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Bartoletti R.,University of Florence | Cai T.,Santa Chiara Regional Hospital
Clinical Uro-Andrology

Human papillomavirus (HPV) is a very resistant, ubiquitous and sexually transmitted virus that can survive in the environment without a host. HPV is involved in the genesis of cervical cancer in women. Men are usually seen as potential vectors for infection through sexual intercourse but not as final targets of the disease with clinical manifestations that include genital condylomata and some cancers such as penile, oral/neck, anal and, more recently, bladder cancer. On the other hand, aside the evidence of genital condylomata, specific criteria for diagnosis in asymptomatic subjects are still missing to determine both the presence of viral DNA (infection) and the possible role of HPV in the cell transformation to cancer. The prevalence of HPV in males ranges from 7 to 45 %. The quadrivalent vaccine against HPV has proved to be effective in preventing external genital lesions in 90.4 % males aged 16–26 years (95 % CI 69.2–98.1). It has also proved to be effective in preventing precancerous anal lesions in 77.5 % (95 % CI 39.6–93.3) of cases in a per-protocol analysis and in 91.7 % (95 % CI: 44.6–99.8) of cases in a post hoc analysis. Another aspect to highlight is the association between HPV infection and male infertility, probably due to the viral adhesion on the spermatozoa wall. However, several studies on this topic are currently in process. Recently, for prevention purposes the vaccination of 12-year-old males against HPV was recommended. As it has done already for females, a facilitated access to vaccination for males (by price reductions) should be implemented as well. More campaigns to raise awareness through all institutional channels are needed, not only regarding anogenital warts but for HPV-related diseases in general, to achieve adequate vaccine coverage in female cohorts and to reduce HPV-related morbidity. © Springer-Verlag Berlin Heidelberg 2015. Source

Bartoletti R.,University of Florence | Cai T.,Santa Chiara Regional Hospital | Nesi G.,University of Florence | Albanese S.,and Microbiology Center | And 3 more authors.
World Journal of Urology

Purpose: We aim to evaluate the role of biofilm-producing bacteria in the clinical response to antibiotic therapy among patients affected by chronic bacterial prostatitis (CBP). Methods: All patients attending our centre from January to December 2008 due to prostatitis-like symptoms with a positive Meares-Stamey test were enroled. The clinical symptoms were assessed according to the NIH-CPSI, and the bacterial strains isolated from the patients enroled were identified and tested for antibiotic sensitivity using cards of the Vitek II semi-automated System for Microbiology (BioMerieux). Quantitative bacterial slime production was assessed by the Christensen microwell assay. All patients were treated with fluoroquinolones for 4 weeks and reevaluated clinically and microbiologically after 3 months. Results: One hundred and sixteen patients were enroled, and 150 bacterial strains were isolated from all patients. About 85 % of these strains were strong or moderate biofilm producers. Patients with strong or moderate biofilm-producing bacteria had a higher NIH-CPSI symptom score than those without biofilm-producing bacteria (mean 17.6 ± 5.6 vs. 14.1 ± 3.3; p = 0.0009). At the follow-up, 68 patients (58.6 %) had negative microbiological tests, but only 11 (9.48 %) reported a reduction in NIH-CPSI score. Improvement of symptoms was found statistically significantly less frequent in patients with biofilm-producing bacteria than in those without (p = 0.03). Ultrastructural analysis showed cellular forms in active replication with aberrant morphology of unknown cause and confirmed strong slime production with consistent bacterial stratification. Conclusion: In our CBP population, biofilm-producing bacteria were commonly found and had a significant negative impact on the clinical response to antibiotic therapy. © 2013 Springer-Verlag Berlin Heidelberg. Source

The therapeutic efficacy of CP/CPPS is not very satisfactory and the impact on young male's quality of life is considerable. The aim of the present study is to evaluate the efficacy of pollen extract associated with vitamins (DEPROX 500®) in order to improve the quality of life of young patients affected by chronic prostatitis type IIIb (CP/CPPS) by pain relieving. All patients with clinical and instrumental diagnosis of CP/CPPS (class b) underwent DEPROX 500® 2 tablets in a single dose daily for 30 days. Clinical and microbiological analyses were carried out at the enrolment and after 1 month. NIH-CPSI and IPSS questionnaires have been used. The main outcome measure was the improvement of quality of life at the end of the whole study period, evaluated by questionnaires results. 20 men (mean age 32.8 ± 6.78) were enrolled in this pilot study. The baseline questionnaire mean scores were 25.90 ± 2.1 and 8.01 ± 3.64 for NIH-CPSI and IPSS, respectively. At the follow-up examination (1 month after treatment), 18 out of 20 patients (90.0%) reported an improvement of quality of life, in terms of pain reduction. The questionnaire results after 1 month from treatment were as follows: NIH-CPSI 12.8 ± 2.20, IPSS 7.6 ± 1.58. Statistically significant differences were then reported between the two visits, in terms of NIH-CPSI scores (p<0.001). No statistically significant differences have been reported in terms of IPSS between the two groups. All patients were negative at the Meares-Stamey test evaluation. The compliance to the study protocol was 100%. The pollen extract associated with vitamins (DEPROX 500®) significantly improved {line separator}total symptoms, pain, and QoL in patients with non-inflammatory CP/CPPS without severe side {line separator}effects. Source

Bartoletti R.,University of Florence | Cai T.,Santa Chiara Regional Hospital | Meliani E.,University of Florence | Mondaini N.,University of Florence | And 5 more authors.
International Braz J Urol

Purpose: To investigate the relationship between human papillomavirus (HPV) infection and prostatitis-related symptoms. Materials and Methods: All young heterosexual patients with prostatitis-related symptoms attending the same Center from January 2005 to December 2010 were eligible for this case-control study. Sexually active asymptomatic men were considered as the control group. All subjects underwent clinical examination, Meares-Stamey test and DNA-HPV test. Patients with prostatitis-related symptoms and asymptomatic men were compared in terms of HPV prevalence. Moreover, multivariable Cox proportional hazards regression analysis was performed to determine the association between HPV infection and prostatitis-related symptoms. Results: Overall, 814 out of 2,938 patients (27.7%) and 292 out of 1,081 controls (27.0%) proved positive to HPV. The HPV genotype distribution was as follows: HR-HPV 478 (43.3%), PHR-HPV 77 (6.9%), LR-HPV 187 (16.9%) and PNG-HPV 364 (32.9%). The most common HPV genotypes were: 6, 11, 16, 26, 51, 53 and 81. No difference was found between the two groups in terms of HPV infection (OR 1.03; 95% CI 0.88-1.22; p = 0.66). We noted a statistically significant increase in HPV infection over the period 2005 to 2010 (p < 0.001) in both groups. Moreover, we found a statistically significant increase in HPV 16 frequency from 2005 to 2010 (p = 0.002). Conclusions: This study highlights that prostatitis-like symptoms are unrelated to HPV infection. Secondary, we highlight the high prevalence of asymptomatic HPV infection among young heterosexual men. Source

Cai T.,Santa Chiara Regional Hospital | Mazzoli S.,Sexually Transmitted Disease Center | Migno S.,Santa Chiara Regional Hospital | Malossini G.,Santa Chiara Regional Hospital | And 6 more authors.
International Journal of Urology

Objectives: To develop and externally validate a novel nomogram predicting recurrence risk probability at 12 months in women after an episode of urinary tract infection. Methods: The study included 768 women from Santa Maria Annunziata Hospital, Florence, Italy, affected by urinary tract infections from January 2005 to December 2009. Another 373 women with the same criteria enrolled at Santa Chiara Hospital, Trento, Italy, from January 2010 to June 2012 were used to externally validate and calibrate the nomogram. Univariate and multivariate Cox regression models tested the relationship between urinary tract infection recurrence risk, and patient clinical and laboratory characteristics. The nomogram was evaluated by calculating concordance probabilities, as well as testing calibration of predicted urinary tract infection recurrence with observed urinary tract infections. Nomogram variables included: number of partners, bowel function, type of pathogens isolated (Gram-positive/negative), hormonal status, number of previous urinary tract infection recurrences and previous treatment of asymptomatic bacteriuria. Results: Of the original development data, 261 out of 768 women presented at least one episode of recurrence of urinary tract infection (33.9%). The nomogram had a concordance index of 0.85. The nomogram predictions were well calibrated. This model showed high discrimination accuracy and favorable calibration characteristics. In the validation group (373 women), the overall c-index was 0.83 (P=0.003, 95% confidence interval 0.51-0.99), whereas the area under the receiver operating characteristic curve was 0.85 (95% confidence interval 0.79-0.91). Conclusions: The present nomogram accurately predicts the recurrence risk of urinary tract infection at 12 months, and can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy. © 2014 The Japanese Urological Association. Source

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