Urogenital Tract Infection

A New Strategy for Elimination of Human Paplloma Virus-related Disease after Human Papillomavirus Vaccines Introduction: Yoo-Jin Park, Tae-Hee Kim, Hae-Hyeog Lee, Jun-Mo Kim; Urogenit Tract Infect 2020;15(3):63-70. Published online December 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.3.63

Abstract PDF PubReader ePub: 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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Clinical Characteristics and Antimicrobial Susceptibility of Elderly Women with Acute Pyelonephritis: Ji Kang Yun, Woong Bin Kim, Sang Wook Lee, Kwang Woo Lee, Jun Mo Kim, Young Ho Kim; Urogenit Tract Infect 2020;15(3):71-78. Published online December 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.3.71

Abstract PDF PubReader ePub: Purpose: Acute pyelonephritis in older patients can lead to a poorer treatment response and prognosis. The objective of this study was to classify older female patients with acute pyelonephritis according to age and compare their clinical characteristics and antibiotic susceptibility.
Materials and Methods: In this retrospective study, 360 patients aged 65 years or older and hospitalized for acute pyelonephritis in a single tertiary medical facility from 2012 to 2016 were selected as research subjects. The patients were divided into three groups according to their age. Their clinical symptoms, blood tests and urinalysis, underlying diseases, causative organisms for urinary tract infections (UTIs), and antibiotic susceptibility were compared.
Results: One hundred and seventy-six patients aged 69.9±2.7 years, 142 patients aged 79.4±3.1 years, and 42 patients aged 87.3±3.1 years were assigned into the young-old, old-old, and oldest-old groups, respectively. The duration of hospitalization and fever due to acute pyelonephritis increased with age. On the other hand, the maximum body temperature was similar among the three groups. In blood tests, erythrocyte sedimentation rate and C-reactive protein increased with age. Among the underlying diseases, the incidence of diabetes and chronic renal disease was similar among the three groups, while cerebrovascular diseases, heart failure, and urinary stones were associated with aging. Older patients were more likely to have UTIs over the past year. Older groups showed a more significant decrease in sensitivity to carbapenems, amikacin, and ciprofloxacin.
Conclusions: Choosing appropriate antibiotics, considering the patientʼs age, is important when treating acute pyelonephritis.

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Varicocele Secondary to Spermatic Cord Hematoma Related to Blunt Trauma: Yeon Won Park, Jun Ho Lee; Urogenit Tract Infect 2020;15(3):79-82. Published online December 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.3.79

Abstract PDF PubReader ePub: A secondary varicocele caused by spermatic cord hematoma has not been reported. This paper presents a 17-year-old patient with varicocele secondary to spermatic cord hematoma related to blunt trauma. Ultrasonography immediately after the injury revealed a hematoma surrounding the spermatic vessels at the level of the left inguinal area where he had been kicked. Distal to the spermatic cord hematoma, the spermatic vessels began to dilate, and their maximum resting diameter was up to 8 mm. Six-months after the injury, ultrasonography still showed a varicocele, and the testosterone level was below the normal range. After a varicocelectomy, ultrasonography revealed a significant decrease in the size of the spermatic vessels, and the testosterone level returned to normal. This case suggests that a varicocele due to trauma might not be a self-limiting disease and can be treated by a varicocelectomy and hematoma removal.

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Korean Translation of the GRADE Series Published in the BMJ, ‘Use of GRADE Grid to Reach Decisions on Clinical Practice Guidelines When Consensus Is Elusive’ (A Secondary Publication): Hyun Jin Jung, Eu Chang Hwang, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation; Urogenit Tract Infect 2020;15(3):83-89. Published online December 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.3.83

Abstract PDF Supplementary Material PubReader ePub: This article is the last of a series providing guidance for the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for rating the quality of evidence and grading the strength of recommendations in systematic reviews and clinical practice guidelines. Formulating recommendations with the applicable evidence can be difficult due to the large and diverse nature of guideline committees. This article describes a simple technique called the GRADE grid for clarifying the opinions from guideline panels, dealing with disagreement, and achieving consensus among guideline panels. The grid may be helpful for any guideline groups who want to use GRADE to develop their guidelines and achieve consensus or understand the patterns of uncertainty that surround the interpretation of scientific evidence.

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