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Tsoumanis A, Vanden Berghe W, Hens N, Van Dijck C. Estimating Partnership Duration among MSM in Belgium-A Modeling Study. Infect Dis Rep 2024; 16:435-447. [PMID: 38804442 PMCID: PMC11130929 DOI: 10.3390/idr16030032] [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: 01/26/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Mathematical modeling is widely used for describing infection transmission and evaluating interventions. The lack of reliable social parameters in the literature has been mentioned by many modeling studies, leading to limitations in the validity and interpretation of the results. Using data from the European MSM Internet survey 2017, we developed a network model to describe sex acts among MSM in Belgium. The model simulates daily sex acts among steady, persistent casual and one-off partners in a population of 10,000 MSM, grouped as low- or high-activity by using three different definitions. Model calibration was used to estimate partnership duration and homophily rates to match the distribution of cumulative sex partners over 12 months. We estimated an average duration between 1065 and 1409 days for steady partnerships, 4-6 and 251-299 days for assortative high- and low-activity individuals and 8-13 days for disassortative persistent casual partnerships, respectively, varying across the three definitions. High-quality data on social network and behavioral parameters are scarce in the literature. Our study addresses this lack of information by providing a method to estimate crucial parameters for network specification.
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Affiliation(s)
- Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, 2610 Antwerp, Belgium;
| | - Wim Vanden Berghe
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, 2610 Antwerp, Belgium;
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
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2
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Castonguay FM, Chesson HW, Jeon S, Rainisch G, Fischer LS, Adhikari BB, Kahn EB, Greening B, Gift TL, Meltzer MI. Building a Simple Model to Assess the Impact of Case Investigation and Contact Tracing for Sexually Transmitted Diseases: Lessons From COVID-19. AJPM FOCUS 2024; 3:100147. [PMID: 38149077 PMCID: PMC10749878 DOI: 10.1016/j.focus.2023.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Introduction During the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention developed a simple spreadsheet-based tool to help state and local public health officials assess the performance and impact of COVID-19 case investigation and contact tracing in their jurisdiction. The applicability and feasibility of building such a tool for sexually transmitted diseases were assessed. Methods The key epidemiologic differences between sexually transmitted diseases and respiratory diseases (e.g., mixing patterns, incubation period, duration of infection, and the availability of treatment) were identified, and their implications for modeling case investigation and contact tracing impact with a simple spreadsheet tool were remarked on. Existing features of the COVID-19 tool that are applicable for evaluating the impact of case investigation and contact tracing for sexually transmitted diseases were also identified. Results Our findings offer recommendations for the future development of a spreadsheet-based modeling tool for evaluating the impact of sexually transmitted disease case investigation and contact tracing efforts. Generally, we advocate for simplifying sexually transmitted disease-specific complexities and performing sensitivity analyses to assess uncertainty. The authors also acknowledge that more complex modeling approaches might be required but note that it is possible that a sexually transmitted disease case investigation and contact tracing tool could incorporate features from more complex models while maintaining a user-friendly interface. Conclusions A sexually transmitted disease case investigation and contact tracing tool could benefit from the incorporation of key features of the COVID-19 model, namely its user-friendly interface. The inherent differences between sexually transmitted diseases and respiratory viruses should not be seen as a limitation to the development of such tool.
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Affiliation(s)
- François M. Castonguay
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montréal, Montréal, Québec, Canada
- Centre for Public Health Research (CReSP), Montréal, Québec, Canada
| | - Harrell W. Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seonghye Jeon
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabriel Rainisch
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah S. Fischer
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Biswha B. Adhikari
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily B. Kahn
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bradford Greening
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martin I. Meltzer
- Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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3
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Rowlinson E, Hughes JP, Khosropour CM, Manhart LE, Golden MR, Barbee LA. Inadequate performance of a risk score to predict asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infection among cisgender men who have sex with men. Sex Transm Infect 2023; 99:380-385. [PMID: 36609346 PMCID: PMC10323043 DOI: 10.1136/sextrans-2022-055608] [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: 08/23/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Epidemiological treatment of persons who are sexual contacts to partners with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) often results in treatment of uninfected persons, which may increase the risk of antibiotic-resistant infections. We sought to identify the predictors of NG and/or CT infections to develop a risk score that could be used to limit epidemiological treatment to persons most likely to have these infections. METHODS We included visits to the Public Health - Seattle & King County Sexual Health Clinic by asymptomatic cisgender men who have sex with men (MSM) aged ≥18 who presented as a sexual contact to partner(s) with CT or NG infection between 2011 and 2019. We used logistic regression to estimate the odds of CT and/or NG infections associated with demographic and clinical predictors, selecting the final set of predictors using the Akaike information criteria and obtaining score weights from model coefficients. We used a cross-validation approach to obtain average model discrimination from each of 10 models, leaving out 10% of the data, and evaluated sensitivity and specificity at various score cut-offs. RESULTS The final model for predicting NG or CT infection included seven predictors (age <35 years, HIV status, receptive oral sex in the prior 2 months, CT diagnosis, condomless receptive anal intercourse, condomless insertive anal intercourse and methamphetamine use in the prior 12 months). Model discrimination, as measured by the receiver operating curve, was 0.60 (95% CI 0.54 to 0.66). Sensitivity for detection of infection was ≥90% for scores ≥3, ≥5 and ≥7; specificity for these cut-offs was <16%. At scores ≥9, ≥12 and ≥14, specificity increased but sensitivity decreased to ≤76%. CONCLUSIONS Our risk score did not sufficiently discriminate between asymptomatic MSM with and without NG/CT infection. Additional studies evaluating epidemiological treatment as a standard of care in diverse populations are needed to guide best practices in the management of contacts to NG/CT infection.
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Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Biostatistics, University of Washington, Seattle, Washington, USA
| | | | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Lindley A Barbee
- Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD, Public Health - Seattle & King County, Seattle, Washington, USA
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4
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Chesson HW, Bernstein KT, Barbee LA. Kiss Around and Find Out: Kissing as a Risk Factor for Pharyngeal Gonorrhea. Sex Transm Dis 2023; 50:402-403. [PMID: 37074310 PMCID: PMC11247368 DOI: 10.1097/olq.0000000000001816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Harrell W. Chesson
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA
| | - Kyle T. Bernstein
- Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lindley A. Barbee
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA
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5
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Saleem K, Ting EL, Loh AJW, Baggaley R, Mello MB, Jamil MS, Barr‐Dichiara M, Johnson C, Gottlieb SL, Fairley CK, Chow EPF, Ong JJ. Missed opportunities for HIV testing among those who accessed sexually transmitted infection (STI) services, tested for STIs and diagnosed with STIs: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26049. [PMID: 37186451 PMCID: PMC10131090 DOI: 10.1002/jia2.26049] [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] [Received: 05/18/2022] [Accepted: 11/16/2022] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Of 37.7 million people living with HIV in 2020, 6.1 million still do not know their HIV status. We synthesize evidence on concurrent HIV testing among people who tested for other sexually transmitted infections (STIs). METHODS We conducted a systematic review using five databases, HIV conferences and clinical trial registries. We included publications between 2010 and May 2021 that reported primary data on concurrent HIV/STI testing. We conducted a random-effects meta-analysis and meta-regression of the pooled proportion for concurrent HIV/STI testing. RESULTS We identified 96 eligible studies. Among those, 49 studies had relevant data for a meta-analysis. The remaining studies provided data on the acceptability, feasibility, barriers, facilitators, economic evaluation and social harms of concurrent HIV/STI testing. The pooled proportion of people tested for HIV among those attending an STI service (n = 18 studies) was 71.0% (95% confidence intervals: 61.0-80.1, I2 = 99.9%), people tested for HIV among those who were tested for STIs (n = 15) was 61.3% (53.9-68.4, I2 = 99.9%), people tested for HIV among those who were diagnosed with an STI (n = 13) was 35.3% (27.1-43.9, I2 = 99.9%) and people tested for HIV among those presenting with STI symptoms (n = 3) was 27.1% (20.5-34.3, I2 = 92.0%). The meta-regression analysis found that heterogeneity was driven mainly by identity as a sexual and gender minority, the latest year of study, country-income level and region of the world. DISCUSSION This review found poor concurrent HIV/STI testing among those already diagnosed with an STI (35.3%) or who had symptoms with STIs (27.1%). Additionally, concurrent HIV/STI testing among those tested for STIs varied significantly according to the testing location, country income level and region of the world. A few potential reasons for these observations include differences in national STI-related policies, lack of standard operation procedures, clinician-level factors, poor awareness and adherence to HIV indicator condition-guided HIV testing and stigma associated with HIV compared to other curable STIs. CONCLUSIONS Not testing for HIV among people using STI services presents a significant missed opportunity, particularly among those diagnosed with an STI. Stronger integration of HIV and STI services is urgently needed to improve prevention, early diagnosis and linkage to care services.
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Affiliation(s)
- Kanwal Saleem
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
| | - Ee Lynn Ting
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Andre J. W. Loh
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Maeve B. Mello
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | | | - Cheryl Johnson
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Sami L. Gottlieb
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Christopher K. Fairley
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Eric P. F. Chow
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Jason J. Ong
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
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6
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Khosropour CM, Coomes DM, Barbee LA. Frequency and Combination of Sequential Sexual Acts That May Lead to Sexually Transmitted Infections at Different Anatomic Sites Within the Same Person. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:823-831. [PMID: 36459349 PMCID: PMC9717570 DOI: 10.1007/s10508-022-02486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Modeling studies suggest that transmission of gonorrhea and chlamydia to multiple anatomic sites within the same person is necessary to reproduce observed high rates of extragenital gonorrhea/chlamydia. Limited empiric behavioral data support this idea. In this cross-sectional study, we enrolled individuals assigned male at birth who reported sex with men (MSM) and denied receptive anal sex (RAS) in the past 2 years. Participants enrolled in-person at the Sexual Health Clinic in Seattle, Washington (December 2019-September 2021) or online (July 2021-September 2021), and completed a sexual history questionnaire that asked about specific sexual acts and sequence of those acts during their last sexual encounter. We enrolled 210 MSM during the 16-month recruiting period. The median number of sex acts reported at last sexual encounter was 4 (interquartile range 3-5). The most commonly reported acts at last sex were: kissing (83%), receiving oral sex (82%), and insertive anal sex (65%). There was substantial variability in the sequence of acts reported; no unique sequence of sex acts was reported by more than 12% of the population. Ninety percent of participants reported sequences of behaviors that could lead to gonorrhea or chlamydia transmission within the same person (respondent or partner); the most common of these combinations was kissing followed by receiving oral sex (64% reporting). Engaging in multiple sex acts within a single sexual encounter is common and may lead to gonorrhea/chlamydia transmission within the same person. This complicates empiric measurements of transmission probabilities needed to estimate population-level transmission.
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Affiliation(s)
- Christine M Khosropour
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA, 98104, USA.
| | - David M Coomes
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA, 98104, USA
| | - Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
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7
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Carey KA, Newman LM, Spicknall IH. Estimating the population level impact of a gonococcal vaccine candidate: Predictions from a simple mathematical model. Vaccine 2022; 40:7176-7181. [PMID: 36333224 PMCID: PMC11261575 DOI: 10.1016/j.vaccine.2022.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neisseria gonorrhoeae cross-protection was suggested in a New Zealand meningitis B vaccine. We modeled the potential impact of similar vaccines on gonorrhea prevalence in heterosexuals in the United States. METHODS Our mathematical model incorporated infection, behavior, and vaccination dynamics. Approximate Bayesian Computation calibrated our model to US prevalence. Primary analyses assumed New Zealand vaccine characteristics: 30% efficacy and 2-year duration of protection. We estimated impact under two vaccine coverages (20%, 50%). RESULTS Reduction in gonorrhea prevalence ranged from 4.8 to 39.4%, depending on vaccine coverage. Vaccine impact was correlated with both size of the highly sexually active subpopulation and sexual mixing between high and low activity subpopulations. CONCLUSIONS A meningitis vaccine providing low efficacy cross-protection against gonorrhea acquisition and short duration of protection could result in a large reduction in gonorrhea prevalence in the United States. Potential dual protective effects can be considered when making vaccine recommendations.
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Affiliation(s)
- Kelly A Carey
- Office of Data Science and Emerging Technologies, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Lori M Newman
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Ian H Spicknall
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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8
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Surgers L, Chiarabini T, Royer G, Rougier H, Mercier-Darty M, Decré D, Valin N, Woerther PL, Decousser JW, Girard PM, Lacombe K, Boyd A. Evidence of sexual transmission of extended-spectrum β-lactamase-producing Enterobacterales: a cross-sectional and prospective study. Clin Infect Dis 2022; 75:1556-1564. [PMID: 35307740 DOI: 10.1093/cid/ciac218] [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: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extended spectrum β-lactamase-producing Enterobacterales (ESBL-E) represent a major threat to public health. Little is known on their potential for sexual transmission. METHODS We recruited individuals at a sexually transmitted infection and HIV-outpatient clinic in Paris, France in whom we evaluated the prevalence of ESBL-E intestinal carriage and among those positive, the proportion with clearance 6 months thereafter. We compared carriage prevalence between groups using logistic regression adjusted for age, geographic origin, travel outside of Europe, and antibiotic use <6 months. RESULTS 2157 individuals participated, of whom 226 (10.5%) were ESBL-E carriers. The proportion of ESBL-E carriers varied across sexual groups: HIV-negative men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP), 16.3% (n=41/251); HIV-negative MSM not on PrEP, 9.7% (n=47/487); HIV-positive MSM, 12.2% (n=61/500); HIV-negative men who exclusively have sex with women, 10.0% (n=44/439); and HIV-negative women who have sex with men (WSM), 6.9% (n=33/480). After adjustment, ESBL-E prevalence was significantly higher in HIV-negative MSM on PrEP (p<0.001) and HIV-positive MSM (p=0.01) compared to WSM. Number of sexual partners <6 months was associated with ESBL-E carriage after adjustment (p=0.004). blaSHV-12-producing ESBL-E and E. coli Sequence Type 14 were observed only in MSM. Of 102 individuals with ESBL-E returning for testing, 26 (25%) had carriage at 6 months. CONCLUSION ESBL-E carriage is more frequent in MSM undergoing PrEP or living with HIV, and with increasing number of sexual partners. More research is warranted to understand the consequences of ESBL-E carriage in these populations and how transmission can be reduced.
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Affiliation(s)
- Laure Surgers
- GHU APHP, Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France
| | - Thibault Chiarabini
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France
| | - Guilhem Royer
- Département de Prévention, Diagnostic et Traitement des Infections, Hôpital Henri Mondor, APHP, 94000 Créteil, France.,LABGeM, Génomique Métabolique, Genoscope, Institut François Jacob, CEA, CNRS, Université Paris-Saclay, 91000, Evry, France
| | - Hayette Rougier
- Institut de Médecine et d'Epidémiologie Appliquée, Paris, France
| | - Mélanie Mercier-Darty
- Département de Prévention, Diagnostic et Traitement des Infections, Hôpital Henri Mondor, APHP, 94000 Créteil, France
| | - Dominique Decré
- Sorbonne University, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI Team 13, Paris, France.,GHU APHP, Sorbonne Université, Département de Microbiologie, Hôpital Saint-Antoine, F75012, Paris, France
| | - Nadia Valin
- GHU APHP, Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012, Paris, France
| | - Paul-Louis Woerther
- Département de Prévention, Diagnostic et Traitement des Infections, Hôpital Henri Mondor, APHP, 94000 Créteil, France.,LABGeM, Génomique Métabolique, Genoscope, Institut François Jacob, CEA, CNRS, Université Paris-Saclay, 91000, Evry, France
| | - Jean-Winoc Decousser
- Département de Prévention, Diagnostic et Traitement des Infections, Hôpital Henri Mondor, APHP, 94000 Créteil, France.,EA 7380 Dynamyc, Université Paris-Est Créteil, 94000 Créteil, France
| | - Pierre-Marie Girard
- GHU APHP, Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France
| | - Karine Lacombe
- GHU APHP, Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France
| | - Anders Boyd
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012, Paris, France
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9
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Yaesoubi R, Cohen T, Hsu K, Gift TL, St. Cyr SB, Salomon JA, Grad YH. Evaluating spatially adaptive guidelines for the treatment of gonorrhea to reduce the incidence of gonococcal infection and increase the effective lifespan of antibiotics. PLoS Comput Biol 2022; 18:e1009842. [PMID: 35139073 PMCID: PMC8863219 DOI: 10.1371/journal.pcbi.1009842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/22/2022] [Accepted: 01/16/2022] [Indexed: 11/19/2022] Open
Abstract
In the absence of point-of-care gonorrhea diagnostics that report antibiotic susceptibility, gonorrhea treatment is empiric and determined by standardized guidelines. These guidelines are informed by estimates of resistance prevalence from national surveillance systems. We examined whether guidelines informed by local, rather than national, surveillance data could reduce the incidence of gonorrhea and increase the effective lifespan of antibiotics used in treatment guidelines. We used a transmission dynamic model of gonorrhea among men who have sex with men (MSM) in 16 U.S. metropolitan areas to determine whether spatially adaptive treatment guidelines based on local estimates of resistance prevalence can extend the effective lifespan of hypothetical antibiotics. The rate of gonorrhea cases in these metropolitan areas was 5,548 cases per 100,000 MSM in 2017. Under the current strategy of updating the treatment guideline when the prevalence of resistance exceeds 5%, we showed that spatially adaptive guidelines could reduce the annual rate of gonorrhea cases by 200 cases (95% uncertainty interval: 169, 232) per 100,000 MSM population while extending the use of a first-line antibiotic by 0.75 (0.55, 0.95) years. One potential strategy to reduce the incidence of gonorrhea while extending the effective lifespan of antibiotics is to inform treatment guidelines based on local, rather than national, resistance prevalence. Antimicrobial resistance threatens the effective treatment of a growing number of infections worldwide. In the absence of rapid point-of-care diagnostics that determine antibiotic susceptibility, the treatment of several infections caused by bacteria (e.g., gonorrhea and tuberculosis) remain empiric and informed by guidelines. These guidelines are usually determined at the national level and based on the estimated resistance prevalence nationally. Here, we show that more cases of gonorrhea could be prevented and the effective lifespan of antibiotics suitable for the treatment of gonorrhea could be extended if treatment guidelines are determined locally and based on the regional resistance prevalence rather than on a single nationwide recommendation. Our analysis provides evidence to highlight the importance of 1) maintaining local surveillance systems of antimicrobial resistance and 2) engaged policymakers who use the data from these surveillance systems to inform timely and effective decisions at the local level.
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Affiliation(s)
- Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Katherine Hsu
- Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Thomas L. Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sancta B. St. Cyr
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joshua A. Salomon
- Department of Health Policy, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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10
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Xu X, Chow EPF, Ong JJ, Shen M, Wang C, Hocking JS, Fairley CK, Zhang L. Modelling the potential role of saliva use during masturbation in the transmission of Neisseria gonorrhoeae at multiple anatomical sites. Sex Health 2021; 18:466-474. [PMID: 34914887 DOI: 10.1071/sh21138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
Background Neisseria gonorrhoeae can be cultured from saliva in men with pharyngeal gonorrhoea and could theoretically be transmitted from the pharynx to the urethra when saliva is used as a lubricant for masturbation. In this work, we proposed that saliva use during masturbation may be a potential transmission route of gonorrhoea. Methods We analysed the transmission of Neisseria gonorrhoeae at the oropharynx, urethra and anorectum with mathematical models among men who have sex with men using data from six different studies. Model 1 included transmission routes (oral sex, anal sex, rimming, kissing, and three sequential sex practices). In Model 2, we added saliva use during solo masturbation and mutual masturbation to model 1. Results Model 2 could replicate single site infection at the oropharynx, urethra and anorectum and multi-site infection across six different datasets. However, the calibration of Model 2 was not significantly different from Model 1 across four datasets. Model 2 generated an incidence of gonorrhoea from masturbation of between 5.2% (95% CI: 3.2-10.1) to 10.6% (95% CI: 5.8-17.3) across six data sets. Model 2 also estimated that about one in four cases of urethral gonorrhoea might arise from solo masturbation and mutual masturbation. Conclusions Our models raise the possibility that saliva use during masturbation may play a role in transmitting gonorrhoea. This is an important area to explore because it contributes to the knowledge base about gonorrhoea transmission.
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Affiliation(s)
- Xianglong Xu
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, PR China
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, PR China
| | - Mingwang Shen
- China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, PR China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, PR China
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, PR China; and Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
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11
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Duan Q, Carmody C, Donovan B, Guy RJ, Hui BB, Kaldor JM, Lahra MM, Law MG, Lewis DA, Maley M, McGregor S, McNulty A, Selvey C, Templeton DJ, Whiley DM, Regan DG, Wood JG. Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia. PLoS Comput Biol 2021; 17:e1009385. [PMID: 34735428 PMCID: PMC8594806 DOI: 10.1371/journal.pcbi.1009385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 11/16/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this population could result in an epidemic that would be difficult and costly to control. An individual-based, anatomical site-specific mathematical model of NG transmission among Australian MSM was developed and used to evaluate the potential for elimination of an imported NG strain under a range of case-based and population-based test-and-treat strategies. When initiated upon detection of the imported strain, these strategies enhance the probability of elimination and reduce the outbreak size compared with current practice (current testing levels and no contact tracing). The most effective strategies combine testing targeted at regular and casual partners with increased rates of population testing. However, even with the most effective strategies, outbreaks can persist for up to 2 years post-detection. Our simulations suggest that local elimination of imported NG strains can be achieved with high probability using combined case-based and population-based test-and-treat strategies. These strategies may be an effective means of preserving current treatments in the event of wider XDR NG emergence. In most high-income settings, gonorrhoea is endemic among men who have sex with men (MSM). While gonorrhoea remains readily treatable with antibiotics, there are major concerns about the threat of antimicrobial resistance arising from recent reports of treatment failure with first-line therapy and limited remaining treatment options. Here we investigated the potential for test-and-treat response strategies to eliminate such strains before their prevalence reaches a level requiring a shift to new first line therapies. Rather than directly consider resistance, we explore the mitigating effect of various test-and-treat measures on outbreaks of a generic imported strain which remains treatable. This is done within the framework of a realistic mathematical model of gonorrhoea spread in an MSM community that captures cases, anatomical sites of infection and sexual contacts at an individual level, calibrated to relevant Australian epidemiological data. The results indicate that strategies such as partner testing and treatment in combination with elevated asymptomatic community testing are highly effective in mitigating outbreaks but can take up to 2 years to achieve elimination. As there are currently no clear alternative drugs of proven efficacy and safety to replace ceftriaxone in first-line therapy, these promising results suggest potential for use of these outbreak response strategies to preserve current treatment recommendations.
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Affiliation(s)
- Qibin Duan
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Chris Carmody
- Liverpool Sexual Health Clinic, South Western Sydney Local Health District, Sydney, Australia
- Western Sydney University, Sydney, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | | | - Ben B. Hui
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Monica M. Lahra
- Microbiology Department, New South Wales Health Pathology, The Prince of Wales Hospital, Sydney, Australia
- School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | | | - David A. Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia
- Westmead Clinical School, Faculty of Health and Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael Maley
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, Australia
- South Western Clinical School, UNSW Sydney, Sydney, Australia
| | | | - Anna McNulty
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Christine Selvey
- Communicable Diseases Branch, Health Protection NSW, Sydney, Australia
| | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Department of Sexual Health Medicine, Sydney Local Health District and Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David M. Whiley
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | | | - James G. Wood
- School of Population Health, UNSW Sydney, Sydney, Australia
- * E-mail:
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12
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Xu X, Chow EPF, Shen M, Zou Z, Wang C, Ong JJ, Fairley CK, Zhang L. Potential effect of antiseptic mouthwash on the incidence of Neisseria gonorrhoeae among men who have sex with men: a mathematical modelling study. BMJ Open 2021; 11:e052823. [PMID: 34620667 PMCID: PMC8499270 DOI: 10.1136/bmjopen-2021-052823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea. DESIGN We developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx; (3) mouthwash reduced the transmissibility from the oropharynx; (4) the combined effect of mouthwash from scenarios 2 and 3. SETTING We used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses. PARTICIPANTS Published available data on MSM with multisite infections of gonorrhoea. PRIMARY AND SECONDARY OUTCOME MEASURES Incidence of gonorrhoea. RESULTS The overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%-80% mouthwash coverage), the total incidence increased (47-60/100 PY) and at all three anatomical sites by between 7.4% (5.9%-60.8%) and 136.6% (108.1%-177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20-39/100 PY) and at all anatomical sites by between 11.6% (10.2%-13.5%) and 99.8% (99.2%-100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22-55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%. CONCLUSIONS The effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.
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Affiliation(s)
- Xianglong Xu
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
| | - Zhuoru Zou
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jason J Ong
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases,School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi an, Shanxi, People's Republic of China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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13
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Xu X, Bradshaw CS, Chow EPF, Ong JJ, Hocking JS, Fairley CK, Zhang L. Modelling the multiple anatomical site transmission of Mycoplasma genitalium among men who have sex with men in Australia. Sci Rep 2021; 11:11087. [PMID: 34045569 PMCID: PMC8160207 DOI: 10.1038/s41598-021-90627-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
Mycoplasma genitalium (M. genitalium) is a recently recognised and important sexually transmitted infection among men who have sex with men (MSM). The role of oral sex, rimming, and kissing on M. genitalium transmission in MSM is unclear. We created four deterministic susceptible-infectious-susceptible epidemic models to examine the role that different sexual behaviours play in transmitting M. genitalium at the oropharynx, urethra anorectum among men who have sex with men in Australia. Our results suggest that oral and anal sex without other sexual practices (model 1) replicate well single site infection at the oropharynx, urethra and anorectum and also multi-site infection. If kissing or rimming are added to model 1 (i.e., model 2–4) no substantial improvements in the calibration of the models occur. Model 1 estimates that 3.4% of infections occur at the oropharynx, 34.8% at the urethra and 61.8% at the anorectum. Model 1 also estimates that the proportion of incident M. genitalium transmitted by anal sex was 82.4%, and by oral sex was about 17.6%. Our findings could provide an enhanced understanding of M. genitalium transmission in MSM, thus providing insights into what sexual practices contribute most to transmission.
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Affiliation(s)
- Xianglong Xu
- China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, Shaanxi, People's Republic of China.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Catriona S Bradshaw
- 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
| | - Jason J Ong
- China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, Shaanxi, People's Republic of China.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jane S Hocking
- China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, Shaanxi, People's Republic of China.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K Fairley
- China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, Shaanxi, People's Republic of China.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lei Zhang
- China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, 710061, Shaanxi, People's Republic of China. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. .,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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14
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Lewis FMT, Spicknall IH, Flagg EW, Papp JR, Kreisel KM. Incidence and Prevalence of Trichomonas vaginalis Infection Among Persons Aged 15 to 59 Years: United States, 2018. Sex Transm Dis 2021; 48:232-237. [PMID: 33492095 PMCID: PMC10240849 DOI: 10.1097/olq.0000000000001383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trichomonas vaginalis (TV) is a sexually transmitted parasite associated with multiple adverse outcomes in women. Estimating TV incidence is challenging because of its largely asymptomatic presentation. METHODS Per-capita prevalence was estimated using the National Health and Nutrition Examination Survey, 2013 to 2018. Incidence was estimated using ordinary differential equations assuming static incidence at steady state and fit using Bayesian techniques. Model inputs included estimates of proportion of asymptomatic cases, natural clearance, and time to symptomatic treatment seeking. Posterior distributions were drawn, and uncertainty was reported, from 25th (Q1) to 75th (Q3) percentiles. Aggregated measures were estimated by combining component distributions. RESULTS Among 15- to 59-year-olds in 2018, the number of prevalent TV infections was 2.6 (Q1, 2.4; Q3, 2.7) million overall, 470,000 (Q1, 414,000; Q3, 530,000) among men, and 2.1 (Q1, 2.0; Q3, 2.2) million among women; the numbers of incident infections were 6.9 (Q1, 6.2; Q3, 7.6) million, 3.3 (Q1, 2.8; Q3, 3.8) million, and 3.5 (Q1, 3.1; Q3, 4.0) million among all persons, men, and women, respectively. Persons aged 15 to 24 years comprised 15.6% and 16.3% of all prevalent and incident infections, respectively; prevalence and incidence in both sexes increased with age. Incidences in both sexes were highly dependent on estimates of natural clearance, which were based on few data. CONCLUSIONS Prevalence and incidence of TV are substantial in the United States, particularly among those 25 years or older. Although estimated prevalence is higher in women, estimated incidence is similar in men and women. Data on key parameters of TV infection are limited; future research should focus on clarifying the natural history of TV.
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Affiliation(s)
| | - Ian H Spicknall
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elaine W Flagg
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - John R Papp
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kristen M Kreisel
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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15
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Spicknall IH, Kreisel KM, Weinstock HS. Estimates of the Prevalence and Incidence of Syphilis in the United States, 2018. Sex Transm Dis 2021; 48:247-252. [PMID: 33492091 DOI: 10.1097/olq.0000000000001364] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Syphilis is a genital ulcerative disease caused by the bacterium Treponema pallidum that is associated with significant complications if left untreated and can facilitate the transmission and acquisition of HIV infection. The last prevalence and incidence estimates of the burden of syphilis in the United States were for 2008. METHODS We generate syphilis prevalence and incidence estimates for 2018 among adults aged 14 to 49 years. We fit a simple mathematical model to 2018 case report data to generate 10,000 sets of estimates for age and sex subpopulations and summarize our estimates by their median (50th percentile); uncertainty intervals are characterized by their 25th (Q1) and 75th (Q3) percentiles. We also used our methodology to reestimate 2008 prevalence and incidence estimates. RESULTS In 2018, there were an estimated 156,000 (Q1, 132,000; Q3, 184,000) prevalent and 146,000 (Q1, 126,000; Q3, 170,000) incident syphilitic infections in people aged 14 to 49 years. Men accounted for roughly 70% of prevalent infections and more than 80% of incident infections. In both sexes, there were more prevalent and incident infections in 25- to 49-year-olds than 14- to 24-year-olds. Using these methods to reanalyze 2008 data, syphilis prevalence and incidence estimates have increased 164% and 175%, respectively, between 2008 and 2018. DISCUSSION Although not as common as other sexually transmitted infections, syphilis should be monitored because of its devastating sequelae. As it continues to increase in frequency, it will be important for future work to continue to track its trajectory and burden.
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Affiliation(s)
- Ian H Spicknall
- From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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16
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Role of saliva use during masturbation in the transmission of Chlamydia trachomatis in men who have sex with men. Epidemiol Infect 2021. [PMCID: PMC8506448 DOI: 10.1017/s0950268821001941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Masturbation is a common sexual practice in men, and saliva is often used as a lubricant during masturbation by men who have sex with men. However, the role of saliva use during masturbation in the transmission of chlamydia is still unclear. We developed population-level, susceptible-infected-susceptible compartmental models to explore the role of saliva use during masturbation on the transmission of chlamydia at multiple anatomical sites. In this study, we simulated both solo masturbation and mutual masturbation. Our baseline model did not include masturbation but included transmission routes (anal sex, oral-penile sex, rimming, kissing and sequential sexual practices) we have previously validated (model 1). We added masturbation to model 1 to develop the second model (model 2). We calibrated the model to five clinical datasets separately to assess the effects of masturbation on the prevalence of site-specific infection. The inclusion of masturbation (model 2) significantly worsened the ability of the models to replicate the prevalence of C. trachomatis. Using model 2 and the five data sets, we estimated that saliva use during masturbation was responsible for between 3.9% [95% confidence interval (CI) 2.0–6.8] and 6.2% (95% CI 3.8–10.5) of incident chlamydia cases at all sites. Our models suggest that saliva use during masturbation is unlikely to play a major role in chlamydia transmission between men, and even if it does have a role, about one in seven cases of urethral chlamydia might arise from masturbation.
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17
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Xu X, Chow EPF, Ong JJ, Hoebe CJPA, Williamson D, Shen M, Kong FYS, Hocking JS, Fairley CK, Zhang L. Modelling the contribution that different sexual practices involving the oropharynx and saliva have on Neisseria gonorrhoeae infections at multiple anatomical sites in men who have sex with men. Sex Transm Infect 2020; 97:183-189. [PMID: 33208511 DOI: 10.1136/sextrans-2020-054565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The spectrum of sexual practices that transmit Neisseria gonorrhoeae in men who have sex with men (MSM) is controversial. No studies have modelled potential Neisseria gonorrhoeae transmission when one sexual practice follows another in the same sexual encounter ('sequential sexual practices'). Our aim was to test what sequential practices were necessary to replicate the high proportion of MSM who have more than one anatomical site infected with gonorrhoea ('multisite infection'). METHODS To test our aim, we developed eight compartmental models. We first used a baseline model (model 1) that included no sequential sexual practices. We then added three possible sequential transmission routes to model 1: (1) oral sex followed by anal sex (or vice versa) (model 2); (2) using saliva as a lubricant for penile-anal sex (model 3) and (3) oral sex followed by oral-anal sex (rimming) or vice versa (model 4). The next four models (models 5-8) used combinations of the three transmission routes. RESULTS The baseline model could only replicate infection at the single anatomical site and underestimated multisite infection. When we added the three transmission routes to the baseline model, oral sex, followed by anal sex or vice versa, could replicate the prevalence of multisite infection. The other two transmission routes alone or together could not replicate multisite infection without the inclusion of oral sex followed by anal sex or vice versa. CONCLUSIONS Our gonorrhoea model suggests sexual practices that involve oral followed by anal sex (or vice versa) may be important for explaining the high proportion of multisite infection.
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Affiliation(s)
- Xianglong Xu
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason J Ong
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Christian J P A Hoebe
- Department of Infectious Diseases, South Limburg Public Health Services, Geleen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Deborah Williamson
- Melbourne Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia.,Doherty Applied Microbial Genomics, Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mingwang Shen
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Fabian Yuh Shiong Kong
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane S Hocking
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Christopher K Fairley
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lei Zhang
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China .,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
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18
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Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model. BMC Med 2020; 18:326. [PMID: 33198750 PMCID: PMC7670797 DOI: 10.1186/s12916-020-01796-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It has been presumed that Chlamydia trachomatis is transmitted between men only through anal or oral sex, but no mathematical models have tested this presumption. METHODS To test this presumption, we created 20 compartmental mathematical models of different sexual practices that included both oral and anal sex and calibrated these models to the observed rates of Chlamydia trachomatis infection at three anatomical sites from 4888 men who have sex with men (MSM) in Melbourne Sexual Health Centre during 2018-2019. RESULTS A model that included only oral and anal sex could replicate the observed rates of single-site infection at the oropharynx, urethra and rectum alone, but could not replicate infection at more than one of these sites (multisite). However, if we included transmission from sexual practices that followed one another in the same sexual episode (e.g. saliva contamination of the penis from oral sex transmitting chlamydia to the rectum by anal sex), we significantly improved the calibration of multisite infection rates substantially. CONCLUSIONS Our modelling study suggests that transmission routes other than just oral and anal sex are necessary to explain the high rate of Chlamydia trachomatis infection at more than one site.
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Chow EPF, Fairley CK. The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission. J Int AIDS Soc 2019; 22 Suppl 6:e25354. [PMID: 31468730 PMCID: PMC6715946 DOI: 10.1002/jia2.25354] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/26/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Gonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade. The majority of cases are extragenital and occur at the oropharynx and anorectum. The aim of this narrative review was to review the risk factors and mode of transmission for gonorrhoea and chlamydia at the oropharynx and anorectum among MSM. RESULTS AND DISCUSSION New evidence suggests that oropharyngeal gonorrhoea can be transmitted by kissing in addition to through the established route of condomless oral sex; and anorectal gonorrhoea can be acquired when saliva is used as a lubricant for anal sex and rimming in addition to the established route of condomless penile-anal sex in MSM. In contrast, condomless penile-anal sex remains the major route for chlamydia transmission. CONCLUSIONS Substantial transmission of gonorrhoea may occur with practices other than the established routes of condomless oral and/or anal sex and hence condoms may not be effective in preventing gonorrhoea transmission to extragenital sites. In contrast, condoms are effective for chlamydia control because it is mainly transmitted through condomless penile-anal sex. Novel interventions for gonorrhoea that reduce the risk of transmission at extragenital site are required.
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Affiliation(s)
- Eric PF Chow
- Melbourne Sexual Health CentreAlfred HealthCarltonVICAustralia
- Central Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Christopher K Fairley
- Melbourne Sexual Health CentreAlfred HealthCarltonVICAustralia
- Central Clinical SchoolMonash UniversityMelbourneVICAustralia
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Erratum - Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex with Men. Sex Transm Dis 2019; 46:e86. [DOI: 10.1097/olq.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fairley CK, Cornelisse VJ, Hocking JS, Chow EPF. Models of gonorrhoea transmission from the mouth and saliva. THE LANCET. INFECTIOUS DISEASES 2019; 19:e360-e366. [PMID: 31324517 DOI: 10.1016/s1473-3099(19)30304-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 11/28/2022]
Abstract
This Personal View argues for a new framework of gonorrhoea transmission in men who have sex with men in which the oropharynx plays a major role in transmitting gonorrhoea to, or acquiring gonorrhoea from, their partner's oropharynx, penis, or anorectum through either direct contact or via saliva. To avoid preconceived notions of transmission dynamics, we ask readers to imagine that they are investigating a new sexually transmitted infection. On the basis of the existing clinical and epidemiological data for gonorrhoea at the penis, oropharynx, and anorectum site, we develop two models for transmission: the so-called penile model and the so-called oropharyngeal model. We argue that the existing epidemiological data and behavioural data best fit the oropharyngeal model. Our argument rests on the observation that, at the population level, the prevalence of urethral gonorrhoea is too rare to explain the high incidence of oropharynx and anorectum infection. We describe studies of gonorrhoea detection in saliva, saliva use during sex, epidemiological studies of kissing and oropharyngeal gonorrhoea, as well as studies aided by mathematical models. Finally, we argue that the correlation between sexual acts (eg, kissing, oral sex, anal sex, and saliva use) is so high that any epidemiological study that does not measure these factors will be prone to confounding.
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Affiliation(s)
- Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Vincent J Cornelisse
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jane S Hocking
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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