Medizinische Universität Graz - Research portal
Selected Publication:
Sadoghi, B.
Prevalence, diagnosis, and treatment of urethritis, cervicitis and genital ulcer diseases.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2022. pp. 117
[OPEN ACCESS]
FullText
- Authors Med Uni Graz:
- Advisor:
- Hutterer Georg
- Komericki Peter
- Kränke Birger
- Altmetrics:
- Abstract:
- Currently, sexually transmitted infections (STIs) are globally on the rise, whereby most of affected patients present either with signs of urethritis, cervicitis, or a genital ulcer. Some STIs differ significantly from each other regarding their prevalence and treatment modalities, depending on sex, certain risk groups, various geographic regions, and their antimicrobial resistance profiles of certain bacteria. The first aim of this doctoral thesis was to accurately describe and evaluate the prevalence, diagnosis, and therapy of sexually transmitted pathogens causing urethritis, as well as cervicitis of patients that presented at the STI outpatient clinic of the Department of Dermatology and Venereology of the Medical University of Graz between September 2019 and September 2021. This evaluation gains particular scientific importance since no published data from Austria are available up to date yet. The second aim was to perform a systematic review and meta-analysis to be able to define a diagnostic algorithm for an underdiagnosed genital ulcer disease, named ulcus vulvae acutum Lipschütz (UVAL). This became significant as we realized that almost all variants of genital ulcers can be clearly identified via histology, serology or molecular methods, which is not the case concerning UVAL. A prospective study evaluating the prevalence, diagnosis and therapy of urethritis and cervicitis was performed, including 178 individuals. In addition, we extracted information with respect to patient characteristics, including age distribution, co-existence of other STIs (including HIV, hepatitis B and C, syphilis), sexual orientation, number of sexual partners within the last 6 months and during lifetime, partnership status, usage of sex toys, vaccination status (against meningitis and human papilloma virus), as well as various treatment regimes, and test of cure (TOC) outcomes in cases of gonorrhea. The prevalence of STIs in our study cohort was highest for CT with 17%, followed by infections with NG (12%); MG and TV infections were detected in 8% and 1% of the cases, respectively. We observed 22.5% cases of STI-related urethritis and 20% cases of STI-related cervicitis. No statistically significant differences between the groups of asymptomatic versus symptomatic patients were detected. However, we found 3 statistically significant risk factors for acquisition of a STI [(Age younger than 25 years (p: 0.042), non-heterosexual sexual orientation (p: 0,027) and presence of discharge (p: 0,001)]. Sexually transmitted pathogens were detected via a newly introduced multiplex DNA microarray from Euroimmun® (Lübeck, Germany) at the Department of Dermatology and Venereology of the Medical University of Graz. This panel includes a PCR-based direct and simultaneous detection of the most important elven sexually transmitted pathogens within just one test kit. Testable pathogens were Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes- Simplex-Virus (HSV)-1 und -2, Haemophilus ducreyi (HD), Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Treponema pallidum (TP), Trichomonas vaginalis (TV), Ureaplasma parvum (UP), and Ureaplasma urealyticum (UU). The respective therapy was performed in accordance with Austrian and European Guideline recommendations. The resistance profiles of NG infected individuals showed a 100% response rate towards the recommended therapy with ceftriaxone. Moreover, a worldwide systematic online literature review and meta-analysis with respect to the rare genital ulcer disease of UVAL was performed, as a systematic description, as well as standardized treatment options are scarce for this disease. This finding is clearly in contrast to almost all other known genital ulcers, where an accurate diagnosis is feasible in a standardized fashion via serology, histology, or established molecular diagnostic methods. According to the extracted data, we formulated a diagnostic algorithm for UVAL, which is defined by