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de Korne-Elenbaas J, Bruisten SM, de Vries HJC, van Dam AP. Within-Host Genetic Variation in Neisseria gonorrhoeae over the Course of Infection. Microbiol Spectr 2022; 10:e0031322. [PMID: 35467402 PMCID: PMC9241688 DOI: 10.1128/spectrum.00313-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/02/2022] [Indexed: 11/20/2022] Open
Abstract
Knowledge of within-host genetic variation informs studies on transmission dynamics. We studied within-host genetic variation in Neisseria gonorrhoeae over the course of infection and across different anatomical locations. Isolates were obtained during a clinical trial, and isolates from consecutive time points reflected persistent infections after treatment failure. We compared sequence types (STs) and recombination unfiltered- and filtered core genome single nucleotide polymorphism (SNP) distances in 65 within-host isolate pairs from the same anatomical location over time-obtained with a median interval of 7 days-and 65 isolate pairs across different anatomical locations at one time point. Isolates with different Multi-Locus Sequence Types (MLST), NG-Sequence Types for Antimicrobial Resistance (NG-STAR) and NG-Multi Antigen Sequence Types (NG-MAST) had a median of 1466 recombination filtered SNPs, whereas a median of 1 SNP was found between isolates with identical STs or a different NG-MAST only. The threshold for differentiating between strains was set at 10 recombination filtered SNPs, showing that isolates from persistent infections could have different NG-MASTs. Antibiotic pressure applied through treatment did not lead to an increase in genetic variation in specific genes or in overall extent of variation, compared to variation across anatomical locations. Instead, within-host genetic variation was proposedly driven by the host immune response, as it was concentrated in genomic regions encoding surface exposed proteins involved in host-microbe interaction. Ultimately, 15/228 (6.5%) between-host pairs contained a single strain, suggesting between-host transmission. However, patient reported data are needed to differentiate within-host persistence from between-host transmission. IMPORTANCE Understanding transmission dynamics of Neisseria gonorrhoeae (Ng) is based on the identification of transmission events. These can be identified by assessing genetic relatedness between Ng isolates, expressed as core genome SNP distances. However, a SNP threshold to differentiate between strains needs to be defined, using knowledge on within- and between-host genetic variation. Here, we assessed within-host genetic variation, using a unique set of within-host Ng isolates from the same anatomical location over time or across different anatomical locations at one time point. The insights in genetic variation that occurred during the infection period contribute to the understanding of infection dynamics. In addition, the obtained knowledge can be used for future research on transmission dynamics and development of public health interventions based on bacterial genomic data.
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Affiliation(s)
- Jolinda de Korne-Elenbaas
- Department of Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Medical Microbiology, Amsterdam Institute for Infection and Immunity (AII), location Academic Medical Center, Amsterdam, the Netherlands
| | - Sylvia M. Bruisten
- Department of Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
| | - Henry J. C. de Vries
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), location Academic Medical Center, Amsterdam, the Netherlands
- Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Alje P. van Dam
- Department of Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Medical Microbiology, Amsterdam Institute for Infection and Immunity (AII), location Academic Medical Center, Amsterdam, the Netherlands
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van der Veer BMJW, Wolffs PFG, Hoebe CJPA, Dukers-Muijrers NHTM, van Alphen LB. Culture-free genotyping of Neisseria gonorrhoeae revealed distinct strains at different anatomical sites in a quarter of patients, the Netherlands, 2012 to 2016. Euro Surveill 2018; 23:1800253. [PMID: 30563596 PMCID: PMC6299510 DOI: 10.2807/1560-7917.es.2018.23.50.1800253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundGenotyping of Neisseria gonorrhoeae (NG) is essential for surveillance to monitor NG transmission and dissemination of resistant strains. Current genotyping methods rely on bacterial culture which frequently fails.AimOur aim was to develop a culture-free genotyping method that is compatible with the widely used N. gonorrhoeae multi-antigen sequence typing (NG-MAST) database, which facilitates genotyping of NG detected at separate anatomical sites in individual patients.MethodsSpecific primers for both PCR targets porB and tbpB were designed and technically validated by assessing the analytical sensitivity, cross-reactivity with 32 non-gonoccocal Neisseria species, and concordance with NG-MAST. Clinical application was assessed on 205 paired samples from concurrent NG infections at different anatomical sites of 98 patients (81 men who have sex with men and 17 women) visiting our sexually transmitted infections clinic.ResultsTyping could be consistently performed on samples with a PCR quantification cycle (Cq) value <35. Furthermore, the method showed no cross-reactivity and was concordant with NG-MAST. Culture-free NG-MAST improved the typing rate from 62% (59/95) for cultured samples to 94% (89/95) compared with culture-dependent NG-MAST. Paired samples of 80 of 98 patients were genotyped, revealing distinct NG strains in separate anatomical sites in 25% (20/80) of the patients.ConclusionsThis NG-specific genotyping method can improve NG surveillance as it facilitates genotyping of non-culturable and extra-genital samples. Furthermore, 25% of patients were infected with multiple NG strains, which is missed in current culture-dependent surveillance. Including non-culturable and concurrent NG infections in surveillance informs actions on dissemination of multidrug-resistant NG strains.
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Affiliation(s)
- Brian MJW van der Veer
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Petra FG Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Christian JPA Hoebe
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands,Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, the Netherlands
| | - Nicole HTM Dukers-Muijrers
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands,Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, the Netherlands
| | - Lieke B van Alphen
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Kwong JC, Chow EPF, Stevens K, Stinear TP, Seemann T, Fairley CK, Chen MY, Howden BP. Whole-genome sequencing reveals transmission of gonococcal antibiotic resistance among men who have sex with men: an observational study. Sex Transm Infect 2017; 94:151-157. [PMID: 29247013 PMCID: PMC5870456 DOI: 10.1136/sextrans-2017-053287] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/10/2017] [Accepted: 11/25/2017] [Indexed: 01/03/2023] Open
Abstract
Objectives Drug-resistant Neisseria gonorrhoeae are now a global public health threat. Direct transmission of antibiotic-resistant gonococci between individuals has been proposed as a driver for the increased transmission of resistance, but direct evidence of such transmission is limited. Whole-genome sequencing (WGS) has superior resolution to investigate outbreaks and disease transmission compared with traditional molecular typing methods such as multilocus sequence typing (MLST) and N. gonorrhoeae multiantigen sequence (NG-MAST). We therefore aimed to systematically investigate the transmission of N. gonorrhoeae between men in sexual partnerships using WGS to compare isolates and their resistance to antibiotics at a genome level. Methods 458 couples from a large prospective cohort of men who have sex with men (MSM) tested for gonorrhoea together between 2005 and 2014 were included, and WGS was conducted on all isolates from couples where both men were culture-positive for N. gonorrhoeae. Resistance-determining sequences were identified from genome assemblies, and comparison of isolates between and within individuals was performed by pairwise single nucleotide polymorphism and pangenome comparisons, and in silico predictions of NG-MAST and MLST. Results For 33 of 34 (97%; 95% CI 85% to 100%) couples where both partners were positive for gonorrhoea, the resistance-determining genes and mutations were identical in isolates from each partner (94 isolates in total). Resistance determinants in isolates from 23 of 23 (100%; 95% CI 86% to 100%) men with multisite infections were also identical within an individual. These partner and within-host isolates were indistinguishable by NG-MAST, MLST and whole genomic comparisons. Conclusions These data support the transmission of antibiotic-resistant strains between sexual partners as a key driver of resistance rates in gonorrhoea among MSM. This improved understanding of the transmission dynamics of N. gonorrhoeae between sexual partners will inform treatment and prevention guidelines.
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Affiliation(s)
- Jason C Kwong
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy P Stinear
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Torsten Seemann
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Life Sciences Computation Initiative, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
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Differences in Neisseria gonorrhoeae population structure and antimicrobial resistance pattern between men who have sex with men and heterosexuals. Epidemiol Infect 2016; 145:379-385. [PMID: 27758727 DOI: 10.1017/s095026881600234x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study compared the antimicrobial susceptibility and genotypes of strains of Neisseria gonorrhoeae isolated from men who have sex with men (MSM) and from heterosexuals. One hundred and eleven strains were characterized from 107 patients, comprising 57 strains from 54 heterosexuals and 54 strains from 53 MSM. Antimicrobial resistance rates were higher in strains from heterosexual patients, with resistance to cefixime (P = 0·0159) and ciprofloxacin (P = 0·002) being significantly higher. Typing by N. gonorrhoeae multi-antigen sequence typing (NG-MAST) showed that the most prevalent sequence types (ST) and genogroups (G) respectively were ST2400, ST2992, and ST5793, and G1407, G2992, and G2400. A statistically significant association was observed for MSM and genogroups G2400 (P = 0·0005) and G2992 (P = 0·0488), and G1407 with heterosexuals (P = 0·0002). We conclude that in our region distinct populations of gonococci are circulating among subjects with different sexual practices, with their corresponding transmission patterns. Furthermore, the high prevalence of genotype G2400 in MSM, has not to our knowledge been previously described.
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Goire N, Kundu R, Trembizki E, Buckley C, Hogan TR, Lewis DA, Branley JM, Whiley DM, Lahra MM. Mixed gonococcal infections in a high-risk population, Sydney, Australia 2015: implications for antimicrobial resistance surveillance? J Antimicrob Chemother 2016; 72:407-409. [PMID: 27707989 DOI: 10.1093/jac/dkw406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Previous studies have shown that mixed-strain gonococcal infections can occur. However, it remains unclear whether such infections impact upon the reliability of Neisseria gonorrhoeae antimicrobial resistance (AMR) surveillance. In this study, we aimed to resolve this question by intensively sampling isolates from gonorrhoea-positive specimens in a high-risk population in Sydney, Australia. METHODS A total of 615 N. gonorrhoeae isolates, originating from 63 clinical samples (31 rectal swabs and 32 throat swabs), were characterized. All isolates were subject to N. gonorrhoeae identification, antimicrobial susceptibility testing and genotyping by SNP-based MLST. RESULTS Only 2 of the 63 (3.2%) samples provided evidence of mixed-strain infections. These comprised two rectal swabs that harboured isolates of different SNP-based MLST genotypes; however, the AMR susceptibility profiles of the different genotypes from these samples were indistinguishable. Within-sample differences in the AMR susceptibility profiles were observed for a further seven samples; however, the differences were not considered significant; MIC values were typically within a 2-fold difference or were close to test breakpoints. CONCLUSIONS Results of this study provide further evidence that mixed-strain gonococcal infections do occur, although at low prevalence. Our data indicate that at a population level such infections are unlikely to impact significantly upon N. gonorrhoeae AMR surveillance.
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Affiliation(s)
- Namraj Goire
- WHO Collaborating Centre for Sexually Transmitted Diseases, Sydney, Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia .,Sydney Medical School Nepean, The University of Sydney, Nepean Hospital, Penrith, New South Wales 2747, Australia
| | - Ratan Kundu
- WHO Collaborating Centre for Sexually Transmitted Diseases, Sydney, Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia
| | - Ella Trembizki
- The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Herston, Queensland 4029, Australia
| | - Cameron Buckley
- The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Herston, Queensland 4029, Australia
| | - Tiffany R Hogan
- WHO Collaborating Centre for Sexually Transmitted Diseases, Sydney, Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, New South Wales 2150, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, New South Wales 2006, Australia
| | - James M Branley
- Sydney Medical School Nepean, The University of Sydney, Nepean Hospital, Penrith, New South Wales 2747, Australia
| | - David M Whiley
- The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Herston, Queensland 4029, Australia.,Pathology Queensland Central Laboratory, Brisbane, Queensland 4029, Australia
| | - Monica M Lahra
- WHO Collaborating Centre for Sexually Transmitted Diseases, Sydney, Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia.,School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Kensington, New South Wales 2033, Australia
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Trembizki E, Doyle C, Buckley C, Jennison A, Smith H, Bates J, Sloots T, Nissen M, Lahra MM, Whiley D. Estimating the prevalence of mixed-type gonococcal infections in Queensland, Australia. Sex Health 2015; 12:439-44. [PMID: 26145099 DOI: 10.1071/sh15009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/07/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Mixed gonococcal infections within the one anatomical site have been recognised but questions remain over how often they occur. In this study, the aim was to estimate the prevalence of mixed gonococcal infections using novel real-time polymerase chain reaction (PCR) methods that were developed and validated, targeting the gonococcal porB gene. METHODS Neisseria gonorrhoeae strains were categorised into three different porB groups, based on sequence data derived from N. gonorrhoeae multi-antigen sequence typing (NG-MAST) analyses of local isolates. Specific PCR methods for each group were then developed and these PCR methods were used to test clinical samples (n=350) that were positive for gonorrhoea as determined by nucleic acid amplification test (NAAT) diagnostic screening. RESULTS Initial validation using isolates showed the group PCR methods proved 100% sensitive and 100% specific for their respective porB groups. When applied to the clinical specimens, 298/350 (85%) provided positive results by the group PCR methods. Of these, four specimens showed evidence of mixed infections, supported by subsequent DNA sequencing of the PCR products. CONCLUSIONS The data provide further evidence of mixed gonococcal infections at the same anatomical site, but show that such infections may be relatively infrequent (1.3%; 95% confidence interval 0.01-2.6%) in a general screening population.
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Affiliation(s)
- Ella Trembizki
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Block 28, Royal Children's Hospital, Herston Road, Herston, Qld 4029, Australia
| | - Christine Doyle
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Archerfield, Qld 4108, Australia
| | - Cameron Buckley
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Block 28, Royal Children's Hospital, Herston Road, Herston, Qld 4029, Australia
| | - Amy Jennison
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Archerfield, Qld 4108, Australia
| | - Helen Smith
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Archerfield, Qld 4108, Australia
| | - John Bates
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Archerfield, Qld 4108, Australia
| | - Theo Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Block 28, Royal Children's Hospital, Herston Road, Herston, Qld 4029, Australia
| | - Michael Nissen
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Block 28, Royal Children's Hospital, Herston Road, Herston, Qld 4029, Australia
| | - Monica M Lahra
- WHO Collaborating Centre for STD, Microbiology Department, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - David Whiley
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Block 28, Royal Children's Hospital, Herston Road, Herston, Qld 4029, Australia
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Public health measures to control the spread of antimicrobial resistance in Neisseria gonorrhoeae in men who have sex with men. Epidemiol Infect 2014; 143:1575-84. [PMID: 25275435 DOI: 10.1017/s0950268814002519] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Gonorrhoea is one of the most common sexually transmitted infections. The control of gonorrhoea is extremely challenging because of the repeated development of resistance to the antibiotics used for its treatment. We explored different strategies to control the spread of antimicrobial resistance and prevent increases in gonorrhoea prevalence. We used a mathematical model that describes gonorrhoea transmission among men who have sex with men and distinguishes gonorrhoea strains sensitive or resistant to three antibiotics. We investigated the impact of combination therapy, switching first-line antibiotics according to resistance thresholds, and other control efforts (reduced sexual risk behaviour, increased treatment rate). Combination therapy can delay the spread of resistance better than using the 5% resistance threshold. Increased treatment rates, expected to enhance gonorrhoea control, may reduce gonorrhoea prevalence only in the short term, but could lead to more resistance and higher prevalence in the long term. Re-treatment of resistant cases with alternative antibiotics can substantially delay the spread of resistance. In conclusion, combination therapy and re-treatment of resistant cases with alternative antibiotics could be the most effective strategies to prevent increases in gonorrhoea prevalence due to antimicrobial resistance.
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Distinct transmission networks of Chlamydia trachomatis in men who have sex with men and heterosexual adults in Amsterdam, The Netherlands. PLoS One 2013; 8:e53869. [PMID: 23342025 PMCID: PMC3547048 DOI: 10.1371/journal.pone.0053869] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 12/06/2012] [Indexed: 11/23/2022] Open
Abstract
Background Genovar distributions of Chlamydia trachomatis based on ompA typing differ between men who have sex with men (MSM) and heterosexuals. We investigated clonal relationships using a high resolution typing method to characterize C. trachomatis types in these two risk groups. Methods C. trachomatis positive samples were collected at the STI outpatient clinic in Amsterdam between 2008 and 2010 and genotyped by multilocus sequence typing. Clusters were assigned using minimum spanning trees and these were combined with epidemiological data of the hosts. Results We typed 526 C. trachomatis positive samples: 270 from MSM and 256 from heterosexuals. Eight clusters, containing 10–128 samples were identified of which 4 consisted of samples from MSM (90%–100%), with genovars D, G, J, and L2b. The other 4 clusters consisted mainly of samples from heterosexuals (87%–100%) with genovars D, E, F, I, and J. Genetic diversity was much lower in the MSM clusters than in heterosexual clusters. Significant differences in number of sexual partners and HIV-serostatus were observed for MSM–associated clusters. Conclusions C. trachomatis transmission patterns among MSM and heterosexuals were largely distinct. We hypothesize that these differences are due to sexual host behavior, but bacterial factors may play a role as well.
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Heymans R, A Matser A, Bruisten SM, Heijman T, Geskus RB, Speksnijder AGCL, Davidovich U, de Vries HJC, Coutinho RA, Schim van der Loeff MF. Distinct Neisseria gonorrhoeae transmission networks among men who have sex with men in Amsterdam, The Netherlands. J Infect Dis 2012; 206:596-605. [PMID: 22693236 DOI: 10.1093/infdis/jis399] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Molecular typing was used to elucidate Neisseria gonorrhoeae transmission networks among men who have sex with men (MSM) in Amsterdam, the Netherlands. We determined whether clusters of patients infected with specific N. gonorrhoeae genotypes were related to various epidemiological characteristics. METHODS MSM (age ≥18 years) visiting the sexually transmitted infections (STI) clinic between July 2008 and August 2009 were eligible. After STI screening, participants completed a behavioral questionnaire concerning the previous 6 months. N. gonorrhoeae cultures were genotyped using multiple-locus variable-number tandem repeat analysis typing. RESULTS We obtained 278 N. gonorrhoeae-positive isolates from 240 MSM. Five large clusters (≥10 isolates), a unique sixth cluster (n = 9), and 8 smaller clusters (5-9 isolates) were identified. Prevalence of human immunodeficiency virus differed between clusters I and VI (P = .003), ranging from 27.8% to 100%. Receptive unprotected anal intercourse was frequently reported by MSM (51.8%) but did not differ significantly among clusters. Significant differences were identified concerning the participant's history of syphilis (P = .030), having met partners at a popular sex venue in Amsterdam (P = .048), and meeting partners outside Amsterdam (P = .036). CONCLUSIONS Distinct N. gonorrhoeae transmission networks were present in a mixed high-risk MSM population; concordance between clusters and epidemiological characteristics was present but not marked.
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Affiliation(s)
- Raymond Heymans
- Public Health Service (GGD) of Amsterdam, Cluster of Infectious Diseases, Department of Research, Postbox 2200, 1000 CE Amsterdam, The Netherlands
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Spratt BG. The 2011 Garrod Lecture: From penicillin-binding proteins to molecular epidemiology. J Antimicrob Chemother 2012; 67:1578-88. [PMID: 22457311 DOI: 10.1093/jac/dks109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this review, based on my Garrod Lecture to the British Society for Antimicrobial Chemotherapy, I have given a brief outline of my career over the past 40 years, starting with research in the 1970s into the properties and functions of penicillin-binding proteins (PBPs), leading to the identification of the high molecular mass PBPs as the physiological targets of penicillin, and subsequent studies showing the emergence of low-affinity PBPs in penicillin-resistant clinical isolates by inter-species recombination and the generation of mosaic PBP genes. The studies of clinical isolates of gonococci, meningococci and pneumococci with PBP-mediated resistance to penicillin led to new interests in molecular epidemiology and the population and evolutionary biology of bacterial pathogens. The development (with colleagues) of multilocus sequence typing provided a method for the unambiguous characterization of bacterial strains that has proved to be very widely used, but the recent remarkable (and ongoing) developments in DNA sequencing technologies have provided the prospect of being able routinely to use whole genome sequences to characterize pathogen isolates. These developments will soon have major implications for diagnostic microbiology, outbreak investigations and our ability to follow the spread of strains of community-acquired and nosocomial pathogens at local, national and international levels. However, there are major barriers to be overcome, particularly with respect to how the avalanche of genome sequence data will be stored so that its transformative potential for molecular epidemiology and international public health are fully realized.
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Affiliation(s)
- Brian G Spratt
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital Campus, Norfolk Place, London W2 1PG, UK.
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Pultorak E, Odoyo-June E, Hayombe J, Opiyo F, Odongo W, Ogollah JA, Moses S, Bailey RC, Mehta SD. Factors associated with repeat visits among clients attending a clinic for sexually transmitted infections in Kisumu, Kenya. Int J STD AIDS 2012; 22:640-4. [PMID: 22096048 DOI: 10.1258/ijsa.2011.010483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To identify factors associated with repeat visits among patients attending a clinic for sexually transmitted infections (STIs) in Kisumu, Kenya, we examined records of clinic visits from March 2009 to May 2010. Multivariable logistic regression identified factors associated with repeat visits occurring >30 days after the initial visit. Among 1473 clients (1296 single-visit individuals versus 177 individuals with repeat visits), the median age was 24 years, 67% were men and 8.6% self-reported being HIV-positive. In adjusted analyses, men with repeat visits were more likely to report ≥ 2 recent sexual partners (adjusted odds ratio [aOR] = 1.60) and being HIV-positive (aOR = 2.35). They were less likely to have been referred from other health facilities (aOR = 0.14) and more likely to have urethral discharge at their initial visit (aOR = 2.46). Among women, repeat visits were associated with vaginal discharge (aOR = 2.22), but attending the clinic with a partner was protective (aOR = 0.38). The association between sexual risk, HIV positivity and repeat visits among male clients highlights the need to focus intervention efforts on this group. For women, attending with a partner may reflect a decreased risk of re-infection if both partners are treated and counselled together.
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Affiliation(s)
- E Pultorak
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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Kushnir AV, Muminov TA, Bayev AI, Khrapov EA, Filipenko ML. Molecular characterization of Neisseria gonorrhoeae isolates in Almaty, Kazakhstan, by VNTR analysis, Opa-typing and NG-MAST. INFECTION GENETICS AND EVOLUTION 2012; 12:570-6. [PMID: 22333840 DOI: 10.1016/j.meegid.2012.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
In the present study, new variable number tandem repeats (VNTR) loci in the Neisseria gonorrhoeae genome were identified in silico. VNTR analysis scheme using PCR and agarose or polyacrylamide gel electrophoresis was developed based on nine VNTR loci with various degrees of polymorphism. The method was used to genotype a collection of 48 isolates, obtained from patients with gonorrhea in Almaty, Kazakhstan during the period from December 2008 to November 2009. This collection of isolates was also characterized by the opa-typing and multiantigen sequence typing (NG-MAST). The discriminatory power of the VNTR analysis translated by Hunter-Gaston Discrimination Index (HGDI) was similar to that of opa typing (HGDI=0.98 versus 0.97) and slightly higher than that of NG-MAST (HDGI=0.95). The adjusted Rand (AR) coefficients and Wallace coefficients showed that the overall concordance between the typing methods was not high. VNTR analysis described here is simple, inexpensive, easy to interpret, and it would be reliable for the comparison of data obtained in different laboratories. The proposed VNTR loci might be used for epidemiological studies of gonococcal infections.
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Affiliation(s)
- Anastasiya V Kushnir
- Group of Pharmacogenomics, Institute of Chemical Biology and Fundamental Medicine, Lavrentjeva 8, Novosibirsk 630090, Russia.
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Evaluation of Neisseria gonorrhoeae multiple-locus variable-number tandem-repeat analysis, N. gonorrhoeae Multiantigen sequence typing, and full-length porB gene sequence analysis for molecular epidemiological typing. J Clin Microbiol 2011; 50:180-3. [PMID: 22075591 DOI: 10.1128/jcm.05386-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance characteristics of Neisseria gonorrhoeae multilocus variable-number tandem-repeat analysis were evaluated, by comparison with N. gonorrhoeae multiantigen sequence typing and full-length porB sequence typing. Assessment of the relatedness of intra- and interpatient isolates showed that all three genotyping techniques display a high resolution and typeability.
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Gwizdala RA, Miller M, Bhat M, Vavagiakis P, Henry C, Neaigus A, Shi Q, Lowy FD. Staphylococcus aureus colonization and infection among drug users: identification of hidden networks. Am J Public Health 2011; 101:1268-76. [PMID: 21653250 DOI: 10.2105/ajph.2010.300028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We combined social-network analysis and molecular epidemiology to investigate Staphylococcus aureus among drug users. METHODS From 2003 through 2005, we recruited adult drug users in Brooklyn, New York. Of 501 individuals recruited, 485 participated. Participants were screened for HIV infection and S. aureus carriage, and they answered a questionnaire assessing risk factors for S. aureus. Participants were asked to nominate up to 10 members of their social networks, and they were invited to recruit nominees to participate. RESULTS We identified 89 sociocentric risk networks, 1 of which contained 327 (67%) members. One third of participants were either colonized (20%) or infected (19%) with S. aureus. Overall strain similarity was unusually high, suggesting spread within and across networks. In multivariate analysis, 7 health-related and drug-use variables remained independently associated with infection. Moreover, 27% of nominees were not drug users. CONCLUSIONS We found a large, linked, hidden network among participants, with no discernible clustering of closely related strains. Our results suggest that once a pathogen is introduced into a sociocentric network of active drug users, an identifiable community S. aureus reservoir is likely created, with significant linkages to the general population.
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Affiliation(s)
- Robert A Gwizdala
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Falchi A, Lasserre A, Gallay A, Blanchon T, Sednaoui P, Lassau F, Massari V, Turbelin C, Hanslik T. A survey of primary care physician practices in antibiotic prescribing for the treatment of uncomplicated male gonoccocal urethritis. BMC FAMILY PRACTICE 2011; 12:35. [PMID: 21592343 PMCID: PMC3118118 DOI: 10.1186/1471-2296-12-35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 05/18/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND The development of resistance to antimicrobial therapy by Neisseria gonorrhoeae causes on-going problems for individual case management of gonorrhoea. Surveillance data about N. gonorrhoeae have indicated an increase in the incidence of gonorrhoea in France in 2006. As a consequence of the development of antibiotic resistance in N. gonorrhoeae, French guidelines excluded fluoroquinolones as a standard treatment for N. gonorrhoeae. Ceftriaxone became the recommended treatment, associated with azithromycin for Clamydia trachomatis infection. Our aim was to describe the practice patterns of general practitioners (GPs) in managing the antibiotic treatment of patients with symptoms suggestive of uncomplicated male urethritis. METHODS We developed a clinical vignette describing a man with typical gonococcal urethritis symptoms to elicit questions about antibiotic treatment. We mailed the electronic questionnaire to a random sample of 1000 French GPs belonging to the Sentinelles Network. RESULTS By the end of the survey period, 350 vignettes were received, yielding a response rate of 35%. Sixty-six GPs (20.2%) prescribed the recommended antibiotics for the simultaneous treatment of N. gonorrhoeae and C. trachomatis infections, while 132 GPs (40.4%) prescribed only non-recommended antibiotics, including ciprofloxacin in 69 cases (21.1%). General practitioners with less than 10 years in practice showed better compliance to guidelines than those with more years in practice (p<0.05). CONCLUSIONS The results suggest a mismatch between the guidelines and the antibiotic treatment of male uncomplicated urethritis by French GPs, mostly among the subgroup of physicians who have been in practice longer. Educational approaches based on practice feedback need to be developed to improve these deficits in the quality of care.
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Analysis of emergence of quinolone-resistant gonococci in Greece by combined use of Neisseria gonorrhoeae multiantigen sequence typing and multilocus sequence typing. J Clin Microbiol 2011; 49:1196-201. [PMID: 21248096 DOI: 10.1128/jcm.02233-10] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence of quinolone-resistant Neisseria gonorrhoeae (QRNG) in Greece remained low from 1997 to 2003 but increased dramatically from 11% to 56% between 2004 and 2007. N. gonorrhoeae multiantigen sequence typing (NG-MAST) and multilocus sequence typing (MLST) were used to investigate trends in quinolone resistance from 1997 to 2007 and explore the origins of the recent increase in QRNG. We characterized 295 QRNG isolates from the study period and 233 quinolone-susceptible (QS) gonococci from 2004 and 2005, when the rapid increase in QRNG occurred. From 1997 to 1999, an outbreak of QRNG was due to the dissemination of isolates of serovar Arst that belonged to two closely related genotypes. Few QRNG isolates, of diverse genotypes, were present between 2001 and 2003, whereas the sharp increase in QRNG from 2004 onwards was due to the appearance of serovar Bropyst isolates of several major NG-MAST sequence type (STs) that previously had not been identified in Greece. These isolates were shown by MLST to be variants of a single multiply antibiotic-resistant QRNG strain (ST1901) that appeared in Greece and rapidly diversified into 31 NG-MAST STs. There were no isolates of MLST ST1901 or any of the 31 NG-MAST STs among QS isolates from 2004 and 2005 or among 8 representatives of multiresistant but quinolone-susceptible serovar Bropyst isolates circulating in Greece during the 1990 s, supporting the view that the recent increase in QRNG was due to importation of a QRNG strain(s) of MLST ST1901 into Greece. Recently, multiresistant QRNG isolates of ST1901 with reduced susceptibility to the newer cephalosporins have appeared in Greece.
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Multiple-locus variable-number tandem repeat analysis of Neisseria gonorrhoeae. J Clin Microbiol 2010; 49:354-63. [PMID: 21084524 DOI: 10.1128/jcm.01059-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence of Neisseria gonorrhoeae in the Netherlands has increased in recent years. A multiple-locus variable-number tandem repeat analysis (MLVA) was developed to assess the molecular epidemiology of N. gonorrhoeae and to elucidate transmission networks in high-risk groups in Amsterdam. The MLVA was evaluated using 5 variable-number tandem repeat (VNTR) loci with various degrees of polymorphism that were amplified in 2 multiplex PCRs and were then separated and sized on an automated sequencer. The assessed number of repeats was used to create MLVA profiles that consisted of strings of 5 integers. The stability of the VNTR loci was assessed using isolates obtained from multiple anatomical locations from the same patient (n = 118) and from patients and their sexual partners (n = 55). When isolates with a single locus variant were considered to belong to the same MLVA type, 87% of samples from multiple anatomical locations and 88% of samples from sexual partners shared an MLVA type. MLVA was ultimately performed on 880 isolates that were previously genotyped by restriction fragment length polymorphism (RFLP) analysis of the por-opa genes. Hierarchical cluster analysis of the MLVA profiles from 716 patient visits (one anatomical location per visit) classified 430 patient visits into 14 larger clusters (≥10 patient visits). In 7 clusters, 81% to 100% of isolates came from men who have sex with men (MSM); in 5 clusters, 79% to 100% of isolates came from heterosexuals; and 2 clusters contained isolates from fully mixed populations. Clusters also differed in characteristics such as ethnic background and coinfections. MLVA provided accurate identification of genetically related N. gonorrhoeae strains and revealed clusters of MSM and heterosexuals reflecting distinct transmission networks.
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Abstract
Many clinical isolates of the human pathogen Neisseria gonorrhoeae contain conjugative plasmids. The host range of these plasmids is limited to Neisseria species, but presence of a tetracycline (tetM) determinant inserted in several of these plasmids is an important cause of the rapid spread of tetracycline resistance. Previously plasmids with different backbones (Dutch and American type backbones) and with and without different tetM determinants (Dutch and American type tetM determinants) have been identified. Within the isolates tested, all plasmids with American or Dutch type tetM determinants contained a Dutch type plasmid backbone. This demonstrated that tetM determinants should not be used to differentiate between conjugal plasmid backbones. The nucleotide sequences of conjugative plasmids with Dutch type plasmid backbones either not containing the tetM determinant (pEP5233) or containing Dutch (pEP5289) or American (pEP5050) type tetM determinants were determined. Analysis of the backbone sequences showed that they belong to a novel IncP1 subfamily divergent from the IncP1α, β, γ, δ and ε subfamilies. The tetM determinants were inserted in a genetic load region found in all these plasmids. Insertion was accompanied by the insertion of a gene with an unknown function, and rearrangement of a toxin/antitoxin gene cluster. The genetic load region contains two toxin/antitoxins of the Zeta/Epsilon toxin/antitoxin family previously only found in Gram positive organisms and the virulence associated protein D of the VapD/VapX toxin/antitoxin family. Remarkably, presence of VapX of pJD1, a small cryptic neisserial plasmid, in the acceptor strain strongly increased the conjugation efficiency, suggesting that it functions as an antitoxin for the conjugative plasmid. The presence of the toxin and antitoxin on different plasmids might explain why the host range of this IncP1 plasmid is limited to Neisseria species. The isolated plasmids conjugated efficiently between N. gonorrhoeae strains, but did not enhance transfer of a genetic marker.
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First neisseria gonorrhoeae genotyping analysis in france: identification of a strain cluster with reduced susceptibility to Ceftriaxone. J Clin Microbiol 2009; 47:3540-5. [PMID: 19794054 DOI: 10.1128/jcm.01236-09] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sexually transmitted infections are a major public health problem in France and other European countries. Particularly, surveillance data about Neisseria gonorrhoeae infections have clearly indicated an increase in the incidence of gonorrhoea in France in 2006. The French laboratories participated on voluntary basis in the RENAGO (Réseau National du Gonocoque) network and sent all of their collected strains to the National Reference Center for Neisseria gonorrhoeae. In this first French molecular epidemiological study, 93 isolates collected in 2006 and representative of the French gonorrhoea epidemiology were selected. Antibiotic susceptibility to six antibiotics was determined, and serotyping and N. gonorrhoeae multiantigen sequence typing (NG-MAST) were performed. NG-MAST identified 53 sequence types (STs), of which 13 STs contained 2 to 16 isolates. The major STs identified in France were previously described elsewhere. However, two newly described STs, ST1479 and ST1987, had only been found in France until now. ST1479 was characterized by a multiple-resistance phenotype, whereas ST1987 presented a susceptibility phenotype. Moreover, among the predominant French STs, ST225, which had already been described in many countries, comprised isolates (14/16) resistant to ciprofloxacin and with reduced susceptibility to ceftriaxone. Thus, the surveillance of resistance to antibiotics is a priority in order to adapt treatment and decrease the transmission of resistant strains. Of note, no predominant ST was identified among rectal isolates from men who have sex with men.
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Heymans R, Kolader ME, van der Helm JJ, Coutinho RA, Bruisten SM. TprK gene regions are not suitable for epidemiological syphilis typing. Eur J Clin Microbiol Infect Dis 2009; 28:875-8. [PMID: 19229562 DOI: 10.1007/s10096-009-0717-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 02/04/2009] [Indexed: 10/21/2022]
Abstract
Given reports of increasing syphilis incidence in Western countries, we used molecular typing and epidemiological data to elucidate Treponema pallidum transmission networks. Samples and data were collected, dating from 2002 to 2005, from a well-defined population of patients with an ulcus and a diagnosis of infectious syphilis. Molecular typing using the tprK gene (V3-V5 region) was performed on 211 isolates from 205 Amsterdam STI clinic patients. We revealed 32 T. pallidum clusters and recognized ten large clusters, consisting predominantly of homosexual men (89%). Yet, no common patient characteristics were found to link the patients in these clusters. We therefore conclude that the highly variable tprK region (V3-V5) is not suitable for elucidating T. pallidum transmission networks in a high risk population.
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Affiliation(s)
- R Heymans
- GGD, Public Health Laboratory, Cluster of Infectious Diseases, Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
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Huang RL, Torzillo PJ, Hammond VA, Coulter ST, Kirby AC. Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program. Med J Aust 2008; 189:442-5. [PMID: 18928437 DOI: 10.5694/j.1326-5377.2008.tb02117.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 04/08/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the impact of a long-term comprehensive control program for sexually transmitted infections (STIs) in remote Aboriginal communities in Central Australia, and to investigate a recent rise in gonorrhoea prevalence. DESIGN STI prevalence was determined from annual, cross-sectional, population-wide, age-based screening, 1996-2006. During 2006, gonococcal isolates were obtained by on-site culture and tested for antimicrobial susceptibility. SETTING Six remote clinics on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, South Australia, which are served by Nganampa Health Council, an Aboriginal community-controlled health service. PARTICIPANTS All resident Aboriginal people aged 14-40 years at the commencement date of each annual population-wide screen. MAIN OUTCOME MEASURES Multivariable logistic regression models were used to compare prevalence of chlamydial infection, gonorrhoea and syphilis measured during each annual population-wide screen; antimicrobial susceptibility of gonococcal isolates obtained in 2006. RESULTS Between 1996 and 2003, there was a significant reduction in prevalence of gonorrhoea and chlamydial infection, by 67% and 58%, respectively. Subsequently, chlamydia prevalence rate plateaued, but there was a rapid rise in prevalence of gonorrhoea. Syphilis prevalence decreased linearly over the study period (odds ratio, 0.81; P < 0.001). During the first 6 months of 2006, 89 gonococcal isolates were obtained, 39 through on-site culture during the 6-week screening period, and all were sensitive to penicillin (in the less-sensitive category). CONCLUSIONS The decrease in STI prevalence associated with the program was maintained until 2006 for chlamydial infection and syphilis, but not for gonorrhoea, which rose in prevalence after 2003. There was no change in antimicrobial resistance to explain this rise, and gonorrhoea transmission dynamics and travel of core transmitters to regions without STI control programs might be responsible.
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Affiliation(s)
- Rae-Lin Huang
- Nganampa Health Council, Alice Springs, NT, Australia.
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Trends in hepatitis A, B, and shigellosis compared with gonorrhea and syphilis in men who have sex with men in Amsterdam, 1992-2006. Sex Transm Dis 2008; 35:930-4. [PMID: 18685550 DOI: 10.1097/olq.0b013e3181812cdf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Since the mid-1990s, sexually transmitted infections (STIs) among men who have sex with men (MSM) have increased and appear to be related to more risky sexual behavior. We compare trends in hepatitis A, acute hepatitis B, and shigellosis with the trends of gonorrhea and infectious syphilis in Amsterdam MSM more than a period of 15 years. METHODS We used data of all reported hepatitis A, acute hepatitis B, and shigellosis, and from all patients newly diagnosed with gonorrhea and infectious syphilis who visited the Public Health Service STI outpatient department in Amsterdam between January 1, 1992 and December 31, 2006. RESULTS Hepatitis A incidence remained unchanged in MSM (mean 0.97 per 1000 MSM, range 0.04-2.27), who had 21% of all 1697 infections. Hepatitis B likewise remained unchanged in MSM (mean 0.47 per 1000 MSM, range 0.19-0.77), who had 41% of all 448 infections. Most shigellosis is travel-related (657/974), and 16% of the infections occurred in MSM. Its incidence dropped in general, but not in MSM. Both gonorrhea and infectious syphilis in MSM show a steep increase, mainly after 1998. DISCUSSION Hepatitis A, B, and shigellosis do not follow the rising trends of conventional STI in MSM, which are believed to result from increased risky sexual behavior. This disparity in trends implies differences in transmission dynamics. Recent molecular epidemiologic studies suggest that clustered transmission in social MSM networks plays a major role.
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Chen MI, Ghani AC, Edmunds WJ. A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations. J R Soc Interface 2008; 6:775-91. [PMID: 18986961 DOI: 10.1098/rsif.2008.0394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gonorrhoea continues to be a public health problem in the UK, and is the second most common bacterial sexually transmitted infection (STI) after chlamydia. In the UK, gonorrhoea is disproportionately concentrated in epidemiologically distinct subpopulations, with much higher incidence rates in young people, some ethnic minorities and inner city subpopulations. The original model of STI transmission proposed by Hethcote and Yorke explained some of these features through the concept of the 'core group'. Since then, several authors have modified the original model approach to include multiple sexual activity classes, but found this modelling approach to be inadequate when applied to low-prevalence settings such as the UK. We present a metapopulation framework for modelling gonorrhoea and other STIs. The model proposes that the epidemiology of gonorrhoea is largely driven by subpopulations with higher than average concentrations of individuals with high sexual risk activity. We show how this conceptualization of gonococcal epidemiology overcomes key limitations associated with some of the prior efforts to model gonorrhoea. We also use the model to explain several epidemiological features of gonorrhoea, such as its asymmetric distribution across subpopulations, and the contextual risk experienced by members of at-risk subpopulations. Finally, we extend the model to explain the distribution of other STIs, using chlamydia as an example of a more ubiquitous bacterial STI.
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Affiliation(s)
- Mark I Chen
- Health Protection Agency, Centre for Infections, London NW9 5EQ, UK.
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Typing of Neisseria gonorrhoeae Opa and NG-MAST gene of 12 pairs of sexual contact gonorrhea patients in China. ACTA ACUST UNITED AC 2008; 28:472-5. [PMID: 18704315 DOI: 10.1007/s11596-008-0422-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Indexed: 01/03/2023]
Abstract
To identify the genomic species of Neisseria gonorrhoeae, evaluate the difference between two molecular epidemiological methods and examine the relationship between sex partners and genotypes of bacteria, 24 strains of Neisseria gonorrhoeae isolated from the outpatients with gonorrhea were identified by using the Opa genotyping and NG-MAST genotyping and the relationship between genotypes and phenotypes was studied. Twenty-four strains of Neisseria gonorrhoeae fell into 10 ST genotypes by NG-MAST genotyping, whereas these strains were classified into 12 OT Opa genotypes by Opa genotyping. A new epidemic strain of ST genotype (217-86% homologisation 178) in China was identified. It is concluded that genotypes of each pair of strains from a pair of patient/ sex partner besides 45/46 are the same, indicating that contagious infection take place between patient and the sex partner. Opa genotyping was more effective than NG-MAST genotyping in identifying the genomic species of Neisseria gonorrhoeae. ST genotype could be further classified into different Opa-types.
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Todd K, Durrheim D, Pickles R, Eastwood K, Merritt T, Tapsall J, Ray S, Limnios A. Using epidemiological and molecular methods to investigate an outbreak of gonorrhoea associated with heterosexual contact in Newcastle, NSW, Australia. Sex Health 2008; 4:233-6. [PMID: 18082065 DOI: 10.1071/sh07037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 08/20/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND We report a cluster of gonorrhoea among mainly heterosexual men that occurred in October 2005, which was first identified when routine weekly surveillance review procedures indicated a three-fold increase in reporting rates compared with historical data. METHODS Each case was followed up with the treating medical officer to review treatment regimes and risk exposures, and to carry out enhanced contact tracing. The phenotype and genotype of the outbreak gonococcal isolates and gonococci prevalent in the months preceding and following the cluster were determined. Links between cases reported from the local Sexual Health Clinic and those reported by general practitioners were established. RESULTS Laboratory data indicated that a particular gonococcal subtype (ST 225 and NR/Brpyst) was prevalent during the outbreak. CONCLUSIONS Gonorrhoea rates returned to pre-outbreak levels following a targeted health promotion intervention with no further cases of the outbreak subtype detected.
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Affiliation(s)
- Kerry Todd
- Hunter New England Population Health, Hunter New England Area Health Service, NSW 2305, Australia.
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Tapsall J, Whiley D, Sloots T. Applications of molecular testing in clinical laboratories for the diagnosis and control of gonorrhea. Future Microbiol 2007; 1:317-24. [PMID: 17661644 DOI: 10.2217/17460913.1.3.317] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The potential for enhanced diagnosis and control of gonococcal infection through the application of advances in molecular medicine is now being realized. However, the introduction of diagnostic nucleic acid amplification assays (NAATs) revealed some significant limitations of these applications. Resolution of some, but not all, of these problems has led to recommendations for refined testing algorithms and a better recognition and acceptance of the limitations of NAATs. Resource restriction has limited the use of diagnostic NAATs, especially in less-developed countries where disease rates are highest. However, NAATs have also proved useful in public health approaches to gonorrhea control in all settings. Additional applications including molecular typing of gonococci to identify and interrupt gonococcal transmission chains and definition of antimicrobial resistance patterns in the gonococcus have been proposed. These approaches, especially those for antimicrobial resistance determination, have been less successful for a number of reasons, including their cost and other unresolved issues.
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Affiliation(s)
- John Tapsall
- The Prince of Wales Hospital, WHO Collaborating Centre for STD & HIV, Microbiology Department, South Eastern Area Laboratory Services, Randwick, Sydney, Australia.
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Bilek N, Martin IM, Bell G, Kinghorn GR, Ison CA, Spratt BG. Concordance between Neisseria gonorrhoeae genotypes recovered from known sexual contacts. J Clin Microbiol 2007; 45:3564-7. [PMID: 17855579 PMCID: PMC2168481 DOI: 10.1128/jcm.01453-07] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) is a highly discriminatory molecular typing procedure that provides precise and unambiguous strain characterization. Since molecular typing can complement contact tracing for reconstructing gonorrhea sexual networks, the concordance between the NG-MAST genotypes of pairs of N. gonorrhoeae isolates from recent sexual contacts was examined. Among 72 pairs of gonococci from recent sexual contacts, the genotypes of each pair were concordant in 65 cases (90.3%). In two further pairs, the isolates from sexual contacts differed by only a single nonsynonymous substitution in the porin gene, and in both of these pairs, the isolates were the same by opa typing. The other five nonconcordant pairs of isolates were clearly different strains. opa typing data were available for 51 of the pairs of isolates from sexual contacts, and concordant opa types were obtained in 38 cases (74.5%). NG-MAST should therefore be better than opa typing at identifying recent sexual contacts and has the important advantage over opa typing of being a more precise method of strain characterization.
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Affiliation(s)
- Nicole Bilek
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, Norfolk Place, London, UK
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