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Padeniya TN, Hui BB, Wood JG, Regan DG, Seib KL. Review of mathematical models of Neisseria gonorrhoeae vaccine impact: Implications for vaccine development. Vaccine 2024; 42:S70-S81. [PMID: 38556390 DOI: 10.1016/j.vaccine.2024.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
An effective prophylactic vaccine for prevention of Neisseria gonorrhoeae infection would have a major impact on sexual and reproductive health worldwide. Interest in developing gonorrhoea vaccines is growing due to the reported high rates of N. gonorrhoeae infections globally, and the threat of antimicrobial resistance. Several gonorrhoea vaccine candidates are currently under evaluation and various mathematical models have been used to assess the potential population-level impact a gonorrhoea vaccine may have once available. Here we review key aspects of gonorrhoea vaccine mathematical modelling studies, including model structures, populations considered, and assumptions used as well as vaccine characteristics and implementation scenarios investigated. The predicted vaccine impact varied between studies, ranging from as little as ∼17 % reduction in N. gonorrhoeae prevalence after 30 years up to 100 % reduction after 5 years. However, all studies predicted that even a partially effective gonorrhoea vaccine could have a substantial impact in reducing N. gonorrhoeae prevalence or incidence, particularly when high coverage is achieved within either important risk groups or the overall sexually active population. As expected, higher vaccine efficacy against acquisition of N. gonorrhoeae and longer duration of protection were linked to greater reductions in infections. A vaccine that alters onward transmission could also substantially reduce infections. Several gaps and research needs have been identified by researchers in the field and via this narrative literature review. For example, future modelling to inform gonorrhoea vaccine development and implementation should consider additional populations that are at high risk of N. gonorrhoeae infection, especially in low- and middle-income settings, as well as the impact of vaccination on the potential adverse sexual and reproductive health outcomes of infection. In addition, more detailed and robust epidemiological, biological, and behavioural data is needed to enable more accurate and robust modelling of gonorrhoea vaccine impact to inform future scientific and public health decision-making.
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Affiliation(s)
- Thilini N Padeniya
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Ben B Hui
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - James G Wood
- School of Population Health, UNSW Sydney, New South Wales, Australia
| | - David G Regan
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
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Hockman BE, Qi M, Rotblatt H, Borenstein L, Flynn RA, Muldrow RA, Rajagopalan S, Greene DN. Overcoming analytical and preanalytical challenges associated with extragenital home collected STI specimens. J Clin Microbiol 2024; 62:e0031124. [PMID: 38836570 PMCID: PMC11250113 DOI: 10.1128/jcm.00311-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
Home sample collection for sexually transmitted infection (STI) screening options can improve access to sexual healthcare across communities. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), genital infections have classically been the focus for remote collection options. However, infections may go undiagnosed if sampling is limited to urogenital sites because some individuals only participate in oral and/or anal intercourse. Here we evaluated samples for CT/NG detection after several pre-analytical collection challenges. A paired provider to self-collection validation was performed on rectal [n = 162; 22 + for CT and 9 + for NG by provider-collected (PC)] and throat (N = 158; 2 + for CT and 11 + for NG by provider-collected) swabs. The positive percent agreement for CT and NG ranged from 90.9% to 100%. The discrepancies were more often positive on self-collected (SC) (n = 9 SC+/PC-; n = 1 PC+/SC-; n = 1 PC+/SC Equiv.; n = 2 PC-/SC Equiv.). An empirical limit of detection (LoD) lower than the manufacturer's claim (0.031 vs 2.5 IFU/mL for CT and 0.063 vs 124.8 CFU/ml for NG, respectively) was used to challenge additional variables. Common hand contaminants, including soap, hand sanitizer, lotion, and sunscreen were added to known positive (3× empirical LoD) or negative samples and did not influence detection. Samples at 2× and 10× the empirical LoD were challenged with extreme temperature cycling and extended room temperature storage. Detection was not affected by these conditions. These results indicate that remote self-collection is an appropriate method of sample acquisition for detecting extragenital CT/NG infections. Additionally, they provide a foundation towards meeting the regulatory standards for commercial testing of home collected extragenital samples. IMPORTANCE There is a clinical need for expanded extragenital bacterial sexually transmitted infection (STI) testing options, but the current regulatory landscape limits the wide-spread promotion and adoption of such services. Improved access, particularly for the LGBTQ+ community, can be achieved by validating testing for specimens that are self-collected at a remote location and arrive at the laboratory via a postal carrier or other intermediary route. Here we provide valuable data showing that self-collected samples for anal and oropharyngeal STI testing are equally or increasingly sensitive compared with those collected by a provider. We systematically consider the effects of storage time, exposure to temperature extremes, and the addition of common toiletries on results.
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Affiliation(s)
- B. E. Hockman
- LetsGetChecked Laboratories, Monrovia, California, USA
| | - M. Qi
- LetsGetChecked Laboratories, Monrovia, California, USA
| | - H. Rotblatt
- Los Angeles County Department of Public Health Division of HIV and STD Programs, Los Angeles, California, USA
| | - L. Borenstein
- Los Angeles County Department of Public Health Laboratory, Los Angeles, California, USA
| | - R. A. Flynn
- Los Angeles LGBT Center Clinic, Los Angeles, California, USA
| | - R. A. Muldrow
- LetsGetChecked Laboratories, Monrovia, California, USA
| | - S. Rajagopalan
- Los Angeles County Department of Public Health Division of HIV and STD Programs, Los Angeles, California, USA
| | - D. N. Greene
- LetsGetChecked Laboratories, Monrovia, California, USA
- Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Tran J, Fairley CK, Ong JJ, Aung ET, Chow EPF. Combinations of Sexual Activities During a Sex Episode with Recent Casual Male Partner Among Men Who Have Sex with Men: A Cross-Sectional Study. JOURNAL OF SEX RESEARCH 2024; 61:968-973. [PMID: 37345999 DOI: 10.1080/00224499.2023.2224310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
We examined combinations of nine sexual activities that occurred during a sex episode with a recent male partner among men who have sex with men (MSM) who attended an urban sexual health clinic from April-2017 to September-2017. We collected the following sexual activities: tongue-kissing, penises touching, using saliva during mutual masturbation, performed rimming, received rimming, performed fellatio, received fellatio, insertive anal sex, and receptive anal sex. During a single-sex episode, the most common combinations of sexual activities involved all nine activities (10.6%, 166/1542). We assessed the agreement between any two sexual activities that occurred together during a sex episode. Agreement was highest for receiving rimming and receptive anal sex (kappa = 0.40; 95% CI: 0.35, 0.45), and performing rimming and insertive anal sex (kappa = 0.38; 95% CI: 0.33, 0.42). Agreement was lowest for insertive anal sex and receiving fellatio (kappa = -0.01; 95% CI: -0.05, 0.03), and receptive anal sex and insertive anal sex (kappa = -0.08; 95% CI: -0.13, 0.03). The sexual activities that occur between men are correlated with one another and this will influence transmission between anatomical sites.
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Affiliation(s)
- Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Jian H, Lu WJ, Chen ZW, Liang SQ, Yue XL, Li J, Zhang JH, Gong XD. Prevalence and trends of Chlamydia trachomatis infection in female sex workers and men who have sex with men in China: a systematic review and meta-analysis. BMC Public Health 2024; 24:1579. [PMID: 38867197 PMCID: PMC11170796 DOI: 10.1186/s12889-024-18804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/09/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Chlamydia trachomatis infection can cause a significant disease burden in high-risk populations. This study aimed to assess the overall prevalence of C. trachomatis infection, and determine the long-term trends and geographic distribution of this infection among female sex workers (FSWs) and men who have sex with men (MSM) in China. METHODS The PubMed, Web of Science, CNKI, Wanfang Data and VIP databases were searched from 1 January 1990 through 30 April 2023. Publications in which C. trachomatis infection was detected using nucleic acid amplification tests (NAATs) were included. The Q test and I2 statistics were used to assess the heterogeneity between studies. A random-effect model was used to estimate the pooled prevalence of C. trachomatis infection. Subgroup, meta-regression, and sensitivity analyses were performed to explore the sources of heterogeneity. Publication bias was evaluated using Egger's test. Trend analysis of the prevalence was performed using the Jonckheere-Terpstra trend test method. RESULTS Sixty-one studies were eligible for inclusion (including 38 for FSWs and 23 for MSM). The pooled prevalence of C. trachomatis infection was 19.5% (95% CI: 16.4, 23.0) among FSWs and 12.7% (95% CI: 9.2, 17.7) in the rectum, 6.4% (95% CI: 5.3, 7.8) in the urethra and 1.3% (95% CI: 0.8, 2.1) in the oropharynx from MSM in China. The subgroup analyses showed that the sample size, study period, study region, specimen collection type, molecular diagnosis method, and recruitment site could explain some heterogeneity among studies of FSWs, and the publication language, study period, study region, molecular diagnosis method, and specimen collection anatomical site could explain some heterogeneity among studies of MSM. From 1998 to 2004, 2005 to 2009, 2010 to 2015, and 2016 to 2021, the pooled prevalence of C. trachomatis infection among FSWs were 30.3%, 19.9%, 21.4%, and 11.3%, respectively. For MSM, the pooled prevalence from 2003 to 2009, 2010 to 2015, and 2016 to 2022 were 7.8%, 4.7%, and 6.5%, respectively. However, no overall decline in the prevalence of C. trachomatis infection was observed among FSWs (z = -1.51, P = 0.13) or MSM (z = -0.71, P = 0.48) in China. CONCLUSIONS The prevalence of C. trachomatis infection was high in these two high-risk populations in China. The findings of this study provide evidence for the formulation of effective surveillance and screening strategies for the prevention and control of C. trachomatis infection among these two specific populations.
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Affiliation(s)
- Hui Jian
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China
| | - Wen-Jie Lu
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ze-Wei Chen
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China
| | - Shi-Qing Liang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiao-Li Yue
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China
| | - Jing Li
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China
| | - Jia-Hui Zhang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China
| | - Xiang-Dong Gong
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China.
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Weng RX, Ning N, Luo YT, Zhang CL, Wen LZ, Ye JB, Li J, Chen XS, Cai YM. Using Self-Reported Sexual Positioning as an Indicator for Rectal Chlamydia and Gonorrhea Screening Among Men Who Have Sex With Men in China: A Missed Opportunity. Sex Transm Dis 2024; 51:400-406. [PMID: 38403298 DOI: 10.1097/olq.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) are escalating public health concerns. This study aimed to explore (1) the reliability of self-reported sexual positioning as an indicator for rectal CT and NG screening, and (2) factors associated with rectal CT and NG infections in Shenzhen, China. METHODS A cross-sectional study was conducted in 2 settings in Shenzhen, China, from April 1, 2021, to March 31, 2022. Data on sociodemographic characteristics, sexual behaviors, and basic CT knowledge were collected. Urine and self-collected rectal swabs were collected for CT and NG testing. RESULTS In total, 195 MSM participated in the study, and 5.1% tested positive for urogenital CT, 29.2% for rectal CT, 1.0% for urogenital NG, and 8.2% for rectal NG. Among those who reported exclusively insertive anal sex, 69.2% of CT infections and 85.7% of NG infections would have remained undetected with urine testing alone. Risk factors for rectal CT infection included engaging in both insertive and receptive anal sex, with a significant association found for coinfection with rectal NG. CONCLUSIONS Self-reported sexual positioning was found to be an unreliable indicator for CT and NG screening, as a substantial proportion of infections would have remained undetected. The findings suggest that CT and NG screening in China should be offered to all MSM regardless of self-reported sexual positioning, and that the dual CT/NG testing is recommended.
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Affiliation(s)
| | - Ning Ning
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Yi-Ting Luo
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Chun-Lai Zhang
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Li-Zhang Wen
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Jian-Bin Ye
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Jing Li
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | | | - Yu-Mao Cai
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
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Faherty EAG, Holly T, Herrera K, Guidry T, Lyang J, Black S, Tabidze I. Prior Sexually Transmitted Infections and HIV in Patients With Mpox, Chicago, Illinois (June 2022-March 2023). J Infect Dis 2024; 229:S197-S202. [PMID: 37947018 DOI: 10.1093/infdis/jiad491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
HIV is associated with severe mpox. Sexually transmitted infections (STIs) could facilitate mpox transmission. We estimated HIV and STI frequency among patients with mpox and compared characteristics associated with mpox severity. Mpox cases during 1 June 2022 to 31 March 2023 were matched to Illinois HIV/AIDS surveillance data. Among 1124 patients with mpox, 489 (44%) had HIV and 786 (70%) had prior or concurrent STI; 307 (39%) had ≥3 STI episodes. More patients with mpox who were living with HIV were hospitalized than those without HIV (10.3% vs 4.1%, P < .001). STI screening visits are opportunities to vaccinate against mpox and provide HIV prophylaxis or treatment.
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Affiliation(s)
- Emily A G Faherty
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
- Disease Control Bureau, Chicago Department of Public Health, Illinois
| | - Taylor Holly
- Syndemic Infectious Diseases Bureau, Chicago Department of Public Health, Illinois
| | - Kara Herrera
- Syndemic Infectious Diseases Bureau, Chicago Department of Public Health, Illinois
| | - Taylor Guidry
- Syndemic Infectious Diseases Bureau, Chicago Department of Public Health, Illinois
| | - Jeffrey Lyang
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health
| | - Stephanie Black
- Disease Control Bureau, Chicago Department of Public Health, Illinois
| | - Irina Tabidze
- Syndemic Infectious Diseases Bureau, Chicago Department of Public Health, Illinois
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7
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Clark JL, Oldenburg CE, Passaro RC, Segura ER, Godwin W, Fulcher JA, Cabello R. Changes in Inflammatory Cytokine Levels in Rectal Mucosa Associated With Neisseria gonorrheae and/or Chlamydia trachomatis Infection and Treatment Among Men Who Have Sex With Men in Lima, Peru. J Infect Dis 2024; 229:845-854. [PMID: 37584273 PMCID: PMC10938210 DOI: 10.1093/infdis/jiad349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/04/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Neisseria gonorrheae and Chlamydia trachomatis are associated with mucosal inflammation and human immunodeficiency virus 1 (HIV-1) transmission. We assessed levels of inflammatory cytokines in men who have sex with men (MSM) with and without rectal gonorrhea and/or chlamydia in Lima, Peru. METHODS We screened 605 MSM reporting condomless receptive anal intercourse for rectal N. gonorrheae/C. trachomatis using nucleic acid testing. We identified 101 cases of gonorrhea and/or chlamydia and randomly selected 50 N. gonorrheae/C. trachomatis positive cases and matched 52 negative controls. We measured levels of IL-1β, IL-6, IL-8, and TNF-α in rectal secretions. Tests for HIV-1, rectal N. gonorrheae/C. trachomatis, and mucosal cytokines were repeated after 3 and 6 months. Cytokine levels in cases and uninfected controls were compared using Wilcoxon rank-sum tests and linear regression. RESULTS MSM with gonorrhea/chlamydia had elevated levels of all cytokines in rectal mucosa compared with matched controls (all P values <.001). Following antibiotic treatment there were no significant differences in cytokine levels at 3- or 6-month follow-up evaluations (all P values >.05). DISCUSSION Rectal gonorrhea/chlamydia infection is associated with transient mucosal inflammation and cytokine recruitment. Our data provide proof of concept for rectal sexually transmitted infection screening as an HIV prevention strategy for MSM. Clinical Trials Registration. NCT03010020.
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Catherine E Oldenburg
- Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Ryan C Passaro
- Department of Emergency Medicine, University of Southern California, Los Angeles County Hospital, Los Angeles, California, USA
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - William Godwin
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Jennifer A Fulcher
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
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Pflüger LS, Nörz D, Grunwald M, Pfefferle S, Giersch K, Christner M, Weber B, Aepfelbacher M, Rohde H, Lütgehetmann M. Analytical and clinical validation of a multiplex PCR assay for detection of Neisseria gonorrhoeae and Chlamydia trachomatis including simultaneous LGV serotyping on an automated high-throughput PCR system. Microbiol Spectr 2024; 12:e0275623. [PMID: 38345391 PMCID: PMC10913481 DOI: 10.1128/spectrum.02756-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/08/2024] [Indexed: 03/06/2024] Open
Abstract
For effective infection control measures for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), a reliable tool for screening and diagnosis is essential. Here, we aimed to establish and validate a multiplex PCR assay on an automated system using a dual-target approach for the detection of CT/NG and differentiation between lymphogranuloma venereum (LGV) and non-LGV from genital and extra-genital specimens. Published primer/probe sets (CT: pmpH, cryptic plasmid; NG: porA, opa) were modified for the cobas 5800/6800/8800. Standards quantified by digital PCR were used to determine linearity and lower limit of detection (LLoD; eSwab, urine). For clinical validation, prospective samples (n = 319) were compared with a CE-marked in vitro diagnostics (CE-IVD) assay. LLoDs ranged from 21.8 to 244 digital copies (dcp)/mL and 10.8 to 277 dcp/mL in swab and urine, respectively. A simple linear regression analysis yielded slopes ranging from -4.338 to -2.834 and Pearson correlation coefficients from 0.956 to 0.994. Inter- and intra-run variability was <0.5 and <1 cycle threshold (ct), respectively. No cross-reactivity was observed (n = 42). Clinical validation showed a sensitivity of 94.74% (95% confidence interval (CI): 87.23%-97.93%) and 95.51% (95% CI: 89.01%-98.24%), a specificity of 99.59% (95% CI: 97.71%-99.98%) and 99.57% (95% CI: 97.58%-99.98%), positive predictive values of 89.91% (estimated prevalence: 3.7%; 95% CI: 80.91%-95.6%) and 88.61% (estimated prevalence: 3.4%; 95% CI: 80.18%-94.34%), and negative predictive values of 99.81% (95% CI: 98.14%-100%) and 99.85% (95% CI: 98.14%-100%) for the detection of CT and NG, respectively. In conclusion, we established a dual-target, internally controlled PCR on an automated system for the detectiwon of CT/NG from genital and extra-genital specimens. Depending on local regulations, the assay can be used as a screening or a confirmatory/typing assay.IMPORTANCEChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) represent a major global health burden, with the World Health Organization estimating that >128 million and >82 million people, respectively, were newly infected in 2020. For effective infection control measures, a reliable tool for sensitive diagnosis and screening of CT/NG is essential. We established a multiplex PCR assay for the detection of CT/NG and simultaneous discrimination between lymphogranuloma venereum (LGV) and non-LGV strains, which has been validated for genital and extra-genital specimens on a fully automated system. To increase assay sensitivity, a dual-target approach has been chosen for both pathogens. This strategy reduces false-positive results in oropharyngeal swabs due to the detection of commensal N. species that may harbor NG DNA fragments targeted in the PCR due to horizontal gene transmission following previous infection. In sum, the established assay provides a powerful tool for use as either a screening/diagnostic or a typing/confirmatory assay.
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Affiliation(s)
- Lisa Sophie Pflüger
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dominik Nörz
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Moritz Grunwald
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Susanne Pfefferle
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katja Giersch
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Christner
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Beatrice Weber
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Aepfelbacher
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Holger Rohde
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Marc Lütgehetmann
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
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9
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Vanbaelen T, Tsoumanis A, Florence E, Van Dijck C, Huis In 't Veld D, Sauvage AS, Herssens N, De Baetselier I, Rotsaert A, Verhoeven V, Henrard S, Van Herrewege Y, Van den Bossche D, Goffard JC, Padalko E, Reyniers T, Vuylsteke B, Hayette MP, Libois A, Kenyon C. Effect of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on incidence of these infections in men who have sex with men and transgender women taking HIV pre-exposure prophylaxis (the Gonoscreen study): results from a randomised, multicentre, controlled trial. Lancet HIV 2024:S2352-3018(23)00299-0. [PMID: 38423024 DOI: 10.1016/s2352-3018(23)00299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Guidelines recommend screening for Neisseria gonorrhoeae and Chlamydia trachomatis at three anatomical sites (urethra, anus, and pharynx) every 3 months (3 × 3) in men who have sex with men (MSM) and transgender women taking HIV pre-exposure prophylaxis (PrEP). We present the first randomised controlled trial to compare the effect of screening versus non-screening for N gonorrhoeae and C trachomatis on the incidence of these infections in MSM and transgender women taking PrEP. METHODS A multicentre, randomised, controlled trial of 3 × 3 screening for N gonorrhoeae and C trachomatis versus non-screening was done among MSM and transgender women taking PrEP in five HIV reference centers in Belgium. Participants attended the PrEP clinics quarterly for 12 months. N gonorrhoeae and C trachomatis was tested at each visit in both arms, but results were not provided to the non-screening arm, if asymptomatic. The primary outcome was incidence rate of N gonorrhoeae and C trachomatis infections in each arm, assessed in the per-protocol population. Non-inferiority of the non-screening arm was proven if the upper limit of the 95% CI of the incidence rate ratio (IRR) was lower than 1·25. This trial is registered with ClinicalTrials.gov, NCT04269434, and is completed. FINDINGS Between Sept 21, 2020, and June 4, 2021, 506 participants were randomly assigned to the 3 × 3 screening arm and 508 to the non-screening arm. The overall incidence rate of N gonorrhoeae and C trachomatis was 0·155 cases per 100 person-days (95% CI 0·128-0·186) in the 3 × 3 screening arm and 0·205 (95% CI 0·171-0·246) in the non-screening arm. The incidence rate was significantly higher in the non-screening arm (IRR 1·318, 95% CI 1·068-1·627). Participants in the non-screening arm had a higher incidence of C trachomatis infections and symptomatic C trachomatis infections. There were no significant differences in N gonorrhoeae infections. Participants in the non-screening arm consumed significantly fewer antimicrobial drugs. No serious adverse events were reported. INTERPRETATION We failed to show that non-screening for N gonorrhoeae and C trachomatis is non-inferior to 3 × 3 screening in MSM and transgender women taking PrEP in Belgium. However, screening was associated with higher antibiotic consumption and had no effect on the incidence of N gonorrhoeae. Further research is needed to assess the benefits and harms of N gonorrhoeae and C trachomatis screening in this population. FUNDING Belgian Health Care Knowledge Centre.
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Affiliation(s)
- Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital of Antwerp, Antwerp, Belgium
| | - Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Anne-Sophie Sauvage
- Department of Infectious Diseases, Liège University Hospital, Liège, Belgium
| | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Sophie Henrard
- Department of Infectious Diseases, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Yven Van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Jean-Christophe Goffard
- Department of Infectious Diseases, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Elizaveta Padalko
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Agnes Libois
- Department of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Williams E, Williamson DA, Hocking JS. Frequent screening for asymptomatic chlamydia and gonorrhoea infections in men who have sex with men: time to re-evaluate? THE LANCET. INFECTIOUS DISEASES 2023; 23:e558-e566. [PMID: 37516129 DOI: 10.1016/s1473-3099(23)00356-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/02/2023] [Accepted: 05/15/2023] [Indexed: 07/31/2023]
Abstract
There is increasing debate regarding the harms and benefits of frequent asymptomatic screening for Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men (MSM). One concern is that frequent asymptomatic screening could result in increased antimicrobial resistance in an array of sexually acquired infections and other pathogens, due to selection pressure exerted by frequent broad-spectrum antimicrobial usage within some sexual networks. Here, we outline the harms and benefits of frequent C trachomatis and N gonorrhoeae screening in MSM in high-income settings and propose that screening frequency be reduced. We describe the evidence gaps that should be further explored to better understand the implications of reducing the frequency of asymptomatic C trachomatis and N gonorrhoeae screening in MSM and the surveillance systems that should be in place to prepare for such changes.
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Affiliation(s)
- Eloise Williams
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
| | - Deborah A Williamson
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Thammajaruk N, Ramautarsing RA, Hiransuthikul A, Suriwong S, Tasomboon W, Thapwong P, Phunkron A, Saiwaew S, Sangpasert T, Pankam T, Avery M, Mills S, Phanuphak P, Phanuphak N. Pooled Pharyngeal, Rectal, and Urine Specimens for the Point-of-Care Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by Lay Providers in Key Population-Led Health Services in Thailand. Pathogens 2023; 12:1268. [PMID: 37887784 PMCID: PMC10609829 DOI: 10.3390/pathogens12101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Routine testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in people with heightened risk is lacking in Thailand. This study aimed to assess the performance of the Cepheid Xpert CT/NG assay, conducted by key population (KP) lay providers, for CT and NG detection on single-site and pooled specimens from the pharynx, rectum, and urine. Between August and October 2019, 188 men who have sex with men and 11 transgender women were enrolled. Participants collected urine specimens while trained KP lay providers obtained pharyngeal and rectal swabs. Compared to single-site testing with the Abbott RealTime CT/NG assay by medical technologists, the Xpert assay missed one pharyngeal NG infection out of 199 single-site specimens, giving a 93.3% sensitivity for pharyngeal NG and one missed pharyngeal NG infection out of fifty pooled specimens, giving an 88.9% sensitivity for pharyngeal NG. There was no discrepancy between the two assays for CT detection. The Cohen's Kappa coefficient of pooled specimen testing by the Xpert was 0.93 for NG and 1 for CT when compared to single-site testing by Abbott. Implementing pooled specimen testing by KP lay providers can be a cost-saving strategy to enhance the uptake of CT/NG services for populations facing increased risk.
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Affiliation(s)
| | | | - Akarin Hiransuthikul
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sujittra Suriwong
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Waranya Tasomboon
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Prasopsuk Thapwong
- The Service Workers In Group Foundation (SWING), Bangkok 10500, Thailand
| | - Atachai Phunkron
- The Service Workers In Group Foundation (SWING), Bangkok 10500, Thailand
| | - Somporn Saiwaew
- Rainbow Sky Association of Thailand (RSAT), Bangkok 10240, Thailand
| | | | - Tippawan Pankam
- Thai Red Cross Anonymous Clinic, Thai Red Cross AIDS Research Centre (TRCARC), Bangkok 10330, Thailand
| | - Matthew Avery
- USAID/EpiC Thailand project, FHI 360, Bangkok 10330, Thailand
| | - Stephen Mills
- USAID/EpiC Thailand project, FHI 360, Bangkok 10330, Thailand
| | - Praphan Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok 10330, Thailand
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12
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Malefo MA, Ayo-Yusuf O, Mokgatle MM. Risk factors for sexually transmitted infections among men who have sex with men. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37916720 PMCID: PMC10623483 DOI: 10.4102/phcfm.v15i1.4080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a global public health concern and sub-Saharan Africa, has limited data on STIs in the men who have sex with men (MSM) population. Syndromic management has controversies for treating asymptomatic STIs (ASTIs). AIM The aim of this study was to describe the risk factors for STIs among MSM. SETTING This study was conducted in Tshwane North, Gauteng Province in South Africa. METHODS A cross-sectional quantitative design was employed using structured questionnaires, rapid plasma reagent test, from December 2021 to May 2022. Bivariate and multivariate analyses were used for statistical analysis. RESULTS A total of 200 MSM with the mean age of 27.6, standard deviations: 6.8 participated, and STIs prevalence was 66%, with 37% concurrent infections. Ureaplasma urealyticum was (24%), Mycoplasma hominis (23%), Chlamydia trachomatis (20%), Treponema pallidum (20%) and Neisseria gonorrhoeae (9%). The risk factors for acquisition of STI include having a new partner in the last month (OR = 1.68; CI: 0.98-3.13). CONCLUSION The prevalence of ASTIs is high. Serial and multiple sexual partners are the risk factors.Contribution: This study contributes to the body of knowledge of the burden of STIs among high-risk population.
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Affiliation(s)
- Matshidiso A Malefo
- School of Health Care Sciences, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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13
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Strobel TM, Desai NA, Arrington-Sanders R. Acute Infectious Proctitis in Adolescents. Pediatr Rev 2023; 44:491-497. [PMID: 37653133 DOI: 10.1542/pir.2022-005862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The diagnosis of acute proctitis requires understanding who is at risk, being aware of symptoms, and leveraging a thorough sexual history with appropriate risk stratification to make the diagnosis. Cases have been concentrated in adolescents (ages 15-19 years), young adults (ages 20-24 years), men and transgender women who have sex with men, and those with a history of human immunodeficiency virus infection. Black adolescents experience a disproportionately high number of cases of proctitis due to an intersection of concentrated cases in sexual networks and delayed screening/diagnosis due to health care access barriers. Signs and symptoms include purulent discharge, bleeding, pain, tenesmus, pruritus, diarrhea or constipation, weight loss, or fever. Multisite sexually transmitted infection testing should be offered based on risk stratification (eg, history of condomless anal sex, oral intercourse, number of sex partners). Further management includes promotion of barrier protection and preexposure prophylaxis, routine surveillance, partner notification, and routine access to preventive immunizations.
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Affiliation(s)
| | - Neerav A Desai
- Division of Adolescent and Young Adult Health, Vanderbilt University Medical Center, Nashville, TN
| | - Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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14
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Turman BJ, Darville T, O'Connell CM. Plasmid-mediated virulence in Chlamydia. Front Cell Infect Microbiol 2023; 13:1251135. [PMID: 37662000 PMCID: PMC10469868 DOI: 10.3389/fcimb.2023.1251135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Chlamydia trachomatis infection of ocular conjunctiva can lead to blindness, while infection of the female genital tract can lead to chronic pelvic pain, ectopic pregnancy, and/or infertility. Conjunctival and fallopian tube inflammation and the resulting disease sequelae are attributed to immune responses induced by chlamydial infection at these mucosal sites. The conserved chlamydial plasmid has been implicated in enhancing infection, via improved host cell entry and exit, and accelerating innate inflammatory responses that lead to tissue damage. The chlamydial plasmid encodes eight open reading frames, three of which have been associated with virulence: a secreted protein, Pgp3, and putative transcriptional regulators, Pgp4 and Pgp5. Although Pgp3 is an important plasmid-encoded virulence factor, recent studies suggest that chlamydial plasmid-mediated virulence extends beyond the expression of Pgp3. In this review, we discuss studies of genital, ocular, and gastrointestinal infection with C. trachomatis or C. muridarum that shed light on the role of the plasmid in disease development, and the potential for tissue and species-specific differences in plasmid-mediated pathogenesis. We also review evidence that plasmid-associated inflammation can be independent of bacterial burden. The functions of each of the plasmid-encoded proteins and potential molecular mechanisms for their role(s) in chlamydial virulence are discussed. Although the understanding of plasmid-associated virulence has expanded within the last decade, many questions related to how and to what extent the plasmid influences chlamydial infectivity and inflammation remain unknown, particularly with respect to human infections. Elucidating the answers to these questions could improve our understanding of how chlamydia augment infection and inflammation to cause disease.
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Affiliation(s)
- Breanna J. Turman
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, United States
| | - Toni Darville
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, United States
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States
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15
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Khosropour CM, Coomes DM, LeClair A, Saechao F, Vorn S, Soge OO, Barbee LA. High Prevalence of Rectal Chlamydia and Gonorrhea Among Men Who Have Sex With Men Who Do Not Engage in Receptive Anal Sex. Sex Transm Dis 2023; 50:404-409. [PMID: 36943790 PMCID: PMC10272102 DOI: 10.1097/olq.0000000000001803] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND In the United States, annual screening for rectal gonorrhea and chlamydia is only recommended for men who report receptive anal sex (RAS), but other behaviors (e.g., rimming) may lead to rectal Chlamydia trachomatis and Neisseria gonorrhoeae acquisition. METHODS We enrolled individuals assigned male sex at birth who reported sex with men and denied RAS in the past 2 years or reported RAS 1 to 2 years ago but were tested and treated since last RAS. Participants enrolled in-person at the Sexual Health Clinic in Seattle, Washington (December 2019-July 2022), or online (July 2021-March 2022). Participants completed a survey that asked about 13 non-RAS behaviors and self-collected a rectal swab for gonorrhea/chlamydia nucleic acid amplification testing. We used log binomial regression to estimate the prevalence of rectal gonorrhea/chlamydia (adjusted prevalence ratio [aPR]) by behavior, adjusting for all other behaviors. RESULTS We enrolled 292 participants (247 in-person and 45 online); 277 (95%) had nucleic acid amplification testing results. Rectal gonorrhea/chlamydia test positivity was 14.1% overall: 10.5% for rectal chlamydia and 4.3% for rectal gonorrhea. Most participants (70%) reported ≥1 behavior that involved direct contact with their anus. We observed a higher risk of rectal chlamydia for those who did versus did not report perianal play at 12 months (aPR, 2.39; 95% confidence interval, 1.10-5.22) and 2 months (aPR, 2.21; 95% confidence interval, 1.02-4.79). This was the only behavior significantly associated with testing positive. CONCLUSIONS Rectal C. trachomatis and N. gonorrhoeae prevalence was high among men who deny RAS, suggesting other possible routes of acquisition. Rectal screening for those who deny RAS should be made with careful consideration of individual- and population-level effects.
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Affiliation(s)
| | - David M. Coomes
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Angela LeClair
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Farchung Saechao
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Seila Vorn
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Olusegun O. Soge
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
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16
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Camino AF, Whitfield M, Pridgen K, Van Der Pol B, Van Wagoner N. Embedding a Dedicated Sexual Health Clinic in a University's Health Services Expands Sexually Transmitted Infection Screening Options. Sex Transm Dis 2023; 50:462-466. [PMID: 36943784 PMCID: PMC10272105 DOI: 10.1097/olq.0000000000001804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The primary objectives of this study were to assess utilization of sexual health services at a university's student health and wellness center and to determine whether the presence of a dedicated sexual health clinic (SHC) was associated with different utilization patterns for sexual health services when compared with primary care clinics. METHODS This was a retrospective chart review of patients presenting to the University of Alabama at Birmingham's Student Health and Wellness Center for sexual health services between January 2015 and June 2019. Utilization of sexual health services, specifically sexually transmitted infection (STI) testing, was compared between the dedicated SHC and primary care clinics. RESULTS A total of 3081 cases were included. There were statistically significant differences in the proportion of male individuals and populations more burdened by STI tested for STI in the SHC (i.e., persons who identify as Black and younger female individual). We also observed a higher percentage of positive gonorrhea and chlamydia test results and a greater likelihood of extragenital screening in men who have sex with men in the SHC. CONCLUSIONS The dedicated SHC within the University of Alabama at Birmingham's Student Health and Wellness Center was associated with an increase in STI screenings. There was a significant difference between the demographics of those presenting to the SHC versus primary care clinics, proportionally more diagnoses of gonorrhea and chlamydia, and, for men who have sex with men, more extragenital screenings performed in the SHC. These findings suggest that there may be a benefit of an embedded SHC in college and university health and wellness centers.
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Affiliation(s)
- Andres F Camino
- From the University of Alabama at Birmingham Heersink School of Medicine
| | | | | | - Barbara Van Der Pol
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Nicholas Van Wagoner
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
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17
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Kahsay AG, Mezgebo TA, Gebrekidan GB, Desta BL, Mihretu HG, Dejene TA. Prevalence, Antibiotic Resistance and Associated Factors of Neisseria gonorrhoeae Among Patients Attending Non-Profitable Private Clinics in Mekelle, Tigrai, Ethiopia. Infect Drug Resist 2023; 16:4065-4072. [PMID: 37383604 PMCID: PMC10295600 DOI: 10.2147/idr.s416344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023] Open
Abstract
Background Globally, Neisseria gonorrhoeae is the second most common cause of bacterial sexually transmitted diseases. The prominent predicament of this bacterium is its complications, non-susceptibility for many drugs, and aggravated transmission of other sexually transmitted infections. There is limited information about the prevalence, antibiotic resistance, and risk factors of N. gonorrhoeae in Tigrai, Ethiopia. Therefore, we aimed to determine the prevalence, antibiotic resistance, and risk factors of N. gonorrhoeae among patients attending non-profitable private clinics in Mekelle, Tigrai, Ethiopia. Methods A cross-sectional study among 229 patients was conducted from February to June 2018. The socio-demographic data and associated factors were gathered using structured questionnaire, and swabs were taken from urethra and cervix of males and females, respectively. Specimens were inoculated on standard bacteriological culture media and antibiotic susceptibility testing was performed using Kirby-Bauer disc diffusion technique following the Clinical and Laboratory Standard Institute. Data were analyzed using Statistical Package for Social Sciences Version 21. The level of significance at p-value <0.05 was considered statistically significant. Results The overall prevalence of N. gonorrhoeae was 23 (10.04%). High prevalence rates of N. gonorrhoeae were observed in females, urban residents and married ones. N. gonorrhoeae had shown statistically significant association with HIV positive, previous history of STIs, shisha users, Khat (Catha edulis) users, condom non-users and having more than two sexual partners. All isolates showed resistance to penicillin followed by tetracycline 16 (69.6%) and ciprofloxacin 8 (34.8%). Four isolates (7.4%) exhibited resistance to azithromycin with no resistance to ceftriaxone. Twelve (52.2%) isolates showed multidrug resistance (MDR). Conclusions The prevalence of N. gonorrhoeae and drug resistance, including multidrug resistance, was high in the study. Multiple factors were associated with the acquisition of N. gonorrhoeae. Therefore, behavioral change and communication should be strengthened.
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Affiliation(s)
- Atsebaha Gebrekidan Kahsay
- Department of Medical Microbiology and Immunology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
| | - Tadele Araya Mezgebo
- Department of Medical Microbiology and Immunology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
| | - Gebregziabher Berihu Gebrekidan
- Department of Health Systems, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
| | - Birhane Lemlem Desta
- Department of Gynecology and Obstetrics, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
| | - Hagos Gidey Mihretu
- Department of Gynecology and Obstetrics, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
| | - Tsehaye Asmelash Dejene
- Department of Medical Microbiology and Immunology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
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18
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Ewers EC, Curtin JM, Ganesan A. Challenges in Managing Gonorrhea and New Advances in Prevention. Infect Dis Clin North Am 2023; 37:223-243. [PMID: 37105643 DOI: 10.1016/j.idc.2023.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Gonorrhea is the second most common bacterial sexually transmitted infection in the United States. Rates are increasing, and multiple challenges compound management, including worsening antimicrobial resistance. New therapeutics, enhanced screening and partner notification, and treatment through point-of-care testing and expedited partner therapy, as well as primary prevention efforts provide opportunities for success in combating these trends.
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Affiliation(s)
- Evan C Ewers
- Infectious Disease Service, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA; Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - John M Curtin
- Department of Medicine, Infectious Disease Service, Walter Reed National Military Medical Center, Building 7, 1st Floor (Liberty Zone), 8960 Brown Drive, Bethesda, MD 20889, USA
| | - Anuradha Ganesan
- Department of Medicine, Infectious Disease Service, Walter Reed National Military Medical Center, Building 7, 1st Floor (Liberty Zone), 8960 Brown Drive, Bethesda, MD 20889, USA; Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program (IDCRP), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.
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Marcus U, Veras M, Casabona J, Caceres CF, Lachowsky N, Schink SB, Schmidt AJ. Comparison of the burden of self-reported bacterial sexually transmitted infections among men having sex with men across 68 countries on four continents. BMC Public Health 2023; 23:1008. [PMID: 37254096 DOI: 10.1186/s12889-023-15946-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/20/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are in general more vulnerable to sexually transmitted infections (STIs) than the heterosexual men population. However, surveillance data on STI diagnoses lack comparability across countries due to differential identification of MSM, diagnostic standards and methods, and screening guidelines for asymptomatic infections. METHODS We compared self-reported overall diagnostic rates for syphilis, gonorrhea, and chlamydia infections, and diagnostic rates for infections that were classified to be symptomatic in the previous 12 months from two online surveys. They had a shared methodology, were conducted in 68 countries across four continents between October 2017 and May 2018 and had 202,013 participants. RESULTS Using multivariable multilevel regression analysis, we identified age, settlement size, number of sexual partners, condom use for anal intercourse, testing frequency, sampling rectal mucosa for extragenital testing, HIV diagnosis, and pre-exposure prophylaxis use as individual-level explanatory variables. The national proportions of respondents screened and diagnosed who notified some or all of their sexual partners were used as country-level explanatory variables. Combined, these factors helped to explain differences in self-reported diagnosis rates between countries. The following differences were not explained by the above factors: self-reported syphilis diagnoses were higher in Latin America compared with Europe, Canada, Israel, Lebanon, and the Philippines (aORs 2.30 - 3.71 for symptomatic syphilis compared to Central-West Europe); self-reported gonorrhea diagnoses were lower in Eastern Europe and in Latin America compared with all other regions (aORs 0.17-0.55 and 0.34 - 0.62 for symptomatic gonorrhea compared to Central-West Europe); and self-reported chlamydia diagnoses were lower in Central East and Southeast Europe, South and Central America, and the Philippines (aORs 0.25 - 0.39 for symptomatic chlamydia for Latin American subregions compared to Central West Europe). CONCLUSIONS Possible reasons for differences in self-reported STI diagnosis prevalence likely include different background prevalence for syphilis and syndromic management without proper diagnosis, and different diagnostic approaches for gonorrhea and chlamydia.
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Affiliation(s)
- Ulrich Marcus
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | - Maria Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr Cesario Mota Jr 61, São Paulo, SP, 01221-020, Brazil
| | | | - Carlos F Caceres
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Susanne B Schink
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Axel J Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
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Rahman MM, Johnson C, Taylor SN, Peterman TA, Bennett TS, Haydel D, Newman DR, Furness BW. Extragenital Sexually Transmitted Infection Testing Among Louisiana Parish Health Units, 2016-2019. Sex Transm Dis 2023; 50:274-279. [PMID: 36630331 PMCID: PMC10190115 DOI: 10.1097/olq.0000000000001764] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) get tested annually for urethral and rectal chlamydia (CT) and gonorrhea (NG), and pharyngeal NG. There are no national recommendations to screen women and heterosexual men at extragenital sites. We assessed extragenital CT/NG screening among men and women at Louisiana's Parish Health Units (PHU). METHODS The Louisiana STD/HIV/Hepatitis Program piloted extragenital screening at 4 PHUs in February 2016 and expanded to 11 PHUs in 2017. Sexual histories were used to identify gender of sex partners and exposed sites. Because of billing restrictions, up to 2 anatomical sites were tested for CT/NG. RESULTS From February 2016 to June 2019, 70,895 urogenital and extragenital specimens (56,086 urogenital, 13,797 pharyngeal, and 1,012 rectal) were collected from 56,086 patients. Pharyngeal CT positivity was 160 of 7,868 (2.0%) among women, 54 of 4,838 (1.1%) among men who have sex with women (MSW) and 33 of 1,091 (3.0%) among MSM. Rectal CT positivity was 51 of 439 (11.6%) among women and 95 of 573 (16.6%) among MSM. Pharyngeal NG positivity was 299 of 7,868 (3.8%) among women, 222 of 4,838 (4.6%) among MSW, and 97 of 1,091 (8.9%) among MSM. Rectal NG positivity was 20 of 439 (4.6%) among women and 134 of 573 (23.4%) among MSM.Urogenital-only screening would have missed: among women, 173 of 3,923 (4.4%) CT and 227 of 1,480 (15.3%) NG infections; among MSW, 26 of 2,667 (1%) CT and 149 of 1,709 (8.7%) NG infections; and among MSM, 116 of 336 (34.5%) CT and 127 of 413 (42.1%) NG infections. CONCLUSIONS Many CT/NG infections would have been missed with urogenital-only screening. Men who have sex with men had much higher extragenital infection rates than women and MSW.
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Affiliation(s)
- Mohammad M. Rahman
- Louisiana Department of Health-STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chaquetta Johnson
- Louisiana Department of Health-Office of Public Health, New Orleans, LA
| | - Stephanie N. Taylor
- Louisiana Department of Health-Office of Public Health, New Orleans, LA
- LSU School of Medicine-Section of Infectious Diseases, New Orleans, LA
| | - Thomas A. Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tammy S. Bennett
- Louisiana Department of Health-Bureau of Family Health, New Orleans, LA
| | - Danielle Haydel
- Louisiana Department of Health-Office of Public Health Laboratory, Baton Rouge, LA
| | - Daniel R. Newman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bruce W. Furness
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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de Jesus Salgado V, de Abreu Oliveira CMP, da Silva ÁMB, de Brito HIL, de Medeiros DS, Soares F, Magno L, Dourado I, Campos GB, Marques LM. Prevalence of Mollicutes among men who have sex with men and transgender women aged 15 to 19 years in Salvador, North-eastern Brazil. BMC Infect Dis 2023; 23:244. [PMID: 37072756 PMCID: PMC10114492 DOI: 10.1186/s12879-023-08213-z] [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: 08/15/2022] [Accepted: 03/31/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Some species of Mollicutes have been associated with different pathologies of the urogenital tract in humans, with a high prevalence among adult men who have sex with men (MSM) and transgender women (TGW). However, few studies have been performed to investigate its prevalence among adolescents. In this study, we estimated the initial prevalence of Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), and Ureaplasma parvum (UP); the rate of misdiagnosis at different anatomical sites; and the associated factors with positive tests for Mollicutes among MSM and TGW aged 15 to 19 years enrolled in the PrEP1519 study. METHODS PrEP-1519 is the first study to investigate the effectiveness of pre-exposure prophylaxis for human immunodeficiency virus among adolescent MSM and TGW aged 15 to 19 in Latin America. Oral, anal, and urethral swabs were taken from 246 adolescents upon enrolment in the study to detect MG, MH, UU, and UP by quantitative polymerase chain reaction (qPCR). Bivariate and multivariate analyses were conducted by Poisson regression and 95% confidence intervals (95% CI) were estimated. RESULTS The prevalence of Mollicutes was 32.1%. UU was the most prevalent species (20.7%), followed by MH (13.4%), MG (5.7%), and UP (3.2%); 67.3% of the positive samples would have been missed if only urethral samples had been taken. Receptive anal sex (prevalence ratio [PR] = 1.79; 95% CI = 1.07-3.01) and clinical suspicion of sexually transmitted infection (PR = 1.62; 95% CI = 1.01-2.61) were factors associated with the detection of Mollicutes in general. Group sex (PR = 1.98; 95% CI = 1.12-3.50) and receptive anal sex (PR = 2.36; 95% CI = 0.95-5.86) were associated with the detection of Mycoplasma spp. No sociodemographic, clinical, or behavioural variable was significantly associated with the detection of Ureaplasma spp. CONCLUSIONS A high prevalence of Mollicutes was observed among adolescent MSM and TGW, especially at extragenital sites. Further research is required to understand the epidemiological profile of high-risk adolescents in different regions and contexts, and to investigate the pathogenesis of Mollicutes in the oral and anal mucosa before routine screening can be recommended in clinical practice.
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Affiliation(s)
- Valdiele de Jesus Salgado
- State University of Santa Cruz, Rod. Jorge Amado, Km 16, Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | | | - Ágatha Morgana Bertoti da Silva
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Henrique Inácio Lima de Brito
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Danielle Souto de Medeiros
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Fabiane Soares
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
- Department of Life Sciences, State University of Bahia, Rua Silveira Martins, 2555, Salvador, Bahia, 41000-150, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
| | - Guilherme Barreto Campos
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Lucas Miranda Marques
- State University of Santa Cruz, Rod. Jorge Amado, Km 16, Salobrinho, Ilhéus, Bahia, 45662-900, Brazil.
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil.
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22
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Sarwar G, Morshed Khan MN, Gourab G, Irfan SD, Rahman M, Rana AKMM, Khan SI. Can oral sex be performed safely among men who have sex with men (MSM) and transgender women in Bangladesh? Challenges, complexities and the way forward. Heliyon 2023; 9:e15553. [PMID: 37128302 PMCID: PMC10148115 DOI: 10.1016/j.heliyon.2023.e15553] [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: 10/09/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
Introduction There is currently ample research and intervention initiatives addressing anal sex and sexually transmitted infections (STIs) among gender and sexually diverse people (i.e., men who have sex with men (MSM) and transgender women). However, oral sex and oral STIs are not prioritized to the same extent, despite their concerning implications. This article aimed to delineate the underlying contexts of unprotected oral sex and the management challenges of oral STIs. Methodology This qualitative study constituted 30 in-depth interviews, 14 focus group discussions, and 10 key-informant interviews with gender and sexually diverse people, service providers of HIV interventions and sexuality researchers. Thematic analysis conventions were applied. Results Findings revealed various contexts of unprotected oral sex. In particular, we found a discordance between pleasure and protected sex where participants believed the two phenomena were mutually exclusive, therefore they did not want to compromise their pleasure by using condoms. Moreover, their low awareness, risk perception, and unchallenged misconceptions about the harms of unprotected oral sex fueled their hesitancy to use condoms during oral sex. Compared to anal sex and STIs, oral sex and STIs were less prioritized in the current HIV intervention modalities, where healthcare providers lacked adequate knowledge and training about oral sex and oral STIs, as well as their complexities. Conclusions In Bangladesh and several other settings, oral sex is considered a taboo, thus imbuing silence about this issue and its complexities. In this context, it is integral to eradicate the taboos and silence surrounding oral sex and oral STIs in order to strengthen the overall STI management strategy. Therefore, HIV/STI prevention programs and mainstream healthcare facilities need to underscore oral STI interventions, otherwise this issue would remain under-prioritized.
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Affiliation(s)
| | | | | | | | | | | | - Sharful Islam Khan
- Corresponding author. Head and Scientist Programme for HIV and AIDS Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, 1212 Dhaka, Bangladesh.
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23
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Tordoff DM, Dombrowski JC, Ramchandani MS, Barbee LA. Trans-inclusive Sexual Health Questionnaire to Improve Human Immunodeficiency Virus/Sexually Transmitted Infection (STI) Care for Transgender Patients: Anatomic Site-Specific STI Prevalence and Screening. Clin Infect Dis 2023; 76:e736-e743. [PMID: 35594554 PMCID: PMC10169399 DOI: 10.1093/cid/ciac370] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2018, the municipal Sexual Health Clinic in Seattle, implemented trans-inclusive questions about sexual behavior, anatomy, gender-affirming surgeries, and sexually transmitted infection (STI) symptoms in the clinic's computer-assisted self-interview (CASI) to improve care for transgender and nonbinary (TNB) patients. METHODS We calculated test positivity, the proportion of TNB patient visits that received testing for human immunodeficiency virus (HIV); syphilis; pharyngeal, rectal, and urogenital gonorrhea (GC); and chlamydia (CT) before (5/2016-12/2018) and after (12/2018-2/2020) implementation of new CASI questions, and the proportion of asymptomatic patients who received anatomic site-specific screening based on reported exposures. RESULTS There were 434 TNB patients with 489 and 337 clinic visits during each period, respectively. Nonbinary patients assigned male at birth (AMAB) had the highest prevalence of GC (10% pharyngeal, 14% rectal, 12% urogenital). Transgender women, transgender men, and nonbinary people AMAB had a high prevalence of rectal CT (10%, 9%, and 13%, respectively) and syphilis (9%, 5%, and 8%). Asymptomatic transgender women, transgender men, and nonbinary patients AMAB were more likely to receive extragenital GC/CT screening compared with nonbinary patients assigned female at birth. After implementation of trans-inclusive questions, there was a 33% increase in the number of annual TNB patient visits but no statistically significant increase in HIV/STI testing among TNB patients. CONCLUSIONS TNB people had a high prevalence of extragenital STIs and syphilis. Implementation of trans-inclusive medical history questions at a clinic that serves cisgender and transgender patients was feasible and important for improving the quality of affirming and inclusive sexual healthcare.
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Affiliation(s)
- Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Meena S Ramchandani
- Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lindley A Barbee
- Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
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24
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Jones J, Jenness SM, Le Guillou A, Sullivan PS, Gift TL, Delaney KP, Chesson H. Estimated Number of Incident HIV Infections in Men Who Have Sex With Men Attributable to Gonorrhea and Chlamydia, Per Gonococcal or Chlamydial Infection, in the United States. Sex Transm Dis 2023; 50:83-85. [PMID: 36630415 PMCID: PMC10753989 DOI: 10.1097/olq.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Using a network model, we simulated transmission of HIV, gonorrhea, and chlamydia among men who have sex with men to estimate the number of HIV infections that can be attributed to gonorrhea and chlamydia, per gonococcal and chlamydial infection. This metric can inform future modeling and health economic studies.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin P. Delaney
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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25
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Berk Cam H. Treatment of Chlamydial Infections. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.109648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Sexually transmitted infections (STIs) are a major health problem with an estimated burden of disease transmission as high as one million new cases per day globally. Chlamydia trachomatis, a member of the genus Chlamydia, is one of the most common and curable causative agents of STIs. C. trochomatis infections usually affect sexually active young adults and adolescents; and are composed of a broad spectrum of diseases varying from asymptomatic infection to severe genito-urinary infection leading to infertility and acute or chronic ocular infection (trachoma), which may result in blindness and pneumonia. Among the members of the genus Chlamydia, there are also two pathogenic species, Chlamydia pneumoniae and Chlamydia psittaci which are responsible for acute respiratory tract infections and febrile illness in humans. The incidence, pathophysiology, and diagnostic methods are discussed in detail in the previous chapters. The purpose of this chapter is to elucidate the management of infections due to C. trachomatis, C. pneumoniae, and C. psittaci including antibiotic susceptibility and resistance mechanisms, treatment recommendations for ocular infections, genito-urinary and respiratory tract infections, and management of sex partners, pregnant women, neonates, and children according to the latest data.
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26
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Weng R, Ning N, Zhang C, Wen L, Ye J, Wang H, Li J, Chen X, Cai Y. Acceptability of rectal self-sampling in non-clinical venues for chlamydia and gonorrhea testing among men who have sex with men: A cross-sectional study in Shenzhen, China. Front Public Health 2022; 10:992773. [PMID: 36466478 PMCID: PMC9712709 DOI: 10.3389/fpubh.2022.992773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) have become an increasingly important concern. The study aimed to explore (1) the acceptability of rectal self-sampling for chlamydia and gonorrhea testing among MSM in non-clinical venues in Shenzhen city, China; (2) factors associated with the acceptability of rectal self-sampling; and (3) factors associated with rectal CT and NG infections, respectively. Methods This cross-sectional study was conducted in two non-clinical settings in Shenzhen, China, from April 2021 to October 2021. Mixed-effects logistic regression analysis was performed to explore the factors associated with acceptance of rectal self-collection for CT and NG testing. Results Of the 306 MSM who were offered to perform rectal self-sampling, 133 (43.46%) accepted, and 96.24% (128/133) of them successfully provided a valid rectal sample. The prevalence of urogenital CT and NG infections among 303 MSM was 4.29 and 0.66%, respectively. The prevalence of rectal CT and NG infections among 128 participants was 31.25 and 9.38%, respectively. Participants having been diagnosed with HIV infection showed a higher acceptance of rectal self-collection for CT and NG testing. Conclusion This study reported that rectal self-sampling in non-clinical venues for CT and NG testing among MSM was barely acceptable and feasible in China. Most CT and NG infections would have been missed if urethral screening was offered alone, which implies that the CT and NG screening should be scaled up in the above setting. Integrating free CT tests into regular STI interventions for MSM could also be considered.
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Affiliation(s)
- Rongxing Weng
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Ning Ning
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China,Shantou University Medical College, Shantou University, Shantou, China
| | - Chunlai Zhang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Lizhang Wen
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jianbin Ye
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Honglin Wang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jing Li
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Xiangsheng Chen
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China,National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, China
| | - Yumao Cai
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China,*Correspondence: Yumao Cai
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27
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Boyd T, Friedman S. Challenges and Opportunities for Advancing Research and Improving Care for Sexual and Gender Minorities With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 29:672-674. [PMID: 36308303 DOI: 10.1093/ibd/izac229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 12/09/2022]
Abstract
Lay Summary
Within the field of gastroenterology and inflammatory bowel disease specifically, there has been little research exploring the healthcare experiences of LGBTQIA+ individuals. This article describes unique clinical challenges and research opportunities that exist particularly at the intersection of inflammatory bowel disease and sexual health.
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Affiliation(s)
| | - Sonia Friedman
- Harvard Medical School, Boston, MA, USA.,Crohn's and Colitis Center, Brigham and Women's Hospital, Brigham and Women's Hospital, Boston, MA, USA
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28
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Jones J, Le Guillou A, Gift TL, Chesson H, Bernstein K, Delaney K, Lyles C, Berruti A, Sullivan PS, Jenness SM. Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis. Sex Transm Dis 2022; 49:669-676. [PMID: 35921635 PMCID: PMC9481699 DOI: 10.1097/olq.0000000000001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM. METHODS Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence. RESULTS Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection. CONCLUSIONS Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kyle Bernstein
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kevin Delaney
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Cynthia Lyles
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Andres Berruti
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
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29
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Ferrer L, González V, Martró E, Folch C, Saludes V, Muñoz R, Rodríguez V, Morales A, Meroño M, Morey F, Sanjosé SD, Casabona J. High HIV/STI prevalence among cisgender men and transgender women sex workers attending community-based centres in Barcelona, Spain: The Sweetie Project. Int J STD AIDS 2022; 33:1045-1053. [DOI: 10.1177/09564624221116536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to describe the socio-demographics, and the sexual and health-seeking behaviours of cisgender men and transgender women sex workers (M & TWSW) attending community-based organisations (CBOs) in Barcelona, Spain, as well as to estimate the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Chlamydia Trachomatis (CT) and Neisseria gonorrhoeae (NG) among them at different anatomical sites. Methods The Sweetie Project was a community-based cross-sectional study of 147 M & TWSW recruited in two CBOs in Barcelona between 2017 and 2018. A nurse collected biological samples from rectum, pharynx and urethra from the subjects at each CBO and the participants self-completed an epidemiological questionnaire. Results The highest prevalence observed was for HIV infection (25.3%) followed by bacterial STIs (NG 19.2% and CT 10.3%). The most prevalent anatomical site was pharyngeal (17.7%) followed by rectal (13.8%). More than half of participants who had a pharyngeal infection presented an isolated pharyngeal infection (57.7%) and half of those who had a rectal or urethral infection presented an isolated infection respectively. The seroprevalence of HCV and HBV was 2.4% and 34.2% respectively. There was a poor but statistically significant correlation between HIV and rectal CT infection ( r = 0.31), previous exposure to HCV ( r = 0.27) or self-reported STI ( r = 0.23), as well as between previous exposure to HCV and rectal CT ( r = 0.21) or self-reported STI ( r = 0.20). Discussion The Sweetie Project confirms the high burden of HIV and bacterial STIs among a sample of M&TWSW recruited in CBOs and reinforces the need to routinely screen them at all exposed anatomical sites.
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Affiliation(s)
- Laia Ferrer
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Victoria González
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Elisa Martró
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Cinta Folch
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Verónica Saludes
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Rafael Muñoz
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - Vanesa Rodríguez
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Francisca Morey
- Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | - Sílvia de Sanjosé
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Casabona
- Centre for Epidemiological Studies on STI and AIDS of Catalonia, Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola), Spain
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Estimated costs and quality-adjusted life-years lost due to N. gonorrhoeae infections acquired in 2015 in the United States: A modelling study of overall burden and disparities by age, race/ethnicity, and other factors. LANCET REGIONAL HEALTH. AMERICAS 2022; 16:100364. [PMID: 36777156 PMCID: PMC9904145 DOI: 10.1016/j.lana.2022.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Disparities in the health and economic burden of gonorrhoea have not been systematically quantified. We estimated population-level health losses and costs associated with gonococcal infection and sequelae in the United States. Methods We used probability-tree models to capture gonorrhoea sequelae and to estimate attributable disease burden in terms of the discounted lifetime costs and quality-adjusted life-years (QALYs) lost due to incident infections acquired during 2015 from the healthcare system perspective. Numbers of infections in 2015 were obtained from a published gonorrhoea transmission model. We evaluated population-level disease burden, disaggregated by sex, age, race/ethnicity, and for men who have sex with men (MSM). We conducted a multivariate sensitivity analysis for key parameters. Findings Discounted lifetime QALYs lost per incident gonococcal infection were estimated as 0.093 (95% uncertainty interval [UI] 0.022-0.22) for women, 0.0020 (0.0015-0.0024) for heterosexual men, and 0.0015 (0.00070-0.0021) for MSM. Discounted lifetime costs per incident infection were USD 261 (109-480), 169 (88-263), and 133 (50-239), respectively. At the population level, total discounted lifetime QALYs lost due to infections acquired during 2015 were 53,293 (12,326-125,366) for women, 621 (430-872) for heterosexual men, and 1,078 (427-1,870) for MSM. Total discounted lifetime costs were USD 150 million (64-277 million), 54 million (25-92 million), and 97 million (34-197 million), respectively. The highest total burden of both QALYs and costs at the population-level was observed in Non-Hispanic Black women, and highest burden per 1,000 person-years was identified in MSM among men and American Indian/Alaska Native among women. Interpretation Gonorrhoea causes substantial health losses and costs in the United States. These results can inform planning and prioritization of prevention services. Funding Centers for Disease Control and Prevention, Charles A. King Trust.
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Hechter RC, Bruxvoort KJ, Zhou H, Towner WJ, Contreras R, Schumacher CM, Grant DL, Jones J. Sexually Transmitted Infections Among Men and Transgender Women Using HIV Pre-exposure Prophylaxis in a Large Integrated Health System-A Cohort Study. J Acquir Immune Defic Syndr 2022; 91:1-8. [PMID: 35499561 DOI: 10.1097/qai.0000000000003015] [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] [Received: 10/20/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are common in people using pre-exposure prophylaxis (PrEP). We examined risk and factors associated with STIs in a cohort of PrEP users in an integrated health system in the United States. SETTING The Kaiser Permanente Southern California is a large integrated health system that provides comprehensive medical services to approximately 4.7 million demographically diverse members. METHODS We identified men and transgender women initiating PrEP between January 1, 2014, and June 1, 2018, and followed through December 31, 2018. Demographic and clinical factors potentially associated with the risk of bacterial STIs during PrEP use were evaluated using Poisson regression models. RESULTS Among 5042 individuals tested for STIs with 7198 person-years of follow-up, 1709 (33.9%) had at least one new STI. The estimated incidence of STIs was 48.3 per 100 person-years, and the most common STI was rectal chlamydia. Most repeat STIs (61.4%) occurred <180 days apart. In a multivariable analysis, an history of STIs in the prior 6 months through 7 days after the PrEP initiation was the most prominent risk factor of STIs during PrEP use (adjusted risk ratio: 1.78, 95% confidence intervals: 1.65 to 1.93). Other risk factors included younger age (<35 years), being Hispanic, and having a history of alcohol use disorder or drug use disorder. CONCLUSIONS Quarterly STI testing and targeted intervention to mitigate STI risk are warranted for young and racial minority PrEP users, particularly for those with prior history of STIs and substance use disorders.
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Affiliation(s)
- Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Katia J Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Richard Contreras
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Christina M Schumacher
- Department of Pediatrics, Center for Child and Community Health Research, John Hopkins University School of Medicine, Baltimore, MD; and
| | - Deborah L Grant
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Joyce Jones
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, MD
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Cox BK, Larson BK, Hutchings DA, Morgan M, Balzer BL, Waters KM. The Histopathology of Anorectal Neisseria gonorrhoeae Infection. Am J Clin Pathol 2022; 158:559-563. [PMID: 35938627 DOI: 10.1093/ajcp/aqac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Neisseria gonorrhoeae infection of the anorectal tract is often asymptomatic and infrequently biopsied, but pathologists can be tasked with identifying the histologic features of possible infection. The study was undertaken to better characterize clinical and morphologic features of confirmed anorectal gonococcal infection. METHODS From 2011 to 2020, 201 positive gonococcal nucleic acid amplification testing samples from 174 patients collected from the distal colorectum and/or anus were matched to eight patients with concurrent biopsy specimens of the distal anorectum. Complete demographic, clinical, and infectious information was collected for each biopsied patient. The histomorphologic features of each biopsy were systematically tabulated. RESULTS All eight gonococcal cases were obtained from men who have sex with men. Each case showed at least mild acute inflammation with moderate activity identified in one case with concurrent cytomegalovirus infection. Intense lymphoplasmacytic infiltration was not commonly seen (two of eight). Half of the cases showed mucosal ulceration, and seven of eight cases demonstrated lymphoid aggregates. CONCLUSIONS The microscopic features are mild compared with other well-described types of infectious proctitis, with most cases displaying mild acute inflammation and scattered lymphoid aggregates. These findings highlight the importance of obtaining a complete patient history and recommending additional infectious workup even when only subtle changes are present.
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Affiliation(s)
- Brian K Cox
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brent K Larson
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Danielle A Hutchings
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Margie Morgan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bonnie L Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevin M Waters
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Test-of-Cure after Treatment of Pharyngeal Gonorrhea in Durham, North Carolina, 2021 - 2022. Sex Transm Dis 2022; 49:677-681. [PMID: 35858472 DOI: 10.1097/olq.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In December 2020 the Centers for Disease Control and Prevention updated its treatment guidelines for gonococcal infection and, for the first time, recommended universal test-of-cure for all individuals treated for pharyngeal gonorrhea. Following the release of these guidelines, data is lacking on rates of return for the test-of-cure, particularly in populations other than men who have sex with men (MSM). METHODS We analyzed the demographic characteristics, clinical characteristics, rate of return for the recommended test-of-cure, and percent positivity for Neisseria gonorrhoeae on repeat pharyngeal specimens at a local public health department in Durham, North Carolina. RESULTS Of 101 individuals treated for pharyngeal gonorrhea between 03/2021 - 04/2022, 54.5% were male, 71.2% Black or African American, and 58.4% between the ages of 20 to 29 years. Most identified as either women who have sex with men (38.6%), MSM (24.8%), or men who have sex with women (22.8%). Of these individuals, 41 (40.6%) returned for a test-of-cure, with LGBTQ+ individuals more likely to return than men who have sex with women and women who have sex with men. Of those who returned for the test-of-cure, 4.9% of pharyngeal samples were equivocal and 2.4% positive for N. gonorrhoeae by nucleic acid amplification testing, likely reflecting false positive tests. CONCLUSION Despite recommendations to perform a test-of-cure 7-14 days following treatment of pharyngeal gonorrhea, rates of return continue to be low. Alternative strategies should be investigated to increase test-of-cure rates.
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Ye ZH, Chen S, Liu F, Cui ST, Liu ZZ, Jiang YJ, Hu QH. Patterns of Sexually Transmitted Co-infections and Associated Factors Among Men Who Have Sex With Men: A Cross-Sectional Study in Shenyang, China. Front Public Health 2022; 10:842644. [PMID: 35712312 PMCID: PMC9193278 DOI: 10.3389/fpubh.2022.842644] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Men who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STIs). We sought to describe patterns of sexually transmitted co-infections and explore factors associated with increased acquisition of STIs among MSM. Methods We enrolled MSM in Shenyang, China, between July and December 2020 to test for four STIs, including human papillomavirus (HPV), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Treponema pallidum (TP). Data regarding demographic and behavioral characteristics of participants were collected through a self-administered digital questionnaire. We adopted the ordinal logistic regression model to identify factors associated with acquiring more STIs. Results Overall, 177 participants with completed test results for all four STIs were analyzed. These participants had a median age of 29.0 (interquartile range: 23.0-38.0) years. The prevalence of STI co-infections was 23.7% [42/177; 95% confidence interval (CI), 17.8%-30.8%], among which HPV/CT (47.1%) and HPV/CT/NG (50.0%) co-infection were the predominant types among participants with dual and multiple infections, respectively. Participants who had a higher educational background [adjusted odds ratio (aOR), 0.46; 95% CI, 0.24-0.85; P = 0.014] and had a history of STIs (aOR, 2.53; 95% CI, 1.24-5.18; P = 0.011) were positively associated with acquiring more STIs. Conclusions MSM in Shenyang suffer a substantial burden of sexually transmitted co-infections. An optimized multi-STI integration strategy targeting prevention, surveillance, screening, and treatment is warranted to reduce the prevalence of sexually transmitted co-infections, especially in less-educated MSM.
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Affiliation(s)
- Ze-Hao Ye
- National Health Commission Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Shuo Chen
- National Health Commission Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Fan Liu
- National Health Commission Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Si-Tong Cui
- National Health Commission Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhao-Zhen Liu
- National Health Commission Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yong-Jun Jiang
- National Health Commission Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- National Health Commission Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Tao G, Gift TL. Healthcare provider awareness of the recent FDA approval on first diagnostic tests for extragenital testing for chlamydia and gonorrhea. Prev Med 2022; 159:107078. [PMID: 35533886 DOI: 10.1016/j.ypmed.2022.107078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/20/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
To assess healthcare provider awareness of the Food and Drug Administration (FDA) 2019 approval of nucleic acid amplification tests (NAAT) using extragenital specimens for chlamydia and gonorrhea, several questions were included in fall 2020 Porter Novelli's DocStyles survey, a US nationally representative semi-annual web-based survey of healthcare providers. There were 1502 respondents included in this study, 1000 family practitioners/internists as primary care physicians (PCPs), 251 obstetricians/gynecologists (OBs/GYNs), and 251 nurse practitioners/physician assistants (NP/PA). Awareness of this FDA approval was 34.3% overall and significantly varied by provider specialty: 45.0% for OB/GYN versus 23.5% for NP/PA, p < 0.01. OB/GYN had the lowest rate of ordering any extragenital gonorrhea and chlamydia tests in the past 12 months (31.6%) versus the other providers (ranging from 46.2% for NP/PA to 60.7% for PCP). The respondents were more likely to be aware of the FDA approval if they had ordered extragenital chlamydia or gonorrhea testing for men who have sex with men (MSM) than those who did not order the tests for MSM (72.3% versus 43.7%, p < 0.01). Of 1502 respondents, lack of reimbursement as a barrier to ordering extragenital tests for chlamydia and gonorrhea was most mentioned (16.6%) overall and did not significantly vary by provider's specialty. Further outreach is needed to educate healthcare providers on the changes in the FDA approval for extragenital gonorrhea and chlamydia testing so that they can provide comprehensive care to their patients and to reduce the potential for antimicrobial resistance.
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Affiliation(s)
- Guoyu Tao
- The Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Thomas L Gift
- The Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Lin XX, Meng SY, Ke WJ, Zhang XH, Wang LY, Liao YY, Liu H, Zhao PZ, Liang CM, Chen HR, Long HY, Yang B, Yang LG. Community engagement on-site rapid test for chlamydia and gonorrhea among men who have sex with men: a pioneering study in Guangzhou, China. BMC Public Health 2022; 22:1036. [PMID: 35606713 PMCID: PMC9128213 DOI: 10.1186/s12889-022-13460-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are prevalent among men who have sex with men (MSM) in China. However, compared to syphilis and HIV, the testing rate for chlamydia and gonorrhea remains low. The purpose of this pilot study was to evaluate the feasibility for conducting rapid nucleic acid test for chlamydia and gonorrhea in MSM community-based organizations (CBO). Method We recruited our participants through an MSM CBO where free HV and syphilis testing were routinely provided. We collected data including social-demographic background, sexual history, chlamydia and gonorrhea testing history, and reasons for accepting this on-site rapid testing. Urine and/or anorectal swab samples were collected and tested for chlamydia and gonorrhea on-site and the testing results were delivered in about 1.5 h. Positive cases received on-site free treatment. Results From August 2020 to October 2020, 634 MSM visited the CBO for syphilis and HIV testing and 158 (158/634, 24.9%) accepted the on-site chlamydia and gonorrhea rapid test, 135 were finally enrolled. The positive rate fo chlamydia was 16.3% (22/135) and 3.0% (4/135) for gonorrhea, respectively. Only 19.3% participants had previously undergone chlamydia and gonorrhea testing and 68.9% (93/135) participants reported that they had heard of gonorrhea, 47.4% (64/135) had heard of chlamydia. The main reason for testing was “free for charge” (66.2%), followed by “convenient, ‘shorter waiting time” (45.2%) and “had high-risk sexual behavior recently” (16.3%). Conclusions This pilot study showed that the chlamydia and gonorrhea infection rate remains high among MSM, while the testing rate was low. On-site rapid testing is feasible and potentially preferred by MSM.
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Affiliation(s)
- Xiao-Xin Lin
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Si-Yan Meng
- UNC Project China, University of North Carolina at Chapel Hill, Guangzhou, China
| | - Wu-Jian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Xiao-Hui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Liu-Yuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Yu-Ying Liao
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Han Liu
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Pei-Zhen Zhao
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Chun-Mei Liang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Hui-Ru Chen
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Hai-Ying Long
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Bin Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
| | - Li-Gang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
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Incidence, Reinfection, and Discrepancy Between Sexual Practice and Anatomic Site Positivity of Sexually Transmitted Infections in Youth With HIV. Pediatr Infect Dis J 2022; 41:306-311. [PMID: 34773398 DOI: 10.1097/inf.0000000000003399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to determine the overall incidence and reinfection rates of sexually transmitted infections (STIs) and the discrepancy between self-reported exposure history and anatomic site positivity of STIs among adolescents and young adults (AYAs) with HIV in Atlanta, GA. METHODS Retrospective chart review was conducted on all patients 13-24 years of age at the Grady Ponce and Family Youth Clinic from January 1, 2009 to December 31, 2018. Data were collected on patient demographics, self-reported sexual history and STI events. First STI incidence and incidence of reinfections were calculated by dividing new cases over corresponding person follow-up time. RESULTS A total of 626 sexually active AYAs with HIV were included in analysis. The mean age at first observation was 18.9 (SD: ±2.8) years; 72% were male, 92% were Black and 80% were horizontally infected. The cumulative first STI incidence rate was 45.49 cases per 100 person-years, and the recurrent STI incidence rate was 119.86 cases per 100 person-years. Among all Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) cases, the most common site of infection was the rectum (48.6% and 49.6%, respectively). Disagreement between exposure history and presence of GC or CT infection was statistically significant for nearly all anatomic sites and types of intercourse. CONCLUSIONS AYAs with HIV in Atlanta have disproportionately high first and recurrent incidence rates of STIs, with many patients not reporting exposure at their site of infection. There is considerable need to increase screening for STIs, including routine extragenital testing for GC and CT, among AYAs with HIV regardless of self-reported exposure history.
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Waltmann A, Duncan JA, Pier GB, Cywes-Bentley C, Cohen MS, Hobbs MM. Experimental Urethral Infection with Neisseria gonorrhoeae. Curr Top Microbiol Immunol 2022:10.1007/82_2021_250. [PMID: 35246736 PMCID: PMC9441470 DOI: 10.1007/82_2021_250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Gonorrhea rates and antibiotic resistance are both increasing. Neisseria gonorrhoeae (Ng) is an exclusively human pathogen and is exquisitely adapted to its natural host. Ng can subvert immune responses and undergoes frequent antigenic variation, resulting in limited immunity and protection from reinfection. Previous gonococcal vaccine efforts have been largely unsuccessful, and the last vaccine to be tested in humans was more than 35 years ago. Advancing technologies and the threat of untreatable gonorrhea have fueled renewed pursuit of a vaccine as a long-term sustainable solution for gonorrhea control. Despite the development of a female mouse model of genital gonococcal infection two decades ago, correlates of immunity or protection remain largely unknown, making the gonococcus a challenging vaccine target. The controlled human urethral infection model of gonorrhea (Ng CHIM) has been used to study gonococcal pathogenesis and the basis of anti-gonococcal immunity. Over 200 participants have been inoculated without serious adverse events. The Ng CHIM replicates the early natural course of urethral infection. We are now at an inflexion point to pivot the use of the model for vaccine testing to address the urgency of improved gonorrhea control. Herein we discuss the need for gonorrhea vaccines, and the advantages and limitations of the Ng CHIM in accelerating the development of gonorrhea vaccines.
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Affiliation(s)
- Andreea Waltmann
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joseph A Duncan
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Gerald B Pier
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Myron S Cohen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Marcia M Hobbs
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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39
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Watson RJ, Collibee C, Maksut JL, Earnshaw VA, Rucinski K, Eaton LA. High levels of undiagnosed rectal STIs suggest that screening remains inadequate among Black gay, bisexual and other men who have sex with men. Sex Transm Infect 2022; 98:125-127. [PMID: 33790050 PMCID: PMC8481425 DOI: 10.1136/sextrans-2020-054563] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 01/23/2021] [Accepted: 02/27/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To better understand rectal STI screening practices for Black gay, bisexual and other men who have sex with men (BGBMSM). FINDINGS Although 15% of BGBMSM lab tested positive for a rectal STI, the majority of these (94%) were asymptomatic. Though all participants reported their status as HIV negative/unknown, 31 of 331 (9.4%) tested positive on HIV rapid tests. Neither condomless anal intercourse nor the number of male sex partners was associated with rectal STI or HIV diagnosis, although rectal STI diagnosis was positively related to testing HIV positive. CONCLUSIONS Findings suggest that substantial numbers of BGBMSM have asymptomatic STIs but are not tested-an outcome that is likely a strong driver of onward HIV acquisition. Therefore, we must address the asymptomatic STI epidemic among GBMSM in order to reduce HIV transmission, as well as temper STI transmission, among this key population.
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Affiliation(s)
- Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Charlene Collibee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, US
| | - Jessica L. Maksut
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, US
| | - Valerie A. Earnshaw
- Department of Human Development & Family Sciences, University of Delaware, Newark, DE, US
| | - Katherine Rucinski
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, US
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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40
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Lourtet-Hascoet J, Mine L, Spindler L, Pilmis B, Aubert M, El Mituialy A, Vieillefond V, de Parades V, Le Monnier A. Epidemiology of symptomatic infective anoproctitis in a population of men having sex with men (MSM). Infection 2022; 50:933-940. [PMID: 35212944 DOI: 10.1007/s15010-022-01766-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/28/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Anoproctitis due to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are Sexual Transmitted Infections (STIs) reported in MSM population. This study describes clinical and microbiological epidemiology of infective anoproctitis in MSM population. METHODS All patients with symptomatic anoproctitis consulting at the proctology Institute of Saint-Joseph's Hospital, Paris, were included. Detection of CT/NG was performed by PCR GeneXpertR and other STIs pathogens Mycoplasma sp., HSV, CMV and T. pallidum were detected by multiplex PCR Allplex (mPCR). RESULTS Symptoms most frequently reported were pain, rectal bleeding and purulent flow in 66%, 52% and 49% of cases, respectively. On the 311 rectal samples collected, 171 (55.2%) were positive to CT/NG. Among the 194 used for mPCR, 148 were positive to STIs pathogens (76.2%) including 106 samples (71.6%) positive in coinfections. Among NG infections, 22.6% of the strains were resistant to azithromycin and 26.8% to tetracyclines. CONCLUSIONS Anorectal infections in this MSM population showed a high prevalence of not only CT/NG but also other pathogens involved in STIs. The high level of coinfections confirms the requirement of accurate PCR tests to improve diagnosis. This study describing increasing antibiotic resistances for NG strains confirms the updating of international guidelines on antibiotic treatments recommendations.
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Affiliation(s)
- J Lourtet-Hascoet
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France.
| | - L Mine
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France
| | - L Spindler
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - B Pilmis
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France
| | - M Aubert
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - A El Mituialy
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | | | - V de Parades
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - A Le Monnier
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France
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41
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Lovett A, Seña AC, Macintyre AN, Sempowski GD, Duncan JA, Waltmann A. Cervicovaginal Microbiota Predicts Neisseria gonorrhoeae Clinical Presentation. Front Microbiol 2022; 12:790531. [PMID: 35222300 PMCID: PMC8867028 DOI: 10.3389/fmicb.2021.790531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/13/2021] [Indexed: 01/11/2023] Open
Abstract
Neisseria gonorrhoeae infection of the female lower genital tract can present with a spectrum of phenotypes ranging from asymptomatic carriage to symptomatic cervical inflammation, or cervicitis. The factors that contribute to the development of asymptomatic or symptomatic infections are largely uncharacterized. We conducted a pilot study to assess differences in the cervicovaginal microbial community of patients presenting with symptomatic vs. asymptomatic N. gonorrhoeae infections to a sexually transmitted infections (STI) clinic. DNA was isolated from cervicovaginal swab specimens from women who tested positive for N. gonorrhoeae infection using a clinical diagnostic nucleic acid amplification test. We performed deep sequencing of 16S ribosomal RNA gene amplicons, followed by microbiome analyses with QIIME, and species-specific real-time PCR to assess the composition of microbial communities cohabitating the lower genital tract with the infecting N. gonorrhoeae. Specimens collected from asymptomatic individuals with N. gonorrhoeae infection and no co-infection with Chlamydia trachomatis and/or Trichomonas vaginalis carried Lactobacillus-dominant microbial communities more frequently than symptomatic patients without co-infection. When compared to asymptomatic individuals, symptomatic women had microbial communities characterized by more diverse and heterogenous bacterial taxa, typically associated with bacterial vaginosis (BV) [Prevotella, Sneathia, Mycoplasma hominis, and Bacterial Vaginosis-Associated Bacterium-1 (BVAB1)/"Candidatus Lachnocurva vaginae"]. Both symptomatic and asymptomatic N. gonorrhoeae patients with additional STI co-infection displayed a BV-like microbial community. These findings suggest that Lactobacillus-dominant vaginal microbial community may protect individuals from developing symptoms during lower genital tract infection with N. gonorrhoeae.
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Affiliation(s)
- Angela Lovett
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Arlene C. Seña
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andrew N. Macintyre
- School of Medicine and Duke Human Vaccine Institute, Duke University, Durham, NC, United States
| | - Gregory D. Sempowski
- School of Medicine and Duke Human Vaccine Institute, Duke University, Durham, NC, United States
| | - Joseph A. Duncan
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andreea Waltmann
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States,*Correspondence: Andreea Waltmann,
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42
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Xiridou M, Heijne J, Adam P, Op de Coul E, Matser A, de Wit J, Wallinga J, van Benthem B. How the Disruption in Sexually Transmitted Infection Care Due to the COVID-19 Pandemic Could Lead to Increased Sexually Transmitted Infection Transmission Among Men Who Have Sex With Men in The Netherlands: A Mathematical Modeling Study. Sex Transm Dis 2022; 49:145-153. [PMID: 34475357 DOI: 10.1097/olq.0000000000001551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, the disruption in care for sexually transmitted infections (STIs) and the social distancing measures have led to reductions in STI testing and sexual behavior. We assessed the impact of these COVID-19-related changes on transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among men who have sex with men (MSM) in The Netherlands. METHODS We developed a mathematical model for CT and NG transmission among MSM, accounting for COVID-19-related changes in sexual behavior and testing in 2020 to 2021. Changes in 2020 were estimated from data from the Dutch COVID-19, Sex, and Intimacy Survey among MSM and the National Database of STI Clinics. Because of the lack of data for 2021, we examined several scenarios covering a range of changes. RESULTS A reduction of 10% and 40% in STI testing of symptomatic and asymptomatic, respectively, individuals with a 10% to 20% reduction in numbers of casual partners (according to partner status and activity level) during the second lockdown, resulted in a 2.4% increase in CT prevalence, but a 2.8% decline in NG prevalence in 2021. A 5% and 30% reduction in STI testing of symptomatic and asymptomatic, respectively, individuals with the same reduction in casual partners resulted in a 0.6% increase in CT prevalence and a 4.9% decrease in NG prevalence in 2021. CONCLUSIONS The disruption in STI care due to COVID-19 might have resulted in a small increase in CT prevalence, but a decrease in NG prevalence. Scaling up STI care is imperative to prevent increases in STI transmission.
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Affiliation(s)
- Maria Xiridou
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Janneke Heijne
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Eline Op de Coul
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | | | | | | | - Birgit van Benthem
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Vickram A, Dhama K, Thanigaivel S, Chakraborty S, Anbarasu K, Dey N, Karunakaran R. Strategies for successful designing of immunocontraceptive vaccines and recent updates in vaccine development against sexually transmitted infections - A Review. Saudi J Biol Sci 2022; 29:2033-2046. [PMID: 35531220 PMCID: PMC9073025 DOI: 10.1016/j.sjbs.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- A.S. Vickram
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Tamil Nadu, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh 243122, India
| | - S. Thanigaivel
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Tamil Nadu, India
| | - Sandip Chakraborty
- Department of Veterinary Microbiology, College of Veterinary Sciences &, Animal Husbandry, R.K.Nagar, West Tripura, Pin- 799008, India
| | - K. Anbarasu
- Department of Bioinformatics, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Tamil Nadu, India
| | - Nibedita Dey
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Tamil Nadu, India
| | - Rohini Karunakaran
- Unit of Biochemistry, Faculty of Medicine, AIMST University, Semeling, Bedong, Kedah, Malaysia
- Corresponding author.
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Hui BB, Padeniya TN, Rebuli N, Gray RT, Wood JG, Donovan B, Duan Q, Guy R, Hocking JS, Lahra MM, Lewis DA, Whiley DM, Regan DG, Seib KL. A gonococcal vaccine has the potential to rapidly reduce the incidence of Neisseria gonorrhoeae infection among urban men who have sex with men. J Infect Dis 2021; 225:983-993. [PMID: 34894134 PMCID: PMC8922007 DOI: 10.1093/infdis/jiab581] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background A gonococcal vaccine is urgently needed due to increasing gonorrhea incidence and emerging multidrug-resistant gonococcal strains worldwide. Men who have sex with men (MSM) have among the highest incidences of gonorrhea and may be a key target population for vaccination when available. Methods An individual-based, anatomical site-specific mathematical model was used to simulate Neisseria gonorrhoeae transmission in a population of 10 000 MSM. The impact of vaccination on gonorrhea prevalence was assessed. Results With a gonococcal vaccine of 100% or 50% protective efficacy, gonorrhea prevalence could be reduced by 94% or 62%, respectively, within 2 years if 30% of MSM are vaccinated on presentation for sexually transmitted infection (STI) testing. Elimination of gonorrhea is possible within 8 years with vaccines of ≥ 50% efficacy lasting 2 years, providing a booster vaccination is available every 3 years on average. A vaccine’s impact may be reduced if it is not effective at all anatomical sites. Conclusions Our study indicates that with a vaccine of modest efficacy and an immunization strategy that targets MSM presenting for STI screening, the prevalence of gonorrhea in this population could be rapidly and substantially reduced.
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Affiliation(s)
- Ben B Hui
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Nic Rebuli
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Richard T Gray
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - James G Wood
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Qibin Duan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Monica M Lahra
- Microbiology Department, New South Wales Health Pathology, The Prince of Wales Hospital, Randwick, NSW, Australia.,School of Medical Sciences, UNSW Sydney, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia.,Westmead Clinical School, Faculty of Health and Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia.,Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - David M Whiley
- Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - David G Regan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, QLD Australia
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45
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Hiyama Y, Takahashi S, Yasuda M. AAUS guideline for chlamydial urethritis. J Infect Chemother 2021; 28:142-145. [PMID: 34887176 DOI: 10.1016/j.jiac.2021.11.024] [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: 09/28/2021] [Revised: 11/22/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
Urogenital chlamydial infection is the most common sexually transmitted infection. Many cases of chlamydial infection are reported worldwide every year. Genital chlamydial infection in women can also cause obstetric issues, including infertility and miscarriage. For that purpose, appropriate care should be conducted with the latest knowledge. Only few guidelines come from Asian countries. The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding chlamydial urethritis. We have collected the feedback and updated the guidelines which is now submitted for consideration of publication. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for chlamydial urethritis.
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Affiliation(s)
- Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Japan; Department of Urology, Hakodate Goryoukaku Hospital, Japan.
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Japan
| | - Mitsuru Yasuda
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Japan
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46
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Khosropour CM, Dombrowski JC, Vojtech L, Patton DL, Campbell LA, Barbee LA, Franzi MC, Hybiske K. Rectal Chlamydia trachomatis Infection: A Narrative Review of the State of the Science and Research Priorities. Sex Transm Dis 2021; 48:e223-e227. [PMID: 34475361 PMCID: PMC8595876 DOI: 10.1097/olq.0000000000001549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chlamydia trachomatis (CT) is the most commonly reported infection in the United States. Most chlamydial research to date has focused on urogenital infection, but a growing body of research has demonstrated that rectal chlamydia is a relatively common infection among clinic-attending men and women. We know that most rectal CT infections are asymptomatic, but the health implications of these infections, particularly for women, are unclear. In addition, there are key knowledge gaps related to the epidemiologic parameters of rectal chlamydia, the routes of acquisition, the duration of infection, and the clinical significance of a positive rectal CT test result. This lack of information has led to a blind spot in the potential role of rectal chlamydia in sustaining high levels of CT transmission in the United States. Furthermore, recent findings from animal models suggest that the immune response generated from gastrointestinal chlamydial infection can protect against urogenital infection; however, it remains to be determined whether rectal chlamydia similarly modulates anti-CT immunity in humans. This is a critical question in the context of ongoing efforts to develop a CT vaccine. In this narrative review, we summarize the state of the science for rectal chlamydia and discuss the key outstanding questions and research priorities in this neglected area of sexual health research.
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Affiliation(s)
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Lucia Vojtech
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Dorothy L. Patton
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Lee Ann Campbell
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | | | - Kevin Hybiske
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Microbiology, University of Washington, Seattle, WA, USA
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47
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Chen JS, Levintow SN, Tran HV, Sripaipan T, Nguyen MX, Nguyen SM, Miller WC, Go VF, Giang LM. HIV and STI prevalence and testing history among men who have sex with men in Hanoi, Vietnam. Int J STD AIDS 2021; 33:193-201. [PMID: 34852691 DOI: 10.1177/09564624211060185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND HIV and other sexually transmitted infections (STIs) have disproportionately affected communities of men who have sex with men (MSM). We describe HIV and STI prevalence and testing patterns among urban Vietnamese MSM. METHODS We conducted a cross-sectional community-based study of MSM in Hanoi, Vietnam in 2016. Participants self-reported experiences of social stigma in healthcare settings and previous HIV and STI testing. STI testing included HIV, herpes simplex virus-2 (HSV-2), syphilis, gonorrhea, and chlamydia. RESULTS 205 MSM participated in the study. STI prevalence was HIV (10%), HSV-2 (4%), syphilis (13%), gonorrhea (34%), and chlamydia (19%). More than half (55%) of participants tested positive for at least one STI. Most participants had been previously tested for HIV or another STI (72%), with 24% previously receiving a positive result. Perceived and enacted social stigma in healthcare contexts was negatively associated with previous HIV or STI testing (adjusted prevalence odds ratio (aPOR): 0.22; 95% confidence interval (CI): 0.10-0.48). DISCUSSION High prevalence of STIs was observed among Vietnamese MSM, and perceived and enacted stigma was related to HIV and STI testing. Our findings reaffirm the importance of regular STI screening among this population as well as additional outreach to promote safe HIV and STI healthcare engagement.
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Affiliation(s)
- Jane S Chen
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara N Levintow
- Department of Epidemiology, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ha V Tran
- Department of Health Behavior, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Teerada Sripaipan
- Department of Health Behavior, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Minh X Nguyen
- Department of Health Behavior, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sang M Nguyen
- Division of Epidemiology, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - William C Miller
- Department of Epidemiology, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Epidemiology, 51113College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Vivian F Go
- Department of Health Behavior, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Le Minh Giang
- Center for Research and Training on HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
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Moreira JS, Vasconcelos R, Doi AM, Avelino-Silva VI. Real-life occurrence of bacterial sexually transmitted infections among PrEP users: improving the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae with multisite screening. Rev Inst Med Trop Sao Paulo 2021; 63:e76. [PMID: 34755815 PMCID: PMC8580482 DOI: 10.1590/s1678-9946202163076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
PrEP users are under high risk for bacterial sexually transmitted infections
(STI), including those caused by Treponema pallidum (Tp),
Chlamydia trachomatis (Ct) and Neisseria
gonorrhoeae (Ng). Ct and Ng screening at multiple anatomic sites
may improve the diagnostic sensitivity among high-risk populations. We analyzed
the prevalence and incidence of Ct, Ng, and Tp and investigated predictors of
bacterial STI occurrence between January 2018 and November 2019 in a
retrospective cohort of PrEP users in Sao Paulo, Brazil. We describe the
frequency and percentage of Ct/Ng per anatomical site and calculate the
percentage of missed diagnosis if molecular testing were applied only in
symptomatic patients, or only in urine samples. Patients underwent syphilis
testing every 3-4 months and Ct/Ng testing every 6 months. We included 413 PrEP
users with a median age of 31 years. At baseline, 25% had a positive treponemal
test and 7% had active syphilis; Ct and Ng were more frequently detected in the
oropharynx and anus (6.4-6.9%) than in urine samples (0.7-2.6%). Twelve months
after the onset of PrEP, the incidence of Tp, Ct and Ng was, respectively,
13.4%, 11.4% and 8.9%. During follow-up, 23 out of 33 Ct/Ng cases (69%, 95% CI
51-84) would have been missed if oropharynx and anus samples had not been
tested. In addition, if only symptomatic cases had been tested, 30 out of 33
Ct/Ng cases (90%, 95% CI 75-98) would have been missed. Participants with
incident STI had a higher baseline number of sexual partners and a longer
follow-up. Our study reinforces that active and frequent screening for STI is a
powerful strategy to improve the diagnostic sensitivity.
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Affiliation(s)
- Jorge Salomão Moreira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Ricardo Vasconcelos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - André Mario Doi
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Escola de Medicina, São Paulo, São Paulo, Brazil
| | - Vivian Iida Avelino-Silva
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein, Escola de Medicina, São Paulo, São Paulo, Brazil
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49
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Diagnostic tests for detecting Chlamydia trachomatis and Neisseria gonorrhoeae in rectal and pharyngeal specimens. J Clin Microbiol 2021; 60:e0021121. [PMID: 34731021 DOI: 10.1128/jcm.00211-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae are two of the most often reported bacterial infections in the United States. The rectum and oropharynx are important anatomic sites of infection and can contribute to ongoing transmission. Nucleic acid amplification tests (NAATs) are the mainstays for the detection of C. trachomatis and N. gonorrhoeae infections owing to their high sensitivity and specificity. Several NAATs have been evaluated for testing in rectal and pharyngeal infections. A few assays recently received clearance by the Food and Drug Administration, including one point-of-care test. Those assays can be used for testing in symptomatic individuals, as well as for asymptomatic screening in certain patient populations. Routine screening for C. trachomatis in pharyngeal specimens is not recommended by the Centers for Disease Control and Prevention, though is often performed due to the use of multiplex assays. While expanding the types of settings for screening and using self-collected rectal and pharyngeal specimens can help to increase access and uptake of testing, additional research is needed to determine the potential benefits and costs associated with increased screening for rectal and pharyngeal C. trachomatis and N. gonorrhoeae infections on a population level.
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Multicenter comparison of nucleic acid amplification tests for the diagnosis of rectal and oropharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae infection. J Clin Microbiol 2021; 60:e0136321. [PMID: 34731020 PMCID: PMC8769746 DOI: 10.1128/jcm.01363-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Research using nucleic acid amplification tests (NAATs) have repeatedly found rectal and oropharyngeal infections with Chlamydia trachomatis and Neisseria gonorrhoeae to be common and potentially more difficult to treat than genital infections. Unfortunately, public health and patient care efforts have been hampered by the lack of FDA-cleared NAATs with claims for anorectal or oropharyngeal samples. At the time of the initiation of this study, no commercially available assays had these claims. We formed a novel partnership among academic institutions and diagnostic manufacturers to address this public health need. From May 2018 through August 2019 we recruited 1108 women, 1256 men and 26 transgender persons each of whom provided 3 anal and 3 oropharyngeal swab specimens. The 3 anal swabs were pooled into a single transport tube as were the 3 oropharyngeal swabs. The performance of each of three study assays was estimated by comparison to the composite result and relative to one another. Percent positivity for chlamydia was 5.9 and 1.2% from anal and oropharyngeal specimens, respectively compared to 4.2 and 4.1% for gonorrhea. Sensitivity for chlamydia detection ranged from 81.0-95.1% and 82.8-100% for anal and oropharyngeal specimens, respectively. Gonorrhea sensitivity ranged from 85.9-99.0% and 74.0-100% for anal and oropharyngeal samples, respectively. Specificity estimates were ≥ 98.9% for all assays, organisms and sample types. Although there was heterogeneity between sensitivity estimates, these assays offer better ability to detect extra genital infections than culture and potential solutions for providing appropriate sexual healthcare for populations in which these infections are of concern.
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