Tuberculosis and other urogenital infections as sexually transmitted diseases

The analysis of domestic and foreign literature on the epidemiology, etiology, and possible sexual transmission of urinary tract infections (UTI) was carried out. It has been established that more than 30 pathogens are currently classified as sexually transmitted infections (STI). The molecular genetic method has shown the identity of uropathogenic Escherichia coli in familial cases of UTI, which confirms the sexual route of infection transmission, which was not previously classified as a classic STI. Several works are cited that undoubtedly testify to the possible sexual transmission of Mycobacterium tuberculosis. Up to date, few reports of sexual transmission of UTI have been published, although tuberculosis is one of the most common infectious diseases worldwide. Perhaps because the partner of a patient with genital tuberculosis or other UTI is not actively evaluated. Thus, the possibility of sexual transmission may be underestimated. Sexual transmission of M. tuberculosis as well as uropathogenic E. coli is unlikely, but possible

ВЛИЯНИЕ ВИЧ-ИНФИЦИРОВАННОСТИ НА СТРУКТУРУ ВНЕЛЕГОЧНОГО ТУБЕРКУЛЕЗА В СИБИРИ И НА ДАЛЬНЕМ ВОСТОКЕ

Introduction. Human immunodeficiency virus (HIV) infection is a risk factor for tuberculosis (TB), increasing the likelihood of its development in 20–37 times. The purpose of the study was to evaluate an influence of HIV infection on a spectrum of extrapulmonary tuberculosis (EPTB). Material and methods. Statistical reports of dispensaries on tuberculosis in Siberia and Far East were analyzed for 2016–2017 years. Of total 1227 patients with isolated EPTB (without pulmonary TB) who have the status of HIV infection were enrolled in the study. пациентов с изолированными формами ВЛТ, у которых определен статус ВИЧинфицирования. Results. In the overall spectrum of the incidence of EPTB in Siberia and the Far East, estimated independently from HIV infection, the leading form with a large predominance was the bone and joints TB (41,0%). The second-third place was divided by urogenital tuberculosis and tuberculosis of the central nervous system (19,4% and 18,7% respectively). The spectrum of the incidence of EPTB changed dramatically depending on HIV infection. If in HIV-infected patients most common form was TB of the central nervous system (43.8%), followed by the second – the bone and joints TB (34.5%), and TB of peripheral lymph node TB (11.7%). The proportion of urogenital tuberculosis in HIV-infected was negligible (1.9%). In the analyzed period, significant changes in the proportions of extrapulmonary tuberculosis localization in both HIV-infected and immunocompetent patients were not found. Conclusion. HIV infection dramatically changes the spectrum of the incidence of EPTB. We recommend making changes in the system of recording patients with EPTB, allocating HIV-infected to a separate group.Введение. Инфицирование вирусом иммунодефицита человека (ВИЧ) является фактором риска для туберкулеза, повышая вероятность его развития в 20–37 раз. Цель исследования: определение влияния инфицирования вирусом иммунодефицита человека на структуру клинических форм внелегочного туберкулеза. Материал и методы: проанализированы данные отчетов противотуберкулезных диспансеров Сибирского и Дальневосточного федеральных округов за 2016 и 2017 гг. В разработку включены 1227 пациентов с изолированными формами внелегочного туберкулеза, у которых определен статус инфицирования вирусом иммунодефицита человека. Результаты. В общей структуре клинических форм внелегочного туберкулеза в Сибири и на Дальнем Востоке, оцениваемой независимо от ВИЧ-инфицирования, ведущей формой с большим преобладанием был костносуставной туберкулез (41,0%). Второе и третье места делят урогенитальный туберкулез и туберкулез центральной нервной системы (19,4% и 18,7% соответственно). Структура клинических форм внелегочного туберкулеза в зависимости от ВИЧ-инфицирования кардинально меняется. У ВИЧ-инфицированных на первом месте стоял туберкулез центральной нервной системы (43,8%), на втором – костно-суставной туберкулез (34,5%), на третьем – туберкулез периферических лимфатических узлов (11,7%). Доля урогенитального туберкулеза у ВИЧ-инфицированных ничтожно мала (1,9%). В анализируемом двухлетнем периоде значимой динамики в пропорциях внелегочных локализаций туберкулеза как у ВИЧ-инфицированных, так и у иммунокомпетентных больных не отмечено. Заключение. ВИЧ-инфекция кардинально меняет структуру клинических форм внелегочного туберкулеза. Полагаем необходимым внести изменения в систему учета больных внелегочным туберкулезом, выделив ВИЧ-инфицированных в отдельную группу

Restoration of erectile function in men after prostate surgery in the immediate postoperative period: the needs assessment for patients and their partners to maintain sexual relations

Introduction. Despite the advances in the modern pharmacopoeia, a significant place is given to surgical methods of treating benign prostatic hyperplasia (BPH) and prostate cancer (PCa). In the postoperative period in men, sexual function usually deteriorates.Purpose of the study. To study the needs of men after prostate surgery and their sexual partners in restoring their previous sexual life.Materials and methods. The pilot open-label prospective randomized non-comparative study included 50 patients in the age range of 53 – 74 years (average 58.3 years). All patients were consistently admitted and operated on at the “Avicenna” Medical Centre, Ltd. (Novosibirsk) from January to December 2020. Upon admission, all patients completed the International Index of Erectile Function (ICEF) questionnaire; one month later, this questionnaire was re-completed, supplemented with five questions.Results. Twenty-one patients were admitted with a diagnosis of PCa T1c – T2N0M0, all of them underwent laparoscopic prostatectomy with lymphadenectomy. Twenty-nine patients were operated on for BPH. They underwent transurethral resection with a bipolar resectoscope. Only 6 patients (12%) had no comorbidities. Surgical intervention worsened sexual function in all patients, while in men aged 50 – 59 years, the IIEF score decreased by 61.0%, at the age of 60 – 69 years by 39.0%, in patients over 70 years old by 55.2%. Eighteen (36.0%) patients showed interest in restoring sexual function. Thirty-two (64%) patients were against the continuation of sexual activity with the following motivation: 19 (59.4%) – lack of desire for a sexual partner, 8 (25.0%) – lack of desire of the patient himself, 5 (15.6%) – unwillingness to re-operated. Nineteen women out of 36 stable couples (52.8%) objected to the restoration of the sexual function of their sexual partners.Conclusion. Prostate surgery affects male sexual function more severely in younger patients. Thirty-two patients after surgery refused to restore sexual activity, in more than half of cases (59.4%) due to the unwillingness of the sexual partner to resume sexual relations

Recurrent cystitis in women: principles of rational therapy

Introduction. Urinary tract infections (UTIs) are one of the most common disease among women.Aim. To determine the efficacy and tolerability of furazidin in the treatment of patients with exacerbation of chronic recurrent cystitis.Material and methods. a purpose was to determine the efficacy and tolerance of furazidin in the treatment of patients with chronic recurrent cystitis. In the study 56 female patients were enrolled, 28 of whom received ciprofloxacin (CG) and 28 – furazidin (FG). The patients received furazidin 100 mg three times a day for seven days (FG) or 500 mg of ciprofloxacin twice a day for seven days (CG). As well we analyzed the histories of 37 patients with bladder tuberculosis (TMP) stage 4in order to estimate the negative effect of non-optimal antibiotic therapy for UTI on the timely diagnosis of urogenital tuberculosis.Results. At the end of antibacterial therapy, dysuria persisted in one patient in the FG and in two in the CG. Urinalysis was normal in both groups in 96.4% of patients. The growth of uropathogens was in one case in each group. For 6 months, there were 5 recurrence episodes in the FG, and there were 11 relapses in the CG (p < 0.05). There were no side effects in the FG, but in the CG, adverse reactions developed in 9 patients (32.1%). Patients with TMP had annually from 4 to 7 exacerbations of cystitis, fluoroquinolones were prescribed to all; none investigations for M. tuberculosis were performed. Conclusion. Immediate results did not show statistically significant differences between the  groups of  patients treated with furazidin and ciprofloxacin, however, the tolerance of ciprofloxacin was lower (p >< 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis. >< 0.05). There were no side effects in the FG, but in the CG, adverse reactions developed in 9 patients (32.1%). Patients with TMP had annually from 4 to 7 exacerbations of cystitis, fluoroquinolones were prescribed to all; none investigations for M. tuberculosis were performed.Conclusion. Immediate results did not show statistically significant differences between the  groups of  patients treated with furazidin and ciprofloxacin, however, the tolerance of ciprofloxacin was lower (p < 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis.>< 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis

Antimicrobial peptides for treatment of patients with herpes virus-associated chronic prostatitis

Introduction. Genital herpes is a chronic sexually transmitted infection characterised by recurrent self-limiting genital ulcers caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) and can be associated with chronic prostatitis (CP).Objective. To determine the efficacy of cytokines-antimicrobial peptides complex in therapy of patients with herpes virus-associated chronic prostatitis.Materials & methods. The pilot, open, prospective, non-comparative study included 23 patients who were followed up for CP for a mean of 9.7 ± 4.2 years. All were diagnosed with abacterial CP / chronic pelvic pain syndrome (CPPS) with signs of inflammation and detection of HSV DNA in urethral swabs by polymerase chain reaction (PCR). Prescribed therapy: Tab. Valaciclovir 500 mg b.i.d. p.o. for 10 days, Tab. Ketoprofen 100 mg q.d. for 5 days, Supp. Superlymph 10 IU q.d. p.r. q.h.s. for 20 days. The results were evaluated at the end of therapy, 3 and 6 months after its completion.Results. At the end of therapy, the leukocytes count in prostate secretion decreased by almost five times and remained stable throughout the entire follow-up period. The total symptom scale score at the end of therapy decreased from 22.96 ± 6.01 to 6.61 ± 3.71 points (p < 0.05). There was also a change in the perception of pain on a visual analog scale. If, before the start of treatment, 14 patients (60.9%) assessed the pain intensity as “severe” and only two (8.7%) had “weak” pain intensity, then after the end of therapy, none of the patients had severe pain, 21 (91.3%) patients noted "mild" pain and in 2 patients (8.7%) the intensity of pain was regarded as "average". Quality of life improved from baseline 8.23 ± 1.91 points to 2.43 ± 1.41 points immediately after completion of therapy (p < 0.05). Three months after therapy, patients assessed the quality of life as 2.43 ± 1.41 points, and six months later, as 2.81 ± 1.21 points. During the first three months, one patient experienced a HPV-relapse; one more — within the next three months. These patients underwent a second course according to a similar scheme. None of the patients reported significant side effects on any component of the therapeutic complex.Conclusion. In abacterial CP/CPPS, a herpes infection should be identified. Being neurotropic, HSV can cause / exacerbate the pain characteristic of CP/CPPS. In case of persistent pain, HSV infection should be excluded. In the treatment of patients with herpes virus-associated abacterial CP, Supp. Superlymph showed good immediate and long-term results

EXTRAPULMONARY TUBERCULOSIS IN SIBERIA AND FAR EAST

Extrapulmonary tuberculosis still remains a mysterious problem greatky due to significant degree of divergence in definitions.Materials and methods. Extrapulmonary tuberculosis incidence and its structure have been analyzed for Siberian and Far Eastern Federal Districts for the last 10 years – from 2006 to 2015.Results. In 2006 in Siberian and Far Eastern Federal Districts there were 871 patients suffering from isolated extrapulmonary tuberculosis, the structure of the forms was as follows: tuberculosis of central nervous system (CNS) – 5.7%; bone and joint tuberculosis – 28.7%; urogenital tuberculosis – 35.9%; tuberculosis of peripheral lymph nodes – 15.8%; ocular tuberculosis – 5.2%, other forms – 8.7%. Starting from 2008 ocular tuberculosis was excluded from reporting, despite the fact that the number of such patients was almost the same as the number of CNS tuberculosis cases. 10 years later in 2015 isolated forms of tuberculosis were diagnosed in 699 (-172) people, forms were the following: CNS tuberculosis – 10.6%, double increase; bone and joint tuberculosis – 39.8%, 1.5 fold increase; urogenital tuberculosis – 24.5%, 1.5 fold decrease respectively. Number of those suffering from tuberculosis of peripheral lymph nodes remained the same – 14.2%, other forms inclusive tuberculosis of salivary glands, pancreas, gall bladder, intestine, breast, skin etc. increased respectively up to 11%.Conclusions. The problem of extrapulmonary tuberculosis in Russia as in the whole world still needs to be resolved. Extrapulmonary tuberculosis incidence greatly depends on the number of properly trained specialists and sufficient technical facilities of dispensaries. The following changes are to be made to Form 8: firstly, urological and genital tuberculosis cases are to be recorded separately; secondly, all forms are to be recorded separately according to HIV status

WAYS OF PROSTATE TUBERCULOSIS DETECTION

Prostate tuberculosis was confirmed by morphological testing during life time in 77% of those died of tuberculosis of any localization and in 28% of respiratory tuberculosis patients. Prostate tuberculosis occupies the important place from social and medical point of view, since it leads to infertility and sexual dysfunction and also it can be sexually transmitted. Detection structure of prostate tuberculosis has been analyzed for Novosibirsk Region

Эффективность и безопасность комбинированной терапии, включающей бедаквилин, у мультиморбидного ВИЧ-позитивного больного туберкулезом с множественной лекарственной устойчивостью

The article describes a clinical observation of the effective treatment of a multimorbid HIV positive patient with multiple drug resistant tuberculosis. It demonstrates modern approaches to treatment and optimal chemotherapy regimens containing bedaquiline. In the treatment of patients with a combination of chronic infectious diseases (tuberculosis, HIV infection, parenteral hepatitis) and oncological pathology (kidney cancer), interdepartmental interaction of specialists (phthisiologists, infectious disease specialists, and oncologists) is needed in order to compile successful treatment regimens taking into account multiple comorbidities and the risk of adverse reactions to drug combinations and choose the right time to perform a successful surgery.Представлено клиническое наблюдение эффективного лечения мультиморбидного ВИЧ-позитивного больного туберкулезом с множественной лекарственной устойчивостью. Показаны современные подходы к лечению, оптимальные режимы химиотерапии, включающие бедаквилин. При лечении пациентов с сочетанием инфекционных заболеваний, имеющих хроническое течение (туберкулез, ВИЧ-инфекция, парентеральные гепатиты), и онкологической патологией (рак почки) необходимо межведомственное взаимодействие специалистов (фтизиатров, инфекционистов, онкологов), с тем чтобы формировать успешные схемы лечения с учетом высокой коморбидности и риска развития побочных реакций на препараты при их сочетании и правильно выбрать момент для успешного проведения операции