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Lesson 29. Urethritis

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References

  • Bachmann LH, Manhart LE, Martin DH, et al. Advances in the understanding and treatment of male urethritis. Clin Infect Dis. 2015;61 Suppl 8:S763-9.
  • Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect. 2016;92:155-60.
  • Bjartling C, Osser S, Persson K. Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol. 2012;206:476.e1-8.
  • Bowie WR, Alexander ER, Stimson JB, Floyd JF, Holmes KK. Therapy for nongonococcal urethritis: double-blind randomized comparison of two doses and two durations of minocycline. Ann Intern Med. 1981;95:306-11.
  • Bradshaw CS, Tabrizi SN, Read TR, et al. Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis. 2006;193:336-45.
  • Burnett AM, Anderson CP, Zwank MD. Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. Am J Emerg Med. 2012;30:1114-7.
  • Charoenwatanachokchai A, Chitwarakorn A, Palanuvej T, Pakdeewong S, Khumhaeng M, Kreaurat M. Azithromycin in non-gonococcal urethritis. J Med Assoc Thai. 1997;80:440-5.
  • Charoenwatanachokchai A, Chitwarakorn A, Siriwongrangsun P, Pariyasak W, Yenyasun N, Sukwit S. Azithromycin in the treatment of chlamydial cervicitis and eradication of Ureaplasma urealyticum in female lower genital tract. J Med Assoc Thai. 1997;80:343-7.
  • Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997;349:1868-73.
  • Deguchi T, Yasuda M, Yokoi S, et al. Treatment of uncomplicated gonococcal urethritis by double-dosing of 200 mg cefixime at a 6-h interval. J Infect Chemother. 2003;9:35-9.
  • Dehon PM, Hagensee ME, Sutton KJ, Oddo HE, Nelson N, McGowin CL. Histological Evidence of Chronic Mycoplasma genitalium-Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study. J Infect Dis. 2016;213:1828-35.
  • Dehon PM, McGowin CL. The immunopathogenesis of Mycoplasma genitalium infections in women: A Narrative Review. Sex Transm Dis. 2017;44:428-432.
  • Falk L, Fredlund H, Jensen JS. Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect. 2005;81:73-8.
  • Geisler WM, Yu S, Venglarik M, Schwebke JR. Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections. Sex Transm Infect. 2004;80:401-5.
  • Geisler WM. Diagnosis and Management of Uncomplicated Chlamydia trachomatis Infections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015;61 Suppl 8:S774-84.
  • Gitau RW, Graham SM, Masese LN, et al. Effect of acquisition and treatment of cervical infections on HIV-1 shedding in women on antiretroviral therapy. AIDS. 2010;24:2733-7.
  • Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-85.
  • Golden MR, Workowski KA, Bolan G. Developing a Public Health Response to Mycoplasma genitalium. J Infect Dis. 2017;216:S420-S426.
  • Holmes KK, Handsfield HH, Wang SP, et al. Etiology of nongonococcal urethritis. N Engl J Med. 1975;292:1199-205.
  • Jernberg E, Moghaddam A, Moi H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study. Int J STD AIDS. 2008;19:676-9.
  • Jordan SJ, Aaron KJ, Schwebke JR, Van Der Pol BJ, Hook EW 3rd. Defining the Urethritis Syndrome in Men Using Patient Reported Symptoms. Sex Transm Dis. 2018;45:e40-e42.
  • Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis. 2005;41:623-9.
  • Kletzel HH, Rotem R, Barg M, Michaeli J, Reichman O. Ureaplasma urealyticum: the Role as a Pathogen in Women's Health, a Systematic Review. Curr Infect Dis Rep. 2018;20:33.
  • Krieger JN, Verdon M, Siegel N, Holmes KK. Natural history of urogenital trichomoniasis in men. J Urol. 1993;149:1455-8.
  • LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
  • Lusk MJ, Konecny P. Cervicitis: a review. Curr Opin Infect Dis. 2008;21:49-55.
  • Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011;53 Suppl 3:S129-42.
  • Manhart LE, Critchlow CW, Holmes KK, et al. Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis. 2003;187:650-7.
  • Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:934-42.
  • Manhart LE. Has the time come to systematically test for Mycoplasma genitalium? Sex Transm Dis. 2009;36:607-8.
  • Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. 2007;44 Suppl 3:S102-10.
  • Marrazzo JM, Whittington WL, Celum CL, et al. Urine-based screening for Chlamydia trachomatis in men attending sexually transmitted disease clinics. Sex Transm Dis. 2001;28:219-25.
  • Marrazzo JM, Wiesenfeld HC, Murray PJ, et al. Risk factors for cervicitis among women with bacterial vaginosis. J Infect Dis. 2006;193:617-24.
  • Martin DH, Pollock S, Kuo CC, Wang SP, Brunham RC, Holmes KK. Chlamydia trachomatis infections in men with Reiter's syndrome. Ann Intern Med. 1984;100:207-13.
  • Mcclelland RS, Wang CC, Mandaliya K, et al. Treatment of cervicitis is associated with decreased cervical shedding of HIV-1. AIDS. 2001;15:105-10.
  • McCormack WM, Dalu ZA, Martin DH, et al. Double-blind comparison of trovafloxacin and doxycycline in the treatment of uncomplicated Chlamydial urethritis and cervicitis. Trovafloxacin Chlamydial Urethritis/Cervicitis Study Group. Sex Transm Dis. 1999;26:531-6.
  • Mikamo H, Sato Y, Hayasaki Y, Hua YX, Tamaya T. Adequate levofloxacin treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 2000;46:150-2.
  • Mikamo H, Sato Y, Hayasaki Y, Tamaya T. Adequate macrolide treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 1999;45:396-8.
  • Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294.
  • Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect. 2009;85:10-4.
  • Moodley P, Sturm AW. Sexually transmitted infections, adverse pregnancy outcome and neonatal infection. Semin Neonatol. 2000;5:255-69.
  • Ong JJ, Morton AN, Henzell HR, et al. Clinical Characteristics of Herpes Simplex Virus Urethritis Compared With Chlamydial Urethritis Among Men. Sex Transm Dis. 2017;44:121-125.
  • Phillips I, Dimian C, Barlow D, et al. A comparative study of two different regimens of sparfloxacin versus doxycycline in the treatment of non-gonococcal urethritis in men. J Antimicrob Chemother. 1996;37 Suppl A:123-34.
  • Pitt RA, Alexander S, Horner PJ, Ison CA. Presentation of clinically suspected persistent chlamydial infection: a case series. Int J STD AIDS. 2013;24:469-75.
  • Pond MJ, Nori AV, Patel S, et al. Performance evaluation of automated urine microscopy as a rapid, non-invasive approach for the diagnosis of non-gonococcal urethritis. Sex Transm Infect. 2015;91:165-70.
  • Read TRH, Fairley CK, Murray GL, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68:554-60.
  • Rietmeijer CA, Mettenbrink CJ. Recalibrating the Gram stain diagnosis of male urethritis in the era of nucleic acid amplification testing. Sex Transm Dis. 2012;39:18-20.
  • Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67:1-31.
  • Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. 2003;30:49-56.
  • Schwartz MA, Hooton TM. Etiology of nongonococcal nonchlamydial urethritis. Dermatol Clin. 1998;16:727-33, xi.
  • Schwebke JR, Hook EW 3rd. High rates of Trichomonas vaginalis among men attending a sexually transmitted diseases clinic: implications for screening and urethritis management. J Infect Dis. 2003;188:465-8.
  • Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis. 2011;52:163-70.
  • Seña AC, Lensing S, Rompalo A, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis. 2012;206:357-65.
  • Stamm WE, Batteiger BE, McCormack WM, Totten PA, Sternlicht A, Kivel NM. A randomized, double-blind study comparing single-dose rifalazil with single-dose azithromycin for the empirical treatment of nongonococcal urethritis in men. Sex Transm Dis. 2007;34:545-52.
  • Stamm WE, Hicks CB, Martin DH, et al. Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double-blind study. JAMA. 1995;274:545-9.
  • Stamm WE, Running K, Hale J, Holmes KK. Etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in women with the acute urethral syndrome. Sex Transm Dis. 1983;10:318-22.
  • Steinhandler L, Peipert JF, Heber W, Montagno A, Cruickshank C. Combination of bacterial vaginosis and leukorrhea as a predictor of cervical chlamydial or gonococcal infection. Obstet Gynecol. 2002;99:603-7.
  • Stimson JB, Hale J, Bowie WR, Holmes KK. Tetracycline-resistant Ureaplasma urealyticum: a cause of persistent nongonococcal urethritis. Ann Intern Med. 1981;94:192-4.
  • Takahashi S, Ichihara K, Hashimoto J, et al. Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis. J Infect Chemother. 2011;17:392-6.
  • Takahashi S, Matsukawa M, Kurimura Y, et al. Clinical efficacy of azithromycin for male nongonococcal urethritis. J Infect Chemother. 2008;14:409-12.
  • Tan HH, Chan RK. An open label comparative study of azithromycin and doxycycline in the treatment of non-gonococcal urethritis in males and Chlamydia trachomatis cervicitis in female sex workers in an STD clinic in Singapore. Singapore Med J. 1999;40:519-23.
  • Taylor SN, DiCarlo RP, Martin DH. Comparison of methylene blue/gentian violet stain to Gram's stain for the rapid diagnosis of gonococcal urethritis in men. Sex Transm Dis. 2011;38:995-6.
  • Taylor SN, Lensing S, Schwebke J, et al. Prevalence and treatment outcome of cervicitis of unknown etiology. Sex Transm Dis. 2013;40:379-85.
  • Taylor SN. Cervicitis of unknown etiology. Curr Infect Dis Rep. 2014;16:409.
  • Taylor SN. Epididymitis. Clin Infect Dis. 2015;61 Suppl 8:S770-3.
  • Thorpe EM Jr, Stamm WE, Hook EW 3rd, et al. Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises. Genitourin Med. 1996;72:93-7.
  • U.S. Food and Drug Administration. FDA permits marketing of first test to aid in the diagnosis of a sexually-transmitted infection known as Mycoplasma genitalium. January 23, 2019
  • Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases characterized by urethritis and cervicitis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
  • Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Emerging Issues. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
  • Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Special populations. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.

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