Unusual presentation of a periurethral abscess following infection with Neisseria gonorrhoea

We describe an unusual case of a male patient presenting with penile and testicular swelling following an unprotected and traumatic sexual encounter. It was suspected that an isolated penile injury occurred during intercourse; however, ultrasound imaging identified an intact tunical layer and right-sided epididymo-orchitis. Following screening for sexually transmitted infections (STIs), he was discharged with antibiotics and advice to attend the Sexual Health Centre for contact tracing. He represented with a periurethral abscess and an antimicrobial-resistant (AMR) strain of Neisseria gonorrhoea was identified. Appropriate antibiotic treatment was initiated. Examination-under-anaesthesia, following abscess drainage, revealed a contained collection with no urethral fistula; however, a flat urethral lesion was seen during urethroscopy. Repeat urethroscopy and biopsy of the lesion indicated polypoid urethritis. Periurethral abscess secondary to gonococcal urethritis is a rare complication, but one that we should be suspicious of, especially with the growing incidence of AMR-STIs.

Detection and Drug Susceptibility Testing of Neisseria gonorrhoeae Using Isothermal Microcalorimetry

Background: Gonorrhea is a frequently encountered sexually transmitted disease that results in urethritis and can further lead to pelvic inflammatory disease, infertility, and possibly disseminated gonococcal infections. Thus, it must be diagnosed promptly and accurately. In addition, drug susceptibility testing should be performed rapidly as well. Unfortunately, Neisseria gonorrhoea is a fastidious microorganism that is difficult to grow and requires culturing in an opaque medium. Methods: Here, we used isothermal microcalorimetry (IMC) to monitor the growth and the antimicrobial susceptibility of N. gonorrhoea. Results: Using IMC, concentrations of N. gonorrhoea between 2000 and 1 CFU·mL−1 were detected within 12 to 33 h. In addition, drug susceptibility could be monitored easily. Conclusions: The use of isothermal microcalorimetry provides an interesting and useful tool to detect and characterize fastidious microbes such as N. gonorrhoea that require media incompatible with optical detection conventionally used in many commercial systems.

Prevalence of sexually transmitted infections among pregnant women attending antenatal clinics in West Coast Region of The Gambia

Background: Sexually Transmitted Infections (STI) are the second most common cause of healthy life years lost by women in the 15 – 44 years age group in Africa. Aim/Objective: To determine the prevalence of STIs among pregnant women attending antenatal care (ANC) clinics in the West Coast Region of The Gambia. Materials and Methods: Blood, urine, and high vaginal swabs samples from 280 pregnant women attending ANC in Brika- ma District Hospital, Brikama, and Bandung Maternity and Child Health Hospital, Bandung were examined. Serum samples were tested for HIV using western blot technique and for syphilis using the Venereal Disease Research Laboratory (VDRL) test, and rapid plasma regimen. Candida albicans, Group B Streptococcus and Neisseria gonorrhoea were identified using Analytical Profile Index (API). Direct urine microscopy was used to identify C. albicans and Trichomonas vaginalis while Chlamydia trachomatis was identified using Direct Fluorescent Antibody (DFA) test. Results: The overall prevalence of STIs was 53.6%. The pathogenic agents isolated were Candida albicans (31.8%), Strep- tococcus agalactiae (15.0%), Treponema pallidum (6.8%), HIV (5.7%), Trichomonas vaginalis (3.9%), Neisseria gonorrhoea (1.8%) and Chlamydia trachomatis (0.7%). STIs were more prevalent among women in the younger age group of 15 – 24 years (54.7%), unemployed (54.0%), Primipara (62.3%), and in the third trimester of pregnancy (72.7%). Conclusion: A high prevalence of STIs was found among pregnant women attending ANC in the West Coast region of The Gambia. Public health intervention programmes should be strengthened to promote the sexual and reproductive health of pregnant women in The Gambia. Keywords: Sexually transmitted infections; pregnant women; antenatal clinics; The Gambia.

Chlamydia trachomatis and Neisseria gonorrhoea Co-Infection Among Patients Attending a Teaching Hospital in Nairobi County: A Retrospective Study

Background: Chlamydia trachomatis and Neisseria gonorrhoea are microbes that have been associated with urethritis in both male and female genders, which often may lead to complicated conditions such as pelvic inflammatory disease (PID) and infertility globally among others health complications. In Kenya and other developing countries, sexually transmitted infections associated with Chlamydia trachomatis and Neisseria gonorrhoea still pose a challenge in public health. Methods: A retrospective study was conducted by reviewing laboratory data from Jan 2018 to Dec 2018 to estimate the prevalence of C trachomatis and N gonorrhoea coinfections in patients attending a tertiary institution and its satellite clinics spread across the country. A total of 1228 patient’s data aged 3-69 years was reviewed; with age, gender and Chlamydia trachomatis and Neisseria gonorrhoea status being analyzed. Results: A total of 1228 patients who visited the hospital in 2018 had their urine samples being tested for Chlamydia trachomatis and Neisseria gonorrhoea by use of a PCR technique. Majority of the patients were males (63.7%). The patients who tested for Chlamydia trachomatis and Neisseria gonorrhoea had an average age of 34 years (range: 3–69 years). Of those 1.4% tested positive for both Chlamydia trachomatis and Neisseria gonorrhoea infections, and males were more infected than females (1.1% vs 0.3). From the information gathered during the study period, the proportion of patients with Chlamydia trachomatis infection was (16.1 %) (95 % CI 9.5, 17.9), and with N. gonorrhoea infection was 5.4%. Coinfection was highest among sexually active group that is those aged between 21 years to 40 years. Conclusion: The prevalence of C. trachomatis is significantly high among male patients. We recommend the implement a molecular screening for Chlamydia trachomatis and Neisseria gonorrhoea to identifying asymptomatic female cases. This study further provides evidence on the importance of contact tracing in the management of Chlamydia trachomatis and other STIs. There is an urgent need for studies designed to investigate the prevalence and risk factors of Chlamydia trachomatis and Neisseria gonorrhoea among female patients who are majorly asymptomatic in Kenya.

Rutin Inhibits F, G, N and O gonorrhea strains, 2008 WHO N-gonorrhea Reference strains, in vitro

Rutin was isolated from methanol extract of the aerial part of Asparagus suaveolens using precipitation method. South Africans use Asparagus suaveolens to treat gonorrhea infections. The obtained Nuclear Magnetic Resonance (NMR) and Liquid Chromatography-Mass Spectroscopy (LC-MS) data and visiting the published data on the isolation of rutin confirmed the structure. The 2008 WHO Neisseria gonorrhea reference strains were used to evaluate microbial activity of rutin against the gonorrhea strains. Rutin found to be bacteriostatic against WHO 2008 Neisseria gonorrhoea F, G, N and O strains with the minimum inhibition concentration of 0.40, 0.65, 0.22 and 0.65 mg/ml, respectively. In addition, rutin fare better than the reference drugs and bactericidal against K, L, M, and P strains. These results support the traditional use of Asparagus suaveolens against gonorrhea infections by South African indigenous people. To our knowledge, this is the first study indicating the activity of rutin against N.gonorrhea strains. Résumé: La rutine a été isolée à partir d'un extrait au méthanol de la partie aérienne d'Asparagus suaveolens en utilisant la méthode de précipitation. Les SudAfricains utilisent Asparagus suaveolens pour traiter les infections gonorrhées. Les données obtenues par résonance magnétique nucléaire (RMN) et par chromatographie liquide-spectroscopie de masse (LCMS) et la consultation des données publiées sur l'isolement de la rutine ont confirmé la structure. Les souches de référence OMS de Neisseria gonorrhea de 2008 ont été utilisées pour évaluer l'activité microbienne de la rutine contre les souches de gonorrhée. La rutine s'est révélée bactériostatique contre les souches de Neisseria gonorrhea F, G, N et O de l'OMS 2008 avec une concentration minimale d'inhibition de 0,40, 0,65, 0,22 et 0,65 mg/ml, respectivement. De plus, la rutine se porte mieux que les médicaments de référence et bactéricide contre les souches K, L, M et P. Ces résultats soutiennent l'utilisation traditionnelle d'Asparagus suaveolens contre les infections gonorrhées par les populations autochtones sud-africaines. À notre connaissance, il s'agit de la première étude indiquant l'activité de la rutine contre les souches de N. gonorrhée.

Prevalence Rates of Chlamydia Trachomatis and Other Sexually Transmitted Organisms in Infertile Couples Attending a Tertiary Medical Centre in Malaysia

INTRODUCTION: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) infections are well recognized and prevalent sexually transmitted infections (STIs). The role of Mycoplasma spp and Ureaplasma spp are still controversial as some are commensals of genitourinary tract. OBJECTIVES: To estimate the prevalence rate of 7 organisms: Chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) in infertile married couples during infertility evaluation. MATERIALS & METHODS: A total of 274 samples from all of the 137 couples who attended the reproductive center from June to December 2014 were collected. Detection of the organisms was performed using multiplex polymerase chain reaction. RESULTS: STI-associated organisms were detected in 35.4% (97/274) of subjects. The prevalence rates of CT, MG, TV, UU, MH were 7.3%,1.1%, 0.4%,5.4% and 5.1% respectively. Twenty-one (7.7%) subjects were positive for more than one organism. 24/274 (8.8%) of subjects had history of urogenital tract-related symptoms and 50% (12/24) were tested positive to one or more organisms. The presence of symptoms in both male and female subjects were found to be 10% (2/20) in CT infection, 10% (7/67) in UP, 14% (2/14) in MH and 13% (2/15) in UU infections. CONCLUSION: Sexually transmitted organisms were detected in one third of subjects planning for fertility evaluation. The absence of symptom in most subjects particularly in CT infection emphasizes the need for microbiological screening during infertility evaluation. The presence of genital ureaplasmas and mycoplasmas in infertile couples should not be neglected. There is a growing need to clarify whether their roles are simply colonizers or pathogens implicated in infertility.