem.
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Clinical Characteristics of Urinary Catheter Use: A Single Center Study in Gyeong-in Province
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Jun-Mo Kim, Woong-Bin Kim, Jae-Heon Kim, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):161-166. Published online October 31, 2010
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- "Purpose: The aim of this study was to assess the clinical characteristics of several types of urinary catheters on prevalence, indication and duration of use at a single medical center. Materials and Methods: This cross-sectional study was performed to investigate the prevalence of in-patients with urinary catheters at 9AM 8th July 2010 among a total of 843 cases at a university hospital located in the Gyeong-in province. We also examined the indication, duration of catheterization use, and the results of urinalysis and urine culture. Results: The prevalence of in-patients with urinary catheter at our hospital was 12% (103/843 cases). The urethral Foley catheter was the most commonly used, in 88.3% of cases. The duration of catheter use was related to indications, short-term use was common in perioperative use (64.7%) and urine output measurement (72.7%), intermediate-term and long-term use were common in bladder outlet obstruction (50%) and prolonged immobilization (50%), respectively. The positive urine culture rate and grade of pyuria were increased in long-term use (81.8%, 3.0grade) compared to short-term (57.1%, 0.9grade) and intermediate-term use (41.6%, 1.8grade) (p<0.001, p=0.032) Conclusions: The urinary catheter was used in 12% of in-patients at a single tertiary medical center, and 88% of used catheter was urethral Foley catheter. The duration of catheter was related to indication, and incidence of pyuria and bacteriuria was higher in long-term use than in short or intermediate-term use. The establishment of a proper Korean guideline for the management of urinary catheter and regular education at each medical center are needed."
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Recent Regional Increasing Incidence of Mumps Orchitis and Risk Factors Related with Testicular Atrophy
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Mi Ho Song, Jong-Hyun Yoon, Kwang-Woo Lee, Jun-Mo Kim, Young-Ho Kim, Min-Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):68-75. Published online April 30, 2010
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- "Purpose: The aim of this study was to compare incidence of mumps parotitis in our region and mumps orchitis in our hospital, and assess risk factors related to testicular atrophy. Materials and Methods: This retrospective study examined the records of 26 post-pubertal patients (mean age 17.2±2.3years) with mumps orchitis from March 2008 to January 2010. These patients were divided into two groups according to the presence of the testicular atrophy (atrophy: group 1, no atrophy: group 2). The national and regional incidence of mumps parotitis was investigated from homepage of Korean Center for Disease Control and Prevention. We also evaluated several risk factors such as time intervals in onset of mumps, mumps orchitis, and admission, and disease severity including WBC, CRP, testicular volume ratio and duration of treatment. Results: The total number of mumps orchitis in our hospital were 0, 8, 28 cases from 2007 to 2009, respectively. The incidence of mumps parotitis in Gyeonggi province from 2008 to 2009 (1,276 and 1,886 cases, respectively) was greater than 2007 (699 cases). The testicular atrophy was developed in 10 patients (38.5%) (group 1), not in 16 patients (61.5%) (group 2). The duration between onset of the first symptoms of mumps and admission in group 1 (4.8 days) was shorter than that of group 2 (7.3 days). Conclusions: The increasing incidence of mumps orchitis in our hospital from 2008 seems to be correlated with surge of mumps parotitis in our province. The early spread of mumps virus to testis and rapid progression may be the main risk factor related to testicular atrophy rather than late in the treatment or severity of testicular swelling."
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Antibiotic Resistance Patterns of Escherichia coli and Non-Escherichia coli Gram Negative Uropathogens in Pediatric Urinary Tract Infections for the Years 2001-2008
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Jun-mo Kim, Hee-bong Shin, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):210-219. Published online October 31, 2009
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- "Purpose: Because many gram negative bacterial species among the members of the Enterobacteriaceae are implicated hospital acquired infection including catheter-associated infection, antimicrobial resistance between Escherichia coli (E. coli) and other gram negative uropathogens could be different. We evaluated the epidemiologic data and antibiotic resistance patterns of E. coli and other gram negative uropathogens. Materials and Methods: Between February 2001 and November 2008, we retrospectively analyzed positive urine samples of 618 pediatric patients under 15 years of age with the first urinary tract infection (UTI) by E. coli and 419 other gram negative uropathogens. Mean age was 1.0±2.4 years. We compared antibiotic resistnace rate according to E. coli and non-E. coli group, each gram negative bacteria, age group, gender, and early and late period. Results: Although resistance rate of E. coli to ciprofloxacin (9.7%) and co-trimoxazole (34.1%) is higher than non-E. coli gram negative uropathogen (2.4%, 21.5%), resistance rate of non-E. coli gram negative uropathogen to ampicillin (90.9%), amoxicillin-clavulanic acid (52.0%), 1st to 3rd generation cephalosporins (65.2% to 23.6%), and imipenem (2.6%) is higher than E. coli. The resistance rate to co-trimoxazole of age group of 1-15 years is higher than age group of less than 1 year in both E. coli (44.0% Vs 30.4%) and non-E. coli gram negative uropathogens (28.0% Vs 18.9%). In comparison between early and late period, resistance rate to 3rd generation cephalosporin (32.9% Vs 17.6%) and gentamicin (36.0% Vs 16.1%) was decreased. Conclusions: The resistance rate of gram negative uropathogens other than E. coli to ampicillin, cephalosporins, and imipenem was higher than E. coli. Because our result shows resistance rate to amikacin is low in all of gram negative uropathogen including E. coli, it could be reasonable choice in the empirical treatment of the first UTI in children."
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Antibiotic Resistance Patterns of Escherichia coli in Pediatric Urinary Tract Infections for 8 Years from 2001 to 2008
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Jae-I Koh, Jun-Mo Kim, Hee-Bong Shin, Min-Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2009;4(1):47-55. Published online April 30, 2009
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- "Purpose: Because the most common causative organism of the pediatric urinary tract infections (UTI) is Escherichia coli (E. coli), epidemiologic data and antibiotic resistance patterns of E. coli in several regions are important for empirical treatment in children with UTI. Materials and Methods: Between February 2001 and November 2008, we retrospectively analyzed positive urine samples of 618 pediatric patients under 15 years of age with the first UTI by E. coli. Mean age was 1.12±2.5 years. We divided the period into early (2001-2004, 217 patients) and late (2005-2008, 401 patients), and analyzed resistance patterns in two age groups: group 1, ≤ 12 months and group 2, 1-15 years. Results: Although resistance to ampicillin (75.1%), co-trimoxazole (34.1%), gentamycin (25.2%), cephalothin (21.5%) was significant resistance against amikacin (0.8%), cefoxitin (3.9%), ciprofloxacin (9.7%), imipenem (0.3%) was less than 10%. Antibiotics resistance rates was significantly decreased from early to late period in gentamycin (35% to 20.0%), cephalothin (32.7% to 15.5%), cefotaxime (17.5% to 8.7%), and there was no antibiotics with increased resistance rates between the early and the late period. In comparison between group 1 and 2, resistance to ampicillin (71.3% Vs 85.1%), amoxacillin-clavulanic acid (7.6% Vs 17.9%), cephalothin (19.1% Vs 28.0%), and co-trimoxazole (30.4% Vs 44.0%) was significantly increased with age. Conclusions: Although the resistance rates of E. coli to commonly used antimicrobial agents like as ampicillin, co-trimoxazole, gentamycin, first-generation cephalosporins was high in children with UTI, there was a trend toward decreasing resistance in our region. Amoxacillin-clavulanic acid, second-generation cephalosporins, amikacin could be reasonable alternative in the empirical treatment of the first UTI in children."
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