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Herrero M, Broner S, Cruells A, Esteve S, Ferré L, Mendioroz J, Jané M, Ciruela P. Epidemiology and antimicrobial resistance profile of Neisseria gonorrhoeae in Catalonia, Spain, 2016-2019. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04601-0. [PMID: 37162616 DOI: 10.1007/s10096-023-04601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Antimicrobial resistance data for Neisseria gonorrhoeae is globally sparse and resistant strains are emerging in Catalonia. We aim to describe epidemiological and antimicrobial resistance in all patients infected with N. gonorrhoeae during the period from 2016 to 2019, using available antimicrobial susceptibility data. We retrospectively analysed confirmed N. gonorrhoeae cases notified to Catalonia's microbiological reporting system. Antibiotic susceptibility testing (azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, spectinomycin, and tetracycline) was assessed using clinical breakpoints published by the European Committee on Antimicrobial Susceptibility Testing. Incidence rates were calculated and proportions were compared using the χ2 test or Fisher's exact test, and analysed using the Statistical Package for Social Sciences (SPSS 18.0). A total of 14,251 confirmed cases of N. gonorrhoeae were notified. Incidence increased from 30.7 cases/100,000 person-years (p < 0.001) in 2016 to 64.7 in 2019. Culture was available in 6,292 isolates (44.2%), of which 5,377 (85.5%) were resistant to at least one of the antibiotics tested. Azithromycin resistance rose from 6.1% in 2016 to 16% in 2019 (p < 0.001). Only 1.0% (45 cases) were resistant to ceftriaxone. Multidrug-resistant N. gonorrhoeae increased from 0.25% in 2016 to 0.42% in 2019 (p = 0.521). One case presented extensively drug-resistant N. gonorrhoeae. In Catalonia, 10% of the N. gonorrhoeae isolates were resistant to azithromycin in the 2016-2019 period. According to World Health Organization guidelines, resistance above 5% indicates an alert to review treatment guidelines. Antimicrobial susceptibility testing in clinical practice followed by surveillance and interventions are essential to monitor trends and prevent the spread of antimicrobial resistance.
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Affiliation(s)
- Mercè Herrero
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain.
| | - Sonia Broner
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Adrià Cruells
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Silvia Esteve
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Lourdes Ferré
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
| | - Jacobo Mendioroz
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
- Research Support Unit of Central Catalonia, Jordi Gol i Gurina University Research Institute for Primary Health Care, 08272, Sant Fruitós de Bages, Spain
| | - Mireia Jané
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Carlos III Health Institute, 28029, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- Subdirectorate General for Public Health Surveillance and Emergency Response, Catalan Public Health Agency, Government of Catalonia, 08005, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Carlos III Health Institute, 28029, Madrid, Spain
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Norris Turner A, Carter A, Tzeng YL, Stephens DS, Brown M, Snyder B, Retchless AC, Wang X, Bazan JA. Infection with the US Neisseria meningitidis urethritis clade does not lower future risk of urethral gonorrhea. Clin Infect Dis 2021; 74:2159-2165. [PMID: 34543381 DOI: 10.1093/cid/ciab824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cross-protective immunity between Neisseria meninigitidis (Nm) and Neisseria gonorrhoeae (Ng) may inform gonococcal vaccine development. Meningococcal serogroup B (MenB) outer membrane vesicle (OMV) vaccines confer modest protection against gonorrhea. However, whether urethral Nm infection protects against gonorrhea is unknown. We examined gonorrhea risk among men with US Nm urethritis clade (US_NmUC) infections. METHODS We conducted a retrospective cohort study of men with urethral US_NmUC (N=128) between January 2015 and April 2018. Using diagnosis date as the baseline visit, we examined Ng status at return visits to compute urethral Ng risk. We compared these data to three referent populations: men with urethral Ng (N=253), urethral chlamydia (Ct) (N=251), and no urethral Ng or Ct (N=255). We conducted sensitivity analyses to assess varied approaches to censoring, missing data, and anatomical site of infection. We also compared sequences of protein antigens in the OMV-based MenB-4C vaccine, US_NmUC, and Ng. RESULTS Participants were primarily Black (65%) and heterosexual (82%). Over follow-up, 91 men acquired urethral Ng. Men with urethral US_NmUC had similar Ng risk to men with prior urethral Ng (adjusted hazard ratio (AHR): 1∙27, 95% CI: 0∙65-2∙48). Men with urethral US_NmUC had insignificantly increased Ng risk compared to men with urethral Ct (AHR: 1∙51, 95% CI: 0∙79-2∙88), and significantly increased Ng risk compared to men without urethral Ng or Ct (AHR: 3∙55, 95% CI: 1∙27-9∙91). Most of the protein antigens analyzed shared high sequence similarity. CONCLUSIONS Urethral US_NmUC infection did not protect against gonorrhea despite substantial sequence similarities in shared protein antigens.
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Affiliation(s)
- Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alexandria Carter
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Yih-Ling Tzeng
- Division of Infectious Diseases, Departments of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David S Stephens
- Division of Infectious Diseases, Departments of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Morgan Brown
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Brandon Snyder
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jose A Bazan
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Sexual Health Clinic, Columbus Public Health, Columbus, Ohio, USA
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Tsadik M, Berhane Y, Worku A, Terefe W. Perceived risk of reinfection among individuals treated for sexually transmitted infections in Northern Ethiopia: implication for use in clinical practice. Pan Afr Med J 2017; 27:87. [PMID: 28819508 PMCID: PMC5554678 DOI: 10.11604/pamj.2017.27.87.12015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/02/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The prevention of reinfection of sexually transmitted infections (STIs) is highly dependent on the level of risk perception and the subsequent adoption of preventive behaviors. While perceived risk is assumed to be key to adoption of preventive measures, the evidence regarding the predictors of perceived risk to STI reinfection are limited. METHODS This paper is based on a cross sectional facility based survey conducted in North Ethiopia from January to June; 2015. Patients attending public health facilities for STI care responded to a structured questionnaire at clinic exist. Ordinal logistic regression was employed to identify factors associated with risk perception. RESULTS Of the 1082 STI patients who participated in the study, 843(77.91%) indicated a high perceived risk of STI reinfection. The major factor associated with low perceived risk of reinfection was willingness to notify partner; the odds of being willing to notify partner was greater among those who perceived low risk (AOR=3.01, 95% CI: 2.13-4.25). In addition, low perceived risk was associated with female index cases (AOR=1.49, 95% CI: 1.07-2.08), those who had high school education and above (AOR=1.68, 95% CI: 1.07-2.65), those aged 25 years and above (AOR=1.52, 95% CI: 1.09-2.12), those who had a single partner (AOR=1.82, 95% CI: 1.20-2.74), and those who had low perceived stigma (AOR=1.42, 95% CI: 1.04-1.95). CONCLUSION The perceived risk of STI reinfection is high and strongly associated with willing to notify partner. Efforts to prevent STI reinfection need to consider interventions that enhance partner notification.
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Affiliation(s)
- Mache Tsadik
- College of Health Science, Mekelle University, Tigray, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Allen UD, MacDonald NE. Sexually transmitted infections in adolescents: Maximizing opportunities for optimal care. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.8.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Allen UD, MacDonald NE. Les infections transmises sexuellement chez les adolescents : maximiser les occasions de soins optimaux. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.8.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Corbo JM, Brown JN, Bryan WE, Townsend ML. Impact of phosphodiesterase type 5 inhibitor treatment on the rates of sexually transmitted diseases in a Veterans Affairs Medical Center patient population. J Pharm Pract 2013; 27:40-5. [PMID: 24128787 DOI: 10.1177/0897190013504956] [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
OBJECTIVE The objective of this study was to investigate whether the rates of sexually transmitted diseases (STDs) are higher in a veteran population prescribed phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction compared to individuals not prescribed these medications. METHODS This retrospective cohort study included male veterans who filled at least 1 prescription for a PDE5 inhibitor at a Veterans Affairs Medical Center (VAMC) between January 1, 2007, and December 31, 2009. A comparator cohort of male veterans was matched for age and marital status. RESULTS A total of 10 154 subjects were evaluated. The number of unique subjects with confirmed STDs within the study period was not significantly different between the PDE5 inhibitor cohort and the comparator cohort (n = 8 vs 10, P = .638) nor was there a significant difference in the total number of STDs acquired (n = 8 vs 13, P = .267). Characteristics of subjects who contracted an STD included younger age, African American race, and single marital status. CONCLUSIONS This study demonstrated that the use of a PDE5 inhibitor in this VAMC patient population was not associated with an increase in the incidence of STDs. Individuals who contracted a new STD tended to be younger, not married, and African American.
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Affiliation(s)
- Jason M Corbo
- Geriatric Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA
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Bernstein KT, Marcus JL, Barry PM, Pandori MW, Buono S, Hess D, Philip SS. Characteristics of males infected with common Neisseria gonorrhoeae sequence types in the Gonococcal Isolate Surveillance Project, San Francisco, California, 2009. Am J Epidemiol 2013; 178:1289-95. [PMID: 24049157 DOI: 10.1093/aje/kwt115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We analyzed 265 urethral Neisseria gonorrhoeae specimens collected from symptomatic males at San Francisco's municipal sexually transmitted disease clinic, a participant in the Gonococcal Isolate Surveillance Project, during 2009. We used N. gonorrhoeae multiantigen sequence typing to describe characteristics of patients infected with common sequence type families. Specimens were classified into 6 homology-based families and 1 additional family of all other identified strains. Strain family results were combined with results of culture-based antibiotic sensitivity minimum inhibitory concentration, sociodemographic and behavioral risk data collected at the clinic, and presence or absence of the mosaic penicillin-binding protein 2 (penA) allele. Characteristics of patients were compared across strain families through the use of χ(2) statistics. Among men who have sex with men, strain distribution differed by those reporting receptive oral sex as their only urethral exposure (P = 0.04), by number of sex partners (P = 0.03), and by race/ethnicity (P < 0.001); there were no differences by age or human immunodeficiency virus status. Also, among men who have sex with men, strain family distributions differed for culture specimens with reduced susceptibility to a range of antibiotics, as well as with presence of the mosaic penA allele (all P < 0.001). The combination of molecular, phenotypic, and epidemiologic data on N. gonorrhoeae infection could help develop a more complete epidemiology of gonorrhea in the United States.
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Shi L, Xie Y, Liu J, Kissinger P, Khan M. Is out-of-pocket cost a barrier to receiving repeat tests for chlamydia and gonorrhoea? Int J STD AIDS 2013; 24:301-6. [PMID: 23970662 DOI: 10.1177/0956462412472821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to examine whether out-of-pocket (OOP) costs associated with chlamydia (CT) and gonorrhoea (GC) screening tests is a barrier to receiving CT/GC re-screening and follow-up annual screening. A major health insurance claims database 2006-2010 was used for analysis. The date of first CT/GC diagnosis was used as the index date, and OOP costs at index date for screening tests were retrieved. A re-screening test and an annual screening were defined as tests that occurred within 90-180 days and 181-395 days of the index date, respectively. Re-screening rates were 11.7% and 10.9% and annual screening rates were 24.7% and 23.7% for CT and GC cases, respectively. Compared with the CT patients without OOP expenses, those with OOP expenses of $30 or higher had significantly reduced likelihood of receiving re-screening and annual screening. Similar results were found for GC patients. We concluded that OOP costs serve as a significant barrier to re-screening and annual screening.
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Affiliation(s)
- L Shi
- Department of Global Health Systems and Development, School of Public Health and Tropical Medicine,Tulane University, New Orleans, LA, USA.
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Park IU, Amey A, Creegan L, Barandas A, Bauer HM. Retesting for repeat chlamydial infection: family planning provider knowledge, attitudes, and practices. J Womens Health (Larchmt) 2012; 19:1139-44. [PMID: 20482236 DOI: 10.1089/jwh.2009.1648] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Repeated genital infections with Chlamydia trachomatis are common and associated with serious adverse reproductive sequelae in women such as infertility, ectopic pregnancy, and chronic pelvic pain. Retesting for repeat chlamydial infection is recommended 3 months after treatment for an initial infection; however, retesting rates in various settings are low. In order to design interventions to increase retesting rates, understanding provider barriers and practices around retesting is crucial. Therefore, in this survey of family planning providers we sought to describe: (1) knowledge about retesting for chlamydia; (2) attitudes and barriers toward retesting; (3) practices currently utilized to ensure retesting, and predictors associated with their use. METHODS We conducted a cross-sectional, self-administered, Internet-based survey of a convenience sample of family planning providers in California inquiring about strategies utilized to ensure retesting in their practice setting. High-intensity strategies included chart flagging, tickler (reminder) systems, follow-up appointments, and phone/mail reminders. RESULTS Of 268 respondents, 82% of providers reported at least 1 barrier to retesting, and only 44% utilized high-intensity interventions to ensure that patients returned. Predictors associated with use of high-intensity interventions included existence of clinic-level retesting policies (OR 3.95, 95% CI 1.98-7.88), and perception of a high/moderate level of clinic priority toward retesting (OR 3.75, 95% CI 2.12-.6.63). CONCLUSION Emphasizing the importance of retesting to providers through adoption of clinic policies will likely be an important component of a multimodal strategy to ensure that patients are retested and that provider/clinic staff take advantage of opportunities to retest patients. Innovative approaches such as home-based retesting with self-collected vaginal swabs and use of cost-effective technologies to generate patient reminders should also be considered.
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Affiliation(s)
- Ina U Park
- Program Development and Evaluation Section, California Department of Public Health STD Control Branch, Richmond, California 94804, USA.
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Newman LM, Dowell D, Bernstein K, Donnelly J, Martins S, Stenger M, Stover J, Weinstock H. A tale of two gonorrhea epidemics: results from the STD surveillance network. Public Health Rep 2012; 127:282-92. [PMID: 22547859 PMCID: PMC3314072 DOI: 10.1177/003335491212700308] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE An increasing proportion of gonorrhea in the United States is diagnosed in the private sector, posing a challenge to existing national surveillance systems. We described gonorrhea epidemiology outside sexually transmitted disease (STD) clinic settings. METHODS Through the STD Surveillance Network (SSuN), health departments in the San Francisco, Seattle, Denver, Minneapolis, and Richmond, Virginia, metropolitan areas interviewed systematic samples of men and women reported with gonorrhea by non-STD clinic providers from 2006 through 2008. RESULTS Of 2,138 interviews, 10.0% were from San Francisco, 26.4% were from Seattle, 25.2% were from Denver, 22.9% were from Minneapolis, and 15.5% were from Richmond. A total of 1,165 women were interviewed; 70.1% (815/1,163) were ≤24 years of age, 51.3% (598/1,165) were non-Hispanic black, and 19.0% (213/1,121) reported recent incarceration of self or sex partner. Among 610 men who have sex with only women, 50.9% were ≤24 years of age, 65.1% were non-Hispanic black, 14.1% reported incarceration of self or sex partner, and 16.7% reported anonymous sex. Among 363 men who have sex with men (MSM), 20.9% were ≤24 years of age, 61.6% were non-Hispanic white, 39.8% reported anonymous sex, 35.7% reported using the Internet to meet sex partners, and 12.1% reported methamphetamine use. CONCLUSIONS These data identified two concurrent gonorrhea epidemics in minority populations: a young, black, heterosexual epidemic with frequently reported recent incarceration, and an older, mostly white MSM epidemic with more frequently reported anonymous sex, Internet use to meet sex partners, and methamphetamine use.
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Affiliation(s)
- Lori Marie Newman
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA 30333, USA.
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Syphilis Testing Behavior Following Diagnosis With Early Syphilis Among Men Who Have Sex With Men—San Francisco, 2005–2008. Sex Transm Dis 2011; 38:24-9. [DOI: 10.1097/olq.0b013e3181ea170b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis 2009; 36:478-89. [PMID: 19617871 DOI: 10.1097/olq.0b013e3181a2a933] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Determining the magnitude of chlamydia and gonorrhea reinfection is critical to inform evidence-based clinical practice guidelines related to retesting after treatment. PubMed was used to identify peer-reviewed English language studies published in the past 30 years that estimated reinfection rates among females treated for chlamydia or gonorrhea. Included in this analysis were original studies conducted in the United States and other industrialized countries that reported data on chlamydia or gonorrhea reinfection in females. Studies were stratified into 3 tiers based on study design. Reinfection rates were examined in relation to the organism, study design, length of follow-up, and population characteristics. Of the 47 studies included, 16 were active cohort (Tier 1), 15 passive cohort (Tier 2), and 16 disease registry (Tier 3) studies. The overall median proportion of females reinfected with chlamydia was 13.9% (n = 38 studies). Modeled chlamydia reinfection within 12 months demonstrated peak rates of 19% to 20% at 8 to 10 months. The overall median proportion of females reinfected with gonorrhea was 11.7% (n = 17 studies). Younger age was associated with higher rates of both chlamydia and gonorrhea reinfection. High rates of reinfection with chlamydia and gonorrhea among females, along with practical considerations, warrant retesting 3 to 6 months after treatment of the initial infection. Further research should investigate effective interventions to reduce reinfection and to increase retesting.
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Patterns of single and multiple claims of epididymitis among young privately-insured males in the United States, 2001 to 2004. Sex Transm Dis 2009; 36:490-2. [PMID: 19455076 DOI: 10.1097/olq.0b013e3181a396d8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
GOAL In San Francisco, coinciding with increases in the western United States, we observed substantial gonorrhea increases among young heterosexuals during 2003-2005. We conducted a case-control study to identify intervention strategies for prevention and control. STUDY DESIGN We interviewed case patients with gonorrhea during February-July, 2006 and control subjects at the local Department of Motor Vehicles. We included sexually active heterosexuals aged 15 to 35 years in sex-stratified analyses. RESULTS We interviewed 225 persons: 24 male and 28 female case patients and 98 male and 75 female control subjects. In multivariable analysis adjusting for black race and multiple partners among men, black race [adjusted odds ratio (AOR), 5.1; 95% confidence interval (CI), 1.7-15.0], having had multiple partners (AOR, 3.1; 95% CI, 1.1-8.5), having had an anonymous partner (AOR, 6.4; 95% CI, 1.9-21.4), and a long-term partnership (AOR, 0.3; 95% CI, 0.1-0.9) were associated with gonococcal infection. Among women, after adjustment for age, multiple partners, and black race (subject or partner), being black or having a black partner (AOR, 6.9; 95% CI, 2.2-21.8), having had a recently incarcerated partner (AOR, 6.2; 95% CI, 1.0-38.4), or meeting partners on the street (AOR, 19.0; 95% CI, 2.0-179.0) were associated with gonococcal infection. CONCLUSIONS Demographic and behavioral factors increase risk for gonorrhea among heterosexuals in San Francisco with partner characteristics being particularly important. Prevention and control efforts are focusing on blacks and incarcerated populations using street-based outreach and expanded screening and treatment.
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Royer HR, Zahner SJ. Providers' Experiences with Young People's Cognitive Representations and Emotions Related to the Prevention and Treatment of Sexually Transmitted Infections. Public Health Nurs 2009; 26:161-72. [DOI: 10.1111/j.1525-1446.2009.00767.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chesson HW, Collins D, Koski K. Formulas for estimating the costs averted by sexually transmitted infection (STI) prevention programs in the United States. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2008; 6:10. [PMID: 18500996 PMCID: PMC2426671 DOI: 10.1186/1478-7547-6-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 05/23/2008] [Indexed: 01/30/2023] Open
Abstract
Background Sexually transmitted infection (STI) prevention programs can mitigate the health and economic burden of STIs. A tool to estimate the economic benefits of STI programs could prove useful to STI program personnel. Methods We developed formulas that can be applied to estimate the direct medical costs and indirect costs (lost productivity) averted by STI programs in the United States. Costs and probabilities for these formulas were based primarily on published studies. Results We present a series of formulas that can be used to estimate the economic benefits of STI prevention (in 2006 US dollars), using data routinely collected by STI programs. For example, the averted sequelae costs associated with treating women for chlamydia is given as (Cw)(0.16)(0.925)(0.70)($1,995), where Cw is the number of infected women treated for chlamydia, 0.16 is the absolute reduction in the probability of pelvic inflammatory disease (PID) as a result of treatment, 0.925 is an adjustment factor to prevent double-counting of PID averted in women with both chlamydia and gonorrhea, 0.70 is an adjustment factor to account for the possibility of re-infection, and $1,995 is the average cost per case of PID, based on published sources. Conclusion The formulas developed in this study can be a useful tool for STI program personnel to generate evidence-based estimates of the economic impact of their program and can facilitate the assessment of the cost-effectiveness of their activities.
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Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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MacDonald N, Mailman T, Desai S. Gonococcal infections in newborns and in adolescents. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2008; 609:108-30. [PMID: 18193661 DOI: 10.1007/978-0-387-73960-1_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Gonococcal infections are now an uncommon problem in newborns in industrialized countries but remain a serious problem in developing countries due to ongoing high infection rates in pregnant women. Prompt diagnosis in the newborn with appropriate treatment can minimize sequelae. The mother and her partner(s) also require investigation and treatment. Adolescents are a core group fuelling the ongoing gonococcal epidemic in industrialized countries. This is unlikely going to change unless sexual behaviour changes substantially. Education is a critical step along with access to more youth friendly STI care. As noted in the 2001 Institute of Medicine Report, learning about sex, sexuality and prevention of STI is a basic human right of adolescents (DiClemente and Crosby 2006).
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Affiliation(s)
- Noni MacDonald
- Dalhousie University, Division Pediatric Infectious Diseases, IWK Health Center, Halifax, Nova Scotia, Canada.
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Fung M, Scott KC, Kent CK, Klausner JD. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect 2007; 83:304-9. [PMID: 17166889 PMCID: PMC2598678 DOI: 10.1136/sti.2006.024059] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2006] [Indexed: 11/03/2022] Open
Abstract
This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting recommendations in men. PubMed and STI conference abstract books from January 1995 to October 2006 were searched to identify studies on chlamydia and gonorrhoea reinfection among men using chlamydia and gonorrhoea nucleic acid amplification tests or gonorrhoea culture. Studies were categorised as using either active or passive follow-up methods. The proportions of chlamydial and gonococcal reinfection among men were calculated for each study and summary medians were reported. Repeat chlamydia infection among men had a median reinfection probability of 11.3%. Repeat gonorrhoea infection among men had a median reinfection probability of 7.0%. Studies with active follow-up had moderate rates of chlamydia and gonorrhoea reinfection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both chlamydia and gonorrhoea reinfections among men, with respective medians of 17.4% and 8.5%. Proportions of chlamydia and gonorrhoea reinfection among men were comparable with those among women. Reinfection among men was strongly associated with previous history of sexually transmitted diseases and younger age, and inconsistently associated with risky sexual behaviour. Substantial repeat chlamydia and gonorrhoea infection rates were found in men comparable with those in women. Retesting recommendations in men are appropriate, given the high rate of reinfection. To optimise retesting guidelines, further research to determine effective retesting methods and establish factors associated with reinfection among men is suggested.
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Affiliation(s)
- Monica Fung
- Wellesley College, 21 Wellesley College Road, Unit 4633, Wellesley, MA 02481-0246, USA.
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Affiliation(s)
- Noni MacDonald
- IWK Health Centre, Division of Infectious Diseases, Halifax, NS
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