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Rakhmatulina MR, Bolshenko NV, Maleev VV. Extragenital sexually transmitted infections. VESTNIK DERMATOLOGII I VENEROLOGII 2023. [DOI: 10.25208/vdv1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aims: to study the prevalence rate and clinical features of extragenital STIs in both males and females.
Materials and methods: a prospective observational clinical study included 57 patients with a history of unprotected orogenital and/or anogenital sexual contacts: group I (n=20) women practicing heterosexual sexual contacts, group II (n=9) men practicing heterosexual sexual contacts, group III (n=28) men who have sex with men (MSM). The identification of STIs was conducted by the polymerase chain reaction method and the ribosomal RNA NASBA detection method was used as an independent additional direct method.
Results: a high level of detection of STIs of extragenital localization has been established: in heterosexual women in the rectum (10; 76.9%), in the oropharynx (9; 69.2%) and in the conjunctiva (2; 15.4%); in heterosexual men in the rectum (2; 40%), in the conjunctiva (2; 40%) and in the oropharynx (1; 20%); in MSM in the rectum (15; 75%), in the oropharynx (11; 55%) and in the conjunctiva (5; 25%); in 14 (36.8%) patients, STI infection of more than 2 localizations was found. In extragenital foci in group I patients chlamydia trachomatis infection was most frequently detected (5; 38.5%), in group II patients gonococcal infection (2; 40%), in group III patients syphilis (9; 45%), gonococcal infection (8; 40%) and chlamydia trachomatis infections (8; 40%). Asymptomatic infections in conjunctiva was detected in 4 (10.5%) patients, in oropharynx in 15 (39.5%), in rectum in 22 (57.9%) patients.
Conclusions: the high level of detection of extragenital STIs and their frequent asymptomatic course dictates the need to study clinical samples from the oropharynx, rectum and conjunctiva not only when detecting objective and/or subjective symptoms of diseases, but also when there is a history of unprotected orogenital and/or anogenital sexual contacts, as well as when detected infections of genital localization.
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Barbee LA, St Cyr SB. Management of Neisseria gonorrhoeae in the United States: Summary of Evidence From the Development of the 2020 Gonorrhea Treatment Recommendations and the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Treatment Guidelines. Clin Infect Dis 2022; 74:S95-S111. [PMID: 35416971 DOI: 10.1093/cid/ciac043] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern given limited antibiotic options currently and an even smaller antimicrobial development pipeline. Since the release of the Centers for Disease Control and Prevention (CDC) 2015 STD Treatment Guidelines, azithromycin, part of the 2015 dual-drug treatment regimen, has had a rapid rise in resistance. The 2020 CDC Gonorrhea Treatment Recommendations and the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were developed weighing the priorities of treating the individual, protecting the population, and preventing antimicrobial resistance. METHODS Gonorrhea subject matter experts (SME) generated 8 key questions and conducted a literature review of updated data from 2013 to 2019 on gonorrhea antimicrobial resistance, treatment failures, clinical trials, and other key topics. More than 2200 abstracts were assessed, and 248 clinically relevant articles were thoroughly reviewed. SMEs also evaluated N gonorrhoeae antimicrobial resistance data from the Gonococcal Isolate Surveillance Project (GISP). EVIDENCE Although there have been reports of ceftriaxone treatment failures internationally, GISP data suggest that ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, with < 0.1% exhibiting an "alert value" MIC (> 0.25 mcg/mL). However, GISP documented a rapid rise in the proportion of isolates with an elevated MIC (≥ 2.0 mcg/mL) to azithromycin-nearly 5% in 2018. At the same time, new pharmacokinetic/pharmacodynamic data are available, and there is greater recognition of the need for antimicrobial stewardship. SUMMARY The 2021 CDC STI Treatment Guidelines now recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites. If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added. Few alternative therapies exist for persons with cephalosporin allergies; there are no recommended alternative therapies for N gonorrhoeae infection of the throat.
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Affiliation(s)
- Lindley A Barbee
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,University of Washington, Seattle, Washington, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, Washington, USA
| | - Sancta B St Cyr
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Meuwly M, Auderset D, Stadelmann S, Suris JC, Barrense-Dias Y. Anal Intercourse among Heterosexual Young Adults: A Population-Based Survey in Switzerland. JOURNAL OF SEX RESEARCH 2021; 58:1061-1068. [PMID: 33428468 DOI: 10.1080/00224499.2020.1866481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Anal intercourse (AI) among heterosexuals is an understudied and taboo subject. This 2017 Swiss national study aimed to describe the characteristics and motivations of heterosexual young adults practicing AI. Participants with any same-sex experience, same-sex attraction or non-heterosexual identity were excluded. The Federal Statistical Office provided the initial sample and potential participants were recruited through postal mail inviting them to an online survey (response rate 15.1%). The sample comprised 3892 participants (52% males; 54% of the overall sample, mean age 26.3 years). Overall, 55% of women and 56% of men had never experienced AI, 17% and 12% had done it once and 28% and 32% more than once, respectively. We found that participants engaging in AI had higher odds of practicing intercourse while intoxicated, being younger at first sexual experience, not using a condom at last intercourse and reporting a history of sexual transmitted infections. The main reason reported by both genders for engaging in their first AI was being curious followed by being in love. In conclusion, AI is a widespread practice among heterosexual young adults and health professionals should be especially attentive to it.
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Affiliation(s)
- Marion Meuwly
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Diane Auderset
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Sophie Stadelmann
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Joan-Carles Suris
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Yara Barrense-Dias
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
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Update your "sore throat" differential list: A case report and discussion of oral chlamydia. J Am Assoc Nurse Pract 2021; 33:1261-1264. [PMID: 33731559 DOI: 10.1097/jxx.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT There has been an exponential increase in sexually transmitted infections (STIs) in the United States, causing the Centers for Disease Control and Prevention to declare an epidemic. Current evidence demonstrates that extragenital STIs of the oropharynx and rectum are often asymptomatic and may not be associated with concurrent positive urogenital infections. As a result, these infections are often missed in primary care. Furthermore, guidelines only recommend extragenital site testing in men who have sex with men, excluding oropharyngeal chlamydia, despite evidence that extragenital STIs are occurring in other high-risk populations as well. A case report is provided to enhance primary health care providers' knowledge of extragenital STIs and promote early recognition and testing to improve patient outcomes.
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van Liere GAFS, Dukers-Muijrers NHTM, Kuizenga-Wessel S, Wolffs PFG, Hoebe CJPA. Routine universal testing versus selective or incidental testing for oropharyngeal Neisseria gonorrhoeae in women in the Netherlands: a retrospective cohort study. THE LANCET. INFECTIOUS DISEASES 2021; 21:858-867. [PMID: 33444559 DOI: 10.1016/s1473-3099(20)30594-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/02/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women are not routinely tested for oropharyngeal Neisseria gonorrhoeae. At present, selective testing based on sexual behaviour or risk groups is advocated by international guidelines. Many oropharyngeal infections are asymptomatic and thus remain undetected, establishing a reservoir for ongoing transmission. Data on effectiveness of routine testing are scarce, thus we aimed to assess the optimal testing strategy for oropharyngeal N gonorrhoeae in women. METHODS In this retrospective cohort study, we used surveillance data obtained from all sexually transmitted infection (STI) clinics in the Netherlands between Jan 1, 2008, and Dec 31, 2017. We collected consultation-level data, and individual-level patient data from 2016 onwards, on sociodemographic characteristics, sexual behaviour in the past 6 months, self-reported symptoms, and STI diagnoses. We compared the prevalence of oropharyngeal N gonorrhoeae between women who attended clinics that offered routine universal testing (defined as >85% of women tested per clinic-year) and women who attended clinics that offered selective testing (defined as 5-85% of women tested per clinic-year) or incidental testing (<5% of women tested per clinic-year). We calculated the number of infections missed by selective testing by extrapolating prevalence for the routine universal testing group to that of weighted and unweighted samples of all selectively tested women. We used multivariable generalised estimating equations to identify independent risk factors for oropharyngeal N gonorrhoeae to identify the optimal selective testing strategy. FINDINGS 554 266 consultations with at least one N gonorrhoeae test were recorded, of which 545 750 consultations (including repeat visits) were included in the analyses. Of 545 750 consultations, routine universal testing was used in 57 359 (10·5%), selective testing in 444 283 (81·4%), and incidental testing in 44 108 (8·1%). The prevalence of oropharyngeal N gonorrhoeae was 1·4% (95% CI 1·3-1·5; 703 of 50 962 consultations) in the routine testing group compared with 1·4% (1·3-1·5; 1858 of 132 276) in the selective testing group (p=0·68) and 2·8% (1·9-3·9; 30 of 1088) in the incidental testing group (p<0·0001). The prevalence of oropharyngeal-only infections was 47·7% (335 of 703 women) in the routine testing group, 53·3% (991 of 1858) in the selective testing group, and 60·0% (18 of 30) in the incidental testing group. Selective testing would have missed an estimated 4363 (70%; 95% CI 69-71) of all 6221 oropharyngeal N gonorrhoeae infections. Independent risk factors for oropharyngeal N gonorrhoeae were being notified for any STI (adjusted odds ratio 2·1, 95% CI 1·5-3·0), reporting sex work (4·0, 2·3-6·7), and having concurrent genital (51·5, 34·1-77·7) or anorectal (2·6, 1·4-4·8) N gonorrhoeae. Selective testing of women notified for any STI, or who reported sex work, would have led to 5418 (27·8%) of 19 455 women being tested and would have identified 119 (55·6%) of 214 oropharyngeal N gonorrhoeae infections. INTERPRETATION Selective testing potentially misses more than two-thirds of oropharyngeal N gonorrhoeae infections in women, of whom half have oropharyngeal infections without concurrent genital or anorectal infections. Using independent risk factors for oropharyngeal infection to guide testing is a minimal testing strategy. Routine universal testing is the optimum scenario to detect the majority of infections. However, future studies are needed to assess the cost-effectiveness of routine testing and its effect on antimicrobial resistance. FUNDING Public Health Service South Limburg.
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Affiliation(s)
- Geneviève A F S van Liere
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands.
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Jann JT, Cunningham NJ, Assaf RD, Bolan RK. Evidence supporting the standardisation of extragenital gonorrhoea and chlamydia screenings for women. Sex Transm Infect 2020; 97:601-606. [PMID: 33361465 DOI: 10.1136/sextrans-2020-054577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/26/2020] [Accepted: 11/28/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Current guidelines for women do not include extragenital screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) and do not mention anal sex behaviour. The objective of this cross-sectional study was to determine the number of potentially missed CT and NG cases by relying on urogenital screening and self-reported anal sex behaviour among women. METHODS Demographic and clinical data of 4658 women attending a community health centre in Los Angeles, California, USA from 2015 to 2018 were examined. CT and NG were detected using nucleic acid amplification test (APTIMA Combo 2, Hologic Gen-Probe, San Diego, California). Demographic and behavioural factors were also examined to assess potentially missed NG/CT cases. Multivariable regression analyses were used to determine whether reported anal sex behaviour predicts NG/CT rectal infection. RESULTS A total of 193 NG cases and 552 CT cases were identified; however, 53.9% of NG cases and 25.5% of CT cases were identified exclusively through extragenital screening. Of all positive cases of rectal CT, 87.0% did not report anal sex without a condom and 91.3% did not report any anal sex with their last sexual partner. Of all positive cases of rectal NG, 78.9% did not report anal sex without a condom and 76.3% did not report any anal sex with their last sexual partner. Anal sex with last partner was not predictive of NG/CT rectal infection. CONCLUSIONS Relying solely on urogenital screening and reported behaviour misses NG/CT cases. Extragenital NG/CT screening should be conducted in all women regardless of reported anal sex behaviour.
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Affiliation(s)
| | | | - Ryan D Assaf
- Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
- Department of Epidemiology, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| | - Robert K Bolan
- Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
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Pediatric Emergency Provider Sexually Transmitted Infection Screening Practices in Adolescents With Oropharyngeal or Anorectal Chief Complaints. Pediatr Emerg Care 2020; 36:e614-e619. [PMID: 29406475 PMCID: PMC6077108 DOI: 10.1097/pec.0000000000001414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sexually transmitted infections (STIs) may present with oropharyngeal or anorectal symptoms. Little is known about the evaluation of adolescents with these complaints in the pediatric emergency department (PED). This study aimed to determine the frequency of and factors associated with STI consideration and testing in this population. METHODS Retrospective chart review of patients aged 13 to 18 years who presented to an urban PED with oropharyngeal or anorectal chief complaints between June 2014 and May 2015. Sexually transmitted infection consideration was defined as sexual history documentation, documentation of STI in differential diagnosis, and/or diagnostic testing. Multivariate logistic regression models were used to identify factors associated with consideration. RESULTS Of 767 visits for oropharyngeal (89.4%), anorectal (10.4%), or both complaints, 153 (19.9%) had STI consideration. Of the 35 visits (4.6%) that included gonorrhea and/or chlamydia testing, 12 (34.3%) included testing at the anatomic site of complaint. Of those 12 tests, 50.0% were the incorrect test. Patients with older age (adjusted odds ratio [aOR] = 1.5, 95% confidence interval [CI] = 1.3-1.7), female sex (aOR = 1.6, 95% CI = 1.03-2.5), or anorectal complaints (aOR = 2.4, 95% CI = 1.3-4.3) were more likely to have STI consideration. CONCLUSIONS In an urban PED, only 20% of visits for adolescents with oropharyngeal or anorectal symptoms included STI consideration. Testing was performed in only 5% of cases and often at an inappropriate anatomic site or with the incorrect test. Interventions to increase awareness of appropriate STI consideration and testing for individuals presenting with possible extragenital complaints may help reduce STIs among adolescents.
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Men and Women Have Similar Neisseria gonorrhoeae Bacterial Loads: a Comparison of Three Anatomical Sites. J Clin Microbiol 2020; 58:JCM.01171-20. [PMID: 32817230 DOI: 10.1128/jcm.01171-20] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/08/2020] [Indexed: 02/07/2023] Open
Abstract
Neisseria gonorrhoeae is a common bacterial sexually transmitted infection (STI). Currently, there are limited data on the bacterial load in both men and women and on both genital and extragenital sites. Therefore, we quantified N. gonorrhoeae bacterial loads in a large population of women, heterosexual men, and men who have sex with men (MSM) at three different anatomical sites. N. gonorrhoeae-positive samples (n = 1265) of STI clinic consultations (n = 944) were tested for N. gonorrhoeae with the Roche Cobas 4800 system, and quantification cycle (Cq) values were used as an inversely proportional measure for N. gonorrhoeae bacterial load after interpolation from a standard curve. Bacterial loads were compared between sample materials and sexes using t tests. The following mean N. gonorrhoeae loads were observed: urine, 4.5 ± 1.0 log10 CFU/ml; vaginal swabs, 4.3 ± 1.1 log10 CFU/ml; anorectal swabs (women), 4.0 ± 1.2 log10 CFU/ml; anorectal swabs (men), 4.5 ± 1.3 log10 CFU/ml; oropharyngeal swabs (women), 2.8 ± 0.9 log10 CFU/ml; and oropharyngeal swabs (men), 3.2 ± 1.0 log10 CFU/ml. Oropharyngeal swabs had a significantly lower N. gonorrhoeae load (P < 0.001) than genital and anorectal samples. Loads did not differ between men and women. This is the first study that determined N. gonorrhoeae load in both women and men at three anatomical sites. The substantial N. gonorrhoeae load at all sample sites suggest that all sites may have transmission potential. However, the oropharyngeal site presents the lowest bacterial load. Men and women have a similar N. gonorrhoeae loads on separate anatomical sites, arguing for similar transmission potential and similar clinical relevance.
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Rowlinson E, Golden MR, Berzkalns A, Thibault C, Barbee LA. Epidemiologic Treatment for Contacts to Neisseria gonorrhoeae and Chlamydia trachomatis Infection in Sexually Transmitted Disease Clinic Patients in Seattle, WA; 1994 to 2018. Sex Transm Dis 2020; 47:665-671. [PMID: 32649579 PMCID: PMC8549494 DOI: 10.1097/olq.0000000000001234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Current Centers for Disease Control and Prevention guidelines recommend that clinicians empirically treat the sex partners of persons with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) infection before confirming that they are infected. It is possible that this practice, known as epidemiologic treatment, results in overtreatment for uninfected persons and may contribute to development of antimicrobial resistance. We sought to quantify the number of patients who received epidemiologic treatment and the proportion of those who were overtreated. METHODS We reviewed records from a municipal sexually transmitted disease clinic in Seattle, WA, from 1994 to 2018 to identify visits by asymptomatic patients seeking care because of sexual contact to a partner with GC and/or CT. We defined overtreatment as receipt of antibiotic(s) in the absence of a positive GC/CT test result and calculated the proportions of contacts epidemiologically treated and tested positive for GC/CT and overtreated in five 5-year periods stratified by sex and gender of sex partner. We used the Cochran-Armitage test to assess for temporal trends. RESULTS The number of asymptomatic contacts epidemiologically treated for GC/CT increased from 949 to 3159 between the 1994-1998 and 2014-2018 periods. In 2014-2018, 55% of persons were overtreated, most (82.1%) of these were men who have sex with men (MSM). The proportion of MSM overtreated decreased from 74% to 65% (P < 0.01), but the total number of overtreated MSM increased from 172 to 1428. DISCUSSION A high proportion of persons receiving epidemiologic treatment of GC/CT are uninfected. The current practice of routinely treating all sex partners of persons with GC/CT merits reconsideration in light of growing antimicrobial resistance.
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Affiliation(s)
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | - Anna Berzkalns
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | | | - Lindley A. Barbee
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
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de Salazar A, Espadafor B, Fuentes-López A, Barrientos-Durán A, Salvador L, Álvarez M, García F. Comparison between Aptima Assays (Hologic) and the Allplex STI Essential Assay (Seegene) for the diagnosis of Sexually transmitted infections. PLoS One 2019; 14:e0222439. [PMID: 31513653 PMCID: PMC6742210 DOI: 10.1371/journal.pone.0222439] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022] Open
Abstract
Sexually transmitted infections (STIs) remain a worldwide problem and a severe threat to public health. The purpose of this study was to compare Aptima® Assays (Hologic®) and the Allplex™ STI Essential Assay (Seegene®) for the simultaneous detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium in clinical practice. The Aptima® assays (Hologic®) are based on a transcription-mediated amplification (TMA) method. The Allplex™ STI Essential assay (Seegene®) is based on a multiplex Real-Time PCR (RT-PCR) method. A total of 622 clinical samples from different anatomical sites were tested using both methods. A total of 88 (14.1%) and 66 (10.6%) positive samples were found for any of the TMA assays used and for the RT-PCR assay, respectively. Aptima® assays showed a slightly higher rate of positive results for all pathogens except for T. vaginalis, the results of which were similar to those obtained with Allplex™. The most commonly detected pathogen was C. trachomatis (37 samples; 5.9% using TMA assays) and the anatomical site with the highest prevalence of microorganisms was a non-urogenital site, the pharynx (27 positive samples; 4.3%). Using the Aptima® assays as reference method, the comparison showed that the average specificity of multiplex RT-PCR was 100.0% for the four pathogens. However an average sensitivity of 74.5% was observed, showing 95.2% (CI95%; 93.6–96.9) of overall concordance (κ = 0.80). In conclusion, the Aptima® assays show a higher sensitivity on a wide range of sample types compared to the Allplex™ assay.
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Affiliation(s)
- Adolfo de Salazar
- Hospital Universitario San Cecilio, Servicio de Microbiología, Instituto de Investigación Ibs, Granada, Spain
| | - Beatriz Espadafor
- Hospital Universitario Virgen de las Nieves, Servicio de Dermatología, Centro de ETS, Granada, Spain
| | - Ana Fuentes-López
- Hospital Universitario San Cecilio, Servicio de Microbiología, Instituto de Investigación Ibs, Granada, Spain
| | - Antonio Barrientos-Durán
- Hospital Universitario San Cecilio, Servicio de Microbiología, Instituto de Investigación Ibs, Granada, Spain
| | - Luis Salvador
- Hospital Universitario Virgen de las Nieves, Servicio de Dermatología, Centro de ETS, Granada, Spain
| | - Marta Álvarez
- Hospital Universitario San Cecilio, Servicio de Microbiología, Instituto de Investigación Ibs, Granada, Spain
| | - Federico García
- Hospital Universitario San Cecilio, Servicio de Microbiología, Instituto de Investigación Ibs, Granada, Spain
- * E-mail:
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Lau A, Kong FYS, Huston W, Chow EPF, Fairley CK, Hocking JS. Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis. Sex Transm Infect 2019; 95:361-367. [PMID: 31097677 DOI: 10.1136/sextrans-2018-053950] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (NG). Given that urogenital NG is more strongly associated with pelvic inflammatory disease, this is an evidence gap. This systematic review and meta-analysis investigates the associations between anorectal CT in women and CT positivity at other sites (urogenital/oropharyngeal) and with anal intercourse, and compares these with anorectal NG within the same study populations. METHODS Electronic databases were searched for English-language studies published to October 2018 using the following terms: ("Chlamydia" OR "Chlamydia trachomatis") AND (("anal" OR "rect*" OR "anorect*") OR ("extra?genital" OR "multi?site")). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression. RESULTS 25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5%, with a summary estimate of 8.0% (95% CI 7.0 to 9.1; I2=88.5%). Anorectal NG positivity ranged from 0% to 17.0%, with a summary estimate of 2.1% (95% CI 1.6 to 2.8; I2=92.7%). The association between urogenital and anorectal positivity was stronger for NG than CT (summary prevalence ratio (PR)=89.3 (95% CI 53.1 to 150.3; I2=80.1%), PR=32.2 (95% CI 25.6 to 40.7; I2=70.3%), respectively), and between oropharyngeal and anorectal positivity it was stronger for NG than CT (PR=34.8 (95% CI 10.2 to 118.2; I2=89.9%), PR=8.8 (95% CI 6.8 to 11.5; I2=58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I2=0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I2=0.0%). CONCLUSIONS Anorectal CT is more common than anorectal NG, but anorectal NG is more strongly associated with anal intercourse, urogenital and oropharyngeal NG, suggesting that ongoing discussion about anorectal CT should also include NG. Longitudinal data are required to further understanding of the aetiology of anorectal STIs and assess whether anorectal screening is needed in women. TRIAL REGISTRATION NUMBER CRD42df017080188.
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Affiliation(s)
- Andrew Lau
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Fabian Yuh Shiong Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Willa Huston
- School of Life Sciences, The University of Technology Sydney, Sydney, New South Wales, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Gaspari V, Marangoni A, D'Antuono A, Roncarati G, Salvo M, Foschi C, Re MC. Pharyngeal Chlamydia and gonorrhea: a hidden problem. Int J STD AIDS 2019; 30:732-738. [PMID: 31046619 DOI: 10.1177/0956462419838922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this study we assessed the prevalence and predictors of pharyngeal infections due to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in a cohort of patients attending an STI Clinic. From January 2016 to September 2018, 893 patients attending the STI Clinic of St Orsola-Malpighi Hospital (Bologna, Italy) and reporting unprotected oral sex were enrolled. A pharyngeal swab for the molecular detection of CT and NG was collected from each patient. Positive CT samples were further genotyped by an omp1 gene PCR. A total of 134 cases of gonorrhea (15%) and 34 chlamydial infections (3.8%) were detected in the pharyngeal site, with no significant differences between males (all men who have sex with men [MSM]) and females. More than 90% of the infections were completely asymptomatic, suggesting that symptoms were not predictors of a pharyngeal infection ( P = 0.7). On the contrary, a history of sexual contacts with a partner positive for CT and/or NG ( P < 0.0001), HIV positivity ( P = 0.01), and the presence of concurrent genital and/or rectal infections ( P < 0.0001) were significantly associated with CT/NG pharyngeal infections. Pharyngeal lymphogranuloma venereum cases were rare (prevalence: 0.4%), asymptomatic, and only found in MSM. Better knowledge about pharyngeal CT/NG infections could help to set up effective strategies for their prevention.
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Affiliation(s)
| | | | | | - Greta Roncarati
- 2 Microbiology, DIMES, University of Bologna, Bologna, Italy
| | - Melissa Salvo
- 2 Microbiology, DIMES, University of Bologna, Bologna, Italy
| | - Claudio Foschi
- 2 Microbiology, DIMES, University of Bologna, Bologna, Italy
| | - Maria Carla Re
- 2 Microbiology, DIMES, University of Bologna, Bologna, Italy
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14
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Deiss R, Byrne M, Echols SM, Cammarata SM, Potswald L, Gomez E, Curry JA, Garges E, Macalino G, Agan BK, Bavaro MF. Extragenital chlamydia infection among active-duty women in the United States Navy. Mil Med Res 2019; 6:3. [PMID: 30691524 PMCID: PMC6350339 DOI: 10.1186/s40779-019-0193-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharyngeal and anorectal reservoirs of gonorrhea (GC) and chlamydia (CT) are increasingly recognized among heterosexual women. While a number of studies performed at sexually transmitted disease (STD) clinics have found a high prevalence of extragenital GC/CT infection, such screening is typically not offered during routine primary care visits for women. We sought to define the prevalence of and factors associated with extragenital GC/CT among women in the U.S. Navy. METHODS We recruited servicewomen stationed in San Diego, California, between the ages of 18 and 25 who presented for an annual physical exam between January and September, 2017. Nucleic acid amplification testing was performed on swabs collected at endocervical, oropharyngeal and anorectal sites to assess the presence of GC/CT. An anonymous behavioral questionnaire was also administered to characterize sexual risk. Descriptive statistics were used to compare women with and without a prior history of any sexually transmitted infection (STI) (self-report) along with a current GC/CT diagnosis. This study was approved by the Institutional Review Board of the Uniformed Services University of Health Sciences. RESULTS Of the 75 patients who were approached, 60 subjects were enrolled in the study, including white 20 (33.3%), black/African American 18 (31.0%), Hispanic/Latina 13 (21.7%) and Asian/Pacific Islander 9 (15.5%) women. Among all the women, six (10.0%) were diagnosed with CT infection, all via endocervical exam. Of these, five (8.3%) had concurrent anorectal infection, including two cases (3.3%) accompanied by pharyngeal infection. Of the subjects, 15 (25.0%) reported anal intercourse in their most recent sexual encounter, most of which was condomless (13/15, 86.7%). A high number of women who reported sex with a casual male partner (19/45, 42.2%) reported rarely or never using condoms; last, 41.7% consuming at least 3 drinks on a typical drinking day, and one-third of the reported drinking more than once per week. CONCLUSIONS We found a high prevalence of anorectal CT infection, although no infections were detected without concurrent endocervical involvement. Nonetheless, the high prevalence of condomless anal intercourse reported by participants argues for further study and ongoing consideration of extragenital screening among high-risk patients. Behavioral interventions are also warranted given the high prevalence of sexual and related risk factors.
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Affiliation(s)
- Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA.,Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA
| | - Morgan Byrne
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Sara M Echols
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Stephanie M Cammarata
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA.,Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA
| | - Lynda Potswald
- 32nd Street Branch Medical Clinic, Naval Medical Center San Diego, 2450 Craven St, San Diego, CA, 92104, USA
| | - Eduardo Gomez
- 32nd Street Branch Medical Clinic, Naval Medical Center San Diego, 2450 Craven St, San Diego, CA, 92104, USA
| | - Jennifer A Curry
- Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA
| | - Eric Garges
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,Division of Tropical Medical Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814-4799, USA
| | - Grace Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,Marimac Insight, LLC, Simpsonville, MD, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Mary F Bavaro
- Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA.
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15
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Rawre J, Agrawal S, Dhawan B. Sexually transmitted infections: Need for extragenital screening. Indian J Med Microbiol 2018; 36:1-7. [PMID: 29735819 DOI: 10.4103/ijmm.ijmm_18_46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Extragenital infections can occur concurrently with simultaneous urogenital infections. Extragenital sites are believed to serve as hidden reservoirs and play a critical role in their transmission. The etiological relationship of the most widespread Sexually transmitted diseases (STD) pathogen to reproductive tract has long been established, but the distribution to extragenital sites appears to be infrequent and its correlation with the sexual practice still requires to be investigated. Optimal-screening strategies for extragenital infections are largely unknown. However, there is a lack of data on clinical outcomes and optimal treatment regimens for rectal and pharyngeal extragenital infections. Further studies are needed in settings other than reproductive health and STD clinics, especially in primary care clinics and resource-limited settings.
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Affiliation(s)
- Jyoti Rawre
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Agrawal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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16
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Chandra NL, Broad C, Folkard K, Town K, Harding-Esch EM, Woodhall SC, Saunders JM, Sadiq ST, Dunbar JK. Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis. Sex Transm Infect 2018; 94:320-326. [PMID: 29431148 DOI: 10.1136/sextrans-2017-053161] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 12/07/2017] [Accepted: 01/15/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Chlamydia trachomatis is the most commonly diagnosed bacterial STI. Lack of prevalence and risk factor data for rectal chlamydia in women has testing and treatment implications, as azithromycin (a first-line urogenital chlamydia treatment) may be less effective for rectal chlamydia. We conducted a systematic review of studies on women in high-income countries to estimate rectal chlamydia prevalence, concurrency with urogenital chlamydia and associations with reported anal intercourse (AI). DESIGN Systematic review and four meta-analyses conducted using random-effects modelling. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Cochrane Database were searched for articles published between January 1997 and October 2017. ELIGIBILITY CRITERIA Studies reporting rectal chlamydia positivity in heterosexual women aged ≥15 years old in high-income countries were included. Studies must have used nucleic acid amplification tests and reported both the total number of women tested for rectal chlamydia and the number of rectal chlamydia infections detected. Conference abstracts, case reports and studies with self-reported diagnoses were excluded. Data extracted included setting, rectal and urogenital chlamydia testing results, AI history, and demographics. RESULTS Fourteen eligible studies were identified, all among diverse populations attending sexual health services. Among routine clinic-attending women, summary rectal chlamydia positivity was 6.0% (95% CI 3.2% to 8.9%); summary concurrent rectal chlamydia infection was 68.1% in those who tested positive for urogenital chlamydia (95% CI 56.6% to 79.6%); and of those who tested negative for urogenital chlamydia, 2.2% (95% CI 0% to 5.2%) were positive for rectal chlamydia. Reported AI was not associated with rectal chlamydia (summary risk ratio 0.90; 95% CI 0.75 to 1.10). CONCLUSIONS High levels of rectal chlamydia infection have been shown in women with urogenital chlamydia infection. The absence of association between reported AI and rectal chlamydia suggests AI is not an adequate indicator for rectal testing. Further work is needed to determine policy and practice for routine rectal testing in women.
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Affiliation(s)
- Nastassya L Chandra
- HIV and STI Department, Public Health England, London, UK
- Field Epidemiology Service, Public Health England, London, UK
| | - Claire Broad
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Kate Folkard
- HIV and STI Department, Public Health England, London, UK
| | - Katy Town
- HIV and STI Department, Public Health England, London, UK
| | - Emma M Harding-Esch
- HIV and STI Department, Public Health England, London, UK
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
- Research Department of Infection and Population Health, St George's University of London, London, UK
| | | | | | - S Tariq Sadiq
- HIV and STI Department, Public Health England, London, UK
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Kevin Dunbar
- HIV and STI Department, Public Health England, London, UK
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17
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Consequences of restricted STI testing for young heterosexuals in the Netherlands on test costs and QALY losses. Health Policy 2017; 122:198-203. [PMID: 29246657 DOI: 10.1016/j.healthpol.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 10/02/2017] [Accepted: 12/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Due to rising costs caused by increasing demand for sexually transmitted infection (STI) care, the Dutch government changed the funding of STI clinics. In 2015, a more restrictive testing policy was introduced with syphilis and HIV tests only on indication for younger, heterosexual clients. We evaluated intended savings and missed syphilis and/or HIV infections and explored efficiency of possible test policies. METHODS Using surveillance data from 2011 to 2013 with extensive testing for all, we estimated effects of restrictive testing on test costs, number of infections missed, costs per Quality Adjusted Life Year (QALY) lost, and calculated the net monetary benefit from a government perspective. RESULTS The 2015 policy led to estimated savings of €1.1 million, while missing approximately three HIV infections and seven syphilis infections annually. Savings were €435,000/QALY lost. If testing second-generation immigrants for syphilis and HIV, savings rose to €525,000/QALY lost. Offering an HIV test when diagnosed with chlamydia or gonorrhoea savings were €568,000/QALY lost. In a sensitivity analysis, the willingness-to-pay threshold had the highest impact on results. CONCLUSIONS The 2015 testing policy resulted in a modest decline of detected HIV and syphilis infections, generating substantial savings. Syphilis and HIV tests for both first- and second-generation immigrants and an HIV test in case of positive chlamydia or gonorrhoea diagnosis could reduce missed infections in a cost-effective way.
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18
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Le PT, Hamasuna R, Matsumoto M, Furubayashi K, Hatanaka M, Kawai S, Yamaguchi T, Uehara K, Murakami N, Yoshioka M, Nakayama K, Shiono Y, Muraoka K, Suzuki M, Fujimoto N, Matsumoto T. The detection of microorganisms related to urethritis from the oral cavity of male patients with urethritis. J Infect Chemother 2017; 23:668-673. [DOI: 10.1016/j.jiac.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/19/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
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19
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Travassos AG, Xavier-Souza E, Netto E, Dantas EV, Timbó M, Nóbrega I, Haguihara T, Neumeyer J, Lisboa N, Soidan MA, Ferreira F, Brites C. Anogenital infection by Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected men and women in Salvador, Brazil. Braz J Infect Dis 2016; 20:569-575. [PMID: 27765581 PMCID: PMC9427556 DOI: 10.1016/j.bjid.2016.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/12/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. METHODS Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). RESULTS The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age <29 years (p=0.033), report of anal intercourse (p=0.029), pain during anal intercourse (p=0.028). On the other hand, no association between genital infection and other variables were detected in bivariate analysis. Among women, we detected an association between Chlamydia trachomatis genital infection and age <29 years (p<0.001), younger age at first sexual intercourse (p=0.048), pregnancy (p<0.001), viral load >50copies/mL (p=0.020), and no antiretroviral use (p=0.008). Anal infection in women was associated with age <29 years old (p<0.001) and pregnancy (p=0.023), and was not associated with report of anal intercourse (p=0.485). CONCLUSION Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.
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Affiliation(s)
- Ana Gabriela Travassos
- Universidade Estadual da Bahia (UNEB), Salvador, BA, Brazil; Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil.
| | | | - Eduardo Netto
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Eda Vinhaes Dantas
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Maiara Timbó
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Isabella Nóbrega
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Tatiana Haguihara
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Júlia Neumeyer
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | | | - Maria Angela Soidan
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Fábio Ferreira
- Laboratório Central de Saúde Pública Professor Gonçalo Moniz (LACEN-BA), Salvador, BA, Brazil
| | - Carlos Brites
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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20
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Dukers-Muijrers NHTM, Wolffs PFG, Eppings L, Götz HM, Bruisten SM, Schim van der Loeff MF, Janssen K, Lucchesi M, Heijman T, van Benthem BH, van Bergen JE, Morre SA, Herbergs J, Kok G, Steenbakkers M, Hogewoning AA, de Vries HJ, Hoebe CJPA. Design of the FemCure study: prospective multicentre study on the transmission of genital and extra-genital Chlamydia trachomatis infections in women receiving routine care. BMC Infect Dis 2016; 16:381. [PMID: 27502928 PMCID: PMC4977887 DOI: 10.1186/s12879-016-1721-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/15/2016] [Indexed: 11/17/2022] Open
Abstract
Background In women, anorectal infections with Chlamydia trachomatis (CT) are about as common as genital CT, yet the anorectal site remains largely untested in routine care. Anorectal CT frequently co-occurs with genital CT and may thus often be treated co-incidentally. Nevertheless, post-treatment detection of CT at both anatomic sites has been demonstrated. It is unknown whether anorectal CT may play a role in post-treatment transmission. This study, called FemCure, in women who receive routine treatment (either azithromycin or doxycycline) aims to understand the post-treatment transmission of anorectal CT infections, i.e., from their male sexual partner(s) and from and to the genital region of the same woman. The secondary objective is to evaluate other reasons for CT detection by nucleic acid amplification techniques (NAAT) such as treatment failure, in order to inform guidelines to optimize CT control. Methods A multicentre prospective cohort study (FemCure) is set up in which genital and/or anorectal CT positive women (n = 400) will be recruited at three large Dutch STI clinics located in South Limburg, Amsterdam and Rotterdam. The women self-collect anorectal and vaginal swabs before treatment, and at the end of weeks 1, 2, 4, 6, 8, 10, and 12. Samples are tested for presence of CT-DNA (by NAAT), load (by quantitative polymerase chain reaction -PCR), viability (by culture and viability PCR) and CT type (by multilocus sequence typing). Sexual exposure is assessed by online self-administered questionnaires and by testing samples for Y chromosomal DNA. Using logistic regression models, the impact of two key factors (i.e., sexual exposure and alternate anatomic site of infection) on detection of anorectal and genital CT will be assessed. Discussion The FemCure study will provide insight in the role of anorectal chlamydia infection in maintaining the CT burden in the context of treatment, and it will provide practical recommendations to reduce avoidable transmission. Implications will improve care strategies that take account of anorectal CT. Trial registration ClinicalTrials.gov Identifier: NCT02694497.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands. .,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - Petra F G Wolffs
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Lisanne Eppings
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Hannelore M Götz
- Department Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond (GGD Rotterdam), Rotterdam, The Netherlands.,National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sylvia M Bruisten
- Public Health Laboratory, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Kevin Janssen
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Mayk Lucchesi
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Titia Heijman
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - Birgit H van Benthem
- National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Jan E van Bergen
- National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Department of General Practice, Academic Medical Centre, Amsterdam, The Netherlands.,STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands
| | - Servaas A Morre
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos Herbergs
- DNalysis Maastricht, Maastricht, The Netherlands
| | - Gerjo Kok
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Mieke Steenbakkers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands
| | - Arjan A Hogewoning
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - Henry J de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.,STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infect Dis Obstet Gynecol 2016; 2016:5758387. [PMID: 27366021 PMCID: PMC4913006 DOI: 10.1155/2016/5758387] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/12/2016] [Accepted: 04/20/2016] [Indexed: 12/30/2022] Open
Abstract
In the United States, sexually transmitted diseases due to Chlamydia trachomatis and Neisseria gonorrhoeae continue to be a major public health burden. Screening of extragenital sites including the oropharynx and rectum is an emerging practice based on recent studies highlighting the prevalence of infection at these sites. We reviewed studies reporting the prevalence of extragenital infections in women, men who have sex with men (MSM), and men who have sex only with women (MSW), including distribution by anatomical site. Among women, prevalence was found to be 0.6–35.8% for rectal gonorrhea (median reported prevalence 1.9%), 0–29.6% for pharyngeal gonorrhea (median 2.1%), 2.0–77.3% for rectal chlamydia (median 8.7%), and 0.2–3.2% for pharyngeal chlamydia (median 1.7%). Among MSM, prevalence was found to be 0.2–24.0% for rectal gonorrhea (median 5.9%), 0.5–16.5% for pharyngeal gonorrhea (median 4.6%), 2.1–23.0% for rectal chlamydia (median 8.9%), and 0–3.6% for pharyngeal chlamydia (median 1.7%). Among MSW, the prevalence was found to be 0–5.7% for rectal gonorrhea (median 3.4%), 0.4–15.5% for pharyngeal gonorrhea (median 2.2%), 0–11.8% for rectal chlamydia (median 7.7%), and 0–22.0% for pharyngeal chlamydia (median 1.6%). Extragenital infections are often asymptomatic and found in the absence of reported risk behaviors, such as receptive anal and oral intercourse. We discuss current clinical recommendations and future directions for research.
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22
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Dukers-Muijrers NHTM, Schachter J, van Liere GAFS, Wolffs PFG, Hoebe CJPA. What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion. BMC Infect Dis 2015; 15:533. [PMID: 26576538 PMCID: PMC4650297 DOI: 10.1186/s12879-015-1280-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Anorectal and pharyngeal infections with Chlamydia trachomatis (CT) and Neisseria gonorrheae (NG) are commonly observed in men who have sex with men (MSM). There is increasing evidence that such infections at extra-genital sites are also common in women. In both sexes, these infections are largely overlooked as they are not routinely tested for in regular care. Testing based on sexual behavior or symptoms would only detect half of these extra-genital infections. This paper elucidates the differences and similarities between women and MSM, regarding the epidemiology of extra-genital CT and NG. It discusses the clinical and public health impact of untested extra-genital infections, how this may impact management strategies, and thereby identifies key research areas. Discussion Extra-genital CT is as common in women as it is in MSM; NG in women is as common at their extra-genital sites as it is at their genital sites. The substantial numbers of extra-genital CT and NG being missed in women and MSM indicate a need to test and treat more patients and perhaps different choices in treatment and partner management strategies. Doing so will likely contribute to reduced morbidity and transmission in both sexes. However, in our opinion, it is clear that there are several knowledge gaps in understanding the clinical and public health impact of extra-genital CT and NG. Key research areas that need to be addressed concern associated morbidity (anorectal and reproductive morbidity due to extra-genital infections), ‘the best’ management strategies, including testing and treatment for extra-genital CT, extra-genital treatment resistance, transmission probabilities between partners and between anatomic sites in a woman, and impact on transmission of other infections. Data are also lacking on cost-effectiveness of pharyngeal testing, and of NG testing and anorectal CT testing in women. Gaps in the management of extra-genital CT and NG may also apply for other STIs, such Mycoplasma genitalium. Summary Current management strategies, including testing, to address extra-genital CT and NG in both sexes are suboptimal. Comparative data on several identified key themes in women and MSM are lacking and urgently needed to guide better management of extra-genital infections.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleenbeeklaan 2, 6166, GR Sittard-Geleen, The Netherlands. .,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - Julius Schachter
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Genevieve A F S van Liere
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleenbeeklaan 2, 6166, GR Sittard-Geleen, The Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleenbeeklaan 2, 6166, GR Sittard-Geleen, The Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Neisseria gonorrhoeae and Chlamydia trachomatis among women reporting extragenital exposures. Sex Transm Dis 2015; 42:233-9. [PMID: 25868133 DOI: 10.1097/olq.0000000000000248] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. We define the prevalence of extragenital GC and CT in women attending 2 urban sexually transmitted disease clinics in Baltimore City and compare it with the prevalence of extragenital infections in MSM and men who have sex with women. METHODS All patients who reported extragenital exposures in the preceding 3 months, who presented for care between June 1, 2011, and May 31, 2013, and who were tested for GC and CT using nucleic acid amplification tests at all sites of exposure were included in the analyses. We used logistic regression models to identify risk factors for extragenital infections. RESULTS A total of 10,389 patients were included in this analysis (88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC infections and 13.8% of CT infections would have been missed with urogenital-only testing. Unlike MSM, age ≤ 18 years was the strongest predictor of extragenital infections in women. CONCLUSIONS Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing. Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women.
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