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Omori R, Chemaitelly H, Abu-Raddad LJ. Understanding dynamics and overlapping epidemiologies of HIV, HSV-2, chlamydia, gonorrhea, and syphilis in sexual networks of men who have sex with men. Front Public Health 2024; 12:1335693. [PMID: 38628844 PMCID: PMC11018893 DOI: 10.3389/fpubh.2024.1335693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction We aimed to investigate the overlapping epidemiologies of human immunodeficiency virus (HIV), herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhea, and syphilis in sexual networks of men who have sex with men (MSM), and to explore to what extent the epidemiology of one sexually transmitted infection (STI) relates to or differs from that of another STI. Methods An individual-based Monte Carlo simulation model was employed to simulate the concurrent transmission of STIs within diverse sexual networks of MSM. The model simulated sexual partnering, birth, death, and STI transmission within each specific sexual network. The model parameters were chosen based on the current knowledge and understanding of the natural history, transmission, and epidemiology of each considered STI. Associations were measured using the Spearman's rank correlation coefficient (SRCC) and maximal information coefficient (MIC). Results A total of 500 sexual networks were simulated by varying the mean and variance of the number of partners for both short-term and all partnerships, degree correlation, and clustering coefficient. HSV-2 had the highest current infection prevalence across the simulations, followed by HIV, chlamydia, syphilis, and gonorrhea. Threshold and saturation effects emerged in the relationship between STIs across the simulated networks, and all STIs demonstrated moderate to strong associations. The strongest current infection prevalence association was between HIV and gonorrhea, with an SRCC of 0.84 (95% CI: 0.80-0.87) and an MIC of 0.81 (95% CI: 0.74-0.88). The weakest association was between HSV-2 and syphilis, with an SRCC of 0.54 (95% CI: 0.48-0.59) and an MIC of 0.57 (95% CI, 0.49-0.65). Gonorrhea exhibited the strongest associations with the other STIs while syphilis had the weakest associations. Across the simulated networks, proportions of the population with zero, one, two, three, four, and five concurrent STI infections were 48.6, 37.7, 11.1, 2.4, 0.3, and < 0.1%, respectively. For lifetime exposure to these infections, these proportions were 13.6, 21.0, 22.9, 24.3, 13.4, and 4.8%, respectively. Conclusion STI epidemiologies demonstrate substantial overlap and associations, alongside nuanced differences that shape a unique pattern for each STI. Gonorrhea exhibits an "intermediate STI epidemiology," reflected by the highest average correlation coefficient with other STIs.
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Affiliation(s)
- Ryosuke Omori
- Division of Bioinformatics, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Cornell University, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Cornell University, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Boudova S, Tholey D, Fenkel JM, Derman R, Boelig RC. Pregnancy as an Opportunity for Hepatitis C Virus Elimination and Eradication. Am J Trop Med Hyg 2024; 110:199-201. [PMID: 38150734 PMCID: PMC10859822 DOI: 10.4269/ajtmh.23-0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 12/29/2023] Open
Abstract
Since the development of highly effective direct-acting antivirals, the WHO has set a goal of hepatitis C virus (HCV) elimination by 2030. Key to this strategy is increased screening and treatment. Pregnancy and the postpartum period represent a unique time when underserved populations have increased contact with the healthcare system. We propose using antenatal care to maximize case identification, treatment, and prevention. Pregnant individuals are an ideal sentinel population for HCV surveillance. Universal screening in pregnancy can provide population-level data. Once cases are identified, pregnancy presents an opportunity for intervention. Although not currently WHO approved, clinical trials are examining treatment during pregnancy. In the interim, identification of infection during pregnancy allows for optimization of the treatment cascade postpartum. Pregnancy can be used as a time for prevention. Taking advantage of patient engagement and existing infrastructure, pregnancy presents an opportunity to intervene in the fight for HCV eradication.
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Affiliation(s)
- Sarah Boudova
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Danielle Tholey
- Division of Gastroenterology and Hepatology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jonathan M. Fenkel
- Division of Gastroenterology and Hepatology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Richard Derman
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rupsa C. Boelig
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Pujol A, Brokhattingen N, Matambisso G, Mbeve H, Cisteró P, Escoda A, Maculuve S, Cuna B, Melembe C, Ndimande N, Munguambe H, Montaña J, Nhamússua L, Simone W, Tetteh KKA, Drakeley C, Gamain B, Chitnis CE, Chauhan V, Quintó L, Chidimatembue A, Martí-Soler H, Galatas B, Guinovart C, Saúte F, Aide P, Macete E, Mayor A. Detecting temporal and spatial malaria patterns from first antenatal care visits. Nat Commun 2023; 14:4004. [PMID: 37414792 PMCID: PMC10326053 DOI: 10.1038/s41467-023-39662-4] [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] [Received: 02/15/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Pregnant women attending first antenatal care (ANC) visits represent a promising malaria surveillance target in Sub-Saharan Africa. We assessed the spatio-temporal relationship between malaria trends at ANC (n = 6471) and in children in the community (n = 3933) and at health facilities (n = 15,467) in southern Mozambique (2016-2019). ANC P. falciparum rates detected by quantitative polymerase chain reaction mirrored rates in children, regardless of gravidity and HIV status (Pearson correlation coefficient [PCC] > 0.8, χ²<1.1), with a 2-3 months lag. Only at rapid diagnostic test detection limits at moderate-to-high transmission, did multigravidae show lower rates than children (PCC = 0.61, 95%CI[-0.12-0.94]). Seroprevalence against the pregnancy-specific antigen VAR2CSA reflected declining malaria trends (PCC = 0.74, 95%CI[0.24-0.77]). 60% (9/15) of hotspots detected from health facility data (n = 6662) using a novel hotspot detector, EpiFRIenDs, were also identified with ANC data (n = 3616). Taken together, we show that ANC-based malaria surveillance offers contemporary information on temporal trends and geographic distribution of malaria burden in the community.
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Affiliation(s)
- Arnau Pujol
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - Glória Matambisso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Henriques Mbeve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pau Cisteró
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Anna Escoda
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sónia Maculuve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Boaventura Cuna
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Cardoso Melembe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nelo Ndimande
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Júlia Montaña
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Lídia Nhamússua
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Wilson Simone
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Benoit Gamain
- Université Paris Cité, INSERM, BIGR, F-75014, Paris, France
| | - Chetan E Chitnis
- Malaria Parasite Biology and Vaccines, Department of Parasites & Insect Vectors, Institut Pasteur, Paris, France
| | - Virander Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | - Beatriz Galatas
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
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Palazzotto E, Bonura F, Calà C, Capra G, Pistoia D, Mangione D, Mascarella C, Minì G, Enea M, Giammanco GM, Ferraro D, De Grazia S. Serological status for TORCH in women of childbearing age: a decade-long surveillance (2012-2022) in Italy. J Med Microbiol 2023; 72. [PMID: 37458733 DOI: 10.1099/jmm.0.001733] [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: 07/20/2023] Open
Abstract
Introduction. Serological screening and seroprevalence data for TORCH infections represent a key instrument to estimate immunity and vaccination levels and exposure rates to prevent and treat TORCH congenital infections.Hypothesis. Serology allows us to identify women susceptible to primary infection.Aim. Assess the prevalence of women at risk of primary infections by TORCH pathogens in Palermo, Sicily, Italy, in the decade 2012-2022.Methodology. A retrospective study was performed to evaluate the serological status (IgG and/or IgM) of 2359 women of childbearing age (WCBA), ranging from 16 to 46 years, attending the AOUP 'P. Giaccone' University Hospital of Palermo.Results. The results showed an overall prevalence of anti-TORCH IgG of 90.5 % for herpesvirus (HSV), 81.2 % for rubella virus (RV), 72.1 % for cytomegalovirus (CMV), 20.9 % for Toxoplasma gondii (TOX) and 4.8 % for Treponema pallidum (TP). IgM positivity was 16.9 % for HSV2, 10.3 % for TOX, 4 % for CMV and, 2 % for RV. A recent/active infection by TP was confirmed in 28.3 % of the seropositive women. Our results indicate that only a small percentage of WCBA were subjected to a comprehensive TORCH serological screening, while most WCBA were only tested for a single pathogen. In addition, no significant differences were found in terms of the overall TORCH IgG seroprevalence among different age groups (P>0.05).Conclusion. Identifying WCBA at risk of exposure during pregnancy allows us to prevent and reduce possible congenital infections, providing detailed guidelines and instructions. The results of this study showed that in Italy the risk of acquiring a primary infection by a TORCH agent is still high, therefore effective prevention strategies, including serological screening, should be implemented.
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Affiliation(s)
- Emilia Palazzotto
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Floriana Bonura
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Cinzia Calà
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Giuseppina Capra
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Daniela Pistoia
- Unit of Microbiology and Virology, University Hospital 'P. Giaccone', Palermo, Italy
| | - Donatella Mangione
- Gynecology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Chiara Mascarella
- Unit of Microbiology and Virology, University Hospital 'P. Giaccone', Palermo, Italy
| | - Giuseppe Minì
- Unit of Microbiology and Virology, University Hospital 'P. Giaccone', Palermo, Italy
| | - Marco Enea
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Giovanni M Giammanco
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Donatella Ferraro
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Simona De Grazia
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
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Women attending antenatal care as a sentinel surveillance population for malaria in Geita region, Tanzania: feasibility and acceptability to women and providers. Malar J 2023; 22:66. [PMID: 36829200 PMCID: PMC9951145 DOI: 10.1186/s12936-023-04480-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Measurement of malaria prevalence is conventionally estimated through infrequent cross-sectional household surveys that do not provide continuous information regarding malaria parasitaemia. Recent studies have suggested that malaria parasitaemia prevalence among women attending antenatal care (ANC) correlates with prevalence among children under 5 years old and that pregnant women could be a sentinel population for tracking malaria prevalence. In mainland Tanzania, 97% of women are tested for malaria parasitaemia during first ANC visits. However, acceptability among pregnant women and healthcare providers of collecting malaria risk factor data during ANC visits is limited. METHODS A tablet-based questionnaire including 15 questions on insecticide-treated net ownership and use and care-seeking for febrile children was introduced at 40 healthcare facilities in Geita Region, Tanzania. Facilities were randomly selected from among those with 15-120 first ANC visits per month. To assess perspectives regarding introduction of the questionnaire, 21 semi-structured interviews were held with providers and facility in-charges at 12 facilities. Thirty pregnant and recently delivered women participated in focus group discussions at seven facilities to assess the acceptability of spending additional time answering questions about malaria risk. RESULTS All pregnant women reported that introduction of ANC surveillance and spending 10 more minutes with providers answering questions about their health would be neutral or beneficial. They perceived being asked about their health as standard of care. Providers and in-charges reported that introduction of ANC surveillance was within their scope of practice. Nine of 21 indicated it could potentially benefit women's health. Six providers expressed concern about staffing shortages and need for reimbursement for extra time and noted that data management occurs after hours. CONCLUSIONS Pregnant women and providers generally perceived ANC surveillance for malaria as acceptable and positive. Pregnant and recently delivered women saw this as a reasonable and even helpful intervention. To be seen as a part of standard practice, efforts are needed to ensure providers perceive a benefit for ANC clients and that staffing concerns are addressed. In addition, staff should receive feedback related to data submissions regarding malaria prevalence and risk factors among women at their facility, with actions to take.
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Pujol A, Brokhattingen N, Matambisso G, Mbeve H, Cisteró P, Escoda A, Maculuve S, Cuna B, Melembe C, Ndimande N, Munguambe H, Lopez JM, Nhamussa L, Simone W, Tetteh K, Drakeley C, Gamain B, Chitnis C, Chauhan VS, Quintó L, Chidimatembue A, Soler HM, Galatas B, Guinovart C, Saute F, Aide P, Macete E, Mayor A. Detecting temporal and spatial malaria patterns from first antenatal care visits. RESEARCH SQUARE 2023:rs.3.rs-2592126. [PMID: 36865132 PMCID: PMC9980210 DOI: 10.21203/rs.3.rs-2592126/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Pregnant women attending first antenatal care (ANC) visits represent a promising malaria surveillance target in Sub-Saharan Africa. Here we assessed the spatio-temporal relationship between malaria at ANC (n=6,471), in children at the community(n=9,362) and at health facilities (n=15,467) in southern Mozambique (2016-2019). ANC P. falciparum rates detected by quantitative polymerase chain reaction mirrored rates in children, regardless of gravidity and HIV status (Pearson correlation coefficient [PCC]>0.8, χ²<1.1), with a 2-3 months lag. Only at rapid diagnostic test detection limits at moderate-to-high transmission, multigravidae showed lower rates than children (PCC=0.61, 95%CI[-0.12-0.94]). Seroprevalence against the pregnancy-specific antigen VAR2CSA reflected declining malaria trends (PCC=0.74, 95%CI[0.24-0.77]). 80% (12/15) of hotspots detected from health facility data using a novel hotspot detector, EpiFRIenDs, were also identified with ANC data. The results show that ANC-based malaria surveillance offers contemporary information on temporal trends and the geographic distribution of malaria burden in the community.
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Affiliation(s)
- Arnau Pujol
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona / Centro de Investigação em Saúde da Manhiça
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, United Kingdom
| | | | | | | | | | | | | | - Beatriz Galatas
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona / Centro de Investigação em Saúde da Manhiça
| | | | | | | | | | - Alfredo Mayor
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona / Centro de Investigação em Saúde da Manhiça
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Vitral GLN, Romanelli RMDC, Reis ZSN, Guimarães RN, Dias I, Mussagy N, Taunde S, Neves GS, de São José CN, Pantaleão AN, Pappa GL, Gaspar JDS, de Aguiar RAPL. Gestational age assessed by optical skin reflection in low-birth-weight newborns: Applications in classification at birth. Front Pediatr 2023; 11:1141894. [PMID: 37056944 PMCID: PMC10086374 DOI: 10.3389/fped.2023.1141894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/02/2023] [Indexed: 04/15/2023] Open
Abstract
Introduction A new medical device was previously developed to estimate gestational age (GA) at birth by processing a machine learning algorithm on the light scatter signal acquired on the newborn's skin. The study aims to validate GA calculated by the new device (test), comparing the result with the best available GA in newborns with low birth weight (LBW). Methods We conducted a multicenter, non-randomized, and single-blinded clinical trial in three urban referral centers for perinatal care in Brazil and Mozambique. LBW newborns with a GA over 24 weeks and weighing between 500 and 2,500 g were recruited in the first 24 h of life. All pregnancies had a GA calculated by obstetric ultrasound before 24 weeks or by reliable last menstrual period (LMP). The primary endpoint was the agreement between the GA calculated by the new device (test) and the best available clinical GA, with 95% confidence limits. In addition, we assessed the accuracy of using the test in the classification of preterm and SGA. Prematurity was childbirth before 37 gestational weeks. The growth standard curve was Intergrowth-21st, with the 10th percentile being the limit for classifying SGA. Results Among 305 evaluated newborns, 234 (76.7%) were premature, and 139 (45.6%) were SGA. The intraclass correlation coefficient between GA by the test and reference GA was 0.829 (95% CI: 0.785-0.863). However, the new device (test) underestimated the reference GA by an average of 2.8 days (95% limits of agreement: -40.6 to 31.2 days). Its use in classifying preterm or term newborns revealed an accuracy of 78.4% (95% CI: 73.3-81.6), with high sensitivity (96.2%; 95% CI: 92.8-98.2). The accuracy of classifying SGA newborns using GA calculated by the test was 62.3% (95% CI: 56.6-67.8). Discussion The new device (test) was able to assess GA at birth in LBW newborns, with a high agreement with the best available GA as a reference. The GA estimated by the device (test), when used to classify newborns on the first day of life, was useful in identifying premature infants but not when applied to identify SGA infants, considering current algohrithm. Nonetheless, the new device (test) has the potential to provide important information in places where the GA is unknown or inaccurate.
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Affiliation(s)
- Gabriela Luiza Nogueira Vitral
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
- Correspondence: Gabriela Luiza Nogueira Vitral
| | | | | | | | - Ivana Dias
- Hospital Central de Maputo, Maputo, Mozabique
| | | | | | - Gabriela Silveira Neves
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Hospital Sofia Feldman, Belo Horizonte, Brazil
| | | | | | - Gisele Lobo Pappa
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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de Andrade BAB, de Arruda JAA, Gilligan G, Piemonte E, Panico R, Molina Ávila I, Pimentel Sola JM, Carmona Lorduy MC, Pupo Marrugo S, Sánchez Tatis AS, Werner LC, Abrahão AC, Agostini M, Buoro L, Israel MS, Freire NDA, Lima LA, Abrantes TDC, Cunha JLS, Pérez-de-Oliveira ME, Roza ALOC, Vargas PA, Lopes MA, Santos-Silva AR, de Almeida OP, Pontes FSC, Pontes HAR, Rondanelli BM, Villarroel-Dorrego M, Bologna-Molina R, Derderian N, Sánchez-Romero C, Abreu LG, Fonseca FP, Mesquita RA, Gomez RS, Martínez-Flores R, Delgado-Azañero W, Alves ATNN, Lourenço SDQC, Coimbra C, Polignano GAC, Assunção Júnior JNR, Souto GR, Souza PEA, Horta MCR, González-Arriagada WA, Romañach MJ. Acquired oral syphilis: A multicenter study of 339 patients from South America. Oral Dis 2022; 28:1561-1572. [PMID: 34263964 DOI: 10.1111/odi.13963] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/01/2021] [Accepted: 07/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.
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Affiliation(s)
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gerardo Gilligan
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eduardo Piemonte
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - René Panico
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | | | | | | | | | | | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luisa Buoro
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Simões Israel
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program of Oral Medicine, Faculdade São Leopoldo Mandic, Rio de Janeiro, Brazil
| | | | - Lucas Ambrósio Lima
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thamiris de Castro Abrantes
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | | | | | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | | | | | | | | | - Ronell Bologna-Molina
- Molecular Pathology Area, Faculty of Dentistry, Universidad de la República, Montevidéu, Uruguay
| | - Nathalie Derderian
- Molecular Pathology Area, Faculty of Dentistry, Universidad de la República, Montevidéu, Uruguay
| | - Celeste Sánchez-Romero
- Molecular Pathology Area, Faculty of Dentistry, Universidad de la República, Montevidéu, Uruguay
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - René Martínez-Flores
- Department of Oral Medicine and Oral Pathology, School of Dentistry, Universidad Andrés Bello, Viña del Mar, Chile
| | - Wilson Delgado-Azañero
- Department of Oral Pathology, Oral Medicine and Oral Surgery, School of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | | | | | - Giovanna Ribeiro Souto
- Graduate Program in Dentistry, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Eduardo Alencar Souza
- Graduate Program in Dentistry, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Mayor A, da Silva C, Rovira-Vallbona E, Roca-Feltrer A, Bonnington C, Wharton-Smith A, Greenhouse B, Bever C, Chidimatembue A, Guinovart C, Proctor JL, Rodrigues M, Canana N, Arnaldo P, Boene S, Aide P, Enosse S, Saute F, Candrinho B. Prospective surveillance study to detect antimalarial drug resistance, gene deletions of diagnostic relevance and genetic diversity of Plasmodium falciparum in Mozambique: protocol. BMJ Open 2022; 12:e063456. [PMID: 35820756 PMCID: PMC9274532 DOI: 10.1136/bmjopen-2022-063456] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Genomic data constitute a valuable adjunct to routine surveillance that can guide programmatic decisions to reduce the burden of infectious diseases. However, genomic capacities remain low in Africa. This study aims to operationalise a functional malaria molecular surveillance system in Mozambique for guiding malaria control and elimination. METHODS AND ANALYSES This prospective surveillance study seeks to generate Plasmodium falciparum genetic data to (1) monitor molecular markers of drug resistance and deletions in rapid diagnostic test targets; (2) characterise transmission sources in low transmission settings and (3) quantify transmission levels and the effectiveness of antimalarial interventions. The study will take place across 19 districts in nine provinces (Maputo city, Maputo, Gaza, Inhambane, Niassa, Manica, Nampula, Zambézia and Sofala) which span a range of transmission strata, geographies and malaria intervention types. Dried blood spot samples and rapid diagnostic tests will be collected across the study districts in 2022 and 2023 through a combination of dense (all malaria clinical cases) and targeted (a selection of malaria clinical cases) sampling. Pregnant women attending their first antenatal care visit will also be included to assess their value for molecular surveillance. We will use a multiplex amplicon-based next-generation sequencing approach targeting informative single nucleotide polymorphisms, gene deletions and microhaplotypes. Genetic data will be incorporated into epidemiological and transmission models to identify the most informative relationship between genetic features, sources of malaria transmission and programmatic effectiveness of new malaria interventions. Strategic genomic information will be ultimately integrated into the national malaria information and surveillance system to improve the use of the genetic information for programmatic decision-making. ETHICS AND DISSEMINATION The protocol was reviewed and approved by the institutional (CISM) and national ethics committees of Mozambique (Comité Nacional de Bioética para Saúde) and Spain (Hospital Clinic of Barcelona). Project results will be presented to all stakeholders and published in open-access journals. TRIAL REGISTRATION NUMBER NCT05306067.
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Affiliation(s)
- Alfredo Mayor
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique
- Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Clemente da Silva
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique
| | - Eduard Rovira-Vallbona
- Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Caitlin Bever
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | - Caterina Guinovart
- Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | - Simone Boene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - Francisco Saute
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique
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Vallejo-Ortega MT, Gaitán Duarte H, Mello MB, Caffe S, Perez F. A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America. Rev Panam Salud Publica 2022; 46:e73. [PMID: 35747471 PMCID: PMC9211030 DOI: 10.26633/rpsp.2022.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean. Methods The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle-Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported. Results Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants). Conclusions Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.
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Affiliation(s)
| | - Hernando Gaitán Duarte
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
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11
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Tessema ZT, Tesema GA, Yazachew L. Individual-level and community-level factors associated with eight or more antenatal care contacts in sub-Saharan Africa: evidence from 36 sub-Saharan African countries. BMJ Open 2022; 12:e049379. [PMID: 35273040 PMCID: PMC8915341 DOI: 10.1136/bmjopen-2021-049379] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To reduce maternal mortality, the WHO has been introducing several antenatal care (ANC) measures. Pregnancy-related preventable morbidity and mortality, on the other hand, remain alarmingly high. This study was conducted to estimate the magnitude and the factors associated with eight or more ANC visits in sub-Saharan Africa. DESIGN A population-based, cross-sectional investigation was conducted. SETTING Sub-Saharan African countries. PARTICIPANTS A total of 300 575 women from recent Demographic and Health Surveys (DHS) conducted in 36 sub-Saharan African countries from 2006 to 2018 were included in this study. METHODS The data were sourced from sub-Saharan African countries' recent DHS data set from 2006 to 2018. A multilevel logistic regression model was fitted to identify factors associated with ANC use. Adjusted OR, with 95% CI and a p value of less than 0.05, was employed to determine parameters linked to ANC use. RESULTS The pooled magnitude of eight or more ANC visits in sub-Saharan African countries was 6.8% (95% CI 6.7% to 6.9%). Residence, maternal education, husband's education, maternal occupation, wealth index, media exposure, contraceptive use and desired pregnancy were all positively associated with eight or more ANC visits in the multilevel logistic regression analysis, whereas birth order was negatively associated with eight or more ANC visits. CONCLUSIONS Compliance with the WHO guidelines on the minimum number of ANC contacts in sub-Saharan Africa is poor. We recommend that mother and child health programmes review existing policies and develop new policies to adopt, execute and address the obstacles to maintaining the WHO-recommended minimum of eight ANC interactions. Women's education, economic position, media exposure and family planning uptake should be prioritised and improved. Urgent intervention is required to meet the minimum of eight ANC contacts in sub-Saharan Africa.
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Affiliation(s)
| | | | - Lake Yazachew
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
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12
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Ford JS, Shevchyk I, Yoon J, Chechi T, Voong S, Tran N, May L. Risk Factors for Syphilis at a Large Urban Emergency Department. Sex Transm Dis 2022; 49:105-110. [PMID: 34471079 DOI: 10.1097/olq.0000000000001543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of syphilis is increasing in the United States. The emergency department (ED) is an important setting to screen and treat underserved populations. To tailor testing protocols to the local population, we aimed to identify risk factors for syphilis positivity in ED patients. METHODS We performed a retrospective analysis of ED patients who were screened for syphilis between November 2018 and August 2020. Patients were screened for Treponema pallidum antibody using a multiplex flow immunoassay, and positive results were confirmed by rapid plasma reagin or T. pallidum particle agglutination. Risk factors for new syphilis diagnoses were identified using multiple logistic regression. RESULTS We screened 1974 patients for syphilis (mean age, 37 ± 16 years; 56% female). We identified 201 patients with new infections without previous treatment. Independent risk factors for a new diagnosis of syphilis included housing status (undomiciled, 23% [60 of 256]; domiciled, 9% [133 of 1559]; adjusted odds ratio [aOR], 1.9 [95% confidence interval {CI}, 1.2-3.0]), history of HIV (positive, 44% [28 of 63]; negative, 9% [173 of 1893]; aOR, 5.8 [95% CI, 3.0-11.2]), tobacco use (positive, 15% [117 of 797]; negative, 4% [29 of 665]; aOR, 2.4 [95% CI, 1.5-3.9]), and illicit drug use (positive, 14% [112 of 812]; negative, 8% [52 of 678]; aOR, 2.2 [95% CI, 1.0-2.5]). CONCLUSIONS Undomiciled housing status, history of HIV, history of tobacco use, and history of illicit drug use were independently associated with a new diagnosis of syphilis in the ED. Broadening targeted syphilis screening algorithms beyond sexually transmitted disease-related complaints could help identify new syphilis cases for treatment.
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Affiliation(s)
| | | | | | | | | | - Nam Tran
- Pathology and Laboratory Medicine, UC Davis Health, Sacramento, CA
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Becerra-Arias C, Alvarado-Socarras JL, Manrique-Hernandez EF, Caballero-Carvajal JA. Estudio ecológico de la sífilis gestacional y congénita en Colombia, 2012-2018. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objetivos: Describir el comportamiento de la sífilis gestacional y congénita en Colombia, entre el 2012 y 2018, a partir de registro de notificación Nacional. Metodología: Estudio ecológico, exploratorio a partir de Notificaciones al sistema de vigilancia de salud Pública. Se estimaron la tasa de incidencia y la razón de prevalencia para cada departamento. Se establecieron cada una las estimaciones según rangos, para los 33 departamentos evaluados y se expresaron en mapas a escala de grises según tasas y razones evaluadas. Además, se presentan curvas epidemiológicas por semanas notificación para sífilis gestacional y congénita. Resultados. Arauca, Santander, Cesar y Caldas, presentaron el mayor incremento entre 2012 y 2018 para sífilis gestacional. Para el mismo periodo, Santander, Casanare y Amazonas presentaron un aumento para sífilis Congénita, mientras que en los demás departamentos se evidenció una disminución en los eventos. Se encontraron diferencias significativas en el reporte de casos entre un año y otro, para el país, en ambos eventos (p< 0,001). Conclusiones. En Colombia se encontró un aumento de sífilis gestacional, mientras, para sífilis congénita existió variabilidad con tendencia a aumentar en los últimos años.
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The effect of public health awareness and behaviors on the transmission dynamics of syphilis in Northwest China, 2006-2018, based on a multiple-stages mathematical model. Infect Dis Model 2021; 6:1092-1109. [PMID: 34585031 PMCID: PMC8455652 DOI: 10.1016/j.idm.2021.08.009] [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: 06/27/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
Syphilis, a sexually transmitted infectious disease caused by the bacterium treponema pallidum, has re-emerged as a global public health issue with an estimated 12 million people infected each year. Understanding the impacts of health awareness and behaviors on transmission dynamics of syphilis can help to establish optimal control strategy in different regions. In this paper, we develop a multiple-stage SIRS epidemic model taking into account the public health awareness and behaviors of syphilis. First, the basic reproduction number R0 is obtained, which determines the global dynamics behaviors of the model. We derive the necessary conditions for implementing optimal control and the corresponding optimal solution for mitigation syphilis by using Pontryagin's Maximum Principle. Based on the data of syphilis in Ningxia from 2006 to 2018, the parameterizations and model calibration are carried out. The fitting results are in good agreement with the data. Moreover, sensitivity analysis shows that the public awareness induced protective behaviors Ce, compliance of condom-induced preventability ε and treatment for the primary syphilis m1 play an important role in mitigating the risk of syphilis outbreaks. These results can help us gain insights into the epidemiology of syphilis and provide guidance for the public health authorities to implement health education programs.
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Ford JS, Chechi T, Otmar M, Baker M, Waldman S, Morgan B, Tan D, Tran NK, May L. ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert. Emerg Med J 2021; 39:emermed-2020-210331. [PMID: 34548414 DOI: 10.1136/emermed-2020-210331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation. METHODS We implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January-November 2018) and the postimplementation period (January-November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time. RESULTS Four-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001). CONCLUSIONS Our study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Michella Otmar
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Melissa Baker
- Georgetown University School of Medicine, Washington, DC, USA
| | - Sarah Waldman
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Brittany Morgan
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - David Tan
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Nam K Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, California, USA
| | - Larissa May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
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16
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Geremew H, Geremew D. Sero-prevalence of syphilis and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis. Syst Rev 2021; 10:223. [PMID: 34384495 PMCID: PMC8359573 DOI: 10.1186/s13643-021-01786-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 08/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilis remained a major cause of reproductive morbidity and poor pregnancy outcomes in developing countries. Previously, studies showed inconsistent results and failed to show the actual picture of the diseases in Ethiopia. Thus, the aim of this meta-analysis was, first, to determine the updated pooled prevalence of syphilis among pregnant women in Ethiopia and, second, to assess its associated factors. METHODS A comprehensive search was made on PubMed, Google scholar, Science Direct, and African Journals Online databases to identify relevant articles. A random effects model was used to estimate pooled syphilis prevalence and odds ratio (OR) with the respective 95% confidence intervals (CIs) using STATA 14 statistical software. I2 statistics and Egger's regression test in conjunction with funnel plot was used to determine heterogeneity and publication bias among included studies respectively. RESULT We identified 13 suitable studies in this analysis. Accordingly, the pooled prevalence of syphilis among pregnant women in Ethiopia was 2.32% (95% CI, 1.68-2.97). Specifically, syphilis prevalence was 2.53% (95% CI, 1.92-3.14%) and 1.90% (95% CI, 0.40-3.40%) as per the treponemal and non-ytreponemal diagnostic test, respectively. On the other hand, regional analysis indicated that 4.06% (95% CI, 2.86-5.26) in Southern Nations Nationalities and Peoples (SNNP), 2.16% (95% CI, 1.57-2.75) in Amhara and 1.46% (95% CI, 0.69-2.23) in Oromia region. Being married (OR, 0.37 (95% CI, 0.12-0.91%)) was less likely to develop syphilis. On the other hand, women with history of multiple sexual partner (OR, 2.98 (95% CI, 1.15-7.70)) and women with history of previous sexually transmitted infection (STI) (OR, 4.88 (95% CI, 1.35-17.62)) have higher risk to develop syphilis. Besides, the pooled syphilis-HIV coinfection was 0.80% (95% CI, 0.60-1.01%). CONCLUSION This study provides evidence of relatively high prevalence of syphilis among pregnant women in Ethiopia. Therefore, it is recommended to further ramping up of current intervention measures to prevent future generations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020211650.
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Affiliation(s)
- Habtamu Geremew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Demeke Geremew
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, University of Gondar, P.o.Box: 196, Gondar, Ethiopia.
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Ahmed B, Konje JC. Screening for infections in pregnancy - An overview of where we are today. Eur J Obstet Gynecol Reprod Biol 2021; 263:85-93. [PMID: 34171635 DOI: 10.1016/j.ejogrb.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 12/09/2022]
Abstract
Although most infections in pregnancy have very little impact, some affect either the mother or fetus or both. Screening must target those infections with consequences and furthermore, must be cost-beneficial. The introduction of any screening test for infections should take into consideration the prevalence of the condition, its consequences (health impact), the accuracy of the test and whether there are remedial steps including primary and secondary prevention to take with a positive or negative test. For some of these infections (for example syphilis and rubella) universal screening of all pregnant women has been the norm world-wide but as the epidemiology of these infections continue to change, a review of this practice must evolve. Furthermore, emerging infections line severe acute respiratory syndrome coronavirus-2 pose greater public health challenges. This article provides an overview of screening for infections in pregnancy, critically appraising screening for the common infections and arguing for abandoning of universal screening for rubella but advocating for universal screening for GBS and selective screening for CMV and toxoplasmosis.
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Affiliation(s)
- Badredeen Ahmed
- Feto Maternal Centre, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Department of Health Sciences, University of Leicester, UK.
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Harfouche M, Maalmi H, Abu-Raddad LJ. Epidemiology of herpes simplex virus type 2 in Latin America and the Caribbean: systematic review, meta-analyses and metaregressions. Sex Transm Infect 2021; 97:490-500. [PMID: 34088792 PMCID: PMC8543241 DOI: 10.1136/sextrans-2021-054972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To characterise epidemiology of herpes simplex virus type 2 (HSV-2) in Latin America and the Caribbean. Methods HSV-2 reports were systematically reviewed and synthesised, and findings were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses and metaregressions were conducted. Finding 102 relevant reports were identified including 13 overall incidence measures, 163 overall (and 402 stratified) seroprevalence measures, and 7 and 10 proportions of virus detection in genital ulcer disease and in genital herpes, respectively. Pooled mean seroprevalence was 20.6% (95% CI 18.7% to 22.5%) in general populations, 33.3% (95% CI 26.0% to 41.0%) in intermediate-risk populations, 74.8% (95% CI 70.6% to 78.8%) in female sex workers, and 54.6% (95% CI 47.4% to 61.7%) in male sex workers, men who have sex with men and transgender people. In general populations, seroprevalence increased from 9.6% (95% CI 7.1% to 12.4%) in those aged <20 years to 17.9% (95% CI 13.6% to 22.5%) in those aged 20–30, 27.6% (95% CI 21.4% to 34.2%) in those aged 30–40 and 38.4% (95% CI 32.8% to 44.2%) in those aged >40. Compared with women, men had lower seroprevalence with an adjusted risk ratio (ARR) of 0.68 (95% CI 0.60 to 0.76). Seroprevalence declined by 2% per year over the last three decades (ARR of 0.98, 95% CI 0.97 to 0.99). Pooled mean proportions of HSV-2 detection in GUD and genital herpes were 41.4% (95% CI 18.9% to 67.0%) and 91.1% (95% CI 82.7% to 97.2%), respectively. Conclusions One in five adults is HSV-2 infected, a higher level than other world regions, but seroprevalence is declining. Despite this decline, HSV-2 persists as the aetiological cause of nearly half of GUD cases and almost all of genital herpes cases.
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Affiliation(s)
- Manale Harfouche
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.,WHO Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Haifa Maalmi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar .,WHO Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
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Epidemiology of herpes simplex virus type 2 in sub-Saharan Africa: Systematic review, meta-analyses, and meta-regressions. EClinicalMedicine 2021. [PMID: 34027335 DOI: 10.1101/2021.01.25.21250443v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Herpes simplex virus type 2 (HSV-2) infection is a prevalent, sexually transmitted infection with a sizable disease burden that is highest in sub-Saharan Africa. This study aimed to characterize HSV-2 epidemiology in this region. METHODS Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings up to August 23, 2020. Meta-analyses and meta-regressions were conducted. FINDINGS From 218 relevant publications, 451 overall outcome measures and 869 stratified measures were extracted. Pooled incidence rates ranged between 2.4-19.4 per 100 person-years across populations. Pooled seroprevalence was lowest at 37.3% (95% confidence interval (CI): 34.9-39.7%) in general populations and high in female sex workers and HIV-positive individuals at 62.5% (95% CI: 54.8-70.0%) and 71.3% (95% CI: 66.5-75.9%), respectively. In general populations, pooled seroprevalence increased steadily with age. Compared to women, men had a lower seroprevalence with an adjusted risk ratio (ARR) of 0.61 (95% CI: 0.56-0.67). Seroprevalence has decreased in recent decades with an ARR of 0.98 (95% CI: 0.97-0.99) per year. Seroprevalence was highest in Eastern and Southern Africa. Pooled HSV-2 proportion in genital ulcer disease was 50.7% (95% CI: 44.7-56.8%) and in genital herpes it was 97.3% (95% CI: 84.4-100%). INTERPRETATION Seroprevalence is declining by 2% per year, but a third of the population is infected. Age and geography play profound roles in HSV-2 epidemiology. Temporal declines and geographic distribution of HSV-2 seroprevalence mirror that of HIV prevalence, suggesting sexual risk behavior has been declining for three decades. HSV-2 is the etiological cause of half of genital ulcer disease and nearly all genital herpes cases with limited role for HSV-1. FUNDING This work was supported by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar and by the Qatar National Research Fund [NPRP 9-040-3-008].
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Harfouche M, Abu-Hijleh FM, James C, Looker KJ, Abu-Raddad LJ. Epidemiology of herpes simplex virus type 2 in sub-Saharan Africa: Systematic review, meta-analyses, and meta-regressions. EClinicalMedicine 2021; 35:100876. [PMID: 34027335 PMCID: PMC8129943 DOI: 10.1016/j.eclinm.2021.100876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Herpes simplex virus type 2 (HSV-2) infection is a prevalent, sexually transmitted infection with a sizable disease burden that is highest in sub-Saharan Africa. This study aimed to characterize HSV-2 epidemiology in this region. METHODS Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2 related findings up to August 23, 2020. Meta-analyses and meta-regressions were conducted. FINDINGS From 218 relevant publications, 451 overall outcome measures and 869 stratified measures were extracted. Pooled incidence rates ranged between 2.4-19.4 per 100 person-years across populations. Pooled seroprevalence was lowest at 37.3% (95% confidence interval (CI): 34.9-39.7%) in general populations and high in female sex workers and HIV-positive individuals at 62.5% (95% CI: 54.8-70.0%) and 71.3% (95% CI: 66.5-75.9%), respectively. In general populations, pooled seroprevalence increased steadily with age. Compared to women, men had a lower seroprevalence with an adjusted risk ratio (ARR) of 0.61 (95% CI: 0.56-0.67). Seroprevalence has decreased in recent decades with an ARR of 0.98 (95% CI: 0.97-0.99) per year. Seroprevalence was highest in Eastern and Southern Africa. Pooled HSV-2 proportion in genital ulcer disease was 50.7% (95% CI: 44.7-56.8%) and in genital herpes it was 97.3% (95% CI: 84.4-100%). INTERPRETATION Seroprevalence is declining by 2% per year, but a third of the population is infected. Age and geography play profound roles in HSV-2 epidemiology. Temporal declines and geographic distribution of HSV-2 seroprevalence mirror that of HIV prevalence, suggesting sexual risk behavior has been declining for three decades. HSV-2 is the etiological cause of half of genital ulcer disease and nearly all genital herpes cases with limited role for HSV-1. FUNDING This work was supported by pilot funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar and by the Qatar National Research Fund [NPRP 9-040-3-008].
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Affiliation(s)
- Manale Harfouche
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
| | - Farah M. Abu-Hijleh
- Department of Public Health, College of Health Sciences, Academic Quality Affairs Office, QU Health, Qatar University, Doha, Qatar
| | - Charlotte James
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Katharine J. Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
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Xie T, Wang G, Sun Q. Prevalence and Predictors of Syphilis in Female Sex Workers in Eastern China: Findings from Six Consecutive Cross-Sectional Surveys. J Multidiscip Healthc 2021; 14:853-860. [PMID: 33888989 PMCID: PMC8057824 DOI: 10.2147/jmdh.s305492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/30/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose Female sex workers play an important role in transmitting HIV and syphilis from high-risk groups to the general population. However, epidemic trends and risk factors for syphilis in Chinese female sex workers (FSWs) remain unclear. Methods Using convenient sampling methods, 2482 FSWs were interviewed and tested for syphilis from 2014 to 2019, all of them were divided into two groups of high-grade FSWs and low-grade FSWs according to service solicited and clients price there were. Demographic data were collected and logistic regression analysis was used to identify risk factors for syphilis. Results 43.67% of participants have received free condoms, 76.15% of them engaged in peer education of the 2482 FSWs tested for syphilis, 107 (4.31%) were positive. The prevalence of syphilis in high-grade FSWs was significantly lower than that in low-grade FSWs (3.14% and 5.62%, respectively).The overall prevalence of syphilis increased from 3.19% to4.47%. The percentage of FSWs received free condoms and engaged in peer education increased significantly. With upgraded awareness of syphilis, the number of FSWs having protected sex also increased significantly. It is also found that low-grade female sex workers are at greater risk of syphilis than those high-grade ones (odds ratio (OR) = 1.76, 95% CI 1.18–2.63, p < 0.05). Conclusion Great awareness of syphilis and the increased utilization of condom did not reduce the prevalence of syphilis, especially in low-grade FSWs group. More effective integrated interventions should be developed for such populations.
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Affiliation(s)
- Tiansheng Xie
- Zhejiang Sino-German Institute of Life Science and Healthcare, School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, Zhejiang, 310023, People's Republic of China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Guohua Wang
- Tongxiang Center for Disease Prevention and Control, Jiaxing, Zhejiang, 314500, People's Republic of China
| | - Qiang Sun
- Tongxiang Center for Disease Prevention and Control, Jiaxing, Zhejiang, 314500, People's Republic of China
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Wanni NHO, Dossary RA, Obeid OE, Qahtani NHA, Siddiqui ZI, El-Badry AA, Alkharsah KR. Seropositivity of syphilis among individuals screened in a tertiary hospital in the Eastern Province of Saudi Arabia. Ann Saudi Med 2021; 41:8-13. [PMID: 33550909 PMCID: PMC7868618 DOI: 10.5144/0256-4947.2021.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sexually transmitted infections are a serious public health problem. Syphilis, a multistage, curable chronic disease caused by the spirochete Treponema pallidum, remains a major health problem worldwide. The disease re-emerged in the era of HIV in many countries despite the accessibility of curative therapy and continuing public health efforts to eliminate it. OBJECTIVE Analyse the seropositivity for syphilis. DESIGN Retrospective cross-sectional. SETTING Tertiary hospital. PATIENTS AND METHODS We retrospectively studied individuals who underwent screening tests for syphilis between January 2014 and December 2018. The samples that were positive by both screening and confirmatory tests were considered as confirmed positive for syphilis. MAIN OUTCOME MEASURES Syphilis positivity identified by chemiluminescence immunoassay, the rapid plasma reagin test, and specific antibodies against Treponema pallidum. SAMPLE SIZE 11 832. RESULTS Of the 11 832, 54 (0.45%) were confirmed as seropositive for syphilis. Thirty-three (61.1%) were non-Saudi; 21 (38.9%) were Saudis. Thirty (55.6%) cases were males. Twenty-two (40.74%) were married and 29 (53.70%) were unmarried. Of the 54 diagnosed as syphilis positive, 28 (51.9%) were expatriate workers screened for pre-employment. The percentage of syphilis among Saudis was 0.36%. In an overall chi-square analysis, a P<.0001 indicated a difference among nationalities in the frequency of syphilis. A post-hoc analysis showed that Somalians (P=.004) and Sudanese (P=.005) differed significantly from other nationalities. CONCLUSION The study showed that syphilis was low among the screened population. More than half of the syphilis positive cases in this study were household employees. Screening for syphilis assists in planning complementary services for target populations and improves syphilis control. LIMITATIONS Retrospective design. Hospital-based findings may not be representative of the seroprevalence of syphilis in the general population. CONFLICT OF INTEREST None.
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Affiliation(s)
- Nahid H. O. Wanni
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem Al Dossary
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Obeid E. Obeid
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nourah Hasan Al Qahtani
- From the Department of Obstetrics and Gynecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Damam, Saudi Arabia
| | - Zaheenul Islam Siddiqui
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayman A. El-Badry
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khaled R. Alkharsah
- From the Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Carvalho RXDC, Araújo TMED. Knowledge, attitudes and practices of university adolescents about syphilis: a cross-sectional study in the Northeast. Rev Saude Publica 2020; 54:120. [PMID: 33295590 PMCID: PMC7688255 DOI: 10.11606/s1518-8787.2020054002381] [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: 02/09/2020] [Accepted: 04/26/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To analyze knowledge, attitudes and practices of university adolescents about syphilis. METHODS Cross-sectional, analytical, census-type study, developed with the universe of adolescents aged 18 and 19 years (n = 598), enrolled in three institutions of higher education in a municipality of Piauí (n = 598), which total 20 courses in the areas of Health Sciences, Applied Social Sciences, Exact and Earth, Engineering and Linguistics, Letters and Art. Data collection occurred from March to May 2019, based on a questionnaire adapted from the Pesquisa de Conhecimentos, Atitudes e Práticas da População Brasileira of 2013 (PCAP - Survey of Knowledge, Attitudes and Practices in the Brazilian Population), consisting of questions related to sociodemographic variables (gender, family arrangement, father's schooling, mother's schooling, skin color or race, employment, household income), knowledge, attitude and practice regarding the disease, the last three being classified by scores. The variables that presented p ≤ 0.20 in the bivariate analysis, by Pearson's chi-square test, were included in three multivariate logistic models, and the outcomes in each model were knowledge, attitude and practice, respectively; remaining at the end those at the level of p < 0.05. RESULTS Boys have a 39.6% lower chance of having adequate/regular knowledge (ORa = 0.604; 95%CI 0.415-0.878), whereas the highest chances are associated with "living alone, with relatives and friends" (ORa = 4.567; 95%CI 1.417-14.719) and having a very positive/positive attitude (ORa = 6.937; 95%CI 4.562-10.550). Lower chances of an adequate practice are associated with boys (ORa = 0.480; 95%CI 0.301-0.766) and lower father's schooling (ORa = 0.440; 95%CI 0.241-0.806). CONCLUSION Most participants' knowledge and attitude regarding syphilis were not sufficient to the adoption of an adequate sexual practice for the prevention of the disease, showing the need to investigate other variables that may be implicated in this cognitive incoherence.
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de Souza CDF, Machado MF, Correia DS, do Carmo RF, Cuevas LE, Santos VS. Spatiotemporal clustering, social vulnerability and risk of congenital syphilis in northeast Brazil: an ecological study. Trans R Soc Trop Med Hyg 2020; 114:657-665. [PMID: 32537650 DOI: 10.1093/trstmh/traa034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/07/2020] [Accepted: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To investigate the spatial distribution of congenital syphilis (CS) and its association to social vulnerability indexes in northeast Brazil. METHODS This was an ecological study referring to all cases of CS and CS deaths recorded in the northeast region of Brazil from 2008 to 2015. Data were obtained from three Brazilian information systems. We examined statistical correlations between CS indicators by state and municipality and their socioeconomic and social vulnerability characteristics. We used Bayesian empirical local models to identify fluctuations of the indicators. Spatial statistical tests were used to identify spatial clusters and the municipalities at high risk of CS. RESULTS The incidence of CS ranged from 2.1 cases/1000 live births (LB) in 2008 to 6.9/1000 LB in 2015, with an annual increase of 19.9% (p < 0.001). The mortality coefficient of CS ranged from 2.9/1000 LB in 2008 to 6.5/1000 LB in 2015, resulting in an annual increase of 15.1% (p < 0.001). Nine spatial clusters were identified. Cases of congenital syphilis occurred in well-defined spatiotemporal clusters and in areas with high levels of social vulnerability. CONCLUSIONS CS incidence is associated with social vulnerability. CS control programmes should target spatial clusters and populations with high levels of social vulnerability.
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Affiliation(s)
| | - Michael F Machado
- Department of Medicine, Federal University of Alagoas, Arapiraca, Brazil
| | | | - Rodrigo F do Carmo
- Postgraduate Program in Health and Biological Sciences, Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Luis E Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Victor S Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
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Yadav S, Verma V, Singh Dhanda R, Yadav M. Insights into the toll-like receptors in sexually transmitted infections. Scand J Immunol 2020; 93:e12954. [PMID: 32762084 DOI: 10.1111/sji.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/10/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022]
Abstract
Toll-like receptors (TLRs) are like soldiers of an innate immune system, which protects vital biological processes against invading pathogens. TLR signalling pathways help in the removal of pathogens and mediate well-established inflammatory processes. However, these processes may also aid in the development or augmentation of an infection or an autoimmune disease. Recent studies have delineated TLR polymorphism's role in the loss of function, making hosts more resistant or vulnerable to the development of an infection. In this review, we have discussed the association of TLRs with sexually transmitted infections (STIs), especially to the pathogen-specific ligands. We have also assessed the impact on TLR downstream signalling and the maintenance of cellular homeostasis during immune responses. Besides, we have discussed the role of TLRs single nucleotide polymorphisms in various STIs. Since TLRs are known to play a part in defence mechanisms and in aiding infections therefore, a thorough understanding of TLRs structure and molecular mechanisms is required to explain how they can influence the outcome of an STI. Such a strategy may lead to the development of novel and useful immunotherapeutic approaches to control pathogen progression and prevent transmission.
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Affiliation(s)
- Sonal Yadav
- Dr. B. R. Ambedkar Center for Biomedical Research (ACBR), University of Delhi, Delhi, India
| | - Vivek Verma
- Dr. B. R. Ambedkar Center for Biomedical Research (ACBR), University of Delhi, Delhi, India
| | | | - Manisha Yadav
- Dr. B. R. Ambedkar Center for Biomedical Research (ACBR), University of Delhi, Delhi, India.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
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Pham MD, Wise A, Garcia ML, Van H, Zheng S, Mohamed Y, Han Y, Wei WH, Yin YP, Chen XS, Dimech W, Braniff S, Technau KG, Luchters S, Anderson DA. Improving the coverage and accuracy of syphilis testing: The development of a novel rapid, point-of-care test for confirmatory testing of active syphilis infection and its early evaluation in China and South Africa. EClinicalMedicine 2020; 24:100440. [PMID: 32637904 PMCID: PMC7327895 DOI: 10.1016/j.eclinm.2020.100440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Current point-of-care tests (POCT) for syphilis, based on the detection of Treponema pallidum (TP) total antibodies, have limited capacity in distinguishing between active and past/treated syphilis. We report the development and early evaluation of a new prototype POCT based on the detection of TP-IgA antibodies, a novel biomarker for active syphilis. METHODS The TP-IgA POCT (index test) was developed in response to the World Health Organisation (WHO) target product profile (TPP) for a POCT for confirmatory syphilis testing. Two sub-studies were conducted consecutively using 458 pre-characterised stored plasma samples in China (sub-study one, addressing the criteria for the WHO TPP), and 503 venous blood samples collected from pregnant/postpartum women in South Africa (sub-study two, addressing potential clinical utility). Performance of the index test was assessed against standard laboratory-based serology using a combination of treponemal (TPHA) and non-treponemal (rapid plasma reagin [RPR]) tests. FINDINGS In sub-study one, the index test demonstrated 96·1% (95%CI=91·7%-98·5%) sensitivity and 84·7% (95%CI=80·15-88·6%) specificity for identification of active syphilis (TPHA positive, RPR positive). It correctly identified 71% (107/150) samples of past-treated syphilis (TPHA positive, RPR negative). In sub-study two, the index test achieved 100% (95%CI=59%-100%) sensitivity for active syphilis and correctly identified all nine women with past syphilis. INTERPRETATION The TP-IgA POCT has met the WHO TPP for a POCT for diagnosis of active syphilis and demonstrated its potential utility in a clinical setting. Future studies are warranted to evaluate field performance of the final manufactured test. FUNDING Saving Lives at Birth: Grand Challenge for Development, Thrasher Research Fund, and the Victorian Government Operational Infrastructure Scheme.
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Affiliation(s)
- Minh D. Pham
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Wise
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Mary L. Garcia
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Huy Van
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Shuning Zheng
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Yasmin Mohamed
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yan Han
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Wan-Hui Wei
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Yue-Ping Yin
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Xiang-Sheng Chen
- National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, PR China
- Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, PR China
| | - Wayne Dimech
- National Serology Reference Laboratory, Melbourne, Australia
| | - Susie Braniff
- National Serology Reference Laboratory, Melbourne, Australia
| | - Karl-Günter Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Stanley Luchters
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - David A. Anderson
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Nanjing BioPoint Diagnostic Technology, Nanjing, PR China
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Targa Martins R, Castilhos RM, Silva da Silva P, Costa LS. Frequency of Screening and Prevalence of Neurosyphilis in Stroke Population. Cerebrovasc Dis 2020; 49:301-306. [PMID: 32570248 DOI: 10.1159/000508491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Syphilis and stroke are high prevalent diseases in south Brazil and estimates of concomitance and possible role of syphilis in acute stroke are lacking. Our aims are to estimate the prevalence of syphilis and neurosyphilis (NS) in a cohort of tertiary stroke center. METHODS We reviewed all hospital records of stroke/transitory ischemic attack (TIA) using International Classification of Diseases, 10th revision, at discharge, frequency of syphilis screen, serology positivity, cerebrospinal fluid (CSF) analysis, and prevalence of NS in this stroke population applying CDC criteria. RESULTS Between 2015 and 2016, there were 1,436 discharges for cerebrovascular events and in 78% (1,119) of these cases, some syphilis screening was performed. We have found a frequency of positive serology for syphilis of 13% (143/1,119), and higher stroke severity was the main determinant for non-screening. Applying standard NS criteria, 4.7% (53/1,119) cases with CSF analysis had NS diagnosis: 8 based on CSF-Venereal Disease Research Laboratory (VDRL) positive and 45 based on abnormal CSF white cells or protein, but CSF VDRL negative. NS VDRL positive cases were younger, had higher serum VDRL title, had more frequent HIV infection, and received NS treatment more often. Demographic and clinical characteristics were not different between NS VDRL negative and non-NS cases. CONCLUSION Positive syphilis serology is frequent in patients with acute stroke/TIA in our region. Acute post-stroke CSF abnormalities make the diagnosis of NS difficult in the context of CSF VDRL negative.
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Affiliation(s)
- Rodrigo Targa Martins
- Neurology and Stroke Unit Service, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil,
| | | | - Pablo Silva da Silva
- Neurology and Stroke Unit Service, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil
| | - Leticia Scaranto Costa
- Neurology and Stroke Unit Service, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil
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Prevalence of syphilis, gonorrhoea and chlamydia in women in Fiji, the Federated States of Micronesia, Papua New Guinea and Samoa, 1995-2017: Spectrum-STI
model estimates. Western Pac Surveill Response J 2020; 11:29-40. [PMID: 32963889 PMCID: PMC7485516 DOI: 10.5365/wpsar.2019.10.2.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To estimate prevalence levels of and time trends for active syphilis, gonorrhoea and chlamydia in women aged 15-49 years in four countries in the Pacific (Fiji, the Federated States of Micronesia [FSM], Papua New Guinea [PNG] and Samoa) to inform surveillance and control strategies for sexually transmitted infections (STIs). Methods The Spectrum-STI model was fitted to data from prevalence surveys and screenings of adult female populations collected during 1995-2017 and adjusted for diagnostic test performance and to account for undersampled high-risk populations. For chlamydia and gonorrhoea, data were further adjusted for age and differences between urban and rural areas. Results Prevalence levels were estimated as a percentage (95% confidence interval). In 2017, active syphilis prevalence was estimated in Fiji at 3.89% (2.82 to 5.06), in FSM at 1.48% (0.93 to 2.16), in PNG at 3.91% (1.67 to 7.24) and in Samoa at 0.16% (0.07 to 0.37). For gonorrhoea, the prevalence in Fiji was 1.63% (0.50 to 3.87); in FSM it was 1.59% (0.49 to 3.58); in PNG it was 11.0% (7.25 to 16.1); and in Samoa it was 1.61% (1.17 to 2.19). The prevalence of chlamydia in Fiji was 24.1% (16.5 to 32.7); in FSM it was 23.9% (18.5 to 30.6); in PNG it was 14.8% (7.39 to 24.7); and in Samoa it was 30.6% (26.8 to 35.0). For each specific disease within each country, the 95% confidence intervals overlapped for 2000 and 2017, although in PNG the 2017 estimates for all three STIs were below the 2000 estimates. These patterns were robust in the sensitivity analyses. Discussion This study demonstrated a persistently high prevalence of three major bacterial STIs across four countries in WHO's Western Pacific Region during nearly two decades. Further strengthening of strategies to control and prevent STIs is warranted.
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The Spectrum-STI Groups model: syphilis prevalence trends across high-risk and lower-risk populations in Yunnan, China. Sci Rep 2020; 10:5472. [PMID: 32214152 PMCID: PMC7096386 DOI: 10.1038/s41598-020-62208-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 03/09/2020] [Indexed: 11/08/2022] Open
Abstract
The Spectrum-STI model, structured by sub-groups within a population, was used in a workshop in Yunnan, China, to estimate provincial trends in active syphilis in 15 to 49-year-old adults. Syphilis prevalence data from female sex workers (FSW), men who have sex with men (MSM), and lower-risk women and men in Yunnan were identified through literature searches and local experts. Sources included antenatal care clinic screening, blood donor screening, HIV/STI bio-behavioural surveys, sentinel surveillance, and epidemiology studies. The 2017 provincial syphilis prevalence estimates were 0.26% (95% confidence interval 0.17-0.34%) in women and 0.28% (0.20-0.36%) in men. Estimated prevalence was 6.8-fold higher in FSW (1.69% (0.68-3.97%) than in lower-risk women (0.25% (0.18-0.35%)), and 22.7-fold higher in MSM (5.35% (2.74-12.47%) than in lower-risk men (0.24% (0.17-0.31%). For all populations, the 2017 estimates were below the 2005 estimates, but differences were not significant. In 2017 FSW and MSM together accounted for 9.3% of prevalent cases. These estimates suggest Yunnan's STI programs have kept the overall prevalence of syphilis low, but prevalence remains high in FSW and MSM. Strengthening efforts targeting FSW and MSM, and identification of other risk populations e.g. among heterosexual men, are critical to reduce syphilis.
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de Souza RL, Dos Santos Madeira LDP, Pereira MVS, da Silva RM, de Luna Sales JB, Azevedo VN, Feitosa RNM, Monteiro JC, de Oliveira Guimarães Ishak M, Ishak R, Ribeiro ALR, Oliveira-Filho AB, Machado LFA. Prevalence of syphilis in female sex workers in three countryside cities of the state of Pará, Brazilian Amazon. BMC Infect Dis 2020; 20:129. [PMID: 32046662 PMCID: PMC7014696 DOI: 10.1186/s12879-020-4850-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/06/2020] [Indexed: 01/18/2023] Open
Abstract
Background Syphilis is a sexually transmitted infection (STI) transmitted from person to person mainly by sexual intercourse or through vertical transmission during pregnancy. Female sex workers (FSWs) are exposed especially to syphilis infection, and besides all the efforts to control the spread of STIs, syphilis prevalence is still rising, mainly occurring in low-income countries. This study aimed to investigate the syphilis prevalence, demographic characteristics and sexual habits among FSWs in the Amazon region of Brazil. Methods A cross-sectional study was carried out including 184 FSWs from 3 countryside cities of the state of Pará, Amazon region of Brazil. A venereal disease research laboratory test and an indirect immunoenzyme assay to test antibodies against Treponema pallidum were used for screening syphilis infection, while sexual habits and demographic data information were collected through a semi-structured questionnaire. Data was analyzed comparing groups with/without syphilis. Poisson regression models were used to estimate the reasons of prevalence (RP). Results The overall prevalence of syphilis was 14.1% (95% CI = 9.8–17.8). FSWs had between 15 and 56 years of age, most were unmarried (65.7%), had attended less than 8 years of formal education (64.1%), had between 10 and 20 partners per week (64.1%), and reported no previous history of STIs (76.1%) and regular use of condom (52.7%). Low level of education attending up to the primary school (RP adjusted = 3.8; 95% CI = 1.4–9.2) and high frequency of anal sex during the past year (RP adjusted = 9.3; 95% CI = 3.5–28.7) were associated with a higher prevalence of syphilis. Conclusions A high prevalence of syphilis among FSWs in the Brazilian Amazon region was identified, showing that syphilis is more likely to be transmitted in FSW working in low-income areas, which is attributed to the low level of education. Anal intercourse was found as a risk factor associated with syphilis. Health programs focused on risk populations appear as a rational way to control syphilis spread, which is a rising problem in Brazil and in other several countries.
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Affiliation(s)
- Ronaldo Lopes de Souza
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Brazil. Augusto Correa 1. Guamá. CEP 66075-110, Belém, Pará, Brazil
| | | | | | - Rachel Macedo da Silva
- Instituto de Ciências Exatas e Naturais, Universidade Federal do Pará, Belém, Pará, Brazil
| | - João Bráullio de Luna Sales
- Laboratorio de Lepidopterologia e Ictiologia Integrada, Centro de Estudos Avançados em Biodiersidade (CEABIO), Universidade Federal do Pará, Belém, Pará, Brazil
| | - Vania Nakauth Azevedo
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | | | | | - Ricardo Ishak
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Andre Luis Ribeiro Ribeiro
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Aldemir B Oliveira-Filho
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, Pará, Brazil
| | - Luiz Fernando Almeida Machado
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Brazil. Augusto Correa 1. Guamá. CEP 66075-110, Belém, Pará, Brazil. .,Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil.
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Victorova Haydudova H, Konstantinov Gospodinov D, Dimitrova Karcheva M. Syphilis in the Pleven region, Bulgaria: a retrospective study. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mayor A, Menéndez C, Walker PGT. Targeting Pregnant Women for Malaria Surveillance. Trends Parasitol 2019; 35:677-686. [PMID: 31395496 PMCID: PMC6708786 DOI: 10.1016/j.pt.2019.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
Women attending antenatal care (ANC) are a generally healthy, easy-access population, contributing valuable data for infectious disease surveillance at the community level. ANC-based malaria surveillance would provide a routine measure of the malaria burden in pregnancy, which countries lack, whilst potentially improving pregnancy outcomes. It could also offer contemporary information on temporal trends and the geographic distribution of malaria burden as well as intervention coverage in the population to guide resource allocation and to assess progress towards elimination. Here, we review the factors underlying the relationship between Plasmodium falciparum in pregnancy and in the community, and outline strengths and limitations of an ANC-based surveillance in sub-Saharan Africa, its potential role within wider malaria surveillance systems, and subsequent programmatic applications.
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Affiliation(s)
- Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Patrick G T Walker
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, Chico RM, Smolak A, Newman L, Gottlieb S, Thwin SS, Broutet N, Taylor MM. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019; 97:548-562P. [PMID: 31384073 PMCID: PMC6653813 DOI: 10.2471/blt.18.228486] [Citation(s) in RCA: 853] [Impact Index Per Article: 170.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/08/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15-49 years, in 2016. METHODS For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI. FINDINGS For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3-4.5); gonorrhoea 0.9% (95% UI: 0.7-1.1); trichomoniasis 5.3% (95% UI:4.0-7.2); and syphilis 0.5% (95% UI: 0.4-0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9-3.7); gonorrhoea 0.7% (95% UI: 0.5-1.1); trichomoniasis 0.6% (95% UI: 0.4-0.9); and syphilis 0.5% (95% UI: 0.4-0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1-165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6-123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4-231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5-7.1 million) syphilis cases. CONCLUSION Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016-2021.
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Affiliation(s)
- Jane Rowley
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Stephen Vander Hoorn
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia
| | | | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
| | - Laith J Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - R Matthew Chico
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, England
| | - Alex Smolak
- Department of Healthcare Policy and Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - Lori Newman
- Enteric and Sexually Transmitted Infections Branch, National Institute of Allergy and Infectious Diseases, Washington DC, United States of America
| | - Sami Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Soe Soe Thwin
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Melanie M Taylor
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Wi TEC, Ndowa FJ, Ferreyra C, Kelly‐Cirino C, Taylor MM, Toskin I, Kiarie J, Santesso N, Unemo M. Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward. J Int AIDS Soc 2019; 22 Suppl 6:e25343. [PMID: 31468679 PMCID: PMC6715950 DOI: 10.1002/jia2.25343] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point-of-care tests (POCTs), including those in the pipeline, to diagnose STIs in resource-constrained settings. METHODS We prioritized updating the systematic review and meta-analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer-reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline. RESULTS AND DISCUSSIONS The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low-cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near-patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource-constrained settings. This is driving the development of lower cost solutions. CONCLUSIONS The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource-constrained settings to support the uptake of aetiological diagnosis and treatment.
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Affiliation(s)
- Teodora EC Wi
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | | | | | | | - Melanie M Taylor
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Igor Toskin
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - James Kiarie
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Nancy Santesso
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityOntarioCanada
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and other STIsDepartment of Laboratory MedicineFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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Prevalence of Syphilis among Pregnant Women Attending Antenatal Care Clinic, Sede Muja District, South Gondar, Northwest Ethiopia. J Pregnancy 2019; 2019:1584527. [PMID: 31380117 PMCID: PMC6662448 DOI: 10.1155/2019/1584527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/22/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
Background Syphilis is a disease caused by bacteria called Treponema pallidum. Major rout of transmission of this bacterium was through sexual and contact with mucocutaneous lesion. Untreated syphilis during pregnancy can greatly affect pregnancy outcome, resulting in spontaneous abortion and stillbirth. Objective The objective of the study was to determine the seroprevalence of syphilis and associated factors among pregnant women attending antenatal care unit at Sede Muja district, Northern Ethiopia. Methods and Materials Facility based cross-sectional study was conducted from November 2018 to January 2019 in two health centers from Sede Muja district, Northwest Ethiopia. The study included a total of 210 participants. The entire participants were recruited by systematic random sampling method after proportional allocation of the sample size in the two health centers. Sociodemographic and clinical data were collected by semistructured questioner. Two milliliter of blood was collected to determine seroprevalence of syphilis using VDRL test method. The data was analyzed by using SPSS version 21. The association between independent and dependent variables was determined using chi-square. P-value less than 0.05 was considered as statistically significant. Result Seroprevalence of syphilis was found to be 1.9% (95 CI, 0.5-3.5%). Women with multiple sexual partners and late trimester of pregnancy during first ANC visit were found to be significantly associated with seropositive syphilis. Conclusion Syphilis remains a major problem in the study area. Seroprevalence of syphilis was significantly associated with women who have multiple sexual partners and late first ANC visit attendees in the study area. Therefore it is recommended to give health education about syphilis etiology and transmission as well as creating awareness about the importance of early ANC visit and follow-up regarding syphilis prevention.
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Korenromp EL, Rowley J, Alonso M, Mello MB, Wijesooriya NS, Mahiané SG, Ishikawa N, Le LV, Newman-Owiredu M, Nagelkerke N, Newman L, Kamb M, Broutet N, Taylor MM. Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLoS One 2019; 14:e0211720. [PMID: 30811406 PMCID: PMC6392238 DOI: 10.1371/journal.pone.0211720] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/26/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates. METHODS Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates. RESULTS The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57-0.81%) resulting in a global CS rate of 473 (385-561) per 100,000 live births and 661,000 (538,000-784,000) total CS cases, including 355,000 (290,000-419,000) adverse birth outcomes (ABO) and 306,000 (249,000-363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs- 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63-0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000-432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment. CONCLUSIONS Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.
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Affiliation(s)
| | - Jane Rowley
- Independent consultant, London, United Kingdom
| | - Monica Alonso
- Department of Communicable Diseases and Environmental Determinants of Health, Pan-American Health Organization, Washington DC, United States of America
| | - Maeve B. Mello
- Department of Communicable Diseases and Environmental Determinants of Health, Pan-American Health Organization, Washington DC, United States of America
| | | | - S. Guy Mahiané
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - Naoko Ishikawa
- World Health Organization, Regional Office for the Western Pacific, Manila, the Philippines
| | - Linh-Vi Le
- World Health Organization, Regional Office for the Western Pacific, Manila, the Philippines
| | - Morkor Newman-Owiredu
- World Health Organization, Sub-Saharan Africa Office, Brazzaville, Republic of Congo
| | | | - Lori Newman
- USA Centers for Disease Control and Prevention, Cambodia Country Office, Phnom Penh, Cambodia
| | - Mary Kamb
- USA Centers for Disease Control and Prevention, Cambodia Country Office, Phnom Penh, Cambodia
| | - Nathalie Broutet
- USA Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, United States of America
| | - Melanie M. Taylor
- USA Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, United States of America
- World Health Organization, Dept. of Reproductive Health and Research, Geneva, Switzerland
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Morris BJ, Hankins CA, Banerjee J, Lumbers ER, Mindel A, Klausner JD, Krieger JN. Does Male Circumcision Reduce Women's Risk of Sexually Transmitted Infections, Cervical Cancer, and Associated Conditions? Front Public Health 2019; 7:4. [PMID: 30766863 PMCID: PMC6365441 DOI: 10.3389/fpubh.2019.00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Male circumcision (MC) is proven to substantially reduce men's risk of a number of sexually transmitted infections (STIs). We conducted a detailed systematic review of the scientific literature to determine the relationship between MC and risk of STIs and associated conditions in women. Methods: Database searches by "circumcision women" and "circumcision female" identified 68 relevant articles for inclusion. Examination of bibliographies of these yielded 14 further publications. Each was rated for quality using a conventional rating system. Results: Evaluation of the data from the studies retrieved showed that MC is associated with a reduced risk in women of being infected by oncogenic human papillomavirus (HPV) genotypes and of contracting cervical cancer. Data from randomized controlled trials and other studies has confirmed that partner MC reduces women's risk not only of oncogenic HPV, but as well Trichomonas vaginalis, bacterial vaginosis and possibly genital ulcer disease. For herpes simplex virus type 2, Chlamydia trachomatis, Treponema pallidum, human immunodeficiency virus and candidiasis, the evidence is mixed. Male partner MC did not reduce risk of gonorrhea, Mycoplasma genitalium, dysuria or vaginal discharge in women. Conclusion: MC reduces risk of oncogenic HPV genotypes, cervical cancer, T. vaginalis, bacterial vaginosis and possibly genital ulcer disease in women. The reduction in risk of these STIs and cervical cancer adds to the data supporting global efforts to deploy MC as a health-promoting and life-saving public health measure and supplements other STI prevention strategies.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia
| | - Catherine A. Hankins
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
| | | | - Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine and Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Adrian Mindel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jeffrey D. Klausner
- Division of Infectious Diseases and the Program in Global Health, Fielding School of Public Health, University of California Los Angeles Care Center, Los Angeles, CA, United States
| | - John N. Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States
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Kularatne RS, Niit R, Rowley J, Kufa-Chakezha T, Peters RPH, Taylor MM, Johnson LF, Korenromp EL. Adult gonorrhea, chlamydia and syphilis prevalence, incidence, treatment and syndromic case reporting in South Africa: Estimates using the Spectrum-STI model, 1990-2017. PLoS One 2018; 13:e0205863. [PMID: 30321236 PMCID: PMC6188893 DOI: 10.1371/journal.pone.0205863] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate trends in prevalence and incidence of syphilis, gonorrhea and chlamydia in adult men and women in South Africa. METHODS The Spectrum-STI tool estimated trends in prevalence and incidence of active syphilis, gonorrhea and chlamydia, fitting South African prevalence data. Results were used, alongside programmatic surveillance data, to estimate trends in incident gonorrhea cases resistant to first-line treatment, and the reporting gap of symptomatic male gonorrhea and chlamydia cases treated but not reported as cases of urethritis syndrome. RESULTS In 2017 adult (15-49 years) the estimated female and male prevalences for syphilis were 0.50% (95% CI: 0.32-0.80%) and 0.97% (0.19-2.28%), for gonorrhea 6.6% (3.8-10.8%) and 3.5% (1.7-6.1%), and for chlamydia 14.7% (9.9-21%) and 6.0% (3.8-10.4%), respectively. Between 1990 and 2017 the estimated prevalence of syphilis declined steadily in women and men, probably in part reflecting improved treatment coverage. For gonorrhea and chlamydia, estimated prevalence and incidence showed no consistent time trend in either women or men. Despite growing annual numbers of gonorrhea cases - reflecting population growth - the estimated number of first line treatment-resistant gonorrhea cases did not increase between 2008 and 2017, owing to changes in first-line antimicrobial treatment regimens for gonorrhea in 2008 and 2014/5. Case reporting completeness among treated male urethritis syndrome episodes was estimated at 10-28% in 2017. CONCLUSION South Africa continues to suffer a high STI burden. Improvements in access and quality of maternal, STI and HIV health care services likely contributed to the decline in syphilis prevalence. The lack of any decline in gonorrhea and chlamydia prevalence highlights the need to enhance STI services beyond clinic-based syndromic case management, to reinvigorate primary STI and HIV prevention and, especially for women, to screen for asymptomatic infections.
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Affiliation(s)
- Ranmini S. Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronelle Niit
- Health Information Systems Programme, Pretoria, South Africa
| | - Jane Rowley
- Independent consultant, London, United Kingdom
| | - Tendesayi Kufa-Chakezha
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Remco P. H. Peters
- Anova Health Institute, Johannesburg, South Africa
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Melanie M. Taylor
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
- USA Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, United States of America
| | - Leigh F. Johnson
- University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa
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