Urogenital Tract Infection

Clinical Guideline of Gonorrhea: Kyung Hyun Moon; Korean J Urogenit Tract Infect Inflamm 2010;5(1):1-12. Published online April 30, 2010

Abstract PDF: Gonorrhea is a worldwide sexually transmitted disease (STD) caused by Neisseria gonorrhoeae. Gonorrhea is the second most often reported STD in the United States behind Chlamydia. An estimated 600,000 people each year in the United States are infected. Only about half this number of cases are reported. Infection with Neisseria gonorrhoeae, a gram-negative diplococcus, is an important cause of cervicitis, urethritis, and pelvic inflammatory disease (PID). Untreated or inappropriately treated gonorrhea can lead to significant morbidity and mortality such as PID, infertility in both males, and females, amplification of HIV transmission, eye infections, and first trimester spontaneous abortions. Given the scale of the public health impact of gonorrhea, selection of appropriate therapy for gonorrhea is essential. However, the selection of appropriate therapy for gonorrhea is complicated by the ability of Neisseria gonorrhoeae to develop resistance to antimicrobial therapies. Key areas addressed include the criteria used to select effective treatment for gonorrhea, the level of antimicrobial resistance at which changing treatment regimens is recommended, the epidemiology of resistance, and the use of quinolones, cephalosporins, and other classes of antimicrobials for the treatment of uncomplicated gonorrhea. The aim of the present review were to recommend effective antimicrobial drugs for the treatment of gonorrhoea considering to the antimicrobial susceptibility and resistance of Neisseria gonorrhoeae in Korea.

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Clinical Guideline of Chancroid: Jae Min Chung, Ki Ho Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(1):13-17. Published online April 30, 2010

Abstract PDF: Chancroid is an acute localized, autoinoculable venereal disease caused by Haemophilus ducreyi, characterized clinically by painful ulceration at the site of incubation, and frequently accompanied by regional lymphadenopathy, and short incubation period. Chancroid is a cofactor for of human immunodeficiency virus (HIV) transmission, as are genital herpes and syphilis; high rates of HIV infection among patients who have chancroid occur in some countries. A definitive diagnosis of chancroid requires the identification of H. ducreyi on special culture media. The combination of a painful genital ulcer and tender suppurative inguinal adenopathy suggests the diagnosis of chancroid. Recommended regimens for chancroid in HIV-infected patients are either azithromycin, 1g as a single oral dose, or ceftriaxone, 250mg as a single intramuscular dose. After prompt treatment, close follow-up is essential.

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Clinical Guideline of Genital Herpes Virus Infection: Jong Kil Nam, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2010;5(1):18-26. Published online April 30, 2010

Abstract PDF: Genital herpes is one of the most common sexually transmitted diseases, While genital herpes can present with self limiting genital lesions. Many such persons have mild or unrecognized infections but shed virus intermittently in the genital tract. It is incurable and persists during the lifetime of the host, often in latent form. Treatment can be expected to reduce the formation of new lesions, the duration of pain, the time required for healing and antiviral shedding. However, antiviral agents do not cure Human simplex virus infections, but rather offer clinical benefits to the majority of symptomatic patients and is the mainstay of management. Our review is to summarize the treatment and management of genital herpes, which is to help patients deal with the infection and be prevented from sexual and perinatal transmission.

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Clinical Guideline of Human Immunodeficiency Virus Infection: Jang-Ho Yoon, Kweon-Sik Min; Korean J Urogenit Tract Infect Inflamm 2010;5(1):27-39. Published online April 30, 2010

Abstract PDF: The human immunodeficiency virus (HIV) has been shown to be the causative agent of acquired immunodeficiency syndrome (AIDS). The first case of HIV infection in South Korea was detected in 1985. The HIV/AIDS epidemic is a complex one, with differing rates of infection in specific at-risk populations. In Korea, the male to female ratio was 9.4:1, and 72.9% of the patients were between 20 and 49 years of age. The major modes of transmission were sexual contacts, accounting for 83% of the cases (50.2% heterosexuals and 32.8% homosexuals) in 2008. Infection with HIV results in the progressive destruction of CD4+T lymphocytes, which cells are crucial to the normal function of the human immune system. After highly active antiretroviral therapy (HAART) decreased progression of AIDS, the mean period of disease progression is increased about 10years. Patients with HIV infection are prevented and controlled by medical, physical and psychological modalities. And other sexually transmitted disease was controlled simultaneously. In this review, it will be discussed up-to dated guideline of management of HIV infection and prevention of transmission and developing AIDS.

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Clinical Guideline of Chlamydia Trachomatis Infection: Ki Ho Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(1):40-50. Published online April 30, 2010

Abstract PDF: Sexually transmitted diseases (STD) are a major public health problem because their incidence is increasing worldwide despite prevention campaigns and because they raise the risk of HIV infection. Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection. Several thousands of cases still remain undiagnosed. Chlamydia infections are most often asymptomatic and can cause pelvic inflammatory disease and infertility to women and epididymo-orchitis to men. At present, there is no guideline for management of chlamydia infection in our country so it will help the patients and physicians to treat chlamydia infection and to make the suitable guideline for our country that we know about recent trends of Chlamydia infection guideline. The objective of this study is to know about recent trends of Chlamydia infection guideline focusing on Scottish Intercollegiate Guidelines Network (SIGN) guideline publicated at 2009 and Center for Disease Control and Prevention (CDC) and Canadian guideline publicated at 2006 and World Health Organization (WHO) guideline publicated at 2003.

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Aminoglycosides Resistance of Escherichia coli Isolates from Acute Uncomplicated Cystitis: Gilho Lee, Min Eui Kim, Yong-Hyun Cho, Chul Sung Kim, Young Ho Kim, Seung Ju Lee; Korean J Urogenit Tract Infect Inflamm 2010;5(1):51-56. Published online April 30, 2010

Abstract PDF: "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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Clinical Characteristics of Children with Febrile Urinary Tract Infection: Chang Soo Park, Seok Gun Jung, Jae Hyun Ahn, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2010;5(1):57-62. Published online April 30, 2010

Abstract PDF: "Purpose: Knowledge of baseline risk of urinary tract infection (UTI) can help clinicians make informed diagnostic and therapeutic decisions. We evaluated the clinical features of children with febrile UTI. Materials and Methods: We identified 141 patients with febrile UTI, who visited for treatment. We retrospectively reviewed the sex, age, hydronephrosis, vesicoureteral reflux (VUR), concomitant disease, previous urologic surgical history, prophylactic antibiotics, voiding symptom, pathogen, used antibiotics and antibiotics resistance. Results: In 105 infants with febrile UTI who were 12 months or less, the male to female ratio was 3:1 (79 boys, 26 girls), which showed a definite male predominance. But, female children had a relatively high prevalence rate of febrile UTI, especially after the first year of life. Comorbidity of hydronephrosis was 38.1%. The most prenatal hydronephrosis persisted until presenting febrile UTI. Comorbidity of VUR was 26.1%. There was no significant difference between the prevalence of febrile UTI and the use of prophylactic antibiotics according to the VUR grade (p>0.05). The most common pathogen was E. coli (70.2%), the most commonly used antibiotics was cefotaxime (79.4%) and the most commonly resistant antibiotics was ampicillin (77.9%). Conclusions: Our results of male to female ratio according to the age are consistent with the data from large epidemiologic UTI studies. Febrile UTI of infant significantly correlated with hydronephrosis and VUR. Understanding pathogen and resistance is mandatory."

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The Correlation between Post-void Residual Urine Volume and Urinary Tract Infection in Asymptomatic Men Visited for Prostate Examination: Seung Hyuk Yim, U-Syn Ha, Dong Wan Sohn, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2010;5(1):63-67. Published online April 30, 2010

Abstract PDF: "Purpose: The large post-void residual urine (PVR) could be related to various complications, especially urinary tract infections (UTIs). Although numerous cut-off value of PVR related to UTIs have been proposed there is still debate on that. We investigated the correlation between PVR and UTIs. Materials and Methods: From January 2008 to December 2008, retrospective analysis was performed on 351 asymptomatic male patients who visited our clinic for prostate examination. The prostate specific antigen (PSA) level, peak urine flow rate, PVR, voided urine volume, International Prostatic Symptom Score (IPSS) and urine culture results were obtained. PVR was measured by portable bladder scanner. A positive result of urine culture was defined as growth of more than 100,000 bacteria per ml. We investigated the association between urine culture results and PVR, and estimated cut-off value of PVR predicting bacteriuria using ROC analysis. Results: The mean age of patients was 63.3±10.4years and 8.83% of the total patients (31 patients) showed positive in urine culture. Mean PVR volume was significantly higher in the group with positive urine culture compare to the group with negative urine culture (105.6mL vs 41.8mL, p<0.001), but we couldn't validate cut-off value of PVR for predicting UTIs. Conclusions: Significant bacteriuria was found in 8.83% of the asymptomatic male patients. Although the positive relationship between PVR and the risk of UTIs was found we couldn't validate cut-off value of PVR for predicting UTIs."

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Recent Regional Increasing Incidence of Mumps Orchitis and Risk Factors Related with Testicular Atrophy: Mi Ho Song, Jong-Hyun Yoon, Kwang-Woo Lee, Jun-Mo Kim, Young-Ho Kim, Min-Eui Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(1):68-75. Published online April 30, 2010

Abstract PDF: "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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The Effects of Human Acellular Dermal Matrix Injected into Mouse Dermis: Jin Suk Chang, Dong Woo Ko, Hahn-Ey Lee, Yun Kyu Oh, Hwancheol Son; Korean J Urogenit Tract Infect Inflamm 2010;5(1):76-81. Published online April 30, 2010

Abstract PDF: "Purpose: Soft tissue augmentation using the injectable human acellular dermal matrix is widely used in Opthamology and Otorhinolaryngology. We performed this study to determine the efficacy and safety of injectable human acellular dermal matrix as a bulking agent, which may be applied to vesicoureteral reflux (VUR) or urinary incontinence later on. Materials and Methods: 0.2ml of normal saline and 0.05, 0.1 and 0.2ml of human acellular dermal matrix were injected into the dermis of the back skin of mouse. At 1, 2, 4, 8 and 12weeks after injection, the volume changes, the histologic changes and the adverse effects were evaluated. Results: In the mouse receiving injections, over 64% of the volume was maintained at 12weeks. The volume change was proportionate to the injected volume of injectable human acellular dermal matrix (p<0.05). After 8weeks, the volume change was stabilized. No inflammatory reaction was noticed in the mouse. Conclusions: The injectable human acellular dermal matrix is effective and safe for augmentation of soft connective tissue. Long term follow-up experiment should be required to prove its usefulness in the treatment of urinary incontinence or VUR as a bulking agent."

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Systemic Candidiasis in Patient with Urinary Stone: Hyoung Sang Kim, Ja Ok Kim, Dong Hoon Lim, Jun Rho, Chul Sung Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(1):82-86. Published online April 30, 2010

Abstract PDF: Invasive fungal infections, especially candidemia and systemic candidiasis, have become a major cause of morbidity and mortality in the last few decades. Invasive candidiasis accounts for up to from 15 to 30% of all nosocomial infections in critically ill patients. Management of these severe infections has been challenging due to a lack of rapid and reliable diagnostic methods, leading to delay in initiating appropriate antifungal therapy. We report a case of 63 year-old male suggesting right acute pyelonephritis with upper ureteral stone and finally identified systemic candidiasis invading to both eyes.

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Lupus Cystitis Associated with Pediatric-onset Systemic Lupus Erythematosus: Jae Min Chung, Geun Tae Kim, Seong Choi, Jae Sun Park; Korean J Urogenit Tract Infect Inflamm 2010;5(1):87-92. Published online April 30, 2010

Abstract PDF: Systemic lupus erythematosus (SLE) is a disease of unknown cause which involves various organs and primary involvement of urinary bladder is very rare. We experienced a case of a girl aged 12 years who was diagnosed as SLE associated with paralytic ileus and urologic manifestations (interstitial cystitis, hydroureters and hydronephrosis). To our knowledge, the combination of paralytic ileus and interstitial cystitis is quite uncommon in pediatric-onset SLE.

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Candida Infection Accompanying Glans Necrosis in Diabetic Patient: Bo sung Shin, Hyunchong Ki, Eu chang Hwang, Chang Min Im, Sook Jung Yun, Seung IL Jung, Dong Deuk Kwon; Korean J Urogenit Tract Infect Inflamm 2010;5(1):93-96. Published online April 30, 2010

Abstract PDF: Candida albicans is considered to be responsible for up to 35% of all cases of infectious balanitis. We report a man with glans necrosis with candidal infection. A 56 year old man visited our institute to consult for penile pain and black colored glans of penis. He had noted two months earlier due to gradually increased wounds, resulting in voiding difficulty. On the physical examination, there was hard necrotic lesion on the glans of penis with secondary meatal stenosis. Tissue culture and biopsy suggested candidial infection. We review the literature on the different forms of presentation of this condition and the differential diagnosis of ischemic penile lesions.

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Urinary Candidiasis Caused by Fluconazole-Resistant Candida glabrata: Moung Jin Lee, Seung Hoon Cho, Jae Young Choi, Seung Tae Lee, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2010;5(1):97-101. Published online April 30, 2010

Abstract PDF: Urinary tract infection caused by Candida glabrata is an uncommon fungal infection. Risk factors for candiduria include diabetes mellitus, antimicrobial use, immunosuppressive therapy and urinary tract defect. We recently experienced a case of urinary tract infection caused by fluconazole-resistant Candida glabrata in a 57-year old woman with diabetes. The diagnosis and management are discussed, and the literature is reviewed

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The Natural History of Urinary Tract Infection in Women: Kun Chul Lee, In Rae Cho; Korean J Urogenit Tract Infect Inflamm 2010;5(1):102-109. Published online April 30, 2010

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비뇨기과 영역에서 수술 전 예방적 항생제 사용: 유럽비뇨기과학회 가이드라인: Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2010;5(1):110-117. Published online April 30, 2010

Abstract: "The aim of antimicrobial prophylaxis in urological surgery is to prevent infective complications resulting from diagnostic and therapeutic procedures. However, the evidence on the best choice of antibiotics and prophylactic regimens is limited. There is no evidence for any benefits of antibiotic prophylaxis in standard non-complicated endoscopic procedures and extracorporeal shockwave lithotripsy (ESWL), though it is recommended in complicated procedures and patients with identified risk factors. For open surgery, the same rules as in abdominal surgery can be applied. No antibiotic prophylaxis is required for clean operations, while a single or 1-day dosage is recommended in clean-contaminated operations. Opening of the urinary tract should be considered as clean-contaminated surgery. A single dose or a short course of antimicrobials can be given, either parenterally or orally. The administration route will depend on the type of intervention and patient characteristics. The use of antimicrobials should be based on knowledge of the local pathogen profile and antibiotic susceptibility pattern. Best practice includes surveillance and an audit of infectious complications."

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