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10:30
12:00
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Diagnosis of Uncomplicated UTIs and Genital Infections
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Stephen S. YangTaiwan
Moderator
UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required.
In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.
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Shingo YamamotoJapan
Speaker
Changes of the Bacterial Resistance from Uncomplicated Cystitis in JapanThe spread of antimicrobial resistance (AMR) is an increasing threat to all of humanity. Southeast and South Asian countries are among the world's leading AMR-endemic countries, with advanced AMR spreading through various international routes.
Considering the mass administration of antibiotics to livestock and pets, and the spread of antibiotics and drug-resistant bacteria in the environment, measures to combat AMR cannot be completed within the human medical field alone. It is necessary to clarify the concept of the One Health approach and for various sectors, including human medical fields (such as veterinary medicine and the environment), to work together toward the same goal.
When Japan's infectious disease control guidelines were published in 2011, fluoroquinolones were positioned as the first-choice drug for the treatment of acute uncomplicated cystitis in both pre- and postmenopausal women, because they are highly effective against both gram-negative and gram-positive bacteria.
However, quinolone-resistant and ESBL-producing strains of Gram-negative bacteria, mainly E. coli, are increasing year by year, and many ESBL-producing strains are quinolone-resistant. Therefore, it is considered that the use of cephalosporins and quinolones should be severely restricted, and it is necessary to discuss the important issue of appropriate use of antibiotics.
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Chia-Hung LiuTaiwan
Speaker
Integrated Chip Provide Rapid Identification of UropathogenThe present study proposes a unique approach for the quick and cost-effective detection of Escherichia coli (E. coli) in urine samples using disposable gold electrode sensing chips. Spectrophotometry and plate counting demonstrated a significant linear correlation coefficient of 0.98986 between absorbance values and E. coli concentration. The electrochemical detection approach used modified electrodes to increase sensitivity. The method used to address cyclic voltammetry (CV) was not effective in depicting the peaks involved in breaking down the bacterial cell wall barrier using a permeabilizer. Square wave voltammetry (SWV) was used to identify changes in the p-nitrophenyl-β-D-galactopyranoside (p-APG) oxidation peak, which served as evidence of the successful integration and hydrolysis of β-galactosidase (β-gal). Both modified and unmodified gold electrodes showed an inversely proportional oxidation peak at 500 mV for p-PAG in E. Coli experiments employing SWV, with the modified electrodes showing greater sensitivity. During clinical testing, the proposed biosensor successfully detected urine bacterial counts with a sensitivity of about 75 colony-forming units per millilitre (cfu/ml), despite difficulties in detecting extremely low E. coli concentrations. The use of electrochemical techniques resulted in a significant decrease in experimental time, allowing real-time analysis for useful applications in the detection of bacteria in urine.
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Pin-Hui LeeTaiwan
Speaker
HIV Screening through the Nation-Wide Sexual Health Friendly Clinical Network: Taiwan ExperiencesAs of the end of 2024, Taiwan has accumulated 45,255 HIV notifications since 1984. The number of people living with HIV has been more than 36000. Analysis by age group highlights that the majority of new HIV cases occur among individuals engaging in unsafe sexual behaviors, accounting for over 90% of transmissions. Despite ongoing efforts, undiagnosed HIV infections remain a public health challenge. Estimates using the CD4 depletion model, recommended by the U.S. CDC, show varying undiagnosed rates across age groups, especially for age of 13-35 years. Taiwan has made considerable progress toward the UNAIDS 95–95–95 targets for 2030. In 2024, estimated 92% of people living with HIV were aware of their status, 96% of those diagnosed were receiving treatment, and 95% of treated individuals had achieved viral suppression.
To strengthen early diagnosis, Taiwan has implemented various HIV screening programs especially through the B1 program, which promotes comprehensive HIV screening for individuals with STIs, also including acute viral hepatitis A,B,C, or substance use disorders. Education and promotion of the B1 program through the medical professional societies to organize the sexual health friendly clinical network has substantially increased the accessibility of HIV testing. The diagnostic process involves a combination of antigen/antibody screening, immunochromatographic tests, and nucleic acid testing. Healthcare institutions are incentivized through the reimbursement system.
The role of urology specialists is particularly emphasized. Between 2019 and 2024, urology clinics and hospitals contributed significantly to the B1 program of HIV testing. The highest HIV positivity rates in these settings were linked to patients diagnosed with syphilis, chlamydia, and condyloma acuminatum (genital warts). Physicians are encouraged to offer HIV testing and health education to at-risk patients and to invite their partners for screening and treatment.
In summary, Taiwan continues to advance in its response to the HIV epidemic by improving diagnostic coverage, optimizing care pathways, and engaging frontline specialties such as urology. Emphasis on integrated care models and proactive partner notification are key strategies moving forward in achieving national and international targets for HIV control.
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Sang-Rak BaeKorea (Republic of)
Speaker
HPV Vaccination in Men, Asia and the WorldHPV Vaccination in Men: Status in Asia and the World
Human papillomavirus (HPV) comprises a group of over 200 virus types, among which certain high-risk types are known to cause genital warts and various cancers. Persistent infection with high-risk HPV types is a leading cause of cervical cancer and is also associated with vulvar, vaginal, oral/oropharyngeal, penile, and anal cancers. Approximately 5.2% of all cancers globally—amounting to around 600,000 new cases annually—are attributed to HPV infection. Prophylactic vaccination remains the most effective method to prevent these HPV-related malignancies. In the case of cervical cancer, HPV screening and treatment of precancerous lesions are also recognized as effective preventive strategies. However, due to the absence of reliable screening methods for HPV-related conditions in men, the burden of male HPV infection has often been overlooked.
As of 2025, around 149 countries have implemented national HPV vaccination programs, of which 82 offer gender-neutral vaccination (GNV). In Asia, Mongolia, Bhutan, the UAE, Qatar, and Kuwait have adopted GNV, and Taiwan is scheduled to expand vaccination to males starting September 2025. This study aims to emphasize the necessity of expanding HPV vaccination for males in Asia, based on global comparisons and the rationale for male vaccination.
1. History of HPV and HPV Vaccination
In the 1970s, HPV infection was first identified as a cause of female genital malignancies. In 1985, HPV DNA was detected in head and neck cancer tissues, and in 1995, HPV types 16 and 18 were officially classified as carcinogenic for genital cancers. The first HPV vaccine was developed in 2006, and in 2007, HPV-16 was acknowledged as a carcinogen for head and neck cancers. As of July 2025, 37 out of 38 OECD countries (excluding Türkiye) have implemented national vaccination programs. Japan and Korea currently only provide government-supported vaccination for females. In Asia, Mongolia, Bhutan, UAE, Qatar, and Kuwait offer vaccination for both sexes, with Taiwan including males starting in September 2025.
2. Global Status of HPV-Related Cancers
To reduce the incidence of cervical cancer to fewer than 4 cases per 100,000 women by 2030, the WHO has launched the "A World Without Cervical Cancer" initiative, targeting 90% vaccination coverage, 70% screening uptake, and 90% treatment rates. Globally, 87–96% of cervical cancers are HPV-related, with 92% in Asia alone. Additionally, head and neck cancers—the fifth most common cancer—are associated with HPV in 20–40% of cases. Penile cancer is linked to HPV in up to 90% of HGSIL cases and approximately 33% of invasive penile cancers. In total, HPV is associated with over 730,000 cancers worldwide, representing over 5% of all malignancies.
3. Rationale for HPV Vaccination in Males
HPV vaccination in males is often underprioritized, as the burden of prevention is traditionally placed on females. Unlike cervical cancer in females, there is no organized screening program for HPV-related non-cervical cancers in men, limiting secondary prevention benefits. Men also show lower awareness of HPV-related diseases, increasing their vulnerability to infection. Due to insufficient vaccine coverage, populations such as MSM and unvaccinated females remain inadequately protected despite herd immunity. Males act as a significant reservoir of HPV. Transmission from female to male occurs at a rate of 5.6 per 100 person-months, while male-to-female transmission is also substantial at 3.5. HPV-infected sperm demonstrates reduced motility and increased DNA fragmentation, potentially affecting fertility. In the U.S., the incidence of HPV-related oropharyngeal cancer in men has surpassed that of cervical cancer in women since the mid-2010s.
4. HPV Vaccination for Males in Asia
Asia is home to approximately 60% of the global population. However, the two most populous countries—China and India—do not include HPV vaccination in their national immunization programs. Among the Asian countries offering vaccination, only Mongolia, Bhutan, UAE, Qatar, Kuwait, and now Taiwan (from September 2025) provide GNV. There is significant variability in vaccination coverage across nations. According to GLOBOCAN data, 58% of global cervical cancer cases—around 352,000 new diagnoses—occur in Asia. Given Asia’s population size and disease burden, expanding HPV vaccination programs, particularly for males, is a critical public health priority.
5. Recommendations
To prevent HPV-related diseases—including cervical cancer, oropharyngeal cancer, and benign HPV-related conditions—HPV vaccination is recommended for both males and females aged 9–26.
Individuals aged 9–14 should receive two doses at 0 and 6 months; those aged 15–26 should receive three doses at 0, 1, and 6 months.
The optimal age for vaccination is 11–12 years.
Women aged 27 and above may receive the vaccine based on individual clinical decision-making.
6. Conclusion
HPV affects both sexes, contributing significantly to disease burden in males through cancers and anogenital warts. The lack of organized screening for HPV-related diseases in men makes gender-neutral vaccination (GNV) a fair and effective public health strategy. GNV may also accelerate cervical cancer elimination and increase program resilience against future disruptions. In particular, the high burden of HPV-related diseases in Asia underscores the urgency and importance of expanding vaccination coverage across the region.
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Koichiro WadaJapan
Speaker
Antimicrobial Resistance on Neisseria Gonorrhoeae and Mycoplasma GenitaliumSexually transmitted diseases, in which Neisseria gonorrhoeae and Mycoplasma genitalium are the pathogenic microorganisms, have become a social problem also in Japan. Drug resistance has been increasing, especially among penicillins, macrolides, and fluoroquinolones in Neisseria gonorrhoeae. Mycoplasma genitalium was originally not highly susceptible to tetracyclines, but has recently become resistant to macrolides and fluoroquinolones. N. gonorrhea can be treated with a 1g single-dose of ceftriaxone, but urethritis caused by M. genitalium sometimes requires sequential/combination therapy, and many cases are difficult to treat. In my presentation, I would like to discuss diagnosis and treatment, especially drug resistance in Japan.
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TICC - 2F 201BC
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