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Wong A, Applegate T, Boettiger DC, Varma R, Guy R, Medland N. Unnecessary antibiotic use in men who have sex with men (MSM) with anogenital symptoms attending a sexual health clinic: a retrospective analysis. Sex Transm Infect 2024:sextrans-2024-056120. [PMID: 38871452 DOI: 10.1136/sextrans-2024-056120] [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: 01/28/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES To quantify the amount of unnecessary antibiotics, in particular ceftriaxone, given to men who have sex with men (MSM) with anogenital symptoms as part of presumptive management in an urban sexual health clinic and examine factors associated with unnecessary ceftriaxone. METHODS This is a retrospective cross-sectional analysis of electronic records from all visits involving MSM reporting symptoms of bacterial sexually transmitted infection (STI) and who received presumptive antibiotics at Sydney Sexual Health Centre. The following variables were extracted: demographic and sexual behaviour data, presenting symptoms, prior STI diagnoses, use of anoscopy, use of point-of-care microscopy, prescriptions of antibiotics and subsequent nucleic acid amplification testing (NAAT) results for chlamydia and gonorrhoea in all anatomical sites (urethra, pharynx and rectum). We defined unnecessary antibiotic as an agent prescribed to treat an STI organism that was subsequently not detected. RESULTS Among 1061 visits in this analysis, 41.8% yielded negative NAAT results for both chlamydia and gonorrhoea in all anatomical sites. There were 44.3% of visits which had positive gonorrhoea NAAT result in at least one anatomical site. There were 187 courses of ceftriaxone prescribed in patients who tested negative for gonorrhoea in all anatomical sites and therefore were unnecessary. Unnecessary ceftriaxone prescribing occurred in 50.2% of visits with anorectal symptoms, 19.6% of scrotal symptoms and 7.3% of urethral symptoms. Microscopy was associated with significantly less unnecessary ceftriaxone in urethral but not anorectal or scrotal presentations. In multivariable analysis, the following factors were associated with a higher likelihood of unnecessary ceftriaxone use: anorectal symptoms, scrotal symptoms, gonorrhoea in the preceding year, contact of a bacterial STI and living with HIV. CONCLUSIONS This study highlights the significant amount of unnecessary ceftriaxone used for STI symptoms in MSM. A new pathway incorporating rapid point-of-care molecular testing in symptomatic patients may improve the precision of antibiotic prescribing and reduce unnecessary use.
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Affiliation(s)
- Arthur Wong
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
- The Kirby Institute, Kensington, New South Wales, Australia
| | | | | | - Rick Varma
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
- The Kirby Institute, Kensington, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, Kensington, New South Wales, Australia
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Tolley A, Bansal A, Murerwa R, Howard Dicks J. Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review. J Antimicrob Chemother 2024; 79:1248-1269. [PMID: 38498622 PMCID: PMC11144491 DOI: 10.1093/jac/dkae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a major threat to global health. By 2050, it is forecast that AMR will cause 10 million deaths and cost 100 trillion USD annually. Point-of-care tests (POCTs) may represent a cost-effective approach to reduce AMR. OBJECTIVES We systematically reviewed which POCTs addressing AMR have undergone economic evaluation in primary and secondary healthcare globally, how these POCTs have been economically evaluated, and which are cost-effective in reducing antimicrobial prescribing or the burden of AMR. Clinical cost-effectiveness was additionally addressed. METHODS This systematic review, accordant with PRISMA guidelines, was pre-registered on PROSPERO (CRD42022315192). MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar were searched from 2000 to 2023 for relevant publications. Quality assessment was performed using the Consensus of Health Economic Criteria. RESULTS The search strategy identified 1421 studies, of which 20 met the inclusion criteria. The most common POCTs assessed were for respiratory infections (n = 10), STIs (n = 3), and febrile patients in low- and middle-income countries (n = 3). All studies assessed costs from a healthcare provider perspective; five additionally considered the societal cost of AMR.Eighteen studies identified POCT strategies that reduced antimicrobial prescribing. Of these, 10 identified POCTs that would be considered cost-effective at a willingness-to-pay (WTP) threshold of £33.80 per antibiotic prescription avoided. Most POCT strategies improved clinical outcomes (n = 14); the remainder were clinically neutral. CONCLUSIONS There is evidence that some POCTs are cost-effective in reducing antimicrobial prescribing, with potential concomitant clinical benefits. Such interventions-especially CRP POCTs in both high- and low-income settings-merit further, large-scale clinical evaluation.
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Affiliation(s)
- Abraham Tolley
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Akhil Bansal
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Internal Medicine, St Vincent’s Hospital, Sydney, Australia
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Colón Pérez J, Villarino Fernández RA, Domínguez Lago A, Treviño Castellano MM, Pérez del Molino Bernal ML, Sánchez Poza S, Torres-Sangiao E. Addressing Sexually Transmitted Infections Due to Neisseria gonorrhoeae in the Present and Future. Microorganisms 2024; 12:884. [PMID: 38792714 PMCID: PMC11124187 DOI: 10.3390/microorganisms12050884] [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: 03/19/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
It was in the 1800s when the first public publications about the infection and treatment of gonorrhoea were released. However, the first prevention programmes were only published a hundred years later. In the 1940s, the concept of vaccination was introduced into clinical prevention programmes to address early sulphonamide resistance. Since then, tons of publications on Neisseria gonorrhoeae are undisputed, around 30,000 publications today. Currently, the situation seems to be just as it was in the last century, nothing has changed or improved. So, what are we doing wrong? And more importantly, what might we do? The review presented here aims to review the current situation regarding the resistance mechanisms, prevention programmes, treatments, and vaccines, with the challenge of better understanding this special pathogen. The authors have reviewed the last five years of advancements, knowledge, and perspectives for addressing the Neisseria gonorrhoeae issue, focusing on new therapeutic alternatives.
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Affiliation(s)
- Julia Colón Pérez
- Servicio de Microbiología y Parasitología Clínica, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain; (J.C.P.); (A.D.L.); (M.M.T.C.); (M.L.P.d.M.B.)
- Grupo Microbiología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Rosa-Antía Villarino Fernández
- Departamento de Microbiología, Facultad de Farmacia, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Adrián Domínguez Lago
- Servicio de Microbiología y Parasitología Clínica, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain; (J.C.P.); (A.D.L.); (M.M.T.C.); (M.L.P.d.M.B.)
- Grupo Microbiología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - María Mercedes Treviño Castellano
- Servicio de Microbiología y Parasitología Clínica, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain; (J.C.P.); (A.D.L.); (M.M.T.C.); (M.L.P.d.M.B.)
- Grupo Microbiología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - María Luisa Pérez del Molino Bernal
- Servicio de Microbiología y Parasitología Clínica, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain; (J.C.P.); (A.D.L.); (M.M.T.C.); (M.L.P.d.M.B.)
- Grupo Microbiología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Sandra Sánchez Poza
- Departamento de Microbiología, Facultad de Farmacia, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Eva Torres-Sangiao
- Servicio de Microbiología y Parasitología Clínica, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain; (J.C.P.); (A.D.L.); (M.M.T.C.); (M.L.P.d.M.B.)
- Grupo Microbiología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
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Ha SM, Lin EY, Klausner JD, Adamson PC. Machine learning to predict ceftriaxone resistance using single nucleotide polymorphisms within a global database of Neisseria gonorrhoeae genomes. Microbiol Spectr 2023; 11:e0170323. [PMID: 37905924 PMCID: PMC10714741 DOI: 10.1128/spectrum.01703-23] [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: 05/03/2023] [Accepted: 09/15/2023] [Indexed: 11/02/2023] Open
Abstract
IMPORTANCE Antimicrobial resistance in Neisseria gonorrhoeae is an urgent global health issue. The objectives of the study were to use a global collection of 12,936 N. gonorrhoeae genomes from the PathogenWatch database to evaluate different machine learning models to predict ceftriaxone susceptibility/decreased susceptibility using 97 mutations known to be associated with ceftriaxone resistance. We found the random forest classifier model had the highest performance. The analysis also reported the relative contributions of different mutations within the ML model predictions, allowing for the identification of the mutations with the highest importance for ceftriaxone resistance. A machine learning model retrained with the top five mutations performed similarly to the model using all 97 mutations. These results could aid in the development of molecular tests to detect resistance to ceftriaxone in N. gonorrhoeae. Moreover, this approach could be applied to building and evaluating machine learning models for predicting antimicrobial resistance in other pathogens.
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Affiliation(s)
- Sung Min Ha
- Department of Integrative Biology and Physiology, UCLA, Los Angeles, California, USA
| | - Eric Y. Lin
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeffrey D. Klausner
- Departments of Population and Public Health Sciences and Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Paul C. Adamson
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Nadal-Barón P, Trejo-Zahinos J, García JN, Salmerón P, Sulleiro E, Arando M, Descalzo V, Álvarez-Lopez P, El Ouazzani R, López L, Zarzuela F, Ruiz E, Llinas M, Blanco-Grau A, Curran A, Larrosa MN, Pumarola T, Hoyos-Mallecot Y. Impact of time of culture specimen collection on the recovery of Neisseria gonorrhoeae after a positive nucleic acid amplification test. Sex Transm Infect 2023; 99:520-526. [PMID: 37802652 DOI: 10.1136/sextrans-2023-055899] [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: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVES Culture of Neisseria gonorrhoeae remains essential for antimicrobial resistance (AMR) surveillance. We evaluated the effect of time of specimen collection on culture yield following a positive nucleic acid amplification test (NAAT). METHODS We retrospectively assessed N. gonorrhoeae culture yield among asymptomatic individuals (largely men who have sex with men) who attended for sexual health screening and had a positive NAAT. Participants underwent either same-day testing and notification (Drassanes Exprés) or standard screening with deferred testing. RESULTS Among 10 423 screened individuals, 809 (7.7%) tested positive for N. gonorrhoeae. A total of 995 different anatomical sites of infection culture was performed in 583 of 995 (58.6%) of anatomical sites (Drassanes Exprés 278 of 347, 80.1%; standard screening 305 of 648, 47.1%; p<0.001). Recovery was highest when culture specimens were collected within 3-7 days of screening with only a slight drop in recovery when the interval extended to 7 days . Recovery from pharynx was 38 of 149 (25.5%) within 3 days, 19 of 81 (23.4%) after 4-7 days (p=0.7245), 11 of 102 (10.7%) after 8-14 days (p<0.0036) and 1 of 22 (4.5%) with longer delays (p=0.00287). Recovery from rectum was 49 of 75 (65.3%) within 3 days, 28 of 45 (62.2%) after 4-7 days (p=0.7318), 41 of 69 (59.4%) after 8-14 days (p=0.4651) and 6 of 18 (33.3%) with longer delays (p=0.0131). Median culture specimen collection time was 1 day within Drassanes Exprés vs 8 days within standard screening. Consequently, the overall culture yield was slightly higher within Drassanes Exprés (102/278, 36.6% vs 99/305, 32.5%; p=0.2934). CONCLUSION Reducing the interval between screening and collection of culture specimens increased N. gonorrhoeae recovery in extragenital samples. Implementing a same-day testing and notification programme increased collection of culture samples and culture yield in our setting, which may help AMR surveillance.
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Affiliation(s)
- Patricia Nadal-Barón
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Trejo-Zahinos
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Nestor García
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Paula Salmerón
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maider Arando
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Vicente Descalzo
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Patricia Álvarez-Lopez
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rachid El Ouazzani
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis López
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Francesc Zarzuela
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Edurne Ruiz
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Montserrat Llinas
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Albert Blanco-Grau
- Department of Clinical Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Adrian Curran
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institute for Research, Barcelona, Spain
| | - María Nieves Larrosa
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Tomàs Pumarola
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yannick Hoyos-Mallecot
- Department of Microbiology and Parasitology, Vall d'Hebron University Hospital, Barcelona, Spain
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Mensah E, Fourie PB, Peters RPH. Antimicrobial effects of Medicines for Malaria Venture Pathogen Box compounds on strains of Neisseria gonorrhoeae. Antimicrob Agents Chemother 2023; 67:e0034823. [PMID: 37791750 PMCID: PMC10648949 DOI: 10.1128/aac.00348-23] [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: 03/16/2023] [Accepted: 08/02/2023] [Indexed: 10/05/2023] Open
Abstract
Therapeutic options for Neisseria gonorrhoeae are limited due to emerging global resistance. New agents and treatment options to treat patients with susceptible and multi-extensively drug-resistant N. gonorrhoeae is a high priority. This study used an in vitro approach to explore the antimicrobial potential, as well as synergistic effects of Medicine for Malaria Venture (MMV) Pathogen Box compounds against ATCC and clinical N. gonorrhoeae strains. Microbroth dilution assay was used to determine pathogen-specific minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the Pathogen Box compounds against susceptible and resistant N. gonorrhoeae strains, with modification, by adding PrestoBlue HS Cell Viability Reagent. A checkerboard assay was used to determine synergy between the active compounds and in conjunction with ceftriaxone. Time-kill kinetics was performed to determine if the compounds were either bactericidal or bacteriostatic. The Pathogen Box compounds: MMV676501, MMV002817, MMV688327, MMV688508, MMV024937, MMV687798 (levofloxacin), MMV021013, and MMV688978 (auranofin) showed potent activity against resistant strains of N. gonorrhoeae at an MIC and MBC of ≤10 µM. Besides the eight compounds, MMV676388 and MMV272144 were active against susceptible N. gonorrhoeae strains, also at MIC and MBC of ≤10 µM. All the compounds were bactericidal and were either synergistic or additive with fractional inhibitory concentration index ranging between 0.40 and 1.8. The study identified novel Pathogen Box compounds with potent activity against N. gonorrhoeae strains and has the potential to be further investigated as primary or adjunctive therapy to treat gonococcal infections.
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Affiliation(s)
- Eric Mensah
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - P. Bernard Fourie
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Remco P. H. Peters
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Foundation for Professional Development, Research Unit, East London, South Africa
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Mitjà O, Suñer C, Giacani L, Vall-Mayans M, Tiplica GS, Ross JD, Bradshaw CS. Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100737. [PMID: 37927440 PMCID: PMC10625009 DOI: 10.1016/j.lanepe.2023.100737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.
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Affiliation(s)
- Oriol Mitjà
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Suñer
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorenzo Giacani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Martí Vall-Mayans
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
| | - George-Sorin Tiplica
- Dermatology 2, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Jonathan D.C. Ross
- Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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8
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Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based assays for Neisseria gonorrhoeae detection and gyrase A determination. mSphere 2023; 8:e0041623. [PMID: 37732792 PMCID: PMC10597441 DOI: 10.1128/msphere.00416-23] [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: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/22/2023] Open
Abstract
Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, the diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where the prevalence of infection is highest. Recent advances in molecular diagnostics, such as specific high-sensitivity enzymatic reporter unlocking (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. We designed and optimized RNA guides and primer sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the porA gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A (gyrA) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For porA, we created both a fluorescence-based assay and lateral flow assay using a biotinylated fluorescein reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyrA, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyrA genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates. IMPORTANCE Neisseria gonorrhoeae, the cause of gonorrhea, disproportionately affects resource-limited settings. Such areas, however, lack the technical capabilities for diagnosing the infection. The consequences of poor or absent diagnostics include increased disease morbidity, which, for gonorrhea, includes an increased risk for HIV infection, infertility, and neonatal blindness, as well as an overuse of antibiotics that contributes to the emergence of antibiotic resistance. We used a novel CRISPR-based technology to develop a rapid test that does not require laboratory infrastructure for both diagnosing gonorrhea and predicting whether ciprofloxacin can be used in its treatment, a one-time oral pill. With further development, that diagnostic test may be of use in low-resource settings.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Goldstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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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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10
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Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based Assays for Neisseria gonorrhoeae Detection and Gyrase A Determination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.21.23290304. [PMID: 37293004 PMCID: PMC10246164 DOI: 10.1101/2023.05.21.23290304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where prevalence is highest. Recent advances in molecular diagnostics, such as Specific High-sensitivity Enzymatic Reporter unLOCKing (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. Methods and Results We designed and optimized RNA guides and primer-sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the por A gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A ( gyr A) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For por A, we created both a fluorescence-based assay and lateral flow assay using a biotinylated FAM reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyr A, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyr A genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. Conclusion We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert Goldstein
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
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Hansman E, Klausner JD. Approach to Managing Sex Partners of People with Sexually Transmitted Infections. Infect Dis Clin North Am 2023; 37:405-426. [PMID: 36931992 DOI: 10.1016/j.idc.2023.02.003] [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: 03/17/2023]
Abstract
Partner management of sexually transmitted infection (STIs) is essential to identify and treat new cases, prevent reinfection in the index case, interrupt chains of transmission, reduce STI-related morbidity, and target STI screening and treatment interventions. The responsibility for partner notification and treatment falls on the health care provider. Approaches to partner management include patient referral, provider referral, contractual referral, and expedited partner therapy (EPT), with EPT and enhanced partner referral outperforming other methods. This article provides an overview of clinical recommendations regarding partner management, with particular emphasis on EPT, and an update on new and emerging evidence in the field.
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Affiliation(s)
- Emily Hansman
- David Geffen School of Medicine University of California Los Angeles, Los Angeles, CA, USA.
| | - Jeffrey D Klausner
- University of Southern California Keck School of Medicine, 1845 North Soto Street, Health Sciences Campus, Los Angeles, CA 90032, USA
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12
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Yang KJ, Kojima N, Bristow CC, Klausner JD. Effectiveness of Cefixime for the Treatment of Neisseria gonorrhoeae Infection at 3 Anatomic Sites: A Systematic Review and Meta-Analysis. Sex Transm Dis 2023; 50:131-137. [PMID: 36729626 PMCID: PMC9906985 DOI: 10.1097/olq.0000000000001742] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/05/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND To treat Neisseria gonorrhoeae infection, the Centers for Disease Control and Prevention recommends a single oral dose of cefixime as an alternative to injectable ceftriaxone. METHODS We conducted a systematic review and meta-analysis to describe the effectiveness of cefixime in treating N. gonorrhoeae infection at 3 different anatomic sites.We searched PubMed and Embase database to abstract treatment success rates and cefixime dosage/frequency for studies that reported the anatomical site of infection. We included reports published between January 1, 1980, and December 7, 2021. Twenty studies published between 1989 and 2015 were included in our meta-analysis. We calculated pooled treatment success percentages and 95% confidence intervals (CIs) using random-effects models. RESULTS Of patients who received a 400-mg single dose of cefixime, 824 of 846 (97%; 95% CI, 96%-98%) patients with urogenital infection, 107 of 112 (97%; 95% CI, 84%-100%) patients with rectal infection, and 202 of 242 (89%; 95% CI, 76%-96%) patients with pharyngeal infection were cured. Of patients who received an 800-mg single dose of cefixime, 295 of 301 (98%; 95% CI, 96%-99%) patients with urogenital infection and 21 of 26 (81%; 95% CI, 61%-92%) patients with pharyngeal infection were cured. CONCLUSIONS Our meta-analysis found that cefixime is highly effective at treating urogenital infections and less effective at treating pharyngeal infections. We recommend more investigation into the effectiveness of cefixime in treating rectal infections and studying multidose therapy for the cefixime treatment of pharyngeal infection.
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Affiliation(s)
- Kevin J. Yang
- From the Keck School of Medicine, University of Southern California
| | - Noah Kojima
- Department of Medicine, University of California Los Angeles, Los Angeles
| | - Claire C. Bristow
- Department of Medicine, University of California San Diego, San Diego
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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13
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Antibiotic Resistance in Neisseria gonorrhoeae: Challenges in Research and Treatment. Microorganisms 2022; 10:microorganisms10091699. [PMID: 36144300 PMCID: PMC9505656 DOI: 10.3390/microorganisms10091699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Gonococcal infection caused by the Gram-negative bacteria Neisseria gonorrhoeae is one of the most common sexually transmitted infections (STIs) worldwide [...]
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