The Korean Association of Urogenital Tract Infection and Inflammation and the Korea Disease Control and Prevention Agency updated the Korean sexually transmitted infections (STIs) guidelines to respond to the changing epidemiologic trends, evolving scientific evidence, and advances in laboratory diagnostics and research. The main recommendations in the Mycoplasma genitalium infection parts of the Korean STIs guidelines 2023 revision are as follows: 1) For initial treatment: azithromycin 500 mg orally in a single dose, then 250 mg once daily for 4 days. 2) In case of treatment failure or recurrence, a macrolide susceptibility/resistance test is required, when susceptibility/resistance test is not feasible, doxycycline or minocycline 100 mg orally twice daily for 7 days, followed by azithromycin 1 g orally on the first day, then azithromycin 500 mg orally once daily for 3 days and then a test-of-cure should be considered 3 weeks after completion of therapy. 3) In case of macrolide sensitivity, doxycycline or minocycline 100 mg orally twice daily for 7 days, followed by azithromycin 1 g orally initial dose, then azithromycin 500 mg orally once daily for 3 days. 4) In case of macrolide resistance, doxycycline or minocycline 100 mg orally twice daily for 7 days, followed by moxifloxacin 400 mg orally once daily for 7 days. In the Korean STIs guideline 2023, macrolide resistance-guided antimicrobial therapy was emphasized due to the increased prevalence of macrolide resistance worldwide. Therefore, in case of treatment failure or recurrence, a macrolide susceptibility/resistance test is required.

PURPOSE: Because of the inconsistent symptoms associated with Ureaplasma infections, their clinical significances in genitourinary tracts are under debate. Therefore, we evaluated the presence of Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) in urine samples and examined their associations with chronic prostatitis (CP) through a case and control study. MATERIALS AND METHODS: We included 696 nonchlamydial nongonococcal (NCNG) urine samples from men; 350 were categorized into non-inflammatory CP, 88 in inflammatory CP, and 258 in non-CP group. We amplified a region in the Ureaplasma urease areas from these samples and determined their biovars using the Sanger method. RESULTS: Among the NCNG population, the rates of UU, UP, and non-UU/UP were 3.88%, 6.46%, and 89.66%, respectively. The overall infection rates of non-CP, inflammatory CP, and non-inflammatory CP groups were 4.15%, 6.10%, and 3.65% in UU (p=0.612) and 6.85%, 7.22%, and 6.50% in UP (p=0.968), respectively. UU infection increased the risk of white blood cell (WBC) counts (≥5) in urine (p=0.005). In contrast, UP infections did not increase the risks of urethritis. Re-analysis from the 633 men who were excluded from urethritis effects did not reveal the associations between UU infection and the clinical characteristics of CP. Furthermore, the profiles from the National Institutes of Health-Chronic Prostatitis Symptom Index questionnaire and WBC counts in expressed prostatic secretion were similar among the non-CP and the two CP groups in each Ureaplasma infection. CONCLUSIONS: We found that UU may induce male urethritis. However, Ureapalsma species in urine were not definitively associated with the occurrence of CP.
Academies and Institutes ; Case-Control Studies ; Humans ; Leukocytes ; Male ; Methods ; Prostate ; Prostatitis ; Ureaplasma Infections ; Ureaplasma urealyticum ; Ureaplasma ; Urease ; Urethritis

BACKGROUND: The prostate is prone to infections. Hypothetically, bacteria can be inoculated into the prostate during a transrectal prostate biopsy (TRPB) and progress into chronic bacterial prostatitis. Therefore, we examined new bacterial infections in biopsied prostates after TRPB and whether they affect clinical characteristics in the biopsied patients. METHODS: Of men whose prostate cultures have been taken prior to TRPB, 105 men with bacteria-free benign prostate pathology underwent an additional repeated prostate culture within a year after TRPB. RESULTS: Twenty out of 105 men (19.05%) acquired new bacteria in their naïve prostates after TRPB. Except for one single case of Escherichia coli infection, 19 men had acquired gram-positive bacteria species. Between the culture-positive and negative groups, there were no significant differences in age, serum prostate-specific antigen (PSA) level, white blood cell (WBC) counts in expressed prostatic secretion (EPS), prostate volume, symptom severities in Korean version of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire, and patient-specific risk factors for biopsy associated infectious complications. Additionally, the TRPB procedure increased the WBC counts in post-biopsy EPS (P = 0.031, McNemar test), but did not increase the serum PSA level and symptoms of NIH-CPSI in 20 men who acquired new bacteria after TRPB. CONCLUSION: The TRPB procedure was significantly associated with acquiring new bacterial infections in the biopsied prostate, but these localized bacteria did not affect patients' serum PSA level and symptoms after biopsy.
Academies and Institutes ; Bacteria ; Bacterial Infections* ; Biopsy* ; Escherichia coli Infections ; Gram-Positive Bacteria ; Humans ; Leukocytes ; Male ; Pathology ; Prostate* ; Prostate-Specific Antigen ; Prostatitis ; Risk Factors

PURPOSE: Curcumin is a nontoxic, chemopreventive agent possessing multifaceted functions. Our previous study showed that curcumin inhibits androgen receptor (AR) through modulation of Wnt/beta-catenin signaling in LNCaP cells. Therefore, we investigated the in vivo effects of curcumin by using LNCaP xenografts. MATERIALS AND METHODS: LNCaP cells were subcutaneously inoculated in Balb/c nude mice. When the tumor volume reached greater than 100 mm3, either curcumin (500 mg/kg body weight) or vehicle was administered through oral gavage three times weekly for 4 weeks. The expression of AR and intermediate products of Wnt/beta-catenin were assessed. RESULTS: Curcumin had an inhibitory effect on tumor growth during the early period, which was followed by a slow increase in growth over time. Tumor growth was delayed about 27% in the curcumin group. The mean prostate-specific antigen (PSA) doubling time in the curcumin group was approximately twice that in the untreated group. Curcumin significantly decreased AR expression at both the mRNA and protein level. The PSA levels tended to be reduced in the curcumin group. However, there were no significant changes in expression of Wnt/beta-catenin pathway intermediates. CONCLUSIONS: This study revealed that curcumin initially interferes with prostate cancer growth by inhibiting AR activity and possibly by reducing PSA expression. Further research is needed to investigate the plausible mechanism of the antiandrogenic action of curcumin.
Adenocarcinoma/drug therapy/*metabolism ; Animals ; Antineoplastic Agents/*pharmacology ; Curcumin/*pharmacology ; Cyclin D1/genetics/metabolism ; Heterografts ; Humans ; Male ; Mice, Inbred BALB C ; Prostate-Specific Antigen/blood/genetics ; Prostatic Neoplasms/drug therapy/*metabolism ; RNA, Messenger/*metabolism ; Receptors, Androgen/genetics/*metabolism ; Wnt Signaling Pathway/*drug effects ; beta Catenin/genetics/metabolism

PURPOSE: While hematospermia is mainly caused by genitourinary inflammatory disorders, very few studies have been published on prostatitis-associated hematospermia (PAH) diagnosed using robust prostatitis evaluation methods. Therefore, we have evaluated the incidence of PAH by using systematic methods for evaluating prostatitis. MATERIALS AND METHODS: We evaluated 37 hematospermia patients from a single hospital over the last five years. We classified the patients into PAH versus hematospermia without any evidence of prostatitis (HWP) by using a NIH-Chronic Prostatitis Symptom Index questionnaire and expressed prostatic secretion studies. RESULTS: The mean age was 55.89+/-14.87 years, and the patients were grouped into two groups: one group had 12 HWP patients and the other 25 PAH patients. PAH patients were further sub-classified: chronic bacterial prostatitis (3 patients), chronic nonbacterial prostatitis (10 patients), prostadynia (7 patients), and asymptomatic prostatitis (5 patients). We found Enterococcus faecalis in the three chronic bacterial prostatitis patients. We could not find any statistically significant difference between the PAH and the HWP groups in terms of the age interval, serum prostate-specific antigen level, and prostate volume. Even though there was no statistically significant difference in the items about urination between the two groups, we found a statistically significant difference in the quality of life (QoL) impact for the patients in this study. CONCLUSIONS: Two-thirds of the hematospermia patients were associated with some evidence of prostatitis. Further, the patients with PAH revealed poor QoL compared with the patients with HWP. Therefore, we must evaluate the presence of prostatitis in hematospermia patients and alleviate the prostatitis-associated symptoms to improve their QoL.
Enterococcus faecalis ; Hemospermia* ; Humans ; Incidence ; Prostate ; Prostate-Specific Antigen ; Prostatitis* ; Quality of Life ; Urination

This multicenter study was undertaken to determine the efficacy of antibiotic prophylaxis and identify the risk factors for infectious complications after prostate surgery in Korean patients. A total of 424 patients who underwent surgery of the prostate were reviewed. All patients underwent urinalysis and urine culture preoperatively and postoperatively. Efficacy of antibiotic prophylaxis and risk factors for infectious complications were investigated. Infectious complications were observed in 34.9% of all patients. Factors independently associated with infectious complications were diabetes mellitus (adjusted OR, 1.99; 95% CI, 1.09-3.65, P=0.025) and operation time (adjusted OR, 1.08; 95% CI, 1.03-1.13, P=0.004). Clinicians should be aware of the high risk of infectious complications in patients with diabetes and those who undergo a prolonged operation time. Neither the type nor duration of prophylactic antibiotics resulted in differences in infectious complications.
Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Antibiotic Prophylaxis ; Diabetes Mellitus, Type 2/complications ; Drug Resistance, Bacterial/drug effects ; Enterococcus/drug effects/isolation & purification ; Escherichia coli/isolation & purification ; Humans ; Klebsiella pneumoniae/drug effects/isolation & purification ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/microbiology/prevention & control ; Prospective Studies ; Prostatic Neoplasms/complications/*surgery ; Quinolones/pharmacology ; Risk Factors ; Time Factors ; Transurethral Resection of Prostate ; Urinalysis ; Urinary Tract Infections/microbiology

PURPOSE: Enterococcus faecalis is one of the most common pathogens linked to chronic bacterial prostatitis (CBP). Owing to a limited number of previous studies addressing this topic, we aimed to determine the drug resistance patterns of E. faecalis strains isolated from CBP patients. MATERIALS AND METHODS: One thousand twenty-one patients visited a single hospital owing to chronic prostatitis for 5 years. Culture specimens were obtained by use of a modified Meares-Stamey method. The minimal inhibitory concentrations of the antimicrobials were assessed by use of the Vitek II microbial identification system as suggested by the Clinical and Laboratory Standards Institute. RESULTS: Forty-one samples from 41 patients who had significant E. faecalis loads for defining CBP were included in this study. The E. faecalis strains in our study were resistant to penicillin (9.7%), ampicillin (0%), ampicillin/sulbactam (0%), nitrofurantoin (0%), imipenem (0%), vancomycin (0%), teicoplanin (0%), quinupristin/dalfopristin (100%), ciprofloxacin (9.7%), levofloxacin (4.8%), norfloxacin (26.8%), erythromycin (95%), gentamicin (46.3%), tetracycline (97.5%), and trimethoprim/sulfamethoxazole (31.5%), respectively. CONCLUSIONS: Fluoroquinolones have been the preferred antibiotics for treating CBP. Because of their low rate of drug resistance, fluoroquinolones are suitable therapeutic agents for E. faecalis strains causing CBP in Korea. Even though tetracycline, erythromycin, and trimethoprim/sulfamethoxazole have been prescribed as an empirical antimicrobial therapy for chronic prostatitis, we cannot recommend these drugs for treatment of E. faecalis isolates because of the high rates of drug resistance.
Ampicillin ; Anti-Bacterial Agents ; Ciprofloxacin ; Drug Resistance ; Enterococcus ; Enterococcus faecalis ; Erythromycin ; Fluoroquinolones ; Gentamicins ; Humans ; Imipenem ; Korea ; Nitrofurantoin ; Norfloxacin ; Ofloxacin ; Penicillins ; Prostatitis ; Teicoplanin ; Tetracycline ; Vancomycin

Crossed testicular ectopia (CTE) is generally defined as both testes located in the same hemiscrotum and contralateral hydrocele with the absence of a testis. However, the initial presentation of CTE in an infant as an incarcerated inguinal hernia is extremely rare. We report on a 10-month-old infant with CTE, who visited the emergency room presenting with a left incarcerated inguinal hernia. After manual reduction for an incarcerated hernia and left inguinal herniorraphy, the left testis was fixed into the left hemiscrotum and right transseptal orchiopexy was performed.
Emergencies ; Hernia ; Hernia, Inguinal* ; Humans ; Infant ; Orchiopexy ; Testis

PURPOSE: Urinary tract infection (UTI) is one of the most prevalent bacterial infections, and fluoroquinolone therapy is a well-known standard regimen for UTI. The prevalence and risk factor analysis of fluoroquinolone resistance in enterococcal UTIs are not well documented. The aim of this study was to evaluate the antimicrobial susceptibility and risk factors for ciprofloxacin resistance in Enterococcus faecalis strains isolated from patients with complicated UTI. MATERIALS AND METHODS: We evaluated 81 E. faecalis strains isolated from 81 male patients at a single teaching hospital over 3 years. The Vitek 2 automatic system was used for antimicrobial susceptibility analysis. RESULTS: Antimicrobial resistance rates were rare for ampicillin/sulbactam, imipenem, and vancomycin in E. faecalis. Forty-six percent of the E. faecalis strains were resistant to levofloxacin, 47% were resistant to ciprofloxacin, and 58% were resistant to norfloxacin. E. faecalis strains were highly resistant to erythromycin (92%) and ftetracycline (96%). The risk factor analysis revealed that age intervals, the underlying diseases, catheterization, and the number of admissions did not increase the risk of ciprofloxacin resistance, whereas patients with hospital-acquired infection (odds ratio [OR], 18.15; 95% confidence interval [CI], 3.46 to 95.13; p=0.001), patients who were treated in a urological department (OR, 6.15; 95% CI, 1.5 to 25.41; p=0.012), and patients who were transferred from health care centers (OR, 7.393; 95% CI, 1.32 to 41.22; p=0.023) had an increased risk of ciprofloxacin resistance compared with the matched controls. CONCLUSIONS: Ciprofloxacin is no longer a recommended therapy for E. faecalis from complicated UTI in men with risk factors. We suggest that ampicillin/sulbactam can be recommended as alternatives for treating ciprofloxacin-resistant E. faecalis strains associated with UTI in Korea.
Bacterial Infections ; Catheterization ; Catheters ; Ciprofloxacin ; Delivery of Health Care ; Drug Resistance ; Enterococcus ; Enterococcus faecalis ; Erythromycin ; Hospitals, Teaching ; Humans ; Imipenem ; Korea ; Male ; Norfloxacin ; Ofloxacin ; Prevalence ; Risk Factors ; Urinary Tract ; Urinary Tract Infections ; Vancomycin

Since the renal epidermoid cyst is too rare, the mechanisms of squamous morphogenesis have not well characterized. A 73-year-old female was referred with an incidentally detected renal pelvis mass. Abdominopelvic computed tomography scan revealed a noncalcified soft tissue mass in the renal pelvis. Total nephroureterectomy was performed under the impression of a renal pelvis malignancy. The patient was discharged without postoperative complication. The outer surface of mass lesion was lined with urothelia and squamous epithelia, containing keratinous materials. The urothelia were positively stained against uroplakin II and cytokeratin 7, whereas almost of the squamous epithelia were negative with uroplakin II. The two different epithelia were generally sharply demarcated. Interestingly, some part of squamous epithelia contained uroplakin-positive and many more cytokeratin 7-positive cells. The atypical clinical features in our case can reconsider the diagnostic clues of renal epidermoid cysts that have been reported before, and the unique immunohistochemical results may understand the histogenetic implications of the lesion.
Epidermal Cyst ; Female ; Humans ; Keratin-7 ; Keratins ; Kidney ; Kidney Pelvis ; Morphogenesis ; Postoperative Complications ; Uroplakin II ; Uroplakins