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Elgalib A, Alexander S, Tong CYW, White JA. Seven days of doxycycline is an effective treatment for asymptomatic rectal Chlamydia trachomatis infection. Int J STD AIDS 2011; 22:474-7. [DOI: 10.1258/ijsa.2011.011134] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There are no evidence-based guidelines for the specific management of rectal Chlamydia trachomatis (CT) infection. All men who have sex with men (MSM) diagnosed with asymptomatic rectal CT by nucleic acid amplification test (NAAT) at a large London genitourinary (GU) medicine clinic between September 2006 and September 2009 were offered oral doxycycline 100 mg twice daily for seven days and invited for a test of cure (TOC) by CT NAAT four weeks after treatment. A total of 487 asymptomatic rectal CT infections were diagnosed and analysis was restricted to 165 TOCs from men whose only treatment had been doxycycline for seven days. The median time post-treatment for TOC was 45 days (interquartile range [IQR], 34–88). Only two patients tested CT-positive at follow-up. One had taken doxycycline only for three days; the other attended for TOC 240 days after the completion of doxycycline treatment and at this time presented with new symptoms in the context of ongoing high sexual risk. Our findings show that doxycycline 100 mg twice daily for seven days is highly effective treatment for asymptomatic rectal CT infection, achieving clearance of CT in 98.8% (163/165; 95% CI 95.4–99.9%) of cases. We advocate doxycycline for seven days as first-line therapy for asymptomatic rectal CT.
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Affiliation(s)
- A Elgalib
- Department of Genitourinary Medicine, Guy's and St Thomas' Hospitals NHS Foundation Trust
| | - S Alexander
- Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency
| | - C Y W Tong
- Department of Infection, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - J A White
- Department of Genitourinary Medicine, Guy's and St Thomas' Hospitals NHS Foundation Trust
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152
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Peters RPH, Verweij SP, Nijsten N, Ouburg S, Mutsaers J, Jansen CL, van Leeuwen AP, Morré SA. Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice. BMC Infect Dis 2011; 11:203. [PMID: 21791061 PMCID: PMC3162902 DOI: 10.1186/1471-2334-11-203] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 07/26/2011] [Indexed: 11/28/2022] Open
Abstract
Background Sexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae has a prominent role in these protocols. Most of the screening programmes concerning men having sex with men (MSM) are based on opportunistic urethral testing. In The Netherlands, a history-based approach is used. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands. Methods All MSM visiting the clinic for STI in The Hague are routinely asked about their sexual practice during consulting. As per protocol, tests for urogenital, oropharyngeal and anorectal infection are obtained based on reported site(s) of sexual contact. All consultations are entered into a database as part of the national STI monitoring system. Data of an 18 months period were retrieved from this database and analysed. Results A total of 1455 consultations in MSM were registered during the study period. The prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol. Conclusions The current strategy of sexual-history based screening of multiple anatomic sites for chlamydia and gonorrhoea in MSM is a useful and valid guideline which is to be preferred over a symptom-based screening protocol.
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Affiliation(s)
- Remco P H Peters
- The Hague Municipal Health Services, STI clinic, The Hague, The Netherlands.
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153
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Walker CK, Sweet RL. Gonorrhea infection in women: prevalence, effects, screening, and management. Int J Womens Health 2011; 3:197-206. [PMID: 21845064 PMCID: PMC3150204 DOI: 10.2147/ijwh.s13427] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Indexed: 12/02/2022] Open
Abstract
Gonorrhea is a set of clinical conditions resulting from infection with the sexually-acquired bacterial pathogen Neisseria gonorrhoeae. Acquisition may involve multiple mucosal sites in the lower female genital tract, including the urethra, cervix, Bartholin’s and Skene’s glands, as well as the anorectal canal, pharynx, and conjunctivae. It may spread to the upper genital tract, uterine tubes, abdominal cavity, and other systemic sites. Gonorrhea is the second most commonly reported sexually-transmitted infection in the US and rates are higher among women than men. Women and infants are affected disproportionately by gonorrhea, because early infection may be asymptomatic and also because extension of infection is often associated with serious sequelae. Screening is critical for infection identification and the prevention or limitation of upper genital tract spread, and horizontal and vertical transmission. Routine genital screening is recommended annually for all sexually active women at risk for infection, including women aged < 25 years and older women with one or more of the following risks: a previous gonorrhea infection, the presence of other sexually transmitted diseases, new or multiple sex partners, inconsistent condom use, commercial sex work, drug use, or human immunodeficiency virus infection with sexual activity or pregnancy. Pharyngeal gonococcal infections are common in adolescents, and direct culture screening is necessary to identify affected individuals. Nucleic acid amplification tests (NAATs) are considered the standard for screening and diagnosis. Although urine NAAT testing is most commonly used, there is growing support for vaginal swabs collected by providers or patients themselves. Resistance to all antibiotics currently recommended for the treatment of gonorrhea has been documented and complicates therapeutic strategies. The Centers for Disease Control and Prevention recommend treatment of gonorrhea with a single class of drugs, ie, the cephalosporins.
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Affiliation(s)
- Cheryl K Walker
- Women's Center for Health, Department of Obstetrics and Gynecology, University of California, Davis School of Medicine, Sacramento, CA, USA
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154
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Fairley CK, Chen MY, Bradshaw CS, Tabrizi SN. Is it time to move to nucleic acid amplification tests screening for pharyngeal and rectal gonorrhoea in men who have sex with men to improve gonorrhoea control? Sex Health 2011; 8:9-11. [PMID: 21371376 DOI: 10.1071/sh10134] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/07/2010] [Indexed: 11/23/2022]
Abstract
The use of nucleic acid amplification tests (NAAT), as well as or in preference to culture for non-genital sites is now recommended both in Australia and overseas because of their greater sensitivity and improved specificity. A survey of 22 Australian sexual health clinics who each year test over 14500 men who have sex with men (MSM) show that culture remains the predominate method for detecting gonorrhoea at pharyngeal (64%) and rectal (73%) sites. This editorial discusses the potential disadvantages of using culture over NAAT in relation to optimal gonorrhoea control among MSM and advocates that significantly improved control would be achieved by moving to NAAT with the proviso that culture samples are taken wherever possible on NAAT-positive samples and from clients with urethritis to ensure continued surveillance for antimicrobial resistance.
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155
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Harkins AL, Munson E. Molecular Diagnosis of Sexually Transmitted Chlamydia trachomatis in the United States. ISRN OBSTETRICS AND GYNECOLOGY 2011; 2011:279149. [PMID: 21822498 PMCID: PMC3148448 DOI: 10.5402/2011/279149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 04/27/2011] [Indexed: 12/03/2022]
Abstract
Chlamydia, with its Chlamydia trachomatis etiology, is the most common bacterial sexually transmitted infection in the United States and is often transmitted via asymptomatic individuals. This review summarizes traditional and molecular-based diagnostic modalities specific to C. trachomatis. Several commercially available, FDA-approved molecular methods to diagnose urogenital C. trachomatis infection include nucleic acid hybridization, signal amplification, polymerase chain reaction, strand displacement amplification, and transcription-mediated amplification. Molecular-based methods are rapid and reliable genital specimen screening measures, especially when applied to areas of high disease prevalence. However, clinical and analytical sensitivity for some commercial systems decreases dramatically when testing urine samples. In vitro experiments and clinical data suggest that transcription-mediated amplification has greater analytical sensitivity than the other molecular-based methods currently available. This difference may be further exhibited in testing of extragenital specimens from at-risk patient demographics. The development of future molecular testing could address conundrums associated with confirmatory testing, medicolegal testing, and test of cure.
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Affiliation(s)
- April L Harkins
- Department of Clinical Laboratory Science, Marquette University, Milwaukee, WI 53233, USA
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156
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Molecular Detection of
Chlamydia trachomatis
and
Neisseria gonorrhoeae. Mol Microbiol 2011. [DOI: 10.1128/9781555816834.ch24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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157
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Lanjouw E, Ossewaarde JM, Stary A, Boag F, van der Meijden WI. 2010 European guideline for the management of Chlamydia trachomatis infections. Int J STD AIDS 2011; 21:729-37. [PMID: 21187352 DOI: 10.1258/ijsa.2010.010302] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This guideline aims to provide comprehensive information regarding the management of infections caused by Chlamydia trachomatis in European countries. The recommendations contain important information for physicians and laboratory staff working with sexually transmitted infections (STIs) and/or STI-related issues. Individual European countries may be required to make minor national adjustments to this guideline as some of the tests or specific local data may not be accessible, or because of specific laws.
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus MC, Rotterdam, Netherlands.
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158
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Abstract
BACKGROUND National guidelines for the care of human immunodeficiency virus (HIV)-infected persons recommend asymptomatic routine screening for sexually transmitted diseases (STDs). Our objective was to determine whether providers who care for HIV-infected men who have sex with men (MSM) followed these guidelines. METHODS We abstracted medical records to evaluate STD screening at 8 large HIV clinics in 6 US cities. We estimated the number of men who had at least one test for syphilis, chlamydia (urethral and/or rectal), or gonorrhea (urethral, rectal, and/or pharyngeal) in 2004, 2005, and 2006. Urethral testing included nucleic acid amplification tests of both urethral swabs and urine. We also calculated the positivity of syphilis, chlamydia, and gonorrhea among screened men. RESULTS Medical records were abstracted for 1334 HIV-infected MSM who made 14,659 visits from 2004-2006. The annual screening rate for syphilis ranged from 66.0% to 75.8% during 2004-2006. Rectal chlamydia and rectal and pharyngeal gonorrhea annual screening rates ranged from 2.3% to 8.5% despite moderate to high positivity among specimens from asymptomatic patients (3.0%-9.8%) during this period. Annual urethral chlamydia and gonorrhea screening rates were higher than rates for nonurethral sites, but were suboptimal, and ranged from 13.8% to 18.3%. CONCLUSIONS Most asymptomatic HIV-infected MSM were screened for syphilis, indicating good provider adherence to this screening guideline. Low screening rates for gonorrhea and chlamydia, especially at rectal and pharyngeal sites, suggest that substantial barriers exist for complying with these guidelines. The moderate to high prevalence of asymptomatic chlamydial and gonococcal infections underscores the importance of screening. A range of clinical quality improvement interventions are needed to increase screening, including increasing the awareness of nucleic acid amplification tests for nonurethral screening.
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159
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Aptima Combo 2 testing detected additional cases of Neisseria gonorrhoeae infection in men and women in community settings. J Clin Microbiol 2011; 49:1970-1. [PMID: 21411585 DOI: 10.1128/jcm.02062-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aptima Combo 2 (AC2) Neisseria gonorrhoeae testing of 81,405 patients who were tested by culture and 14,666 who were AC2 tested for Chlamydia trachomatis detected 142 extra infections and confirmed 106 culture-positive samples (the positivity rate increased from 0.13 in testing by culture to 0.26 in testing by AC2). Retrievable AC2 positive samples were confirmed (98.5%) by an alternate AGC test.
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160
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Fresse AS, Sueur JM, Hamdad F. Diagnosis and follow-up of genital chlamydial infection by direct methods and by detection of serum IgG, IgA and secretory IgA. Indian J Med Microbiol 2011; 28:326-31. [PMID: 20966563 DOI: 10.4103/0255-0857.71823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine the prevalence of Chlamydia trachomatis infection in a high-risk population by direct and indirect methods and to evaluate the diagnosis of secretory immunoglobulin A (sIgA). PATIENTS AND METHODS Urethral or endocervical specimens from 78 patients (48 females and 30 males) were examined by cell culture, direct fluorescence assay, PCR Cobas Amplicor (Roche Molecular Diagnostics), and sIgA was detected by the recombinant lipopolysaccharide (LPS)-enzyme-linked immunoassay (rELISA). Serum from each patient was also obtained and analysed for the presence of IgG and IgA antibody by in-house microimmunofluorescence (MIF) and by the rELISA method (Medac, Hamburg, Germany). RESULTS The overall C. trachomatis prevalence determined by direct methods was 28%. The detection of sIgA antibodies was significantly higher in the group of patients with a positive direct detection (50%) than in the group of negative direct detection (10.7%). The Chlamydia-specific IgA antibodies were detected by the rELISA in 40.9 and 53.6% of group I (positive direct detection) and group II patients (negative direct detection), respectively. The species-specific IgA antibodies were detected by the MIF method in 18.2 and 16.1% of group I and II patients, respectively. Chlamydia genus-specific IgG antibodies were detected by the rELISA in 86.4 and 83.9% of group I and group II patients and, C. trachomatis specific IgG were present in 81.8 and 73.2% of group I and group II patients, respectively, as assessed by the MIF test. CONCLUSION Combining the positive direct methods and/or positive sIgA antibody results from cervical or urethral specimens had an indication of current C. trachomatis infection.
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Affiliation(s)
- A S Fresse
- Departmental Laboratory of Picardie, Amiens University Hospital, France
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161
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Karlsson A, Österlund A, Forssén A. Pharyngeal Chlamydia trachomatis is not uncommon any more. ACTA ACUST UNITED AC 2011; 43:344-8. [DOI: 10.3109/00365548.2011.553243] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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162
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TANO EVA, MELHUS ÅSA. Evaluation of three swab transport systems for the maintenance of clinically important bacteria in simulated mono- and polymicrobial samples. APMIS 2011; 119:198-203. [DOI: 10.1111/j.1600-0463.2010.02710.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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163
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Walsh A, Rourke FO, Crowley B. Molecular detection and confirmation of Neisseria gonorrhoeae in urogenital and extragenital specimens using the Abbott CT/NG RealTime assay and an in-house assay targeting the porA pseudogene. Eur J Clin Microbiol Infect Dis 2010; 30:561-7. [DOI: 10.1007/s10096-010-1120-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 11/13/2010] [Indexed: 11/25/2022]
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164
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Abstract
There are few documented reports of antibiotic resistance in Chlamydia and no examples of natural and stable antibiotic resistance in strains collected from humans. While there are several reports of clinical isolates exhibiting resistance to antibiotics, these strains either lost their resistance phenotype in vitro, or lost viability altogether. Differences in procedures for chlamydial culture in the laboratory, low recovery rates of clinical isolates and the unknown significance of heterotypic resistance observed in culture may interfere with the recognition and interpretation of antibiotic resistance. Although antibiotic resistance has not emerged in chlamydiae pathogenic to humans, several lines of evidence suggest they are capable of expressing significant resistant phenotypes. The adept ability of chlamydiae to evolve to antibiotic resistance in vitro is demonstrated by contemporary examples of mutagenesis, recombination and genetic transformation. The isolation of tetracycline-resistant Chlamydia suis strains from pigs also emphasizes their adaptive ability to acquire antibiotic resistance genes when exposed to significant selective pressure.
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Affiliation(s)
- Kelsi M Sandoz
- Molecular & Cellular Biology Program & the Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331–4804, USA
| | - Daniel D Rockey
- Molecular & Cellular Biology Program & the Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331–4804, USA
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165
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166
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Benzie A, Alexander S, Gill N, Greene L, Thomas S, Ison C. Gonococcal NAATs: what is the current state of play in England and Wales? Int J STD AIDS 2010; 21:246-8. [PMID: 20378894 DOI: 10.1258/ijsa.2010.010004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to determine how widespread the use is of dual nucleic acid amplification tests (NAATs) for the diagnosis of both Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in England and Wales. A structured telephone questionnaire was used to collect information on the method of dual testing used by laboratories, the patient groups tested, the types of specimens obtained and the use of GC culture. Of the 108 laboratories participating, 29% performed dual CT and GC NAAT assays. The platforms used included: (i) BD Probetec (19/31), (ii) Aptima Combo 2 (9/31) and (iii) COBAS AMPLICOR (2/31). GC-positive specimens were either repeated using the same test (21) or an alternative target (9). Most laboratories confirmed positive GC NAATs by performing culture (26/31). Laboratories performed dual NAAT testing on specimens sourced from both community and genitourinary medicine clinic settings, and on a wide variety of different specimen types. This survey highlights a lack of consistency in the current use of dual NAAT platforms in the UK and the need for national guidelines.
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Affiliation(s)
- A Benzie
- Department of Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
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167
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Hammerschlag MR, Guillén CD. Medical and legal implications of testing for sexually transmitted infections in children. Clin Microbiol Rev 2010; 23:493-506. [PMID: 20610820 PMCID: PMC2901660 DOI: 10.1128/cmr.00024-09] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Testing for sexually transmitted infections (STIs) in children presents a number of problems for the practitioner that are not usually faced when testing adults for the same infections. The identification of an STI in a child can have, in addition to medical implications, serious legal implications. The presence of an STI is often used to support the presence or allegations of sexual abuse, and conversely, the identification of an STI in a child will prompt an investigation of possible abuse. The purpose of this paper is to review the epidemiology of child sexual abuse, including the epidemiology of major STIs including Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, herpes simplex virus (HSV), Trichomonas vaginalis, and human papillomavirus, and the current recommendations for diagnostic testing in this population.
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Affiliation(s)
- Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203-2098, USA.
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168
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169
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Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections. J Clin Microbiol 2010; 48:1827-32. [PMID: 20335410 DOI: 10.1128/jcm.02398-09] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It is uncertain which methods for the diagnosis of rectal gonococcal and chlamydial infection are optimal. This study evaluated the performance of culture and nucleic acid amplification tests (NAATs) for rectal chlamydial and gonococcal diagnosis. From July 2003 until February 2007, 441 rectal test sets were collected from individuals attending a sexually transmitted disease clinic and three HIV clinics who gave a history of anal intercourse or were women at high risk for Neisseria gonorrhoeae or Chlamydia trachomatis infections. Rectal swab specimens were tested using culture and commercial NAATs employing transcription-mediated amplification (TMA), strand displacement amplification (SDA), and PCR amplification. Test performance was evaluated using a rotating standard by which patients were classified as infected if either two or three comparator tests were positive. Test sensitivities for the detection of N. gonorrhoeae ranged from 66.7% to 71.9% for culture to 100% for TMA. Specificities were 99.7% to 100% for culture and greater than 95.5% for all three NAATs. Test sensitivities for C. trachomatis ranged from 36.1% to 45.7% for culture and among NAATS from 91.4% to 95.8% for PCR to 100% for TMA. Specificities of the NAATs ranged from 95.6% to 98.5% (two-of-three standard) and from 88.8% to 91.8% (three-of-three standard). Over 60% and 80% of gonococcal and chlamydial infections, respectively, among men who have sex with men and over 20% of chlamydial infections in women would have been missed if the rectal site had not been tested. Currently available NAATs are more sensitive for the detection of chlamydial and gonococcal infection at the rectal site than is culture.
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170
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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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171
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Sentinel Surveillance of Rectal Chlamydia and Gonorrhea Among Males—San Francisco, 2005–2008. Sex Transm Dis 2010; 37:59-61. [DOI: 10.1097/olq.0b013e3181b76c42] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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172
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Cachay ER, Sitapati A, Caperna J, Freeborn K, Lonergan JT, Jocson E, Mathews WC. Denial of risk behavior does not exclude asymptomatic anorectal sexually transmitted infection in HIV-infected men. PLoS One 2009; 4:e8504. [PMID: 20041143 PMCID: PMC2794382 DOI: 10.1371/journal.pone.0008504] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 11/23/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Centers for Disease Control recommend screening for asymptomatic sexually transmitted infection (STI) among HIV-infected men when there is self-report of unprotected anal-receptive exposure. The study goals were: (1) to estimate the validity and usefulness for screening policies of self-reported unprotected anal-receptive exposure as a risk indicator for asymptomatic anorectal infection with Neisseria gonorrhoeae (GC) and/or Chlamydia trachomatis (CT). (2) to estimate the number of infections that would be missed if anal diagnostic assays were not performed among patients who denied unprotected anorectal exposure in the preceding month. METHODS AND FINDINGS Retrospective analysis in HIV primary care and high resolution anoscopy (HRA) clinics. HIV-infected adult men were screened for self-reported exposure during the previous month at all primary care and HRA appointments. Four sub-cohorts were defined based on microbiology methodology (GC culture and CT direct fluorescent antibody vs. GC/CT nucleic acid amplification test) and clinical setting (primary care vs. HRA). Screening question operating characteristics were estimated using contingency table methods and then pooled across subcohorts. Among 803 patients, the prevalence of anorectal GC/CT varied from 3.5-20.1% in the 4 sub-cohorts. The sensitivity of the screening question for self-reported exposure to predict anorectal STI was higher in the primary care than in the HRA clinic, 86-100% vs. 12-35%, respectively. The negative predictive value of the screening question to predict asymptomatic anorectal STI was > or = 90% in all sub-cohorts. In sensitivity analyses, the probability of being an unidentified case among those denying exposure increased from 0.4-8.1% in the primary care setting, and from 0.9-18.8% in the HRA setting as the prevalence varied from 1-20%. CONCLUSION As STI prevalence increases, denial of unprotected anal-receptive exposure leads to an increasingly unacceptable proportion of unidentified asymptomatic anorectal STI if used as a criterion not to obtain microbiologic assays.
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Affiliation(s)
- Edward R. Cachay
- School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Amy Sitapati
- School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Joseph Caperna
- School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Kellie Freeborn
- School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Joseph T. Lonergan
- School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Edward Jocson
- School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - William C. Mathews
- School of Medicine, University of California San Diego, San Diego, California, United States of America
- * E-mail:
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Shipitsyna E, Zolotoverkhaya E, Hjelmevoll SO, Maximova A, Savicheva A, Sokolovsky E, Skogen V, Domeika M, Unemo M. Evaluation of six nucleic acid amplification tests used for diagnosis ofNeisseria gonorrhoeaein Russia compared with an international strictly validated real-timeporApseudogene polymerase chain reaction. J Eur Acad Dermatol Venereol 2009; 23:1246-53. [DOI: 10.1111/j.1468-3083.2009.03290.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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174
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Ng SC, Gazzard B. Advances in sexually transmitted infections of the gastrointestinal tract. Nat Rev Gastroenterol Hepatol 2009; 6:592-607. [PMID: 19707179 DOI: 10.1038/nrgastro.2009.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The gastrointestinal mucosa is a target of many sexually transmitted infections, and major advances have increased our understanding of the consequences of such infections within the gastrointestinal system. HIV-1 is associated with a marked loss of mucosal CD4(+) T cells that express CC-chemokine receptor 5. This process seems to be more rapid and more severe in mucosa-associated lymphoid tissue than in the peripheral blood. Mechanistic insights into the underlying cause of acute and chronic gastrointestinal damage with HIV infection-microbial translocation, defects in intestinal epithelial barrier function and activation of a systemic immune response-have also been achieved. Increased understanding of the pathogenesis of mucosal HIV-1 infection may identify therapeutic targets to restore immunological function and the integrity of the intestinal mucosal epithelial barrier. The increasing prevalence of lymphogranuloma venereum in Europe, mostly in HIV-positive men who have sex with men, suggests a change in the epidemiology of what was previously considered to be a 'tropical' disease. The increasing incidence of acute HCV infection transmitted via sexual contact has also been fueled by high-risk sexual behaviors among men who have sex with men, many of whom are also HIV-positive. The first part of this Review discusses the pathogenesis and gastrointestinal complications of HIV infection, and the second part summarizes advances in our understanding of other sexually transmitted infections of the gastrointestinal system.
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Affiliation(s)
- Siew C Ng
- Department of Gastroenterology, Chelsea and Westminster Hospital, London, UK
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175
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High Performance and Acceptability of Self-Collected Rectal Swabs for Diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in Men Who Have Sex With Men and Women. Sex Transm Dis 2009; 36:493-7. [DOI: 10.1097/olq.0b013e3181a44b8c] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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176
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Baker J, Plankey M, Josayma Y, Elion R, Chiliade P, Shahkolahi A, Menna M, Miniter K, Slack R, Yang Y, Masterman B, Margolick JB. The prevalence of rectal, urethral, and pharyngeal Neisseria gonorrheae and Chlamydia trachomatis among asymptomatic men who have sex with men in a prospective cohort in Washington, D.C. AIDS Patient Care STDS 2009; 23:585-8. [PMID: 19591608 DOI: 10.1089/apc.2008.0277] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Max Menna
- Whitman Walker Clinic, Washington, D.C
| | | | - Rebecca Slack
- Georgetown University Medical Center, Washington, D.C
| | - Yang Yang
- Georgetown University Medical Center, Washington, D.C
| | | | - Joseph B. Margolick
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Munson E, Firmani MA. Molecular diagnosis ofNeisseria gonorrhoeaeinfection in the United States. ACTA ACUST UNITED AC 2009; 3:327-43. [DOI: 10.1517/17530050902860229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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178
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Evaluation of self-collected glans and rectal swabs from men who have sex with men for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of nucleic acid amplification tests. J Clin Microbiol 2009; 47:1657-62. [PMID: 19369445 DOI: 10.1128/jcm.02269-08] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Self-collected glans and rectal swab specimens from men who have sex with men (MSM) may be appropriate, convenient specimens for testing. We evaluated the use of self-collected swabs for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae by a transcription-mediated amplification test (AC2; Aptima Combo 2; Gen-Probe Inc.) and a strand displacement amplification test (SDA; ProbeTec; Becton Dickinson Co.) in MSM seen at the city sexually transmitted disease clinic in San Francisco, CA. For the glans swab specimen, subjects enrolled early in the study rolled a Dacron swab across the meatus three times (method 1). A slightly more invasive procedure was performed later in the study: the subjects inserted the swab 1/4 in. into the urethra, rotated the swab, and then withdrew the swab (method 2). MSM self-collected a rectal swab specimen and also provided first-catch urine (FCU). Additional rectal swab samples were then obtained by the clinician. For the detection of C. trachomatis and N. gonorrhoeae, all swabs were evaluated by AC2 and SDA, FCU was tested by AC2, and the clinician-collected rectal swabs were cultured. A rectal true-positive (TP) result was defined as a culture-positive result for C. trachomatis or N. gonorrhoeae, two or more positive nucleic acid amplification test (NAAT) results, or a single NAAT-positive result confirmed by an alternate amplification method (the Aptima C. trachomatis or N. gonorrhoeae test). A glans TP result was defined as a positive result for FCU, positive results for both glans specimens (one tested by AC2 and one tested by SDA), or a positive result for a single glans specimen confirmed by an alternate amplification method. The prevalence rates of C. trachomatis and N. gonorrhoeae by testing of FCU were 6.8% (60/882 specimens) and 12.2% (108/882 specimens), respectively. Mixed results were obtained with the glans swab: N. gonorrhoeae detection by AC2 and SDA (method 1) had the best performance (sensitivities, >92%) with samples from a population with a higher prevalence of infection, but their performance for the detection of C. trachomatis was poor and varied by collection method (sensitivities, 56 to 68%). The prevalence rates of C. trachomatis and N. gonorrhoeae in the rectum were 7.3% (66/907 specimens) and 9.4% (83/882 specimens), respectively. The sensitivities of the tests with self-collected and clinician-collected rectal swab specimens were comparable (for C. trachomatis, 41% and 44%, respectively, by SDA and 82% and 71%, respectively, by AC2; for N. gonorrhoeae, 77% and 68%, respectively, by SDA and 84% and 78%, respectively, by AC2). AC2 and SDA were far superior to culture for the detection of C. trachomatis and N. gonorrhoeae in the rectum, with both tests detecting at least twice as many infections. While we found self-collected rectal swabs from MSM to be valid specimens for testing, the sensitivities of the tests with glans swab specimens were disappointing except for those from patients with symptomatic N. gonorrhoeae infections. Self-collected glans swab specimens may not be appropriate for the detection of C. trachomatis or for the detection of N. gonorrhoeae in low-risk or asymptomatic patients by AC2 and SDA, and we would not recommend their use on the basis of our results. Further studies are needed.
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Davis TW, Goldstone SE. Sexually transmitted infections as a cause of proctitis in men who have sex with men. Dis Colon Rectum 2009; 52:507-12. [PMID: 19333054 DOI: 10.1007/dcr.0b013e31819ad537] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Many men who have sex with men (MSM) present with complaints of bleeding, pain, and inflammation. We endeavored to determine the incidence of sexually transmitted infections in MSM referred for treatment of these symptoms and the effect of empiric therapy. METHODS A retrospective chart review of all MSM seen in 2007 at one surgical practice diagnosed with presumptive proctitis was performed. All MSM are routinely tested for sexually transmitted infections. RESULTS Twenty-six MSM were identified (mean age, 38 years), and 17 (65 percent) were HIV+. Bleeding and pain were the most common complaints seen in 19 (73 percent) and 16 (62 percent), respectively. The most common findings were discharge in 15 (58 percent) and blood in 14 (54 percent). Sexually transmitted infections were identified in 21 (86 percent) and 3 (11 percent) had unidentified etiology. Gonorrhea was found in eight (43 percent), herpes simplex virus in six (29 percent), lymphogranuloma venereum in four (19 percent), and two each (10 percent) had Chlamydia and syphilis. Three had multiple infections. All but two treated empirically responded without complication and they had Crohn's colitis (n = 1) and rectal lymphoma (n = 1). CONCLUSIONS Sexually transmitted infections are a common cause of proctitis and appropriate testing is imperative. Lymphogranuloma venereum is a common cause. Empiric treatment leads to rapid resolution and diminishes the chance for spread.
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Affiliation(s)
- Tony W Davis
- Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA
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180
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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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Buchacz K, Rangel M, Blacher R, Brooks JT. Changes in the clinical epidemiology of HIV infection in the United States: Implications for the clinician. Curr Infect Dis Rep 2008; 11:75-83. [DOI: 10.1007/s11908-009-0011-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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183
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Takahashi S, Kurimura Y, Hashimoto J, Takeyama K, Tsukamoto T, Koroku M, Tanda H, Nishimura M. Pharyngeal Neisseria gonorrhoeae detection in oral-throat wash specimens of male patients with urethritis. J Infect Chemother 2008; 14:442-4. [DOI: 10.1007/s10156-008-0649-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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