1
|
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.
Collapse
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
| |
Collapse
|
2
|
Waltmann A, Thomas C, Duncan JA. The role of the genital microbiota in the acquisition and pathogenesis of sexually transmitted infections. Curr Opin Infect Dis 2023; 36:35-48. [PMID: 36729748 PMCID: PMC10500551 DOI: 10.1097/qco.0000000000000893] [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: 02/03/2023]
Abstract
PURPOSE OF REVIEW There are an estimated 374 million new sexually transmitted infections (STIs) worldwide every year. Our review article examines the current evidence of how STI acquisition, transmission, and pathogenesis is impacted upon by the genital microbiota, with a focus on epidemiological, biochemical, and immunological features. RECENT FINDINGS At least in women, a genital microbiota dominated by lactobacilli has long been considered optimal for reproductive health, while depletion of lactobacilli may lead to a genital microenvironment dominated by anaerobic pathogens, which can manifest clinically as bacterial vaginosis. Recent research efforts have characterized genital microbiota composition in greater resolution, sometimes at species-level, using proteomics, metabolomics, and deep sequencing. This has enhanced our understanding of how specific microbiota members influence acquisition or clinical manifestation of STI pathogen infection. Other advances include a steady, though still slow, increase in the number of studies that sought to determine the genital (penile or urethral) microbiota of males and how it may impact that of their female partners' genital microbiota and risk of STI acquisition. Altogether, these data enabled us to explore the concept that genital microbiota may be sexually transmitted and influence pathogenesis and clinical presentation of other STI. SUMMARY With STI infection rates increasing worldwide, it is important now more than ever to find novel STI prevention strategies. Understanding if and how the genital microbiota is a modifiable risk factor for STI transmission, acquisition, and clinical manifestation may prove to be an important strategy in our efforts to curb morbidity in at risk populations.
Collapse
Affiliation(s)
- Andreea Waltmann
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cynthia Thomas
- Graduate Program, Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph A Duncan
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Pharmacology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
3
|
Tamarelle J, Shardell MD, Ravel J, Brotman RM. Factors Associated With Incidence and Spontaneous Clearance of Molecular-Bacterial Vaginosis: Results From a Longitudinal Frequent-Sampling Observational Study. Sex Transm Dis 2022; 49:649-656. [PMID: 35969846 PMCID: PMC9387550 DOI: 10.1097/olq.0000000000001662] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We sought to assess time-independent and time-varying factors associated with incidence and spontaneous clearance of molecular-bacterial vaginosis (BV; without treatment). METHODS Midvaginal samples were self-collected daily by 100 participants recruited at the University of Alabama Birmingham for 10 weeks (4778 samples). Vaginal microbiota was characterized by 16S rRNA gene amplicon sequencing and clustered into community state types (CSTs). A low-Lactobacillus CST defined the molecular-BV outcome in this study. Factors associated with molecular-BV incidence and spontaneous clearance were modeled using Andersen-Gill recurrent event Cox models. Community class identified the predominant CST of a participant during follow-up. RESULTS Menstruations (adjusted odds ratio [aHR], 2.09 [95% confidence interval, 1.51-2.89] in the prior 24 hours) and CST III (Lactobacillus iners dominated) at the previous sample (aHR, 2.25 [1.48-3.40]) were associated with increased molecular-BV incidence. Participants with a majority of L. iners-dominated samples longitudinally (community class LI) displayed less stable patterns of vaginal microbiota. In LI participants, reduced molecular-BV spontaneous clearance was observed in African American participants (aHR, 0.44 [0.26-0.75]) compared with White participants, older participants (age, 40-49 years [aHR, 0.38; 0.23-0.61]; age, 30-39 years [aHR, 0.48; 0.28-0.83]) compared with participants aged 18 to 29 years, and after douching (0.45 [0.28-0.73] within prior 72 hours). CONCLUSIONS Although it is now well documented that vaginal microbiota are dynamic, there are few available data on factors associated with spontaneous clearance of molecular-BV. Lactobacillus iners-dominated vaginal microbiota are more likely to be dynamic and associated with different risk factors for incidence and clearance of BV. Among L. iners-dominated participants, age, race, and douching were linked to reduced clearance. Most transitions to molecular-BV during menstruations were short-lived.
Collapse
Affiliation(s)
- Jeanne Tamarelle
- Department of Fundamental Microbiology, University of
Lausanne, Lausanne, Switzerland
| | - Michelle D. Shardell
- Institute for Genome Sciences, University of Maryland
School of Medicine, Baltimore, MD
- Department of Epidemiology and Public Health, University of
Maryland School of Medicine, Baltimore, MD
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland
School of Medicine, Baltimore, MD
- Department of Microbiology and Immunology, University of
Maryland School of Medicine, Baltimore, MD
| | - Rebecca M. Brotman
- Institute for Genome Sciences, University of Maryland
School of Medicine, Baltimore, MD
- Department of Epidemiology and Public Health, University of
Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
4
|
Vallejo-Ortega MT, Gaitán Duarte H, Mello MB, Caffe S, Perez F. A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America. Rev Panam Salud Publica 2022; 46:e73. [PMID: 35747471 PMCID: PMC9211030 DOI: 10.26633/rpsp.2022.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean. Methods The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle-Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported. Results Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants). Conclusions Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.
Collapse
Affiliation(s)
| | - Hernando Gaitán Duarte
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
| | | | | | | |
Collapse
|
5
|
Geisler WM, Hocking JS, Darville T, Batteiger BE, Brunham RC. Diagnosis and Management of Uncomplicated Chlamydia trachomatis Infections in Adolescents and Adults: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis 2022; 74:S112-S126. [PMID: 35416965 PMCID: PMC9006972 DOI: 10.1093/cid/ciac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To prepare for the development of the 2021 Centers for Disease Control and Prevention (CDC) sexually transmitted infections treatment guidelines, the CDC convened a committee of expert consultants in June 2019 to discuss recent abstracts and published literature on the epidemiology, diagnosis, and management of sexually transmitted infections.This paper summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infections in adolescents and adults that were reviewed and discussed for consideration in developing the guidelines. The evidence reviewed mostly focused on efficacy of doxycycline and azithromycin for urogenital, rectal, and oropharyngeal CT infection, CT risk factors in women, performance of CT nucleic acid amplification tests on self-collected meatal specimens in men, and performance of newer CT point-of-care tests.
Collapse
Affiliation(s)
- William M Geisler
- Division of Infectious Diseases, Department of Medicine and Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Toni Darville
- Department of Pediatrics and Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Byron E Batteiger
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert C Brunham
- Vaccine Research Laboratory, University of British Columbia Centre for Disease Control, Vancouver, Canada
| |
Collapse
|
6
|
Tjahyadi D, Ropii B, Tjandraprawira KD, Parwati I, Djuwantono T, Permadi W, Li T. Female urogenital chlamydia: Epidemiology, chlamydia on pregnancy, current diagnosis, and treatment. Ann Med Surg (Lond) 2022; 75:103448. [PMID: 35386801 PMCID: PMC8977933 DOI: 10.1016/j.amsu.2022.103448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Female urogenital chlamydia is a disease caused by Chlamydia trachomatis infection in the female urogenital tract. It is a common bacterial sexually transmitted disease. The bacteria is transmitted through sexual contact with an infected partner or from mother to newborn during vaginal delivery. The prevalence varies among studies and the number is possibly higher due to the lack of massive screening. Many patients were asymptomatic and still be able to transmit the disease. The undiagnosed and untreated disease could cause pelvic inflammatory disease, which leads to infertility, ectopic pregnancy, and chronic pelvic pain. The prevalence among pregnant women is similar to non-pregnant women, therefore chlamydia screening in pregnant women is highly recommended. The nucleic acid amplification test is the most reliable method for the diagnosis due to high sensitivity. The current treatment is given by prescribing antibiotics. Female urogenital chlamydia is caused by Chlamydia trachomatis. Urogenital chlamydia affects young and sexually active women. Female urogenital chlamydia is diagnosed through indirect methods (serology-based tests) and direct methods (culture). Treatment of chlamydia consists of antibiotics with doxycycline being the first-line choice.
Collapse
|
7
|
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]
|
8
|
Vaginal Microbiota of the Sexually Transmitted Infections Caused by Chlamydia trachomatis and Trichomonas vaginalis in Women with Vaginitis in Taiwan. Microorganisms 2021; 9:microorganisms9091864. [PMID: 34576759 PMCID: PMC8470505 DOI: 10.3390/microorganisms9091864] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022] Open
Abstract
The three most common sexually transmitted infections (STIs) are Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and Trichomonas vaginalis (TV). The prevalence of these STIs in Taiwan remains largely unknown and the risk of STI acquisition affected by the vaginal microbiota is also elusive. In this study, a total of 327 vaginal swabs collected from women with vaginitis were analyzed to determine the presence of STIs and the associated microorganisms by using the BD Max CT/GC/TV molecular assay, microbial cultures, and 16S rRNA sequencing. The prevalence of CT, TV, and GC was 10.8%, 2.2% and 0.6%, respectively. A culture-dependent method identified that Escherichia coli and Streptococcus agalactiae (GBS) were more likely to be associated with CT and TV infections. In CT-positive patients, the vaginal microbiota was dominated by L. iners, and the relative abundance of Gardnerella vaginalis (12.46%) was also higher than that in TV-positive patients and the non-STIs group. However, Lactobacillus spp. was significantly lower in TV-positive patients, while GBS (10.11%), Prevotella bivia (6.19%), Sneathia sanguinegens (12.75%), and Gemella asaccharolytica (5.31%) were significantly enriched. Using an in vitro co-culture assay, we demonstrated that the growth of L. iners was suppressed in the initial interaction with TV, but it may adapt and survive after longer exposure to TV. Additionally, it is noteworthy that TV was able to promote GBS growth. Our study highlights the vaginal microbiota composition associated with the common STIs and the crosstalk between TV and the associated bacteria, paving the way for future development of health interventions targeting the specific vaginal bacterial taxa to reduce the risk of common STIs.
Collapse
|
9
|
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: 784] [Impact Index Per Article: 261.3] [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.
Collapse
|
10
|
Chen X, Lu Y, Chen T, Li R. The Female Vaginal Microbiome in Health and Bacterial Vaginosis. Front Cell Infect Microbiol 2021; 11:631972. [PMID: 33898328 PMCID: PMC8058480 DOI: 10.3389/fcimb.2021.631972] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
The vaginal microbiome is an intricate and dynamic microecosystem that constantly undergoes fluctuations during the female menstrual cycle and the woman's entire life. A healthy vaginal microbiome is dominated by Lactobacillus which produce various antimicrobial compounds. Bacterial vaginosis (BV) is characterized by the loss or sharp decline in the total number of Lactobacillus and a corresponding marked increase in the concentration of anaerobic microbes. BV is a highly prevalent disorder of the vaginal microbiota among women of reproductive age globally. BV is confirmed to be associated with adverse gynecologic and obstetric outcomes, such as sexually transmitted infections, pelvic inflammatory disease, and preterm birth. Gardnerella vaginalis is the most common microorganism identified from BV. It is the predominant microbe in polymicrobial biofilms that could shelter G. vaginalis and other BV-associated microbes from adverse host environments. Many efforts have been made to increase our understanding of the vaginal microbiome in health and BV. Thus, improved novel and accurate diagnosis and therapeutic strategies for BV have been developed. This review covers the features of vaginal microbiome, BV, BV-associated diseases, and various strategies of diagnosis and treatment of BV, with an emphasis on recent research progresses.
Collapse
Affiliation(s)
| | | | | | - Rongguo Li
- Department of Clinical Laboratory, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| |
Collapse
|
11
|
Debonnet C, Robin G, Prasivoravong J, Vuotto F, Catteau-Jonard S, Faure K, Dessein R, Robin C. [Update of Chlamydia trachomatis infection]. ACTA ACUST UNITED AC 2021; 49:608-616. [PMID: 33434747 DOI: 10.1016/j.gofs.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Indexed: 12/25/2022]
Abstract
Chlamydia trachomatis (CT) is the most common sexually transmitted bacterial infection worldwide. It is asymptomatic in most cases and mainly affects young women, with potential long term sequelae (pelvic inflammatory disease, tubal infertility, obstetric complications). The impact on male fertility is controversial. Screening methods as well as antibiotics use have recently been reassessed due to resistance phenomena and the negative effect on the urogenital microbiota. Positive CT serology may be indicative of tuboperitoneal pathology, which may not be noticed on hysterosalpingography. New research on single-nucleotide polymorphisms (SNPs) aims to establish a patient profile at higher risk of infectious tubal damage due to CT. CT seropositivity is also associated with decreased spontaneous pregnancy rates and is a predictive factor for obstetrical complications.
Collapse
Affiliation(s)
- C Debonnet
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France.
| | - G Robin
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France; Service d'andrologie, université de Lille, CHU Lille, 59000 Lille, France
| | - J Prasivoravong
- Service d'andrologie, université de Lille, CHU Lille, 59000 Lille, France
| | - F Vuotto
- Service de maladies infectieuses, université de Lille, CHU Lille, 59000 Lille, France
| | - S Catteau-Jonard
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France
| | - K Faure
- Service de maladies infectieuses, université de Lille, CHU Lille, 59000 Lille, France
| | - R Dessein
- Institut de microbiologie et service de bactériologie, université de Lille, CHU Lille, 59000 Lille, France
| | - C Robin
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France
| |
Collapse
|
12
|
Tamarelle J, Ma B, Gajer P, Humphrys MS, Terplan M, Mark KS, Thiébaut ACM, Forney LJ, Brotman RM, Delarocque-Astagneau E, Bavoil PM, Ravel J. Nonoptimal Vaginal Microbiota After Azithromycin Treatment for Chlamydia trachomatis Infection. J Infect Dis 2020; 221:627-635. [PMID: 31573603 PMCID: PMC7530545 DOI: 10.1093/infdis/jiz499] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/27/2019] [Indexed: 12/26/2022] Open
Abstract
We characterized the composition and structure of the vaginal microbiota in a cohort of 149 women with genital Chlamydia trachomatis infection at baseline who were followed quarterly for 9 months after antibiotic treatment. At time of diagnosis, the vaginal microbiota was dominated by Lactobacillus iners or a diverse array of bacterial vaginosis–associated bacteria including Gardnerella vaginalis. Interestingly, L. iners–dominated communities were most common after azithromycin treatment (1 g monodose), consistent with the observed relative resistance of L. iners to azithromycin. Lactobacillus iners–dominated communities have been associated with increased risk of C. trachomatis infection, suggesting that the impact of antibiotic treatment on the vaginal microbiota could favor reinfections. These results provide support for the dual need to account for the potential perturbing effect(s) of antibiotic treatment on the vaginal microbiota, and to develop strategies to protect and restore optimal vaginal microbiota.
Collapse
Affiliation(s)
- Jeanne Tamarelle
- Unité Mixte de Recherche 1181 , Université Versailles-Saint-Quentin-en-Yvelines, Institut Pasteur, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Bing Ma
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pawel Gajer
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mike S Humphrys
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mishka Terplan
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, Maryland, USA, Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Katrina S Mark
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, Maryland, USA, Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anne C M Thiébaut
- Unité Mixte de Recherche 1181 , Université Versailles-Saint-Quentin-en-Yvelines, Institut Pasteur, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Larry J Forney
- Department of Biological Sciences, University of Idaho, Moscow, Idaho, USA
| | - Rebecca M Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elisabeth Delarocque-Astagneau
- Unité Mixte de Recherche 1181 , Université Versailles-Saint-Quentin-en-Yvelines, Institut Pasteur, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Patrik M Bavoil
- Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: A narrative review. Tob Induc Dis 2020; 18:60. [PMID: 32765200 PMCID: PMC7398598 DOI: 10.18332/tid/123845] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023] Open
Abstract
Smoking is relevant to infectious diseases resulting in increased prevalence and mortality. In this article, we aim to provide an overview of the effects of smoking in various infections and to explain the potential mechanisms. We searched PubMed and other relevant databases for scientific studies that explored the relationship between smoking and infection. The mechanisms of susceptibility to infection in smokers may include alteration of the structural, functional and immunologic host defences. Smoking is one of the main risk factors for infections in the respiratory tract, digestive tract, reproductive tract, and other systems in humans, increasing the prevalence of HIV, tuberculosis, SARS-CoV, and the current SARS-CoV-2. Smoking cessation can reduce the risk of infection. Smoking increases the incidence of infections and aggravates the progress and prognosis of infectious diseases in a dose-dependent manner. Smoking cessation promotion and education are the most practical and economical preventive measures to reduce aggravation of disease infection owing to tobacco use.
Collapse
Affiliation(s)
- Chen Jiang
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiong Chen
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxuan Xie
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
14
|
Abstract
OBJECTIVES The aim of the study was to investigate whether the use of dating apps is a risk factor for acquiring Chlamydia trachomatis (CT) infections. METHODS Patients attending the drop-in facility at the STI clinic at Umeå University Hospital between April 2016 and November 2017 were asked to fill in a survey about their sexual preferences and behaviors, including dating app use. RESULTS Of 943 participants, 80 (8.5%) received a CT diagnosis (34 women and 46 men). Dating app users did not seem to have an increased risk of CT infection. Having 3 or more sex partners within the last year was a risk factor for CT only among those not using a dating app. Alcohol use before sex and unprotected sex with a new partner were risk factors for CT infection in the univariate but not in the multivariate analysis. CONCLUSIONS Dating app users did not seem to have an increased risk of acquiring CT and for dating app users the seemingly well-established risk factor of having many partners was not valid.
Collapse
|
15
|
Association between human papillomavirus and chlamydia trachomatis infection risk in women: a systematic review and meta-analysis. Int J Public Health 2019; 64:943-955. [DOI: 10.1007/s00038-019-01261-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022] Open
|
16
|
Human Papilloma Virus and Chlamydia trachomatis: Casual Acquaintances or Partners in Crime? CURRENT CLINICAL MICROBIOLOGY REPORTS 2019. [DOI: 10.1007/s40588-019-00117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
17
|
O'Connell CM, Brochu H, Girardi J, Harrell E, Jones A, Darville T, Seña AC, Peng X. Simultaneous profiling of sexually transmitted bacterial pathogens, microbiome, and concordant host response in cervical samples using whole transcriptome sequencing analysis. MICROBIAL CELL 2019; 6:177-183. [PMID: 30854394 PMCID: PMC6402362 DOI: 10.15698/mic2019.03.672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pelvic inflammatory disease (PID) is a female upper genital tract inflammatory disorder that arises after sexually transmitted bacterial infections (STI). Factors modulating risk for reproductive sequelae include co-infection, microbiota, host genetics and physiology. In a pilot study of cervical samples obtained from women at high risk for STIs, we examined the potential for unbiased characterization of host, pathogen and microbiome interactions using whole transcriptome sequencing analysis of ribosomal RNA-depleted total RNAs (Total RNA-Seq). Only samples from women with STI infection contained pathogen-specific sequences (3 to 38% transcriptome coverage). Simultaneously, we identified and quantified their active microbial communities. After integration with host-derived reads from the same data, we detected clustering of host transcriptional profiles that reflected microbiome differences and STI infection. Together, our study suggests that total RNA profiling will advance understanding of the interplay of pathogen, host and microbiota during natural infection and may reveal novel, outcome-relevant biomarkers.
Collapse
Affiliation(s)
- Catherine M O'Connell
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hayden Brochu
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Jenna Girardi
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin Harrell
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Aiden Jones
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Toni Darville
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arlene C Seña
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xinxia Peng
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA.,Bioinformatics Research Center, North Carolina State University, Raleigh, North Carolina, USA
| |
Collapse
|
18
|
Thng CCM. A Review of Sexually Transmitted Infections in Australia - Considerations in 2018. Acad Forensic Pathol 2018; 8:938-946. [PMID: 31240082 DOI: 10.1177/1925362118821492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/28/2018] [Indexed: 01/02/2023]
Abstract
Sexually transmitted infections (STIs) bear a high burden of disease and, subsequently, high health costs globally. Chlamydia, gonorrhoea, syphilis, and trichomoniasis contribute to nearly one million infections every day worldwide. Sexually transmitted infections continue to be the most frequently notified condition to the Australian National Notifiable Diseases Surveillance System and the numbers continue to increase. Australia has achieved several significant successes in reducing STIs and blood-borne viruses (BBV) including the significant decrease in genital warts in those less than 30 years old since 2007 following the launch of human papillomavirus vaccines in women, the virtual elimination of mother to child transmission of HIV, and the increased uptake of successful hepatitis C treatment following the availability of direct acting antiviral treatment on the Pharmaceutical Benefits Scheme. However, several challenges remain, including the ongoing rise of chlamydia, gonorrhoea, and syphilis over the last five years; the emergence of antibiotic resistance; and the increasing disparity in the prevalence of STIs and BBV in men who have sex with men, young people, and Aboriginal and Torres Strait Islander people, and challenges in the delivery of services to rural and remote Australia. In this paper, we aim to provide a snapshot of the current landscape and challenges for chlamydia, gonorrhoea, mycoplasma, syphilis and HIV infections in Australia.
Collapse
|
19
|
Tabacco L, Chung SE, Perin J, Huettner S, Butz A, Trent M. Relationship Status and Sexual Behaviors in Post-Pelvic Inflammatory Disease (PID) Affected Urban Young Women: A Sub-Study of a Randomized Controlled Trial. INTERNATIONAL ARCHIVES OF NURSING AND HEALTH CARE 2018; 4. [PMID: 30221216 PMCID: PMC6136437 DOI: 10.23937/2469-5823/1510088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adolescent and young adult women disproportionately experience Pelvic Inflammatory Disease (PID) as a complication of Sexually Transmitted Infections (STIs). This study seeks to understand the relationship context, changes in sexual behavior, and impact of partner sexual behavior on recurrent STI diagnoses at 3-months post-diagnosis. Adolescents and young adult women 13–25 were recruited from an outpatient disposition from an outpatient clinic, and pediatric and adult emergency rooms. Participants received treatment at baseline and follow-up at 2-weeks, 1-month and 3-month post-diagnosis, including interviews about personal and partner sexual behaviors and STI screening (n = 94). At the 2-week interview, 53% of participants (50/94) believed they could acquire an STI from their current partner if they did not use a condom. However, at 3-month follow-up only 35% reported condom usage at last sex. At 3-month follow-up, 55% (50/91) of participants were still in a sexual relationship with the previously reported partner and 38% of participants who reported they could get an STI from their partner were diagnosed with an STI; compared with 25% of participants who predicted that they could not get an STI (OR 1.85; 95% CI: 0.67–5.30). There was no association between maintaining the same partner and having an STI at 3-months (OR 0.5; 95% CI: 0.27–1.96). Most young women diagnosed with PID report exclusive relationships, but are simultaneously aware of their risk for recurrent STIs. Given the short-term stability of many relationships, couples interventions are an unexplored opportunity for prevention of recurrent STIs after PID.
Collapse
Affiliation(s)
- Lisa Tabacco
- Division of General Pediatrics and Adolescent Medicine, School of Medicine, Johns Hopkins University, USA
| | | | - Jamie Perin
- Division of Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Steven Huettner
- Division of General Pediatrics and Adolescent Medicine, School of Medicine, Johns Hopkins University, USA
| | - Arlene Butz
- Division of General Pediatrics and Adolescent Medicine, School of Medicine, Johns Hopkins University, USA
| | - Maria Trent
- Division of General Pediatrics and Adolescent Medicine, School of Medicine, Johns Hopkins University, USA
| |
Collapse
|
20
|
Kerry-Barnard S, Fleming C, Reid F, Phillips R, Drennan VM, Adams EJ, Majewska W, Balendra A, Harding-Esch E, Cousins E, Tariq Sadiq S, Oakeshott P. 'Test n Treat (TnT)'- Rapid testing and same-day, on-site treatment to reduce rates of chlamydia in sexually active further education college students: study protocol for a cluster randomised feasibility trial. Trials 2018; 19:311. [PMID: 29871673 PMCID: PMC5989383 DOI: 10.1186/s13063-018-2674-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We will conduct a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing and same-day treatment (Test and Treat (TnT)) in six FE colleges (with parallel qualitative and economic assessments) to assess the feasibility of conducting a future trial to investigate if TnT reduces chlamydia rates. METHODS We will recruit 80 sexually active students aged 16-24 years from public areas at each of six colleges. All participants (total n = 480) will be asked to provide samples (urine for males, self-taken vaginal swabs for females) and complete questionnaires on sexual lifestyle and healthcare use at baseline and after 7 months. Participants will be informed that baseline samples will not be tested for 7 months and be advised to get screened separately. Colleges will be randomly allocated to the intervention (TnT) or the control group (no TnT). One and 4 months after recruitment, participants at each intervention college (n = 3) will be texted and invited for on-site chlamydia tests using the 90-min Cepheid GeneXpert system. Students with positive results will be asked to see a visiting nurse health adviser for same-day treatment and partner notification, (backed by genitourinary medicine follow-up). Participants in control colleges (n = 3) will receive 'thank you' texts 1 and 4 months after recruitment. Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to students with positive results. Acceptability of TnT will be assessed by qualitative interviews of purposively sampled students (n = 30) and college staff (n = 12). We will collect data on costs of TnT and usual healthcare. DISCUSSION Findings will provide key values to inform feasibility, sample size and timescales of a future definitive trial of TnT in FE colleges, including: Recruitment rates TnT uptake rates Follow-up rates Prevalence of chlamydia in participants at baseline and 7 months Acceptability of TnT to students and college staff Estimate of the cost per person screened/treated in TnT versus usual care TRIAL REGISTRATION: International Standard Randomised Controlled Trials Registry, ID: ISRCTN58038795 , Registered on 31 August 2016.
Collapse
Affiliation(s)
- Sarah Kerry-Barnard
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
| | - Charlotte Fleming
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
| | - Fiona Reid
- Department of Primary Care and Public Health Sciences, King’s College London, 4th Floor, Addison House, Guy’s Campus, London, SE1 1UL UK
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King’s College London, 4th Floor, Addison House, Guy’s Campus, London, SE1 1UL UK
| | - Vari M. Drennan
- Centre for Health and Social Care Research, Kingston University and St George’s University of London, London, SW17ORE UK
| | - Elisabeth J. Adams
- Aquarius Population Health Limited, 58a Highgate High Street, London, N6 5HX UK
| | - Wendy Majewska
- WEM Consultancy Ltd., 96 Tantallon Road, London, SW12 8DH UK
| | - Anjella Balendra
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
| | - Emma Harding-Esch
- Infection and Immunity, St George’s, University of London, London, SW17ORE UK
| | - Emma Cousins
- Infection and Immunity, St George’s, University of London, London, SW17ORE UK
| | - S. Tariq Sadiq
- Infection and Immunity, St George’s, University of London, London, SW17ORE UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s, University of London, London, SW17ORE UK
| |
Collapse
|
21
|
Phillips R, Oakeshott P, Kerry-Barnard S, Reid F. 'Test n Treat (TnT)': a cluster-randomised feasibility trial of frequent, rapid-testing and same-day, on-site treatment to reduce rates of chlamydia in high-risk further education college students: statistical analysis plan. Trials 2018; 19:312. [PMID: 29871668 PMCID: PMC5989377 DOI: 10.1186/s13063-018-2675-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 05/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There are high rates of sexually transmitted infections (STIs) in ethnically diverse, sexually active students aged 16-24 years attending London further education (FE) colleges. However, uptake of chlamydia screening remains low. The TnT study aims to assess the feasibility of conducting a future trial in FE colleges to investigate if frequent, rapid, on-site testing and treatment (TnT) reduces chlamydia rates. This article presents the statistical analysis plan for the main study publication as approved and signed off by the Trial Management Group prior to the first data extraction for the final report. METHODS/DESIGN TnT is a cluster-randomised feasibility trial conducted over 7 months with parallel qualitative and economic assessments. Colleges will be randomly allocated into the intervention (TnT) or the control group (no TnT). Six FE colleges in London will be included. At each college for 2 days, 80 consecutive sexually active students aged 16-24 years (total 480 students across all six colleges) will be recruited from public areas and asked to provide baseline samples. One and 4 months after recruitment intervention colleges will be visited on two consecutive days by the TnT team where participating students will be texted and invited to come for same-day, on-site, rapid chlamydia testing and, if positive, treatment. Participants in the control colleges will receive 'thank you' texts 1 and 4 months after recruitment. Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to participants with positive results. Key feasibility outcomes include: recruitment rates, testing and treatment uptake rates (at 1 and 4 months) and follow-up rates (at 7 months). TRIAL REGISTRATION ISRCTN 58038795 . Registered on 31 August 2016.
Collapse
Affiliation(s)
- Rachel Phillips
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute St George’s, University of London, London, UK
| | - Sarah Kerry-Barnard
- Population Health Research Institute St George’s, University of London, London, UK
| | - Fiona Reid
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| |
Collapse
|
22
|
Chlamydia trachomatis Incidence Using Self-Reports and Serology by Gender, Age Period, and Sexual Behavior in a Birth Cohort. Sex Transm Dis 2018; 44:344-350. [PMID: 28499283 DOI: 10.1097/olq.0000000000000605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although understanding chlamydia incidence assists prevention and control, analyses based on diagnosed infections may distort the findings. Therefore, we determined incidence and examined risks in a birth cohort based on self-reports and serology. METHODS Self-reported chlamydia and behavior data were collected from a cohort born in New Zealand in 1972/3 on several occasions to age 38 years. Sera drawn at ages 26, 32, and 38 years were tested for antibodies to Chlamydia trachomatis Pgp3 antigen using a recently developed assay, more sensitive in women (82.9%) than men (54.4%). Chlamydia incidence by age period (first coitus to age 26, 26-32, and 32-38 years) was calculated combining self-reports and serostatus and risk factors investigated by Poisson regression. RESULTS By age 38 years, 32.7% of women and 20.9% of men had seroconverted or self-reported a diagnosis. The highest incidence rate was to age 26, 32.7 and 18.4 years per 1000 person-years for women and men, respectively. Incidence rates increased substantially with increasing number of sexual partners. After adjusting age period incidence rates for partner numbers, a relationship with age was not detected until 32 to 38 years, and then only for women. CONCLUSIONS Chlamydia was common in this cohort by age 38, despite the moderate incidence rates by age period. The strongest risk factor for incident infection was the number of sexual partners. Age, up to 32 years, was not an independent factor after accounting for partner numbers, and then only for women. Behavior is more important than age when considering prevention strategies.
Collapse
|
23
|
A 30-Min Nucleic Acid Amplification Point-of-Care Test for Genital Chlamydia trachomatis Infection in Women: A Prospective, Multi-center Study of Diagnostic Accuracy. EBioMedicine 2018; 28:120-127. [PMID: 29396306 PMCID: PMC5897918 DOI: 10.1016/j.ebiom.2017.12.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 01/31/2023] Open
Abstract
Background Rapid Point-Of-Care Tests for Chlamydia trachomatis (CT) may reduce onward transmission and reproductive sexual health (RSH) sequelae by reducing turnaround times between diagnosis and treatment. The io® single module system (Atlas Genetics Ltd.) runs clinical samples through a nucleic acid amplification test (NAAT)-based CT cartridge, delivering results in 30 min. Methods Prospective diagnostic accuracy study of the io® CT-assay in four UK Genito-Urinary Medicine (GUM)/RSH clinics on additional-to-routine self-collected vulvovaginal swabs. Samples were tested “fresh” within 10 days of collection, or “frozen” at − 80 °C for later testing. Participant characteristics were collected to assess risk factors associated with CT infection. Results CT prevalence was 7.2% (51/709) overall. Sensitivity, specificity, positive and negative predictive values of the io® CT assay were, respectively, 96.1% (95% Confidence Interval (CI): 86.5–99.5), 97.7% (95%CI: 96.3–98.7), 76.6% (95%CI: 64.3–86.2) and 99.7% (95%CI: 98.9–100). The only risk factor associated with CT infection was being a sexual contact of an individual with CT. Conclusions The io® CT-assay is a 30-min, fully automated, high-performing NAAT currently CE-marked for CT diagnosis in women, making it a highly promising diagnostic to enable specific treatment, initiation of partner notification and appropriately intensive health promotion at the point of care. The io® CT assay's sensitivity is comparable to that of laboratory-based assays commonly used for Chlamydia detection. The specificity as shown is this study is at the lower end of the range reported for laboratory-based assays. The resulting positive predictive value, in this population, indicates that a targeted testing approach may be optimal.
Until now, there have been no ≤ 30-min point-of-care test (POCT) nucleic acid amplification tests (NAATs) on the market for detecting Chlamydia trachomatis (CT), despite cost-effectiveness analyses demonstrating they may improve Genito-Urinary Medicine (GUM)/Reproductive and Sexual Health (RSH) clinical care pathway efficiencies and patient outcomes. Our evaluation of the 30-min Atlas Genetics io® CT NAAT POCT, on vaginal swabs from women attending four GUM/RSH clinics in England, shows that the test's sensitivity (accurately detecting CT-positive infections) is similar to that of laboratory-based NAATs, and its specificity (accurately detecting CT-negative infections) is at the lower end of the laboratory-based NAAT range.
Collapse
|
24
|
Somayaji R, Naugler C, Guo M, Church DL. Examining sociodemographic risk factors for Chlamydia trachomatis infection: a population-based cohort study. Future Microbiol 2017; 12:1363-1370. [PMID: 29022366 DOI: 10.2217/fmb-2017-0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection in developed nations and is an important public health concern. We aimed to assess the factors associated with testing and positivity of C. trachomatis in a large population. METHODS A retrospective study of a large Canadian health region was undertaken using 2011 census and laboratory data. Demographic and socioeconomic data from the national household survey were linked to microbiologic data for C. trachomatis. Multivariable generalized estimating equation models were constructed to examine relative risk for C. trachomatis testing and positivity. RESULTS For testing and positivity, female sex and younger age groups were associated with increased risk. University education and South Asian ethnicity were associated with lower risk of positivity. CONCLUSION Incorporating socio-demographic factors will be critical to the success of future sexually transmitted infection public health programs.
Collapse
Affiliation(s)
- Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Christopher Naugler
- Calgary Laboratory Services, Calgary, AB, T2L 2K8, Canada.,Department of Pathology & Laboratory Medicine & Medicine, University of Calgary, Calgary, AB, T2L 2K8, Canada.,Department of Family Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Maggie Guo
- Calgary Laboratory Services, Calgary, AB, T2L 2K8, Canada
| | - Deirdre L Church
- Department of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada.,Calgary Laboratory Services, Calgary, AB, T2L 2K8, Canada.,Department of Pathology & Laboratory Medicine & Medicine, University of Calgary, Calgary, AB, T2L 2K8, Canada
| |
Collapse
|
25
|
Párducz L, Eszik I, Wagner G, Burián K, Endrész V, Virok DP. Impact of antiseptics on Chlamydia trachomatis growth. Lett Appl Microbiol 2017; 63:260-7. [PMID: 27472980 DOI: 10.1111/lam.12625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/30/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Bacterial vaginosis is a frequent dysbiosis, where the normal lactobacillus-dominated flora is replaced by an anaerob/aerob polymicrobial flora. Bacterial vaginosis increases the risk of acquiring sexually transmitted infections (STI) including the most frequent Chlamydia trachomatis infections. Intravaginal antiseptics are part of the bacterial vaginosis treatment, and ideally they should also inhibit the bacterial vaginosis-related STI. Therefore, we tested the antichlamydial activity of four antiseptics: iodine aqueous solution, povidone-iodine, chlorhexidine and borax. First, we measured the impact of antiseptics on the viability of the HeLa cervical epithelial cells, and calculated the maximum nontoxic concentrations. Next, we infected the cells with C. trachomatis preincubated for 1 h with the particular antiseptic. The chlamydial growth was measured by direct quantitative PCR (qPCR) of the infected cells. The minimal inhibitory concentrations (MIC) of chlorhexidine and povidone-iodine were 3·91 and 97 μg ml(-1) respectively; however, the MIC of chlorhexidine was close to its maximum nontoxic concentration. The iodine aqueous solution and the borax showed no antichlamydial activity. Our in vitro studies showed that chlorhexidine and particularly povidone-iodine are potentially able to limit the bacterial vaginosis-related C. trachomatis infection. SIGNIFICANCE AND IMPACT OF THE STUDY We measured the antichlamydial effects of various antiseptics. These antiseptics are being used for the treatment of bacterial vaginosis, but their effect on the bacterial vaginosis-related sexually transmitted infections, particularly the most frequent Chlamydia trachomatis (C. trachomatis) infections has not been investigated. We showed that povidone-iodine (Betadine) inhibited the chlamydial growth in concentrations that was not toxic to the epithelial cells. We concluded that due to its additional antichlamydial effect, povidone-iodine could be a preferable antiseptic in bacterial vaginosis treatment.
Collapse
Affiliation(s)
- L Párducz
- Pándy Kálmán County Hospital, Gyula, Hungary
| | - I Eszik
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - G Wagner
- Pándy Kálmán County Hospital, Gyula, Hungary
| | - K Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - V Endrész
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - D P Virok
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary.
| |
Collapse
|
26
|
Abstract
Adolescents are at high risk for acquisition and transmission of sexually transmitted infections (STI) secondary to both cognitive and biological susceptibility. The prevention, diagnosis, and treatment of STIs are a critical part of adolescent health care. This article discusses the most common bacterial, parasitic, and viral STIs encountered in this age group with an emphasis on new guidelines for screening and management.
Collapse
|
27
|
Goyal V, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Lifetime Sexual Assault and Sexually Transmitted Infections Among Women Veterans. J Womens Health (Larchmt) 2017; 26:745-754. [PMID: 28281918 DOI: 10.1089/jwh.2016.5775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Women veterans report a high prevalence of sexual assault. Unfortunately, there are limited data on the reproductive health sequelae faced by these women. Our objective was to evaluate the association between completed lifetime sexual assault (LSA) and sexually transmitted infections (STIs) among a cohort of women veterans, adjusting for sexual risk behaviors. MATERIALS AND METHODS We conducted a retrospective study among women veterans aged 51 years or younger who enrolled for care at two Veterans Administration (VA) healthcare sites between 2000 and 2008. Participants completed a telephone interview assessing reproductive health and sexual violence history. We compared the frequencies of past STI diagnoses among those who had and had not experienced LSA. We used logistic regression to assess the effect of sexual assault with history of an STI diagnosis after adjusting for age, sexual risk behaviors, and substance abuse treatment. RESULTS Among 996 women veterans, a history of STIs was reported by 32%, including a lifetime history of gonorrhea (5%), chlamydia (15%), genital herpes infection (8%), and human papillomavirus infection (15%), not mutually exclusive; 51% reported LSA. Women with a history of LSA were significantly more likely to report a history of STIs (unadjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.45-2.50; adjusted OR 1.49, 95% CI 1.07-2.08). CONCLUSIONS Women veterans who have experienced LSA are at increased risk for lifetime STI diagnoses. To adequately address the reproductive health needs of the growing population of women veterans, STI risk assessments should include queries of military service and LSA histories.
Collapse
Affiliation(s)
- Vinita Goyal
- 1 South Texas Veterans Health Care System , San Antonio, Texas
| | - Michelle A Mengeling
- 2 Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Health Care System , Iowa City, Iowa.,3 VA Office of Rural Health, Veteran Rural Health Resource Center , Iowa City, Iowa.,4 Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Brenda M Booth
- 5 Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System , Little Rock, Arkansas.,6 Department of Psychiatry, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - James C Torner
- 7 Department of Epidemiology, University of Iowa College of Public Health , Iowa City, Iowa.,8 Department of Neurosurgery and Surgery, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Craig H Syrop
- 9 Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Anne G Sadler
- 2 Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Health Care System , Iowa City, Iowa.,10 Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, Iowa
| |
Collapse
|
28
|
Risk Factors for Incident and Redetected Chlamydia trachomatis Infection in Women: Results of a Population-Based Cohort Study. Sex Transm Dis 2016; 43:113-9. [PMID: 26760181 DOI: 10.1097/olq.0000000000000394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate risk factors for incident and redetected Chlamydia trachomatis (CT) infection in women, including the role of high-risk human papillomavirus (HPV). METHODS In this population-based, prospective cohort study conducted in Copenhagen, Denmark, 10,729 women aged 20 to 29 years were tested for CT and HPV DNA and provided information on sexual and health behavior at baseline. Of these, 7998 (74.5%) participated in a follow-up visit 2 years later with identical data collection. We used logistic regression to investigate risk factors for incident and redetected CT infection at follow-up. RESULTS Among CT DNA negative women at baseline (n = 7529), 106 (1.4%) were CT DNA positive at follow-up (incident infection). Increasing number of sexual partners during follow-up (odds ratio [OR], 1.07 per partner; 95% confidence interval (CI), 1.02-1.11), low educational level (OR, 1.69; 95% CI, 1.11-2.56; for basic education vs. high school or higher), and high-risk HPV positivity at baseline (OR, 1.66; 95% CI, 1.06-2.58) were risk factors for incident infection, whereas older age (OR, 0.86 per year increase; 95% CI, 0.80-0.93) and condom use (OR, 0.60; 95% CI, 0.38-0.94) were associated with reduced risk. Among CT DNA positive women at baseline (n = 469), 108 (23.0%) tested positive at follow-up (redetected infection). We found no statistically significant associations between age, educational level, sexual behavior, smoking, or high-risk HPV status and the risk for redetected CT. CONCLUSION Young age, low educational level, high number of sexual partners, failure to use condoms, and high-risk HPV positivity are associated with increased risk for incident CT infection. These findings may guide the development of targeted CT prevention strategies, including screening and information campaigns.
Collapse
|
29
|
Chlamydia trachomatis re-infection in Spain: A STI clinic-based cohort study. Enferm Infecc Microbiol Clin 2016; 35:165-173. [PMID: 27743678 DOI: 10.1016/j.eimc.2016.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chlamydia trachomatis (C. trachomatis) is the most frequently reported sexually transmitted infection (STI) in developed countries, but there is a lack data on its incidence and population dynamics in Spain. The objectives of this study were to estimate the incidence of C. trachomatis in patients seeking medical attention in an STI clinic with a defined population catchment area, to identify factors associated with this infection, and to explore differences between factors associated with new infections and re-infections. METHODS A retrospective study was conducted on a cohort of patients from a STI clinic who underwent chlamydia testing at least twice between 2007 and 2015. RESULTS Of the 2633 patients who met study selection criteria, 795 (30.2%) tested positive for C. trachomatis at baseline (baseline Chlamydia). The overall incidence was 7.97/100 person-years (95% CI: 7.2-8.8): 5.9/100 person-years (95% CI: 5.2-6.7) among patients testing negative for C. trachomatis at baseline, and 18.3 person-years (95% CI: 15.6-21.5) among those testing positive at baseline. In multivariate analysis, the factors independently associated with overall incidence were a history of infection with C. trachomatis in the previous 6 months (hazard ratio=3.6; 95% CI: 2.3-5.4), younger age (HR <20 vs ≥35 years=5.5; 95% CI: 3.2-9.5), male sex, 2 or more sexual partners in the previous month and year, and inconsistent condom use. CONCLUSIONS Guidelines should be established for C. trachomatis in Spain, including recommendations on the need for follow-up and re-testing, independently of age. Though data concerning the optimal timing of re-testing are inconclusive, our findings support the establishment of a 3-6 month interval.
Collapse
|
30
|
Abstract
Etiology, transmission and protection: Chlamydia
trachomatis is the leading cause of bacterial sexually transmitted
infection (STI) globally. However, C. trachomatis also causes
trachoma in endemic areas, mostly Africa and the Middle East, and is a leading
cause of preventable blindness worldwide. Epidemiology, incidence and
prevalence: The World Health Organization estimates 131 million
new cases of C. trachomatis genital infection occur annually.
Globally, infection is most prevalent in young women and men (14-25 years),
likely driven by asymptomatic infection, inadequate partner treatment and
delayed development of protective immunity.
Pathology/Symptomatology: C.
trachomatis infects susceptible squamocolumnar or transitional
epithelial cells, leading to cervicitis in women and urethritis in men. Symptoms
are often mild or absent but ascending infection in some women may lead to
Pelvic Inflammatory Disease (PID), resulting in reproductive sequelae such as
ectopic pregnancy, infertility and chronic pelvic pain. Complications of
infection in men include epididymitis and reactive arthritis.
Molecular mechanisms of infection: Chlamydiae
manipulate an array of host processes to support their obligate intracellular
developmental cycle. This leads to activation of signaling pathways resulting in
disproportionate influx of innate cells and the release of tissue damaging
proteins and pro-inflammatory cytokines. Treatment and
curability: Uncomplicated urogenital infection is treated with
azithromycin (1 g, single dose) or doxycycline (100 mg twice daily x 7 days).
However, antimicrobial treatment does not ameliorate established disease. Drug
resistance is rare but treatment failures have been described. Development of an
effective vaccine that protects against upper tract disease or that limits
transmission remains an important goal.
Collapse
Affiliation(s)
- Catherine M O'Connell
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Morgan E Ferone
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
31
|
Veličko I, Ploner A, Sparén P, Marions L, Herrmann B, Kühlmann-Berenzon S. Sexual and testing behaviour associated with Chlamydia trachomatis infection: a cohort study in an STI clinic in Sweden. BMJ Open 2016; 6:e011312. [PMID: 27566631 PMCID: PMC5013445 DOI: 10.1136/bmjopen-2016-011312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Genital chlamydia infection (chlamydia) is the most commonly reported sexually transmitted infection (STI) in Sweden. To guide prevention needs, we aimed to investigate factors associated with chlamydia. METHODS A cohort of visitors aged 20-40 years at an urban STI clinic in Sweden was recruited. Behavioural data were collected using a self-administered questionnaire. Self-sampled specimens were tested for chlamydia by a DNA amplification assay. Statistically significant (p<0.05) and epidemiologically relevant covariates were entered in a multivariate Poisson model adjusted for potential confounders (age and gender). Backward stepwise elimination produced a final model. Multiple imputation was used to account for missing values. RESULTS Out of 2814 respondents, 1436 were men with a chlamydia positivity rate of 12.6% vs 8.9% in women. Lifetime testing for chlamydia and HIV was high (82% and 60%, respectively). Factors significantly associated with chlamydia were: 20-24 years old (adjusted risk ratio (ARR)=2.10, 95% CI 1.21 to 3.65); testing reason: contact with a chlamydia case (ARR=6.55, 95% CI 4.77 to 8.98) and having symptoms (ARR=2.19, 95% CI 1.48 to 3.24); 6-10 sexual partners (ARR=1.53, 95% CI 1.06 to 2.21); last sexual activity 'vaginal sex and oral sex and anal sex and petting' (ARR=1.84, 95% CI 1.09 to 3.10); alcohol use before sex (ARR=1.98, 95% CI 1.10 to 3.57); men with symptoms (ARR=2.09, 95% CI 1.38 to 3.18); tested for chlamydia (ARR=0.72, 95% CI 0.55 to 0.94). CONCLUSIONS Risk factors associated with chlamydia were consistent with previous reports in similar settings and suggest no major changes over time. Increased risk for chlamydia infection associated with high-risk behaviour (eg, alcohol use, increased number of sexual partners) supports the need for behavioural interventions in this population such as promotion of safer sex behaviour (condom use) and testing.
Collapse
Affiliation(s)
- Inga Veličko
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Unit of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Section of Obstetrics and Gynaecology, Stockholm South General Hospital, Stockholm, Sweden
| | - Björn Herrmann
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
32
|
Nasioudis D, Linhares IM, Ledger WJ, Witkin SS. Bacterial vaginosis: a critical analysis of current knowledge. BJOG 2016; 124:61-69. [PMID: 27396541 DOI: 10.1111/1471-0528.14209] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 01/12/2023]
Abstract
Bacterial vaginosis (BV), the change from a Lactobacillus-dominant vaginal microbiota to an anaerobic and facultative bacterial dominance, is associated with pathological sequelae. In many BV-positive women their microbiota is in fact normal and unrelated to pathology. Whether or not the dominance of BV-associated bacteria persists depends upon interactions between host and bacterial factors. Inconsistencies in diagnosis and erroneous associations with pathology may be due to a failure to differentiate between sub-populations of women. It is only in those women with a BV diagnosis in which the identified bacteria are atypical and persist that BV may be a clinical problem requiring intervention. TWEETABLE ABSTRACT Improved diagnosis of bacterial vaginosis is needed to accurately determine its role in pathology.
Collapse
Affiliation(s)
- D Nasioudis
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - I M Linhares
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.,Department of Gynaecology and Obstetrics, Sao Paulo University Medical School, Sao Paulo, Brazil
| | - W J Ledger
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - S S Witkin
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
33
|
Hay PE, Kerry SR, Normansell R, Horner PJ, Reid F, Kerry SM, Prime K, Williams E, Simms I, Aghaizu A, Jensen J, Oakeshott P. Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study. Sex Transm Infect 2016; 92:63-6. [PMID: 26082320 PMCID: PMC4752626 DOI: 10.1136/sextrans-2015-052063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/26/2015] [Accepted: 05/30/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify risk factors for pelvic inflammatory disease (PID) in female students. METHODS We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004-2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians. RESULTS Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6, 95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis. CONCLUSIONS Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups. TRIAL REGISTRATION NUMBER (ClinicalTrials.gov NCT00115388).
Collapse
Affiliation(s)
- Phillip E Hay
- Department of Genitourinary Medicine, Courtyard Clinic, St George's Hospital, London, UK
| | - Sarah R Kerry
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Fiona Reid
- Department of Primary Care & Public Health Sciences, Kings College London, London, UK
| | - Sally M Kerry
- Pragmatic Clinical Trials Unit, Queen Mary's, University of London, London, UK
| | - Katia Prime
- Department of Genitourinary Medicine, Courtyard Clinic, St George's Hospital, London, UK
| | - Elizabeth Williams
- Homerton Sexual Health Services, Homerton University Hospital, London, UK
| | - Ian Simms
- Health Protection Services, Public Health England, London, UK
| | - Adamma Aghaizu
- Health Protection Services, Public Health England, London, UK
| | | | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, UK
| |
Collapse
|
34
|
Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. Background review for the '2015 European guideline on the management of Chlamydia trachomatis infections'. Int J STD AIDS 2015:0956462415618838. [PMID: 26608578 DOI: 10.1177/0956462415618838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SummaryChlamydia trachomatis infections are major public health concerns globally. Of particular grave concern is that the majority of persons with anogenital Chlamydia trachomatis infections are asymptomatic and accordingly not aware of their infection, and this silent infection can subsequently result in severe reproductive tract complications and sequelae. The current review paper provides all background, evidence base and discussions for the 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS 2015). Comprehensive information and recommendations are included regarding the diagnosis, treatment and prevention of anogenital, pharyngeal and conjunctival Chlamydia trachomatis infections in European countries. However, Chlamydia trachomatis also causes the eye infection trachoma, which is not a sexually transmitted infection. The 2015 European Chlamydia trachomatis guideline provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections; clearer recommendation of using validated nucleic acid amplification tests only for diagnosis; advice on (repeated) Chlamydia trachomatis testing; recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection and recommendations to identify, verify and report Chlamydia trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of Chlamydia trachomatis patients are crucial to control its spread.
Collapse
Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
35
|
Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. 2015 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS 2015; 27:333-48. [PMID: 26608577 DOI: 10.1177/0956462415618837] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/01/2015] [Indexed: 12/19/2022]
Abstract
Chlamydia trachomatis infections, which most frequently are asymptomatic, are major public health concerns globally. The 2015 European C. trachomatis guideline provides: up-to-date guidance regarding broader indications for testing and treatment of C. trachomatis infections; a clearer recommendation of using exclusively-validated nucleic acid amplification tests for diagnosis; advice on (repeated) C. trachomatis testing; the recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection; and recommendations to identify, verify and report C. trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of C. trachomatis patients are crucial to control its spread. For detailed background, evidence base and discussions, see the background review for the present 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS. 2015).
Collapse
Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, United Kingdom
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
36
|
Russell AN, Zheng X, O'Connell CM, Taylor BD, Wiesenfeld HC, Hillier SL, Zhong W, Darville T. Analysis of Factors Driving Incident and Ascending Infection and the Role of Serum Antibody in Chlamydia trachomatis Genital Tract Infection. J Infect Dis 2015; 213:523-31. [PMID: 26347571 DOI: 10.1093/infdis/jiv438] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/27/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis genital tract infection is a major cause of female reproductive morbidity. Risk factors for ascending infection are unknown, and the role for antibody in protection is not well established. METHODS We recruited 225 women from urban outpatient clinics and followed them for a median of 12 months. We performed a cross-sectional analysis of serum anti-chlamydial immunoglobulin G (IgG), behavioral factors, and microbiological factors associated with endometrial infection at enrollment, and a longitudinal analysis of factors associated with incident infection. RESULTS Oral contraceptives (adjusted relative risk [RR], 2.02 [95% confidence interval {CI}, 1.38-2.97]) and gonorrhea (adjusted RR, 1.66 [95% CI, 1.07-2.60]) were associated with endometrial infection. Gonorrhea (adjusted hazard ratio [HR], 3.09 [95% CI, 1.41-6.78]), cervical infection at enrollment (adjusted HR, 2.33 [95% CI, 1.07-5.11]), and exposure to uncircumcised partners (adjusted HR, 2.65 [95% CI, 1.21-5.82]) or infected partners (adjusted HR, 4.99 [95% CI, 2.66-9.39]) significantly increased the risk of incident infection. Seropositivity was associated with a reduced cervical burden (P < .05) but no differences in rates of ascending infection (adjusted RR, 1.24 [95% CI, .71-2.19]) or incident infection (adjusted HR, 0.94 [95% CI, .52-1.69]). CONCLUSIONS Serum anti-chlamydial IgG is not associated with a lowered rate of ascending or repeat infection. Identification of factors associated with ascending infection and increased risk of incident infection provide guidance for targeted screening of women at increased risk for sequelae.
Collapse
Affiliation(s)
- Ali N Russell
- Department of Pediatrics, University of North Carolina-Chapel Hill
| | - Xiaojing Zheng
- Department of Pediatrics, University of North Carolina-Chapel Hill
| | | | - Brandie D Taylor
- Department of Epidemiology and Biostatistics, Texas A&M Health Science Center, College Station
| | - Harold C Wiesenfeld
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh and Magee Womens Research Institute, Pennsylvania
| | - Sharon L Hillier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh and Magee Womens Research Institute, Pennsylvania
| | - Wujuan Zhong
- Department of Biostatistics, University of North Carolina-Chapel Hill
| | - Toni Darville
- Department of Pediatrics, University of North Carolina-Chapel Hill
| |
Collapse
|
37
|
Mongelos P, Mendoza LP, Rodriguez-Riveros I, Castro A, Gimenez G, Araujo P, Paez M, Castro W, Basiletti J, González J, Echagüe G, Diaz V, Laspina F, Ever S, Marecos R, Deluca G, Picconi MA. Distribution of human papillomavirus (HPV) genotypes and bacterial vaginosis presence in cervical samples from Paraguayan indigenous. Int J Infect Dis 2015; 39:44-9. [PMID: 26283550 DOI: 10.1016/j.ijid.2015.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/29/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To determine the frequency of human papillomavirus (HPV) types and to assess bacterial vaginosis (BV) possible associations with cervical infections in indigenous Paraguayan women of the Department of Presidente Hayes. METHODS This study included 181 sexually active women without cervical lesions. HPV typing was performed by polymerase chain reaction with primers PGMY 09/11 followed by reverse line hybridization. BV was diagnosed by the Nugent criteria using the results from a Gram stain smear. RESULTS Sixteen percent of women were positive for at least one high risk HPV type (HR-HPV). The most frequent genotypes were HPV 16 (4.4%), followed by HPV 58 (3.3%), HPV 45 (3.3%), HPV 53 (2.8%) and HPV 11 (2.8%). A significant association between HR-HPV and BV was observed (p=0.01). In addition, women with BV had a higher frequency of Chlamydia trachomatis (p=0.0007), Trichomonas vaginalis (p=0.00009), Mycoplasma hominis (p=0.001). CONCLUSIONS A large variety of HPV genotypes was detected and showed a slightly different pattern from previous studies on urban women in Paraguay, with the predominance of HR-HPV. Furthermore, the information of co-infections involved in BV could be useful for the improvement of national prevention programs, as well as for laboratory surveillance of these genital infections.
Collapse
Affiliation(s)
- Pamela Mongelos
- Department of Public Health, Health Sciences Research Institute (IICS), National University of Asuncion (UNA), Paraguay.
| | - Laura Patricia Mendoza
- Department of Public Health, Health Sciences Research Institute (IICS), National University of Asuncion (UNA), Paraguay.
| | - Isabel Rodriguez-Riveros
- Department of Public Health, Health Sciences Research Institute (IICS), National University of Asuncion (UNA), Paraguay.
| | - Amalia Castro
- Department of Public Health, Health Sciences Research Institute (IICS), National University of Asuncion (UNA), Paraguay.
| | - Graciela Gimenez
- Department of Public Health, Health Sciences Research Institute (IICS), National University of Asuncion (UNA), Paraguay.
| | - Patricia Araujo
- Department of Public Health, Health Sciences Research Institute (IICS), National University of Asuncion (UNA), Paraguay.
| | - Malvina Paez
- Department of Public Health, Health Sciences Research Institute (IICS), National University of Asuncion (UNA), Paraguay.
| | - Wilberto Castro
- Cervical Pathology Department, Faculty of Medical Sciences, UNA, Paraguay.
| | - Jorge Basiletti
- Oncogenic Virus Service, National Institute of Infectious Diseases (INEI) - ANLIS "Dr. Malbrán", Buenos Aires, Argentina.
| | - Joaquín González
- Oncogenic Virus Service, National Institute of Infectious Diseases (INEI) - ANLIS "Dr. Malbrán", Buenos Aires, Argentina.
| | - Gloria Echagüe
- Department of Clinical and microbiological analysis, IICS, UNA, Paraguay.
| | - Valentina Diaz
- Department of Clinical and microbiological analysis, IICS, UNA, Paraguay.
| | - Florentina Laspina
- Department of Clinical and microbiological analysis, IICS, UNA, Paraguay.
| | - Santiago Ever
- Regional Hospital of Villa Hayes, Ministry of Public Health, Department of President Hayes, Paraguay.
| | - Ramón Marecos
- Health Center of Pozo Colorado, Ministry of Public Health, Department of Presidente Hayes, Paraguay.
| | - Gerardo Deluca
- Molecular Applications Laboratory, Faculty of Medicine, Northeast National University, Corrientes, Argentina.
| | - María Alejandra Picconi
- Oncogenic Virus Service, National Institute of Infectious Diseases (INEI) - ANLIS "Dr. Malbrán", Buenos Aires, Argentina.
| |
Collapse
|
38
|
Kong FYS, Hocking JS. Treatment challenges for urogenital and anorectal Chlamydia trachomatis. BMC Infect Dis 2015; 15:293. [PMID: 26220080 PMCID: PMC4518511 DOI: 10.1186/s12879-015-1030-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/16/2015] [Indexed: 11/25/2022] Open
Abstract
While true antimicrobial resistance to Chlamydia trachomatis is a rare occurrence, repeat chlamydia infections continue to be reported following treatment with a single 1 g dose of azithromycin or week long doxycycline - with considerable more concern about azithromycin treatment failure. While most repeat positive cases are likely to be reinfections, emerging evidence indicates treatment failure may play a role. Current data suggests that there may are differences in the efficacy of the drugs between rectal and non-rectal sites of infection and factors such as immune response, drug pharmacokinetics, organism load, auto-inoculation from rectum to cervix in women and the genital microbiome may play a role in treatment failure. Other possible reasons for repeat infection include the low discriminatory power of NAAT tests to differentiate between viable and nonviable organisms and failure to detect LGV infection. This review will present the current evidence regarding the management challenges for urogenital and anorectal chlamydia infections and provide some suggestions for where future research efforts are needed to address important knowledge gaps in this area and provide stronger evidence for the development of robust treatment guidelines.
Collapse
Affiliation(s)
- Fabian Yuh Shiong Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne, 3004, Australia.
| | - Jane Simone Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne, 3004, Australia.
| |
Collapse
|