1
|
Ladhani SN, White PJ, Campbell H, Mandal S, Borrow R, Andrews N, Bhopal S, Saunders J, Mohammed H, Drisdale-Gordon L, Callan E, Sinka K, Folkard K, Fifer H, Ramsay ME. Use of a meningococcal group B vaccine (4CMenB) in populations at high risk of gonorrhoea in the UK. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00031-8. [PMID: 38521080 DOI: 10.1016/s1473-3099(24)00031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 03/25/2024]
Abstract
The meningococcal group B vaccine, 4CMenB, is a broad-spectrum, recombinant protein vaccine that is licensed for protection against meningococcal group B disease in children and adults. Over the past decade, several observational studies supported by laboratory studies have reported protection by 4CMenB against gonorrhoea, a sexually transmitted infection caused by Neisseria gonorrhoeae. Gonorrhoea is a major global public health problem, with rising numbers of diagnoses and increasing resistance to multiple antibiotics. In England, more than 82 000 cases of gonorrhoea were diagnosed in 2022, with nearly half of the cases diagnosed among gay, bisexual, and other men who have sex with men. There are currently no licensed vaccines against gonorrhoea but 4CMenB is estimated to provide 33-47% protection against gonorrhoea. On Nov 10, 2023, the UK Joint Scientific Committee on Vaccination and Immunisation agreed that a targeted programme should be initiated using 4CMenB to prevent gonorrhoea among individuals at higher risk of infection attending sexual health services in the UK. This decision was made after reviewing evidence from retrospective and prospective observational studies, laboratory and clinical data, national surveillance reports, and health economic analyses. In this Review, we summarise the epidemiology of invasive meningococcal disease and gonorrhoea in England, the evidence supporting the use of 4CMenB for protection against gonorrhoea, and the data needed to inform long-term programme planning and extension to the wider population.
Collapse
Affiliation(s)
- Shamez N Ladhani
- Immunisation Division, UK Health Security Agency, London, UK; Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK.
| | - Peter J White
- Modelling and Economics Unit, UK Health Security Agency, London, UK; MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, London, UK
| | - Helen Campbell
- Immunisation Division, UK Health Security Agency, London, UK
| | - Sema Mandal
- Immunisation Division, UK Health Security Agency, London, UK
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, UK Health Security Agency, London, UK
| | - Sunil Bhopal
- Immunisation Division, UK Health Security Agency, London, UK
| | - John Saunders
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Lana Drisdale-Gordon
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Emma Callan
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Katy Sinka
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Kate Folkard
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Mary E Ramsay
- Immunisation Division, UK Health Security Agency, London, UK
| |
Collapse
|
2
|
Bruxvoort KJ, Lewnard JA, Chen LH, Tseng HF, Chang J, Veltman J, Marrazzo J, Qian L. Prevention of Neisseria gonorrhoeae With Meningococcal B Vaccine: A Matched Cohort Study in Southern California. Clin Infect Dis 2023; 76:e1341-e1349. [PMID: 35642527 DOI: 10.1093/cid/ciac436] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Neisseria gonorrhoeae is acquiring increasing resistance to available oral antibiotics, and current screening and treatment approaches have not decreased gonorrhea incidence. Although a gonorrhea-specific vaccine does not exist, N. gonorrhoeae shares much of its genome with Neisseria meningitidis, notably critical antigenic determinants including outer membrane vesicles (OMV). Prior observational studies have suggested that OMV-based meningococcal serogroup B vaccines confer protection against gonorrhea. METHODS We conducted a matched cohort study from 2016 to 2020 to examine the association of OMV-containing recombinant meningococcal serogroup B vaccine (4CMenB) with gonorrhea infection among teens and young adults at Kaiser Permanente Southern California. Recipients of 4CMenB were matched in a ratio of 1:4 to recipients of non-OMV-containing polysaccharide-conjugate vaccine targeting serotypes A, C, W, and Y (MenACWY) who had not received 4CMenB and were followed for incident gonorrhea. We used Cox proportional hazards regression to compare gonorrhea rates among recipients of 4CMenB vs MenACWY, adjusting for potential confounders. We conducted the same analysis with chlamydia as a negative control outcome. RESULTS The study included 6641 recipients of 4CMenB matched to 26 471 recipients of MenACWY. During follow-up, gonorrhea incidence rates per 1000 person-years (95% confidence intervals [CIs]) were 2.0 (1.3-2.8) for recipients of 4CMenB and 5.2 (4.6-5.8) for recipients of MenACWY. In adjusted analyses, gonorrhea rates were 46% lower among recipients of 4CMenB vs MenACWY (hazard ratio [HR], 0.54; 95% CI, .34-.86), but chlamydia rates were similar between vaccine groups (HR, 0.98; 95% CI, .82-1.17). CONCLUSIONS These results suggest cross-protection of 4CMenB against gonorrhea, supporting the potential for vaccination strategies to prevent gonorrhea.
Collapse
Affiliation(s)
- Katia J Bruxvoort
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California-Berkeley, Berkeley, California, USA.,Division of Infectious Diseases & Vaccinology, School of Public Health, University of California-Berkeley, Berkeley, California, USA.,Center for Computational Biology, College of Engineering, University of California-Berkeley, Berkeley, California, USA
| | - Lie H Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Hung Fu Tseng
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Jennifer Chang
- Department of Infectious Diseases, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, California, USA
| | - Jennifer Veltman
- Division of Infectious Diseases, Loma Linda University Health School of Medicine, Loma Linda, CA, USA
| | - Jeanne Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| |
Collapse
|
3
|
Meesaeng M, Sakboonyarat B, Thaiwat S. Incidence and risk factors of gonococcal urethritis reinfection among Thai male patients in a multicenter, retrospective cohort study. Sci Rep 2021; 11:22992. [PMID: 34837031 PMCID: PMC8626475 DOI: 10.1038/s41598-021-02398-6] [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: 05/25/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
Gonococcal urethritis (GU) is the second most common sexually transmitted infection (STI). Epidemiologic studies of the situation of GU reinfection and its related risk factors among patients with a history of GU in Thailand remain somewhat limited. A hospital-based retrospective cohort study was conducted between January 1, 2010 and December 31, 2020 to determine the incidence and risk factors of GU reinfection among male patients visiting in Royal Thai Army (RTA) Hospitals. A total of 2,465 male patients presenting a history of GU was included in this study. In all, 147 (6.0%; 95% CI 5.1–6.9) male patients presented GU reinfection, representing an incidence rate of 1.3 (95% CI 1.1–1.5) per 100 person-years. The independent risk factors for GU reinfection were age < 30 years (AHR 1.7; 95% CI 1.0–2.8), number of sexual partners equal to 2 (AHR 3.4; 95% CI 1.0–11.2), \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\ge$$\end{document}≥ 3 (AHR 5.6; 95% CI 2.7–11.6), and participants residing in the north (AHR 4.1; 95% CI 2.3–7.5) and northeast regions (AHR 2.1; 95% CI 1.1–3.9). Incidence of GU reinfection among male patients visiting RTA Hospitals was significantly high among younger aged patients, especially in the north and northeast regions. Multiple sex partners played a major role in GU reinfection. Effective STI prevention programs should be provided to alleviate reinfection and its complications.
Collapse
Affiliation(s)
- Monai Meesaeng
- Department of Medicine, Phramongkutklao Hospital, Bangkok, 10400, Thailand
| | - Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Supitchaya Thaiwat
- Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, Bangkok, 10400, Thailand.
| |
Collapse
|
4
|
Duan Q, Carmody C, Donovan B, Guy RJ, Hui BB, Kaldor JM, Lahra MM, Law MG, Lewis DA, Maley M, McGregor S, McNulty A, Selvey C, Templeton DJ, Whiley DM, Regan DG, Wood JG. Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia. PLoS Comput Biol 2021; 17:e1009385. [PMID: 34735428 PMCID: PMC8594806 DOI: 10.1371/journal.pcbi.1009385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 11/16/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this population could result in an epidemic that would be difficult and costly to control. An individual-based, anatomical site-specific mathematical model of NG transmission among Australian MSM was developed and used to evaluate the potential for elimination of an imported NG strain under a range of case-based and population-based test-and-treat strategies. When initiated upon detection of the imported strain, these strategies enhance the probability of elimination and reduce the outbreak size compared with current practice (current testing levels and no contact tracing). The most effective strategies combine testing targeted at regular and casual partners with increased rates of population testing. However, even with the most effective strategies, outbreaks can persist for up to 2 years post-detection. Our simulations suggest that local elimination of imported NG strains can be achieved with high probability using combined case-based and population-based test-and-treat strategies. These strategies may be an effective means of preserving current treatments in the event of wider XDR NG emergence. In most high-income settings, gonorrhoea is endemic among men who have sex with men (MSM). While gonorrhoea remains readily treatable with antibiotics, there are major concerns about the threat of antimicrobial resistance arising from recent reports of treatment failure with first-line therapy and limited remaining treatment options. Here we investigated the potential for test-and-treat response strategies to eliminate such strains before their prevalence reaches a level requiring a shift to new first line therapies. Rather than directly consider resistance, we explore the mitigating effect of various test-and-treat measures on outbreaks of a generic imported strain which remains treatable. This is done within the framework of a realistic mathematical model of gonorrhoea spread in an MSM community that captures cases, anatomical sites of infection and sexual contacts at an individual level, calibrated to relevant Australian epidemiological data. The results indicate that strategies such as partner testing and treatment in combination with elevated asymptomatic community testing are highly effective in mitigating outbreaks but can take up to 2 years to achieve elimination. As there are currently no clear alternative drugs of proven efficacy and safety to replace ceftriaxone in first-line therapy, these promising results suggest potential for use of these outbreak response strategies to preserve current treatment recommendations.
Collapse
Affiliation(s)
- Qibin Duan
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Chris Carmody
- Liverpool Sexual Health Clinic, South Western Sydney Local Health District, Sydney, Australia
- Western Sydney University, Sydney, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | | | - Ben B. Hui
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Monica M. Lahra
- Microbiology Department, New South Wales Health Pathology, The Prince of Wales Hospital, Sydney, Australia
- School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | | | - David A. Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia
- Westmead Clinical School, Faculty of Health and Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael Maley
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, Australia
- South Western Clinical School, UNSW Sydney, Sydney, Australia
| | | | - Anna McNulty
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Christine Selvey
- Communicable Diseases Branch, Health Protection NSW, Sydney, Australia
| | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Department of Sexual Health Medicine, Sydney Local Health District and Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David M. Whiley
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | | | - James G. Wood
- School of Population Health, UNSW Sydney, Sydney, Australia
- * E-mail:
| |
Collapse
|
5
|
Zhu T, McClure R, Harrison OB, Genco C, Massari P. Integrated Bioinformatic Analyses and Immune Characterization of New Neisseria gonorrhoeae Vaccine Antigens Expressed during Natural Mucosal Infection. Vaccines (Basel) 2019; 7:E153. [PMID: 31627489 PMCID: PMC6963464 DOI: 10.3390/vaccines7040153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 02/07/2023] Open
Abstract
There is an increasingly severe trend of antibiotic-resistant Neisseria gonorrhoeae strains worldwide and new therapeutic strategies are needed against this sexually-transmitted pathogen. Despite the urgency, progress towards a gonococcal vaccine has been slowed by a scarcity of suitable antigens, lack of correlates of protection in humans and limited animal models of infection. N. gonorrhoeae gene expression levels in the natural human host does not reflect expression in vitro, further complicating in vitro-basedvaccine analysis platforms. We designed a novel candidate antigen selection strategy (CASS), based on a reverse vaccinology-like approach coupled with bioinformatics. We utilized the CASS to mine gonococcal proteins expressed during human mucosal infection, reported in our previous studies, and focused on a large pool of hypothetical proteins as an untapped source of potential new antigens. Via two discovery and analysis phases (DAP), we identified 36 targets predicted to be immunogenic, membrane-associated proteins conserved in N. gonorrhoeae and suitable for recombinant expression. Six initial candidates were produced and used to immunize mice. Characterization of the immune responses indicated cross-reactive antibodies and serum bactericidal activity against different N. gonorrhoeae strains. These results support the CASS as a tool for the discovery of new vaccine candidates.
Collapse
Affiliation(s)
- Tianmou Zhu
- Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA.
| | - Ryan McClure
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99352, USA.
| | - Odile B Harrison
- Department of Zoology, University of Oxford, Oxford OX1 3SY, UK.
| | - Caroline Genco
- Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA.
| | - Paola Massari
- Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA.
| |
Collapse
|
6
|
Mwatelah R, McKinnon LR, Baxter C, Abdool Karim Q, Abdool Karim SS. Mechanisms of sexually transmitted infection-induced inflammation in women: implications for HIV risk. J Int AIDS Soc 2019; 22 Suppl 6:e25346. [PMID: 31468677 PMCID: PMC6715949 DOI: 10.1002/jia2.25346] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/20/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Globally, sexually transmitted infections (STI) affect >300 million people annually, and are a major cause of sexual and reproductive health complications in women. In this commentary, we describe how STIs interact with the immune and non-immune cells, both within and below the cervicovaginal mucosal barrier, to cause inflammation, which in turn has been associated with increased HIV acquisition risk. DISCUSSION STIs have a major impact on the female genital mucosa, which is an important biological and physical barrier that forms the first line of defence against invading microorganisms such as HIV. Pattern recognition of STI pathogens, by receptors expressed either on the cell surface or inside the cell, typically triggers inflammation at the mucosal barrier. The types of mucosal responses vary by STI, and can be asymptomatic or culminate in the formation of discharge, ulcers and/or warts. While the aim of this response is to clear the invading microbes, in many cases these responses are either evaded or cause pathology that impairs barrier integrity and increases HIV access to target cells in the sub-mucosa. In addition, innate responses to STIs can result in an increased number of immune cells, including those that are the primary targets of HIV, and may contribute to the association between STIs and increased susceptibility to HIV acquisition. Many of these cells are mediators of adaptive immunity, including tissue-resident cells that may also display innate-like functions. Bacterial vaginosis (BV) is another common cause of inflammation, and evidence for multiple interactions between BV, STIs and HIV suggest that susceptibility to these conditions should be considered in concert. CONCLUSIONS STIs and other microbes can induce inflammation in the genital tract, perturbing the normal robust function of the mucosal barrier against HIV. While the impact of STIs on the mucosal immune system and HIV acquisition is often under-appreciated, understanding their interactions of the infections with the immune responses play an important role in improving treatment and reducing the risk of HIV acquisition. The frequent sub-clinical inflammation associated with STIs underscores the need for better STI diagnostics to reverse the immunological consequences of infection.
Collapse
Affiliation(s)
- Ruth Mwatelah
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegCanada
| | - Lyle R McKinnon
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegCanada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
- Department of EpidemiologyColumbia UniversityNew YorkNYUSA
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
- Department of EpidemiologyColumbia UniversityNew YorkNYUSA
| |
Collapse
|
7
|
Petousis-Harris H, Radcliff FJ. Exploitation of Neisseria meningitidis Group B OMV Vaccines Against N. gonorrhoeae to Inform the Development and Deployment of Effective Gonorrhea Vaccines. Front Immunol 2019; 10:683. [PMID: 31024540 PMCID: PMC6465565 DOI: 10.3389/fimmu.2019.00683] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/13/2019] [Indexed: 01/13/2023] Open
Abstract
Have potential clues to an effective gonorrhea vaccine been lurking in international disease surveillance data for decades? While no clinically effective vaccines against gonorrhea have been developed we present direct and indirect evidence that a vaccine is not only possible, but may already exist. Experience from Cuba, New Zealand, and Canada suggest that vaccines containing Group B Neisseria meningitides outer membrane vesicles (OMV) developed to control type-specific meningococcal disease may also prevent a significant proportion of gonorrhea. The mechanisms for this phenomenon have not yet been elucidated but we present some strategies for unraveling potential cross protective antigens and effector immune responses by exploiting stored sera from clinical trials and individuals primed with a meningococcal group B OMV vaccine (MeNZB). Elucidating these will contribute to the ongoing development of high efficacy vaccine options for gonorrhea. While the vaccine used in New Zealand, where the strongest empirical evidence has been gathered, is no longer available, the OMV has been included in the multi component recombinant meningococcal vaccine 4CMenB (Bexsero) which is now licensed and used in numerous countries. Several lines of evidence suggest it has the potential to affect gonorrhea prevalence. A vaccine to control gonorrhea does not need to be perfect and modeling supports that even a moderately efficacious vaccine could make a significant impact in disease prevalence. How might we use an off the shelf vaccine to reduce the burden of gonorrhea? What are some of the potential societal barriers in a world where vaccine hesitancy is growing? We summarize the evidence and consider some of the remaining questions.
Collapse
Affiliation(s)
- Helen Petousis-Harris
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Fiona J Radcliff
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
8
|
Paynter J, Goodyear-Smith F, Morgan J, Saxton P, Black S, Petousis-Harris H. Effectiveness of a Group B Outer Membrane Vesicle Meningococcal Vaccine in Preventing Hospitalization from Gonorrhea in New Zealand: A Retrospective Cohort Study. Vaccines (Basel) 2019; 7:5. [PMID: 30621260 PMCID: PMC6466174 DOI: 10.3390/vaccines7010005 10.3390/vaccines7010031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 09/11/2023] Open
Abstract
Gonorrhea is a major global public health problem with emergence of multiple drug-resistant strains with no effective vaccine. This retrospective cohort study aimed to estimate the effectiveness of the New Zealand meningococcal B vaccine against gonorrhea-associated hospitalization. The cohort consisted of individuals born from 1984 to 1999 residing in New Zealand. Therefore, it was eligible for meningococcal B vaccination from 2004 to 2008. Administrative datasets of demographics, customs, hospitalization, education, income tax, and immunization were linked using the national Integrated Data Infrastructure. The primary outcome was hospitalization with a primary diagnosis of gonorrhea. Cox's proportional hazards models were applied with a Firth correction for rare outcomes to generate estimates of hazard ratios. Vaccine effectiveness estimates were calculated as 1-Hazard Ratio expressed as a percentage. There were 1,143,897 eligible cohort members with 135 missing information on gender, 16,245 missing ethnicity, and 197,502 missing deprivation. Therefore, only 935,496 cohort members were included in the analysis. After adjustment for gender, ethnicity, and deprivation, vaccine effectiveness (MeNZB™) against hospitalization caused by gonorrhea was estimated to be 24% (95% CI 1⁻42%). In conclusion, the data suggests vaccination with MeNZB™ significantly reduced the rate of hospitalization from gonorrhea. This supports prior research indicating possible cross protection of this vaccine against gonorrhea acquisition and disease in the outpatient setting.
Collapse
Affiliation(s)
- Janine Paynter
- Department of General Practice and Primary Health, University of Auckland, Auckland 1142, New Zealand.
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health, University of Auckland, Auckland 1142, New Zealand.
| | - Jane Morgan
- Sexual Health Services Waikato District Health Board and Honorary Senior Lecturer, School of Medicine, University of Auckland, Auckland 1142, New Zealand.
| | - Peter Saxton
- Department of Social and Community Health, University of Auckland, Auckland 1142, New Zealand.
| | - Steven Black
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA.
| | - Helen Petousis-Harris
- Immunisation Advisory Centre, Department of General Practice and Primary Health Care, University of Auckland, Auckland 1142, New Zealand.
| |
Collapse
|
9
|
Effectiveness of a Group B Outer Membrane Vesicle Meningococcal Vaccine in Preventing Hospitalization from Gonorrhea in New Zealand: A Retrospective Cohort Study. Vaccines (Basel) 2019; 7:vaccines7010005. [PMID: 30621260 PMCID: PMC6466174 DOI: 10.3390/vaccines7010005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 12/22/2022] Open
Abstract
Gonorrhea is a major global public health problem with emergence of multiple drug-resistant strains with no effective vaccine. This retrospective cohort study aimed to estimate the effectiveness of the New Zealand meningococcal B vaccine against gonorrhea-associated hospitalization. The cohort consisted of individuals born from 1984 to 1999 residing in New Zealand. Therefore, it was eligible for meningococcal B vaccination from 2004 to 2008. Administrative datasets of demographics, customs, hospitalization, education, income tax, and immunization were linked using the national Integrated Data Infrastructure. The primary outcome was hospitalization with a primary diagnosis of gonorrhea. Cox’s proportional hazards models were applied with a Firth correction for rare outcomes to generate estimates of hazard ratios. Vaccine effectiveness estimates were calculated as 1-Hazard Ratio expressed as a percentage. There were 1,143,897 eligible cohort members with 135 missing information on gender, 16,245 missing ethnicity, and 197,502 missing deprivation. Therefore, only 935,496 cohort members were included in the analysis. After adjustment for gender, ethnicity, and deprivation, vaccine effectiveness (MeNZB™) against hospitalization caused by gonorrhea was estimated to be 24% (95% CI 1–42%). In conclusion, the data suggests vaccination with MeNZB™ significantly reduced the rate of hospitalization from gonorrhea. This supports prior research indicating possible cross protection of this vaccine against gonorrhea acquisition and disease in the outpatient setting.
Collapse
|
10
|
Bautista CT, Wurapa EK, Sanchez JL. Does the Hazard of Chlamydia Increase with the Number of Gonorrhea Diagnoses? A Large Population-Based Study Among U.S. Army Women. J Womens Health (Larchmt) 2018; 28:220-224. [PMID: 30010470 DOI: 10.1089/jwh.2018.7253] [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: 10/28/2022] Open
Abstract
BACKGROUND In the U.S. military, chlamydia and gonorrhea are common sexually transmitted infections, especially among female service members. The aim of this study was to determine whether the number of gonorrhea diagnoses sustained an increased hazard of chlamydia among military women. METHODS This population-based study involved an analysis of all female gonorrhea cases in the U.S. Army reported in the Defense Medical Surveillance System between 2006 and 2012. The effect of the number of gonorrhea diagnoses on the hazard of chlamydia was analyzed using the Prentice-Williams-Peterson gap-time model. RESULTS Among 3,618 women with gonorrhea diagnosis, 702 (19.4%) had a subsequent chlamydia diagnosis yielding a rate of 6.06 (95% CI = 5.63-6.53) cases per 100 person-years. Compared to women with one gonorrhea diagnosis, the hazard ratio of chlamydia for women with two gonorrhea diagnoses was 5.09 (95% CI = 4.42-5.86) and for women with three gonorrhea diagnoses was 6.53 (95% CI = 3.93-10.83). The median time to chlamydia diagnosis decreased from 2.39 to 0.67 years for women with two to three gonorrhea diagnoses. CONCLUSIONS The hazard of chlamydia increased significantly with the number of gonorrhea diagnoses and the median time to chlamydia diagnosis decreased with an increasing number of gonorrhea diagnoses among U.S. Army women.
Collapse
Affiliation(s)
| | - Eyako K Wurapa
- 2 Center for Infectious Disease Research, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Jose L Sanchez
- 3 Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency , Silver Spring, Maryland
| |
Collapse
|
11
|
Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior Across Four Samples of STI Clinic Patients. Ann Behav Med 2018; 51:39-56. [PMID: 27550626 DOI: 10.1007/s12160-016-9826-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patients in sexually transmitted infection (STI) clinics report high levels of alcohol use, which are associated with risky sexual behavior. However, no studies have examined how changes in alcohol use relate to changes in sexual risk behavior. PURPOSE We used parallel process latent growth modeling to explore how changes in alcohol use related to changes in sexual behavior across four samples of clinic patients. METHODS Patients participating in HIV prevention trials from urban clinics in the Northeastern and Midwestern USA (N = 3761, 59 % male, 72 % Black) completed measures at 3-month intervals over 9-12 months. Integrative data analysis was used to create composite measures of alcohol use across samples. Sexual risk measures were counts of partners and unprotected sex acts. Parallel process models tested whether alcohol use changes were correlated with changes in the number of partners and unprotected sex. RESULTS Growth models with good fit showed decreases that slowed over time in sexual risk behaviors and alcohol use. Parallel process models showed positive correlations between levels of (rs = 0.17-0.40, ps < 0.001) and changes in (rs = 0.21-0.80, ps < 0.05) alcohol use and number of sexual partners across studies. There were strong associations between levels of (rs = 0.25-0.43, ps < 0.001) and changes in (rs = 0.24-0.57, ps < 0.01) alcohol use and unprotected sex in one study recruiting hazardous drinkers. CONCLUSIONS Across four samples of clinic patients, reductions in alcohol use were associated with reductions in the number of sexual partners. HIV prevention interventions may be strengthened by addressing alcohol use.
Collapse
|
12
|
Kenyon CR, Osbak K, Vandenbruane M. What is the appropriate therapy for asymptomatic gonorrhoea in men who have sex with men? Int J STD AIDS 2017; 27:812-3. [PMID: 27485832 DOI: 10.1177/0956462416642933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chris R Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium. Department of Medicine, University of Cape Town, South Africa
| | - Kara Osbak
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium. Department of Medicine, University of Cape Town, South Africa
| | - Marc Vandenbruane
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium. Department of Medicine, University of Cape Town, South Africa
| |
Collapse
|
13
|
Petousis-Harris H, Paynter J, Morgan J, Saxton P, McArdle B, Goodyear-Smith F, Black S. Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study. Lancet 2017; 390:1603-1610. [PMID: 28705462 DOI: 10.1016/s0140-6736(17)31449-6] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gonorrhoea is a major global public health problem that is exacerbated by drug resistance. Effective vaccine development has been unsuccessful, but surveillance data suggest that outer membrane vesicle meningococcal group B vaccines affect the incidence of gonorrhoea. We assessed vaccine effectiveness of the outer membrane vesicle meningococcal B vaccine (MeNZB) against gonorrhoea in young adults aged 15-30 years in New Zealand. METHODS We did a retrospective case-control study of patients at sexual health clinics aged 15-30 years who were born between Jan 1, 1984, and Dec 31, 1998, eligible to receive MeNZB, and diagnosed with gonorrhoea or chlamydia, or both. Demographic data, sexual health clinic data, and National Immunisation Register data were linked via patients' unique personal identifier. For primary analysis, cases were confirmed by laboratory isolation or detection of Neisseria gonorrhoeae only from a clinical specimen, and controls were individuals with a positive chlamydia test only. We estimated odds ratios (ORs) comparing disease outcomes in vaccinated versus unvaccinated participants via multivariable logistic regression. Vaccine effectiveness was calculated as 100×(1-OR). FINDINGS 11 of 24 clinics nationally provided records. There were 14 730 cases and controls for analyses: 1241 incidences of gonorrhoea, 12 487 incidences of chlamydia, and 1002 incidences of co-infection. Vaccinated individuals were significantly less likely to be cases than controls (511 [41%] vs 6424 [51%]; adjusted OR 0·69 [95% CI 0·61-0·79]; p<0·0001). Estimate vaccine effectiveness of MeNZB against gonorrhoea after adjustment for ethnicity, deprivation, geographical area, and sex was 31% (95% CI 21-39). INTERPRETATION Exposure to MeNZB was associated with reduced rates of gonorrhoea diagnosis, the first time a vaccine has shown any protection against gonorrhoea. These results provide a proof of principle that can inform prospective vaccine development not only for gonorrhoea but also for meningococcal vaccines. FUNDING GSK Vaccines.
Collapse
Affiliation(s)
- Helen Petousis-Harris
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
| | - Janine Paynter
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Jane Morgan
- School of Medicine, University of Auckland, Auckland, New Zealand; Sexual Health Services, Waikato District Health Board, Hamilton, New Zealand
| | - Peter Saxton
- Department of Social and Community Health, University of Auckland, Auckland, New Zealand
| | - Barbara McArdle
- Conectus, Auckland Uniservices, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Steven Black
- Center for Global Health, Cincinnati Children's Hospital, Cincinnati, OH, USA
| |
Collapse
|
14
|
Bautista CT, Wurapa EK, Sateren WB, Morris SM, Hollingsworth BP, Sanchez JL. Repeat infection with Neisseria gonorrhoeae among active duty U.S. Army personnel: a population-based case-series study. Int J STD AIDS 2016; 28:962-968. [PMID: 27885067 PMCID: PMC5542132 DOI: 10.1177/0956462416681940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Little information is known on the rate of repeat gonorrhea infection among U.S. military personnel. We analyzed all gonorrhea cases reported to the Defense Medical Surveillance System during 2006–2012 to determine the rate of repeat infection. During the seven-year study period, 17,602 active duty U.S. Army personnel with a first incident gonorrhea infection were reported. Among the 4987 women with a first gonorrhea infection, 14.4% had at least one repeat infection. Among the 12,615 men with a first gonorrhea infection, 13.7% had at least one repeat infection. Overall, the rate of repeat gonorrhea infection was 44.5 and 48.9 per 1000 person-years for women and men, respectively. Service members aged 17–19 years (hazard ratio [HR] for women = 1.51; HR for men = 1.71), African-American personnel (HR for women = 1.26; HR for men = 2.17), junior enlisted personnel (HR for women = 2.64; HR for men = 1.37), and those with one year or less of service (HR for women = 1.23; HR for men = 1.37) were at higher risk of repeat infection. The findings from this study highlight the need to develop targeted prevention initiatives including education, counseling, and retesting to prevent gonorrhea reinfections among U.S. Army personnel.
Collapse
Affiliation(s)
| | - Eyako K Wurapa
- 2 Infectious Disease Research Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Warren B Sateren
- 2 Infectious Disease Research Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sara M Morris
- 1 Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Jose L Sanchez
- 3 Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, MD, USA
| |
Collapse
|
15
|
Caron M, Bédard L, Latreille J, Buckeridge DL. An exploratory analysis of individuals with multiple episodes of different reportable diseases, Montreal, 1990-2012. Public Health 2015; 131:49-55. [PMID: 26715312 DOI: 10.1016/j.puhe.2015.10.032] [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] [Received: 03/26/2015] [Revised: 08/28/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Studies of public health reporting have only examined multiple episodes of the same communicable disease within an individual. We aimed to characterize Montreal residents with multiple reportable disease episodes from 1990 to 2012, while accounting for all types of reportable diseases. STUDY DESIGN Retrospective cohort study. METHODS We performed an exploratory analysis using descriptive statistics, contingency tables, and logistic regression. RESULTS There were 157,839 individuals with at least one disease report and a total of 179,455 disease reports. The 9.8% of subjects with more than one episode accounted for 20.7% of all reported episodes. Among subjects with four or fewer episodes, 54.0% were women, while 74.3% of subjects with five or more episodes were men. Subjects with multiple episodes were more likely to be reported for sexually transmitted infections than were persons with a single episode [difference of proportions: 10.4% (95% CI: 10.0%-10.9%)] and to reside in the neighbourhood encompassing Montreal's gay village. CONCLUSIONS Individuals with multiple communicable disease reports place a large burden on public health officials. These results may help guide investigation and prevention efforts to reduce the number of excess episodes.
Collapse
Affiliation(s)
- M Caron
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - L Bédard
- Direction de santé publique, CIUSSS du Centre-Est-de-l'Île-de-Montréal, Montreal, QC, Canada; École de santé publique, Université de Montréal, Montreal, QC, Canada
| | - J Latreille
- Direction de santé publique, CIUSSS du Centre-Est-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - D L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Direction de santé publique, CIUSSS du Centre-Est-de-l'Île-de-Montréal, Montreal, QC, Canada.
| |
Collapse
|
16
|
Carey MP, Senn TE, Walsh JL, Coury-Doniger P, Urban MA, Fortune T, Vanable PA, Carey KB. Evaluating a Brief, Video-Based Sexual Risk Reduction Intervention and Assessment Reactivity with STI Clinic Patients: Results from a Randomized Controlled Trial. AIDS Behav 2015; 19:1228-46. [PMID: 25433653 DOI: 10.1007/s10461-014-0960-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We report results from a randomized controlled trial designed to evaluate the efficacy of a video-based sexual risk reduction intervention and to measure assessment reactivity. Patients (N = 1010; 56 % male; 69 % African American) receiving care at a sexually transmitted infection (STI) clinic were assigned to one of four conditions formed by crossing assessment condition (i.e., sexual health vs. general health) with intervention condition (i.e., sexual risk reduction intervention vs. general health promotion). After completing their assigned baseline assessment, participants received their assigned intervention, and subsequently returned for follow-up assessments at 3, 6, 9, and 12 months. Participants in all conditions reduced their self-reported sexual risk behavior, and the incidence of new STIs declined from baseline through the follow-ups; however, there was no effect of intervention or assessment condition. We conclude that further risk reduction will require more intensive interventions, especially in STI clinics that already provide excellent clinical care.
Collapse
Affiliation(s)
- Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA,
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Retreatment rates for uncomplicated gonorrhea infection: comparing ceftriaxone and azithromycin versus ceftriaxone and doxycycline. Sex Transm Dis 2015; 40:539-45. [PMID: 23965767 DOI: 10.1097/olq.0b013e3182941325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The current recommended first-line regimen to treat gonorrhea is ceftriaxone in combination with either azithromycin or doxycycline. Azithromycin is the preferred second agent. We retrospectively measured and compared gonorrhea retreatment rates between patients receiving ceftriaxone plus azithromycin and those receiving ceftriaxone plus doxycycline. METHODS Using data from public sexually transmitted disease clinics for patients treated for gonorrhea in Baltimore, Maryland, between January 2004 and December 2011, we measured time to retreatment from the date the ceftriaxone regimen was received. Censoring occurred on the earlier of 2 years posttreatment or March 31, 2012. Survival analysis methods were used to compare retreatment rates. RESULTS One tenth (9.9%; n = 4457) of patients were retreated within 2 years. Treatment regimen was not related to time to retreatment (adjusted hazard ratio [aHR], 0.88; 95% confidence interval, 0.69-1.12). Patients receiving expedited partner therapy (EPT) were 45% less likely to be retreated (aHR, 0.55 [0.31-0.96]) compared with patients treated before EPT became available. A subanalysis among patients retested for gonorrhea within 90 and 30 days found retreatment rates of 18.8% (n = 91/485) and 13.5% (n = 19/140), respectively. The 90-day cohort showed no association with treatment regimen (aHR, 0.95 [0.55-1.65]); however, all of the retreated patients in the 30-day cohort had received the doxycycline regimen. CONCLUSIONS Gonorrhea retreatment was common, highlighting the need for rescreening and better partner therapies. The protective effect of EPT further underscores the need for effective oral therapies. Azithromycin may be preferable as the second agent to treat gonorrhea, although doxycycline seems to be a reasonable alternative.
Collapse
|
18
|
Fernando KA, Fowler T, Harding J, Flew S, Caley M, Phattey J, Ross J. Detecting re-infection in patients after an initial diagnosis of gonorrhoea: is routine recall for re-screening useful? Int J STD AIDS 2014; 26:640-7. [PMID: 25161175 DOI: 10.1177/0956462414548905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 07/24/2014] [Indexed: 11/15/2022]
Abstract
To assess the outcome of routine sexually transmitted infection re-screening after a three-month interval in unselected patients diagnosed with gonorrhoea, we sought to assess whether this active approach would result in an increase in the number of people attending clinic and subsequently diagnosed with gonorrhoea re-infection, compared with normal re-presentation rates. A recall group of patients were invited for re-screening three months after their initial diagnosis of gonorrhoea. Permission was sought to send a reminder two weeks prior to their scheduled recall appointment. Comparisons were made with a historical control group of patients with gonorrhoea in the absence of any formal recall. Of the 242 patients in the intervention arm, 96 (40%) re-attended within six months, and 15 (6%) tested gonorrhoea positive. Two hundred and two patients were assessed in the control group, of whom 45 (22%) re-attended within six months, and 13 (6%) tested gonorrhoea positive. Women were more likely than men to re-attend following active recall, but they were not at higher risk of re-attending while re-infected with gonorrhoea. Active recall following a gonorrhoea diagnosis significantly increases re-attendance rates for repeat screening but did not result in an increased number of subsequent gonorrhoea diagnoses.
Collapse
Affiliation(s)
- K A Fernando
- Department of Genitourinary Medicine, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Cobridge Community Health Centre, Stoke-on-Trent, UK
| | - T Fowler
- Field Epidemiology Services - West Midlands, Public Health England, Birmingham, UK Public Health, Epidemiology & Biostatistics Home, University of Birmingham, Birmingham, UK
| | - J Harding
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - S Flew
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - M Caley
- Department of Public Health, NHS Warwickshire/Warwickshire County Council, Warwick, UK
| | - J Phattey
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Jdc Ross
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| |
Collapse
|
19
|
Cook PA, Evans-Jones J, Mallinson H, Wood M, Alloba F, Jones K, Strodtbeck S, Hanna-Bashara L. Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genitourinary medicine clinic. BMJ Open 2014; 4:e004862. [PMID: 24633530 PMCID: PMC3963091 DOI: 10.1136/bmjopen-2014-004862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To compare the clinical, socioeconomic and demographic characteristics of individuals diagnosed with Neisseria gonorrhoeae (NG) in the community using a concomitant nucleic acid amplification test (NAAT, AptimaCombo2) as part of the (community-based) UK Chlamydia Screening Programme (CSP), with those diagnosed in hospital-based genitourinary medicine (GUM) services. DESIGN A retrospective case note review of all 643 patients treated for NG at a GUM in north west England (January 2007-April 2009). PARTICIPANTS All 643 treated for NG (including CSP cases, since all cases were referred to GUM for treatment). Limited data were available for 13 CSP cases who failed to attend GUM. PRIMARY OUTCOME MEASURE Whether the case was detected in the community or GUM services. Predictors were demographics (age, gender, postcode for deprivation analysis), sexual history (eg, number of partners) and clinical factors (eg, culture positivity). RESULTS 131 cases were diagnosed by CSP (13 of whom did not attend GUM). A further four cases were contacts of these. The GUM caseload was thus inflated by 23% (from 521 to 643). Community cases were overwhelmingly female (85% vs 27% in GUM, p<0.001) and younger (87% females were <25 years vs 70% GUM females, p=0.001). Logistic regression analysis restricted to the target age of the CSP (<25 years) revealed that CSP cases, compared with GUM cases, were more likely to reside in deprived areas (adjusted OR=5.6, 95% CI 1.4 to 21.8 and 5.3, CI 1.7 to 16.6 for the most and second most deprived group respectively, compared with the averagely deprived group, p=0.037) and be asymptomatic (adjusted OR=1.9, CI 1.1 to 3.4, p=0.02). CONCLUSIONS Community screening for NG led to a 79% increase in the number of infections detected in women aged <25 years. Screening is targeted at young people, and tends to disproportionately attract young women, a group under-represented at GUM. Screening also contributed further to case detection in deprived areas.
Collapse
Affiliation(s)
- Penny A Cook
- University of Salford, School of Health Sciences, Salford, UK
| | | | - Harry Mallinson
- Microbiology Laboratory, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Martyn Wood
- Centre for Sexual Health and Contraception, Mid-Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | - Fath Alloba
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Kathy Jones
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Layla Hanna-Bashara
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hospital, Liverpool, UK
| |
Collapse
|
20
|
A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections. J Prim Prev 2014; 34:81-7. [PMID: 23355254 DOI: 10.1007/s10935-013-0290-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to develop and test a sexual-partner-related risk behavior index to identify high-risk individuals most likely to have a sexually transmitted infection (STI). Patients from five STI and adolescent medical clinics in three US cities were recruited (N = 928; M age = 29.2 years). Data were collected using audio-computer-assisted self-interviewing. Of seven sexual-partner-related variables, those that were significantly associated with the outcomes were combined into a partner-related risk behavior index. The dependent variables were laboratory-confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. Nearly one-fifth of the sample (169/928; 18.4%) tested positive for an STI. Three of the seven items were significantly associated with having one or more STIs: sex with a newly released prisoner, sex with a person known or suspected of having an STI, and sexual concurrency. In combined form, this three-item index was significantly associated with STI prevalence (p < .001). In the presence of three covariates (gender, race, and age), those classified as being at-risk by the index were 1.8 times more likely than those not classified as such to test positive for an STI (p < .001). Among individuals at risk for STIs, a three-item index predicted testing positive for one or more of three STIs. This index could be used to prioritize and guide intensified clinic-based counseling for high-risk patients of STI and other clinics.
Collapse
|
21
|
Sexually Transmitted Infections in Women Participating in a Biomedical Intervention Trial in Durban: Prevalence, Coinfections, and Risk Factors. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:358402. [PMID: 26316957 PMCID: PMC4436868 DOI: 10.1155/2013/358402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 08/23/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022]
Abstract
Background. Sexually transmitted infections (STIs) continue to be a significant public health problem especially among women of reproductive age in Africa. Methods. A total of 2236 women that had enrolled in the MDP301 vaginal microbicide trial were tested for the presence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Treponema pallidum, and Trichomonas vaginalis (TV). Results. CT was identified as the most prevalent STI (11%) followed by TV (10%), NG, and Syphilis (3%). The highest prevalence of coinfection was reported between T. pallidum and TV (19.67%, P = 0.004), followed by CT and TV (13.52%, P ≤ 0.001). Risk factors that were significantly associated with STI acquisition were women of 23 years of age or younger (HR: 1.50, 95% CI 1.17, 1.93), baseline STI with CT (HR: 1.77, 95% CI 1.32, 2.35), TV (HR: 1.58, 95% CI, 1.20, 2.10), and T. pallidum (HR: 5.13, 95% CI 3.65, 7.22), and a low education level (HR: 1.30, 95% CI 1.02, 1.66). Conclusion. Young women with lower education and a history of STIs are at high risk of multiple STIs. Prevention programs should consider target approach to STI prevention among young women. This trial is registered with ISRCTN64716212.
Collapse
|
22
|
Abraham T, Macauda M, Erickson P, Singer M. "And let me see them damn papers!" The role of STI/AIDS screening among urban African American and Puerto Rican youth in the transition to sex without a condom. AIDS Behav 2011; 15:1359-71. [PMID: 20844945 DOI: 10.1007/s10461-010-9811-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Common strategies employed in preventing STI/AIDS transmission among young adults in America include abstinence, monogamy and safer sex. These strategies require a high level of vigilance and responsibility and, according to inner city participants in Project PHRESH.comm, neither option is always desirable, available, or rational in the context of their lived experiences. This article reports findings from Project PHRESH.comm, a mixed-method, ethnographic study incorporating data from focus group discussions, semi-structured interviews, coital diaries, systematic cultural assessments and a structured survey designed to explore concepts of risk and decision making about condom use among at risk African American and Puerto Rican young adults aged 18-25 years in Hartford, CT. We found that many young adults from our study population rely on a strategy of using clinic-sponsored STI/AIDS screening when wanting to discontinue condom use with a partner. While our data suggest that screening is a common strategy used by many couples to transition to having sex without a condom, the data also show that most youth do not maintain monogamy even in long-term, serious relationships. Thus, sharing test results may provide a false sense of security in the sexual culture of inner city, minority youth.
Collapse
|
23
|
Syphilis Testing Behavior Following Diagnosis With Early Syphilis Among Men Who Have Sex With Men—San Francisco, 2005–2008. Sex Transm Dis 2011; 38:24-9. [DOI: 10.1097/olq.0b013e3181ea170b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic. J Natl Med Assoc 2010; 102:614-20. [PMID: 20690325 DOI: 10.1016/s0027-9684(15)30639-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES High rates of psychosocial and health problems have been identified among patients attending sexually transmitted disease (STD) clinics, who are disproportionately urban, have low income, and are racial/ethnic minorities. This study sought to determine whether these problems co-occurred and whether they indicated the presence of a syndemic. METHODS Patients (N = 1557, 46% female, 64% African American) attending an urban STD clinic completed a computerized survey assessing childhood sexual abuse (CSA), depressive symptoms, binge drinking, marijuana use, intimate partner violence (IPV), and sexual risk behavior. Medical records were reviewed to determine incident STD diagnosis. RESULTS The psychosocial and health problems were interrelated. Endorsing more psychosocial problems was associated with a greater likelihood of having multiple sexual partners and STD diagnosis. Interactions between CSA and marijuana use and between CSA and IPV predicted STD diagnosis. CONCLUSIONS Numerous psychosocial and health problems co-occur among urban STD clinic patients. There was some evidence of a syngergistic relationship (i.e., a syndemic) between these conditions, resulting in worsened sexual health outcomes. Health care needs to be multidisciplinary to address the multiple psychosocial and health problems faced by STD clinic patients. Research needs to identify factors that may underlie these comorbid conditions.
Collapse
Affiliation(s)
- Theresa E Senn
- Center for Health and Behavior, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244, USA.
| | | | | |
Collapse
|
25
|
Fowler T, Caley M, Johal R, Brown R, Ross JDC. Previous history of gonococcal infection as a risk factor in patients presenting with gonorrhoea. Int J STD AIDS 2010; 21:277-8. [PMID: 20378901 DOI: 10.1258/ijsa.2009.009235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recidivism is common in patients infected with gonorrhoea. Identifying the factors most closely associated with recurrent gonococcal infection can help to target health promotion and disease prevention interventions. A case-control study design was used to quantify the importance of past infection as a risk marker for gonorrhoea while controlling for other demographic and behavioural factors. Data were available for 134 cases of gonorrhoea and 150 controls. A history of gonorrhoea (odds ratio [OR] 4.36 [95% CI 1.78-10.71]) was the strongest predictor of current infection. The number of partners in the last month (OR 2.19 [95% CI 1.20-4.02]) was also significantly associated with a diagnosis of gonorrhoea. Patients presenting with gonorrhoea are a specific high-risk group who require additional interventions and should be prioritized for evidence-based, enhanced and interactive counselling.
Collapse
Affiliation(s)
- T Fowler
- Health Protection Agency, West Midlands East, UK
| | | | | | | | | |
Collapse
|
26
|
In the Shadow of Academic Medical Centers: A Systematic Review of Urban Health Research in Baltimore City. J Community Health 2010; 35:433-52. [PMID: 20422444 DOI: 10.1007/s10900-010-9258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
27
|
Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis 2009; 36:478-89. [PMID: 19617871 DOI: 10.1097/olq.0b013e3181a2a933] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Determining the magnitude of chlamydia and gonorrhea reinfection is critical to inform evidence-based clinical practice guidelines related to retesting after treatment. PubMed was used to identify peer-reviewed English language studies published in the past 30 years that estimated reinfection rates among females treated for chlamydia or gonorrhea. Included in this analysis were original studies conducted in the United States and other industrialized countries that reported data on chlamydia or gonorrhea reinfection in females. Studies were stratified into 3 tiers based on study design. Reinfection rates were examined in relation to the organism, study design, length of follow-up, and population characteristics. Of the 47 studies included, 16 were active cohort (Tier 1), 15 passive cohort (Tier 2), and 16 disease registry (Tier 3) studies. The overall median proportion of females reinfected with chlamydia was 13.9% (n = 38 studies). Modeled chlamydia reinfection within 12 months demonstrated peak rates of 19% to 20% at 8 to 10 months. The overall median proportion of females reinfected with gonorrhea was 11.7% (n = 17 studies). Younger age was associated with higher rates of both chlamydia and gonorrhea reinfection. High rates of reinfection with chlamydia and gonorrhea among females, along with practical considerations, warrant retesting 3 to 6 months after treatment of the initial infection. Further research should investigate effective interventions to reduce reinfection and to increase retesting.
Collapse
|
28
|
de Irala J, Osorio A, del Burgo CL, Belen VA, de Guzman FO, Calatrava MDC, Torralba AN. Relationships, love and sexuality: what the Filipino teens think and feel. BMC Public Health 2009; 9:282. [PMID: 19656369 PMCID: PMC2907520 DOI: 10.1186/1471-2458-9-282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 08/05/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In order to achieve a change among teens' sexual behavior, an important step is to improve our knowledge about their opinions concerning relationships, love and sexuality. METHODS A questionnaire including topics on relationships, love and sexuality was distributed to a target population of 4,000 Filipino students from third year high school to third year college. Participants were obtained through multi-stage sampling of clusters of universities and schools. This paper concentrates on teens aged 13 to 18. RESULTS Students reported that they obtained information about love and sexuality mainly from friends. However, they valued parents' opinion more than friends'. They revealed few conversations with their parents on these topics. A majority of them would like to have more information, mainly about emotion-related topics. Almost half of respondents were not aware that condoms are not 100% effective in preventing STIs or pregnancies. More girls, compared to boys, were sensitive and opposed to several types of sexism. After adjusting for sex, age and institution, the belief of 100% condom effectiveness and the approval of pornography and sexism were associated with being sexually experienced. CONCLUSION There is room for further encouraging parents to talk more with their children about sexuality, specially aspects related to feelings and emotions in order to help them make better sexual choices. Indeed, teens wish to better communicate with their parents on these issues. Condoms are regarded as safer than what they really are by almost half of the participants of this study, and such incorrect knowledge seems to be associated with sexual initiation.
Collapse
Affiliation(s)
- Jokin de Irala
- Preventive Medicine and Public Health, School of Medicine, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Alfonso Osorio
- Department of Education, University of Navarra, 31008 Pamplona, Spain
| | - Cristina López del Burgo
- Preventive Medicine and Public Health, School of Medicine, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Vina A Belen
- University of Asia and the Pacific, Pearl Drive cor St J Escriva Drive, Ortigas Center, Pasig City, Philippines
| | - Filipinas O de Guzman
- Research for Education Intervention and Development, CRC Foundation Incorporated, Manila, Philippines
- Unit 1103, Pacific Center Building, San Miguel Avenue, Ortigas Center, Pasig City 1605, Philippines
| | - María del Carmen Calatrava
- Preventive Medicine and Public Health, School of Medicine, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Antonio N Torralba
- University of Asia and the Pacific, Pearl Drive cor St J Escriva Drive, Ortigas Center, Pasig City, Philippines
| |
Collapse
|
29
|
California guidelines for expedited partner therapy for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Transm Dis 2008; 35:314-9. [PMID: 18166849 DOI: 10.1097/olq.0b013e31815b0158] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In California, medical providers have the option to provide expedited partner therapy (EPT) for Chlamydia trachomatis and Neisseria gonorrhoeae. California law was amended in 2001 and 2007 to allow physicians to prescribe, and nurse practitioners, physician assistants, and certified nurse-midwives to dispense, antibiotic therapy for the sex partners of individuals infected with chlamydia and gonorrhea, even if they have not been able to perform an examination of the patient's partner(s).In collaboration with the California STD Controllers Association, the California Department of Public Health STD Control Branch developed clinical guidelines for EPT for chlamydia and gonorrhea. These guidelines are focused on EPT strategies and provide information on the most appropriate patients, medications, and counseling procedures recommended to maximize patient and public health benefit while minimizing risk to partners.
Collapse
|
30
|
de Irala J, Urdiain IG, López Del Burgo C. Analysis of content about sexuality and human reproduction in school textbooks in Spain. Public Health 2008; 122:1093-103. [PMID: 18614191 DOI: 10.1016/j.puhe.2008.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 08/27/2007] [Accepted: 01/07/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The spread of sexually transmitted infections (STIs) inadolescents and teenage pregnancy rates are increasing. A decrease in the average age of youth's first sexual experience has also been noted. Sexual education programmes in schools have an important role to play in addressing these issues. The objective of this study was to analyse the content of textbooks in the areas of sexuality and human reproduction in order to evaluate the extent to which these textbooks promote healthy reproductive lifestyles, as well as avoidance of risk behaviour among adolescent students. STUDY DESIGN Descriptive study of the content of school textbooks. METHODS The study sample consisted of 12 textbooks (approximately 80% of all the textbooks used in Spanish secondary schools) which were edited in 2002. Content analysis evaluated the extent to which these books demonstrated reliable scientific information about: (a) condom effectiveness; (b) consequences, prevention and treatment of STIs; (c) family planning methods; (d) assisted reproductive technologies; and (e) the promotion of healthy reproductive lifestyles. RESULTS All textbooks presented inaccurate information in the areas studied. One hundred and fifty one quotes were identified that facilitated incomplete perception of sexuality or risky behaviour. On average, 12.6 incorrect messages were identified in each textbook. CONCLUSIONS The textbooks examined are neither appropriate nor sufficiently comprehensive for adolescent education on issues of sexuality. Results suggest a need for alternative textbooks based on better scientific evidence. It is essential that textbooks empower adolescents to make healthy decisions through the promotion of useful life skills that provide a more integrated concept of sexuality. There is a need for approaches to sexual education to integrate values commonly held by parents of the youth that use such texts.
Collapse
Affiliation(s)
- J de Irala
- Preventive Medicine and Public Health, School of Medicine, University of Navarra, Irunlarrea 1, 31080 Pamplona, Navarra, Spain.
| | | | | |
Collapse
|
31
|
Van der Bij AK, Geskus RB, Fennema HSA, Adams K, Coutinho RA, Dukers NHTM. No evidence for a sustained increase in sexually transmitted diseases among heterosexuals in Amsterdam, the Netherlands: a 12-year trend analysis at the sexually transmitted disease outpatient clinic, Amsterdam. Sex Transm Dis 2007; 34:461-7. [PMID: 17195773 DOI: 10.1097/01.olq.0000251230.62493.f3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Sexually transmitted diseases (STDs) are on the rise, mainly among men having sex with men (MSM). GOAL The goal of this study was to evaluate whether STD increases as seen in MSM are also visible among heterosexuals. STUDY DESIGN Attendees of the STD clinic in Amsterdam, The Netherlands, are routinely tested for chlamydia, gonorrhea, and syphilis. Additionally, all women are tested for trichomoniasis. STD time trends of heterosexual attendees between 1994 and 2005 were analyzed by logistic regression and generalized linear models with a negative binomial distribution. RESULTS The number of consultations doubled since 1994. However, no long-term increase was seen in the number of syphilis and gonorrhea infections. Additionally, the trichomonas prevalence declined. However, the number of chlamydia infections increased over time. CONCLUSIONS Although the number of attendees increased, no evidence for increasing STD incidence was found among heterosexuals. The increase in chlamydia infections can probably be explained by increased screening resulting from increased numbers of attendees.
Collapse
Affiliation(s)
- Akke K Van der Bij
- Department of Research, Cluster Infectious Diseases, Health Service of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
32
|
Leonard L, Greene JL, Erbelding E. Persons, Places, and times: the meanings of repetition in an STD clinic. Med Anthropol Q 2007; 21:154-68. [PMID: 17601082 DOI: 10.1525/maq.2007.21.2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article we work the tensions between the way clinical medicine and public health necessarily construct the problem of "repetition" in the context of a sexually transmitted disease (STD) clinic and the ways patients narrate their illness experiences. This tension-between clinical and epidemiological exigencies and the messiness of lived experience-is a recurring theme of work conducted at the intersections of epidemiology, anthropology, and clinical medicine. Clinically, repeated infections are a threat to the individual body and to "normal" biological processes like reproduction. From a public health perspective, "repeaters" are imagined to be part of a "core group" that keeps infections in circulation, endangering the social body. Yet patients' accounts are anchored in particular social histories, and their experiences rely on different time scales than those implicated in either of these types of readings. Extended analyses are provided of two such accounts: one in which repetition can be "read" as part of a performance of recovery, and one in which repetition is bound up in the effort to avoid becoming the involuntary subject of institutionally administered intervention. We argue the need to open up the category of repeaters to include the social and draw on work by Cheryl Mattingly to suggest that one way to do this in the context of the STD clinic might be to adopt forms of therapeutic practice that make use of interpretive, in addition to technical, skills.
Collapse
Affiliation(s)
- Lori Leonard
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, USA
| | | | | |
Collapse
|
33
|
Fung M, Scott KC, Kent CK, Klausner JD. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect 2007; 83:304-9. [PMID: 17166889 PMCID: PMC2598678 DOI: 10.1136/sti.2006.024059] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2006] [Indexed: 11/03/2022] Open
Abstract
This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting recommendations in men. PubMed and STI conference abstract books from January 1995 to October 2006 were searched to identify studies on chlamydia and gonorrhoea reinfection among men using chlamydia and gonorrhoea nucleic acid amplification tests or gonorrhoea culture. Studies were categorised as using either active or passive follow-up methods. The proportions of chlamydial and gonococcal reinfection among men were calculated for each study and summary medians were reported. Repeat chlamydia infection among men had a median reinfection probability of 11.3%. Repeat gonorrhoea infection among men had a median reinfection probability of 7.0%. Studies with active follow-up had moderate rates of chlamydia and gonorrhoea reinfection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both chlamydia and gonorrhoea reinfections among men, with respective medians of 17.4% and 8.5%. Proportions of chlamydia and gonorrhoea reinfection among men were comparable with those among women. Reinfection among men was strongly associated with previous history of sexually transmitted diseases and younger age, and inconsistently associated with risky sexual behaviour. Substantial repeat chlamydia and gonorrhoea infection rates were found in men comparable with those in women. Retesting recommendations in men are appropriate, given the high rate of reinfection. To optimise retesting guidelines, further research to determine effective retesting methods and establish factors associated with reinfection among men is suggested.
Collapse
Affiliation(s)
- Monica Fung
- Wellesley College, 21 Wellesley College Road, Unit 4633, Wellesley, MA 02481-0246, USA.
| | | | | | | |
Collapse
|
34
|
Johnson-Mallard V, Lengacher CA, Kromrey JD, Campbell DW, Jevitt CM, Daley E, Schmitt K. Increasing knowledge of sexually transmitted infection risk. Nurse Pract 2007; 32:26-32. [PMID: 17264791 DOI: 10.1097/00006205-200702000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
|
35
|
Crosby RA, Yarber WL, Sanders SA, Graham CA, McBride K, Milhausen RR, Arno JN. Men with broken condoms: who and why? Sex Transm Infect 2007; 83:71-5. [PMID: 16870644 PMCID: PMC2598576 DOI: 10.1136/sti.2006.021154] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2006] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To identify (1) the prevalence of condom breakage, and demographic and sexuality-related differences among young men who have sex with women reporting and not reporting this event; (2) condom-specific behaviours associated with breakage. METHODS Young men (n = 278) attending a clinic for treatment of sexually transmitted infections (STIs) responded to an anonymous questionnaire aided by a CD recording of the questions. The samples were screened to include only men who had used a condom during penile-vaginal sex at least three times in the past 3 months. Condom-specific behaviours (including breakage) were assessed using these last three acts of condom use as the recall period. Correlates achieving bivariate significance were subjected to multivariate analysis. RESULTS Nearly one third (31.3%) of the men reported recent breakage. The breakage rate was 15%. Three correlates significantly distinguished between men who did and did not report breakage. Men who had past STIs were more likely to report breakage (adjusted odds ratio (AOR) 2.08), as were men who also reported condom slippage (AOR 2.72). Less self-efficacy for correct condom use was also significantly associated with breakage (AOR 1.07). Further, three condom-specific behaviours were significantly associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), experiencing problems with the "fit or feel" of condoms (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0). CONCLUSIONS Breakage may be common and may occur in a larger context of difficulties with condoms. STI clinics could potentially benefit some men by providing instructions on the correct use of condoms.
Collapse
Affiliation(s)
- R A Crosby
- College of Public Health, University of Kentucky, 121 Washington Avenue, Room 111C, Lexington, KY 40506-0003, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
De P, Singh AE, Wong T, Kaida A. Predictors of Gonorrhea Reinfection in a Cohort of Sexually Transmitted Disease Patients in Alberta, Canada, 1991–2003. Sex Transm Dis 2007; 34:30-6. [PMID: 16878054 DOI: 10.1097/01.olq.0000230485.85132.e9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to identify characteristics associated with reinfection in sexually transmitted disease (STD) patients in Alberta, Canada. METHODS A retrospective cohort of 5,701 STD patients with gonorrhea diagnosed between 1991 and 2003 were followed for incident gonorrhea. Rates of reinfection were estimated and multivariate logistic regression was used to identify patient characteristics associated with reinfection. RESULTS There were 568 reinfections in 460 individuals, with reinfection occurring at a median of 9.2 months with an incidence rate of 2.34 per 100 person-years (95% confidence interval [CI], 2.09-2.59). The highest risk of reinfection was found in patients of black ethnicity (adjusted hazard ratio [aHR], 3.31; 95% CI, 2.27-4.81), aboriginal ethnicity (aHR, 2.64; 95% CI, 1.96-3.56), those reporting homo-/bisexual practice (aHR, 2.05; 95% CI, 1.40-3.02), or treated at an STD clinic (aHR, 1.49; 95% CI, 1.15-1.94). CONCLUSION The recognition of key demographic and behavioral characteristics can help focus interventions for patients at higher risk of gonorrhea reinfection.
Collapse
Affiliation(s)
- Prithwish De
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
| | | | | | | |
Collapse
|
37
|
Warner L, Stone KM, Macaluso M, Buehler JW, Austin HD. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33:36-51. [PMID: 16385221 DOI: 10.1097/01.olq.0000187908.42622.fd] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically. OBJECTIVES The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates. DESIGN We reviewed studies published 1966-2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use. RESULTS Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04). CONCLUSIONS Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness.
Collapse
Affiliation(s)
- Lee Warner
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
| | | | | | | | | |
Collapse
|
38
|
Bernstein KT, Zenilman J, Olthoff G, Marsiglia VC, Erbelding EJ. Gonorrhea Reinfection Among Sexually Transmitted Disease Clinic Attendees in Baltimore, Maryland. Sex Transm Dis 2006; 33:80-6. [PMID: 16432478 DOI: 10.1097/01.olq.0000187233.53622.8a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We hypothesized that an active follow-up program to assess for reinfection after gonorrhea treatment could be a useful disease control strategy. GOAL We evaluated an active follow-up and repeat testing program for all Baltimore sexually transmitted disease clinic patients diagnosed with gonorrhea. STUDY DESIGN From September 2003 to May 2004, all clients with a treated gonorrhea infection were advised to return 3 months later for repeat testing. If clients did not return as scheduled, field outreach was attempted. At follow-up visits, urine was tested for gonorrhea and consenting participants completed a behavioral survey. In addition, we reviewed morbidity records for any intercurrent gonorrhea infections reported during the project period. RESULTS Of the 667 participants diagnosed with gonorrhea at baseline, 54 had a gonorrhea reinfection diagnosed for an incidence of 13.8 per 100 person-years. One hundred seventy-eight (27%) either presented for a follow-up visit or were located through field efforts, and of these, 5 (2.8%) had gonorrhea detected on follow-up urine testing. No measured factors had predictive value in identifying gonorrhea reinfection. CONCLUSIONS Although reinfection rates were high, we found that field staff intervention to increase follow-up testing rates did not identify a significant amount of repeat infections compared with passive surveillance.
Collapse
Affiliation(s)
- Kyle T Bernstein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | | | | | | | | |
Collapse
|
39
|
Lee JD, Clarke J. Cover up or cool it? Sexual intercourse during therapy for bacterial sexually transmitted infections--a discussion of evidence for efficacy of condom use preventing transmission during an acute bacterial STI. Int J STD AIDS 2004; 15:285-8. [PMID: 15117492 DOI: 10.1177/095646240401500501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Effective treatment of sexually transmitted infections (STIs) such as gonorrhoea and chlamydia needs sexual behaviour modification, in addition to antibiotics, to protect the index patient and their sexual partner from re-infection during treatment. This may mean advice to avoid sex, or to use condoms for intercourse, until all current sexual partners have completed treatment. This article discusses the effectiveness of condoms as re-infection protection during therapy of gonorrhoea and chlamydial infection. Indirect evidence from studies on primary prevention indicates that, although physically, condoms are impermeable to STI pathogens, the risk of failure depends on the experience of the user and the frequency of use. Health care workers may over-estimate the protective value of condoms in this situation. Patients should be made aware of the risk of infection present, even in experienced condom users, if they choose to continue protected sexual intercourse during therapy for acute bacterial STIs.
Collapse
Affiliation(s)
- John D Lee
- Department of Genitourinary Medicine, Mid-Yorkshire Hospitals Trust, Clayton Hospital, Wakefield WF1 3JS, UK
| | | |
Collapse
|
40
|
Erbelding EJ, Hutton HE, Zenilman JM, Hunt WP, Lyketsos CG. The Prevalence of Psychiatric Disorders in Sexually Transmitted Disease Clinic Patients and Their Association With Sexually Transmitted Disease Risk. Sex Transm Dis 2004; 31:8-12. [PMID: 14695951 DOI: 10.1097/01.olq.0000105326.57324.6f] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Psychiatric disorders could limit the success of behavioral counseling strategies. We evaluated the prevalence of psychiatric disorders among sexually transmitted disease (STD) clinic patients and their association with STD risk. METHODS A systematic sample of 201 patients presenting to a public STD clinic in Baltimore, Maryland, participated in the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. RESULTS Overall, 45% of 201 STD clinic patients interviewed had a current axis I disorder and 29% had an axis II personality disorder. Substance use disorders predominated among axis I diagnoses; antisocial personality disorder (ASPD) predominated among axis II diagnoses, with an ASPD prevalence of 29.4% in men. ASPD was associated with a diagnosis of an STD (odds ratio, 3.67; 95% confidence interval, 1.63-8.30; P = 0.002). Substance use was not associated with an STD diagnosis. CONCLUSIONS STD clinic patients have complex psychopathology that could increase HIV risk and compromise prevention interventions. Specialized counseling strategies, particularly targeting personality traits of ASPD, could improve prevention outcomes.
Collapse
Affiliation(s)
- Emily J Erbelding
- Baltimore City Health Department, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | |
Collapse
|
41
|
Melville J, Sniffen S, Crosby R, Salazar L, Whittington W, Dithmer-Schreck D, DiClemente R, Wald A. Psychosocial impact of serological diagnosis of herpes simplex virus type 2: a qualitative assessment. Sex Transm Infect 2003; 79:280-5. [PMID: 12902574 PMCID: PMC1744709 DOI: 10.1136/sti.79.4.280] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the emotional and psychosocial responses to a serological diagnosis of HSV-2 infection in individuals without previous history of genital herpes. METHODS 24 individuals who had a positive HSV-2 serology by western blot and no clinical history of disease were recruited from four clinics (sexually transmitted disease, maternal and infant care, family medicine, and virology research) over a 10 month period. In-depth qualitative interviews were conducted to elicit an individual's responses to the HSV-2 diagnosis. RESULTS Three categories of themes were identified from the interviews. Short term emotional responses included surprise, denial, confusion, distress, sadness, disappointment, and relief to know. Short term psychosocial responses included fear of telling sex partners, anger at the source partner, guilt about acquiring or transmitting, and concern about transmitting to a child. Perceived ongoing responses included fear of telling future partners, concern about transmitting to a sex partner, feeling sexually undesirable, feeling socially stigmatised, feeling like "damaged goods," sex avoidance due to social responsibility, fear of transmitting to a newborn, and relationship concerns relating to the diagnosis. CONCLUSIONS Individuals exhibit strong emotional and psychosocial responses to a serological diagnosis of HSV-2 infection. Many of the negative responses may be time limited and influenced by factors that are potentially amenable to counselling.
Collapse
Affiliation(s)
- J Melville
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA 98195-6460, USA.
| | | | | | | | | | | | | | | |
Collapse
|