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Chow EP, Cornelisse VJ, Read TR, Chen MY, Bradshaw CS, Fairley CK. Saliva use in sex: Associations with use of smartphone dating applications in men who have sex with men. Int J STD AIDS 2017; 29:362-366. [PMID: 28835197 DOI: 10.1177/0956462417727669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Smartphone dating applications have become a primary source for men who have sex with men (MSM) to meet sexual partners. It has been found that MSM who used smartphone dating applications are at higher risk of gonorrhoea, but the reasons remain unknown. This study aimed to investigate whether MSM who met their partners via smartphone dating applications are more likely to engage in sexual practices such as rimming (oro-anal sex), and use of partner's saliva as a lubricant, that are associated with the risk of gonorrhoea. A cross-sectional study was conducted among 1672 MSM attending the Melbourne Sexual Health Centre, Australia, between 31 July 2014 and 30 June 2015. Multivariate logistic regression was conducted to examine the associations between sources of meeting partners and the two aforementioned sexual practices. MSM who used smartphone dating applications were 1.78 (95% CI: 1.38-2.28) times more likely to get rimmed, and 1.63 (95% CI: 1.27-2.09) times more likely to use partner's saliva as a lubricant during anal sex, compared to other sources, after adjusting for age and other sources for meeting partners. These practices are highly associated with gonorrhoea.
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Affiliation(s)
- Eric Pf Chow
- 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Victoria, Australia
| | - Vincent J Cornelisse
- 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Victoria, Australia
| | - Tim Rh Read
- 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Victoria, Australia
| | - Marcus Y Chen
- 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Victoria, Australia
| | - Christopher K Fairley
- 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,2 Central Clinical School, 22457 Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Victoria, Australia
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The Case for Extragenital Screening of Chlamydia trachomatis and Neisseria gonorrhoeae in the College Health Setting. Sex Transm Dis 2017; 44:274-277. [PMID: 28407642 DOI: 10.1097/olq.0000000000000593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the Centers for Disease Control and Prevention does not recommend routine oropharyngeal and anorectal screening for Chlamydia trachomatis and Neisseria gonorrhoeae in the general population, they do recommend it for men who have sex with men. However, risk-based extragenital screening of men may not have been adopted at all college health centers, and existing research has not focused on the college population. METHODS We examined health records of men at a college health center in a large urban university over 6 years to evaluate effectiveness of C. trachomatis and N. gonorrhoeae screening. We also evaluated the proportion of C. trachomatis and N. gonorrhoeae infections that would have been missed if risk-based extragenital screening were not performed. Decisions to screen at extragenital sites were based on patient-reported risk behavior. RESULTS For 4093 male college students screened, 7.6% of the screening visits used extragenital screening in response to self-reported risk behaviors. The case positivity rate for C. trachomatis was 3.1% with urogenital-only screening and 3.7% with risk-prompted extragenital screening. The case positivity rate for N. gonorrhoeae was 0.7% with urogenital-only screening and 3.3% with risk-prompted extragenital screening. If the college health center had relied solely on urogenital screening rather than risk-based extragenital screening, 26.4% of C. trachomatis infections and 63.2% of N. gonorrhoeae infections would have been missed. CONCLUSIONS One out of four C. trachomatis infections and 2 of 3 N. gonorrhoeae infections would have been missed without extragenital screening in this analysis of college men. This study reinforces Centers for Disease Control and Prevention recommendations for risk-based extragenital screening and is the first report to focus on college men. Because guidelines exist only for men, future studies should focus on extragenital screening in college women to build evidence for another group of patients that may benefit from this practice, given the high risk in young adults.
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Santosh ABR, Reddy BVR. Oral Mucosal Infections: Insights into Specimen Collection and Medication Management. Dent Clin North Am 2017; 61:283-304. [PMID: 28317567 DOI: 10.1016/j.cden.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Oral mucosal infections appear as localized or generalized lesions. Symptoms range from almost unnoticeable lesions to severe pain. Systemic disease, age, immunocompromised condition, and medication use are common causes. Local causes include dentures, poor oral hygiene, traumatized epithelium, ulcerations, dentures, implants, oral piercing, and reduced salivary secretion. Oral mucosal infections are underdiagnosed and microbiological diagnosis should be more frequently used. Candidiasis is most frequently diagnosed. Clinical appearances are not always clear and are varied, creating a diagnostic challenge. Thorough understanding of clinical appearance and updated information on diagnostic and therapeutic management are essential for successful patient outcome.
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Affiliation(s)
| | - Baddam Venkat Ramana Reddy
- Department of Oral and Maxillofacial Pathology, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522601, India
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Weyand NJ. Neisseria models of infection and persistence in the upper respiratory tract. Pathog Dis 2017; 75:3078547. [DOI: 10.1093/femspd/ftx031] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/15/2017] [Indexed: 12/15/2022] Open
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Walker S, Bellhouse C, Fairley CK, Bilardi JE, Chow EPF. Pharyngeal Gonorrhoea: The Willingness of Australian Men Who Have Sex with Men to Change Current Sexual Practices to Reduce Their Risk of Transmission-A Qualitative Study. PLoS One 2016; 11:e0164033. [PMID: 27992427 PMCID: PMC5167548 DOI: 10.1371/journal.pone.0164033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/19/2016] [Indexed: 11/18/2022] Open
Abstract
Background The pharynx is a common site of gonorrhoea among men who have sex with men (MSM) and may serve as a reservoir for infection, with saliva implicated in transmission possibly through oral sex, kissing, and rimming. Reducing sexual activities involving saliva may reduce pharyngeal gonorrhoea. This study aimed to explore MSM’s views and knowledge of pharyngeal gonorrhoea and their willingness to change saliva transmitting sexual practices. MSM were also asked their views on using alcohol-containing mouthwash to potentially reduce transmission. Methods Using a qualitative descriptive approach, 30 MSM who were part of a larger study (GONE) conducted at the Melbourne Sexual Health Centre agreed to take part in semi-structured interviews between 14th May and 8th September 2015. The 10 interviews conducted face to face and 20 by telephone, lasted between 20–45 minutes. Data were analysed using qualitative content analysis. Results Most men considered pharyngeal gonorrhoea to be a non-serious sexually transmitted infection and attributed transmission primarily to oral sex. Almost all men reported they would not stop kissing, oral sex, or consider using condoms for oral sex to reduce their risk of pharyngeal gonorrhoea. Kissing and oral sex were commonly practised and considered enjoyable low risk sexual activities. Men were more likely to consider stopping sexual activities they did not enjoy or practice often, in particular insertive rimming. If proven effective, the majority of men reported they would use alcohol-containing mouthwash to reduce or prevent their risk of pharyngeal gonorrhoea. Conclusion Findings from this study suggest MSM are unlikely to stop saliva transmitting sexual practices they enjoy and consider low risk. Men would, however, consider using alcohol-containing mouthwash if found to be effective, highlighting the importance of exploring innovative strategies to reduce pharyngeal gonorrhoea.
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Affiliation(s)
- Sandra Walker
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- * E-mail:
| | - Clare Bellhouse
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jade E. Bilardi
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
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Barriers to Bacterial Sexually Transmitted Infection Testing of HIV-Infected Men Who Have Sex With Men Engaged in HIV Primary Care. Sex Transm Dis 2016; 42:590-4. [PMID: 26372931 DOI: 10.1097/olq.0000000000000320] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Approximately 15% of HIV-infected men who have sex with men (MSM) engaged in HIV primary care have been diagnosed as having a sexually transmitted infection (STI) in the past year, yet STI testing frequency remains low. METHODS We sought to quantify STI testing frequencies at a large, urban HIV care clinic, and to identify patient- and provider-related barriers to increased STI testing. We extracted laboratory data in aggregate from the electronic medical record to calculate STI testing frequencies (defined as the number of HIV-infected MSM engaged in care who were tested at least once over an 18-month period divided by the number of MSM engaged in care). We created anonymous surveys of patients and providers to elicit barriers. RESULTS Extragenital gonorrhea and chlamydia testing was low (29%-32%), but the frequency of syphilis testing was higher (72%). Patients frequently reported high-risk behaviors, including drug use (16.4%) and recent bacterial STI (25.5%), as well as substantial rates of recent testing (>60% in prior 6 months). Most (72%) reported testing for STI in HIV primary care, but one-third went elsewhere for "easier" (42%), anonymous (21%), or more frequent (16%) testing. HIV primary care providers lacked testing and treatment knowledge (25%-32%) and cited lack of time (68%), discomfort with sexual history taking and genital examination (21%), and patient reluctance (39%) as barriers to increased STI testing. CONCLUSION Sexually transmitted infection testing in HIV care remains unacceptably low. Enhanced education of providers, along with strategies to decrease provider time and increase patient ease and frequency of STI testing, is needed.
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Why should 1 gram of ceftriaxone monotherapy be considered as a therapeutic option in gonococcal sexually transmitted diseases? Clin Microbiol Infect 2016; 22:903-904. [PMID: 27404364 DOI: 10.1016/j.cmi.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 11/21/2022]
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Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infect Dis Obstet Gynecol 2016; 2016:5758387. [PMID: 27366021 PMCID: PMC4913006 DOI: 10.1155/2016/5758387] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/12/2016] [Accepted: 04/20/2016] [Indexed: 12/30/2022] Open
Abstract
In the United States, sexually transmitted diseases due to Chlamydia trachomatis and Neisseria gonorrhoeae continue to be a major public health burden. Screening of extragenital sites including the oropharynx and rectum is an emerging practice based on recent studies highlighting the prevalence of infection at these sites. We reviewed studies reporting the prevalence of extragenital infections in women, men who have sex with men (MSM), and men who have sex only with women (MSW), including distribution by anatomical site. Among women, prevalence was found to be 0.6–35.8% for rectal gonorrhea (median reported prevalence 1.9%), 0–29.6% for pharyngeal gonorrhea (median 2.1%), 2.0–77.3% for rectal chlamydia (median 8.7%), and 0.2–3.2% for pharyngeal chlamydia (median 1.7%). Among MSM, prevalence was found to be 0.2–24.0% for rectal gonorrhea (median 5.9%), 0.5–16.5% for pharyngeal gonorrhea (median 4.6%), 2.1–23.0% for rectal chlamydia (median 8.9%), and 0–3.6% for pharyngeal chlamydia (median 1.7%). Among MSW, the prevalence was found to be 0–5.7% for rectal gonorrhea (median 3.4%), 0.4–15.5% for pharyngeal gonorrhea (median 2.2%), 0–11.8% for rectal chlamydia (median 7.7%), and 0–22.0% for pharyngeal chlamydia (median 1.6%). Extragenital infections are often asymptomatic and found in the absence of reported risk behaviors, such as receptive anal and oral intercourse. We discuss current clinical recommendations and future directions for research.
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Prevalence and Correlates of Chlamydia trachomatis and Neisseria gonorrhoeae by Anatomic Site Among Urban Thai Men Who Have Sex With Men. Sex Transm Dis 2016; 42:440-9. [PMID: 26165436 DOI: 10.1097/olq.0000000000000311] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection are prevalent among men who have sex with men (MSM) and may infect multiple anatomic sites. We measured site-specific prevalence and correlates of CT and NG infection among Bangkok MSM Cohort Study participants. METHODS In April 2006 to November 2010, 1744 men enrolled in the Bangkok MSM Cohort Study. Participants provided historical information and underwent physical examination. Rectal, urethral, and pharyngeal CT and NG screening were performed by nucleic acid amplification and/or culture. Logistic regression was used to identify correlates of site-specific CT, NG, and coinfection. RESULTS Among 1743 participants, 19.2% were infected with CT and/or NG. CT, NG, and CT-NG coinfection were detected in 11.6%, 4.6%, and 2.9%, of participants, respectively. Rectal, urethral, and pharyngeal CT infections were detected in 9.5%, 4.5%, and 3.6% of cases. N. gonorrhoeae was present at these sites in 6.1%, 1.8%, and 0.5% of cases. Most infections were asymptomatic (CT: 95.3%, NG: 83.2%). Rectal CT and NG infections were mutually associated (CT: adjusted odds ratio [AOR], 5.4; 95% confidence interval [CI], 3.4-8.7; NG: AOR, 2.4; 95% CI, 1.1-5.2) and independently associated with HIV infection (CT: AOR, 1.6, 95% CI, 1.0-2.4; NG: AOR, 2.0, 95% CI, 1.3-3.1). Numerous behavioral correlates of infection were observed. CONCLUSIONS CT and NG infections are highly prevalent among MSM in Bangkok, most frequently affect the rectum, and are most often asymptomatic. Routine screening of asymptomatic MSM for CT and NG infection should include rectal sampling and focus on men with HIV and a history of other sexually transmitted infections.
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Evaluation of gonorrhea test of cure at 1 week in a Los Angeles community-based clinic serving men who have sex with men. Sex Transm Dis 2015; 41:595-600. [PMID: 25211254 DOI: 10.1097/olq.0000000000000190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because of the decreasing susceptibility of Neisseria gonorrhoeae to cephalosporin therapy, the Centers for Disease Control and Prevention recommends test of cure (TOC) 1 week after gonorrhea (GC) treatment if therapies other than ceftriaxone are used. In addition, the Centers for Disease Control and Prevention asks clinicians, particularly those caring for men who have sex with men (MSM) on the west coast, to consider retesting all MSM at 1 week. However, it is unclear if this is acceptable to providers and patients or if nucleic acid amplification tests (NAATs) are useful for TOC at 7 days. METHODS Between January and July 2012, MSM with GC were advised to return 1 week after treatment for TOC using NAAT. A multivariate logistic regression model was used to determine demographic and behavioral differences between MSM who returned for follow-up and MSM who did not. RESULTS Of 737 men with GC, 194 (26.3%) returned between 3 and 21 days of treatment. Individuals who returned were more likely to have no GC history (P = 0.0001) and to report no initial symptoms (P = 0.02) when compared with individuals who did not return for TOC. Of those who returned, 0% of urethral samples, 7.4% of rectal samples, and 5.3% of pharyngeal samples were NAAT positive at TOC. CONCLUSIONS Although TOC may be an important strategy in reducing complications and the spread of GC, low return rates may make implementation challenging. If implemented, extra efforts should be considered to enhance return rates among individuals with a history of GC. If TOCs are recommended at 1 week and NAATs are used, the interpretation of positive results, particularly those from extragenital sites, may be difficult.
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Lewis DA. Will targeting oropharyngeal gonorrhoea delay the further emergence of drug-resistant Neisseria gonorrhoeae strains? Sex Transm Infect 2015; 91:234-7. [PMID: 25911525 DOI: 10.1136/sextrans-2014-051731] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 03/31/2015] [Indexed: 11/03/2022] Open
Abstract
Gonorrhoea is an important sexually transmitted infection associated with serious complications and enhanced HIV transmission. Oropharyngeal infections are often asymptomatic and will only be detected by screening. Gonococcal culture has low sensitivity (<50%) for detecting oropharyngeal gonorrhoea, and, although not yet approved commercially, nucleic acid amplification tests (NAAT) are the assay of choice. Screening for oropharyngeal gonorrhoea should be performed in high-risk populations, such as men-who-have-sex-with-men(MSM). NAATs have a poor positive predictive value when used in low-prevalence populations. Gonococci have repeatedly thwarted gonorrhoea control efforts since the first antimicrobial agents were introduced. The oropharyngeal niche provides an enabling environment for horizontal transfer of genetic material from commensal Neisseria and other bacterial species to Neisseria gonorrhoeae. This has been the mechanism responsible for the generation of mosaic penA genes, which are responsible for most of the observed cases of resistance to extended-spectrum cephalosporins (ESC). As antimicrobial-resistant gonorrhoea is now an urgent public health threat, requiring improved antibiotic stewardship, laboratory-guided recycling of older antibiotics may help reduce ESC use. Future trials of antimicrobial agents for gonorrhoea should be powered to test their efficacy at the oropharynx as this is the anatomical site where treatment failure is most likely to occur. It remains to be determined whether a combination of frequent screening of high-risk individuals and/or laboratory-directed fluoroquinolone therapy of oropharyngeal gonorrhoea will delay the further emergence of drug-resistant N. gonorrhoeae strains.
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Affiliation(s)
- D A Lewis
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Lutz AR. Screening for Asymptomatic Extragenital Gonorrhea and Chlamydia in Men Who Have Sex with Men: Significance, Recommendations, and Options for Overcoming Barriers to Testing. LGBT Health 2015; 2:27-34. [PMID: 26790015 DOI: 10.1089/lgbt.2014.0056] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men (MSM) have a disproportionately greater risk than other populations of acquiring Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC), the two most commonly reported notifiable diseases in the United States according to the Centers for Disease Control and Prevention (CDC). The presence of either of these diseases is a significant risk factor for the acquisition and transmission of human immunodeficiency virus (HIV). Recent studies have shown that significant rates of asymptomatic GC and CT infection are found at the extragenital oropharygeal and rectal sites in MSM, with or without concurrent urogenital infection. However, extragenital sites are not being routinely screened and, thus, many asymptomatic GC and CT infections at the oropharyngeal and rectal sites may go undiagnosed. This review will begin with the current evidence-based screening recommendations for extragenital GC and CT in MSM. This will be followed by recently reported extragenital GC and CT infection rates in asymptomatic MSM, and a discussion of the risks and potential implications of undiagnosed extragenital GC and CT infections. Finally, a discussion on the frequency of, and potential barriers to, screening will be presented with a summary of potential interventions for increasing screening frequency found in the literature. The scope of this review will focus primarily on U.S. recommendations, infection rates, and screening frequencies, with the inclusion of relevant international recommendations and studies for comparative and illustrative purposes.
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Affiliation(s)
- Anthony R Lutz
- Columbia University School of Nursing, Columbia University , New York, New York
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Bissessor M, Whiley DM, Fairley CK, Bradshaw CS, Lee DM, Snow AS, Lahra MM, Hocking JS, Chen MY. Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection. Clin Infect Dis 2014; 60:557-63. [PMID: 25371490 DOI: 10.1093/cid/ciu873] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To guide interpretation of gonorrhea tests of cure using nucleic acid amplification testing, this study examined the persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea. METHODS Men who had sex with men diagnosed with pharyngeal or rectal gonorrhea underwent swabbing from the pharynx or rectum 7 and 14 days following treatment. Repeat testing for N. gonorrhoeae was undertaken using real-time polymerase chain reaction (PCR) assays targeting the opa gene and porA pseudogene. RESULTS One hundred pharyngeal and 100 rectal gonorrhea infections in 190 men were included. For pharyngeal gonorrhea, positivity of N. gonorrhoeae DNA on both PCR assays was present at days 7 or 14 in 13% (95% confidence interval [CI], 6.4%-19.6%) and 8% (95% CI, 2.7%-13.3%), respectively. For rectal gonorrhea, DNA positivity was present in 6% (95% CI, 1.4%-10.7%) and 8% (95% CI, 2.7%-13.3%), respectively. Among 200 baseline pharyngeal and rectal isolates, there were 10 with ceftriaxone minimum inhibitory concentration (MIC) ≥0.06 mg/L and azithromycin MIC ≥0.5 mg/L, of which 3 (30%) had DNA detected at day 14; among the 190 isolates with lower ceftriaxone and azithromycin MICs, only 13 (7%) had persistent DNA (odds ratio, 5.8 [95% CI, 1.3-25.4]; P = .019). One man initially infected with N. gonorrhoeae multiantigen sequence type 2400 had type 4244 infection at day 14, indicating reinfection. CONCLUSIONS Pharyngeal and rectal gonorrhea DNA persisted in 8% of men 14 days after treatment. Persistence was associated with elevated ceftriaxone and azithromycin MICs. Persistence can also reflect reinfection.
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Affiliation(s)
- Melanie Bissessor
- Melbourne Sexual Health Centre Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - David M Whiley
- The University of Queensland, St Lucia Queensland Paediatric Infectious Diseases Laboratory, Royal Children's Hospital, Herston
| | - Christopher K Fairley
- Melbourne Sexual Health Centre Central Clinical School, Monash University, Melbourne, Victoria
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre Central Clinical School, Monash University, Melbourne, Victoria
| | | | | | - Monica M Lahra
- World Health Organization Collaborating Centre for Sexually Transmitted Diseases, SEALS Microbiology, The Prince of Wales Hospital, Randwick University of New South Wales, Kensington, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Marcus Y Chen
- Melbourne Sexual Health Centre Central Clinical School, Monash University, Melbourne, Victoria
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Effect of nucleic acid amplification testing on detection of extragenital gonorrhea and chlamydial infections in men who have sex with men sexually transmitted disease clinic patients. Sex Transm Dis 2014; 41:168-72. [PMID: 24521722 DOI: 10.1097/olq.0000000000000093] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2010, the Centers for Disease and Control and Prevention recommended using nucleic acid amplification tests (NAATs) for extragenital gonorrhea (GC) and chlamydia (CT) testing because of NAATs' improved sensitivity compared with culture. METHODS In 2011, the Public Health-Seattle & King County Sexually Transmitted Disease Clinic introduced NAAT-based testing for extragenital GC and CT infection in men who have sex with men (MSM) using AptimaCombo2. We compared extragenital GC and CT test positivity and infection detection yields in the last year of culture-based testing (2010) to the first year of NAAT testing (2011). RESULTS Test positivity of GC increased by 8% for rectal infections (9.0%-9.7%) and 12% for pharyngeal infections (5.8%-6.5%) from 2010 to 2011; CT test positivity increased 61% for rectal infections (7.4%-11.9%). Pharyngeal CT was identified in 2.3% of tested persons in 2011 (not tested in 2010). We calculated the ratio of extragenital cases per 100 urethral infections to adjust for a possible decline in GC/CT incidence in 2011; the GC rectal and pharyngeal ratios increased 77% and 66%, respectively, and the CT rectal ratio increased 127%. The proportion of infected persons with isolated extragenital infections (i.e., extragenital infections without urethral infection) increased from 43% in 2010 to 57% in 2011. CONCLUSIONS Extragenital testing with NAAT substantially increases the number of infected MSM identified with GC or CT infection and should continue to be promoted.
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Chen A, Dowdy DW. Clinical effectiveness and cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men: risk calculators for real-world decision-making. PLoS One 2014; 9:e108742. [PMID: 25285793 PMCID: PMC4186823 DOI: 10.1371/journal.pone.0108742] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral pre-exposure prophylaxis (PrEP) can be clinically effective and cost-effective for HIV prevention in high-risk men who have sex with men (MSM). However, individual patients have different risk profiles, real-world populations vary, and no practical tools exist to guide clinical decisions or public health strategies. We introduce a practical model of HIV acquisition, including both a personalized risk calculator for clinical management and a cost-effectiveness calculator for population-level decisions. METHODS We developed a decision-analytic model of PrEP for MSM. The primary clinical effectiveness and cost-effectiveness outcomes were the number needed to treat (NNT) to prevent one HIV infection, and the cost per quality-adjusted life-year (QALY) gained. We characterized patients according to risk factors including PrEP adherence, condom use, sexual frequency, background HIV prevalence and antiretroviral therapy use. RESULTS With standard PrEP adherence and national epidemiologic parameters, the estimated NNT was 64 (95% uncertainty range: 26, 176) at a cost of $160,000 (cost saving, $740,000) per QALY--comparable to other published models. With high (35%) HIV prevalence, the NNT was 35 (21, 57), and cost per QALY was $27,000 (cost saving, $160,000), and with high PrEP adherence, the NNT was 30 (14, 69), and cost per QALY was $3,000 (cost saving, $200,000). In contrast, for monogamous, serodiscordant relationships with partner antiretroviral therapy use, the NNT was 90 (39, 157) and cost per QALY was $280,000 ($14,000, $670,000). CONCLUSIONS PrEP results vary widely across individuals and populations. Risk calculators may aid in patient education, clinical decision-making, and cost-effectiveness evaluation.
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Affiliation(s)
- Anders Chen
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Kenyon C, Osbak K. Certain attributes of the sexual ecosystem of high-risk MSM have resulted in an altered microbiome with an enhanced propensity to generate and transmit antibiotic resistance. Med Hypotheses 2014; 83:196-202. [PMID: 24857261 DOI: 10.1016/j.mehy.2014.04.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 04/03/2014] [Accepted: 04/22/2014] [Indexed: 01/30/2023]
Abstract
Surveillance data from a number of countries have indicated that antibiotic resistance in Neisseriagonorrhoea is strongly associated with men who have sex with men (MSM). This manuscript advances the hypothesis that certain features of the MSM sexual ecosystem may be responsible for this association. It is argued that in comparison with heterosexuals, high-risk MSM (hrMSM) have a higher prevalence of oro-penile, oro-rectal and anal sex which facilitates an enhanced mixing of the pharyngeal, rectal and penile microbiomes. In addition, hrMSM have an increased number of sexual partners per unit time and an increased prevalence of sexual relationships overlapping in time. The increased flux of microbiomes between different body habitats between sexual partners, in combination with the increased connectivity of the sexual network, serve to create a novel high-risk MSM sexual ecosystem with important consequences for the genesis and spread of antibiotic resistance.
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Affiliation(s)
- C Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.
| | - K Osbak
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
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van Liere GAFS, Hoebe CJPA, Dukers-Muijrers NHTM. Evaluation of the anatomical site distribution of chlamydia and gonorrhoea in men who have sex with men and in high-risk women by routine testing: cross-sectional study revealing missed opportunities for treatment strategies: Table 1. Sex Transm Infect 2013; 90:58-60. [DOI: 10.1136/sextrans-2013-051248] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Cephalosporin and azithromycin susceptibility in Neisseria gonorrhoeae isolates by site of infection, British Columbia, 2006 to 2011. Sex Transm Dis 2013; 40:46-51. [PMID: 23250301 DOI: 10.1097/olq.0b013e31827bd64c] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Widespread resistance of Neisseria gonorrhoeae to penicillin, tetracycline, and fluoroquinolones has challenged effective treatment and control; recent international case reports of cefixime, ceftriaxone, and azithromycin resistance suggest that the remaining treatment options are now additionally threatened. To explore trends in antimicrobial susceptibility of N. gonorrhoeae, we reviewed provincial laboratory data from British Columbia, 2006 to 2011. METHODS Susceptibility testing was performed for all N. gonorrhoeae isolates detected in-house or forwarded to the reference laboratory. Resistance or intermediate resistance (nonsusceptibility) was defined by standard breakpoints for penicillin, tetracycline, ciprofloxacin, and spectinomycin. Elevated minimum inhibitory concentrations (MICs) at serial dilutions of 0.064 μg/mL or greater were explored for cefixime/ceftriaxone and 0.5 μg/mL or greater for azithromycin. Nonsusceptibility/elevated MIC was compared by year, site of infection, sex, and age. RESULTS A total of 1837 isolates representing 22% of all reported gonorrhea cases were analyzed. Nonsusceptibility to penicillin was established at baseline. Nonsusceptibility to tetracycline and ciprofloxacin increased over the study period, reaching 96% and 36%, respectively, in 2011. Sixteen isolates (1%) had a cefixime MIC of 0.25 μg/mL (none ≥0.5), none had a ceftriaxone MIC of 0.25 μg/mL or greater, and 15 (1%) had an azithromycin MIC of 2.0 μg/mL or greater. Elevated MIC of these agents showed an increasing trend over time. Nonsusceptibility and elevated MIC were consistently highest at the rectal and pharyngeal sites and higher in isolates from males, including when stratified to the pharyngeal site. INTERPRETATION Increases in elevated MIC of cefixime/ceftriaxone/azithromycin were superimposed on a background of established resistance to penicillin, tetracycline, and ciprofloxacin and may signal impending gonococcal resistance to first-line treatments. Ongoing surveillance will inform timely shifts in treatment recommendations.
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Dudareva-Vizule S, Haar K, Sailer A, Wisplinghoff H, Wisplinghoff F, Marcus U. Prevalence of pharyngeal and rectal Chlamydia trachomatis and Neisseria gonorrhoeae infections among men who have sex with men in Germany. Sex Transm Infect 2013; 90:46-51. [PMID: 23920398 DOI: 10.1136/sextrans-2012-050929] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the prevalence of pharyngeal and rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) in Germany and describe associations between these infections, sexual practices and other factors to provide an evidence base for screening recommendations. METHODS We conducted a cross-sectional study in 22 sentinel sites of sexually transmitted infections across Germany. Pharyngeal and rectal swabs were collected and tested for CT and NG with a nucleic acid amplification test (NAAT). Information on HIV status, number of sex partners and sexual practices was collected and linked to NAAT results. RESULTS Overall, 2247 MSM were screened for pharyngeal or rectal CT and NG infections; median age was 34 years (range 16-83). Prevalence of CT was 1.5% in pharyngeal and 8.0% in rectal specimens. Prevalence of NG was 5.5% in pharyngeal and 4.6% in rectal specimens. Local symptoms were reported in 5.1% of pharyngeal and 11.9% of rectal infections. Altogether 90.8% of rectal or pharyngeal infections would remain undetected if only symptomatic cases were tested. Rectal infection was significantly more likely in men reporting multiple partners (2-5 partners, OR=1.85; 6-10 partners, OR=2.10; >11 partners, OR=2.95), men diagnosed with HIV (OR=1.60) and men practising receptive anal intercourse without a condom (OR=1.54). Pharyngeal infection was more likely in men reporting multiple partners (6-10 partners, OR=2.88; >11 partners, OR=4.96), and men diagnosed with HIV (OR=1.78). CONCLUSIONS Pharyngeal and rectal infections in sexually active MSM can remain undetected and thus transmissible if swabbing is not offered routinely. Screening should be offered particularly to MSM diagnosed with HIV and MSM reporting multiple partners.
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Affiliation(s)
- Sandra Dudareva-Vizule
- HIV/AIDS, STI and Bloodborne Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, , Berlin, Germany
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Jiménez E, Pedrazuela MG, Pérez MM, de Mosteyrín SF, Arrieta JJ, Guerrero MLF. Prevalence of pharyngeal infection by Neisseria gonorrhoeae among human immunodeficiency virus-positive men who have sex with men in downtown Madrid, 2011. Int J STD AIDS 2013; 24:875-8. [DOI: 10.1177/0956462413486455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of pharyngeal gonorrhoea in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) is not entirely known. We cultured the pharynx of 264 asymptomatic HIV-positive MSM in downtown Madrid. A questionnaire on sexual and drug use risk behaviours was also administered. Gonococci were isolated in 25 (9.5%). Among the whole study population, 65% had a history of sexual intercourse with two or more partners on a single day and 26% were involved in group sex with other men. Only 29% regularly used condoms in all sexual encounters and 63% used condoms only in insertive anal intercourse. When asked about oral sex, 89% of patients engaged in insertive and/or receptive oral sex and 86% recognized that they did not regularly request the use of condoms when practising “ fellatio” on a partner. Cocaine, crystal methamphetamine or alcohol use and a previous history of ≥1 sexually transmitted infection were significantly more common among culture-positive patients. Gonococcal colonization of the pharynx was self-limited in patients that were not treated and re-cultured a mean 18.5 ± 5.2 days after diagnosis. Asymptomatic pharyngeal gonorrhoea is common among HIV-positive MSM and may contribute to the increasing epidemic of gonorrhoea in Madrid.
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Affiliation(s)
- Esther Jiménez
- Division of Infectious Diseases (Department of Internal Medicine) and the Services of Clinical Microbiology and Dentistry, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - María García Pedrazuela
- Division of Infectious Diseases (Department of Internal Medicine) and the Services of Clinical Microbiology and Dentistry, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Marta Martínez Pérez
- Division of Infectious Diseases (Department of Internal Medicine) and the Services of Clinical Microbiology and Dentistry, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Sol Fernández de Mosteyrín
- Division of Infectious Diseases (Department of Internal Medicine) and the Services of Clinical Microbiology and Dentistry, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Juan J Arrieta
- Division of Infectious Diseases (Department of Internal Medicine) and the Services of Clinical Microbiology and Dentistry, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Manuel L Fernández Guerrero
- Division of Infectious Diseases (Department of Internal Medicine) and the Services of Clinical Microbiology and Dentistry, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
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Mitchell M, Rane V, Fairley CK, Whiley DM, Bradshaw CS, Bissessor M, Chen MY. Sampling technique is important for optimal isolation of pharyngeal gonorrhoea. Sex Transm Infect 2013; 89:557-60. [DOI: 10.1136/sextrans-2013-051077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Standard Symptom- and Sexual History–Based Testing Misses Anorectal Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Swingers and Men Who Have Sex With Men. Sex Transm Dis 2013; 40:285-9. [DOI: 10.1097/olq.0b013e31828098f8] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barbee LA, Kerani RP, Dombrowski JC, Soge OO, Golden MR. A retrospective comparative study of 2-drug oral and intramuscular cephalosporin treatment regimens for pharyngeal gonorrhea. Clin Infect Dis 2013; 56:1539-45. [PMID: 23408680 DOI: 10.1093/cid/cit084] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention guidelines for pharyngeal gonorrhea treatment recommend dual therapy with intramuscular ceftriaxone and either azithromycin or doxycycline. Few clinical data exist to support this recommendation. METHODS We conducted a retrospective analysis of patients diagnosed with pharyngeal gonorrhea during 1993-2011, at a sexually transmitted disease clinic in Seattle, Washington, and compared the proportion of repeat positive tests for pharyngeal gonorrhea 7-180 days following treatment among persons receiving different drug regimens. Associations of treatment regimens were assessed using relative risks through Poisson regression models with log link and robust standard errors. RESULTS A total of 1440 cases of pharyngeal gonorrhea were diagnosed during the study period, 25% of which (n = 360) underwent retesting. Among retested patients, the risk of repeat positive test was lowest among persons receiving an oral cephalosporin and azithromycin (7%, reference group), and highest among those receiving an oral cephalosporin alone (30%; relative risk [RR], 3.98; 95% confidence interval [CI], 1.70-9.36) or in combination with doxycycline (33%; RR, 4.18; 95% CI, 1.64-10.7). The risk of repeat test positivity did not significantly differ between persons treated with an oral cephalosporin and azithromycin and those treated with ceftriaxone alone (9.1%; RR, 0.81; 95% CI, .18-3.60) or ceftriaxone combined with azithromycin or doxycycline (11.3%; RR, 1.20; 95% CI, .43-3.33). CONCLUSIONS In this retrospective study, dual therapy with an oral third-generation cephalosporin and azithromycin was comparable to ceftriaxone-based regimens in the treatment of pharyngeal gonorrhea. Combination oral therapy with doxycycline was associated with an elevated risk of persistent or recurrent infection.
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Affiliation(s)
- Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, WA 98104, USA.
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Koedijk FDH, van Bergen JEAM, Dukers-Muijrers NHTM, van Leeuwen AP, Hoebe CJPA, van der Sande MAB. The value of testing multiple anatomic sites for gonorrhoea and chlamydia in sexually transmitted infection centres in the Netherlands, 2006–2010. Int J STD AIDS 2012; 23:626-31. [DOI: 10.1258/ijsa.2012.011378] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
National surveillance data from 2006 to 2010 of the Dutch sexually transmitted infection (STI) centres were used to analyse current practices on testing extragenital sites for chlamydia and gonorrhoea in men who have sex with men (MSM) and women. In MSM, 76.0% and 88.9% were tested at least at one extragenital site (pharyngeal and/or anorectal) for chlamydia and gonorrhoea, respectively; for women this was 20.5% and 30.2%. Testing more than one anatomic site differed by STI centre, ranging from 2% to 100%. In MSM tested at multiple sites, 63.0% and 66.5% of chlamydia and gonorrhoea diagnoses, respectively, would have been missed if screened at the urogenital site only, mainly anorectal infections. For women tested at multiple sites, the proportions of missed chlamydia and gonorrhoea diagnoses would have been 12.9% and 30.0%, respectively. Testing extragenital sites appears warranted, due to the numerous infections that would have been missed. Adding anorectal screening to urogenital screening for all MSM visiting an STI centre should be recommended. Since actual testing practices differ by centre, there is a need for clearer guidelines. Routine gonorrhoea and chlamydia screening at multiple sites in STI centres should be investigated further as this might be a more effective approach to reduce transmission than current practice.
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Affiliation(s)
- F D H Koedijk
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven
| | - J E A M van Bergen
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven
- STI AIDS Netherlands, Amsterdam, Keizersgracht 392, 1016 GB Amsterdam
| | - N H T M Dukers-Muijrers
- Department of Infectious Diseases, Public Health Service South Limburg, PO Box 2022, 6160 HA Geleen
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), PO Box 5800, 6202 AZ Maastricht
| | - A P van Leeuwen
- Department of Infectious Diseases, Municipal Health Service Amsterdam, PO Box 2200, 1000 CE Amsterdam
| | - C J P A Hoebe
- Department of Infectious Diseases, Public Health Service South Limburg, PO Box 2022, 6160 HA Geleen
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), PO Box 5800, 6202 AZ Maastricht
| | - M A B van der Sande
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven
- Academic Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
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Stoltey JE, Barry PM. The use of cephalosporins for gonorrhea: an update on the rising problem of resistance. Expert Opin Pharmacother 2012; 13:1411-20. [PMID: 22646654 PMCID: PMC4079034 DOI: 10.1517/14656566.2012.690396] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Over the last several years, Neisseria gonorrhoeae has developed decreased susceptibility to extended-spectrum cephalosporins worldwide. Gonococcal antimicrobial surveillance programs in multiple regions have documented the rise in N. gonorrhoeae isolates' minimum inhibitory concentrations to cephalosporins, and the first cases of ceftriaxone treatment failure have been reported. These developments have prompted the use of the term 'superbug' and concerns about the emergence of untreatable gonococcal infections. AREAS COVERED Since the publication of the last detailed review of the use of cephalosporins for gonorrhea in 2009, several new developments have occurred, which are detailed in this review. A variety of treatment strategies have been proposed in response to this 'superbug' threat, including increasing the dose or providing multiple doses of cephalosporins, multidrug therapy, rotating therapeutic regimens and individualized treatment based on susceptibility testing. EXPERT OPINION A robust public health response is needed that includes better diagnosis and treatment of pharyngeal gonorrhea, improved surveillance of antimicrobial resistance, informed treatment approaches and reduction of the global burden of gonococcal infections.
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Affiliation(s)
- Juliet E Stoltey
- San Francisco Department of Public Health STD Prevention and Control Services, University of California-San Francisco, Division of Infectious Diseases, 513 Parnassus Avenue, Box 0654, San Francisco, CA 94143, USA.
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Heymans R, A Matser A, Bruisten SM, Heijman T, Geskus RB, Speksnijder AGCL, Davidovich U, de Vries HJC, Coutinho RA, Schim van der Loeff MF. Distinct Neisseria gonorrhoeae transmission networks among men who have sex with men in Amsterdam, The Netherlands. J Infect Dis 2012; 206:596-605. [PMID: 22693236 DOI: 10.1093/infdis/jis399] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Molecular typing was used to elucidate Neisseria gonorrhoeae transmission networks among men who have sex with men (MSM) in Amsterdam, the Netherlands. We determined whether clusters of patients infected with specific N. gonorrhoeae genotypes were related to various epidemiological characteristics. METHODS MSM (age ≥18 years) visiting the sexually transmitted infections (STI) clinic between July 2008 and August 2009 were eligible. After STI screening, participants completed a behavioral questionnaire concerning the previous 6 months. N. gonorrhoeae cultures were genotyped using multiple-locus variable-number tandem repeat analysis typing. RESULTS We obtained 278 N. gonorrhoeae-positive isolates from 240 MSM. Five large clusters (≥10 isolates), a unique sixth cluster (n = 9), and 8 smaller clusters (5-9 isolates) were identified. Prevalence of human immunodeficiency virus differed between clusters I and VI (P = .003), ranging from 27.8% to 100%. Receptive unprotected anal intercourse was frequently reported by MSM (51.8%) but did not differ significantly among clusters. Significant differences were identified concerning the participant's history of syphilis (P = .030), having met partners at a popular sex venue in Amsterdam (P = .048), and meeting partners outside Amsterdam (P = .036). CONCLUSIONS Distinct N. gonorrhoeae transmission networks were present in a mixed high-risk MSM population; concordance between clusters and epidemiological characteristics was present but not marked.
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Affiliation(s)
- Raymond Heymans
- Public Health Service (GGD) of Amsterdam, Cluster of Infectious Diseases, Department of Research, Postbox 2200, 1000 CE Amsterdam, The Netherlands
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Klein H. Felching among men who engage in barebacking (unprotected anal sex). ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:377-384. [PMID: 21573705 PMCID: PMC6124491 DOI: 10.1007/s10508-011-9770-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Revised: 05/28/2010] [Accepted: 02/05/2011] [Indexed: 05/30/2023]
Abstract
Felching (sucking or eating semen out of someone's anus) is a sexual behavior about which virtually nothing has been written in the scholarly literature, despite the fact that it appears to be a not-uncommon practice among certain subpopulations of men who have sex with men (MSM). This study examined three broad research questions: (1) How common is felching? (2) How does a desire for felching relate to other HIV risk practices and risk behavior preferences? (3) What factors are associated with the desire to engage in felching? The data were from a content analysis study of one of the largest Internet websites specifically targeting MSM looking for partners for unprotected sex. A total of 1,316 profiles on the site were analyzed and selected randomly based on users' ZIP codes. Felching was mentioned as a sought-after practice in approximately one-sixth of the men's profiles. Men who wanted to find felching partners were significantly more likely than those not searching for felching partners to seek other types of risky sex, including unprotected oral and unprotected anal sex, and various enhanced risk preferences (e.g., having sex while high, multiple-partner sex, unwillingness to withdraw the penis prior to internal ejaculation). Multivariate analysis revealed several factors that were related to an interest in identifying partners online for felching, including race/ethnicity, indifference to sex partners' HIV serostatus, several sensation-seeking measures (e.g., wanting "wild" or "uninhibited" sex, self-identification as a "bug chaser"), and eroticizing ejaculatory fluids.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, 401 Schuyler Road, Silver Spring, MD 20910, USA.
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Crosby RA, DiClemente RJ, Salazar LF, Nash R, Younge S, Head S. Human papillomavirus vaccine intention among college men: what's oral sex got to do with it? JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:8-12. [PMID: 22171724 DOI: 10.1080/07448481.2011.552538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To identify associations between engaging in oral sex and perceived risk of oral cancer among college men. Also, to identify associations, and their moderating factors, between oral sex and human papillomavirus (HPV) vaccine acceptance. METHODS Young men were recruited from 2 university campuses in the South (N = 150). Men completed an audio computer-assisted self-administered interview. RESULTS With the exception of receiving fellatio, each measure of oral sex behavior was significantly associated with greater perceived risk of oral cancer. Four oral sex behaviors evidenced significant associations with vaccine acceptance. Men engaging in recent oral sex or reporting oral sex behaviors with more than 2 partners were more likely to indicate vaccine intent. African American/black race, communication with parents about sex-related topics, and HPV-related stigma/shame were identified as moderating factors. CONCLUSION Young college men giving or receiving oral sex with multiple partners may be predisposed to HPV vaccination.
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Affiliation(s)
- Richard A Crosby
- College of Public Health and the Rural Cancer Prevention Center, University of Kentucky, Lexington, Kentucky, USA.
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Pinsky L, Chiarilli DB, Klausner JD, Kull RM, O'Keefe R, Heffer C, Seward SL. Rates of asymptomatic nonurethral gonorrhea and chlamydia in a population of university men who have sex with men. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:481-484. [PMID: 22857141 DOI: 10.1080/07448481.2012.690465] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The study determined prevalence of asymptomatic nonurethral gonorrhea and chlamydia in men who have sex with men (MSM) seen at the Columbia University Health Service for routine care. PARTICIPANTS The study enrolled 200 participants from March 2007 to May 2010. RESULTS Specimens were tested using culture and nucleic acid amplification testing (NAAT): 3.5% (n = 7) tested positive for pharyngeal gonorrhea by NAAT, none were positive by culture; 3% (n = 6) tested positive for rectal chlamydia by NAAT and 0.5% (n = 1) by culture. CONCLUSIONS The incidence of pharyngeal gonorrhea and rectal chlamydia in MSM who visited the Columbia Health Service was similar to rates of asymptomatic nonurethral gonorrhea and chlamydia in studies conducted in the MSM population in non-university settings. This suggests that, following the Centers for Disease Control and Prevention guidelines, 3-site testing for MSM seen at the Columbia clinic is indicated. NAAT is more sensitive than culture for nonurethral gonorrhea and chlamydia.
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Affiliation(s)
- Laura Pinsky
- Health Services, Columbia University, New York, New York 10027, USA.
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Evaluation of Self-Collected Versus Clinician-Collected Swabs for the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae Pharyngeal Infection Among Men Who Have Sex With Men. Sex Transm Dis 2011; 38:1036-9. [DOI: 10.1097/olq.0b013e318227713e] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW The present review discusses the recent finding on behavioral risk factors for HIV transmission from cohort studies in MSM. RECENT FINDINGS HIV incidence among MSM has been increasing in many countries around the world. Some data support early detection and widespread use of antiretroviral treatment (ART) to decrease HIV incidence. However, suboptimal ART adherence could lead to relapse of viremia and new transmission events. Condom use for unprotected anal sex among MSM remains an important prevention tool, but use remains low in many parts of the world. Seroadaptive behaviors by MSM, such as serosorting, may also decrease condom use. However, when serosorting is practiced by MSM who receive frequent HIV testing, the risk of HIV acquisition is reduced. Serosorting and other characteristics of sexual networks, such as concurrency, may be major determinants of transmission for HIV and sexually transmitted infections among MSM. Worldwide, detailed evaluation of the factors related to rising MSM HIV incidence, as well as access to testing and care, is limited by stigma and criminalization of HIV and homosexuality. SUMMARY Cohort studies of MSM remain an important strategy to characterize the behavioral factors that drive HIV transmission and how use of ART for prevention and treatment may affect both the risk of HIV transmission and acquisition by MSM.
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Wei C, Raymond HF, Wong FY, Silvestre AJ, Friedman MS, Documét P, McFarland W, Stall R. Lower HIV prevalence among Asian/Pacific Islander men who have sex with men: a critical review for possible reasons. AIDS Behav 2011; 15:535-49. [PMID: 21153049 DOI: 10.1007/s10461-010-9855-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We conducted a critical literature review for possible reasons that may explain the lower HIV prevalence observed among API MSM compared to MSM of other races/ethnicities. Trends emerging from the literature suggest that traditional individual-level factors-unprotected anal intercourse, substance use, STD prevalence, rates and frequency of HIV testing, and utilization of HIV prevention services-do not appear to be related to the lower HIV prevalence among API MSM. Some evidence suggests that socio-cultural and structural factors might be the more critical forces in determining racial/ethnic disparities of HIV among MSM. For API MSM, these factors include structures of sexual networks, access to and reception of medical care and treatment among HIV-positive MSM, and influences of different levels and types of acculturation. Moreover, emerging risk reduction strategies, such as seroadaptive behaviors, could play a role. Future research should address these factors in intervention design. In addition, better theories of resilience and measurement of strengths and protective factors are needed to enhance the efficacy of HIV interventions.
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Affiliation(s)
- Chongyi Wei
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
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Nagasawa Z, Ikeda-Dantsuji Y, Niwa T, Miyakoshi H, Nagayama A. Evaluation of APTIMA Combo 2 for cross-reactivity with oropharyngeal Neisseria species and other microorganisms. Clin Chim Acta 2010; 411:776-8. [PMID: 20138032 DOI: 10.1016/j.cca.2010.01.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 01/28/2010] [Accepted: 01/28/2010] [Indexed: 11/26/2022]
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Jakopanec I, Borgen K, Aavitsland P. The epidemiology of gonorrhoea in Norway, 1993-2007: past victories, future challenges. BMC Infect Dis 2009; 9:33. [PMID: 19298649 PMCID: PMC2666741 DOI: 10.1186/1471-2334-9-33] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 03/19/2009] [Indexed: 11/17/2022] Open
Abstract
Background Gonorrhoea, a bacterial infection caused by Neisseria gonorrhoeae, has been increasing in several European countries, particularly among men who have sex with men (MSM) and teenagers. We describe the epidemiology of gonorrhoea in Norway in the recent 15 years in order to guide recommendations on the diagnosis, treatment and prevention of gonorrhoea. An evaluation of the Norwegian Surveillance System for Communicable Diseases (MSIS) in 1994, involving GPs and microbiological laboratories, suggested that the system has a high coverage, capturing over 90% of patients diagnosed with gonorrhoea. Methods Using MSIS data on gonorrhoea cases we analysed specific trends by route of transmission, age, gender, anatomical sampling site, antimicrobial resistance and travel history from 1993–2007 and, to focus on more recent trends, from 2003–2007. MSM and heterosexual cases were defined by route of transmission. Results From 1993 to 2007, 3601 gonorrhoea cases were reported. MSM cases increased from 10 in 1994 to 109 cases in 2004. From 2003–2007, the incidence of gonorrhoea was 5.4/100,000 person-years (95%CI: 4.9–6.0). Over these five years, MSM accounted for an average of 80 cases per year, of which 69% were infected by casual partners. In the same period, 98% of heterosexually infected had a positive swab from urethra only and only two (0.3%) from the pharynx. Only one woman (0.5%) was positive from the rectum. From 1993 – 2007, antimicrobial resistance results were reported for 3325 N. gonorrhoeae isolates (98% of cultured samples). The proportion resistant to quinolone has risen from 3% in 1995 to 47% in 2007, with 81% of the latter isolated from patients infected in Asia. Conclusion The overall incidence of gonorrhoea in Norway remains low, but the increasing number of MSM cases calls for new, more effective approaches to prevention. Infections originating from abroad represent a constant risk of importing antimicrobial resistant N. gonorrhoeae. Due to the prevalence of quinolone resistant N. gonorrhoeae in Norway, third-generation cephalosporins should replace quinolones as the first choice in treatment guidelines. We advocate antimicrobial susceptibility testing for all cases and recommend taking samples for culture from all exposed anatomical sites.
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Affiliation(s)
- Irena Jakopanec
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway.
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88
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Barry PM, Klausner JD. The use of cephalosporins for gonorrhea: the impending problem of resistance. Expert Opin Pharmacother 2009; 10:555-77. [PMID: 19284360 PMCID: PMC2657229 DOI: 10.1517/14656560902731993] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gonorrhea remains an important clinical and public health problem throughout the world. Gonococcal infections have historically been diagnosed by Gram stain and culture but are increasingly diagnosed through nucleic acid tests, thereby eliminating the opportunity for antimicrobial susceptibility testing. Gonococcal infections are typically treated with single-dose therapy with an agent found to cure > 95% of cases. Unfortunately, the gonococcus has repeatedly developed resistance to antimicrobials including sulfonamides, penicillin, tetracyclines and fluoroquinolones. This has now left third-generation cephalosporins as the lone class of antimicrobials recommended as first-line therapy for gonorrhea in some regions. However, resistance to oral third-generation cephalosporins has emerged and spread in Asia, Australia and elsewhere. The mechanism of this resistance seems to be associated with a mosaic penicillin binding protein (penA) in addition to other chromosomal mutations previously found to confer resistance to beta-lactam antimicrobials (ponA, mtrR, penB, pilQ). Few good options exist or are in development for treating cephalosporin-resistant isolates, as most have had multidrug resistance. Preventing the spread of resistant isolates will depend on ambitious antimicrobial management programs, strengthening and expanding surveillance networks, and through effective sexually transmitted disease control and prevention.
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Affiliation(s)
- Pennan M Barry
- University of California San Francisco, San Francisco Department of Public Health, San Francisco, CA 94103, USA.
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89
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Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae oropharyngeal infections. J Clin Microbiol 2009; 47:902-7. [PMID: 19193848 DOI: 10.1128/jcm.01581-08] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The optimal methods for the diagnosis of pharyngeal Neisseria gonorrhoeae infection are uncertain. The objective of this study was to define the performance of culture and nucleic acid amplification tests (NAATs) for the diagnosis of pharyngeal N. gonorrhoeae. In this cross-sectional study, males and females >15 years old who acknowledged performing fellatio or cunnilingus (in the previous 2 months) were recruited from three clinics (two human immunodeficiency virus clinics and one sexually transmitted diseases clinic) located in Birmingham, AL. The test performance of culture for N. gonorrhoeae, the Gen-Probe Aptima Combo 2 transcription-mediated amplification assay (TMA), the BD ProbeTec ET amplified DNA strand displacement assay (SDA), and the Roche Cobas Amplicor PCR was defined by using a rotating "gold standard" of any positive results by two or three of the three tests that excluded the test being evaluated. A total of 961 evaluable test sets were collected. On the basis of a rotating gold standard of positive results by two of three comparator tests, the sensitivity and the specificity were as follows: culture for N. gonorrhoeae, 50.0% and 99.4%, respectively; PCR, 80.3% and 73.0%, respectively; TMA, 83.6% and 98.6%, respectively; and SDA, 93.2% and 96.3%, respectively. On the basis of a rotating gold standard of positive results by three of three comparator tests, the sensitivity and specificity were as follows: culture for N. gonorrhoeae, 65.4% and 99.0%, respectively; PCR, 91.9% and 71.8%, respectively; TMA, 100% and 96.2%, respectively; and SDA, 97.1% and 94.2%, respectively. In conclusion, currently available NAATs are more sensitive than culture for the detection of pharyngeal gonorrhea in at-risk patients. PCR is substantially less specific than culture, TMA, or SDA and should not be used for the detection of pharyngeal gonorrhea.
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90
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Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS 2009; 23:243-52. [PMID: 19098494 DOI: 10.1097/qad.0b013e32831fb51a] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A range of risk reduction behaviours in which homosexual men practise unprotected anal intercourse (UAI) has been described. We aimed to assess the extent of any reduction in HIV risk associated with these behaviours. DESIGN A prospective cohort study of HIV-negative homosexual men in Sydney, Australia. METHODS Men were followed up with 6-monthly detailed behavioural interviews and annual testing for HIV. The four risk reduction behaviours (behaviourally defined) examined were serosorting, negotiated safety, strategic positioning, and withdrawal during receptive UAI (UAI-R). RESULTS In 88% of follow-up periods in which UAI was reported, it occurred in the context of consistent risk reduction behaviours. Compared with those who reported no UAI, the risk of HIV infection was not raised in negotiated safety [hazard ratio = 1.67, 95% confidence interval (CI) 0.59-4.76] and strategic positioning (hazard ratio = 1.54, 95% CI 0.45-5.26). Serosorting outside negotiated safety was associated with an intermediate rate of HIV infection (hazard ratio = 3.11, 95% CI 1.09-8.88). Withdrawal was associated with a higher risk than no UAI (hazard ratio = 5.00, 95% CI 1.94-12.92). Patterns of UAI differed greatly according to partner's serostatus. Men who reported serosorting were less likely to report either strategic positioning or withdrawal. CONCLUSION Each behaviour examined was associated with an intermediate HIV incidence between the lowest and highest risk sexual behaviours. The inverse association between individual behaviours suggests that men who practise serosorting rely on this protection. The high prevalence of these behaviours demands that researchers address the contexts and risks associated with specific types of UAI.
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91
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Rosen T, Vandergriff T, Harting M. Antibiotic Use in Sexually Transmissible Diseases. Dermatol Clin 2009; 27:49-61. [DOI: 10.1016/j.det.2008.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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92
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Rieg G, Lewis RJ, Miller LG, Witt MD, Guerrero M, Daar ES. Asymptomatic sexually transmitted infections in HIV-infected men who have sex with men: prevalence, incidence, predictors, and screening strategies. AIDS Patient Care STDS 2008; 22:947-54. [PMID: 19072101 PMCID: PMC2929381 DOI: 10.1089/apc.2007.0240] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sexually transmitted infections (STIs) have increased among men who have sex with men (MSM) and are associated with unsafe sex practices, intrinsic morbidity, and enhanced genital shedding and transmission of HIV. Screening for asymptomatic STIs is recommended as part of the HIV prevention efforts, however, optimal screening strategies among HIV-infected MSM have not been well defined. In this study, conducted from April 2004 to September 2006, 212 HIV-infected MSM from two urban HIV clinics were screened for asymptomatic STIs. Testing for Neisseria gonorrhea and Chlamydia trachomatis from pharynx, rectum, and urine, as well as serologic testing for syphilis were performed initially, and then after 6 and 12 months. A self-administered questionnaire was used to assess possible predictors of incident asymptomatic STIs. A cost analysis was performed to assess different screening strategies for detecting incident STIs. The baseline prevalence of STIs was 14% (n = 29; 95% confidence interval [CI] 9%-19%) and the incidence of new infections was 20.8 cases per 100 person years (95% CI 14.8-28.4 cases per 100 person years). Younger age, higher CD4 cell count, and marijuana use were associated with increased risk of acquiring an asymptomatic STI. The laboratory cost to detect one positive STI did not significantly differ between once- and twice-yearly screening. However, almost half of all incident STIs were detected at the 6-month screening visit, potentially resulting in an increased duration of infectivity if these cases remained undiagnosed. In conclusion, prevalent and incident asymptomatic STIs are common among HIV-infected MSM. Our data support current Center for Disease Control and Prevention STI guidelines that recommend routine screening at increased frequency for HIV-infected MSM.
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Affiliation(s)
- Gunter Rieg
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California 90502, USA.
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93
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McNally L, Templeton D, Jin F, Grulich A, Donovan B, Whiley D, Cunningham P. Low Positive Predictive Value of a Nucleic Acid Amplification Test for NongenitalNeisseria gonorrhoeaeInfection in Homosexual Men. Clin Infect Dis 2008; 47:e25-7. [DOI: 10.1086/589299] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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94
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Nucleic Acid Amplification Tests in the Diagnosis of Chlamydial and Gonococcal Infections of the Oropharynx and Rectum in Men Who Have Sex With Men. Sex Transm Dis 2008; 35:637-42. [DOI: 10.1097/olq.0b013e31817bdd7e] [Citation(s) in RCA: 215] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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95
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Clinical Validation of a Real-Time Polymerase Chain Reaction Detection of Neisseria gonorrheae porA Pseudogene Versus Culture Techniques. Sex Transm Dis 2008; 35:517-20. [DOI: 10.1097/olq.0b013e3181644bc9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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96
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Now I Know My STDs Part II: Bacterial and Protozoal. J Nurse Pract 2008. [DOI: 10.1016/j.nurpra.2008.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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97
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Abstract
Acute pharyngitis is one of the most common illnesses for which patients visit primary care physicians. Most cases are of viral origin, and with few exceptions these illnesses are both benign and self-limited. The most important bacterial cause is the beta-hemolytic group A streptococcus. There are other uncommon or rare types of pharyngitis. For some of these treatment is required or available, and some may be life threatening. Among those discussed in this article are diphtheria, gonorrhea, HIV infection, peritonsillar abscess, and epiglottitis.
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Affiliation(s)
- Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, 090-A Dominion Tower #812, Miami, FL 33136, USA
- Medical Service, Infectious Diseases Section (111-1), Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125, USA
| | - Alan L. Bisno
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, 090-A Dominion Tower #812, Miami, FL 33136, USA
- Medical Service (111), Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125, USA
- Corresponding author. Medical Service (111), Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125.
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