Search Results (260)

Background: Epididymo-orchitis can be caused by sexually transmitted pathogens, including Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium, or entero-bacteria. The aim of this study was to explore the demographics, microbiological findings, and treatment outcomes of patients presenting to a tertiary sexual health clinic with epididymo-orchitis. Methods: We reviewed the clinical notes of 200 randomly selected patients seen in the clinic with a diagnosis of epididymo-orchitis between 2021 and 2025. We extracted data on demographics, microbiological findings, follow-up, and clinical response rate to treatment. Results: The median age was 33 years (Interquartile range (IQR) = 24–44), 97 (49%) identified as MSM, 11 (6%) were living with HIV (all MSM), and 55 out of the 86 HIV-negative MSM (64%) were using HIV pre-exposure prophylaxis. In total, 35 (18%, 95% confidence intervals = 12.5–23.5%) people were diagnosed with a causative organism: 17 (9%) C. trachomatis, 10 (5%) N. gonorrhoeae, 7 (4%) M. genitalium, 3 (2%) Escherichia coli. Overall, 91 out of 200 (46%) had a documented partner notification plan. Conclusions: A minority of men attending our sexually transmitted infection clinic with clinical epididymo-orchitis have positive microbiology, including M. genitalium. More work is needed to understand the clinical pathophysiology of epididymo-orchitis to streamline treatment algorithms. Full article

Objective: To explore healthcare professionals’ beliefs and concerns about doxyPEP by systematically reviewing the literature. Method: A systematic review of three bibliographical databases (CINAHL, EMBASE and MEDLINE) and MedRxiv in August 2024, updated in February 2026 explored healthcare professionals’ beliefs and concerns about doxyPEP. Three researchers independently reviewed full-text manuscripts for eligibility and narratively synthesized data. We used the Joanna Briggs Institute toolkit to assess risk of bias. This review was registered on PROSPERO (ID:CRD42024570646). Results: Eight manuscripts were included in the final review: five cross-sectional studies, two qualitative studies, and one mixed method study from the USA (n = 5), Australia (n = 1), Kenya (n = 1), and the UK (n = 1) published between 2020–2025 and including 1840 healthcare professionals. Healthcare professionals recognised the high burden of bacterial STIs and believed that doxyPEP should be made available to MSM. There was a strong willingness to provide doxyPEP to MSM with the support of national guidelines. Healthcare professionals suggest that implementing doxyPEP would be feasible with educational support, but were concerned about antimicrobial resistance, drug–drug interactions, pill burden, cost, implementation logistics and the effect on clinical service demands. They acknowledged the lack of research and access to doxyPEP for other groups, specifically trans people and cis-gendered women. They also highlighted the need for community involvement in the implementation of doxyPEP. Conclusions: This review highlights that healthcare professionals were willing and ready to provide doxyPEP; however, they have concerns including antimicrobial resistance, the effect on service capacity, and the lack of research on cis-gendered women and trans people. Patients and health professionals need to be involved in the implementation of doxyPEP. Full article

Background/Objectives: Chlamydia trachomatis (CT) infection is one of the most prevalent sexually transmitted infections (STIs) worldwide and has been consistently associated with adverse reproductive outcomes, including female infertility. However, the molecular mechanisms underlying this association remain incompletely understood. This study aimed to investigate whether genes previously associated with female infertility display altered expression patterns in response to CT infection by reanalyzing publicly available transcriptomic data derived from a human in vitro infection model. Methods: An integrative in silico approach was employed. A curated list of 106 genes associated with female infertility was compiled from publicly available databases and integrated with transcriptomic data from the Gene Expression Omnibus (GEO) dataset GSE109428, which profiles primary human fallopian tube mesenchymal cells infected in vitro with CT serovar L2. Gene expression changes were evaluated at two time points (24 and 48 h post-infection) by comparing infected cells with uninfected control samples, followed by functional and phenotype enrichment analyses. Results: One female infertility-associated gene (AKAP12) was consistently dysregulated at both 24 and 48 h post-infection. In addition, fourteen genes (ANAPC4, BMP1, BNC2, BTG4, EFHD1, FBXO43, INHBB, PATL2, SCARB1, SND1, SYNE1, TRIP13, TTC28, and TUBA1C) became significantly dysregulated exclusively at 48 h post-infection, indicating a time-dependent host transcriptional response to CT infection. Functional and phenotype enrichment analyses revealed associations with biological processes related to embryonic development and meiosis, as well as phenotypes linked to female infertility. These enriched terms were supported by a small subset of genes and were therefore interpreted cautiously. Conclusions: Overall, these findings suggest that CT infection modulates the expression of several infertility-associated genes and may influence biological pathways critical for female reproductive function. While exploratory, this study provides a molecular context that aligns with previously reported associations between CT infection and female infertility. Full article

Chlamydia is the most common sexually transmitted infection (STI) worldwide. In 2020, the global prevalence was estimated to be 4.0% among women and 2.5% among men aged 15 to 49 years. In more than 80% of cases, the infection is asymptomatic, thereby increasing the risk of subsequent infections. Complications in women can include chronic pain, pelvic inflammatory disease, and an increased risk of ectopic pregnancies. Chlamydia trachomatis (CT) infections can be diagnosed using several techniques, including cell culture, immunofluorescence, enzyme immunoassays, and polymerase chain reaction (PCR). PCR is regarded as the gold standard for screening and detection of CT. We conducted a three-year retrospective study from January 2022 to December 2024, collecting 4241 cervicovaginal swab samples from outpatient gynecology patients. The overall prevalence of CT in our study was 2.02%. An increase in CT detection during the study period was observed: from 24 cases (1.7%) in 2022 to 30 cases (2%; p = 0.64) in 2023 and 32 cases (2.35%; p = 0.26) in 2024. The highest proportion of cases was observed in the 20–24 and 25–34 age groups. Notably, 7 out of 10 cases were asymptomatic. Risk factors for chlamydial infections include behavioral factors, such as having multiple sexual partners and engaging in risky sexual practices, as well as social and lifestyle influences. Full article

Pyroptosis enables host cells to eliminate intracellular pathogens effectively. However, how Chlamydia trachomatis (C. trachomatis) evades host pyroptosis remains unclear. This study reveals that C. trachomatis exploits the host Long non-coding RNA (lncRNA) SBF2-AS1 as a key factor to regulate the host pyroptosis. The SBF2-AS1 was significantly upregulated during C. trachomatis infection. Knockdown of SBF2-AS1 activated NLRP3/caspase-1/GSDMD pyroptosis pathway. Mechanistically, it verified that SBF2-AS1 functions as a competing endogenous RNA for miR-196b-5p targeting RIPK2 through dual-luciferase reporter gene assay. We further identified the interaction between RIPK2 and Caspase-1 by Co-immunoprecipitation (Co-IP). Silencing SBF2-AS1 or RIPK2, as well as overexpressing miR-196b-5p, triggered pyroptosis and suppressed the replication of C. trachomatis. In conclusion, C. trachomatis upregulates SBF2-AS1 to increase RIPK2 by binding miR-196b-5p, which shields against pyroptosis mediated by Caspase-1 to promote its proliferation. These results uncover a novel mechanism of pathogen–host interaction and provide insights for developing new therapeutic strategies against C. trachomatis infection. Full article

Chlamydia suis, a close relative of the human pathogen C. trachomatis, can be detected in the porcine gut, yet its prevalence and viability across intestinal segments remain poorly defined. This study aimed to assess the segment-specific prevalence, isolation success, and tetracycline susceptibility of C. suis in grower-finisher pigs. Jejunal, ileal, and colonic samples (n = 200 per intestinal segment) were collected from 600 pigs at slaughter and analyzed using C. suis-specific real-time PCR and culture. PCR revealed significantly higher detection rates in the colon (40%) than in the jejunum or ileum (both 4.5%), accompanied by significantly higher calculated bacterial loads in colonic samples. In contrast, viable C. suis was most frequently isolated from ileal material, indicating that the ileum may provide a more favorable condition for active bacterial replication. Among 24 culture-confirmed isolates, 75% were susceptible to tetracycline (MIC/MBC < 2 µg/mL), 12.5% exhibited an intermediate phenotype (2 µg/mL < MIC/MBC < 4 µg/mL) and another 12.5% were resistant (MIC/MBC > 4 µg/mL). Intermediate phenotypes were recovered from the jejunum and ileum, whereas resistant isolates were found in the ileum and colon. These findings suggest that the porcine colon may serve as an intestinal reservoir for C. suis, while the ileum supports more robust bacterial replication. Overall, these data contribute to our understanding of the intestinal ecology of C. suis under field conditions and its tetracycline susceptible patterns. Full article

In this work, we evaluate the efficiency of a DNA purification protocol from gynecological samples using locally synthesized Fe₃O₄@SiO₂ magnetic microparticles and a low-cost, guanidinium thiocyanate (GITC)-free lysis buffer. The microparticles were characterized by SEM, EDS, FTIR, and magnetic measurements, confirming the formation of compact silica-coated aggregates with suitable magnetic responsiveness for rapid and complete capture. Using this material in combination with a simple, GITC-free lysis buffer, we achieved DNA extraction yields comparable to those obtained with standard methods based on chaotropic salts. The purified DNA showed high compatibility with molecular assays for the detection of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, and human papilloma virus. Clinical validation demonstrated excellent diagnostic performance, with only a few discrepancies observed in samples near the detection threshold of qPCR, a limitation shared with commercial kits. Overall, the method represents a low-cost, safe, and sustainable alternative for routine clinical and epidemiological applications, compared to methods based on chaotropic salt buffers. Furthermore, it reduces reliance on imported commercial consumables and minimizes the handling of hazardous reagents. Full article

This study aims to explore characteristics and clinical predictors of Lymphogranuloma venereum (LGV) and non-LGV Chlamydia trachomatis (Ct) serovars. We conducted a retrospective study on men who have sex with men (MSM) diagnosed with rectal or urethral Ct between 2015 and 2022 at the Infectious Diseases Unit of San Raffaele Scientific Institute, Milan, Italy. Nucleic acid amplification test with sequencing was used for Ct serovar determination. Individuals’ characteristics were described by median (interquartile, IQR) or frequency (%) and compared using Kruskal–Wallis or Chi-Square tests, as appropriate. Logistic regression model was used to identify predictors of LGV; multinomial logistic regression model, with LGV group as reference category, investigated factors associated with the LGV group (serovars L1, L2B, L2C), specific highly prevalent non-LGV serovars (D, E, G) or the non-amplifiable group. Overall, 211 MSM were included: 29.8% with LGV, 50.2% non-LGV and 19.9% non-amplifiable. Symptomatic cases were 46% of which 48% LGV; rectal infection was the most common (86%), followed by urethral (10%) and both sites (4%). People living with HIV were 91.5%; 31.3% had ≥1 concomitant STI and 65.4% ≥1 previous one. According to logistic regression analysis, after adjustment for the diagnosis of ≥1 concomitant and previous STI, LGV serovars were significantly associated with symptomatic infections (adjusted odds ratio, aOR = 6.05; 95%CI = 2.92, 13.13; p < 0.001) and anorectal site (aOR = 17.12; 95%CI = 3.17–319.17, p = 0.007) compared to non-LGV. Among MSM, almost 30% of Ct infections were due to LGV serovars. Presence of symptoms and anorectal site involvement, identified as clinical predictors of LGV, should guide clinicians during diagnosis. Full article

Chlamydia trachomatis has a significant impact on public health, especially among adolescents and young women; it primarily affects urogenital epithelial cells, leading to cervicitis and urethritis, with >90% of cases showing no symptoms. Consequently, chlamydial infections are commonly misdiagnosed, and, if untreated, they may result in severe reproductive sequelae including infertility. A better understanding of C. trachomatis cell biology and bacterial–host cell interactions may be helpful to identify strategies able to counter its transmission among the population, as well as its dissemination in reproductive tissues, reducing the risk of developing severe reproductive sequelae. Therefore, the present review aims to summarize the evidence on the interplay between C. trachomatis and the host defence factors within the cervicovaginal environment. The sophisticated strategies employed by this clinically significant pathogen to counteract these mechanisms are also discussed. In the literature, the main defence factors include the microbiota dominated by Lactobacillus crispatus and several molecules like lactoferrin, able to protect the cervicovaginal microenvironment against C. trachomatis through several mechanisms (e.g., EB coaggregation and competitive exclusion, as well as anti-inflammatory activity). However, the major player in clearing chlamydial infections remains the interferon-gamma (IFN-γ) produced by natural killer and T cells, via the depletion of critical nutrients for C. trachomatis such as tryptophan, or via the ubiquitylation and destruction of chlamydial inclusions. Full article

In 2020, 128.5 million new chlamydia infections were reported worldwide in adults aged 15–49 years. Notably, the prevalence of Chlamydia trachomatis infection in pregnant women varies between 2% and 35%, correlating with increased risks of low birth weight, preterm birth, and neonatal death. C. trachomatis is a leading preventable cause of miscarriage. Recurrent first-trimester pregnancy loss can be induced by asymptomatic chlamydia infection through the immune response. In this study, we performed immunohistochemical characterization of the immune response in endometrial tissue biopsies from women diagnosed with chronic endometritis caused by C. trachomatis. Hematoxylin and eosin staining was used for histological evaluation of endometrial biopsies, and immunohistochemical detection was performed for the following markers: CD138, CD45, CD3, CD4, CD8, CD20, CD56, and CD68. As a result, we observed the presence of edematous tissue with hemorrhage; we also observed a heightened inflammatory response with the presence of plasma cells, CD4 and CD8 T lymphocytes, B lymphocytes, NK cells, and macrophages. The findings described here can help better understand the disease and its histopathological diagnosis. Full article

Background and Clinical Significance: Pelvic inflammatory disease represents a multifaceted sexually transmitted disease affecting women of reproductive age, beginning in adolescence. Clinical presentation ranges from asymptomatic patients to acute abdominal pain in the setting of tubo-ovarian abscesses; however, presentation as primary peritonitis with seemingly intact fallopian tubes is exceptional. Primary peritonitis in the absence of other comorbid conditions (e.g., liver cirrhosis and nephrotic syndrome) in healthy, immunocompetent women is rare and typically occurs without an identifiable intra-abdominal source. The diagnosis can be challenging due to its mild-to-moderate, nonspecific symptoms. Case Presentation: We report the case of a 21-year-old immunocompetent woman who presented with lower abdominal and left iliac fossa pain with hyperleukocytosis. Laparoscopic exploration confirmed the diagnosis of primary peritonitis. Following diagnosis, she underwent peritoneal lavage and was started on empiric broad-spectrum parenteral antibiotic therapy. Cervico-vaginal cultures established the diagnosis of PID following identification of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma parvum. The clinical course was favorable. Conclusions: An early multidisciplinary approach, including consultation with an infectious disease specialist and clinical pharmacologist, is recommended in cases of peritonitis with an unclear source. PID may present as primary peritonitis and this clinical scenario should be considered in sexually active young women with unexplained peritoneal infection when no gastrointestinal or gynecologic source is evident intraoperatively. Full article

Background: Pelvic inflammatory disease (PID) is a common and potentially severe infection of the upper genital tract. Complications such as tubo-ovarian abscess (TOA), sepsis, and diffuse peritonitis contribute significantly to reproductive morbidity, particularly when diagnosis or treatment is delayed. Aim: The aim of this review is to present an updated, clinically relevant synthesis of the current evidence on the epidemiology, microbiology, diagnostic approach, imaging modalities, and management of PID, with a focus on severe forms including TOA, sepsis, and peritonitis. Content: PID is most frequently initiated by sexually transmitted pathogens—primarily Chlamydia trachomatis and Neisseria gonorrhoeae—which rapidly progresses to a polymicrobial infection involving anaerobic and enteric organisms. Diagnosis is predominantly clinical, supported by nucleic acid amplification tests, inflammatory markers, and imaging. Transvaginal ultrasonography remains the first-line diagnostic approach for suspected TOA, while CT or MRI is reserved for unclear cases or to assess rupture. Mild to moderate disease is managed with broad-spectrum combination antibiotics, whereas severe PID or TOA requires hospitalization, parenteral therapy, and timely source control through image-guided drainage or surgery. Ruptured abscesses and PID-associated sepsis demand urgent surgical intervention and multidisciplinary supportive care. Tailored approaches are necessary in pregnancy, adolescence, and immunosuppressed and postmenopausal patients. Conclusions: Prompt recognition, a low threshold for empiric antimicrobial therapy, the appropriate use of imaging, and decisive escalation to drainage or surgery are essential to limit morbidity and preserve reproductive health. Integrating guideline-based practice with structured clinical pathways may improve outcomes and reduce long-term sequelae of PID. Full article

Co-infection by human papillomavirus (HPV) and human immunodeficiency virus (HIV) facilitates cervical carcinogenesis, and additional cofactors such as other sexually transmitted infections (STI) further aggravate this scenario. This study aimed to validate a molecular detection strategy for Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae and to assess the association of these infections with cervical lesions in HPV-positive women living with HIV in Northeastern Brazil. In total, 155 samples were collected from CRIST/AIDS. After microorganism detection by conventional PCR, a multiplex PCR was standardized and validated. A prevalence of 9.03% was observed for C. trachomatis and 6.45% for T. vaginalis, with 0.64% co-infection. In addition, infection with both STIs showed a prevalence of 0.64%. Among HPV-positive women, high-risk genotypes accounted for 70.9% of cases, with HPV-16 being the most prevalent (35.5%). Overall, 18.2% of women presented cervical lesions, and 13.2% of those with co-detection of C. trachomatis and T. vaginalis were associated with high-grade squamous intraepithelial lesions (HSIL). These findings highlight the clinical relevance of screening for multiple STIs in HPV-positive women living with HIV and support the incorporation of multiplex molecular testing into public health strategies to improve early detection and targeted management. Full article

Background and Objectives: Despite the development of medicine, there is no clearly established scheme for the prediction of intra-amniotic infection (IAI). In this study, evaluation of some predictors of IAI confirmed in histopathological examination was performed. Materials and Methods: The study population included 70 patients all giving birth by cesarean section divided into two groups: study (n = 34) consisting of patients with histologically confirmed IAI and control (n = 36) without IAI. Biological material included the mother’s venous blood to determine C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin (PCT) concentrations; vaginal discharge to determine IL-6; cervical canal swabs to perform cultures for bacteria and fungi and polymerase chain reaction (PCR) for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis; amniotic fluid to perform cultures for aerobic and anaerobic bacteria and PCR for atypical pathogens, and to determine glucose, IL-6, and PCT concentrations; umbilical cord blood to determine PCT, CRP, Il-6 and blood culture. A fragment of the placenta and fetal membranes was taken for histopathological assessment of the inflammatory infiltrate. Results: Mothers’ serum CRP assessments as well as serum PCT assessments are of poor diagnostic value in the prediction of IAI confirmed in histopathological examination. Conclusions: The best predictive values of IAI confirmed in histopathological examination were amniotic fluid glucose and vaginal fluid IL-6 determinations. Full article

Understanding the diversity of pathogenic microorganisms in wild primates is essential for assessing their health and zoonotic risks. In this study, metagenomic sequencing was applied to investigate the composition and seasonal dynamics of potential pathogenic microorganisms in the feces of François’ langurs. A total of 77 potential pathogenic taxa were identified, mainly belonging to Bacillota and Pseudomonadota. The most abundant genera were Streptococcus, Staphylococcus, Salmonella, Listeria, and Pseudomonas, while dominant species included Staphylococcus aureus, Streptococcus pneumoniae, Salmonella enterica, Listeria monocytogenes, and Escherichia coli. Significant seasonal differences were detected in both α- and β-diversity indices, with higher microbial diversity in spring and distinct community structures across seasons. Several genera and species, including Vibrio, Chlamydia, Mycobacteroides, Vibrio cholerae, Yersinia enterocolitica, Chlamydia trachomatis, and Mycobacteroides abscessus, showed marked seasonal fluctuations. The findings reveal that the pathogenic microbial community of François’ langurs is strongly shaped by seasonal environmental factors. The detection of multiple zoonotic pathogens suggests a potential risk of cross-species transmission, providing valuable baseline data for primate disease ecology and conservation health management. Full article