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Olivas J, Nogueira C, Helble J, Starnbach MN. Cytotoxic CD4+ T Cells Are Induced during Infection with Chlamydia trachomatis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2024; 213:328-338. [PMID: 38905023 PMCID: PMC11279525 DOI: 10.4049/jimmunol.2300131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/29/2024] [Indexed: 06/23/2024]
Abstract
Chlamydia trachomatis is the most common cause of bacterial sexually transmitted infection in both men and women. Immunity to C. trachomatis involves many cell types, but CD4+ T cells play a key role in protecting the host during natural infection. Specifically, IFN-γ production by CD4+ T cells is the main effector responsible for bacterial clearance, yet the exact mechanism by which IFN-γ confers protection is poorly defined. In our efforts to define the specific mechanisms for bacterial clearance, we now show that IFN-γ upregulates expression of MHC class II (MHCII) on nonhematopoietic cells during C. trachomatis infection in vivo. We also find that MHCII expression on epithelial cells of the upper genital tract contributes to the efficient clearance of bacteria mediated by pathogen-specific CD4+ Th1 cells. As we further cataloged the protective mechanisms of C. trachomatis-specific CD4+ T cells, we found that the T cells also express granzyme B (GzmB) when coincubated with infected cells. In addition, during C. trachomatis infection of mice, primed activated-naive CD4+ Th1 cells displayed elevated granzyme transcripts (GzmA, GzmB, GzmM, GzmK, GzmC) compared with memory CD4+ T cells in vivo. Finally, using intracellular cytokine staining and a GzmB-/- mouse strain, we show that C. trachomatis-specific CD4+ Th1 cells express GzmB upon Ag stimulation, and that this correlates with Chlamydia clearance in vivo. Together these results have led us to conclude that Chlamydia-specific CD4+ Th1 cells develop cytotoxic capacity through engagement with nonhematopoietic MHCII, and this correlates to C. trachomatis clearance.
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Affiliation(s)
- Joanna Olivas
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Caterina Nogueira
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Helble
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
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Montiel A, Ablona A, Klassen B, Card K, Lachowsky NJ, Brennan DJ, Grace D, Worthington C, Gilbert M. Reach of GetCheckedOnline among gay, bisexual, transgender and queer men and Two-Spirit people and correlates of use 5 years after program launch in British Columbia, Canada. Sex Transm Infect 2024; 100:208-215. [PMID: 38604697 PMCID: PMC11187377 DOI: 10.1136/sextrans-2023-056007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/09/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Understanding who uses internet-based sexually transmitted and blood-borne infection (STBBI) services can inform programme implementation, particularly among those most impacted by STBBIs, including gender and sexual minority (GSM) men. GetCheckedOnline, an internet-based STBBI testing service in British Columbia, Canada, launched in 2014. Our objectives were to assess reach, identify factors associated with use of GetCheckedOnline 5 years into implementation and describe reasons for using and not using GetCheckedOnline among GSM men. METHODS The Sex Now 2019 Survey was an online, cross-sectional survey of GSM men in Canada administered from November 2019 to February 2020. Participants were asked a subset of questions related to use of GetCheckedOnline. Multivariable binary logistic regression modelling was used to estimate associations between correlates and use of GetCheckedOnline. RESULTS Of 431 British Columbia (BC) participants aware of GetCheckedOnline, 27.6% had tested using the service. Lower odds of having used GetCheckedOnline were found among participants with non-white race/ethnicity (adjusted OR (aOR)=0.41 (95% CI 0.21 to 0.74)) and those living with HIV (aOR=0.23 (95% CI 0.05 to 0.76)). Those who usually tested at a walk-in clinic, relative to a sexual health clinic, had greater odds of using GetCheckedOnline (aOR=3.91 (95% CI 1.36 to 11.61)). The most commonly reported reason for using and not using GetCheckedOnline was convenience (78%) and only accessing the website to see how the service worked (48%), respectively. CONCLUSION Over a quarter of GSM men in BC aware of GetCheckedOnline had used it. Findings demonstrate the importance of social/structural factors related to use of GetCheckedOnline. Service promotion strategies could highlight its convenience and privacy benefits to enhance uptake.
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Affiliation(s)
- Andrés Montiel
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Aidan Ablona
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Ben Klassen
- Community Based Research Centre, Vancouver, British Columbia, Canada
| | - Kiffer Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- Community Based Research Centre, Vancouver, British Columbia, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- The University of British Columbia, Vancouver, British Columbia, Canada
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Cheng Y, Zheng G, Song Z, Zhang G, Rao X, Zeng T. Trends in chlamydia prevalence in the United States, 2005-2016. Sci Rep 2024; 14:11825. [PMID: 38783017 PMCID: PMC11116379 DOI: 10.1038/s41598-024-61818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
In the United States (US), chlamydia is the most frequently reported sexually transmitted infection that is nationally notifiable. We examined trends in chlamydia prevalence in the US in 2011-2016 compared with 2005-2010. Cross-sectional, nationally representative surveys, National Health and Nutrition Examination Surveys (NHANES), were used to compare national chlamydia prevalence estimates from 2011 to 2016 with those from 2005 to 2010, and changes in prevalence since 1999-2004 were also reviewed. Persons aged 18-39 years were included in these analyses. Prevalence of chlamydia was based on results from urine specimens. Results were weighted to represent the U.S. civilian, noninstitutionalized population. The baseline characteristics of the study population were similar in gender, age and race/ethnicity between the two groups (P > 0.05). The overall chlamydia prevalence was 1.88% (95% confidence interval [CI] 1.55-2.22%) in 2011-2016 and 1.57% (95% CI 1.27-1.87%) in 2005-2010, a relative increase of 19.7% (95% CI 0.2-39.2%; P < 0.05) between the two surveys. Increases in chlamydia prevalence was especially concentrated in persons who were male, aged 18 to 29 years, had > high school educational level, never married, age at first sex < 18 years, had 2-5 sexual partners in lifetime and had no past sexually transmitted diagnosis between 2005 and 2016 (P < 0.05). Multivariable logistic regression analysis demonstrated that chlamydia was more prevalent in those aged 18-29 years, being non-Hispanic Blacks, had high school educational level, being widowed/divorced/separated and had > 5 sexual partners. The chlamydia prevalence had an increasing trend from 2005-2010 to 2011-2016. Those with high chlamydia prevalence such as sexually active young adults and Non-Hispanic Black should be screened annually so that infected persons can be diagnosed and they and their sex partners can be treated promptly.
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Affiliation(s)
- Yu Cheng
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Guanghao Zheng
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Zhen Song
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Gan Zhang
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Xuepeng Rao
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Tao Zeng
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China.
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Séguin LJ, Gareau E, Bosom M. DépistaFest: The evaluation of an inclusive, positive, and playful STBBI screening campaign's effectiveness. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:250-258. [PMID: 38393551 PMCID: PMC11027723 DOI: 10.17269/s41997-024-00862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Young adults are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs), and rates of STBBI screening in this population are persistently low. The present study examined the effectiveness of Club Sexu's social marketing campaign, DépistaFest, in increasing STBBI screening, screening intentions, and general STBBI and STBBI screening knowledge among young adults in Quebec, Canada. Grounded in the health belief model, the campaign provided practical and scientifically accurate information on STBBIs and screening using an inclusive, positive, and playful approach. METHODS A sample of 686 participants (M = 28.0 years old) was recruited through Club Sexu's social media to complete an online survey assessing campaign exposure, recent STBBI screening, screening intentions, and general STBBI and screening knowledge. Logistic regressions and ANCOVAs were performed to examine group differences on outcome variables. RESULTS Compared to nonexposed participants, those who were exposed to the campaign were 2.11 times more likely to report having been tested in the past 6 months, and 2.07 times more likely to report planning to get tested in the next 6 months. Exposed participants were also more likely to correctly answer general STBBI knowledge questions and reported higher levels of self-perceived STBBI screening knowledge than nonexposed participants. CONCLUSION The findings support the effectiveness of an STBBI prevention campaign grounded in the health belief model. Future STBBI prevention campaigns aimed at young adults would benefit from destigmatizing STBBIs and normalizing STBBI screening using an inclusive, positive, and playful approach.
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Affiliation(s)
- Léa J Séguin
- Department of Sexology, Université du Québec à Montréal (UQÀM), Montreal, QC, Canada.
| | - Emmanuelle Gareau
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Morag Bosom
- Department of Sexology, Université du Québec à Montréal (UQÀM), Montreal, QC, Canada
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Olsen AW, Rosenkrands I, Jacobsen CS, Cheeseman HM, Kristiansen MP, Dietrich J, Shattock RJ, Follmann F. Immune signature of Chlamydia vaccine CTH522/CAF®01 translates from mouse-to-human and induces durable protection in mice. Nat Commun 2024; 15:1665. [PMID: 38396019 PMCID: PMC10891140 DOI: 10.1038/s41467-024-45526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/10/2024] [Indexed: 02/25/2024] Open
Abstract
The clinical development of an effective Chlamydia vaccine requires in-depth understanding of how well protective pre-clinical immune signatures translate to humans. Here, we report a comparative immunological characterization of CTH522/CAF®01 in female mice and humans. We find a range of immune signatures that translate from mouse to human, including a Th1/Th17 cytokine profile and antibody functionality. We identify vaccine-induced T cell epitopes, conserved among Chlamydia serovars, and previously found in infected individuals. Using the mouse model, we show that the common immune signature protected against ascending infection in mice, and vaccine induced antibodies could delay bacterial ascension to the oviduct, as well as development of pathology, in a T cell depleted mouse model. Finally, we demonstrate long-lasting immunity and protection of mice one year after vaccination. Based on the results obtained in the present study, we propose to further investigate CTH522/CAF®01 in a phase IIb study.
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Affiliation(s)
- Anja W Olsen
- Center for Vaccine Research, Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark.
| | - Ida Rosenkrands
- Center for Vaccine Research, Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Christina S Jacobsen
- Center for Vaccine Research, Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
- PharmaRelations, Virum, Denmark
| | | | - Max P Kristiansen
- Center for Vaccine Research, Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Jes Dietrich
- Center for Vaccine Research, Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Robin J Shattock
- Department of Infectious Disease, Imperial College London, London, UK
| | - Frank Follmann
- Center for Vaccine Research, Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
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Clay PA, Asher JM, Carnes N, Copen CE, Delaney KP, Payne DC, Pollock ED, Mermin J, Nakazawa Y, Still W, Mangla AT, Spicknall IH. Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the USA during the 2022 outbreak. Sex Transm Infect 2024; 100:70-76. [PMID: 38050171 DOI: 10.1136/sextrans-2023-055922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The 2022 mpox outbreak has infected over 30 000 people in the USA, with cases declining since mid-August. Infections were commonly associated with sexual contact between men. Interventions to mitigate the outbreak included vaccination and a reduction in sexual partnerships. Understanding the contributions of these interventions to decreasing cases can inform future public health efforts. METHODS We fit a dynamic network transmission model to mpox cases reported by Washington DC through 10 January 2023. This model incorporated both vaccine administration data and reported reductions in sexual partner acquisition by gay, bisexual or other men who have sex with men (MSM). The model output consisted of daily cases over time with or without vaccination and/or behavioural adaptation. RESULTS We found that initial declines in cases were likely caused by behavioural adaptations. One year into the outbreak, vaccination and behavioural adaptation together prevented an estimated 84% (IQR 67% to 91%) of cases. Vaccination alone averted 79% (IQR 64% to 88%) of cases and behavioural adaptation alone averted 25% (IQR 10% to 42%) of cases. We further found that in the absence of vaccination, behavioural adaptation would have reduced the number of cases, but would have prolonged the outbreak. CONCLUSIONS We found that initial declines in cases were likely caused by behavioural adaptation, but vaccination averted more cases overall and was key to hastening outbreak conclusion. Overall, this indicates that outreach to encourage individuals to protect themselves from infection was vital in the early stages of the mpox outbreak, but that combination with a robust vaccination programme hastened outbreak conclusion.
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Affiliation(s)
- Patrick A Clay
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason M Asher
- Office of the Director, Center for Forecasting and Outbreak Analytics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Casey E Copen
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin P Delaney
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne & Environmental Diseases, National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily D Pollock
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Mermin
- Office of the Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yoshinori Nakazawa
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William Still
- DC Department of Health, Washington, District of Columbia, USA
| | - Anil T Mangla
- DC Department of Health, Washington, District of Columbia, USA
| | - Ian H Spicknall
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Yu H, Geisler WM, Dai C, Gupta K, Cutter G, Brunham RC. Antibody responses to Chlamydia trachomatis vaccine candidate antigens in Chlamydia-infected women and correlation with antibody-mediated phagocytosis of elementary bodies. Front Cell Infect Microbiol 2024; 14:1342621. [PMID: 38371301 PMCID: PMC10869445 DOI: 10.3389/fcimb.2024.1342621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Murine research has revealed a significant role for antibody responses in protection against Chlamydia reinfection. To explore potential humoral immune markers of protection elicited by Chlamydia trachomatis (CT) antigens in humans in the context of presumed clinical correlates of protection, we used both an IgG1-based ELISA and a conventional total IgG ELISA to evaluate antibody responses. We evaluated responses to five CT outer membrane proteins (PmpE, PmpF, PmpG, PmpH, and MOMP), along with other promising CT antigens (Pgp3 and HSP60), negative control antigens (RecO and AtpE), and CT elementary bodies (EBs) in sera from a well-characterized cohort of 60 women with different CT infection outcomes, including two outcomes that are likely clinical correlates of protective immunity: spontaneous resolution of infection and absence of reinfection after treatment. Furthermore, we used a flow cytometry-based assay to measure antibody-mediated phagocytosis by neutrophils in these sera. Results demonstrated that IgG1 ELISA displayed higher sensitivity than conventional total IgG ELISA in assessing antibody responses to CT EBs and antigens. Pgp3 IgG1 ELISA exhibited the highest sensitivity compared to IgG1 ELISA incorporating CT EBs or other antigens, confirming Pgp3 IgG1 ELISA as an ideal assay for CT antibody detection. Most (95%) sera from women with CT infection outcomes exhibited antibody-mediated phagocytosis of CT EBs, which was significantly correlated with IgG1 antibody responses to MOMP, Pgp3, HSP60, and PmpF. However, neither IgG1 responses to CT antigens and EBs nor antibody-mediated phagocytosis were associated with clinical correlates of protection. These findings suggest that neither CT IgG1 antibody detection nor antibody-mediated phagocytosis will be useful as immune correlates of protection against CT infection in humans.
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Affiliation(s)
- Hong Yu
- Department of Medicine, British Columbia Centre for Disease Control, University of British Columbia, Vancouver, BC, Canada
| | - William M. Geisler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Chuanbin Dai
- Department of Medicine, British Columbia Centre for Disease Control, University of British Columbia, Vancouver, BC, Canada
| | - Kanupriya Gupta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert C. Brunham
- Department of Medicine, British Columbia Centre for Disease Control, University of British Columbia, Vancouver, BC, Canada
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Klasner C, Macintyre AN, Brown SE, Bavoil P, Ghanem KG, Nylander E, Ravel J, Tuddenham S, Brotman RM. A Narrative Review on Spontaneous Clearance of Urogenital Chlamydia trachomatis: Host, Microbiome, and Pathogen-Related Factors. Sex Transm Dis 2024; 51:112-117. [PMID: 38290156 PMCID: PMC11017733 DOI: 10.1097/olq.0000000000001905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection in the United States. Untreated urogenital infection in women can result in adverse sequelae such as pelvic inflammatory disease and infertility. Despite national screening and treatment guidelines, rates continue to rise; because most infections are asymptomatic, the actual prevalence of CT infection is likely significantly higher than reported. Spontaneous clearance of CT in women (in the absence of antibiotic treatment) has been described in multiple epidemiologic studies. Given the serious consequences and high prevalence of CT infection, there is growing interest in understanding this phenomenon and factors that may promote CT clearance in women. Spontaneous CT clearance is likely the result of complex interactions between CT, the host immune system, and the vaginal microbiota (i.e., the communities of bacteria inhabiting the vagina), which has been implicated in CT acquisition. Herein, we briefly review current literature regarding the role of each of these factors in spontaneous CT clearance, identify knowledge gaps, and discuss future directions and possible implications for the development of novel interventions that may protect against CT infection, facilitate clearance, and prevent reproductive sequelae.
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Affiliation(s)
- Carson Klasner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew N. Macintyre
- Duke Human Vaccine Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sarah E. Brown
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Khalil G. Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elisabeth Nylander
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca M. Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Castonguay FM, Chesson HW, Jeon S, Rainisch G, Fischer LS, Adhikari BB, Kahn EB, Greening B, Gift TL, Meltzer MI. Building a Simple Model to Assess the Impact of Case Investigation and Contact Tracing for Sexually Transmitted Diseases: Lessons From COVID-19. AJPM FOCUS 2024; 3:100147. [PMID: 38149077 PMCID: PMC10749878 DOI: 10.1016/j.focus.2023.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Introduction During the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention developed a simple spreadsheet-based tool to help state and local public health officials assess the performance and impact of COVID-19 case investigation and contact tracing in their jurisdiction. The applicability and feasibility of building such a tool for sexually transmitted diseases were assessed. Methods The key epidemiologic differences between sexually transmitted diseases and respiratory diseases (e.g., mixing patterns, incubation period, duration of infection, and the availability of treatment) were identified, and their implications for modeling case investigation and contact tracing impact with a simple spreadsheet tool were remarked on. Existing features of the COVID-19 tool that are applicable for evaluating the impact of case investigation and contact tracing for sexually transmitted diseases were also identified. Results Our findings offer recommendations for the future development of a spreadsheet-based modeling tool for evaluating the impact of sexually transmitted disease case investigation and contact tracing efforts. Generally, we advocate for simplifying sexually transmitted disease-specific complexities and performing sensitivity analyses to assess uncertainty. The authors also acknowledge that more complex modeling approaches might be required but note that it is possible that a sexually transmitted disease case investigation and contact tracing tool could incorporate features from more complex models while maintaining a user-friendly interface. Conclusions A sexually transmitted disease case investigation and contact tracing tool could benefit from the incorporation of key features of the COVID-19 model, namely its user-friendly interface. The inherent differences between sexually transmitted diseases and respiratory viruses should not be seen as a limitation to the development of such tool.
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Affiliation(s)
- François M. Castonguay
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montréal, Montréal, Québec, Canada
- Centre for Public Health Research (CReSP), Montréal, Québec, Canada
| | - Harrell W. Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seonghye Jeon
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabriel Rainisch
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah S. Fischer
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Biswha B. Adhikari
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily B. Kahn
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bradford Greening
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martin I. Meltzer
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Brown SE, Tuddenham S, Shardell MD, Klebanoff MA, Ghanem KG, Brotman RM. Bacterial Vaginosis and Spontaneous Clearance of Chlamydia trachomatis in the Longitudinal Study of Vaginal Flora. J Infect Dis 2023; 228:783-791. [PMID: 37158693 PMCID: PMC10503950 DOI: 10.1093/infdis/jiad142] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Up to 26% of urogenital Chlamydia trachomatis infections spontaneously resolve between detection and treatment. Mechanisms governing natural resolution are unknown. We examined whether bacterial vaginosis (BV) was associated with greater chlamydia persistence versus spontaneous clearance in a large, longitudinal study. METHODS Between 1999 and 2003, the Longitudinal Study of Vaginal Flora followed reproductive-age women quarterly for 1 year. Baseline chlamydia screening and treatment were initiated after ligase chain reaction testing became available midstudy, and unscreened endocervical samples were tested after study completion. Chlamydia clearance and persistence were defined between consecutive visits without chlamydia-active antibiotics (n = 320 persistence/n = 310 clearance). Associations between Nugent score (0-3, no BV; 4-10, intermediate/BV), Amsel-BV, and chlamydia persistence versus clearance were modeled with alternating and conditional logistic regression. RESULTS Of chlamydia cases, 48% spontaneously cleared by the next visit (310/630). Nugent-intermediate/BV was associated with higher odds of chlamydia persistence (adjusted odds ratio [aOR] = 1.89; 95% confidence interval [CI], 1.30-2.74), and the findings were similar for Amsel-BV (aOR 1.39; 95% CI, .99-1.96). The association between Nugent-intermediate/BV and chlamydia persistence was stronger in a within-participant analysis of 67 participants with both clearance/persistence intervals (aOR = 4.77; 95% CI, 1.39-16.35). BV symptoms did not affect any results. CONCLUSIONS BV is associated with greater chlamydia persistence. Optimizing the vaginal microbiome may promote chlamydia clearance.
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Affiliation(s)
- Sarah E Brown
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle D Shardell
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca M Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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11
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Farrell J, Spolyar O, Greenhalgh S. The effect of screening on the health burden of chlamydia: An evaluation of compartmental models based on person-days of infection. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:16131-16147. [PMID: 37920006 DOI: 10.3934/mbe.2023720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Sexually transmitted diseases (STDs) are detrimental to the health and economic well-being of society. Consequently, predicting outbreaks and identifying effective disease interventions through epidemiological tools, such as compartmental models, is of the utmost importance. Unfortunately, the ordinary differential equation compartmental models attributed to the work of Kermack and McKendrick require a duration of infection that follows the exponential or Erlang distribution, despite the biological invalidity of such assumptions. As these assumptions negatively impact the quality of predictions, alternative approaches are required that capture how the variability in the duration of infection affects the trajectory of disease and the evaluation of disease interventions. So, we apply a new family of ordinary differential equation compartmental models based on the quantity person-days of infection to predict the trajectory of disease. Importantly, this new family of models features non-exponential and non-Erlang duration of infection distributions without requiring more complex integral and integrodifferential equation compartmental model formulations. As proof of concept, we calibrate our model to recent trends of chlamydia incidence in the U.S. and utilize a novel duration of infection distribution that features periodic hazard rates. We then evaluate how increasing STD screening rates alter predictions of incidence and disability adjusted life-years over a five-year horizon. Our findings illustrate that our family of compartmental models provides a better fit to chlamydia incidence trends than traditional compartmental models, based on Akaike information criterion. They also show new asymptomatic and symptomatic infections of chlamydia peak over drastically different time frames and that increasing the annual STD screening rates from 35% to 40%-70% would annually avert 6.1-40.3 incidence while saving 1.68-11.14 disability adjusted life-years per 1000 people. This suggests increasing the STD screening rate in the U.S. would greatly aid in ongoing public health efforts to curtail the rising trends in preventable STDs.
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Affiliation(s)
- Jack Farrell
- Department of Mathematics, Siena College, Loudonville, NY, USA
| | - Owen Spolyar
- Department of Mathematics, Siena College, Loudonville, NY, USA
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12
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Shukla JD, Kleppa E, Holmen S, Ndhlovu PD, Mtshali A, Sebitloane M, Vennervald BJ, Gundersen SG, Taylor M, Kjetland EF. The Association Between Female Genital Schistosomiasis and Other Infections of the Lower Genital Tract in Adolescent Girls and Young Women: A Cross-Sectional Study in South Africa. J Low Genit Tract Dis 2023; 27:291-296. [PMID: 37379442 PMCID: PMC10309100 DOI: 10.1097/lgt.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVES/PURPOSES OF THE STUDY This study aimed to explore the relationship between female genital schistosomiasis (FGS), sexually transmitted infections, bacterial vaginosis, and yeast among young women living in Schistosoma haematobium-endemic areas. METHODS In a cross-sectional study of young women, sexually active, aged 16 to 22 years in rural KwaZulu-Natal, South Africa, in 32 randomly selected rural schools in schistosomiasis-endemic areas, the authors performed gynecological and laboratory investigations, diagnosed FGS and other infections, and did face-to-face interviews. RESULTS Female genital schistosomiasis was the second most prevalent current genital infection (23%), significantly more common in those who had urinary schistosomiasis (35%), compared with those without (19%, p < .001). In the FGS-positive group, 35% had human papillomavirus compared with 24% in the FGS-negative group (p = .010). In the FGS-positive group, 37% were seropositive for herpes simplex virus infection, compared with 30% in the FGS-negative group (p = .079). There were significantly fewer chlamydia infections among women with FGS (20%, p = .018) compared with those who did not have FGS (28%). CONCLUSIONS Female genital schistosomiasis was the second most common genital infection after herpes simplex virus. Human papillomavirus infection was significantly associated with FGS, but Chlamydia was negatively associated with FGS. Women with FGS may have had more frequent contact with the health system for genital discharge. The results show the importance of the inclusion of FGS in the national management protocols for genital infections in areas endemic for S. haematobium and highlight a more comprehensive approach to diagnosis and genital disease management.
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Affiliation(s)
- Jilna Dilip Shukla
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigve Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Andile Mtshali
- Department of Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Motshedisi Sebitloane
- Discipline of Gynaecology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svein Gunnar Gundersen
- Department for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Global Health, Oslo University Hospital, Norway
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13
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Nightingale KJ, Makeneni S, Bonett S, Wood SM. The Relationship Between Directly Observed Therapy for Chlamydia Infections and Retesting Rates in an Adolescent Population. Sex Transm Dis 2023; 50:342-345. [PMID: 36863059 PMCID: PMC10175119 DOI: 10.1097/olq.0000000000001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chlamydia trachomatis is the most common reportable sexually transmitted infection in the United States, with >60% of reported cases occurring in individuals aged 15 to 24 years. US practice guidelines recommend directly observed therapy (DOT) for the treatment of chlamydia in adolescents, but almost no research has been done to evaluate whether DOT results in improved outcomes. METHODS We conducted a retrospective cohort study of adolescents who sought care at 1 of 3 clinics within a large academic pediatric health system for a chlamydia infection. The study outcome was return for retesting within 6 months. Unadjusted analyses were performed using χ2 , Mann-Whitney U , and t tests, and adjusted analyses were performed using multivariable logistic regression. RESULTS Of the 1970 individuals included in the analysis, 1660 (84.3%) received DOT and 310 (15.7%) had a prescription sent to a pharmacy. The population was primarily Black/African American (95.7%) and female (78.2%). After controlling for confounders, individuals who had a prescription sent to a pharmacy were 49% (95% confidence interval, 31%-62%) less likely than individuals who received DOT to return for retesting within 6 months. CONCLUSIONS Despite clinical guidelines recommending the use of DOT for chlamydia treatment in adolescents, this is the first study to describe the association between DOT and an increase in the number of adolescents and young adults who return for sexually transmitted infection retesting within 6 months. Further research is needed to confirm this finding in diverse populations and explore nontraditional settings for the provision of DOT.
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Affiliation(s)
| | | | - Stephen Bonett
- University of Pennsylvania School of Nursing, Philadelphia, PA
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Taylor BD, Adekanmbi V, Zhang Y, Berenson A. The Impact of Neisseria gonorrhoeae Mono- and Coinfection on Adverse Pregnancy Outcomes. Open Forum Infect Dis 2023; 10:ofad220. [PMID: 37250177 PMCID: PMC10220503 DOI: 10.1093/ofid/ofad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Background Sexually transmitted infections (STIs) have recently been linked to hypertensive disorders of pregnancy (HDP). However, the impact of Neisseria gonorrhoeae on risk of HDP is not well understood. This study determined the impact of gonorrhea and gonorrhea coinfection on HDP and other adverse pregnancy outcomes in a population with a high screening rate and presumed treatment. Methods This retrospective study included 29 821 singleton births between 2016 and 2021. The STI testing results, demographic variables, and pregnancy outcomes were identified from electronic health records. The HDP were primary outcomes of interest including gestational hypertension, preeclampsia, and superimposed preeclampsia. We further examined preeclampsia subtypes defined by severe features and gestational age of delivery (term and preterm preeclampsia). Secondary outcomes included preterm premature rupture of membranes, chorioamnionitis, and preterm delivery. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Models were adjusted for maternal age, maternal race/ethnicity, and smoking. Results Gonorrhea screening occurred in 95% of the population. Gonorrhea increased the odds of preterm preeclampsia (adjusted OR [ORadj.], 1.95; 95% CI, 1.02-3.73) and preterm birth (ORadj., 1.78; 95% CI, 1.22-2.60). Furthermore, gonorrhea-chlamydia coinfection was associated with preterm birth (ORadj., 1.77; 95% CI, 1.03-3.04). However, results were similar when we examined gonorrhea monoinfection (ORadj., 1.76; 95% CI, 1.04-2.97). Conclusions Among a diverse population of pregnant individuals, gonorrhea increased odds of preterm preeclampsia and preterm delivery Further research is needed to determine the burden of STIs on HDP, including investigations into biological effects during pregnancy.
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Affiliation(s)
- Brandie DePaoli Taylor
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Population Health and Health Disparities, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Victor Adekanmbi
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yuanyi Zhang
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, Texas, USA
| | - Abbey Berenson
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, USA
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15
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Rahman MM, Johnson C, Taylor SN, Peterman TA, Bennett TS, Haydel D, Newman DR, Furness BW. Extragenital Sexually Transmitted Infection Testing Among Louisiana Parish Health Units, 2016-2019. Sex Transm Dis 2023; 50:274-279. [PMID: 36630331 PMCID: PMC10190115 DOI: 10.1097/olq.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) get tested annually for urethral and rectal chlamydia (CT) and gonorrhea (NG), and pharyngeal NG. There are no national recommendations to screen women and heterosexual men at extragenital sites. We assessed extragenital CT/NG screening among men and women at Louisiana's Parish Health Units (PHU). METHODS The Louisiana STD/HIV/Hepatitis Program piloted extragenital screening at 4 PHUs in February 2016 and expanded to 11 PHUs in 2017. Sexual histories were used to identify gender of sex partners and exposed sites. Because of billing restrictions, up to 2 anatomical sites were tested for CT/NG. RESULTS From February 2016 to June 2019, 70,895 urogenital and extragenital specimens (56,086 urogenital, 13,797 pharyngeal, and 1,012 rectal) were collected from 56,086 patients. Pharyngeal CT positivity was 160 of 7,868 (2.0%) among women, 54 of 4,838 (1.1%) among men who have sex with women (MSW) and 33 of 1,091 (3.0%) among MSM. Rectal CT positivity was 51 of 439 (11.6%) among women and 95 of 573 (16.6%) among MSM. Pharyngeal NG positivity was 299 of 7,868 (3.8%) among women, 222 of 4,838 (4.6%) among MSW, and 97 of 1,091 (8.9%) among MSM. Rectal NG positivity was 20 of 439 (4.6%) among women and 134 of 573 (23.4%) among MSM.Urogenital-only screening would have missed: among women, 173 of 3,923 (4.4%) CT and 227 of 1,480 (15.3%) NG infections; among MSW, 26 of 2,667 (1%) CT and 149 of 1,709 (8.7%) NG infections; and among MSM, 116 of 336 (34.5%) CT and 127 of 413 (42.1%) NG infections. CONCLUSIONS Many CT/NG infections would have been missed with urogenital-only screening. Men who have sex with men had much higher extragenital infection rates than women and MSW.
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Affiliation(s)
- Mohammad M. Rahman
- Louisiana Department of Health-STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chaquetta Johnson
- Louisiana Department of Health-Office of Public Health, New Orleans, LA
| | - Stephanie N. Taylor
- Louisiana Department of Health-Office of Public Health, New Orleans, LA
- LSU School of Medicine-Section of Infectious Diseases, New Orleans, LA
| | - Thomas A. Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tammy S. Bennett
- Louisiana Department of Health-Bureau of Family Health, New Orleans, LA
| | - Danielle Haydel
- Louisiana Department of Health-Office of Public Health Laboratory, Baton Rouge, LA
| | - Daniel R. Newman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bruce W. Furness
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Rodrigues DL, de Visser RO, Lopes D, Prada M, Garrido MV, Balzarini RN. Prevent2Protect Project: Regulatory Focus Differences in Sexual Health Knowledge and Practices. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1701-1713. [PMID: 36702994 PMCID: PMC9879562 DOI: 10.1007/s10508-023-02536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/05/2022] [Accepted: 01/07/2023] [Indexed: 06/18/2023]
Abstract
The way people perceive risks and make decisions about their health is regulated by two motivational systems-prevention of harm or promotion of pleasure. People more focused on prevention strive to avoid negative outcomes and enact more health-protective behaviors. In contrast, people more focused on promotion strive to attain positive outcomes and take more risks with their health. Building upon recent evidence extending this framework to sexual behaviors and health, we conducted a pre-registered online survey ( OSF ) with Portuguese and Spanish adults (N = 742; Mage = 31.42, SD = 9.16) to examine whether self-reported STI knowledge and sexual health practices differ based on predominant regulatory focus. This study was part of the Prevent2Protect project ( OSF ). Results showed that prevention-focused participants had heard about more STIs and retrieved more of their knowledge from scientific sources but had been tested for fewer STIs in the past. In contrast, promotion-focused participants indicated they had specific knowledge about more STIs, retrieved more of their knowledge from medical and peer sources, and had been tested for more STIs in the past. They also reported more frequent STI testing, using free testing facilities or asking their family practice doctor to get tested, more routine sexual health check-ups, and more use of other contraceptive methods, such as birth control pills. These results remained unchanged after controlling for demographic differences. Overall, our findings showed that different motives in sexuality shape sexual health knowledge and sexual health practices.
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Affiliation(s)
- David L Rodrigues
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal.
| | | | - Diniz Lopes
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Marília Prada
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Margarida V Garrido
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Rhonda N Balzarini
- Department of Psychology, Texas State University, San Marcos, TX, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
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Martin K, Dziva Chikwari C, Dauya E, Mackworth-Young CRS, Bath D, Tucker J, Simms V, Bandason T, Ndowa F, Katsidzira L, Mugurungi O, Machiha A, Marks M, Kranzer K, Ferrand R. Investigating point-of-care diagnostics for sexually transmitted infections and antimicrobial resistance in antenatal care in Zimbabwe (IPSAZ): protocol for a mixed-methods study. BMJ Open 2023; 13:e070889. [PMID: 37080628 PMCID: PMC10124298 DOI: 10.1136/bmjopen-2022-070889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) can cause serious morbidity, including pelvic inflammatory disease, and adverse pregnancy outcomes. In low/middle-income countries, limited laboratory infrastructure has resulted in a syndrome-based approach being used for management of STIs, which has poor sensitivity and specificity, leading to considerable underdiagnosis and overtreatment. The WHO has called for development and evaluation of strategies to inform replacement of syndromic management by diagnostic testing.The aim of this project is to evaluate a strategy of point-of-care testing for six STIs in antenatal care (ANC) in Zimbabwe. METHODS AND ANALYSIS A prospective interventional study will be conducted in ANC clinics in Harare province, Zimbabwe. One thousand pregnant women will be recruited when registering for routine ANC. Alongside routine HIV and syphilis testing, participants will be offered an integrated screening package including testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and hepatitis B. All individuals with STIs will receive treatment, partner notification services, risk reduction counselling and referral if needed according to national guidelines. Gonorrhoea samples will be cultured and tested for antimicrobial resistance as per WHO enhanced gonococcal antimicrobial surveillance programme guidelines.The primary outcome measure is the composite prevalence of CT, NG, TV, syphilis and hepatitis B. A mixed-methods process evaluation and economic evaluation will be conducted to understand the acceptability, feasibility and cost-effectiveness of integrated STI testing, compared with standard of care (syndromic management). ETHICS AND DISSEMINATION The study protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board, and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policymaking bodies. TRIAL REGISTRATION NUMBER NCT05541081.
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Affiliation(s)
- Kevin Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Chido Dziva Chikwari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Constance R S Mackworth-Young
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - David Bath
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Joseph Tucker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Francis Ndowa
- Skin & Genito-Urinary Medicine Clinic, Harare, Zimbabwe
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Katharina Kranzer
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Rashida Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
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Pollock ED, Clay PA, Kreisel KM, Spicknall IH. Estimated Incidence and Prevalence of Gonorrhea in the United States, 2006-2019. Sex Transm Dis 2023; 50:188-195. [PMID: 36598837 PMCID: PMC10006303 DOI: 10.1097/olq.0000000000001763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We extend recent work estimating incidence and prevalence of gonococcal infections among men and women aged 15 to 39 years in the United States in 2018 by applying the same modeling framework to estimate gonococcal incidence and prevalence during 2006 to 2019. METHODS The model is informed by cases from the Nationally Notifiable Disease Surveillance System, data from the National Survey of Family Growth, and data on other factors known to impact gonococcal incidence and prevalence. We use Monte Carlo simulation to account for uncertainty in input parameters. Results are reported as median annual per-capita incidence and prevalence; uncertainty intervals are characterized by the 25th and 75th simulated percentiles. RESULTS There were 1,603,473 (1,467,801-1,767,779) incident cases of gonorrhea estimated in 2019. Per-capita incidence increased 32%, from 1101 (1002-1221) to 1456 (1333-1605) infections per 100,000 persons. This trend in per-capita incidence had 3 phrases: an initial decline during 2006 to 2009, a plateau through 2013, and a rapid increase of 66% through 2019. Men aged 25 to 39 years experienced the greatest increase in incidence (125%, 541 [467-651] to 1212 infections [1046-1458] per 100,000 men). Women aged 25 to 39 years had the lowest incidence in 2019, with 1040 infections (882-1241) per 100,000 women. Prevalence increased more slowly among those aged 25 to 39 years versus 15 to 24 years. The incidence ratio comparing men with women aged 25 to 39 years increased from 0.76 to 1.18. CONCLUSIONS The burden of gonorrhea has increased among men and women aged 15 to 39 years since 2013. An increasing proportion of incident infections are among men. Additional biomedical and behavioral interventions are needed to control gonococcal transmission.
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Affiliation(s)
- Emily D Pollock
- From the Division of STD Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
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Abstract
Sexually transmitted infections (STIs) are caused by various pathogens, many of which have common symptoms. Diagnostic tests are critical to supporting clinical evaluations in making patient management decisions. Molecular diagnostics are the preferred test type when available, especially in asymptomatic patients for many STIs. However, for some infections, serology offers the best insight into infectious status. Clinicians should be aware of the performance characteristics of the available STI diagnostic tests and understand how to use them. Point-of-care tests are helpful to implement rapid and accurate treatment responses, which are particularly helpful in certain at-risk populations.
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Jones J, Jenness SM, Le Guillou A, Sullivan PS, Gift TL, Delaney KP, Chesson H. Estimated Number of Incident HIV Infections in Men Who Have Sex With Men Attributable to Gonorrhea and Chlamydia, Per Gonococcal or Chlamydial Infection, in the United States. Sex Transm Dis 2023; 50:83-85. [PMID: 36630415 PMCID: PMC10753989 DOI: 10.1097/olq.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Using a network model, we simulated transmission of HIV, gonorrhea, and chlamydia among men who have sex with men to estimate the number of HIV infections that can be attributed to gonorrhea and chlamydia, per gonococcal and chlamydial infection. This metric can inform future modeling and health economic studies.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin P. Delaney
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Looker KJ, Booton R, Begum N, Beck E, Shen J, Turner KME, Christensen H. The potential public health impact of adolescent 4CMenB vaccination on Neisseria gonorrhoeae infection in England: a modelling study. BMC Public Health 2023; 23:1. [PMID: 36624437 PMCID: PMC9829524 DOI: 10.1186/s12889-022-14670-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Diagnoses of gonorrhoea in England rose by 26% between 2018 and 2019. Recent evidence that a vaccine against meningococcal B disease currently offered to infants in the UK (4CMenB) could additionally protect (with 31% efficacy) against gonorrhoea has led to renewed hope for a vaccine. A Phase 2 proof-of-concept trial of 4CMenB vaccination against gonorrhoea in adults is currently underway. OBJECTIVES To investigate the potential public health impact of adolescent gonorrhoea vaccination in England, considering different implementation strategies. METHODS We developed a deterministic transmission-dynamic model of gonorrhoea infection among heterosexual 13-64-year-olds stratified by age, sex and sexual activity. We explored the impact of a National Immunisation Programme (NIP) among 14-year-olds for a vaccine with 31% efficacy, 6 years' duration of protection, and 85% uptake. We also explored how impact might change for varying efficacy (20-50%) and uptake (75-95%), the addition of a catch-up programme, the use of boosters, and varying duration of protection. RESULTS An NIP against gonorrhoea could lead to 50,000 (95% credible interval, CrI 31,000-80,000) and 849,000 (95%CrI 476,000-1,568,000) gonorrhoea infections being averted over 10 and 70 years, respectively, in England, for a vaccine with 31% efficacy and 85% uptake. This is equivalent to 25% (95%CrI 17-33%) of heterosexual infections being averted over 70 years. Vaccine impact is predicted to increase over time and be greatest among 13-18-year-olds (39% of infections 95%CrI 31-49% averted) over 70 years. Varying vaccine efficacy and duration of protection had a noticeable effect on impact. Catch-up and booster vaccination increased the short- and long-term impact, respectively. CONCLUSIONS A partially-effective vaccine against gonorrhoea infection, delivered to 14-year-olds alongside the MenACWY vaccine, could have an important population impact on gonorrhoea. Catch-up and booster vaccination could be considered alongside cohort vaccination to increase impact.
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Affiliation(s)
- Katharine J. Looker
- grid.5337.20000 0004 1936 7603Research Fellow in Mathematical Epidemiology of Infectious Diseases, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Ross Booton
- grid.5337.20000 0004 1936 7603Senior Research Associate in Mathematical Epidemiology of Infectious Diseases, Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU UK
| | - Najida Begum
- grid.425090.a0000 0004 0468 9597Freelance Consultant c/o GSK, Wavre, Belgium 1300
| | - Ekkehard Beck
- grid.425090.a0000 0004 0468 9597Senior Director, Value Evidence and Outcomes, GSK, Wavre, Belgium 1300
| | - Jing Shen
- grid.425090.a0000 0004 0468 9597Senior Manager, Health Economics, GSK, Wavre, Belgium 1300
| | - Katherine M. E. Turner
- grid.5337.20000 0004 1936 7603Reader in Infectious Disease Epidemiology, Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU UK
| | - Hannah Christensen
- grid.5337.20000 0004 1936 7603Senior Lecturer in Infectious Disease Mathematical Modelling, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN UK
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22
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Free C, Palmer MJ, Potter K, McCarthy OL, Jerome L, Berendes S, Gubijev A, Knight M, Jamal Z, Dhaliwal F, Carpenter JR, Morris TP, Edwards P, French R, Macgregor L, Turner KME, Baraitser P, Hickson FCI, Wellings K, Roberts I, Bailey JV, Hart G, Michie S, Clayton T, Devries K. Behavioural intervention to reduce sexually transmitted infections in people aged 16–24 years in the UK: the safetxt RCT. PUBLIC HEALTH RESEARCH 2023. [DOI: 10.3310/dane8826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background
The prevalence of genital chlamydia and gonorrhoea is higher in the 16–24 years age group than those in other age group. With users, we developed the theory-based safetxt intervention to reduce sexually transmitted infections.
Objectives
To establish the effect of the safetxt intervention on the incidence of chlamydia/gonorrhoea infection at 1 year.
Design
A parallel-group, individual-level, randomised superiority trial in which care providers and outcome assessors were blinded to allocation.
Setting
Recruitment was from 92 UK sexual health clinics.
Participants
Inclusion criteria were a positive chlamydia or gonorrhoea test result, diagnosis of non-specific urethritis or treatment started for chlamydia/gonorrhoea/non-specific urethritis in the last 2 weeks; owning a personal mobile phone; and being aged 16–24 years.
Allocation
Remote computer-based randomisation with an automated link to the messaging system delivering intervention or control group messages.
Intervention
The safetxt intervention was designed to reduce sexually transmitted infection by increasing partner notification, condom use and sexually transmitted infection testing before sex with new partners. It employed educational, enabling and incentivising content delivered by 42–79 text messages over 1 year, tailored according to type of infection, gender and sexuality.
Comparator
A monthly message regarding trial participation.
Main outcomes
The primary outcome was the incidence of chlamydia and gonorrhoea infection at 12 months, assessed using nucleic acid amplification tests. Secondary outcomes at 1 and 12 months included self-reported partner notification, condom use and sexually transmitted infection testing prior to sex with new partner(s).
Results
Between 1 April 2016 and 23 November 2018, we assessed 20,476 people for eligibility and consented and randomised 6248 participants, allocating 3123 to the safetxt intervention and 3125 to the control. Primary outcome data were available for 4675 (74.8%) participants. The incidence of chlamydia/gonorrhoea infection was 22.2% (693/3123) in the intervention group and 20.3% (633/3125) in the control group (odds ratio 1.13, 95% confidence interval 0.98 to 1.31). There was no evidence of heterogeneity in any of the prespecified subgroups. Partner notification was 85.6% in the intervention group and 84.0% in the control group (odds ratio 1.14, 95% confidence interval 0.99 to 1.33). At 12 months, condom use at last sex was 33.8% in the intervention group and 31.2% in the control group (odds ratio 1.14, 95% confidence interval 1.01 to 1.28) and condom use at first sex with most recent new partner was 54.4% in the intervention group and 48.7% in the control group (odds ratio 1.27, 95% confidence interval 1.11 to 1.45). Testing before sex with a new partner was 39.5% in the intervention group and 40.9% in the control group (odds ratio 0.95, 95% confidence interval 0.82 to 1.10). Having two or more partners since joining the trial was 56.9% in the intervention group and 54.8% in the control group (odds ratio 1.11, 95% confidence interval 1.00 to 1.24) and having sex with someone new since joining the trial was 69.7% in the intervention group and 67.4% in the control group (odds ratio 1.13, 95% confidence interval 1.00 to 1.28). There were no differences in safety outcomes. Additional sensitivity and per-protocol analyses showed similar results.
Limitations
Our understanding of the mechanism of action for the unanticipated effects is limited.
Conclusions
The safetxt intervention did not reduce chlamydia and gonorrhoea infections, with slightly more infections in the intervention group. The intervention increased condom use but also increased the number of partners and new partners. Randomised controlled trials are essential for evaluating health communication interventions, which can have unanticipated effects.
Future work
Randomised controlled trials evaluating novel interventions in this complex area are needed.
Trial registration
This trial is registered as ISRCTN64390461.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Caroline Free
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kimberley Potter
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona L McCarthy
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lauren Jerome
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Sima Berendes
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Megan Knight
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Zahra Jamal
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Farandeep Dhaliwal
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - James R Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim P Morris
- Medical Research Council Clinical Trials Unit, London, UK
| | - Phil Edwards
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca French
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Macgregor
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Katy ME Turner
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | | | - Ford CI Hickson
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia V Bailey
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Graham Hart
- Department of Infection and Population Health, University College London, London, UK
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Tim Clayton
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen Devries
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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23
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Hojilla JC, Sarovar V, Lam JO, Park IU, Vincent W, Hare CB, Silverberg MJ, Satre DD. Sexually Transmitted Infection Screening in Key Populations of Persons Living with HIV. AIDS Behav 2023; 27:96-105. [PMID: 35916949 PMCID: PMC9851927 DOI: 10.1007/s10461-022-03747-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
Annual screening for bacterial sexually transmitted infections (STI), including gonorrhea/chlamydia (GC/CT) and syphilis, is recommended for persons with HIV (PWH). We used the prevention index to quantify the extent to which STI screening was completed at guideline-recommended frequency in African American and Latinx persons, women, persons with alcohol (AUD) and substance (SUD) use disorders. Data from PWH at Kaiser Permanente Northern California were collected from electronic health records. We defined receipt of GC/CT and syphilis screening consistent with recommendations as a prevention index score ≥ 75%. Among 9655 PWH (17.7% Latinx; 16.2% African American; 9.6% female; 12.4% AUD; 22.1% SUD), prevention index scores for GC/CT and syphilis increased from 2015 to 2019. African American PWH had lower odds of receiving an annual syphilis screen (aOR 0.87 [95% CI 0.79-0.97]). Female sex was associated with lower odds of GC/CT (aOR 0.30 [95% CI 0.27-0.34]) and syphilis (aOR 0.27 [95% CI 0.24-0.310) screening. AUD and SUD were not associated with differences in annual GC/CT or syphilis screening. Key PWH subgroups experience ongoing challenges to annual STI screening despite comparable healthcare access.
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Affiliation(s)
- J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ina U Park
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
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24
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Gutman CK, Newton N, Duda E, Alevy R, Palmer K, Wetzel M, Figueroa J, Griffiths M, Koyama A, Middlebrooks L, Camacho-Gonzalez A, Morris CR. Comparison of Targeted and Routine Adolescent HIV Screening in a Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e1613-e1619. [PMID: 35686965 DOI: 10.1097/pec.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were (1) to compare targeted and routine HIV screening in a pediatric emergency department (PED) and (2) to compare provider documented HIV risk assessment with adolescent perception of HIV risk assessment conducted during the PED visit. METHODS This prospective study ran concurrent to a PED routine HIV screening pilot. Adolescents could be tested for HIV by the PED provider per usual care (targeted testing); if not tested, they were approached for the routine screening pilot. A subset of adolescents completed a questionnaire on HIV risk. χ 2 analysis compared adolescents with targeted testing and routine screening. HIV-tested patients were asked if HIV risk was assessed; κ analysis compared this with documentation in the provider note. RESULTS Over 4 months, 107 adolescents received targeted testing and 344 received routine screening. One 14-year-old patient tested positive by routine screening; this adolescent had 2 PED visits without targeted testing within 60 days. Compared with routine screening, adolescents with targeted testing were more likely female (82% vs 57%, P < 0.001), 16 years or older (71% vs 44%, P < 0.001), or had genitourinary/gynecologic concerns (48% vs 6%, P < 0.001). Adolescents with HIV risk factors were missed by targeted testing but received routine screening. Adolescents with documented HIV risk assessment were more likely to receive targeted testing. There was moderate agreement (κ = 0.61) between provider documentation and adolescent perception of HIV risk assessment. CONCLUSIONS There are gaps in PED HIV risk assessment and testing, which may miss opportunities to diagnose adolescent HIV. Routine HIV screening addresses these gaps and expands adolescent HIV testing in the PED.
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Affiliation(s)
| | | | | | | | | | - Martha Wetzel
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Janet Figueroa
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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25
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Van Gerwen OT, Muzny CA, Marrazzo JM. Sexually transmitted infections and female reproductive health. Nat Microbiol 2022; 7:1116-1126. [PMID: 35918418 PMCID: PMC9362696 DOI: 10.1038/s41564-022-01177-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
Women are disproportionately affected by sexually transmitted infections (STIs) throughout life. In addition to their high prevalence in women, STIs have debilitating effects on female reproductive health due to female urogenital anatomy, socio-cultural and economic factors. In this Review, we discuss the prevalence and impact of non-HIV bacterial, viral and parasitic STIs on the reproductive and sexual health of cisgender women worldwide. We analyse factors affecting STI prevalence among transgender women and women in low-income settings, and describe the specific challenges and barriers to improved sexual health faced by these population groups. We also synthesize the latest advances in diagnosis, treatment and prevention of STIs. Women are more affected by sexually transmitted infections than men. This Review examines the impact of non-HIV STIs on women’s health, and discusses recent advances and current challenges in the treatment and prevention of STIs.
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Affiliation(s)
- Olivia T Van Gerwen
- Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jeanne M Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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26
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Manhart LE, Geisler WM, Bradshaw CS, Jensen JS, Martin DH. Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches. Emerg Infect Dis 2022; 28. [PMID: 35876565 PMCID: PMC9328920 DOI: 10.3201/eid2808.220094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This systematic review demonstrates increasing antimicrobial resistance and incomplete understanding of the bacterium’s natural history. Since Mycoplasma genitalium was identified 40 years ago, much of the epidemiology has been described, diagnostic tests have been developed and approved, and recommended treatment approaches have been identified. However, the natural history remains incompletely understood, and antimicrobial resistance has rapidly increased. This review summarizes evidence published since the US Centers for Disease Control and Prevention 2015 Sexually Transmitted Diseases Treatment Guidelines. Data on sequelae remain insufficient, macrolide resistance is common, and fluoroquinolone resistance is increasing. Potential benefits of testing and treatment include resolving symptoms, interrupting transmission, and preventing sequelae. Potential harms include cost, patient anxiety, and increasing antimicrobial resistance.
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27
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Martin K, Wenlock R, Roper T, Butler C, Vera JH. Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review. BMC Infect Dis 2022; 22:561. [PMID: 35725437 PMCID: PMC9208134 DOI: 10.1186/s12879-022-07534-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so. Methods A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing. Results The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing. Conclusion Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07534-9.
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Affiliation(s)
- Kevin Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe. .,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Rhys Wenlock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tom Roper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ceri Butler
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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28
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Twahirwa Rwema JO, Herbst S, Hamill MM, Liestman B, Nyombayire J, Lyons CE, Mugwaneza P, Makuza JD, Sullivan PS, Allen S, Karita E, Baral S. Cross-sectional assessment of determinants of STIs among men who have sex with men and transgender women in Kigali, Rwanda. Sex Transm Infect 2022; 98:178-187. [PMID: 33958492 PMCID: PMC9889132 DOI: 10.1136/sextrans-2020-054753] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND STIs among men who have sex with men (MSM) and transgender women (TGW) continue to increase. In Rwanda, STI management relies on syndromic management with limited empirical data characterising the burden of specific STIs among MSM/TGW. This study evaluated the prevalence of syphilis, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and associated factors among MSM/TGW in Kigali. METHODS From March to August 2018, 737 MSM/TGW >18 years were enrolled using respondent-driven sampling (RDS). Structured interviews and HIV/STI screening were conducted. Syphilis was screened with rapid plasma reagin confirmed by Treponema pallidum hemagglutination assay. CT/NG were tested by Cepheid GeneXpert. RDS-adjusted multivariable Poisson regression models with robust variance estimation were used to evaluate factors associated with any STI, and determinants of urethral and rectal STIs separately. RESULTS Prevalence of any STI was 20% (RDS adjusted: 16.7% (95% CI: 13.2% to 20.2%)). Syphilis was 5.7% (RDS adjusted: 6.8% (95% CI: 4.3% to 9.4%)). CT was 9.1% (RDS adjusted: 6.1% (95% CI: 3.9% to 8.4%)) and NG was 8.8% (RDS adjusted: 7.1% (95% CI: 4.9% to 9.2%)). STIs were more common among older MSM and those with HIV (p<0.05). Of CT infections, 67% were urethral, 27% rectal and 6% were dual site. For NG infections, 52% were rectal, 29% urethral and 19% were dual site. Overall, 25.8% (23 of 89) of those with confirmed STI and returned for their results were symptomatic at time of testing.STI symptoms in the previous year (adjusted prevalence ratio (aPR): 1.94 (95% CI: 1.26 to 2.98)) were positively associated with any STI. Being circumcised was negatively associated with any STI (aPR: 0.47 (95% CI: 0.31 to 0.73)). HIV was positively associated with rectal STIs (aPR: 3.50 (95% CI: 1.09 to 11.21)) but negatively associated with urethral STIs. CONCLUSION MSM/TGW, especially those living with HIV, are at high risk of STIs in Rwanda with the vast majority being asymptomatic. These data suggest the potential utility of active STI surveillance strategies using highly sensitive laboratory methods among those at high risk given the anatomical distribution and limited symptomatology of STIs observed among Rwandan MSM/TGW.
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Affiliation(s)
| | - Sara Herbst
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Matthew M Hamill
- Infectious Diseases, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Benjamin Liestman
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Carrie E Lyons
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Patrick Sean Sullivan
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Emory University, Atlanta, Georgia, USA
| | | | - Stefan Baral
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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29
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Jarolimova J, Platt LR, Curtis MR, Philpotts LL, Bekker LG, Morroni C, Shahmanesh M, Mussa A, Barracks K, Ciaranello AL, Parker RA, Bassett IV, Dugdale CM. Curable sexually transmitted infections among women with HIV in sub-Saharan Africa. AIDS 2022; 36:697-709. [PMID: 34999605 PMCID: PMC8957553 DOI: 10.1097/qad.0000000000003163] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sexually transmitted infections (STIs) cause significant morbidity among women with HIV and increase HIV transmission. We estimated the prevalence of four STIs among women with HIV in sub-Saharan Africa (SSA) and compared prevalence among women with and without HIV. DESIGN Systematic review and meta-analysis. METHODS We searched for studies published 1 January 1999 to 19 December 2019 reporting prevalence of gonorrhea, chlamydia, trichomoniasis, or Mycoplasma genitalium among women with HIV in SSA. We excluded studies conducted in high-risk groups (e.g. female sex workers). We extracted data on laboratory-confirmed STIs among women with HIV, and when included, among women without HIV. We estimated pooled prevalence for each STI among women with HIV using inverse variance heterogeneity meta-analysis, compared prevalence to women without HIV, and examined the influences of region, clinical setting, and pregnancy status in subgroup analyses. RESULTS We identified 3756 unique records; 67 studies were included in the meta-analysis. Prevalence of gonorrhea, chlamydia, trichomoniasis, and M. genitalium was 3.5, 4, 15.6, and 10.2%, respectively. Chlamydia prevalence was lower in Eastern (2.8%) than in Southern (12.5%) and West/Central (19.1%) Africa combined. Prevalence of chlamydia and trichomoniasis was higher among pregnant (8.1%, 17.6%) than nonpregnant (1.7%, 12.3%) women. All STIs were more prevalent among women with than without HIV (relative risks ranging 1.54-1.89). CONCLUSION STIs are common among women with HIV in SSA, and more common among women with than without HIV. Integrated STI and HIV care could substantially impact STI burden among women with HIV, with potential downstream impacts on HIV transmission.
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Affiliation(s)
- Jana Jarolimova
- Medical Practice Evaluation Center
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School
| | - Laura R Platt
- Medical Practice Evaluation Center
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School
| | - Megan R Curtis
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Chelsea Morroni
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- MRC Center for Reproductive Health, University of Edinburgh, UK
- Botswana Harvard AIDS Institute Partnership
- Botswana Sexual and Reproductive Health Initiative, Gaborone, Botswana
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College of London, London, UK
| | | | | | - Andrea L Ciaranello
- Medical Practice Evaluation Center
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School
| | - Robert A Parker
- Harvard Medical School
- Biostatistics Center, Massachusetts General Hospital
- Center for AIDS Research, Harvard University, Boston, Massachusetts, USA
| | - Ingrid V Bassett
- Medical Practice Evaluation Center
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School
- Center for AIDS Research, Harvard University, Boston, Massachusetts, USA
| | - Caitlin M Dugdale
- Medical Practice Evaluation Center
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School
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30
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Fu L, Sun Y, Han M, Wang B, Xiao F, Zhou Y, Gao Y, Fitzpatrick T, Yuan T, Li P, Zhan Y, Lu Y, Luo G, Duan J, Hong Z, Fairley CK, Zhang T, Zhao J, Zou H. Incidence Trends of Five Common Sexually Transmitted Infections Excluding HIV From 1990 to 2019 at the Global, Regional, and National Levels: Results From the Global Burden of Disease Study 2019. Front Med (Lausanne) 2022; 9:851635. [PMID: 35308518 PMCID: PMC8924524 DOI: 10.3389/fmed.2022.851635] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Sexually transmitted infections (STIs) are common worldwide and pose a challenge to public health. We conducted this study to assess the annual incidence of five common STIs, including syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes at the global, regional, and national levels. Materials and Methods We obtained detailed data on STIs excluding HIV from 1990 to 2019 from the Global Burden of Disease (GBD) 2019 database. Estimated annual percentage change (EAPC) was calculated to quantify trends in age-standardized incidence rates (ASR) of STIs, stratified by gender, sociodemographic index (SDI) region, and pathogenic microorganism. Results Globally, incident cases of STIs increased by 58.15% from 486.77 million in 1990 to 769.85 million in 2019, but the annual change in ASR was only -0.04% (95% CI -0.09 to 0.01) per year. EAPC was 0.16 (0.06 to 0.26) for syphilis, 0.09 (0.05 to 0.13) for genital herpes, 0.06 (0.03 to 0.09) for trichomoniasis, -0.21 (-0.36 to -0.06) for chlamydia, and -0.14 (-0.19 to -0.08) for gonorrhea. High SDI regions reported significant increases in ASR of syphilis and chlamydia. Conclusions The burden of disease from STIs remains large, though control of STIs has contributed to the decreasing incidence in most regions, especially in the low-SDI regions. Globally, over the past 20 years, the ASR has remained stable for trichomoniasis and genital herpes decreased for chlamydia and gonorrhea, and increased for syphilis.
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Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Min Han
- Department of Medical Administration, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Fei Xiao
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yiguo Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Peiyang Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuewei Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yong Lu
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Junyi Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhongsi Hong
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jin Zhao
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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31
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Pastolero PC, Suss A, Cambridge R, Hammerschlag MR. If We Make It, Will They Take It? Attitudes Toward the Acceptability of Chlamydia Point-of-Care Testing Among Adolescents and Young Adults. Sex Transm Dis 2022; 49:204-207. [PMID: 34561372 DOI: 10.1097/olq.0000000000001563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent women, 15 to 19 years of age, have the highest rate of Chlamydia trachomatis infection in the United States. The objective of this study was to ascertain knowledge and experience of C. trachomatis and acceptance of C. trachomatis point-of-care testing (POCT) if made available over-the-counter (OTC). Currently, there are no tests for C. trachomatis available OTC for purchase. METHODS Patients attending adolescent clinics at University Hospital of Brooklyn and Kings County Hospital received an anonymous 12-item questionnaire. Both clinics serve predominantly African and Caribbean American urban populations. Questions included demographics, sexual orientation, chlamydia knowledge, testing history, prior infection, partner notification, and acceptance of OTC POCT for C. trachomatis. RESULTS Surveys from 151 patients (116 women, 35 men) aged 12 to 21 years (mean age, 17.6 years) were analyzed. Only 34 of the 151 (22.5%) respondents understood C. trachomatis transmission; 31 (20.5%) knew its complications. Sixty-seven (44.4%) would purchase an OTC test but 101 (66.8%) would pay no more than $20. All 151 patients reported that they would follow-up with doctor if positive; 143 (94.7%) would notify partners, although 5 of the 31 (16.1%) women with prior infection did not notify partners. CONCLUSIONS Nearly half (44%) of adolescents in our population would be interested in using a potential OTC test for C. trachomatis. Cost was a major disincentive. Knowledge of infection remains cursory. However, those with a history of C. trachomatis infection and familiar with its complications were more interested in purchasing a home test. Although 100% of the respondents reported that they would follow-up with their physician if they tested positive, past behavior suggests that partner notification might be suboptimal.
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Affiliation(s)
| | - Amy Suss
- From the Division of Adolescent Medicine
| | | | - Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, NY
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Martin K, Dziva Chikwari C, Mackworth-Young CRS, Chisenga M, Bandason T, Dauya E, Olaru ID, Francis SC, Mavodza C, Nzombe P, Nyamwanza R, Hove F, Tshuma M, Machiha A, Kranzer K, Ferrand RA. "It was difficult to offer same day results": evaluation of community-based point-of-care testing for sexually transmitted infections among youth using the GeneXpert platform in Zimbabwe. BMC Health Serv Res 2022; 22:171. [PMID: 35144602 PMCID: PMC8830017 DOI: 10.1186/s12913-022-07557-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Point-of-care testing for sexually transmitted infections (STIs) may improve diagnosis and treatment of STIs in low- and middle-income counties. We explored the facilitators and barriers to point-of-care testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) for youth in community-based settings in Zimbabwe. METHODS This study was nested within a cluster randomised trial of community-based delivery of integrated HIV and sexual and reproductive health services for youth aged 16 to 24 years. On-site CT/NG testing on urine samples using the Xpert® CT/NG test was piloted in four intervention clusters, with testing performed by service providers. On-site testing was defined as sample processing on the same day and site as sample collection. Outcomes included proportion of tests processed on-site, time between sample collection and collection of results, and proportion of clients receiving treatment. In-depth interviews were conducted with nine service providers and three staff members providing study co-ordination or laboratory support to explore facilitators and barriers to providing on-site CT/NG testing. RESULTS Of 847 Xpert tests, 296 (35.0%) were performed on-site. Of these, 61 (20.6%) were positive for CT/NG; one (1.6%) received same day aetiological treatment; 33 (54.1%) presented later for treatment; and 5 (8.2%) were treated as a part of syndromic management. There was no difference in the proportion of clients who were treated whether their sample was processed on or off-site (64% (39/61) vs 60% (66/110); p = 0.61). The median (IQR) number of days between sample collection and collection of positive results was 14 (7-35) and 14 (7-52.5) for samples processed on and off-site, respectively, The interviews revealed four themes related to the provision of on-site testing associated with the i) diagnostic device ii) environment, iii) provider, and iv) clients. Some of the specific barriers identified included insufficient testing capacity, inadequate space, as well as reluctance of clients to wait for their results. CONCLUSIONS In addition to research to optimise the implementation of point-of-care tests for STIs in resource-limited settings, the development of new platforms to reduce analytic time will be necessary to scale up STI testing and reduce the attrition between testing and treatment. TRIAL REGISTRATION Registered in clinical trials.gov ( NCT03719521 ).
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Affiliation(s)
- Kevin Martin
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
| | - Chido Dziva Chikwari
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ioana D Olaru
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Suzanna C Francis
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Portia Nzombe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Fadzanai Hove
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Maureen Tshuma
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Jones J, Pampati S, Siegler AJ. Alignment of PrEP use and sexual behavior over four months among men who have sex with men in the southern United States. AIDS Behav 2022; 26:3378-3385. [PMID: 35429308 PMCID: PMC9012906 DOI: 10.1007/s10461-022-03685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
Unlike antiretrovirals for HIV treatment, pre-exposure prophylaxis (PrEP) does not require continual adherence to be fully effective; rather, PrEP adherence is important only in the context of episodes of sexual risk. Therefore, studies of PrEP adherence and persistence must incorporate contemporaneous measurement of sexual behavior. Short, frequent surveys of PrEP use and sexual behavior allow for the measurement of the alignment between PrEP use and sexual behavior. We assessed the feasibility of using biweekly PrEP use and sexual behavior questionnaires to measure adherence and persistence on PrEP over a period of four months. We also measured the alignment of PrEP use and condomless anal sex. PrEP-using MSM in the southern US were recruited using online advertisements. Participants completed a baseline survey followed by brief surveys every two weeks for 16 weeks to report their PrEP use and sexual behavior over the preceding two-week period. Study retention was high: 91% of participants completed the baseline and final survey and, overall, 86% of study surveys were completed. Self-reported PrEP adherence and persistence were high, but instances of PrEP non-adherence were observed to frequently overlap with episodes of condomless anal sex. The most prominent reasons cited for missing PrEP doses were being too busy, not having PrEP on hand, and not being sexually active. Completing short, biweekly surveys of PrEP use and sexual behavior is feasible and acceptable to MSM in the southern US. Future studies should investigate incorporating biomarker measurements to validate self-reported adherence.
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Affiliation(s)
- Jeb Jones
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University, 1518 Clifton Road, 30322 Atlanta, GA Georgia
| | - Sanjana Pampati
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University, 1518 Clifton Road, 30322 Atlanta, GA Georgia
| | - Aaron J. Siegler
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University, 1518 Clifton Road, 30322 Atlanta, GA Georgia
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Schmidt N, Gomes G, Scott G, Wise B, Craig-Kuhn MC, Lederer AM, Martin DH, Kissinger PJ. Check It: A Community-Based Chlamydia Seek, Test, and Treat Program for Young Black Men Who Have Sex With Women in New Orleans, Louisiana. Sex Transm Dis 2022; 49:5-11. [PMID: 34310525 DOI: 10.1097/olq.0000000000001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Check It is a novel, bundled, community-based seek, test, and treat Chlamydia trachomatis (Ct) screening program for 15- to 24-year-old Black men in New Orleans who have sex with women. The program design addressed barriers and facilitators to Ct screening/treatment by enlisting trusted community partners, incorporating participant input, providing free index/partner expedited treatment, developing relatable marketing materials and an educational Web site, encouraging peer referral, and providing a modest monetary incentive. METHODS Areas of high poverty were identified using census data; ethnographic/key informant interviews identified sites in those areas where the target population congregated. Black youth informed Web site design and social marketing. Content was inspirational/educational/amusing and endorsed recruitment and brand awareness. A community advisory board, participant interviews, community partner feedback, and recruitment staff involvement in the process evaluation helped refine the program in an ongoing manner. RESULTS During formative stages, 41 key informant/community advisory board members informed program refinement. Community partners provided venue locations (n = 65) and participant referrals. Between May 22, 2017, and February 28, 2020, 1890 men were enrolled (acceptance rate, 96.0%) with Ct infection rate of 10.2%. Overall study treatment was provided to 86.1% (71.4%-90.9%) of participants who tested positive and 28.5% (14.5%-41.5%) of their partners. Findings from in-depth interviews with participants (n = 43) led to increased treatment uptake. CONCLUSIONS C. trachomatis community screening of young Black men was successful through collaboration with trusted community partners, by tailoring implements/marketing with participant input, reducing barriers to treatment, and providing modest monetary incentives. The Check It program can serve as a roadmap for reducing health disparities in this population.
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Affiliation(s)
| | | | | | | | | | - Alyssa M Lederer
- Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
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35
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Iwuji C, Pillay D, Shamu P, Murire M, Nzenze S, Cox LA, Mullick S. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:2074-2093. [PMID: 35578892 PMCID: PMC9333409 DOI: 10.1093/jac/dkac159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/23/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be contributing to an increase in AMR in the region. This systematic review aimed to synthesize data on the prevalence of AMR in common STIs in SSA and identify some research gaps that exist. Methods We searched three electronic databases for studies published between 1 January 2000 and 26 May 2020. We screened the titles and abstracts for studies that potentially contained data on AMR in SSA. Then we reviewed the full text of these studies to identify articles that reported data on the prevalence of AMR in Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in SSA. We summarized the data using a narrative synthesis. Results The 40 included studies reported on AMR data from 7961 N. gonorrhoeae isolates from 15 countries in SSA and 350 M. genitalium specimens from South Africa. All four SSA regions reported very high rates of ciprofloxacin, tetracycline and penicillin resistance in N. gonorrhoeae. Resistance to cefixime or ceftriaxone was observed in all regions except West Africa. Azithromycin resistance, recommended as part of dual therapy with an extended-spectrum cephalosporin for gonorrhoea, was reported in all the regions. Both macrolide and fluoroquinolone-associated resistance were reported in M. genitalium in South Africa. Studies investigating AMR in C. trachomatis and T. vaginalis were not identified. Conclusions There is a need to strengthen AMR surveillance in SSA for prompt investigation and notification of drug resistance in STIs.
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Affiliation(s)
| | - Diantha Pillay
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Patience Shamu
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mercy Murire
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Susan Nzenze
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Laura Ashleigh Cox
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Genital Chlamydia trachomatis Seroprevalence and Uterine Fibroid Development: Cohort Study of Young African-American Women. Microorganisms 2021; 10:microorganisms10010010. [PMID: 35056458 PMCID: PMC8780141 DOI: 10.3390/microorganisms10010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Few studies have investigated the 1930s hypothesis that reproductive tract infections are risk factors for fibroid development. In our 2017 cross-sectional analysis from the Study of Environment, Lifestyle, and Fibroids (2010–2018), a large Detroit community-based cohort of 23–35 year-old African-American women with ultrasound fibroid screening, we found an inverse association between seropositivity for genital Chlamydia trachomatis (gCT) infection and fibroids. With prospective data from the cohort (standardized ultrasounds every 20 months over 5 years), we examined gCT’s associations with fibroid incidence (among 1158 women fibroid-free at baseline) and growth. We computed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incidence by gCT serostatus using Cox proportional hazards models. GCT’s influence on growth was assessed by estimating the difference between fibroid size change for seropositive vs. seronegative between successive ultrasounds (1254 growth measures) using a linear mixed model. Growth was scaled to change over 18 months. GCT seropositivity was not associated with fibroid incidence (aHR, 1.0 95% CI: 0.79, 1.29) or growth (4.4%, 95% CI: −5.02, 14.64). The current evidence based on both biomarker gCT data, which can capture the common undiagnosed infections, and prospective ultrasound data for fibroids suggests that Chlamydia is unlikely to increase fibroid risk.
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Relhan V, Bansal A, Hegde P, Sahoo B. Sexually transmitted infections in the elderly: A 6-year retrospective study in a tertiary care hospital in New Delhi. Indian J Sex Transm Dis AIDS 2021; 42:144-149. [PMID: 34909619 PMCID: PMC8628091 DOI: 10.4103/ijstd.ijstd_60_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Worldwide, a steady rise in the incidence of sexually transmitted infections (STIs) in the elderly has been reported and is attributed to aging, unsafe sexual practices, and delayed health-care seeking behavior, leading to a delayed diagnosis and persistence of infection in the community. The aim of this study was to assess the demographic profile, risk factors, and clinical pattern of geriatric STIs. Aims: The aim of the study was to assess the demographic profile, risk factors, and clinical pattern of STIs among patients aged ≥60 years presenting to the STI clinic in the dermatology outpatient department at a large tertiary care hospital in New Delhi, over a period of 6 years. Materials and Methods: This was a retrospective observational study. Data collection was done for all patients of 60 years and above age group who visited the STI clinic in the dermatology outpatient department, over a period of past 6 years, with symptoms/signs suggestive of an STI, irrespective of whether the final evaluation demonstrated an STI. Results: A total number of 123 patients above 60 years of age presented to the STI clinic between 2013 and 2018. The cases presenting annually demonstrated a rising trend and increased from 17 cases in 2013 to 33 in 2018. The most common complaints were ulcers over the genitalia and genital discharge noted in 28.4% of cases each. The most common syndromic diagnosis was vaginal discharge in 25% of cases. Other STDs diagnosed were candidial balanoposthitis in 19.5%, herpes genitalis and genital warts in 16.2% each, and genital scabies in 6.5% cases. Limitations: The limitations included a small sample size, retrospective analysis, and categorization of the STDs as syndromes, following standard guidelines developed by the National Aids Control Organization (NACO) and the WHO. Conclusion: It is necessary to destigmatize STDs among the elderly, encourage inclusion in screening programs, and offer prompt diagnosis and treatment.
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Affiliation(s)
- Vineet Relhan
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
| | - Anuva Bansal
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
| | - Pallavi Hegde
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
| | - Bijaylaxmi Sahoo
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
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Diesel J, Peterson A, Peterman T. Reported Chlamydia and Gonorrhea Are Decreasing Among Young Black Women: Good News or Bad News? A Narrative Review. Sex Transm Dis 2021; 48:e228-e235. [PMID: 34091582 PMCID: PMC10308433 DOI: 10.1097/olq.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Since 2010, reported chlamydia and gonorrhea rates decreased among Black women aged 15 to 19 years and were stable for Black women aged 20 to 24 years in the United States. Rates increased for older Black women aged 25 to 39 years and all White women. The Black/White rate ratio decreased across age groups. We examined whether trends in reported rates reflected changing prevalence or changing screening. We analyzed trends in reported chlamydia and gonorrhea rates from 2010 to 2018 among women in the United States aged 15 to 39 years by age and race/ethnicity subgroup, state, and reporting source. Most jurisdictions reported decreased chlamydia and gonorrhea rates among Black teens and increased rates among White teens and older women. Between 2010 and 2018, public clinics reported fewer cases, especially among young Black women, that were not restored by increases elsewhere. We reviewed literature on trends in screening, prevalence, and sequelae. Family planning clinics annual reports showed chlamydia tests among women younger than 25 years decreased by 541,573 tests (-38%) in 2018 compared with 2010 and the number of women visiting sexually transmitted disease clinics had decreased 50% by 2016 compared with 2010. Prevalence of chlamydia in a sentinel population (Job Corps) was unchanged for Black women younger than 25 years and increased for Whites aged 20 to 24 years. Sequelae trends using data from a large all-payer emergency department database were mixed: pelvic inflammatory disease decreased, whereas ectopic pregnancy increased. Decreases in testing at public clinics likely missed diagnoses among young Black women, a group traditionally at highest risk and in need of more testing. Innovative approaches to screening are needed.
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Affiliation(s)
- Jill Diesel
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
- Michigan Department of Health and Human Services, Detroit, MI
| | - Amy Peterson
- Michigan Department of Health and Human Services, Detroit, MI
| | - Thomas Peterman
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
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Dudiak BM, Nguyen TM, Needham D, Outlaw TC, McCafferty DG. Inhibition of the futalosine pathway for menaquinone biosynthesis suppresses Chlamydia trachomatis infection. FEBS Lett 2021; 595:2995-3005. [PMID: 34741525 PMCID: PMC9980418 DOI: 10.1002/1873-3468.14223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/29/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023]
Abstract
Chlamydia trachomatis, an obligate intracellular bacterium with limited metabolic capabilities, possesses the futalosine pathway for menaquinone biosynthesis. Futalosine pathway enzymes have promise as narrow-spectrum antibiotic targets, but the activity and essentiality of chlamydial menaquinone biosynthesis have yet to be established. In this work, menaquinone-7 (MK-7) was identified as a C. trachomatis-produced quinone through liquid chromatography-tandem mass spectrometry. An immunofluorescence-based assay revealed that treatment of C. trachomatis-infected HeLa cells with the futalosine pathway inhibitor docosahexaenoic acid (DHA) reduced inclusion number, inclusion size, and infectious progeny. Supplementation with MK-7 nanoparticles rescued the effect of DHA on inclusion number, indicating that the futalosine pathway is a target of DHA in this system. These results open the door for menaquinone biosynthesis inhibitors to be pursued in antichlamydial development.
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Affiliation(s)
| | - Tri M. Nguyen
- Department of Chemistry, Duke University, Durham, NC, USA
| | - David Needham
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
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Olson KM, Geisler WM, Bakshi RK, Gupta K, Tiwari HK. Predicting the Probability of Chlamydia Reinfection in African American Women Using Immunologic and Genetic Determinants in a Bayesian Model. Sex Transm Dis 2021; 48:813-818. [PMID: 33993163 PMCID: PMC8550879 DOI: 10.1097/olq.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African Americans have the highest rates of Chlamydia trachomatis (CT) infection in the United States and also high reinfection rates. The primary objective of this study was to develop a Bayesian model to predict the probability of CT reinfection in African American women using immunogenetic data. METHODS We analyzed data from a cohort of CT-infected African American women enrolled at the time they returned to a clinic in Birmingham, AL, for the treatment of a positive routine CT test result. We modeled the probability of CT reinfection within 6 months after treatment using logistic regression in a Bayesian framework. Predictors of interest were presence or absence of an HLA-DQB1*06 allele and CT-specific CD4+ IFN-γ response, both of which we had previously reported were independently associated with CT reinfection risk. RESULTS Among 99 participants evaluated, the probability of reinfection for those with a CT-specific CD4+ IFN-γ response and no HLA-DQB1*06 alleles was 14.1% (95% credible interval [CI], 3.0%-45.0%), whereas the probability of reinfection for those without a CT-specific CD4+ IFN-γ response and at least one HLA-DQB1*06 allele was 61.5% (95% CI, 23.1%-89.7%). CONCLUSIONS Our model demonstrated that presence or absence of an HLA-DQB1*06 allele and CT-specific CD4+ IFN-γ response can have an impact on the predictive probability of CT reinfection in African American women.
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Affiliation(s)
- Kristin M. Olson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William M. Geisler
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rakesh K. Bakshi
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kanupriya Gupta
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hemant K. Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Tomcho MM, Lou Y, O'Leary SC, Rinehart DJ, Thomas-Gale T, Douglas CM, Wu FJ, Penny L, Federico SG, Frost HM. An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care. Pediatrics 2021; 148:e2020027508. [PMID: 34675130 PMCID: PMC8972200 DOI: 10.1542/peds.2020-027508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of chlamydia and gonorrhea among adolescents continue to rise. We aimed to evaluate if a universal testing program for chlamydia and gonorrhea improved testing rates in an urban general pediatric clinic and an urban family medicine clinic within a system of federally qualified health care centers and evaluated the feasibility, cost, and logistic challenges of expanding implementation across 28 primary care clinics within a federally qualified health care centers system. METHODS A universal testing quality improvement program for male and female patient 14 to 18 years old was implemented in a general pediatrics and family medicine clinic in Denver, Colorado. The intervention was evaluated by using a controlled pre-post quasi-experimental design. The difference in testing rates due to the intervention was assessed by using a difference-in-differences regression model weighted with the inverse probability of treatment. RESULTS In total, 15 541 pediatric encounters and 5420 family medicine encounters were included in the analyses. In pediatrics, the unadjusted testing rates increased from 32.0% to 66.7% in the intervention group and from 20.9% to 28.9% in the comparison group. For family medicine, the rates increased from 38.5% to 49.9% in the intervention group and decreased from 26.3% to 24.8% in the comparison group. The intervention resulted in an adjusted increase in screening rates of 25.2% (P < .01) in pediatrics and 11.8% (P < .01) in family medicine. The intervention was well received and cost neutral to the clinic. CONCLUSIONS Universal testing for chlamydia and gonorrhea in primary care pediatrics and family medicine is a feasible approach to improving testing rates .
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Affiliation(s)
| | - Yingbo Lou
- Ambulatory Care Services, Denver Health Medical Center, Denver, Colorado
| | - Sonja C O'Leary
- Departments of General Pediatrics
- Departments of General Pediatrics
| | | | - Tara Thomas-Gale
- Ambulatory Care Services, Denver Health Medical Center, Denver, Colorado
| | - Claudia M Douglas
- Departments of General Pediatrics
- Departments of General Pediatrics
- Internal Medicine
| | - Florence J Wu
- Departments of General Pediatrics
- Departments of General Pediatrics
| | - Lara Penny
- Family Medicine
- Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Holly M Frost
- Departments of General Pediatrics
- Center for Health Systems Research, Denver, Colorado
- Departments of General Pediatrics
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42
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Carveth-Johnson T, Dunin De Skrzynno S, Wynn A, Moshashane N, Ramontshonyana K, Lebelonyane R, Mussa A, Ramogola-Masire D, Klausner J, Morroni C. Integrating Sexually Transmitted Infection Testing and Treatment With Routine HIV Care in Gaborone, Botswana. Sex Transm Dis 2021; 48:887-894. [PMID: 34174039 PMCID: PMC8505143 DOI: 10.1097/olq.0000000000001492] [Citation(s) in RCA: 2] [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: 01/17/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infection (STI) testing is not routinely offered in many countries, and management is symptoms based. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are associated with an increased risk of HIV transmission. We assess the feasibility and acceptability of integrating CT/NG testing into routine HIV care in Botswana, as well as the prevalence and correlates of CT/NG infections. METHOD A prospective study was conducted at an HIV clinic in Gaborone between February and October 2019. Eligibility criteria included the following: ≥18 years, HIV infected, and not treated for CT/NG in the past month. Participants self-collected samples and responded to a questionnaire on sociodemographic and health characteristics. Samples were processed using the GeneXpert. Patients were offered same-day results in person or by telephone. Those who tested positive were treated. RESULTS Of 806 patients informed of the study, 526 (65%) expressed interest and 451 (60%) were enrolled. The median age was 48 years, and 66% were women. All participants provided self-collected samples, were successfully tested, and received results. Almost all reported sample self-collection was easy. The prevalence of CT/NG was 5%. Most participants (73%) with a positive result were asymptomatic. Among infected, 20 (91%) received same-day results and all were treated. Younger age, female sex, and pain during sex were associated with having CT/NG. CONCLUSIONS Integrating STI testing into routine HIV care was feasible, self-collecting specimens was highly acceptable, but uptake of testing was low. Where blanket screening to the entire clinic population may not be feasible because of resource limitation, one strategy could be to prioritize sexually active patients, younger patients, and women.
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Affiliation(s)
| | | | - Adriane Wynn
- From the Botswana-UPenn Partnership (BUP), Gaborone, Botswana
- Division of Infectious Diseases and Global Health, Department of Medicine, University of California, Los Angeles, California
| | - Neo Moshashane
- Botswana Harvard AIDS Institute Partnership (BHP), Gaborone, Botswana
| | | | | | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership (BHP), Gaborone, Botswana
| | | | - Jeffrey Klausner
- Department of Medicine, University of California, Los Angeles, California
| | - Chelsea Morroni
- From the Botswana-UPenn Partnership (BUP), Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership (BHP), Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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43
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Jen FEC, El-Deeb IM, Zalucki YM, Edwards JL, Walker MJ, von Itzstein M, Jennings MP. A drug candidate for Alzheimer's and Huntington's disease, PBT2, can be repurposed to render Neisseria gonorrhoeae susceptible to natural cationic antimicrobial peptides. J Antimicrob Chemother 2021; 76:2850-2853. [PMID: 34450628 DOI: 10.1093/jac/dkab291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Neisseria gonorrhoeae is a Gram-negative bacterial pathogen that causes gonorrhoea. No vaccine is available to prevent gonorrhoea and the emergence of MDR N. gonorrhoeae strains represents an immediate public health threat. OBJECTIVES To evaluate whether PBT2/zinc may sensitize MDR N. gonorrhoeae to natural cationic antimicrobial peptides. METHODS MDR strains that contain differing resistance mechanisms against numerous antibiotics were tested in MIC assays. MIC assays were performed using the broth microdilution method according to CLSI guidelines in a microtitre plate. Serially diluted LL-37 or PG-1 was tested in combination with a sub-inhibitory concentration of PBT2/zinc. Serially diluted tetracycline was also tested with sub-inhibitory concentrations of PBT2/zinc and LL-37. SWATH-MS proteomic analysis of N. gonorrhoeae treated with PBT2/zinc, LL-37 and/or tetracycline was performed to determine the mechanism(s) of N. gonorrhoeae susceptibility to antibiotics and peptides. RESULTS Sub-inhibitory concentrations of LL-37 and PBT2/zinc synergized to render strain WHO-Z susceptible to tetracycline, whereas the killing effect of PG-1 and PBT2/zinc was additive. SWATH-MS proteomic analysis suggested that PBT2/zinc most likely leads to a loss of membrane integrity and increased protein misfolding and, in turn, results in bacterial death. CONCLUSIONS Here we show that PBT2, a candidate Alzheimer's and Huntington's disease drug, can be repurposed to render MDR N. gonorrhoeae more susceptible to the endogenous antimicrobial peptides LL-37 and PG-1. In the presence of LL-37, PBT2/zinc can synergize with tetracycline to restore tetracycline susceptibility to gonococci resistant to this antibiotic.
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Affiliation(s)
- Freda E-C Jen
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
| | - Ibrahim M El-Deeb
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
| | - Yaramah M Zalucki
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
| | - Jennifer L Edwards
- The Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital and The Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark von Itzstein
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
| | - Michael P Jennings
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
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44
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Stevermer J, Tseng CW, Wong JB. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:949-956. [PMID: 34519796 DOI: 10.1001/jama.2021.14081] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Chlamydia and gonorrhea are among the most common sexually transmitted infections in the US. Infection rates are highest among adolescents and young adults of both sexes. Chlamydial and gonococcal infections in women are usually asymptomatic and may lead to pelvic inflammatory disease and its associated complications. Newborns of pregnant persons with untreated infection may develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia. Infection in men may lead to urethritis and epididymitis. Both types of infection can increase risk of acquiring or transmitting HIV. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for chlamydia and gonorrhea in sexually active adolescents and adults, including pregnant persons. POPULATION Asymptomatic, sexually active adolescents and adults, including pregnant persons. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes with moderate certainty that screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. RECOMMENDATION The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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45
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Xu SX, Gray-Owen SD. Gonococcal Pelvic Inflammatory Disease: Placing Mechanistic Insights Into the Context of Clinical and Epidemiological Observations. J Infect Dis 2021; 224:S56-S63. [PMID: 34396410 DOI: 10.1093/infdis/jiab227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
While infection by Neisseria gonorrhoeae is often asymptomatic in women, undetected infections can ascend into the upper genital tract to elicit an inflammatory response that manifests as pelvic inflammatory disease, with the outcomes depending on the intensity and duration of inflammation and whether it is localized to the endometrial, fallopian tube, ovarian, and/or other tissues. This review examines the contribution of N. gonorrhoeae versus other potential causes of pelvic inflammatory disease by considering new insights gained through molecular, immunological, and microbiome-based analyses, and the current epidemiological burden of infection, with an aim to highlighting key areas for future study.
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Affiliation(s)
- Stacey X Xu
- Department of Molecular Genetics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott D Gray-Owen
- Department of Molecular Genetics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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46
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Kang-Birken SL. Challenges in Treating Chlamydia trachomatis, Including Rectal Infections: Is It Time to Go Back to Doxycycline? Ann Pharmacother 2021; 56:330-338. [PMID: 34218681 DOI: 10.1177/10600280211029945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis. DATA SOURCES A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials. STUDY SELECTION AND DATA EXTRACTION English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered. DATA SYNTHESIS Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice. CONCLUSIONS Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.
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Affiliation(s)
- S Lena Kang-Birken
- University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA, USA.,Cottage Health System, Santa Barbara, CA, USA
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47
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Bonett S, Petsis D, Dowshen N, Bauermeister J, Wood SM. The Impact of the COVID-19 Pandemic on Sexually Transmitted Infection/Human Immunodeficiency Virus Testing Among Adolescents in a Large Pediatric Primary Care Network. Sex Transm Dis 2021; 48:e91-e93. [PMID: 33783411 PMCID: PMC8500357 DOI: 10.1097/olq.0000000000001427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT Disruptions in sexually transmitted infection (STI) testing infrastructure during the COVID-19 pandemic threaten to impact STI service delivery for adolescents. Within a large pediatric primary care network, we compared STI testing encounters between the pandemic period and an analogous prepandemic period. The STI test counts decreased and test positivity increased during the pandemic period.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Danielle Petsis
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia
| | - Nadia Dowshen
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Sarah M. Wood
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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48
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Donovan LC, Fairley CK, Aung ET, Traeger MW, Wright EJ, Stoové MA, Chow EPF. The Presence or Absence of Symptoms Among Cases of Urethral Gonorrhoea Occurring in a Cohort of Men Taking Human Immunodeficiency Virus Pre-exposure Prophylaxis in the PrEPX Study. Open Forum Infect Dis 2021; 8:ofab263. [PMID: 34189177 PMCID: PMC8231363 DOI: 10.1093/ofid/ofab263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/20/2021] [Indexed: 12/02/2022] Open
Abstract
We aimed to estimate how often urethral gonorrhoea is symptomatic among men in the Pre-Exposure Prophylaxis Expanded Victoria study. Eighty-seven percent of 213 cases of urethral gonorrhoea were symptomatic. Ensuring men with urethral gonorrhoea both recognize and present early for treatment is critical to reduce transmission.
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Affiliation(s)
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwina J Wright
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Alfred Hospital, Monash Central Clinical School, Melbourne, Victoria, Australia.,Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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49
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Martin K, Roper T, Vera JH. Point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review protocol. JBI Evid Synth 2021; 19:155-162. [PMID: 32813408 DOI: 10.11124/jbisrir-d-19-00381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will explore how point-of-care tests for sexually transmitted infections have been implemented into health care systems in low- and middle-income countries, and the facilitators and barriers to implementation. INTRODUCTION Sexually transmitted infections contribute to significant global morbidity. In low- and middle-income countries, syndromic management of sexually transmitted infections is recommended. However, due to the limitations of syndromic management, there is increasing interest in the potential for point-of-care tests to be incorporated into models of care for sexually transmitted infections in low-resource settings. It is therefore important to explore how point-of-care tests for sexually transmitted infections have been used in these settings previously, and the facilitators and barriers to implementation on a wider scale. INCLUSION CRITERIA This scoping review will consider studies that explore the use of point-of-care-testing for chlamydia, gonorrhea, trichomoniasis, or syphilis, and how they are implemented into models of care in low- and middle-income countries. Study participants may be those receiving sexually transmitted infection testing or health care professionals providing testing. HIV testing will not be covered. Quantitative, qualitative, and mixed methods study designs, as well as review papers will be considered for inclusion. METHODS The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. The authors will search databases including MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, African Index Medicus, and the Cochrane library from 1998 onwards. Results will be screened by two independent reviewers and data extracted using a data extraction tool developed by the reviewers. Data will be presented both narratively and in tabular form.
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Affiliation(s)
- Kevin Martin
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Tom Roper
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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50
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Suboptimal prenatal screening of Chlamydia trachomatis and Neisseria gonorrhoeae infections in a Montréal birthing and tertiary care centre: A retrospective cohort study. ACTA ACUST UNITED AC 2021; 47:209-215. [PMID: 34035667 DOI: 10.14745/ccdr.v47i04a05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background The Canadian Paediatric Society no longer recommends the use of universal ocular prophylaxis with erythromycin ointment to prevent ophthalmia neonatorum. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae in all pregnant women is considered the most effective way of preventing vertical transmission and ophthalmia neonatorum. Objective The aims of this study were to assess prenatal screening rates of C. trachomatis and N. gonorrhoeae and to compare sociodemographic factors between those screened and those not screened. Methods The list of all women who delivered at a tertiary care hospital in Montréal, Québec, between April 2015 and March 2016, was cross-referenced with the list of samples tested for C. trachomatis and N. gonorrhoeae. Maternal medical records were reviewed for demographic, prenatal and diagnostic information. Results Of 2,688 mothers, 2,245 women were screened at least once, but only 2,206 women had at least one valid C. trachomatis and N. gonorrhoeae result the day of delivery (82.1%; 95% CI: 80.6%-83.5%). Infection was detected in 46/2,206 (2.1%) screened women: 42 had C. trachomatis infection, two had N. gonorrhoeae infection and two were co-infected. C. trachomatis infection was more frequent in women younger than 25 years (9.8%; 95% CI: 6.7%-13.8%) than in older women (0.8%; 95% CI: 0.4%-1.3%; p<0.001). Each increase in parity decreased the probability of being tested (adjusted odds ratio=0.89; 95% CI: 0.80%-0.97%; p=0.01). Of those with an initial negative test result, 35/267 (13.1%; 95% CI: 9.3%-17.8%) of women younger than 25 years and 122/1,863 (6.6%; 95% CI: 5.5%-7.8%; p<0.001) of women aged 25 years and older were retested. Subsequent infection was detected in 4/35 (11%) women, all younger than 25. Conclusion Suboptimal screening rates for C. trachomatis and N. gonorrhoeae suggest that current universal ocular prophylaxis cannot be discontinued. Repeating universal screening should be considered, especially among those younger than 25 years.
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