1
|
Rossignol L, Feuillepain L, Ndeikoundam Ngangro N, Souty C, Fournet N, Le Strat Y, Baroux N, Hanslik T, Lot F, Blanchon T. Estimate of male urethritis incidences in France between 2007 and 2017 with a specific focus on Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infections. BMC Infect Dis 2019; 19:561. [PMID: 31248368 PMCID: PMC6598258 DOI: 10.1186/s12879-019-4202-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 06/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In a context of increasing use of Nucleic Acid Amplification Test, diagnoses of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men increased in Europe and USA since 2007. We aimed to describe trends in the incidence of male urethritis in France between 2007 and 2017. METHODS We analysed male urethritis clinical cases reported by the French GPs' Sentinelles network. RESULTS GPs reported 1944 cases of male urethritis during the study period. The estimated annual incidence rates in men aged 15 years and older remained stable between 226 cases per 100,000 seen in 2007 and 196 in 2017 (P value = 0.9). A third-generation cephalosporin with macrolide or tetracycline was prescribed in 17.5% of cases in 2009 (27/154) and 32.4% in 2017 (47/145) (P value = 0.0327). CONCLUSIONS The incidence rates for adult male urethritis diagnosed in primary care have remained stable since 2007 in France in contrast with the increasing trend of Neisseria gonorrhoeae and Chlamydia trachomatis infections based on microbiological surveillance. Using stable clinical definition for male urethritis seems essential to follow correctly epidemiological dynamic.
Collapse
Affiliation(s)
- Louise Rossignol
- Réseau Sentinelles, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), UMR S 1136 Inserm Sorbonne Université, Faculté de médecine Sorbonne Université - site Saint Antoine, 27 rue Chaligny, 75571, cedex 12 Paris, France
| | - Laurianne Feuillepain
- Réseau Sentinelles, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), UMR S 1136 Inserm Sorbonne Université, Faculté de médecine Sorbonne Université - site Saint Antoine, 27 rue Chaligny, 75571, cedex 12 Paris, France
| | | | - Cécile Souty
- Réseau Sentinelles, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), UMR S 1136 Inserm Sorbonne Université, Faculté de médecine Sorbonne Université - site Saint Antoine, 27 rue Chaligny, 75571, cedex 12 Paris, France
| | - Nelly Fournet
- Infectious Diseases Division, Santé publique France, F-954415 Saint-Maurice, France
| | - Yann Le Strat
- Data Science Division, Santé publique France, F-954415 Saint-Maurice, France
| | - Noémie Baroux
- Réseau Sentinelles, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), UMR S 1136 Inserm Sorbonne Université, Faculté de médecine Sorbonne Université - site Saint Antoine, 27 rue Chaligny, 75571, cedex 12 Paris, France
| | - Thomas Hanslik
- Réseau Sentinelles, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), UMR S 1136 Inserm Sorbonne Université, Faculté de médecine Sorbonne Université - site Saint Antoine, 27 rue Chaligny, 75571, cedex 12 Paris, France
- Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine, FR-78000 Versailles, France
- Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique - Hôpitaux de Paris, APHP, FR-92100, Boulogne Billancourt, France
| | - Florence Lot
- Infectious Diseases Division, Santé publique France, F-954415 Saint-Maurice, France
| | - Thierry Blanchon
- Réseau Sentinelles, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), UMR S 1136 Inserm Sorbonne Université, Faculté de médecine Sorbonne Université - site Saint Antoine, 27 rue Chaligny, 75571, cedex 12 Paris, France
| |
Collapse
|
2
|
Pal S, Sarcon AK, de la Maza LM. A new murine model for testing vaccines against genital Chlamydia trachomatis infections in males. Vaccine 2010; 28:7606-12. [PMID: 20920574 DOI: 10.1016/j.vaccine.2010.09.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 09/15/2010] [Accepted: 09/19/2010] [Indexed: 10/19/2022]
Abstract
Two groups of 50 BALB/c male mice were immunized with live Chlamydia trachomatis mouse pneumonitis (MoPn) using the intranasal (i.n.) or the meatus urethra (intraurethral: i.u.) routes. As a control group, 100 male mice were sham-immunized in parallel. Both groups of animals vaccinated with live organisms developed strong Chlamydia-specific humoral and cell mediated immune responses. Based on the IgG2a/IgG1 ratio and the levels of IFN-γ both groups mounted a Th1 immune response. At six weeks following the immunization, all mice were challenged in the meatus urethra. The urethra, urinary bladder, testes and epididymides were harvested at weekly intervals and tested for the presence of C. trachomatis. Based on the culture results from these four organs both groups of Chlamydia-immunized mice showed significant protection. In the group immunized i.u., 10% (5/50) had positive cultures, while in the group immunized i.n. 28% (14/50) had positive cultures during the 5 weeks of observation. In contrast, in the sham-immunized animals 47% (47/100) had positive cultures (P<0.005) during the study period. In addition, the number of positive organs, the length of time that the animal had positive cultures, and the total number of inclusion forming units (IFU) recovered were overall significantly lower in the i.u. or i.n. groups in comparison with the sham-immunized animals. However, in relation to the i.u. immunized group, the protection elicited in the i.n. group was delayed and not as robust. In conclusion, immunization of mice in the meatus urethra may provide the gold standard for testing Chlamydia vaccines in a male model.
Collapse
Affiliation(s)
- Sukumar Pal
- Department of Pathology and Laboratory Medicine, Medical Sciences, Room D440, University of California, Irvine, Irvine, CA 92697-4800, USA
| | | | | |
Collapse
|
3
|
Massari V, Viboud C, Dorléans Y, Flahault A. Decline in HCV testing and compliance with guidelines in patients of Sentinelles general practitioners, 1996–2002. Eur J Epidemiol 2006; 21:397-405. [PMID: 16715351 DOI: 10.1007/s10654-006-9011-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
Between 1996 and 2002, the French Sentinelles Network observed a more than 2-fold decline in the annual rate of hepatitis C virus (HCV) screening tests prescribed by general practitioners. During this period it droped from 1080 to 450 per 100,000 inhabitants. The proportion of HCV-positives increased from 9.7% to 12.9% between 1996 and 1998 but declined steadily afterwards, reaching 7% in 2002. The majority of HCV-positive patients were men (57%), 38% were aged 30-39 years and 45% were injecting drug users. Two French guidelines for HCV screening were issued in 1997 and 2001. Of the 3462 patients with a known HCV test result, 27.4% were offered following the 1997 guidelines, among which 23.7% were HCV-positive. Of the same 3462 patients, 36.8% were offered following the extended definition of the risk group in the 2001 guidelines, among which 19.9% were positive. The percentage of subjects tested with no biological sign or clinical symptom and no HCV risk factor varies from 11% to 26% showing that SGPs carry out a targeted screening even if they deviate from the strict recommendations. Of the HCV-positive patients, 14% did not meet any criteria of the guidelines suggesting a lack of sensitivity in the current definition of patients recommended for testing.
Collapse
|
4
|
Massari V, Dorléans Y, Flahault A. Trends in voluntary HIV testing in general practices in France between 1987 and 2002. Eur J Epidemiol 2006; 20:543-7. [PMID: 16121764 DOI: 10.1007/s10654-005-4265-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To measure the level of voluntary HIV testing and to assess its changes in the French general population according to the evolution of HIV testing policies. METHODS When general practitioners belonging to the Sentinelles network (SGP) offer HIV testing to their patients, they send the network an anonymous description of the patient and a report of the test results. RESULTS The number of HIV tests peaked in 1993 at 1760 per 100,000 inhabitants. Since 1995 the rate has fallen slightly, from 1474 to 810 per 100,000 in 2002. Between 1987 and 2002 there was a significant fall in the proportion of persons with a history of STD (31.4-5.1%, p = 0.0001), clinical signs of HIV infection (9.1-4.5%, p = 0.0002) and a history of prior testing (19.3-13.6%, p = 0.0005). CONCLUSIONS Our results show that demand for HIV testing among the French general practice patient population has fallen since 1995, along with the frequency with which GPs offer HIV testing.
Collapse
|
5
|
Lowndes CM, Fenton KA. Surveillance systems for STIs in the European Union: facing a changing epidemiology. Sex Transm Infect 2004; 80:264-71. [PMID: 15295122 PMCID: PMC1744868 DOI: 10.1136/sti.2004.010389] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To characterise the nature, content, and performance characteristics of existing national STI surveillance systems in the European Union (EU) and Norway, to facilitate collection of comparable surveillance data. METHODS Cross sectional survey using a structured questionnaire. RESULTS Case reporting from clinicians and/or laboratories is the mainstay of EU surveillance systems for bacterial STIs. Coverage of case reporting varies from less than 10% to over 75%, and lack of and/or heterogeneity in case definitions affect the relative specificity and sensitivity of reporting systems. Considerable variations also exist in STI care sites; the populations who use these services; and in partner notification practices, STI screening practices, and STI laboratory diagnostic tests employed, affecting the representativeness of reported data and the sensitivity of surveillance systems for detecting the true number of STI cases. CONCLUSIONS The heterogeneity of current surveillance systems complicates direct comparison of STI incidence rates across Europe. Introduction of standardised case definitions for reporting, and increased coverage of mandatory reporting systems where necessary, are needed. Definition of standardised minimum datasets and use of sentinel and enhanced surveillance systems to supplement universal case/laboratory notification data, could improve our understanding of the distribution and determinants of STIs across Europe, and aid in the design of effective public health responses. In the context of the changing epidemiology of STIs, systems for detection and monitoring of localised outbreaks of acute bacterial STIs (syphilis and antimicrobial resistant gonorrhoea), as well as prevalence monitoring systems for frequently asymptomatic STIs (chlamydial infection and viral STIs), are also necessary.
Collapse
Affiliation(s)
- C M Lowndes
- Department of HIV and Sexually Transmitted Infections, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.
| | | |
Collapse
|
6
|
Pal S, Peterson EM, de la Maza LM. New murine model for the study of Chlamydia trachomatis genitourinary tract infections in males. Infect Immun 2004; 72:4210-6. [PMID: 15213165 PMCID: PMC427456 DOI: 10.1128/iai.72.7.4210-4216.2004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The lack of an experimental model has significantly limited the understanding of the pathogenesis of Chlamydia trachomatis infections in males. In an attempt to establish a model using the natural route of infection, we inoculated male mice in the meatus urethra. To establish the 50% infectious dose (ID(50)), C3H/HeN (H-2(k)) male mice were inoculated in the meatus urethra with doses ranging from 10(1) to 10(7) inclusion-forming units (IFU) of C. trachomatis mouse pneumonitis biovar (MoPn) and were euthanized at 10 days postinfection (p.i.). Approximately 50% of the animals inoculated with 5 x 10(4) IFU had positive cultures of the urethra, urinary bladder, epididymides, and/or testes. Subsequently, to characterize the course of the infection, a group of animals was inoculated with 10(6) IFU/mouse (20 times the ID(50)). Positive cultures from the urethra, urinary bladder, epididymides, and testes were obtained from the animals. The infection peaked in the first 2 weeks p.i. and subsequently declined over the 7 weeks of observation. C. trachomatis-specific antibodies were first detected in serum by 2 weeks p.i. and rose over the period of observation. The titers of immunoglobulin G2a (IgG2a) were 16-fold higher than those of IgG1. A lymphoproliferative assay using splenocytes and local lymph nodes showed a strong cell-mediated immune response. Levels of gamma interferon were significantly higher than those of interleukin-4 in the supernatants from stimulated lymphocytes. An acute inflammatory infiltrate consisting of polymorphonuclear leukocytes was detected in the urethra at 1 week p.i. At 3 weeks p.i., a mixed acute and chronic inflammatory infiltrate was observed in the urethra that by 5 to 6 weeks was mainly composed of mononuclear cells. Similar findings were also observed in the urinary bladder, although the inflammatory infiltrate was delayed by approximately a week relative to that in the urethra. Sections of the epididymides showed a focal acute inflammatory infiltrate at 2 weeks p.i. Immunohistochemical staining demonstrated multiple chlamydial inclusions in the epithelium of the urethra and urinary bladder. No chlamydial inclusions were observed in the epididymides or testes. In conclusion, inoculation of male mice in the meatus urethra with C. trachomatis MoPn results in an infection of the genitourinary tract that closely parallels that described in humans. This model should help to characterize the pathogenesis of chlamydial infections in males and to test therapeutic and preventive measures.
Collapse
Affiliation(s)
- Sukumar Pal
- Department of Pathology, Medical Sciences, Room D440, University of California-Irvine, Irvine, CA 92697-4800, USA
| | | | | |
Collapse
|
7
|
Abstract
OBJECTIVE The objectives of this study were to monitor epidemiologic trends in Neisseria gonorrhoeae (NG) infections and to assess antimicrobial resistance patterns of NG. METHODS RENAGO, a voluntary-based laboratory surveillance system, including private and public laboratories, was set up in France in 1986. Every NG strain isolated by the participating laboratories was sent to the National Reference Center, Institut Alfred Fournier, Paris, where susceptibility to 6 antibiotics was tested. These laboratories reported monthly numbers of positive NG isolates and associated epidemiologic data. Because the number of laboratories varied every year, the average number of NG isolates per laboratory per year was computed to monitor annual trends in gonorrhea incidence. RESULTS The average number of NG isolated per laboratory per year decreased steadily from 10.6 in 1986 to 0.6 in 1997 but then yearly increased and reached 1.9 in 2000. Increasing gonorrhea was observed mostly in men and in the Paris area. The proportion of rectal strains increased significantly from 0.9% in 1986 to 9.2% in 2000. From 1998 to 2000, 5.3% of the isolates had reduced susceptibility or were resistant to ciprofloxacin, 7.3% were PPNG strains and 27.4% were resistant to tetracycline, 18.5% had a reduced susceptibility to thiamphenicol, and 1 strain was resistant to the latter. Neither strain was resistant to ceftriaxone or to spectinomycin. CONCLUSION From 1998 to 2000, gonorrhea markedly increased in France and seemed to affect mainly gay men in Paris, which suggests relapses to risky sexual behaviors and highlights the need for strengthening prevention. During the same period, NG ciprofloxacin resistance has sharply increased and should be carefully monitored because of the wide use of ciprofloxacin single-dose treatment.
Collapse
Affiliation(s)
- Magid Herida
- Infectious Diseases Department, Institut de Veille Sanitaire, Saint-Maurice, France.
| | | | | |
Collapse
|