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Causer LM, Ward J, Smith K, Saha A, Andrewartha K, Wand H, Hengel B, Badman SG, Tangey A, Matthews S, Mak D, Gunathilake M, Moore E, Speers D, Persing D, Anderson D, Whiley D, Maher L, Regan D, Donovan B, Fairley C, Kaldor J, Shephard M, Guy R. Clinical effectiveness and analytical quality of a national point-of-care testing network for sexually transmitted infections integrated into rural and remote primary care clinics in Australia, 2016-2022: an observational program evaluation. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101110. [PMID: 38952441 PMCID: PMC11215331 DOI: 10.1016/j.lanwpc.2024.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/12/2024] [Accepted: 05/23/2024] [Indexed: 07/03/2024]
Abstract
Background To address inequitable diagnostic access and improve time-to-treatment for First Nations peoples, molecular point-of-care (POC) testing for chlamydia, gonorrhoea and trichomonas was integrated into 49 primary care clinics across Australia. We conducted an observational evaluation to determine clinical effectiveness and analytical quality of POC testing delivered through this national program. Methods We evaluated (i) implementation by measuring trends in mean monthly POC testing; ii) clinical effectiveness by comparing proportions of positive patients treated by historical control/intervention period and by test type, and calculated infectious days averted; (iii) analytical quality by calculating result concordance by test type, and proportion of unsuccessful POC tests. Findings Between 2016 and 2022, 46,153 POC tests were performed; an increasing mean monthly testing trend was observed in the first four years (p < 0.0001). A greater proportion of chlamydia/gonorrhoea positives were treated in intervention compared with historical control periods (≤2 days: 37% vs 22% [RR 1.68; 95% CI 1.12, 2.53]; ≤7 days: 48% vs 30% [RR 1.6; 95% CI 1.10, 2.33]; ≤120 days: 79% vs 54% [RR 1.46; 95% CI 1.10, 1.95]); similarly for trichomonas positives and by test type. POC testing for chlamydia, gonorrhoea and trichomonas averted 4930, 5620 and 7075 infectious days, respectively. Results concordance was high [99.0% (chlamydia), 99.3% (gonorrhoea) and 98.9% (trichomonas)]; unsuccessful POC test proportion was 1.8% for chlamydia/gonorrhoea and 2.1% for trichomonas. Interpretation Molecular POC testing was successfully integrated into primary care settings as part of a routinely implemented program achieving significant clinical benefits with high analytical quality. In addition to the individual health benefits of earlier treatment, fewer infective days could contribute to reduced transmissions in First Nations communities. Funding This work was supported by an Australian National Health and Medical Research Council Partnership Grant (APP1092503), the Australian Government Department of Health, Western Australia and Queensland Departments of Health.
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Affiliation(s)
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Queensland, Australia
| | - Kirsty Smith
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Amit Saha
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Kelly Andrewartha
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
| | - Handan Wand
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Belinda Hengel
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Steven G. Badman
- Kirby Institute, UNSW Sydney, New South Wales, Australia
- Cepheid, California, USA
| | - Annie Tangey
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Susan Matthews
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
| | - Donna Mak
- WA Health, Western Australia, Australia
| | | | - Elizabeth Moore
- Aboriginal Medical Services Alliance of Northern Territory, Darwin, Northern Territory, Australia
| | | | | | | | - David Whiley
- Centre for Clinical Research, University of Queensland, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - David Regan
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | | | - John Kaldor
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Mark Shephard
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - TTANGO2 Collaboration
- Kirby Institute, UNSW Sydney, New South Wales, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Queensland, Australia
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
- Cepheid, California, USA
- WA Health, Western Australia, Australia
- NT Health, Northern Territory, Australia
- Aboriginal Medical Services Alliance of Northern Territory, Darwin, Northern Territory, Australia
- PathWest, Western Australia, Australia
- Burnet Institute, Victoria, Australia
- Centre for Clinical Research, University of Queensland, Australia
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
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2
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Guglielmino CJD, Sandhu S, Lau CL, Buckely C, Trembizki E, Whiley DM, Jennison AV. Molecular characterisation of Neisseria gonorrhoeae associated with disseminated gonococcal infections in Queensland, Australia: a retrospective surveillance study. BMJ Open 2022; 12:e061040. [PMID: 35918119 PMCID: PMC9351343 DOI: 10.1136/bmjopen-2022-061040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Gonorrhoea caused by Neisseria gonorrhoeae is the second most notified sexually transmitted infection (STI) in Australia and the case numbers for this STI have been increasing globally. Progressive gonococcal infection may lead to disseminated gonococcal infection (DGI), which causes significant morbidity among patients. This study aims to examine the genetic diversity of N. gonorrhoeae isolates collected in Queensland from January 2010 to August 2015 and to determine factors associated with DGI in Queensland. DESIGN Retrospective surveillance study for epidemiological purposes. SETTING All gonorrhoeae isolates referred by private and public pathology laboratories to the state of Queensland, Australia Neisseria reference laboratory. METHODS Between January 2010 and August 2015, 3953 N. gonorrhoeae isolates from both metropolitan and regional Queensland infections were typed with NG-MAST (N. gonorrhoeae multiantigen sequence typing) to assess the genetic diversity between strains. Whole-genome sequencing (WGS) was used to investigate strain-related factors associated with DGI. RESULTS ST6876 was the most common NG-MAST type, detected in 7.6% of the isolates. DGI was significantly more likely in females <30 years (OR 13.02, p<0.0001) and in older males >30 years (OR 6.04, p<0.0001), with most cases originating from North Queensland (OR 8.5, p<0.0001). Strains harbouring PIA class of porB type were associated with DGI (OR 33.23, p<0.0001). CONCLUSION Genotyping techniques, such as NG-MAST and WGS, are proving instrumental in providing an insight into the population structure of N. gonorrhoeae, and genetic mechanisms of pathogenesis, such as for DGI.
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Affiliation(s)
- Christine J D Guglielmino
- Public Health Microbiology, Forensic and Scientific Services, Queensland Health, Archerfield, Queensland, Australia
| | - Sumeet Sandhu
- Public Health Microbiology, Forensic and Scientific Services, Queensland Health, Archerfield, Queensland, Australia
| | - Colleen L Lau
- Australian National University Research School of Population Health, Canberra, Australian Capital Territory, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Cameron Buckely
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland Central Laboratory, Queensland Health, Brisbane, Queensland, Australia
| | - Ella Trembizki
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - David M Whiley
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland Central Laboratory, Queensland Health, Brisbane, Queensland, Australia
| | - Amy V Jennison
- Public Health Microbiology, Forensic and Scientific Services, Queensland Health, Archerfield, Queensland, Australia
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3
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Gonococcal arthritis: case series of 58 hospital cases. Clin Rheumatol 2022; 41:2855-2862. [PMID: 35590115 DOI: 10.1007/s10067-022-06208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Extra-genital manifestations of gonococcal infection are rare (0.5-3%). Among them, gonococcal arthritis (GA) is the most frequent, accounting for 30-90% of disseminated infections. Our study aimed to describe all hospital cases of GA in Reunion Island, a French overseas territory. METHODS We conducted a retrospective, multicentric, observational study of all cases of certain, probable or possible GA from 2008 to 2020. RESULTS We identified 58 cases of GA, mostly certain cases (n = 48). Sex ratio was balanced, but men were older than women (51 vs 27 years, p < 0.001). A total of 41% had travelled abroad during the previous 3 months, mostly in Madagascar or South-East Asia. The most frequently infected joint was the knee, followed by ankle, wrist and fingers or carpal joints. Only 16% of cases had genital symptoms, but 50% had another extra-genital manifestation, mainly skin lesions (40%). Positivity rate of joint puncture was 91%, with a purulent liquid. Only 58% had a positive culture, and 33% had only a positive PCR. There was no 3GC-resistant strain. In comparison with gonococcal infection without arthritis, patients were older and had fewer genital but more extra-genital symptoms. On discharge 60% had persistent articular symptoms. GA represented 18% of all hospitalised septic arthritis cases with microbial identification in 2019. CONCLUSIONS GA is rare but it is important to make an early diagnosis and treat promptly, as joint destruction may be important, leading to persistent symptoms after discharge. PCR use in joint puncture is useful in cases with negative culture.
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Barbee LA, St Cyr SB. Management of Neisseria gonorrhoeae in the United States: Summary of Evidence From the Development of the 2020 Gonorrhea Treatment Recommendations and the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Treatment Guidelines. Clin Infect Dis 2022; 74:S95-S111. [PMID: 35416971 DOI: 10.1093/cid/ciac043] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern given limited antibiotic options currently and an even smaller antimicrobial development pipeline. Since the release of the Centers for Disease Control and Prevention (CDC) 2015 STD Treatment Guidelines, azithromycin, part of the 2015 dual-drug treatment regimen, has had a rapid rise in resistance. The 2020 CDC Gonorrhea Treatment Recommendations and the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were developed weighing the priorities of treating the individual, protecting the population, and preventing antimicrobial resistance. METHODS Gonorrhea subject matter experts (SME) generated 8 key questions and conducted a literature review of updated data from 2013 to 2019 on gonorrhea antimicrobial resistance, treatment failures, clinical trials, and other key topics. More than 2200 abstracts were assessed, and 248 clinically relevant articles were thoroughly reviewed. SMEs also evaluated N gonorrhoeae antimicrobial resistance data from the Gonococcal Isolate Surveillance Project (GISP). EVIDENCE Although there have been reports of ceftriaxone treatment failures internationally, GISP data suggest that ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, with < 0.1% exhibiting an "alert value" MIC (> 0.25 mcg/mL). However, GISP documented a rapid rise in the proportion of isolates with an elevated MIC (≥ 2.0 mcg/mL) to azithromycin-nearly 5% in 2018. At the same time, new pharmacokinetic/pharmacodynamic data are available, and there is greater recognition of the need for antimicrobial stewardship. SUMMARY The 2021 CDC STI Treatment Guidelines now recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites. If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added. Few alternative therapies exist for persons with cephalosporin allergies; there are no recommended alternative therapies for N gonorrhoeae infection of the throat.
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Affiliation(s)
- Lindley A Barbee
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,University of Washington, Seattle, Washington, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, Washington, USA
| | - Sancta B St Cyr
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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In Vitro Analysis of Matched Isolates from Localized and Disseminated Gonococcal Infections Suggests That Opa Expression Impacts Clinical Outcome. Pathogens 2022; 11:pathogens11020217. [PMID: 35215160 PMCID: PMC8880309 DOI: 10.3390/pathogens11020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022] Open
Abstract
Gonorrhea is the second most common sexually transmitted infection, which is primarily localized but can be disseminated systemically. The mechanisms by which a localized infection becomes a disseminated infection are unknown. We used five pairs of Neisseria gonorrhoeae isolates from the cervix/urethra (localized) and the blood (disseminated) of patients with disseminated gonococcal infection to examine the mechanisms that confine gonococci to the genital tract or enable them to disseminate to the blood. Multilocus sequence analysis found that the local and disseminated isolates from the same patients were isogenic. When culturing in vitro, disseminated isolates aggregated significantly less and transmigrated across a polarized epithelial monolayer more efficiently than localized isolates. While localized cervical isolates transmigrated across epithelial monolayers inefficiently, those transmigrated bacteria self-aggregated less and transmigrated more than cervical isolates but comparably to disseminating isolates. The local cervical isolates recruited the host receptors of gonococcal Opa proteins carcinoembryonic antigen-related cell adhesion molecules (CEACAMs) on epithelial cells. However, the transmigrated cervical isolate and the disseminated blood isolates recruit CEACAMs significantly less often. Our results collectively suggest that switching off the expression of CEACAM-binding Opa(s), which reduces self-aggregation, promotes gonococcal dissemination.
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Nossent J, Raymond W, Keen H, Preen DB, Inderjeeth CA. Septic arthritis due to Neisseria gonorrhoea in Western Australia. Intern Med J 2020; 52:1029-1034. [PMID: 33347691 DOI: 10.1111/imj.15169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the frequency, risk factors and long-term outcome of gonococcal arthritis in Western Australia (WA). METHODS A population-based data linkage study of patients with a hospital-based diagnosis of gonococcal arthritis (GA) in WA between 1990-2014. Demographics, standardised incidence rates (IR) per million and comorbidity accrued before (lookback 186 months ,IQR 86-267) and after the index hospital contact for GA (follow-up 100 months, IQR 60-209). are presented as frequency (%), median (interquartile range) or rates /1,000 months. RESULTS In total 98 patients were diagnosed with GA. The annual incidence of GA increased from 1.35 to 2.10 per million between 1990 and 2014, but the rate of GA complicating all gonococcal infections was stable around 0.25%. Female patients with GA (54%, n=53/98) were younger (24 vs 38 years), and more frequently identified as Indigenous (88% vs 49%) than male patients (46%, n=45/98) (p=0.002). Female patients had higher rates of prior infections (15.5 vs 8.1 per 1,000 months, p=0.002) and diabetes mellitus (15.9% vs 2.5%, p=0.03) and a longer hospital stay (10 vs 8 days, p=0.02). GA recurrence rate during follow-up was low (2%), but a broad range of comorbidities developed contributing to a 14% crude death rate. CONCLUSIONS GA stably complicates 0.25% of gonococcal infections in WA with young Indigenous females and middle-aged non-Indigenous males most affected. Prior infectious disease and diabetes mellitus are potential risk factors for GA in females. GA recurs rarely, but its development reflects a high risk of morbidity and mortality over the following ten years. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Johannes Nossent
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, University, Western Australia
| | - Warren Raymond
- Rheumatology Group, School of Medicine, University, Western Australia
| | - Helen Keen
- Rheumatology Group, School of Medicine, University, Western Australia.,Dept. Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University, Western Australia
| | - Charles A Inderjeeth
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, University, Western Australia
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Abstract
BACKGROUND In recent years, gonorrhea notifications have increased in women in Australia and other countries. We measured trends over time and risk factors among Australian Aboriginal and Torres Strait Islander ("Aboriginal") and non-Aboriginal women. METHODS We conducted a cross-sectional analysis of data from 41 sexual health clinics. Gonorrhea positivity at each patient's first visit (first-test positivity) during the period 2009 to 2016 was calculated. Univariate and multivariate analyses assessed risk factors for first-test positivity in Aboriginal and non-Aboriginal women. RESULTS Gonorrhea positivity decreased among Aboriginal women (7.1% in 2009 to 5.2% in 2016, P < 0.001) and increased among non-Aboriginal women (0.6%-2.9%, P < 0.001). Among Aboriginal women, first-test positivity was independently associated with living in a regional or remote area (adjusted odds ratio [aOR], 4.29; 95% confidence interval [CI], 2.52-7.31; P < 0.01) and chlamydia infection (aOR, 4.20; 95% CI,3.22-5.47; P < 0.01). Among non-Aboriginal women, first-test positivity was independently associated with greater socioeconomic disadvantage (second quartile: aOR, 1.68 [95% CI, 1.31-2.16; P < 0.01]; third quartile: aOR, 1.54 [95% CI, 1.25-1.89; P < 0.01]) compared with least disadvantaged quartile: recent sex work (aOR, 1.69; 95% CI, 1.37-2.08; P < 0.01), recent injecting drug use (aOR, 1.85; 95% CI, 1.34-2.57; P < 0.01), and chlamydia infection (aOR, 2.35; 95% CI, 1.90-2.91; P < 0.01). For non-Aboriginal women, being aged 16 to 19 years (aOR, 0.62; 95% CI, 0.49-0.80; P < 0.01) compared with those ≥30 years was a protective factor. CONCLUSIONS These findings highlight 2 different epidemics and risk factors for Aboriginal and non-Aboriginal women, which can inform appropriate health promotion and clinical strategies.
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8
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Anwar S, Acharya S, Shahab A, Glaser A. Osteomyelitis and extensor tenosynovitis- an unusual presentation of Neisseria gonorrhoeae. IDCases 2020; 22:e00967. [PMID: 33088711 PMCID: PMC7559867 DOI: 10.1016/j.idcr.2020.e00967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022] Open
Abstract
Disseminated gonococcal infection (DGI) commonly presents with arthritis, flexor compartment tenosynovitis, and dermatitis. Osteomyelitis and extensor compartment tenosynovitis caused by DGI is rarely reported in medical literature. We describe one such case of extensor tenosynovitis and osteomyelitis of the wrist joint which symptomatically improved after arthrotomy and intravenous antibiotics.
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Affiliation(s)
- Shamsuddin Anwar
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, United States
| | - Sudeep Acharya
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, United States
| | - Asna Shahab
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, United States
| | - Allison Glaser
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, United States
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Rubin DHF, Ross JDC, Grad YH. The frontiers of addressing antibiotic resistance in Neisseria gonorrhoeae. Transl Res 2020; 220:122-137. [PMID: 32119845 PMCID: PMC7293957 DOI: 10.1016/j.trsl.2020.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
The sexually transmitted infection gonorrhea, caused by the Gram-negative bacterium Neisseria gonorrhoeae, can cause urethritis, cervicitis, and systemic disease, among other manifestations. N. gonorrhoeae has rapidly rising incidence along with increasing levels of antibiotic resistance to a broad range of drugs including first-line treatments. The rise in resistance has led to fears of untreatable gonorrhea causing substantial disease globally. In this review, we will describe multiple approaches being undertaken to slow and control this spread of resistance. First, a number of old drugs have been repurposed and new drugs are being developed with activity against Neisseria gonorrhoeae. Second, vaccine development, long an important goal, is advancing. Third, new diagnostics promise rapid detection of antibiotic resistance and a shift from empiric to tailored treatment. The deployment of these new tools for addressing the challenge of antibiotic resistance will require careful consideration to provide optimal care for all patients while extending the lifespan of treatment regimens.
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Affiliation(s)
- Daniel H F Rubin
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jonathan D C Ross
- Department of Sexual Health and HIV, Birmingham University Hospitals NHS Foundation Trust, Birmingham, UK
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Birrell JM, Gunathilake M, Singleton S, Williams S, Krause V. Characteristics and Impact of Disseminated Gonococcal Infection in the "Top End" of Australia. Am J Trop Med Hyg 2020; 101:753-760. [PMID: 31392956 DOI: 10.4269/ajtmh.19-0288] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The "Top End" of Australia is presently experiencing a gonorrhea epidemic. Gonococcal infection is usually limited to mucosal tissues but can lead to disseminated gonococcal infection (DGI), joint destruction, and severe sepsis. This study aimed to explore the epidemiology, presentation, management, and health-care impact of DGI in the Top End of the Northern Territory. Health records of patients diagnosed with proven, probable, or possible DGI between January 2010 and September 2018 were analyzed retrospectively. One hundred six cases of DGI were identified. Ninety-four patients (88.7%) were Indigenous Australian. The incidence of proven and probable DGI in the Indigenous population was 27.1 per 100,000 person-years, compared with 7.1 in the Top End population overall. Of 7,540 laboratory-proven gonococcal notifications, 1.3% (n = 97) were complicated by DGI. The highest incidence was in the 15-19-year age-group. Thirteen cases (12.3%) occurred in patients younger than 15 years. High rates of comorbid alcohol misuse, diabetes, systemic lupus erythematosus, rheumatic fever, and complement deficiency were observed. The "classic triad" of tenosynovitis, dermatitis, and polyarthralgia was rare. Ninety-four patients (88.7%) presented with purulent arthritis. Disseminated gonococcal infection was estimated to cause at least 10.0% of nonpenetrating septic arthritis in the Top End and 1,234 days of hospitalization during the study period. DGI is an important cause of morbidity in the Top End, particularly in the young, remote Indigenous Australian population. Clinical presentation varies from classical teaching. Urgent action in the health and community sector is required, particularly for at-risk populations, to prevent further debilitating and costly complications of gonococcal infection.
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Affiliation(s)
| | | | - Sally Singleton
- Northern Territory Centre for Disease Control, Darwin, Australia
| | - Shellee Williams
- Northern Territory Centre for Disease Control, Darwin, Australia
| | - Vicki Krause
- Northern Territory Centre for Disease Control, Darwin, Australia
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11
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Smith EL, Hodgetts KE, Ralph AP, Anstey NM. Case Report: Severe Disseminated Gonococcal Infection with Polyarticular Gout: Two Cases in Older Travelers. Am J Trop Med Hyg 2019; 100:209-212. [PMID: 30457099 DOI: 10.4269/ajtmh.18-0589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Two male travelers with histories of gout and hazardous alcohol consumption, presented with a triad of severe culture-positive disseminated gonococcal infection, crystal-positive polyarticular gout, and gonococcal soft tissue collections, following unprotected sexual contact in The Philippines. Both men initially attributed symptoms to gout, since their usual joints were affected, but clinical deterioration occurred with self-administration of anti-inflammatory agents alone. The clinical courses were severe and protracted, requiring aggressive management of infection with prolonged intravenous antimicrobials and repeated surgery, and prolonged anti-inflammatory agents for gout. Joint symptom onset in each case occurred within a week of sexual exposure in conjunction with hazardous alcohol ingestion. We speculate that acute dissemination of infection to previously damaged joints triggered polyarticular gout, with progressive infection, exacerbated by unopposed anti-inflammatory agents and delayed antibiotics. Disseminated gonococcal infection can occur with polyarticular gout and delays in recognition and treatment, including while traveling, can lead to severe disease from both.
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Affiliation(s)
- Emma L Smith
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Kay E Hodgetts
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia
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12
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da Cruz M, Palma NZ, Ferraz RV, Oliveira M, Meireles R. Disseminated Gonococcal Infection: A Case Report of Arthritis-Dermatitis Syndrome. J Med Cases 2019; 10:312-314. [PMID: 34434298 PMCID: PMC8383516 DOI: 10.14740/jmc3381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022] Open
Abstract
The bacteremic spread of the sexually transmitted pathogen, Neisseria gonorrhoeae (N. gonorrhoeae), results in disseminated gonococcal infection (DGI), which can lead to a variety of clinical signs and symptoms, such as multiple skin lesions, tenosynovitis and arthralgias/arthritis. The Centers for Disease Control and Prevention listed that drug-resistant N. gonorrhoeae (cephalosporin resistance) poses an urgent threat due to antimicrobial resistance. The authors describe the case of a young woman presenting in the emergency department (ED) with skin lesions and malaise. DGI was confirmed by blood cultures, nucleic acid amplification testing (NAAT) in cervical mucosa and urine gonococcal probe. One week of intravenous ceftriaxone was administrated with complete clinical and analytical resolution. The patient made a full clinical recovery. Clinicians must be aware of the signs and symptoms of this rare yet reemerging disease.
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Affiliation(s)
- Mariana da Cruz
- Internal Medicine Service, Centro Hospitalar Tamega e Sousa, Penafiel, Portugal
| | - Nuno Zarcos Palma
- Internal Medicine Service, Centro Hospitalar Tamega e Sousa, Penafiel, Portugal
| | - Rita Veiga Ferraz
- Infectious Diseases Service, Centro Hospitalar Tamega e Sousa, Penafiel, Portugal
| | - Marvin Oliveira
- Microbiology Service, Centro Hospitalar Tamega e Sousa, Penafiel, Portugal
| | - Ricardo Meireles
- Internal Medicine Service, Centro Hospitalar Tamega e Sousa, Penafiel, Portugal
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Graham S, Smith LW, Fairley CK, Hocking J. Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis. Sex Health 2018; 13:99-113. [PMID: 26775118 DOI: 10.1071/sh15171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022]
Abstract
Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia. The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12-29 years) and prisoners]. The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included. The pooled prevalence was 11.2% (95%CI: 9.4-13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5-14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0-22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5-26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I(2) <97.5%, P<0.01). In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%). This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people.
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Affiliation(s)
- Simon Graham
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3052, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre and Central Clinical School, Monash University, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3052, Australia
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Cassell JA. Highlights from this issue. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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