The JAID/JSC guidelines to Clinical Management of Infectious Disease 2017 concerning male urethritis and related disorders

Sexually transmitted infections (STIs) are infectious diseases by sexual activities in the broad sense. Common STIs urethritis males and cervicitis females. also include that cause skin lesions around genitalia such as genital herpes, syphilis, condyloma acuminatum, phthiriasis pubis. In addition, causative agents of have recently been detected extragenital areas rectum, pharynx, conjunctiva due to increased diversity practice including oral sex occasionally symptoms. Urethritis frequently caused Neisseria gonorrhoeae Chlamydia trachomatis, gonococcal chlamydial used terms indicate these conditions. Recently, concept microorganisms other than N. C. trachomatis has recognized. Particularly, males, term non-chlamydial non-gonococcal begun be for conditions which neither gonococcus nor chlamydia is detected. Among agents, pathogenicity Mycoplasma genitalium demonstrated [[1]Taylor-Robinson D. Jensen J.S. genitalium: from Chrysalis multicolored butterfly.Clin Microbiol Rev. 2011; 24: 498-514Crossref PubMed Scopus (313) Google Scholar]. Many patients with male exhibit severe symptoms often initiated treat at initial visit. Moreover, percentage strains resistant many kinds antibiotics increasing. Therefore, guidelines can recommend drugs likely cure necessary. The Japanese Association Infectious Disease (JAID) Society Chemotherapy (JSC) published JAID/JSC Guide Clinical Management 2011 2012, a revised version 2014 [[2]Kiyota H. Arakawa S. Hamasuna R. Uehara Kawai Y. Takahashi et al.The clinical management disease 2014.in: guide/guidelines preparing committee. Life Science Publishing Co.,Ltd., 2014Google treatments were summarized guides. However, it difficult show recommendation grades evidence level literature concerning all Here, this guideline diagnosis treatment presented comments focusing on urethritis, most frequent STI requires early treatment. Concerning STIs, Transmitted Infections (JSSTI) [[3]Japanese Guidelines Preparing CommitteeGuidelines 2016.2016http://jssti.umin.jp/pdf/guideline-2016.pdfGoogle Scholar], text prepared maximum consistency JSSTI guidelines. should noted there some differences matters selection items newly clarified drug susceptibility STIs. Supplementary notes: levels determined according Outline Preparation established JAID/JSC. While materials cited selected primarily literature, evaluated comprehensively reviewing overseas literature.•Recommendation gradesA: Strongly recommendedB: General recommendationC: Comprehensive evaluation attending physician•Evidence levelsI: Randomized controlled studyII: Non-randomized studyIII: Case reportIV: Specialist's opinion [Executive summary]•Urethritis presents pain urination urethral discharge. It classified into depending microorganism (I, A). Non-gonococcal called B).•On first diagnosis, desirable judge whether condition or confirming presence absence gonococcus, Gram-negative (diplo)coccus, results Gram staining discharge urinary sediment If microscopy gonococci impossible, nucleic acid amplification tests (NAATs) examined using first-catch urine. tested simultaneously B).•Details shown sections urethritis. details described urethritis.•During treatment, contacts not condom must avoided, partners treated presenting mostly occurs an STI, but may common bacteria, drugs, mechanical stimulation, distinguished STI. attaches mucosa navicular fossa located slightly inside meatus proliferates there. Japan, incidence 1990 began decrease after peak 2002 leveled out since 2009 [4Ministry Health, Labour Welfare. Numbers reported cases 2016http://www.mhlw.go.jp/topics/2005/04/tp0411-1.htmlGoogle Scholar, 5Yamagishi T. Tada Recent trends STI.Obstet Gynecol. 2014; 4: 421-426Google 6Onodera Japan.Mod Med. 2012; 58: 210-218Google detection no gonococcus. others Trichomonas vaginalis detected, when trichomonal microbial species involved [7Bradshaw C.S. Tabrizi S.N. Read T.R. Garland S.M. Hopkins C.A. Moss L.M. al.Etiologies nongonococcal urethritis: viruses, association orogenital exposure.J Infect Dis. 2006; 193: 336-345Crossref (201) 8Ito Hanaoka Shimuta K. Seike Tsuchiya Yasuda M. al.Male microbiological etiologies demographic features.Int J Urol. 2016; 23: 325-331Crossref (48) 9You Ogawa Fukuda Hachisuga Matsumoto report: analysis bacterial flora voided urine specimens 16S ribosomal RNA gene-based clone library method.Microb Pathog. 95: 95-100Crossref (10) 10Yokoi Maeda Kubota Tamaki Mizutani role Ureaplasma urealyticum biovar 2 postgonococcal urethritis.Clin 2007; 45: 866-871Crossref (43) 11Deguchi Yoshida Miyazawa Ishiko al.Association (biovar 2) urethritis.Sex Transm 2004; 31: 192-195Crossref (115) them, studies Scholar,12Jensen Cusini Gomberg Moi 2016 European infections.J Eur Acad Dermatol Venereol. 30: 1650-1656Crossref (191) 13Workowski K.A. Bolan G.A. guidelines, 2015. MMWR. Recommendations reports : morbidity mortality weekly report.Recomm Rep Centers Dis Control. 2015; 64: 1-137Crossref (25) 14Manhart L.E. emergent sexually disease?.Infect Clin North Am. 2013; 27: 779-792Abstract Full Text PDF (26) 15Deguchi Ito Hagiwara Antimicrobial chemotherapy genitalium-positive urethritis.Expert Rev Anti Ther. 10: 791-803Crossref (14) 16Jensen Bradshaw - we hit moving target?.BMC 15: 343Crossref (81) 17Jensen infections.Dan Med Bull. 53: 1-27PubMed 18Hamasuna Japan.Int 20: 676-684Crossref (12) Scholar] while available, its use approved health insurance system presently research purposes alone. involvement section 20–30% [[8]Ito Scholar,[13]Workowski Scholar,[19]Sho Akasaka Muratani Terado al.Trends Kitakyushu area.Jpn Sex Infect. 22: 56-61Google B). frequency varied year region examination was performed, followed [[10]Yokoi Scholar,[11]Deguchi Symptoms differ between appear 3–7 days infection. patient complains intense shows reddening meatus. There copious discharge, yellowish white purulent. 1–3 weeks Urethral milder, complain discomfort, itching, feeling strangeness urethra. small amount serous [[20]Takahashi Takeyama Kunishima Takeda Suzuki Nishimura al.Analysis manifestations urethritis.J Chemother. 12: 283-286Abstract (19) (III, vary individually, mild even present Also, about 50% considered asymptomatic despite [21Imai Nakao Shinohara Fujii Tsukino al.Population-based study infection among female students.Int STD AIDS. 2010; 21: 362-366Crossref (20) 22Takahashi Miyamoto Ichihara al.Incidence healthy young men.J 2005; 11: 270-273Abstract (17) 23Ito Horie Yokoi al.Usefulness quantifying leukocytes first-voided predict positivity men high risk infection.J 748-751Abstract (5) caution necessary they [[23]Ito Scholar,[24]Takahashi Kurimura Hashimoto J. Sunaoshi al.Management whose diagnosed 17: 76-79Abstract based demonstration inflammation, principle inflammation confirmed checking elastase test urine, smear. Pyuria judged positive leukocyte count ≥ 5/high power field (hpf) under ×400 (≥10/hpf CDC Guidelines) [[13]Workowski more ×1000 oil immersion Gram-stained diplococci confirmed. simple staining, differentiation cocci microscopic examination, recommended send culture testing. NAATs performed detect (Table 1). microscopy, both trachomatis. cannot perform NAAT cervicitis, [[24]Takahashi microorganisms, later.Table 1Nucleic available Japan gnorrhoeae trachomatisNucleic testTranscription mediated (TMA)Strand displacement (SDA)TaqMan PCRReal-time PCRQProbeTRCProduct nameAptimaTM Combo2 Chlamydia/GonorrheaBD ProbeTec™ ETChlamydia gonorrhoeaeCobas® 4800 System CT/NGAccuGENETMm-CT/NGGENECUBE® trachomatisTRCReadyRCT/NGDistributorHologic JapanBecton, Dickinson Company JapanRoche DiagnosticsAbbott JapanToyoboTosoh BioscienceSample typesFirst-catch swab, cervical pharyngeal gargle fluidFirst-catch swabFirst-catch vaginal swabMale swabUrethral fluid Open table new tab develop epididymitis, trachhomatis. isolated further accumulation confirm epididymitis Scholar,[25]Ito Nakano Deguchi Prevalence mycoplasmas ureaplasmas younger 40 years-of-age acute epididymitis.Int 19: 234-238Crossref Scholar,[26]Hamasuna Editorial Comment Dr 239Crossref (3) Primary fever (often fever) accompanied enlargement tenderness scrotal contents. They patients, pharynx [27Muratani Inatomi Ando Single dose 1 g ceftriaxone urogenital gonorrhoeae.Int 2008; 837-842Crossref (29) 28Matsumoto Ikuyama Yokoo al.Multiple doses cefodizime 145-147Abstract 29Takahashi Koroku Tanda al.Pharyngeal oral-throat wash 14: 442-444Abstract (8) 30Hamasuna Hoshina Imai Osada Usefulness detecting high-risk groups 473-475Crossref (18) 31Ohnishi Saika Iwasaku Nakayama Watanabe al.Ceftriaxone-resistant gonorrhoeae, Japan.Emerg 148-149Crossref (158) 32Wada Mitsuhata Kariyama Nose Sako al.Prevalence heterosexual Japan.J 18: 729-733Abstract (9) 33Kojima Takei Positive rates rectum infections.Jpn 1994; 68: 1237-1242Google 34Kameoka Tashiro Niwa Karasawa E. Okuni Assessment aptima Chlamydia/gonorrhea, solution simultaneous samples.Jpn Pharm Sci. 2009; 62: 507-514Google 35Yoda Onoue Tanaka Arai our department clinic.Jpn Soc Stomato-pharngology. 347-353Google 36Iyoda Seika Kaneyama A. Hasegawa Kobayashi I. Onoye al.Bacteriological epidemiological gonorrhea.Sex 2003; 77: 103-109Google 37Kumamoto Fujisawa Detection cobas(R) 4800, APTIMA Combo 2(R) TMA, ProbeTec ET SDA assays.Eur Immunol (Bp). 2012 2; 121-127Crossref 38Hamasuna Should urologists care urethritis?.J 410-413Abstract (13) 39Yoda Nishida Current status oropharynx genitals clinic three prospective studies.Jpn 207-212Google (II, absent patients. Rare hoarseness. Both [[29]Takahashi Scholar,[30]Hamasuna Scholar,[32]Wada Scholar,[34]Kameoka Scholar,[35]Yoda Scholar,37Kumamoto 40Papp J.R. Ahrens Phillips Kent C.K. Philip Klausner J.D. performance rinses infections.Diagn 59: 259-264Crossref (22) Some uncertain points, timing remain evaluate effectiveness testing samples covered insurance. rectal swabs who engage anal Scholar,[3]Japanese Scholar,[41]Ootani Mizuguchi Tsunada Sakata Iwakiri Toda al.Chlamydia proctitis.Gastrointest Endosc. 60: 161-162Abstract (6) Causative eye blood, ascites, arthrocentesis fluid, etc., [42Yabe Nomoto Yamazoe Yoshikawa Disseminated infection.Intern 94: 1146-1148Google 43Haki Jo Takizawa Tamiya Nakajima Shina al.Two cellulitis eyelids.Rin Gan. 1791-1793Google 44Yokota Gomi Morishita A case disseminated without typical rash.Sex 85: 370-372Google 45Furumoto Mizuta Mori report generalized peritonitis gonorrhoeae.Surgery. 71: 872-876Google 46Suzaki Hayashi Kosuge Soma Hayakawa Japan: review.Intern 50: 2039-2043Crossref (24) 47Hamasuna Matsuoto Oral infections.Clin Virol. 38: 289-295Google possible NAATs, Japan. properly microorganism. poor compliance terminating alleviated taking instructed do visit re-examination [[48]ojima Yada Hayase Evaluation latest single administration gonorrheal urethritis.Jpn 98-102Google Furthermore, possibility multiple well optimal select expected response rate ≥95% against only urethra sites much possible. As above, distinguishing mildly symptomatic asymptomatic, identify become available. US therapeutic regimen effective dual therapies, because again manage system, initiate re-visit tests, explain importance later, CTRX first-line Since treatable 1g therapies consideration unlike foreign countries. added discuss changed state resistance CT