Urogenital Tract Infection

Prostatic Disease Associated with Trichomonas vaginalis: Jae-Sook Ryu; Korean J Urogenit Tract Infect Inflamm 2014;9(2):61-67. Published online October 31, 2014

Abstract PDF: Trichomonas vaginalis is an extracellular protozoan parasite that binds to the epithelium of the human urogenital tract during infection, and causes contact-dependent cytotoxicity. Neutrophils, macrophages and mast cells known to be involved in innate immunity produced proinflammatory cytokines by stimulation with T. vaginalis. Crosstalk between vaginal epithelial cells (VEC) infected with T. vaginalis and mast cells showed increased inflammatory response compared with that by VECs only. In addition, we confirmed that T. vaginalis caused prostatitis in rat by injection via urethra, and prostate epithelial and stromal cells reacted with trichomonads produced cytokines, including interleukin-1β, CXCL8, and CCL2, resulting in increased migration of neutrophils and monocytes. In further study, we will investigate the role of crosstalk between prostate cells infected with T. vaginalis and inflammatory cells on prostatic cell proliferation or prostatic cancerous change. However, it has not yet been determined whether prostate cancer is associated with T. vaginalis infection. In order to determine their association, a serologic test showing high sensitivity and specificity is necessary. In addition, a molecular diagnostic test with improved sensitivity should be developed for early detection and treatment of trichomoniasis.

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Recommended Managements for the Herpes Genitalia: Heung Jae Park; Korean J Urogenit Tract Infect Inflamm 2014;9(2):68-73. Published online October 31, 2014

Abstract PDF: Herpes simplex virus (HSV) is a member of herpesviridae family viruses, which belong to DNA viruses. HSV-associated diseases are one of the most widespread infection and most genital herpes is caused by HSV type 2 (HSV-2). Treatment of genital herpes is complex. In addition to administration of the standard antiviral medications, an ideal management protocol should also address various aspects of the disease. Oral acyclovir, valacyclovir, and famciclovir are recommended for routine treatment. Long-term suppressive therapy is effective in reducing recurrence rate as well as the risk of transmission to others. However, antiviral drugs cannot cure HSV infection and persist during the lifetime of the host, often in latent form. Management of the sex partner, appropriate counseling, and prevention advice or education are equally important in management of genital herpes. This review provides a summary of several important recent guidelines regarding recommended management for the herpes genitalia.

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Challenge of Developing a Herpes Simplex Virus Vaccine: Hong Chung; Korean J Urogenit Tract Infect Inflamm 2014;9(2):74-78. Published online October 31, 2014

Abstract PDF: Herpes simplex virus 1 and 2 (HSV-1 and HSV-2), also known as human herpes virus 1 and 2 (HHV-1 and HHV-2), are two members of the herpes virus family, herpes viridae, which infect humans. Both HSV-1 (which produces most cold sores) and HSV-2 (which produces most genital herpes) are ubiquitous and contagious. They can be spread when an infected person is producing and shedding the virus. Herpes Simplex can be spread through contact with saliva, such as sharing drinks. HSV-2 is one of the most prevalent sexually transmitted infections worldwide. In addition to recurrent genital ulcers, HSV-2 causes neonatal herpes, and is associated with a 3-fold increased risk for HIV acquisition. Many HSV-2 vaccines have been studied in animal models, however, few have reached clinical trials, and those that have been tested in humans were not consistently effective. Here, I review HSV-2 pathogenesis, with a focus on novel understanding of mucosal immunobiology of HSV-2, and vaccine efforts to date, in an attempt to stimulate thinking about future directions for development of effective prophylactic and therapeutic HSV-2 vaccines.

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Recommended Managements for the Male Human Papillomavirus Infection: Jun Hyun Han; Korean J Urogenit Tract Infect Inflamm 2014;9(2):79-85. Published online October 31, 2014

Abstract PDF: Genital human papillomavirus (HPV) is a common, usually transient, dermatologic infection transmitted by genital contact which can cause a variety of anogenital diseases, including warts (condyloma), dysplasia (cervical, vaginal, vulvar, anal), and squamous cell carcinoma. A number of treatment modalities are available for treatment of anogenital warts, both patient- and provider-applied. Genital warts are benign and resolve spontaneously in some patients, and removal of lesions does not guarantee elimination of all organisms or confer protection from recurrence. Treatment consists of diverse drug application locally and surgical therapy. Urethral warts are an uncommon presentation of HPV and could be treated by endoscopic surgery accompanied by intraurethral instillation of medications. Bivalent and quadrivalent vaccines are approved for prevention of HPV infection. Both are indicated for prevention of cervical cancer, while the quadrivalent vaccine is also approved for prevention of vaginal/vulvar cancers as well as genital warts in males and females.

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Anti-Inflammatory Effect of Phlorotannin on Chronic Nonbacterial Prostatitis in a Rat Model: Yun Seok Jung, Yong-Hyun Cho, Chang Hee Han; Korean J Urogenit Tract Infect Inflamm 2014;9(2):86-92. Published online October 31, 2014

Abstract PDF: Purpose
Chronic nonbacterial prostatitis and chronic pelvic pain syndrome account for 90-95% of all prostatitis. Little is known about its pathophysiology, thus, various treatments are used. Ecklonia cava, a seaweed, is a member of the brown algae family; many recent reports have demonstrated that its extract containing phlorotannin has anti-oxidative and anti-inflammatory properties. Using the hormone-induced prostatitis rat model, we investigated the anti-inflammatory effects of E. cava extracts via its anti-oxidative process on chronic nonbacterial prostatitis. Materials and Methods: Forty, 10-week-old male white Wistar rats were utilized, and divided equally into the following five groups: 1) control, 2) E. cava-fed, 3) hormone-induced prostatitis (HIP), 4) E. cava-treated HIP, and 5) nonsteroidal anti-inflammatory drug (NSAID)-treated HIP. Results: The results showed statistically-significant improvement in the tissue response to the hormone-induced inflammation among the E. cava-treated and NSAID-treated groups (p＜0.05). Lower malonedialdehyde levels were observed in the group with E. cava-treated HIP than with HIP alone, which was statistically significant. We believe that this supports the anti-oxidative properties of E. cava. Conclusions: This study demonstrates that phlorotannin has anti-inflammatory properties via its anti-oxidative process, which we expect to play an important role in prevention and as an adjuvant therapy for chronic nonbacterial prostatitis.

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Profiles of Yeast Isolated from Urinary Tracts with and without Catheter during 2011-2013: Jae Hyung Ryu, Tae-Hyoung Kim, Oh Joo Kweon, Mi-Kyung Lee; Korean J Urogenit Tract Infect Inflamm 2014;9(2):93-98. Published online October 31, 2014

Abstract PDF: Purpose
Indwelling urinary catheter is considered the most important risk factor for healthcare-associated urinary tract infection (UTI). The aim of the current study was to compare the prevalence of species distribution and susceptibilities of antifungals against clinical isolates of yeasts from funguria with and without urinary catheter. Materials and Methods: We analyzed 45,839 urine specimens collected from patients between 2011 and 2013. Species identification and antifungal susceptibility test to amphotericin B, fluconazole, voriconazole, and flucytosine were performed using the VITEK 2 system (Biomérieux Inc.). Results: A total of 1,048 (2.29%) urine specimens were yeast culture positive. The most frequent species was Candida albicans (49.0%), followed by C. tropicalis (18.6%), C. glabrata (12.2%), and Trichosporon asahii (7.2%). C. tropicalis was isolated more frequently in catheterized urine than in voided urine (p＜0.05). For C. albicans and C. glabrata, frequencies of non-susceptible to fluconazole or voriconazole were higher in catheterized urine than in voided urine. Conclusions: The results of this study suggest the possibility that urinary catheter may influence species distribution of yeast and antifungal susceptibilities. Further investigation is warranted to improve infection control strategies for healthcare- associated UTI.

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Evaluation of Clinical Sample for Accupower UU Real-Time PCR Kit: Seung Ki Min, Soon Ki Kim, Yoo Seok Kim, In-Chang Cho, Gyeong In Lee; Korean J Urogenit Tract Infect Inflamm 2014;9(2):99-103. Published online October 31, 2014

Abstract PDF: Purpose
In recent years, various diagnostic methods, including culture, immunological detection, conventional polymerase chain reaction (PCR) based methods, and microarray experiment have been applied for detection of Mycoplasma genitalium and Ureaplasma urealyticum infection. We assayed results of real time PCR and culture of variable clinical samples and evaluated various diagnostic indexes for assessing the clinical usefulness of the Accupower UU Real-Time PCR Kit (Bioneer Corp.) for detection of U. urealyticum/parvum. Materials and Methods: We surveyed 111 results of culture test and antibiotic sensitivity test of Ureaplasma spp. that were requested to the department of laboratory medicine, National Police Hospital from January to April 2011. The specimens of Ureaplasma spp. were collected from 97 uterine cervical swab samples, 13 urine samples, and one expressed prostate secretion sample. Real-time PCR and culture methods were performed using the Accupower UU Real-Time PCR Kit (Bioneer Corp.) and Mycoplasma IST2 Kit (BioMérieux). Results: The real-time PCR results showed that 80 clinical specimens were infected with U. urealyticum/parvum. These results were compared with those confirmed by microbiological culture. Compared with the culture, the diagnostic indexes (sensitivity, specificity, positive predictive value, and negative predictive value) of Accupower UU Real-Time PCR were 88.6%, 38.8%, 48.8%, and 83.9%, and the concordance between the Accupower UU Real-Time PCR Kit and the microbiological culture method was 58.5%. Conclusions: Accupower UU Real-Time PCR is a very valuable technique which can process analysis of a massive number of samples with high speed, high sensitivity and specificity, and a high detection rate, particularly for Ureaplasma spp.

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Antimicrobial Prophylaxis in Transurethral Enucleation and Resection of the Prostate: A Comparison of 1-Day Treatment and More than 2-Day Treatment: Min Seok Kim, Won Jin Cho, Seung Baik, Dong Hoon Lim, Joon Nho, Chul Sung Kim; Korean J Urogenit Tract Infect Inflamm 2014;9(2):104-110. Published online October 31, 2014

Abstract PDF: Purpose
To evaluate the efficacy of 1-day treatment of antimicrobial prophylaxis by analysis of the incidence and risk factors for postoperative infectious complications such as bacteriuria and urinary tract infection in the transurethral enucleation and resection of the prostate (TUERP). Materials and Methods: A retrospective review of 78 patients who underwent TUERP was performed. Of 78 patients, 32 patients received antibiotics less than 1 day (group A). The other 46 patients received antibiotics for more than 2 days (group B). All patients had urinalysis and urine culture preoperatively, on the day of removal, at 1-2 weeks and 3-4 weeks after discharge. The incidence and the risk factors for postoperative infectious complication were investigated. Results: The incidence of infectious complications after TUERP was not statistically significant between group A and group B (18.8% vs. 15.2%, p=0.680). Multivariate analysis documented only two independent risk factors of postoperative infectious complications: preoperative catheterization (OR, 4.189; 95% CI, 1.071-16.382; p=0.040) and diabetes mellitus (DM) (OR, 5.589; 95% CI, 1.469-21.256; p=0.012). Comparative analysis performed in subgroups with two risk factors also showed no difference in the incidence of infectious complication regardless of antibiotic duration. Conclusions: No significant difference in the incidence of postoperative infectious complications was observed between two groups. Therefore, it seems reasonable to prescribe prophylactic antibiotics less than 1 day for reducing postoperative infectious complications after TUERP. Preoperative urethral catheterization and DM were identified as significant risk factors for postoperative infectious complications and preventive management directed against the risk factors preoperatively is recommended.

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Is Postoperative Prophylactic Antibiotics Necessary for Pediatric Scrotal and Inguinal Outpatient Surgeries?: Seungsoo Lee, Chang Soo Park, Sung Hye Jo, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2014;9(2):111-114. Published online October 31, 2014

Abstract PDF: Purpose
Excess usage of antibiotics can cause complications of antibiotics and rise of antibiotic-resistant strains. However, guidelines for antibiotic prophylaxis differ between countries. We evaluated necessity of postoperative prophylactic antibiotics for pediatric patients who underwent scrotal and inguinal outpatient surgeries. Materials and Methods: From April 2011 to April 2014, 725 patients (mean age, 30.5±21.6 months) who underwent outpatient surgery (hydrocelectomy, orchiopexy, orchiectomy, and inguinal herniorrhaphy) were evaluated. In group 1 (556 cases), each patient had intravenous antibiotic prophylaxis only preoperatively. In group 2 (169 cases), each patient had intravenous antibiotic prophylaxis pre- and post-operatively. In group 1 and group 2, we analyzed postoperative complications including wound dehiscence, fever, skin erythema, pain, pus, and diarrhea with medical records. Results: In group 1 and group 2, mean age was 30.4±21.7 months (5.0-108.0 months) and 30.8±21.2 months (7.0-108.0 months), respectively. In group 1 and group 2, the mean operative time was 29.6±2.4 minutes and 29.7±2.5 minutes, respectively. The differences of mean age and mean operative time were not statistically significant (p=0.82 and p=0.77, respectively). Nine patients in group 1 and two patients in group 2 had postoperative complications. The difference between two groups was statistically insignificant (p=0.69). According to age and operation, the differences of postoperative complications were not statistically significant. However, in patients under 2 years old, more complications tended to occur in group 1 than in group 2. Conclusions: Postoperative prophylactic antibiotics may not be necessary for pediatric scrotal and inguinal outpatient surgeries.

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Bacterial Urosepsis by a Fungal Ball Mimicking a Ureteral Stone: Jae Hyung You, Myung Ki Kim; Korean J Urogenit Tract Infect Inflamm 2014;9(2):115-118. Published online October 31, 2014

Abstract PDF: Ureteral obstruction caused by a fungal ball is rare. Diabetes mellitus and immunocompromised conditions constitute the predisposing factors. Urosepsis due to unilateral ureteral obstruction with a fungal ball is extremely rare. The radiologic findings of fungal ball have been described as nonspecific. We report on a female patient with urosepsis that occurred by unilateral ureteral obstruction by a fungal ball, mimicking a ureteral stone. She was managed with systemic antibiotics, percutaneous nephrostomy, and ureteroscopic fungal ball removal.

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Median Raphe Cysts of the Scrotum and Perineum Presenting with Recurrent Infection: Jun Nyung Lee, Hyun Tae Kim, Sung Kwang Chung; Korean J Urogenit Tract Infect Inflamm 2014;9(2):119-121. Published online October 31, 2014

Abstract PDF: Median raphe cysts of the perineum are rare congenital anomalies of the male genitalia, which form during embryological development, and can be found in the midline from the distal penis to the perineum. However, the incidence of median raphe cyst is likely under-reported and under-recognized. We report on the case of a median raphe cyst extending from the scrotum to the perineum with recurrent infection and purulent discharge in a 28-year-old man, which first developed at the age of 5 years. We believe it is important that urologists recognize median raphe cysts and have knowledge of their management in order to provide appropriate information to patients.

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Recurrent Urinary Tract Infection from Urethral Stricture and Urethral Hair Growing after Hypospadias Repair Surgery: Yoo Seok Kim, Sung Bin Kim, Soon Ki Kim, In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2014;9(2):122-125. Published online October 31, 2014

Abstract PDF: Despite successful hypospadias repair surgery, complications may occur. We report on a case of recurrent urinary tract infection from urethral stricture and urethral hair growth after hypospadias repair surgery. A 33-year-old man who first underwent hypospadias repair surgery at the age of seven underwent two more visual internal urethrotomy operations afterward. He was referred to our hospital because of voiding difficulty, dysuria, and residual urine sense. His urethral meatus was located at 1 cm proximal ventral sulcus from the glans. We found the urethral stricture and one hair in the urethra at the 2 cm proximal portion from the urethral meatus by retrograde urethrography and urethroscopy. Bacteriuria was found on urine culture, thus, we resolved the problems with soundation, epilation, and antibiotic therapy. However, the patient kept experiencing these problems recurrently; therefore, we managed his problems by recurrent urethral soundation, hair epilation, and antibiotic treatment with three years of regular follow-up.

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