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Abed A, Torabi M, Mashreghi Z. Gonorrhea cluster detection in Manitoba, Canada: Spatial, temporal, and spatio-temporal analysis. Infect Dis Model 2024; 9:1045-1056. [PMID: 38974897 PMCID: PMC11222937 DOI: 10.1016/j.idm.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 07/09/2024] Open
Abstract
In Canada, Gonorrhea infection ranks as the second most prevalent sexually transmitted infection. In 2018, Manitoba reported an incidence rate three times greater than the national average. This study aims to investigate the spatial, temporal, and spatio-temporal patterns of Gonorrhea infection in Manitoba, using individual-level laboratory-confirmed administrative data provided by Manitoba Health from 2000 to 2016. Age and sex patterns indicate that females are affected by infections at younger ages compared to males. Moreover, there is an increase in repeated infections in 2016, accounting for 16% of the total infections. Spatial analysis at the 96 Manitoba regional health authority districts highlights significant positive spatial autocorrelation, demonstrating a clustered distribution of the infection. Northern districts of Manitoba and central Winnipeg were identified as significant clusters. Temporal analysis shows seasonal patterns, with higher infections in late summer and fall. Additionally, spatio-temporal analysis reveals clusters during high-risk periods, with the most likely cluster in the northern districts of Manitoba from January 2006 to June 2014, and a secondary cluster in central Winnipeg from June 2004 to November 2012. This study identifies that Gonorrhea infection transmission in Manitoba has temporal, spatial, and spatio-temporal variations. The findings provide vital insights for public health and Manitoba Health by revealing high-risk clusters and emphasizing the need for focused and localized prevention, control measures, and resource allocation.
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Affiliation(s)
- Amin Abed
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Mahmoud Torabi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Zeinab Mashreghi
- Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, Manitoba, R3B 2E9, Canada
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Löckener I, Behrmann LV, Reuter J, Schiefer A, Klöckner A, Krannich S, Otten C, Mölleken K, Ichikawa S, Hoerauf A, Schneider T, Pfarr KM, Henrichfreise B. The MraY Inhibitor Muraymycin D2 and Its Derivatives Induce Enlarged Cells in Obligate Intracellular Chlamydia and Wolbachia and Break the Persistence Phenotype in Chlamydia. Antibiotics (Basel) 2024; 13:421. [PMID: 38786149 PMCID: PMC11117252 DOI: 10.3390/antibiotics13050421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Chlamydial infections and diseases caused by filarial nematodes are global health concerns. However, treatment presents challenges due to treatment failures potentially caused by persisting Chlamydia and long regimens against filarial infections accompanied by low compliance. A new treatment strategy could be the targeting of the reduced peptidoglycan structures involved in cell division in the obligate intracellular bacteria Chlamydia and Wolbachia, the latter being obligate endosymbionts supporting filarial development, growth, and survival. Here, cell culture experiments with C. trachomatis and Wolbachia showed that the nucleoside antibiotics muraymycin and carbacaprazamycin interfere with bacterial cell division and induce enlarged, aberrant cells resembling the penicillin-induced persistence phenotype in Chlamydia. Enzymatic inhibition experiments with purified C. pneumoniae MraY revealed that muraymycin derivatives abolish the synthesis of the peptidoglycan precursor lipid I. Comparative in silico analyses of chlamydial and wolbachial MraY with the corresponding well-characterized enzyme in Aquifex aeolicus revealed a high degree of conservation, providing evidence for a similar mode of inhibition. Muraymycin D2 treatment eradicated persisting non-dividing C. trachomatis cells from an established penicillin-induced persistent infection. This finding indicates that nucleoside antibiotics may have additional properties that can break bacterial persistence.
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Affiliation(s)
- Iris Löckener
- Institute for Pharmaceutical Microbiology (IPM), University of Bonn, University Hospital Bonn, Meckenheimer Allee 168, 53115 Bonn, Germany (C.O.); (B.H.)
| | - Lara Vanessa Behrmann
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.V.B.)
| | - Jula Reuter
- Institute for Pharmaceutical Microbiology (IPM), University of Bonn, University Hospital Bonn, Meckenheimer Allee 168, 53115 Bonn, Germany (C.O.); (B.H.)
| | - Andrea Schiefer
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.V.B.)
| | - Anna Klöckner
- Institute for Pharmaceutical Microbiology (IPM), University of Bonn, University Hospital Bonn, Meckenheimer Allee 168, 53115 Bonn, Germany (C.O.); (B.H.)
| | - Sebastian Krannich
- Institute for Pharmaceutical Microbiology (IPM), University of Bonn, University Hospital Bonn, Meckenheimer Allee 168, 53115 Bonn, Germany (C.O.); (B.H.)
| | - Christian Otten
- Institute for Pharmaceutical Microbiology (IPM), University of Bonn, University Hospital Bonn, Meckenheimer Allee 168, 53115 Bonn, Germany (C.O.); (B.H.)
| | - Katja Mölleken
- Institute for Functional Microbial Genomics, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany;
| | - Satoshi Ichikawa
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.V.B.)
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
| | - Tanja Schneider
- Institute for Pharmaceutical Microbiology (IPM), University of Bonn, University Hospital Bonn, Meckenheimer Allee 168, 53115 Bonn, Germany (C.O.); (B.H.)
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
| | - Kenneth M. Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.V.B.)
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
| | - Beate Henrichfreise
- Institute for Pharmaceutical Microbiology (IPM), University of Bonn, University Hospital Bonn, Meckenheimer Allee 168, 53115 Bonn, Germany (C.O.); (B.H.)
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Gardella CM, Borgerding J, Maier MM, Beste LA. Chlamydial and Gonococcal Infections and Adverse Reproductive Health Conditions Among Patients Assigned Female at Birth in the Veterans Health Administration. Sex Transm Dis 2024; 51:320-324. [PMID: 38301633 DOI: 10.1097/olq.0000000000001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Reproductive age female individuals comprise the fastest-growing segment of Veterans Health Administration patients, but little is known about rates of reproductive health outcomes among those with chlamydia or gonorrhea infections. Our aim was to estimate the risk of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain in female veterans tested for chlamydia or gonorrhea. METHODS We performed a retrospective cohort analysis of female veterans tested for chlamydia or gonorrhea between January 1, 2010, and December 31, 2020. We calculated rates of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain per 100,000 person-years and used Cox proportional hazards regression models to estimate the risk of these reproductive health conditions according to infection status after adjustment for age, race, ethnicity, military sexual trauma, mental health diagnoses, and substance use disorder. RESULTS Of female veterans, 232,614 were tested at least once for chlamydia or gonorrhea, with a total of 1,665,786 person-years of follow-up. Of these, 12,971 had positive chlamydia or gonorrhea results (5.8%, 796 cases per 100,000 person-years). Compared with people who tested negative, those testing positive had double the risk of pelvic inflammatory disease (adjusted hazard ratio [aHR], 1.94; 95% confidence interval [CI], 1.81-2.07), 11% increased risk of infertility (aHR, 1.11; 95% CI, 1.04-1.18), 12% increased risk of pelvic pain (aHR, 1.12; 95% CI, 1.08-1.17), and 21% increased risk of any of these conditions (aHR, 1.21; 95% CI, 1.17-1.25). People with positive chlamydia or gonorrhea testing tended to have an increased risk of ectopic pregnancy (aHR, 1.14; 95% CI, 1.0-1.30). Among those with a positive test result, 2218 people (17.1%) had 1 or more additional positive test results. Compared with those with 1 positive test result, people with more than 1 positive test result had a significantly increased risk of pelvic inflammatory disease (aHR, 1.37; 95% CI, 1.18-1.58), infertility (aHR, 1.20; 95% CI, 1.04-1.39), and pelvic pain (aHR1.16; 95% CI, 1.05-1.28), but not ectopic pregnancy (aHR, 1.09; 95% CI, 0.80-1.47). CONCLUSIONS Female veterans with positive chlamydia or gonorrhea results experience a significantly higher risk of pelvic inflammatory disease, infertility, and pelvic pain, especially among those with repeat infection.
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Solnick RE, López LH, Martinez PM, Zucker JE. Sexually Transmitted Infections in the Emergency Department. Emerg Med Clin North Am 2024; 42:335-368. [PMID: 38641394 DOI: 10.1016/j.emc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
As the United States faces a worsening epidemic of sexually transmitted infections (STIs), emergency departments (EDs) play a critical role in identifying and treating these infections. The growing health inequities in the distribution and disproportionate impact of STIs add to the urgency of providing high-quality sexual health care through the ED. Changes in population health are reflected in the new Centers for Disease Control recommendations on screening, diagnostic testing, and treatment of STIs. This review covers common, as well as and less common or emerging STIs, and discusses the state-of-the-art guidance on testing paradigms, extragenital sampling, and antimicrobial treatment and prevention of STIs.
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Affiliation(s)
- Rachel E Solnick
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA.
| | - Laura Hernando López
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Patricia Mae Martinez
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Jason E Zucker
- Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, Box 82, New York, NY 10032, USA
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Hansman E, Mussa A, Ryan R, Babalola CM, Ramontshonyana K, Tamuthiba L, Ndlovu N, Bame B, Klausner JD, Morroni C, Wynn A. Use of Expedited Partner Therapy for Pregnant Women Treated for Sexually Transmitted Infections in Gaborone, Botswana. Sex Transm Dis 2024; 51:331-336. [PMID: 38301627 DOI: 10.1097/olq.0000000000001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Partner notification and treatment for sexually transmitted infections are critical to prevent reinfection and reduce transmission. However, partner treatment rates are low globally. Expedited partner therapy (EPT), in which the patient delivers treatment directly to their partner, may result in more partners treated. We assessed partner notification and treatment outcomes among pregnant women in Gaborone, Botswana, including EPT intent, uptake, and effectiveness. METHODS The Maduo study was a cluster-controlled trial evaluating the effect of antenatal Chlamydia trachomatis and Neisseria gonorrhoeae infection screening in pregnant women. The intervention arm received screening at first antenatal care (ANC), third-trimester, and postnatal care visits. The standard-of-care arm received screening postnatally. Participants screening positive were given options for partner treatment: contact slips, in-clinic treatment, or EPT. Self-reported partner notification and treatment outcomes were assessed at test-of-cure visit. RESULTS Of 51 women who screened positive for C. trachomatis / N. gonorrhoeae at first ANC and returned for test of cure, 100% reported notifying their partner and 48 (94.1%) reported their partner received treatment. At third trimester 100% (n = 5), reported partners were treated. Before testing, EPT intent was lower than EPT uptake at all time points (first ANC: 17.9% vs. 80.4%; third-trimester: 57.1% vs. 71.4%; postnatal care: 0% vs. 80.0%). Partner treatment success was 100% among EPT users compared with 70% among nonusers ( P = 0.006). CONCLUSIONS Partner notification and treatment success was high in this population. Despite low pretest intent to use EPT, uptake was high and associated with greater partner treatment success. Our findings suggest that EPT may be a successful partner treatment strategy to pursue in low- and middle-income countries.
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Affiliation(s)
| | | | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Chibuzor M Babalola
- Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA
| | | | - Lefhela Tamuthiba
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Neo Ndlovu
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Bame Bame
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA
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Okwuraiwe AP, Ogbonne EL, Adeniyi AO, Ihurhe PI, Musa BO, Abe TR, Shodipe OO, Audu RA. Detection of High-Risk Human Papillomavirus Genotypes Among HIV-Infected Women in Four States in Nigeria. Cureus 2024; 16:e57120. [PMID: 38681319 PMCID: PMC11055541 DOI: 10.7759/cureus.57120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction The World Health Organization states that almost all cervical cancer cases are linked to infection with high-risk human papillomaviruses transmitted through sexual contact. Implementing effective surveillance and preventive measures would enable the prevention of most cervical cancer cases, especially in HIV-infected women. Every year, about 12,000 women in Nigeria are diagnosed, with almost 8,000 deaths. HPV cervical cancer testing capacity is low in Nigeria. Testing scale-up and sensitization efforts across health facilities, including cervical tissue sample collection, are needed to reduce the cases of cervical cancer. This study aimed to assess the genotype-specific prevalence of clinically relevant high-risk HPV among women living with HIV in Nigeria. Methods A descriptive, cross-sectional study was conducted among adult HIV-infected women attending health facilities in four Nigerian states. From August to October 2022, cervical tissue was collected into PCR cell media, transported to the Nigerian Institute of Medical Research, and assayed for HPV presence and genotype using the Cobas 6800 System (Roche Diagnostics). Statistical analysis was conducted with Stata 2. Results A total of 4423 cervical swab samples were tested. The ages of women ranged from 18 to 72 years (mean 36.61±8.61). In our study, we found that 16.3% of participants tested positive for HPV. Among the high-risk HPV genotypes detected, HPV16 was present in 1.44% of participants, HPV18 in 1.29%, and other high-risk HPV (OHR-HPV) in 11.35%. Additionally, co-infections were observed, with 0.98% of participants testing positive for both HPV16 and OHR-HPV, 1.12% for HPV18 and OHR-HPV, and 0.12% for HPV16, HPV18, and OHR-HPV concurrently. However, 7.4% of the total results were deemed invalid. Conclusion OHR-HPV is prevalent among HIV-infected women across the north and west geopolitical zones of Nigeria. Policies and interventions geared towards curtailing the incidence of cervical cancer are fervently solicited.
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Affiliation(s)
- Azuka P Okwuraiwe
- Genomics Strategic Core Platform, Medical Research Council Unit, Banjul, GMB
- Microbiology, Nigerian Institute of Medical Research, Yaba, NGA
| | - Ebere L Ogbonne
- Microbiology, Nigerian Institute of Medical Research, Yaba, NGA
| | | | | | - Blessing O Musa
- Microbiology, Nigerian Institute of Medical Research, Yaba, NGA
| | - Temilade R Abe
- Microbiology, Nigerian Institute of Medical Research, Yaba, NGA
| | | | - Rosemary A Audu
- Microbiology, Nigerian Institute of Medical Research, Yaba, NGA
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Klasner C, Macintyre AN, Brown SE, Bavoil P, Ghanem KG, Nylander E, Ravel J, Tuddenham S, Brotman RM. A Narrative Review on Spontaneous Clearance of Urogenital Chlamydia trachomatis: Host, Microbiome, and Pathogen-Related Factors. Sex Transm Dis 2024; 51:112-117. [PMID: 38290156 PMCID: PMC11017733 DOI: 10.1097/olq.0000000000001905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection in the United States. Untreated urogenital infection in women can result in adverse sequelae such as pelvic inflammatory disease and infertility. Despite national screening and treatment guidelines, rates continue to rise; because most infections are asymptomatic, the actual prevalence of CT infection is likely significantly higher than reported. Spontaneous clearance of CT in women (in the absence of antibiotic treatment) has been described in multiple epidemiologic studies. Given the serious consequences and high prevalence of CT infection, there is growing interest in understanding this phenomenon and factors that may promote CT clearance in women. Spontaneous CT clearance is likely the result of complex interactions between CT, the host immune system, and the vaginal microbiota (i.e., the communities of bacteria inhabiting the vagina), which has been implicated in CT acquisition. Herein, we briefly review current literature regarding the role of each of these factors in spontaneous CT clearance, identify knowledge gaps, and discuss future directions and possible implications for the development of novel interventions that may protect against CT infection, facilitate clearance, and prevent reproductive sequelae.
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Affiliation(s)
- Carson Klasner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew N. Macintyre
- Duke Human Vaccine Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sarah E. Brown
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Khalil G. Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elisabeth Nylander
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca M. Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Markowitz MA, Ackerman-Banks CM, Oliveira CR, Fashina O, Pathy SR, Sheth SS. Expedited Partner Therapy: A Multicomponent Initiative to Boost Provider Counseling. Sex Transm Dis 2024; 51:15-21. [PMID: 37921862 DOI: 10.1097/olq.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Expedited partner therapy prescription remains low and highly variable throughout the United States, leading to frequent reinfections with Chlamydia trachomatis and Neisseria gonorrhoeae . We examined provider counseling on expedited partner therapy before and after an electronic smart tool-based initiative. METHODS In this quasi-experimental interrupted time-series study, we implemented an initiative of electronic smart tools and education for expedited partner therapy in March 2020. We reviewed the records of patients with chlamydia and/or gonorrhea at an urban, academic obstetrics and gynecology clinic in the preimplementation (March 2019-February 2020) and postimplementation (March 2020-February 2021) groups. Descriptive statistics and an interrupted time-series model were used to compare the percent of expedited partner therapy offered by clinicians to patients in each group. RESULTS A total of 287 patient encounters were analyzed, 155 preintervention and 132 postintervention. An increase in expedited partner therapy counseling of 13% (95% confidence interval [CI], 2%-24%) was observed before the intervention (27.1% [42 of 155]) versus after the intervention (40.2% [53 of 132]). Significant increases in provider counseling were seen for patients who were single (15%; 95% CI, 3%-26%), 25 years or older (21%; 95% CI, 6%-37%), receiving public insurance (15%; 95% CI, 3%-27%), seen by a registered nurse (18%; 95% CI, 4%-32%), or seen for an obstetrics indication (21%; 95% CI, 4%-39%). No difference was seen in patients' acceptance of expedited partner therapy ( P = 1.00). CONCLUSIONS A multicomponent initiative focused on electronic smart tools is effective at increasing provider counseling on expedited partner therapy. Further research to understand patient perceptions and acceptance of expedited partner therapy is critical.
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Affiliation(s)
| | | | | | | | - Shefali R Pathy
- From the Department of Obstetrics, Gynecology and Reproductive Sciences
| | - Sangini S Sheth
- From the Department of Obstetrics, Gynecology and Reproductive Sciences
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Kumbaroff Z, Duff P, Saxton P, Sonder GJB, Thirkell C, Scott J, Walls T, Anglemyer A. Sexually Transmitted Infections and the Risk of Reinfection Within 12 Months: A Population-Based Cohort. Sex Transm Dis 2023; 50:775-781. [PMID: 37824285 DOI: 10.1097/olq.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Chlamydia, gonorrhea, and syphilis are common sexually transmitted infections that disproportionately affect specific groups in New Zealand (NZ). Predictors of reinfection are not well studied in NZ but could inform public health strategies to decrease sexually transmitted infection (STI) incidence. METHODS New Zealand-wide chlamydia, gonorrhea, and syphilis cases during 2019 were identified using nationally collected data. Cases were followed-up to identify reinfection with the same STI within 12 months of initial infections. Logistic regression models were used to identify predictors for each STI reinfection. RESULTS Determinants identified for increased odds of chlamydia reinfection were age groups 16-19 and 20-24 years, females, Māori and Pacific peoples, cases in the Northern region, and cases with at least one test before the initial infection. Age 40 years and older was associated with lower odds of gonorrhea reinfection, as was being of Asian ethnicity, living in Midland or Southern regions, and reporting heterosexual behavior. Region was the only statistically significant predictor for syphilis reinfection, with higher odds of reinfection for people living in the Central region. CONCLUSIONS Our findings reflect disproportionate STI rates for some groups in NZ, with younger age groups, Māori and Pacific peoples, men who have sex with men, and people living in the Northern region experiencing higher odds of reinfection. Groups identified with higher odds for reinfection require increased access to culturally responsive health services to treat, understand, and prevent possible reinfection. Changes to current public health strategies could include culturally specific behavioral counseling, and improvements to and adherence to effective contract tracing.
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Affiliation(s)
- Zoe Kumbaroff
- From the Health Intelligence Team, Institute of Environmental Science and Research, Wellington
| | - Putu Duff
- From the Health Intelligence Team, Institute of Environmental Science and Research, Wellington
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland
| | | | - Callum Thirkell
- From the Health Intelligence Team, Institute of Environmental Science and Research, Wellington
| | - Julia Scott
- From the Health Intelligence Team, Institute of Environmental Science and Research, Wellington
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch
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Gupta K, Wiener HW, Tiwari HK, Geisler WM. HLA-DQB1*06 and Select Neighboring HLA Variants Predict Chlamydia Reinfection Risk. Int J Mol Sci 2023; 24:15803. [PMID: 37958786 PMCID: PMC10647357 DOI: 10.3390/ijms242115803] [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: 09/21/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Associations of HLA class II alleles with genital chlamydial infection outcomes have been reported, especially HLA DQB1*06. However, the potential role of DQB1*06 in influencing reinfection risk has still not been established. The purpose of this study was to determine whether the association of DQB1*06 with chlamydia reinfection was impacted by any other nearby HLA class II variants that were also associated with reinfection. We used next-generation sequencing to map HLA class II variants spanning the HLA-DQ and -DR loci. DQB1*06 as well as DQB1*04 were confirmed as significant predictors of chlamydia reinfection, when controlling for age and percent African ancestry. SKAT analysis revealed one region each in DRB1, DRB5, DQA2, and three intergenic regions that had variants associated with reinfection. Further analyses of these variants revealed that rs112651494 within DRB5 and an intergenic SNP rs617058 in DRB1:DQA1 were significantly associated with reinfection, but this did not impact the significance of the association of DQB1*06 or DQB1*04 with reinfection.
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Affiliation(s)
- Kanupriya Gupta
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Howard W. Wiener
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Hemant K. Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - William M. Geisler
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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López de Munain J, Cámara Pérez MDM, López Martinez M, Alava Menica JA, Hernandez Ragpa L, Imaz Pérez M, Teijeiro Pulido MJ, Mojas Díez I, de la Peña Trigueros M, Díaz de Tuesta Del Arco JL, Muñoz Sánchez J. Alarming incidence of reinfections after treatment for Chlamydia trachomatis and gonorrhoea: Can we predict and prevent them? ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:269-277. [PMID: 36610838 DOI: 10.1016/j.eimce.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/14/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are a public health problem, worsened by frequent reinfections, whose incidence rate is not known in Spain. The objective of this study is to estimate in patients diagnosed with NG, CT or mixed infection (NG and CT): (1) the incidence of reinfections by the same microorganism, (2) the total incidence of Sexually Transmitted Infections (STI), both by the same microorganism and by infections other than the initial one, and (3) to identify predictors of reinfection. METHODS Observational prospective case series involving 986 patients with CT and/or NG at specialized STI clinics in Biscay (Spain) between 2016 and 2019. RESULTS The six month cumulative incidence of reinfection by the same microorganism was 17.24% (CI95%: 14.9-19.7) and 24.65% (CI95%: 21.9-27.4) for any STI (reinfection or other). Being an immigrant (OR=1.8; CI95%: 1.3-2.6), men who have sex with men (OR=1.8; CI95%: 1.3-2.6), number of sexual partners (OR=4.3; CI95%: 2.7-6.8 for more than 5 partners), having a new partner (OR=1.7; CI95%: 1.08-2.6), not always using a condom (OR=1.4; CI95%: 1.02-1.9) and consumption of alcohol prior to sex (OR=3.8; CI95%: 1.5-9.5) were associated with reinfection by any STI. CONCLUSION These characteristics allow doctors to identify patients in whom to prioritize short-term rescreening for repeated infections with any STIs after initial treatment for NG or CT.
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Affiliation(s)
- Josefina López de Munain
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain; Biocruces-Bizkaia Research Institute, Barakaldo, Bizkaia, Spain.
| | - Maria Del Mar Cámara Pérez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Miriam López Martinez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Jose Angel Alava Menica
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Leonora Hernandez Ragpa
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Manuel Imaz Pérez
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Maria José Teijeiro Pulido
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Iker Mojas Díez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Mireia de la Peña Trigueros
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Jose Luis Díaz de Tuesta Del Arco
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Josefa Muñoz Sánchez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain; Biocruces-Bizkaia Research Institute, Barakaldo, Bizkaia, Spain
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12
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Schirmer P, Sharma A, Lucero-Obusan C, Oda G, Holodniy M. Trends in Follow-up Testing Among Patients Positive for Chlamydia and Gonorrhea in the Veterans Health Administration, 2013 to 2019. Sex Transm Dis 2023; 50:258-264. [PMID: 36649595 PMCID: PMC10097481 DOI: 10.1097/olq.0000000000001765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommends testing patients with chlamydia (CT)/gonorrhea (GC) for other sexually transmitted infections (STIs) and repeating CT/GC testing 3 to 12 months later. We assessed repeat CT/GC testing and testing for HIV/syphilis in accordance with CDC guidelines in the US Veterans Health Administration. METHODS Molecular laboratory testing for CT/GC during January 1, 2013-December 31, 2020 was retrieved from Veterans Health Administration data sources. Patients were evaluated for syphilis, HIV, and repeat CT/GC testing within 1 year after a positive CT/GC test result. Differences of CT/GC-positive patients associated with receiving recommended testing were assessed using χ2 /Fisher exact tests. RESULTS A total of 41,630 of 1,005,761 CT (4.1%) and 17,649 of 1,013,198 GC (1.7%) results were positive. Median ages of positive CT/GC patients were 29 and 36 years, respectively. Repeat testing rates for CT/GC within 90 to 119 days were 3.9% and 2.9%, and rates within 90 to 365 days were 32.8% and 34.7%, with 8.6% and 15% being positive again, respectively. Guideline-compatible repeat testing in known HIV-positive patients nearly doubled (75.7% for CT and 67.8% for GC). The CDC-recommended HIV testing was performed for 72.4% and 65.5% CT and GC first positives, respectively, whereas syphilis testing was completed for 66.5% and 60.5% CT and GC, respectively. Compared with 25- to 34-year-old patients with CT or GC, those younger than 25 years had higher odds of guideline-discordant repeat testing but had lower odds of not receiving HIV/syphilis testing. CONCLUSIONS Nearly two-thirds of patients did not receive recommended repeat testing, and nearly one-third were not tested for HIV/syphilis. Veterans Health Administration providers may benefit from additional education on CDC-recommended sexually transmitted infection guidelines and testing recommendations.
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Affiliation(s)
| | - Aditya Sharma
- From the VHA Public Health National Program Office, Palo Alto
| | | | - Gina Oda
- From the VHA Public Health National Program Office, Palo Alto
| | - Mark Holodniy
- From the VHA Public Health National Program Office, Palo Alto
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA
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Tamarelle J, Penaud B, Tyssandier B, Guichoux E, de Barbeyrac B, Peuchant O. Effects of azithromycin and doxycycline on the vaginal microbiota of women with urogenital Chlamydia trachomatis infection: a substudy of the Chlazidoxy randomized controlled trial. Clin Microbiol Infect 2023:S1198-743X(23)00193-3. [PMID: 37100225 DOI: 10.1016/j.cmi.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Dysbiotic bacterial communities within the vagina are associated with Chlamydia trachomatis infection. We compared the effect of treatment with azithromycin and doxycycline on the vaginal microbiota in a cohort of women with a urogenital C. trachomatis infection randomly assigned to one of these treatments (Chlazidoxy trial). METHODS We analysed vaginal samples from 284 women (135 in the azithromycin group and 149 in the doxycycline group) collected at baseline and 6 weeks after treatment initiation. The vaginal microbiota was characterized using 16S rRNA gene sequencing and classified into community state types (CSTs). RESULTS At baseline, 75% (212/284) of the women had a high-risk microbiota (CST-III or CST-IV). A cross-sectional comparison 6 weeks after treatment showed that 15 phylotypes were differentially abundant, but this difference was not reflected at the CST (p=0.772) or diversity level (p=0.339). Between baseline and the 6-week visit, α-diversity (p=0.140) and transition probabilities between CSTs were not significantly different between the groups, and no phylotype was differentially abundant. CONCLUSION In women with urogenital C. trachomatis infection, the vaginal microbiota does not seem to be affected by azithromycin or doxycycline 6 weeks after treatment. Because the vaginal microbiota remains susceptible to C. trachomatis infection (with CST-III or CST-IV) following antibiotic treatment, women remain at risk of reinfection, which could originate from unprotected sexual intercourse or untreated anorectal C. trachomatis infection. This last consideration advocates for the use of doxycycline instead of azithromycin because of its higher anorectal microbiological cure rate.
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Affiliation(s)
- Jeanne Tamarelle
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland.
| | | | | | | | - Bertille de Barbeyrac
- Bordeaux University Hospital, Bacteriology department, French National Reference Center for bacterial STIs, F-33000 Bordeaux, France
| | - Olivia Peuchant
- Bordeaux University Hospital, Bacteriology department, French National Reference Center for bacterial STIs, F-33000 Bordeaux, France; Univ. Bordeaux, CNRS, Microbiologie Fondamentale et Pathogénicité, UMR 5234, F-33000, Bordeaux, France.
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14
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Xu X, Chow EPF, Fairley CK, Chen M, Aguirre I, Goller J, Hocking J, Carvalho N, Zhang L, Ong JJ. Determinants and prediction of Chlamydia trachomatis re-testing and re-infection within 1 year among heterosexuals with chlamydia attending a sexual health clinic. Front Public Health 2023; 10:1031372. [PMID: 36711362 PMCID: PMC9880158 DOI: 10.3389/fpubh.2022.1031372] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
Background Chlamydia trachomatis (chlamydia) is one of the most common sexually transmitted infections (STI) globally, and re-infections are common. Current Australian guidelines recommend re-testing for chlamydia 3 months after treatment to identify possible re-infection. Patient-delivered partner therapy (PDPT) has been proposed to control chlamydia re-infection among heterosexuals. We aimed to identify determinants and the prediction of chlamydia re-testing and re-infection within 1 year among heterosexuals with chlamydia to identify potential PDPT candidates. Methods Our baseline data included 5,806 heterosexuals with chlamydia aged ≥18 years and 2,070 re-tested for chlamydia within 1 year of their chlamydia diagnosis at the Melbourne Sexual Health Center from January 2, 2015, to May 15, 2020. We used routinely collected electronic health record (EHR) variables and machine-learning models to predict chlamydia re-testing and re-infection events. We also used logistic regression to investigate factors associated with chlamydia re-testing and re-infection. Results About 2,070 (36%) of 5,806 heterosexuals with chlamydia were re-tested for chlamydia within 1 year. Among those retested, 307 (15%) were re-infected. Multivariable logistic regression analysis showed that older age (≥35 years old), female, living with HIV, being a current sex worker, patient-delivered partner therapy users, and higher numbers of sex partners were associated with an increased chlamydia re-testing within 1 year. Multivariable logistic regression analysis also showed that younger age (18-24 years), male gender, and living with HIV were associated with an increased chlamydia re-infection within 1 year. The XGBoost model was the best model for predicting chlamydia re-testing and re-infection within 1 year among heterosexuals with chlamydia; however, machine learning approaches and these self-reported answers from clients did not provide a good predictive value (AUC < 60.0%). Conclusion The low rate of chlamydia re-testing and high rate of chlamydia re-infection among heterosexuals with chlamydia highlights the need for further interventions. Better targeting of individuals more likely to be re-infected is needed to optimize the provision of PDPT and encourage the test of re-infection at 3 months.
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Affiliation(s)
- Xianglong Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ivette Aguirre
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia
| | - Jane Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Natalie Carvalho
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China,*Correspondence: Lei Zhang ✉
| | - Jason J. Ong
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom,Jason J. Ong ✉
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15
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Free C, Palmer MJ, Potter K, McCarthy OL, Jerome L, Berendes S, Gubijev A, Knight M, Jamal Z, Dhaliwal F, Carpenter JR, Morris TP, Edwards P, French R, Macgregor L, Turner KME, Baraitser P, Hickson FCI, Wellings K, Roberts I, Bailey JV, Hart G, Michie S, Clayton T, Devries K. Behavioural intervention to reduce sexually transmitted infections in people aged 16–24 years in the UK: the safetxt RCT. PUBLIC HEALTH RESEARCH 2023. [DOI: 10.3310/dane8826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background
The prevalence of genital chlamydia and gonorrhoea is higher in the 16–24 years age group than those in other age group. With users, we developed the theory-based safetxt intervention to reduce sexually transmitted infections.
Objectives
To establish the effect of the safetxt intervention on the incidence of chlamydia/gonorrhoea infection at 1 year.
Design
A parallel-group, individual-level, randomised superiority trial in which care providers and outcome assessors were blinded to allocation.
Setting
Recruitment was from 92 UK sexual health clinics.
Participants
Inclusion criteria were a positive chlamydia or gonorrhoea test result, diagnosis of non-specific urethritis or treatment started for chlamydia/gonorrhoea/non-specific urethritis in the last 2 weeks; owning a personal mobile phone; and being aged 16–24 years.
Allocation
Remote computer-based randomisation with an automated link to the messaging system delivering intervention or control group messages.
Intervention
The safetxt intervention was designed to reduce sexually transmitted infection by increasing partner notification, condom use and sexually transmitted infection testing before sex with new partners. It employed educational, enabling and incentivising content delivered by 42–79 text messages over 1 year, tailored according to type of infection, gender and sexuality.
Comparator
A monthly message regarding trial participation.
Main outcomes
The primary outcome was the incidence of chlamydia and gonorrhoea infection at 12 months, assessed using nucleic acid amplification tests. Secondary outcomes at 1 and 12 months included self-reported partner notification, condom use and sexually transmitted infection testing prior to sex with new partner(s).
Results
Between 1 April 2016 and 23 November 2018, we assessed 20,476 people for eligibility and consented and randomised 6248 participants, allocating 3123 to the safetxt intervention and 3125 to the control. Primary outcome data were available for 4675 (74.8%) participants. The incidence of chlamydia/gonorrhoea infection was 22.2% (693/3123) in the intervention group and 20.3% (633/3125) in the control group (odds ratio 1.13, 95% confidence interval 0.98 to 1.31). There was no evidence of heterogeneity in any of the prespecified subgroups. Partner notification was 85.6% in the intervention group and 84.0% in the control group (odds ratio 1.14, 95% confidence interval 0.99 to 1.33). At 12 months, condom use at last sex was 33.8% in the intervention group and 31.2% in the control group (odds ratio 1.14, 95% confidence interval 1.01 to 1.28) and condom use at first sex with most recent new partner was 54.4% in the intervention group and 48.7% in the control group (odds ratio 1.27, 95% confidence interval 1.11 to 1.45). Testing before sex with a new partner was 39.5% in the intervention group and 40.9% in the control group (odds ratio 0.95, 95% confidence interval 0.82 to 1.10). Having two or more partners since joining the trial was 56.9% in the intervention group and 54.8% in the control group (odds ratio 1.11, 95% confidence interval 1.00 to 1.24) and having sex with someone new since joining the trial was 69.7% in the intervention group and 67.4% in the control group (odds ratio 1.13, 95% confidence interval 1.00 to 1.28). There were no differences in safety outcomes. Additional sensitivity and per-protocol analyses showed similar results.
Limitations
Our understanding of the mechanism of action for the unanticipated effects is limited.
Conclusions
The safetxt intervention did not reduce chlamydia and gonorrhoea infections, with slightly more infections in the intervention group. The intervention increased condom use but also increased the number of partners and new partners. Randomised controlled trials are essential for evaluating health communication interventions, which can have unanticipated effects.
Future work
Randomised controlled trials evaluating novel interventions in this complex area are needed.
Trial registration
This trial is registered as ISRCTN64390461.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Caroline Free
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kimberley Potter
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona L McCarthy
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lauren Jerome
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Sima Berendes
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Megan Knight
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Zahra Jamal
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Farandeep Dhaliwal
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - James R Carpenter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim P Morris
- Medical Research Council Clinical Trials Unit, London, UK
| | - Phil Edwards
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca French
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Macgregor
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Katy ME Turner
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | | | - Ford CI Hickson
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia V Bailey
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Graham Hart
- Department of Infection and Population Health, University College London, London, UK
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Tim Clayton
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen Devries
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Grunnill M, Hall I, Finnie T. Check your assumptions: Further scrutiny of basic model frameworks of antimicrobial resistance. J Theor Biol 2022; 554:111277. [PMID: 36150539 DOI: 10.1016/j.jtbi.2022.111277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 01/14/2023]
Abstract
Since the mid-1990s, growing concerns over antimicrobial resistant (AMR) organisms has led to an increase in the use of mathematical models to explore the inter-host transmission of such infections. Previous work reviewing such models categorised them into generic frameworks based on their underlying assumptions. These assumptions dictated the coexistence between AMR and antimicrobial sensitive strains. We add to this work performing stability analyses of the frameworks, along with simulating them deterministically and stochastically. Stability analyses found that many of these assumptions lead to models having the same equilibria, but showed differences in the equilibria's stability between models. Deterministic simulations reveal that assuming replacement of one infecting strain by another leads to an unusual antimicrobial treatment threshold. Increasing beyond this threshold causes a discontinuous increase in disease burden. The cost of AMR to pathogen fitness (lowered transmission) dictates both the threshold of treatment that causes the discontinuous increase in disease burden and the size of that increase. It was also shown that Superinfection states can be biased against resident strains and so favour coexistence of both strains. Stochastic simulations demonstrated that differing scenario starting conditions can guide models to converge upon equilibria that they may not have under deterministic simulation. These findings highlight the importance of checking assumptions when modelling AMR and strain competition more widely.
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Affiliation(s)
- Martin Grunnill
- Laboratory of Applied Mathematics (LIAM), York University, North York, M3J 3K1, Ontario, Canada.
| | - Ian Hall
- Department of Mathematics, University of Manchester, Manchester, M13 9PL, Greater Manchester, United Kingdom
| | - Thomas Finnie
- Directorate of Emergency Preparedness, Resilience and Response, UK Health Security Agency, Porton Down, Salisbury, SP4 0JG, Wiltshire, United Kingdom
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17
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Marconi A, Falk-Hanson E, Gage J. Adherence to chlamydia and gonorrhea follow up testing in a college population. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2289-2294. [PMID: 33400634 DOI: 10.1080/07448481.2020.1851232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/17/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Objectives: To examine differences in compliance to follow-up for STD based on demographic, clinical and academic characteristics. Methods: Cross-sectional study examining associations between clinical, demographic and academic variables and compliance to follow-up for STDs in a college population. Participants: Chart review data collected at University Health Services (UHS) UW- Madison, where 449 cases were reported in 2017. Results: Final model includes sex, sex of partners and its interaction. It shows no significant difference in follow-up for males compared to females or for students having partners of the same sex nor students having partners of the same and different sex. Finally, when interactions are introduced, males having partners of a different sex were significantly associated with less compliant follow-up (AOR: 10.36; 95% CI= 1.57- 68.35). Conclusions: The effect of the sexual partners in noncompliance differs by sex. Males with partners of a different sex were 10 times more likely to noncompliance to follow up than females with partners of a different sex.
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Affiliation(s)
- Agustina Marconi
- University Health Services, University of Wisconsin, Madison, Wisconsin, USA
| | - Elizabeth Falk-Hanson
- Women's Health and Sexual Health Clinics, University Health Services, University of Wisconsin, Madison, Wisconsin, USA
| | - Janine Gage
- Sexual Health Clinic University Health Services, University of Wisconsin, Wisconsin, USA
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18
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Teixeira da Silva D, Petsis D, Santos T, Mahajan A, Bonett S, Wood S. Chlamydia Trachomatis/Neisseria Gonorrhea Retesting Among Adolescents and Young Adults in a Primary Care Network. J Adolesc Health 2022; 71:545-551. [PMID: 35963759 PMCID: PMC9588690 DOI: 10.1016/j.jadohealth.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. METHODS We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting. RESULTS Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period. DISCUSSION Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.
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Affiliation(s)
- Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle Petsis
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tatiane Santos
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjali Mahajan
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephen Bonett
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Wood
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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19
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Wang J, Wang K. New insights into Chlamydia pathogenesis: Role of leukemia inhibitory factor. Front Cell Infect Microbiol 2022; 12:1029178. [PMID: 36329823 PMCID: PMC9623337 DOI: 10.3389/fcimb.2022.1029178] [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: 08/26/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Chlamydia trachomatis (Ct) is the leading cause of bacterial sexually transmitted infections worldwide. Since the symptoms of Ct infection are often subtle or absent, most people are unaware of their infection until they are tested or develop severe complications such as infertility. It is believed that the primary culprit of Ct-associated tissue damage is unresolved chronic inflammation, resulting in aberrant production of cytokines, chemokines, and growth factors, as well as dysregulated tissue influx of innate and adaptive immune cells. A member of the IL-6 cytokine family, leukemia inhibitory factor (LIF), is one of the cytokines induced by Ct infection but its role in Ct pathogenesis is unclear. In this article, we review the biology of LIF and LIF receptor (LIFR)-mediated signaling pathways, summarize the physiological role of LIF in the reproductive system, and discuss the impact of LIF in chronic inflammatory conditions and its implication in Ct pathogenesis. Under normal circumstances, LIF is produced to maintain epithelial homeostasis and tissue repair, including the aftermath of Ct infection. However, LIF/LIFR-mediated signaling – particularly prolonged strong signaling – can gradually transform the microenvironment of the fallopian tube by altering the fate of epithelial cells and the cellular composition of epithelium. This harmful transformation of epithelium may be a key process that leads to an enhanced risk of infertility, ectopic pregnancy and cancer following Ct infection.
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Affiliation(s)
- Jun Wang
- Canadian Center for Vaccinology, Halifax, NS, Canada
- Department of Microbiology & Immunology, Halifax, NS, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Izaak Walton Killam (IWK) Health Centre, Halifax, NS, Canada
- *Correspondence: Jun Wang,
| | - Katherine Wang
- Canadian Center for Vaccinology, Halifax, NS, Canada
- Department of Microbiology & Immunology, Halifax, NS, Canada
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Accelerated partner therapy contact tracing for people with chlamydia (LUSTRUM): a crossover cluster-randomised controlled trial. THE LANCET PUBLIC HEALTH 2022; 7:e853-e865. [DOI: 10.1016/s2468-2667(22)00204-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023] Open
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21
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Free C, Palmer MJ, McCarthy OL, Jerome L, Berendes S, Knight M, Carpenter JR, Morris TP, Jamal Z, Dhaliwal F, French RS, Hickson FCI, Gubijev A, Wellings K, Baraitser P, Roberts I, Bailey JV, Clayton T, Devries K, Edwards P, Hart G, Michie S, Macgregor L, Turner KME, Potter K. Effectiveness of a behavioural intervention delivered by text messages (safetxt) on sexually transmitted reinfections in people aged 16-24 years: randomised controlled trial. BMJ 2022; 378:e070351. [PMID: 36170988 PMCID: PMC9516322 DOI: 10.1136/bmj-2022-070351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify the effects of a series of text messages (safetxt) delivered in the community on incidence of chlamydia and gonorrhoea reinfection at one year in people aged 16-24 years. DESIGN Parallel group randomised controlled trial. SETTING 92 sexual health clinics in the United Kingdom. PARTICIPANTS People aged 16-24 years with a diagnosis of, or treatment for, chlamydia, gonorrhoea, or non-specific urethritis in the past two weeks who owned a mobile phone. INTERVENTIONS 3123 participants assigned to the safetxt intervention received a series of text messages to improve sex behaviours: four texts daily for days 1-3, one or two daily for days 4-28, two or three weekly for month 2, and 2-5 monthly for months 3-12. 3125 control participants received a monthly text message for one year asking for any change to postal or email address. It was hypothesised that safetxt would reduce the risk of chlamydia and gonorrhoea reinfection at one year by improving three key safer sex behaviours: partner notification at one month, condom use, and sexually transmitted infection testing before unprotected sex with a new partner. Care providers and outcome assessors were blind to allocation. MAIN OUTCOME MEASURES The primary outcome was the cumulative incidence of chlamydia or gonorrhoea reinfection at one year, assessed by nucleic acid amplification tests. Safety outcomes were self-reported road traffic incidents and partner violence. All analyses were by intention to treat. RESULTS 6248 of 20 476 people assessed for eligibility between 1 April 2016 and 23 November 2018 were randomised. Primary outcome data were available for 4675/6248 (74.8%). At one year, the cumulative incidence of chlamydia or gonorrhoea reinfection was 22.2% (693/3123) in the safetxt arm versus 20.3% (633/3125) in the control arm (odds ratio 1.13, 95% confidence interval 0.98 to 1.31). The number needed to harm was 64 (95% confidence interval number needed to benefit 334 to ∞ to number needed to harm 24) The risk of road traffic incidents and partner violence was similar between the groups. CONCLUSIONS The safetxt intervention did not reduce chlamydia and gonorrhoea reinfections at one year in people aged 16-24 years. More reinfections occurred in the safetxt group. The results highlight the need for rigorous evaluation of health communication interventions. TRIAL REGISTRATION ISRCTN registry ISRCTN64390461.
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Affiliation(s)
- Caroline Free
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa J Palmer
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ona L McCarthy
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lauren Jerome
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Sima Berendes
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Megan Knight
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - James R Carpenter
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Zahra Jamal
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Farandeep Dhaliwal
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca S French
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Anasztazia Gubijev
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ian Roberts
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Julia V Bailey
- eHealth Unit, Research Department of Primary care and Population Health, University College London, London, UK
| | - Tim Clayton
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Devries
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Phil Edwards
- Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Graham Hart
- Department of Infection and Population Health, University College London, London, UK
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Louis Macgregor
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Katy M E Turner
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Kimberley Potter
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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Gupta K, Van Der Pol B, Press CG, Geisler WM. Chlamydia trachomatis Infection and Seropositivity in Women Reporting Sexual Contact to a Chlamydia-Infected Partner. Sex Transm Dis 2022; 49:e97-e99. [PMID: 35728006 PMCID: PMC9357228 DOI: 10.1097/olq.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Among 73 women presenting to a sexually transmitted infection (STI) clinic in Birmingham, Alabama for reported sexual contact to a chlamydia-infected partner, Chlamydia trachomatis was detected in genital specimens in 24 (32.8%), less often in women reporting prior chlamydial infection ( P = 0.001). Most women (93.2%) were C. trachomatis seropositive.
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Affiliation(s)
- Kanupriya Gupta
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Van Der Pol
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christen G. Press
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William M. Geisler
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Barbee LA, St Cyr SB. Management of Neisseria gonorrhoeae in the United States: Summary of Evidence From the Development of the 2020 Gonorrhea Treatment Recommendations and the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Treatment Guidelines. Clin Infect Dis 2022; 74:S95-S111. [PMID: 35416971 DOI: 10.1093/cid/ciac043] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern given limited antibiotic options currently and an even smaller antimicrobial development pipeline. Since the release of the Centers for Disease Control and Prevention (CDC) 2015 STD Treatment Guidelines, azithromycin, part of the 2015 dual-drug treatment regimen, has had a rapid rise in resistance. The 2020 CDC Gonorrhea Treatment Recommendations and the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were developed weighing the priorities of treating the individual, protecting the population, and preventing antimicrobial resistance. METHODS Gonorrhea subject matter experts (SME) generated 8 key questions and conducted a literature review of updated data from 2013 to 2019 on gonorrhea antimicrobial resistance, treatment failures, clinical trials, and other key topics. More than 2200 abstracts were assessed, and 248 clinically relevant articles were thoroughly reviewed. SMEs also evaluated N gonorrhoeae antimicrobial resistance data from the Gonococcal Isolate Surveillance Project (GISP). EVIDENCE Although there have been reports of ceftriaxone treatment failures internationally, GISP data suggest that ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, with < 0.1% exhibiting an "alert value" MIC (> 0.25 mcg/mL). However, GISP documented a rapid rise in the proportion of isolates with an elevated MIC (≥ 2.0 mcg/mL) to azithromycin-nearly 5% in 2018. At the same time, new pharmacokinetic/pharmacodynamic data are available, and there is greater recognition of the need for antimicrobial stewardship. SUMMARY The 2021 CDC STI Treatment Guidelines now recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites. If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added. Few alternative therapies exist for persons with cephalosporin allergies; there are no recommended alternative therapies for N gonorrhoeae infection of the throat.
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Affiliation(s)
- Lindley A Barbee
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,University of Washington, Seattle, Washington, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, Washington, USA
| | - Sancta B St Cyr
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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24
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Patterns of sexual behaviour associated with repeated chlamydia testing and infection in men and women: a latent class analysis. BMC Public Health 2022; 22:652. [PMID: 35382799 PMCID: PMC8981706 DOI: 10.1186/s12889-021-12394-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents and young adults are at higher risk of acquiring Chlamydia trachomatis infection (chlamydia), so testing is promoted in these populations. Studies have shown that re-testing for chlamydia is common amongst them. We investigated how sexual risk behaviour profiles are associated with repeated testing for chlamydia. METHODS We used baseline data from a cohort of 2814 individuals recruited at an urban STI -clinic. We applied latent class (LC) analysis using 9 manifest variables on sexual behaviour and substance use self-reported by the study participants. We fitted ordered logistic regression to investigate the association of LC membership with the outcomes repeated testing during the past 12 months and lifetime repeated testing for chlamydia. Models were fit separately for men and women. RESULTS We identified four LCs for men and three LCs for women with increasing gradient of risky sexual behaviour. The two classes with the highest risk among men were associated with lifetime repeated testing for chlamydia: adjOR = 2.26 (95%CI: 1.50-3.40) and adjOR = 3.03 (95%CI: 1.93-4.74) as compared with the class with lowest risk. In women, the class with the highest risk was associated with increased odds of repeated lifetime testing (adjOR =1.85 (95%CI: 1.24-2.76)) and repeated testing during past 12 months (adjOR = 1.72 (95%CI: 1.16-2.54)). An association with chlamydia positive test at the time of the study and during the participant's lifetime was only found in the male highest risk classes. CONCLUSION Prevention messages with regard to testing for chlamydia after unprotected sexual contact with new/casual partners seem to reach individuals in highest risk behaviour classes who are more likely to test repeatedly. Further prevention efforts should involve potentially more tailored sex-specific interventions taking into consideration risk behaviour patterns.
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25
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Pitt R, Doyle R, Theilgaard Christiansen M, Horner P, Hathorn E, Alexander S, Woodford N, Cole M, Breuer J. Whole-genome sequencing of Chlamydia trachomatis isolates from persistently infected patients. Int J STD AIDS 2022; 33:442-446. [PMID: 35239412 DOI: 10.1177/09564624211048662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Current understanding of the causes of treatment failure in Chlamydia trachomatis is poor and antimicrobial susceptibility data are lacking. We used genome sequencing to seek evidence of antimicrobial resistance in isolates sourced from patients who were persistently infected. METHODS Genomic DNA was extracted from C. trachomatis isolates cultured in McCoy cell monolayers. Sequencing libraries were prepared using the SureSelectXT Illumina paired-end protocol. Paired reads were mapped against a reference genome and single nucleotide variants (SNVs) were identified. RESULTS Seven isolates from persistently infected patients and five isolates from successfully treated patients were sequenced. No previously reported SNVs associated with antimicrobial resistance were found. A unique SNV was identified in the gyrA gene of one treatment failure isolate but was located outside of the quinolone resistance determining region; this SNV has been previously reported in other members of the Chlamydiaceae family. CONCLUSION No genomic evidence was found to explain the differences in clinical outcome for our two groups of patients. A mutation unrelated to antimicrobial susceptibility was found in an isolate from a persistently infected patient. The cause of these persistent infections with C. trachomatis remains unclear.
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Affiliation(s)
- Rachel Pitt
- National Infection Service, Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), 372064Public Health England, London, UK
| | - Ronan Doyle
- Division of Infection and Immunity, 4919University College London, London, UK
| | | | - Paddy Horner
- Population Health Sciences, 1980University of Bristol, Bristol, UK.,Unity Sexual Health, 1984University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Emma Hathorn
- Whittal Street Clinic, 1732University Hospitals Birmingham, Birmingham, UK
| | - Sarah Alexander
- Sexually Transmitted Bacteria Reference Unit, 371011Public Health England, London, UK
| | - Neil Woodford
- National Infection Service, Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), 372064Public Health England, London, UK
| | - Michelle Cole
- National Infection Service, Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), 372064Public Health England, London, UK
| | - Judith Breuer
- Division of Infection and Immunity, 4919University College London, London, UK
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26
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Milkovich R, Schumacher C, Tao X, Lamidi T, Edwards A, Liebow E, Ruby K, Marcell AV, Jennings JM. Public health detailing to increase expedited partner therapy for chlamydia and gonorrhea in Maryland: Changes in awareness and implementation among prescribing community providers. Prev Med Rep 2022; 24:101530. [PMID: 34976607 PMCID: PMC8683882 DOI: 10.1016/j.pmedr.2021.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of this evaluation was to assess the use of public health detailing in a pilot program to increase Expedited Partner Therapy (EPT) uptake among community-based providers in two Maryland jurisdictions. Public health detailing is a method designed to raise awareness and increase implementation of evidence-based clinical practices by delivering educational content via one-on-one meetings with providers. EPT is a voluntary clinical practice of treating all sexual partners of patients diagnosed with STIs by prescribing medications without the provider first examining said sexual partners. The aim of EPT is to prevent STI reinfection and reduce further transmission. From April 2017 to March 2019, detailers visited community-based health care practice sites to conduct EPT detailing with providers. The effectiveness of this program was evaluated by comparing provider responses from pre- to post-detailing surveys, administered six months after detailing. Survey responses assessed EPT awareness and practices, barriers to implementation, and satisfaction with detailing. The proportion of providers (170) aware of EPT for treating chlamydia and gonorrhea increased from 61.7% (114) to 99.4% (169) (p-value < 0.001). The proportion who reported prescribing EPT increased from 63.2% (72) to 86.4% (146) (p-value < 0.001). Providers reporting no barriers to prescribing EPT increased from 30.6% (52) to 55.9% (95) (p-value < 0.001). Most providers were satisfied with detailing, 95.5% (164), and 95.3% (162) preferred this method to communicate about public health measures. Detailing appears to be a strategy to improve provider awareness of EPT, increase EPT implementation, and reduce barriers to prescribing EPT.
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Affiliation(s)
- Rachel Milkovich
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Christina Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Xueting Tao
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tina Lamidi
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ashley Edwards
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kenneth Ruby
- Maryland Department of Health, Baltimore, MD, USA
| | - Arik V Marcell
- Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacky M Jennings
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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27
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Willis SJ, Elder H, Cocoros NM, Callahan M, Hsu KK, Klompas M. Impact of an Electronic Medical Record Best Practice Alert on Expedited Partner Therapy for Chlamydia Infection and Reinfection. Open Forum Infect Dis 2022; 9:ofab574. [PMID: 35024371 PMCID: PMC8743117 DOI: 10.1093/ofid/ofab574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Atrius Health implemented a best practice alert (BPA) to encourage clinicians to provide expedited partner therapy (EPT) in October 2014. We assessed (1) the impact of the BPA on EPT provision and chlamydial reinfection and (2) the impact of EPT on testing for chlamydia reinfection and reinfection rates. Methods We included patients ≥15 years with ≥1 positive chlamydia test between January 2013 and March 2019. Tests-of-reinfection were defined as chlamydia tests 28–120 days after initial infection, and corresponding positive results were considered evidence of reinfection. We used interrupted time series analyses to identify changes in (1) frequency of EPT, (2) tests-of-reinfection, and (3) reinfections after the BPA was released. Log-binomial regression models, with generalized estimating equation methods, assessed associations between (1) EPT and tests-of-reinfection and (2) EPT and reinfection. Results Among 7267 chlamydia infections, EPT was given to 1475 (20%) patients. Expedited partner therapy frequency increased from 15% to 22% of infections between January 2013 and September 2014 (β = 0.003, P = .03). After the BPA was released, EPT frequency declined to 19% of infections by March 2019 (β = −0.004, P = .008). On average, 35% of chlamydia infections received a test-of-reinfection and 7% were reinfected; there were no significant changes in these percentages after BPA implementation. Patients given EPT were more likely to receive tests-of-reinfection (prevalence ratio [PR] 1.09; 95% confidence interval [CI], 1.01–1.16) but without change in reinfections (PR 0.88; 95% CI, 0.66–1.17). Conclusions Best practice alerts in electronic medical record systems may not be effective at increasing EPT prescribing and decreasing chlamydial reinfection. However, patients given EPT were more likely to receive a test of chlamydia reinfection.
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Affiliation(s)
- Sarah J Willis
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Heather Elder
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Noelle M Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | - Katherine K Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Fleischer C, Hogans-Mathews S. Vulvovaginitis and Cervicitis. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oglesby A, Ricke I, Swenson A, Lyden GR, Moe S, Doll V, Nguyen RHN. Women's knowledge and hypothetical acceptance of expedited partner therapy for chlamydia. Sex Health 2021; 18:502-507. [PMID: 34924101 DOI: 10.1071/sh21157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
Abstract
Background Expedited partner therapy (EPT) for chlamydia can be an important public health tool to treat the sex partners of newly diagnosed individuals, especially when those sex partners are women of reproductive ages. Untreated and repeat chlamydia infections increase a woman's risk for subfertility. This study aimed to determine the knowledge of EPT, and the factors associated with EPT knowledge, among reproductive-aged women. Methods Women aged 18-40 years were recruited for a community sample from a large state fair; 871 women completed a questionnaire for this study. Women reported on their knowledge of sexually transmitted infections, and about their knowledge and attitudes toward EPT. Using a hypothetical example, women were asked if they would accept EPT. Results This community sample of reproductive-aged women found overwhelming hypothetical support for chlamydia testing, partner notification, and partner treatment. However, only 12% of women reported having heard of EPT prior to the survey; once EPT was described, there were high levels of support for EPT and the belief that EPT could reduce chlamydia rates. Half of the women strongly agreed that EPT could reduce chlamydia rates, and 48% supported the state law allowing for EPT. Working in the healthcare field was the only independent determinant of prior EPT knowledge, increasing the odds of hearing about EPT by more than 2.5-fold. Conclusions Despite overwhelming support of the tenets of EPT, our results indicate that prior knowledge of EPT is low among women, meaning that education about EPT is needed for those outside of the healthcare field.
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Affiliation(s)
- Ashley Oglesby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Isabel Ricke
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Alyssa Swenson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Grace R Lyden
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Stacey Moe
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Victoria Doll
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Ruby H N Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
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López de Munain J, Cámara Pérez MDM, López Martinez M, Alava Menica JA, Hernandez Ragpa L, Imaz Pérez M, Teijeiro Pulido MJ, Mojas Díez I, de la Peña Trigueros M, Díaz de Tuesta del Arco JL, Muñoz Sánchez J. Alarming incidence of reinfections after treatment for Chlamydia trachomatis and gonorrhoea: Can we predict and prevent them? Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wang LY, Peterson A, Li J, Coleman K, Dunville R. Cost-Effectiveness Analysis of Michigan's School-Wide Sexually Transmitted Disease Screening Program in Four Detroit High Schools. J Adolesc Health 2021; 69:957-963. [PMID: 34289955 PMCID: PMC9281505 DOI: 10.1016/j.jadohealth.2021.05.014] [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: 01/08/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The Michigan Department of Health and Human Services, in collaboration with St. John Providence Health System, initiated voluntary school-wide sexually transmitted disease (STD) screenings in four Detroit public high schools. We sought to assess the cost-effectiveness of the STD screening program from 2010 to 2015, with a focus on chlamydia. METHODS The costs and effectiveness of the school-based screening were compared with those of a "no school screening" scenario using a healthcare system perspective. A decision tree model was constructed to project cases of chlamydia, epididymitis, and pelvic inflammatory disease (PID) in each of the two scenarios among students tested positive and their partners. Health effects were measured as cases of PID prevented, and quality-adjusted life-years (QALYs) gained. Cost estimates included program costs, chlamydia testing/treatment costs in the absence of school screening, and treatment costs for epididymitis, PID, and PID sequelae. The incremental cost-effectiveness ratio (ICER) was measured as cost/QALY gained. Multivariate sensitivity analyses were conducted on key parameter estimates and assumptions used. RESULTS Under base-case assumptions, at a total program cost of $333,848 over 5 years, the program prevented an estimated 1.9 cases of epididymitis and 17.3 cases of PID, resulting in an ICER of $38,235/QALY gained (yearly ICER ranging from $27,417 to $50,945/QALY). Of 10,000 Monte Carlo simulation runs, the yearly ICER remained ≤$50,000/QALY in 64%-98% of the simulation runs. CONCLUSIONS We found favorable cost-effectiveness ratios for Michigan's school-wide STD screening program in Detroit. School-based STD screening programs of this type warrant careful considerations by policy makers and program planners.
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Affiliation(s)
- Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Amy Peterson
- Division of HIV and STD Programs, Michigan Department of Health and Human Services, Detroit, Michigan
| | - Jingjing Li
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kenneth Coleman
- Ascension Southeast Michigan Community Health, Detroit, Michigan
| | - Richard Dunville
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Olson KM, Geisler WM, Bakshi RK, Gupta K, Tiwari HK. Predicting the Probability of Chlamydia Reinfection in African American Women Using Immunologic and Genetic Determinants in a Bayesian Model. Sex Transm Dis 2021; 48:813-818. [PMID: 33993163 PMCID: PMC8550879 DOI: 10.1097/olq.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African Americans have the highest rates of Chlamydia trachomatis (CT) infection in the United States and also high reinfection rates. The primary objective of this study was to develop a Bayesian model to predict the probability of CT reinfection in African American women using immunogenetic data. METHODS We analyzed data from a cohort of CT-infected African American women enrolled at the time they returned to a clinic in Birmingham, AL, for the treatment of a positive routine CT test result. We modeled the probability of CT reinfection within 6 months after treatment using logistic regression in a Bayesian framework. Predictors of interest were presence or absence of an HLA-DQB1*06 allele and CT-specific CD4+ IFN-γ response, both of which we had previously reported were independently associated with CT reinfection risk. RESULTS Among 99 participants evaluated, the probability of reinfection for those with a CT-specific CD4+ IFN-γ response and no HLA-DQB1*06 alleles was 14.1% (95% credible interval [CI], 3.0%-45.0%), whereas the probability of reinfection for those without a CT-specific CD4+ IFN-γ response and at least one HLA-DQB1*06 allele was 61.5% (95% CI, 23.1%-89.7%). CONCLUSIONS Our model demonstrated that presence or absence of an HLA-DQB1*06 allele and CT-specific CD4+ IFN-γ response can have an impact on the predictive probability of CT reinfection in African American women.
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Affiliation(s)
- Kristin M. Olson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William M. Geisler
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rakesh K. Bakshi
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kanupriya Gupta
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hemant K. Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Amutah C, Petsis D, Fields NF, Wood S, Timko A, Akers AY. Effect of Previous Adverse Reproductive Health Outcomes on Young Women's Engagement in a Health Coaching Intervention to Improve Contraceptive Continuation. J Pediatr Adolesc Gynecol 2021; 34:732-738. [PMID: 33571659 PMCID: PMC8670013 DOI: 10.1016/j.jpag.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Nonadherence in sexual risk reduction interventions might be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a previous pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation. DESIGN Secondary data analysis from a feasibility study of a health-coaching intervention to improve contraceptive continuation. SETTING Three urban pediatric clinics in Philadelphia. PARTICIPANTS Women ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method. INTERVENTIONS At baseline, participants completed a sociodemographic questionnaire and semistructured interview, followed by 5 monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content. MAIN OUTCOME MEASURES Intervention completion was defined as the number of completed coaching sessions. Secondary outcomes were qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception. RESULTS Participants with a previous adverse outcome (a previous STI and/or a previous pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs 4; P = .03). Both groups had low HIV/STI knowledge, negative attitudes toward pregnancy, and low HIV/STI risk perception. Those with a previous adverse reproductive outcome held more negative attitudes toward condoms. CONCLUSION Despite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome might be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize the intervention's reach for vulnerable youth.
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Affiliation(s)
- Christina Amutah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle Petsis
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Naomi F Fields
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Wood
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman school of medicine, PolicyLab and the Division of Adolescent Medicine
| | - Alix Timko
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, PolicyLab and the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Aletha Y Akers
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Adolescent Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Abstract
Gonorrhea and chlamydia rates have risen to record-high levels in the United States over the past decade. Because these infections are often asymptomatic, effective clinical management relies on screening of asymptomatic patients, particularly women younger than 25 years and men who have sex with men. If undetected and untreated, gonorrhea and chlamydia can lead to infertility, ectopic pregnancy, and chronic pelvic pain and can facilitate HIV acquisition and transmission. Primary care providers need to be aware of recent changes in recommended treatments for both infections.
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Affiliation(s)
- Julia C Dombrowski
- University of Washington and Public Health - Seattle & King County, Seattle, Washington (J.C.D.)
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Omollo V, Bukusi EA, Kidoguchi L, Mogaka F, Odoyo JB, Celum C, Morton J, Johnson R, Baeten JM. A Pilot Evaluation of Expedited Partner Treatment and Partner Human Immunodeficiency Virus Self-Testing Among Adolescent Girls and Young Women Diagnosed With Chlamydia trachomatis and Neisseria gonorrhoeae in Kisumu, Kenya. Sex Transm Dis 2021; 48:766-772. [PMID: 33859147 PMCID: PMC8460075 DOI: 10.1097/olq.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expedited partner treatment (EPT) is effective for preventing sexually transmitted infection recurrence, but concerns about intimate partner violence and missed opportunities for human immunology virus (HIV) testing have limited its use in African settings. METHODS We conducted a pilot prospective evaluation of EPT among adolescent girls and young women (AGYW) accessing HIV preexposure prophylaxis in an implementation project in Kisumu, Kenya. Those with etiologic diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae were treated and given the option of delivering sexually transmitted infection medication and HIV self-test kits to their current sexual partner(s). At enrollment, we assessed their reasons for declining. Three months after they delivered medication and kits to the partner(s), we assessed their reasons for failing to deliver medication and kits to their partner and reported partner's reactions. RESULTS Between September 2018 and March 2020, 63 AGYW were enrolled. The majority (59/63 [94%]) accepted EPT, and 50 (79%) of 63 partner HIV self-testing (HIVST). Three quarters (46/59) of those accepting EPT returned for the assessment visit with 41 (89%) of 46 successfully delivering medication to 54 partners, of whom 49 (91%) used it. Seventy percent (35/50) who took partner HIVST kits returned for the assessment, with 80% (28/35) reporting providing kits to 40 partners, of whom 38 (95%) used it. Reported barriers to EPT and partner HIVST uptake among women who declined included anticipated fear that their partner could become angry or violent and loss of relationship. CONCLUSIONS Both EPT and partner HIVST were acceptable despite noted barriers among Kenyan AGYW with etiologic diagnosis of Chlamydia trachomatis/Neisseria gonorrhoeae and their partners.
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Affiliation(s)
- Victor Omollo
- From the Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A. Bukusi
- From the Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health
| | | | - Felix Mogaka
- From the Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Josephine B. Odoyo
- From the Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Jared M. Baeten
- Department of Global Health
- Department of Epidemiology
- Department of Medicine, University of Washington, Seattle, WA
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Zofkie AC, Fomina YY, Roberts SW, McIntire DD, Nelson DB, Adhikari EH. Effectiveness of Chlamydia trachomatis expedited partner therapy in pregnancy. Am J Obstet Gynecol 2021; 225:325.e1-325.e7. [PMID: 33894150 DOI: 10.1016/j.ajog.2021.04.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Expedited partner therapy for Chlamydia trachomatis has had mixed efficacy in different populations, but limited data exist on the efficacy of the therapy in a pregnant population. OBJECTIVE This study aimed to evaluate the real-world effectiveness of establishing a prenatal expedited partner therapy program in eradicating chlamydia before delivery and to examine the maternal and neonatal outcomes between women who received expedited partner therapy for chlamydia and women who received standard partner referral testing and treatment during pregnancy. STUDY DESIGN An expedited partner therapy program was implemented on August 21, 2019, at a public hospital in a county with high chlamydia prevalence. Pregnant women were provided with single-dose packets of azithromycin to treat partners following a diagnosis of chlamydia infection. We prospectively observed pregnant women treated in the expedited partner therapy program who delivered at our institution in the same year and compared the outcomes with a historic cohort from the previous year that had traditional partner referral testing and treatment. We excluded women with concurrent gonorrhea, HIV, syphilis, or current intimate partner violence. The primary outcome was chlamydia reinfection or no-cure rates at repeat testing in 4 to 6 weeks following treatment or at the 36-week prenatal care screening. Secondary outcomes included obstetrical, maternal, and neonatal outcomes, including premature rupture of membranes, chorioamnionitis, endometritis, neonatal intensive care unit admission, neonatal sepsis, pneumonia, and conjunctivitis. RESULTS The rate of chlamydia infection was 3.6% over a 2-year period in our delivered population. In the year following the implementation of the expedited partner therapy, compared with 419 women (mean±standard deviation, 23.4±5.5 years) who were diagnosed with chlamydia infection in the previous year, 471 women (mean±standard deviation age, 23.8±5.3 years) who delivered at our institution were diagnosed with chlamydia infection. There was no difference in race, parity, prenatal care attendance, or concomitant sexually transmitted infections. Compared with the pre-expedited partner therapy group, the rate of reinfection in the post-expedited partner therapy group was not statistically different (60/471 [13%] vs 61/419 [15%]; odds ratio, 0.86 [95% confidence interval 0.58-1.26]). In a per-protocol analysis, 72 women (17%) in the pre-expedited partner therapy group and 389 women (83%) in post-expedited partner therapy group received expedited partner therapy; reinfection was not statistically different between groups (P=.47). There was no difference in secondary outcomes, although a trend toward improved rates of endometritis was noted in the post-expedited partner therapy group (odds ratio, 0.13; 95% confidence interval, 0.02-1.02). CONCLUSION The implementation of a prenatal expedited partner therapy program did not affect the rate of chlamydia reinfection before delivery. Treatment of chlamydia in an inner-city population has multiple factors that lead to successful treatment. Future efforts to reduce sexually transmitted infection and chlamydia reinfection rates in an at-risk population should include exploring patient education and safe sex practices beyond expedited partner therapy alone during pregnancy.
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Affiliation(s)
- Amanda C Zofkie
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology, Parkland Health and Hospital Systems, Dallas, TX.
| | - Yevgenia Y Fomina
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology, Parkland Health and Hospital Systems, Dallas, TX
| | - Scott W Roberts
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology, Parkland Health and Hospital Systems, Dallas, TX
| | - Donald D McIntire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology, Parkland Health and Hospital Systems, Dallas, TX
| | - Emily H Adhikari
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology, Parkland Health and Hospital Systems, Dallas, TX
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EVO100 prevents chlamydia and gonorrhea in women at high risk of infection. Am J Obstet Gynecol 2021; 225:162.e1-162.e14. [PMID: 33705748 DOI: 10.1016/j.ajog.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND According to the Centers for Disease Control and Prevention, rates of infection for Chlamydia trachomatis and Neisseria gonorrhoeae are increasing in the United States. EVO100 is an investigational antimicrobial, pH-modulating, vaginal gel with active ingredients L-lactic acid, citric acid, and potassium bitartrate that is being evaluated for the prevention of sexually transmitted infections. OBJECTIVE The objective of this phase 2B/3 study was to assess the efficacy and safety of EVO100 for the prevention of chlamydia and gonorrhea. STUDY DESIGN AMPREVENCE was a double-blinded, placebo-controlled, multicenter study based in the United States conducted over approximately 16 weeks in women at the age of 18 to 45 years who were at risk of urogenital chlamydia and gonorrhea infection. Enrolled women had been diagnosed as having and treated for chlamydia or gonorrhea ≤16 weeks before enrollment. Women received either EVO100 or placebo vaginal gel and were instructed to apply the study drug immediately before or up to 1 hour before each act of vaginal sexual intercourse. The primary and secondary endpoints were the prevention of urogenital chlamydia and gonorrhea, respectively. Exploratory outcomes include women's overall satisfaction with EVO100. RESULTS In total, 860 women were randomized 1:1 to receive EVO100 (n=426) or placebo (n=434), and 764 women (EVO100, n=376; placebo, n=388) were documented as using the study drug at least once. Baseline characteristics were similar between treatment arms. Overall, women had a mean age of 27.7 years (standard deviation, 6.9) and body mass index of 28.9 kg/m2 (standard deviation, 8.0). Most women were of White (54.3% [467 of 860]) or African American (41.6% [358 of 860]) race and of non-Hispanic/Latina ethnicity (67.1% [577 of 860]). The chlamydia infection rate in EVO100 users was 4.8% (14 of 289) compared with 9.7% (28 of 290) among placebo users (P=.0256), representing a relative risk reduction of 50%. For gonorrhea, the infection rate was 0.7% (2 of 280) in the EVO100 arm compared with 3.2% (9 of 277) in the placebo arm (P=.0316), representing a relative risk reduction of 78%. Increased efficacy was observed with increased adherence, and chlamydia infection rates were significantly reduced with increased adherence in the EVO100 group compared with placebo. Across both arms, there were similar rates of all-cause adverse events (EVO100, 21.3% [80 of 376]; placebo, 20.4% [79 of 388]) and treatment-related adverse events (EVO100, 7.2% [27 of 376]; placebo, 7.5% [29 of 388]). The most common adverse events in the EVO100 arm were vulvovaginal candidiasis (5.1% [19 of 376]), vaginal discharge (3.2% [12 of 376]), and urinary tract infection (3.2% [12 of 376]) and, in the placebo arm, bacterial vaginosis (4.6% [18 of 388]), urinary tract infection (2.6% [10 of 388]), and vaginal discharge (2.6% [10 of 388]). Few women discontinued owing to adverse events in either arm (EVO100, 1.1% [4 of 376]; placebo, 1.5% [6 of 388]). No treatment-related serious adverse events were reported. Most EVO100 users (88%) were satisfied or very satisfied with EVO100 after 16 weeks of use. CONCLUSION EVO100 significantly reduced the risk of chlamydia and gonorrhea infections in women at high risk of Chlamydia trachomatis and Neisseria gonorrhoeae infection and was well tolerated, with observed adverse events consistent with its known safety profile.
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Gupta K, Harrison SA, Davis NA, Culp ML, Hand SC, Simpson T, Van Der Pol B, Galbraith JW, Van Wagoner NJ, Morrison SG, Morrison RP, Geisler WM. Prevalence of Chlamydia trachomatis Infection in Young Women and Associated Predictors. Sex Transm Dis 2021; 48:529-535. [PMID: 34110759 PMCID: PMC8847232 DOI: 10.1097/olq.0000000000001372] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) infection remains highly prevalent, and young women are disproportionately affected. Most CT-infected women are asymptomatic, and their infection often goes unrecognized and untreated. We hypothesized that testing for active CT infection with molecular diagnostics and obtaining a reported history of CT infection underestimate the prevalence of current and past CT infection, and incorporating serum CT antibody testing in addition to these other prevalence measures would generate more accurate estimates of the prevalence of CT infection in asymptomatic young women. METHODS We enrolled 362 asymptomatic women aged 16 to 29 years at 4 different clinical settings in Birmingham, AL, between August 2016 and January 2020 and determined the prevalence of CT infection based on having 1 or more of the following prevalence measures: an active urogenital CT infection based on molecular testing, reported prior CT infection, and/or being CT seropositive. Multivariable regression analysis was used to determine predictors of the prevalence of CT infection after adjustment for participant characteristics. RESULTS The prevalence of CT infection was 67.7% (95% confidence interval, 62.6%-72.5%). Addition of CT antibody testing to the other individual prevalence measures more than doubled the CT infection prevalence. Non-Hispanic Black race, reported prior gonorrhea, and reported prior trichomoniasis predicted a higher prevalence of CT infection. CONCLUSIONS More than half of women were unaware of ever having CT infection, suggesting many were at risk for CT-associated reproductive complications. These data reinforce the need to adhere to chlamydia screening guidelines and to increase screening coverage in those at risk.
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Affiliation(s)
- Kanupriya Gupta
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sally A. Harrison
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nkele A. Davis
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matilda L. Culp
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samuel C. Hand
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tina Simpson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Van Der Pol
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James W. Galbraith
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas J. Van Wagoner
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandra G. Morrison
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Richard P. Morrison
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William M. Geisler
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 737] [Impact Index Per Article: 245.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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McCool-Myers M, Goedken P, Henn MC, Sheth AN, Kottke MJ. Who Is Practicing Expedited Partner Therapy and Why? Insights From Providers Working in Specialties With High Volumes of Sexually Transmitted Infections. Sex Transm Dis 2021; 48:474-480. [PMID: 33264262 DOI: 10.1097/olq.0000000000001337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Expedited partner therapy (EPT), the practice of prescribing antibiotics for sexual partners of patients, is underutilized in Georgia. This qualitative study in a large urban institution aimed to (1) characterize the clinical specialties that predominantly treat sexually transmitted infections (STIs), (2) identify perceived barriers to EPT, and (3) describe strategies to advance routine EPT use. METHODS Providers in obstetrics/gynecology (OB/GYN), infectious disease (ID), and emergency medicine (EM) were interviewed using a structured discussion guide. Transcripts were double-coded and iteratively analyzed using qualitative content analysis. Barriers and strategies were summarized and supported with quotes from providers (n = 23). RESULTS Perceived EPT barriers overlapped across OB/GYN, ID, and EM, yet the settings were diverse in their patient populations, resources, and concerns. Providers in OB/GYN were the only ones practicing EPT, yet there was a lack of standardization. Providers in ID noted that an EPT prescription from an ID provider could inadvertently disclose the HIV status of a patient to a sexual partner, posing an ethical dilemma. Providers in EM exhibited readiness for EPT, although routine empiric treatment for index patients in EM (estimated at 90%) gave some providers pause in prescribing for partners: "I do not know what I'm treating." Point-of-care testing could increase providers' confidence in prescribing EPT, yet some worried it could contribute to overutilization of the emergency department as a sexually transmitted infection clinic. All settings prioritized setting-specific training and protocols. CONCLUSIONS Providers in OB/GYN, ID, and EM report unique hurdles, specific to their settings and patient populations; tailored EPT implementation strategies, particularly provider training, are urgently needed to improve patient/partner outcomes.
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Affiliation(s)
| | - Peggy Goedken
- From the Jane Fonda Center, Departments of Gynecology and Obstetrics
| | | | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Melissa J Kottke
- From the Jane Fonda Center, Departments of Gynecology and Obstetrics
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Lai S, Kitamura K. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leenen J, Hoebe CJPA, Bos AER, Wolffs PFG, van Loo IHM, de Wit JBF, Jonas KJ, Dukers-Muijrers NHTM. Systematic Development of an Intervention to Promote Self-Sampling for HIV and Sexually Transmitted Infections for Men Who Have Sex With Men: An Intervention Mapping Approach. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:634032. [DOI: 10.3389/frph.2021.634032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Sexual healthcare aims to reduce HIV and sexually transmitted infections (STIs) by promoting testing and prevention. To better reach men who have sex with men (MSM), additional strategies are needed. Here, we describe development of an intervention, which is part of a broader HIV/STI home-care program, targeted to reach MSM and motivate them to use self-sampling tests. Self-sampling includes blood sampling (finger prick) for HIV, hepatitis B, and syphilis, and a urine sample and oral and anorectal swab samples for chlamydia and gonorrhea. Intervention mapping, a systematic six-step approach, was used to guide the development process: (1) needs assessment including interviews with MSM, (2) create a matrix of change, (3) selection of theory-based methods and practical strategies, (4) intervention development, (5) implementation plan, and (6) evaluation (not included in this paper). Stakeholders were involved to increase program support and feasibility. The needs assessment revealed that testing barriers among MSM related to stigma, time, and privacy concerns. Barriers among healthcare providers related to time, competing priorities, lack of expertise, and guideline restrictions. Included intervention components are designed to overcome these barriers, e.g., engaging role models, with a website with a role model story, and providing tailored information. Methods to reach MSM were a variety of information channels (posters, flyers, and audio-visual displays) and delivery modes, such as advertisements on websites and invitational cards (online and paper) distributed by healthcare providers and MSM themselves (social network testing/peer testing). Our intervention aims to encourage MSM to engage in testing, re-testing, and providing a test to peer MSM. Evidence-based methods to overcome barriers were included to reach and motivate an increased number of MSM. Using intervention mapping stimulated systematic evidence-based decision making and adapting the intervention to the target audience and setting. The next step (step 6) is to implement and evaluate the intervention.
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Evaluation of Text Message Reminders to Encourage Retesting for Chlamydia and Gonorrhea Among Female Patients at the Municipal Sexually Transmitted Disease Clinic in Seattle, Washington. Sex Transm Dis 2021; 47:458-463. [PMID: 32541305 DOI: 10.1097/olq.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND United States guidelines recommend retesting for chlamydia (CT) and gonorrhea (GC) approximately 3 months after treatment, but adherence to these guidelines is poor. METHODS In May 2016, the municipal sexually transmitted disease (STD) Clinic in Seattle, WA, integrated opt-in short message system (SMS) (text message) retesting reminders for female patients into our clinic's routine electronic intake. Women were asked if they wanted to receive an SMS reminder for retesting for GC/CT in 3 months. We used Fisher exact tests to compare the proportion who returned to the clinic for retesting and the proportion who retested GC/CT positive 3 to 6 months after their initial diagnosis. We used sexually transmitted disease surveillance data to ascertain repeat GC/CT diagnoses. RESULTS From May 2016 to December 2017, 743 (36%) of 2067 women opted to receive an SMS reminder. Overall, 95 of these women tested positive for GC or CT and provided a valid phone number; 31 (33%) had opted into SMS reminders. The percentage of women who returned to the clinic 3 to 6 months after their initial GC/CT diagnosis did not significantly differ for women who did and did not opt in to receive SMS reminders (23% vs 9%; P = 0.11). Repeat GC/CT diagnosis 3 to 6 months after the initial GC/CT diagnosis was not significantly different between women who did and did not opt in (7% vs 3%; P = 0.58). CONCLUSIONS Uptake of automated SMS reminders among women was low, and most women who received reminders did not return for retesting. Despite this, SMS reminders integrated into an existing clinic infrastructure may somewhat increase retesting among women with GC/CT.
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Do Prescriptions for Expedited Partner Therapy for Chlamydia Get Filled? Findings From a Multi-Jurisdictional Evaluation, United States, 2017-2019. Sex Transm Dis 2021; 47:376-382. [PMID: 32149956 DOI: 10.1097/olq.0000000000001163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expedited partner therapy (EPT) is commonly provided by prescription; however, the efficacy of this modality is unknown. We examined whether EPT prescriptions are filled when the cost barrier is removed. METHODS To track EPT prescription fill rates, we used single-use pharmacy vouchers that covered the cost of azithromycin, 1 g (chlamydia treatment). We recruited clinical sites to distribute vouchers to patients with chlamydia who would receive an EPT prescription under clinic policies. When distributing vouchers, sites recorded and retained: voucher unique identifier, sex and age of index patient, distribution date, and whether partner name was written on the EPT prescription. Pharmacists receiving vouchers entered the identifier, sex and age of presenting person, and redemption date into a standard pharmacy claim transmission system. Data for redeemed vouchers were retrieved from an industry portal and linked with data retained at clinical sites. RESULTS Thirty-two clinical sites distributed 931 vouchers during September 2017 to January 2019; 382 (41%) were redeemed. Vouchers distributed to patients 18 years or younger (49 [30%] of 163) were less likely to be redeemed compared with those distributed to patients older than 18 years (322 [44%] of 736; P = 0.001). Just over half of vouchers were redeemed the same day (196 [56%] of 352) and 1 mile or less from the clinical site (188 [54%] of 349). After excluding an outlier site, vouchers accompanied by EPT prescriptions including a partner name (15 [56%] of 27) were more likely to be redeemed than those lacking a name (83 [34%] of 244; P = 0.03). CONCLUSIONS Less than half of EPT prescriptions were filled, even when medication was free. Whenever possible, EPT should be provided as drug-in-hand.
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Facilitators and Barriers to Expedited Partner Therapy: Results From a Survey of Family Physicians. Sex Transm Dis 2021; 47:525-529. [PMID: 32520882 DOI: 10.1097/olq.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expedited partner therapy (EPT) can prevent transmission of sexually transmitted infections (STIs) and reinfection of the index patient. We surveyed family physicians (FPs) in British Columbia to understand their perceptions of barriers and facilitators to EPT use and explored how perceptions varied by demographic and practice characteristics. METHODS Survey participants were recruited through the Divisions of Family Practice, which include greater than 90% of FPs in British Columbia. Common barriers and facilitators for EPT were identified using descriptive statistics. The association between each EPT barrier and facilitator and demographic and practice characteristics were tested using χ test. RESULTS One hundred eighty-one FPs started the survey, of which 146 (80.7%) answered 10 questions or more and were analyzed. Overall, inaccurate information about sex partners (88 [60.3%] of 146) and medicolegal concerns (87 [59.6%] of 146) were the most common barriers reported. Family physicians in nonurban settings were more likely to identify insufficient time as a barrier compared with FPs in urban settings (P < 0.01). The most common facilitators were having a health care professional for follow-up after prescribing EPT (110 [75.3%] of 146), improved remuneration (93 [63.7%] of 146), clear clinical guidelines around EPT (87/146, 59.6%), and having a legal framework (92 [63.0%] of 146). Family physicians practicing for less than 9 years (the median) were more likely to identify the latter as facilitating EPT compared with FPs practicing for 9 years or longer (P < 0.05). CONCLUSIONS Ensuring patients have access to a health care professional for follow-up, improved remuneration, and development of clinical guidelines and a legal framework can support the implementation of EPT. Tools catered to different practice types and contexts may help increase EPT use.
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Pillay J, Wingert A, MacGregor T, Gates M, Vandermeer B, Hartling L. Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences. Syst Rev 2021; 10:118. [PMID: 33879251 PMCID: PMC8056106 DOI: 10.1186/s13643-021-01658-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients' place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. METHODS We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. RESULTS Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female's risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. DISCUSSION Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733 .
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Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Men and Women Repeatedly Infected With Chlamydia trachomatis Have a Lower Urogenital Bacterial Load. Sex Transm Dis 2021; 47:e51-e53. [PMID: 32569256 DOI: 10.1097/olq.0000000000001219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We assessed whether patients repeatedly infected with Chlamydia trachomatis (CT) have a lower urogenital or anorectal CT load. A CT-positive retest was independently associated with higher vaginal and higher urine Cq values (P<0.01). Partial immunity could play a role in repeat urogenital infections, potentially not in anorectal infections.
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D Helble J, N Starnbach M. T cell responses to Chlamydia. Pathog Dis 2021; 79:6164867. [PMID: 33693620 DOI: 10.1093/femspd/ftab014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/07/2021] [Indexed: 12/27/2022] Open
Abstract
Chlamydia trachomatis is the most commonly reported sexually transmitted infection in the United States. The high prevalence of infection and lack of a vaccine indicate a critical knowledge gap surrounding the host's response to infection and how to effectively generate protective immunity. The immune response to C. trachomatis is complex, with cells of the adaptive immune system playing a crucial role in bacterial clearance. Here, we discuss the CD4+ and CD8+ T cell response to Chlamydia, the importance of antigen specificity and the role of memory T cells during the recall response. Ultimately, a deeper understanding of protective immune responses is necessary to develop a vaccine that prevents the inflammatory diseases associated with Chlamydia infection.
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Affiliation(s)
- Jennifer D Helble
- Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
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Cannoni G, Ribbeck D, Hernández O, Casacuberta MJ. Actualización de la infección por Chlamydia trachomatis en mujeres. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Douglas CM, O’ Leary SC, Tomcho MM, Wu FJ, Penny L, Federico SG, Wilson ML, Rinehart DJ, Frost HM. Gonorrhea and Chlamydia Rates Among 12- to 24-Year-Old Patients in an Urban Health System. Sex Transm Dis 2021; 48:161-166. [PMID: 33003186 PMCID: PMC7867586 DOI: 10.1097/olq.0000000000001302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection rates continue to rise. Screening guidelines have largely focused on sexually active female individuals and men who have sex with men populations. Health care system testing and infection rates, particularly among heterosexual male individuals, are poorly understood. Our aim was to evaluate CT and GC testing and prevalence among 12- to 24-year-old patients in an urban federally qualified health center system. METHODS This retrospective study analyzed electronic health record data from 2017 to 2019 in a large system of federally qualified health centers in Denver, CO. Abstracted data included demographics, sexual activity, sexual orientation, and laboratory results. χ2 Tests were used to evaluate differences between groups. RESULTS Of the 44,021 patients included, 37.6% were tested, 15.0% were positive for CT, and 3.4% were positive for GC. Heterosexual male patients had a testing rate of 22.8% and positivity rates of CT and GC at 13.1% and 3.0%, respectively. Among tested patients documented as not sexually active, 7.5% were positive for CT. Multiple or reinfections were detected in 29% of patients. CONCLUSIONS This study shows low testing rates and high rates of CT and GC infections among all patients, including heterosexual male patients and those documented as not sexually active. Improved screening of these populations in the primary care setting may be key to combating the sexually transmitted disease epidemic.
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Affiliation(s)
- Claudia M. Douglas
- Department of General Pediatrics, Denver Health Medical Center, Denver, CO
- Department of General Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Sonja C. O’ Leary
- Department of General Pediatrics, Denver Health Medical Center, Denver, CO
- Department of General Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Margaret M. Tomcho
- Department of General Pediatrics, Denver Health Medical Center, Denver, CO
- Department of General Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Florence J. Wu
- Department of General Pediatrics, Denver Health Medical Center, Denver, CO
- Department of General Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Lara Penny
- Department of Family Medicine, Denver Health Medical Center, Denver, CO
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Steven G. Federico
- Department of General Pediatrics, Denver Health Medical Center, Denver, CO
- Department of General Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Michael L. Wilson
- Department of Pathology and Laboratory Services, Denver Health Medical Center, Denver, CO
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - Deborah J. Rinehart
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
- Center for Health Systems Research, Denver Health, Denver, CO
| | - Holly M. Frost
- Department of General Pediatrics, Denver Health Medical Center, Denver, CO
- Department of General Pediatrics, University of Colorado School of Medicine, Aurora, CO
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