IntroductionAcute epididymo-orchitis (AEO) is a male urological emergency without an approved clinical classification. We aimed to determine the clinical value of proposed in 2012 local AEO classification system and summarize results of partner's follow-up.Material and methodsA total of 293 patients with AEO were enrolled into our study. Based on the investigated AEO classification, they were divided into four groups: 118 patients (40.3%) with Stage I AEO; 97 patients (33.1%) with Stage II AEO; 42 patients (14.3%) with Stage IIIA AEO; 36 patients (12.3%) with Stage IIIB AEO.If after 72 hours of conservative treatment there was no clinical improvement, AEO patients underwent surgery. We analyzed the clinical value of the investigated classification system and results of partner's follow-up.ResultsOnly 3 (2.5%) patients with Stage I AEO required surgery. In patients with Stage II AEO, conservative treatment was effective in 79 (81.4%) cases. A total of 27 (64.3%) patients with Stage IIIA and 36 (100%) patients with stage IIIB AEO underwent surgery. Sexually transmitted infections (STIs) were detected in 176 (60.1%) cases among 293 patients with AEO and bacterial infection in 117 (39.9%) cases. We registered a statistically lower incidence rate of trichomoniasis in AEO patients compared to their sole female partners (13.8% vs. 23.3%, p <0.05). Distribution of other STIs in AEO patients and their sole partners was similar.ConclusionsThe investigated classification system enables the determination of a treatment strategy in patients with AEO. Partner's follow-up allows for the clarification of the etiology of disease, complete evaluation of STIs and prevents reinfection in couples.

The article presents the results of a prospective study on the presence of antiphospholipid antibodies in healthy primagravida with the analysis of further gestational complications. The objective: to determine the serum circulation of antibodies to different types of phospholipids in the first and second gestational trimester and to study the incidence of obstetric complications depending on this circulation. Materials and methods. Determination of antibodies to phospholipids in 11–12 and 18–20 gestational weeks by immunoassay analysis. The study included 150 primagravida (11-12 weeks) without reproductive impairment in history, a re-study was performed in 148 women, since 2 cases of spontaneus abortion were observed. The relative risk of development of major obstetric complications in women with the appearance of antibodies to phospholipids in the second trimester of pregnancy is calculated. Results. At the first inspection, the frequency of detection of antibodies to phospholipids ranged from 3 to 4%, which corresponds to global data on the prevalence of antibody circulation in a healthy population. However, in 18-20 weeks, a statistically significant increase in the frequency of antibody circulation, mainly to phosphatidylserine (21.6%) and phosphatidylethanolamine (17.4%), was detected. The peculiarities of the structure of the cell membrane are asymmetry of the location of phospholipids, in which negatively charged molecules, including phosphatidylserine and phosphotadylethanolamine, are located dominantly in a inner layer. The emergence of antibodies precisely to these molecules in the dynamics of pregnancy is evidence of their externalization, which may be the result of a violation of the normal functioning of the endothelium. Analysis of the course of the second half of pregnancy in patients with detected antibody subtypes showed an increase in the relative risk of severe preeclampsia, placental dysfunction and premature labor. Conclusions: 1. The APA circulation frequency by healthy primagravida in first gestational trimester is in accordance to world population. 2. In the second trimester an increasing of APA detection is registered, exactly for phosphatidylserin (21.6%) and phosphatidyletanolamin (17.4%) antibodies 3. Appearance of antibodies to negative phospholipids in the second pregnancy trimester lets propose destabilization of endothelium membranes in these patients, what is confirmed by a higher frequency of main obstetrics complications prospectively. Key words: antibodies to phospholipids, phosphatidylserine antibodies, phosphatidylethanolamine antibodies, endothelial dysfunction.

Background: Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) are common sexually transmitted infections (STIs) that are diagnosed in infertile couples (cps). In cases with their simultaneous presence in a patient (mixed STI, MSTIs), treatment is complicated by the different sensitivity of microorganisms to antibacterial drugs. Moreover, in cases of complicated infections, the empirical treatment should be started before obtaining the results of drug susceptibilities. Objective: The objective of the current study is to find the effective and well-tolerated combination of drugs for the empirical antibacterial treatment of mixed STIs presented by TV, MG and UU in infertile couples. We also aimed to establish the influence of mixed STIs on semen quality. Method: Our prospective study included 154 infertile couples (308 patients) with confirmed symptomatic MSTIs in one of the couples caused by the simultaneous presence of TV, MG and UU. All couples were randomized on three groups for empirical treatment: Group 1 (n=49 cps, 98 pts) who were treated by initial prescribing of anti-trichomoniasis drug Secnidazole, 2.0 g po followed by Azythromycin 500 mg on day 1 continuing by 250 mg on days 2-7; Group 2 (n=52 cps, 104 pts: Secnidazole, 2.0 g po followed by Josamycin 1000 mg bid for 12 days); Group 3 (n=53 cps, 106 pts: Secnidazole, 2.0 g po followed by Moxifloxacin 400 mg once daily for 12 days). The endpoints were clinical and microbiological cure rates as well as the frequency of side-effects in analyzed groups. We determined the basic parameters of the spermogram and Deoxyribonucleic acid (DNA) fragmentation levels in 59 patients with MSTIs before and at the 3rd, 6th and 9th month after pathogens eradication comparing them with results in 63 healthy sperm donors. Result: After the treatment, clinical cure rates in analyzed groups were 82.6% (Group 1) vs 96.1% (Group 2) vs 92.3% (Group 3). Microbiological cure rates (UU+MG) were 73.9 % vs 97.1 % vs 84.5% correspondingly (p<0.05). TV microbiological cure rates were 97.8% vs 98.0% vs 96.1% (p>0.05). Side-effects were registered in 28.6% vs 12.5% vs 18.9% cases correspondingly (p<0.05). In MSTIs patients, we registered the increasing DNA fragmentation rates, leucocytes count and decreasing semen volume, motility, vitality, sperm concentration, total spermatozoa number and number of spermatozoa with normal morphology. At the 6th month after complete pathogens eradication, these parameters approached normal values. Conclusion: At the present time, the combination of Secnidazole+Josamycin can be considered the most effective and well-tolerated for the empirical treatment in patients with MSTIs presented by TV, MG and UU. Complete eradication of these MSTIs in males improves their semen parameters.

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