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Marshall H, Ward J, Wang B, Andraweera P, McMillan M, Flood L, Bell C, Sisnowski J, Krause V, Webby R, Childs E, Gunathilake M, Egoroff N, Leong L, Lawrence A, Baird R, Freeman K, Menouhos D, Whiley DM, Karnon J, van Hal S, Lahra MM. Comprehensive observational study evaluating the enduring effectiveness of 4CMenB, the meningococcal B vaccine against gonococcal infections in the Northern Territory and South Australia, Australia: study protocol. BMJ Open 2024; 14:e079144. [PMID: 38719318 PMCID: PMC11086485 DOI: 10.1136/bmjopen-2023-079144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The effectiveness of antibiotics for treating gonococcal infections is compromised due to escalating antibiotic resistance; and the development of an effective gonococcal vaccine has been challenging. Emerging evidence suggests that the licensed meningococcal B (MenB) vaccine, 4CMenB is effective against gonococcal infections due to cross-reacting antibodies and 95% genetic homology between the two bacteria, Neisseria meningitidis and Neisseria gonorrhoeae, that cause the diseases. This project aims to undertake epidemiological and genomic surveillance to evaluate the long-term protection of the 4CMenB vaccine against gonococcal infections in the Northern Territory (NT) and South Australia (SA), and to determine the potential benefit of a booster vaccine doses to provide longer-term protection against gonococcal infections. METHODS AND ANALYSES This observational study will provide long-term evaluation results of the effectiveness of the 4CMenB vaccine against gonococcal infections at 4-7 years post 4CMenB programme implementation. Routine notifiable disease notifications will be the basis for assessing the impact of the vaccine on gonococcal infections. Pathology laboratories will provide data on the number and percentage of N. gonorrhoeae positive tests relative to all tests administered and will coordinate molecular sequencing for isolates. Genome sequencing results will be provided by SA Pathology and Territory Pathology/New South Wales Health Pathology, and linked with notification data by SA Health and NT Health. There are limitations in observational studies including the potential for confounding. Confounders will be analysed separately for each outcome/comparison. ETHICS AND DISSEMINATION The protocol and all study documents have been reviewed and approved by the SA Department for Health and Well-being Human Research Ethics Committee (HREC/2022/HRE00308), and the evaluation will commence in the NT on receipt of approval from the NT Health and Menzies School of Health Research Human Research Ethics Committee. Results will be published in peer-reviewed journals and presented at scientific meetings and public forums.
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Affiliation(s)
- Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - James Ward
- Poche Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prabha Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Louise Flood
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Charlotte Bell
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Jana Sisnowski
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Vicki Krause
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Rosalind Webby
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Emma Childs
- Immunisation and Notifiable Diseases, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Manoji Gunathilake
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Natasha Egoroff
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Lex Leong
- SA Pathology, SA Health, Government of South Australia, Adelaide, South Australia, Australia
| | - Andrew Lawrence
- SA Pathology, SA Health, Government of South Australia, Adelaide, South Australia, Australia
| | - Rob Baird
- Territory Pathology, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Kevin Freeman
- Territory Pathology, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Dimitrios Menouhos
- Territory Pathology, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, The University of Queensland and Pathology Queensland, Brisbane, Queensland, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sebastian van Hal
- Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Monica M Lahra
- Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
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López de Munain J, Cámara Pérez MDM, López Martinez M, Alava Menica JA, Hernandez Ragpa L, Imaz Pérez M, Teijeiro Pulido MJ, Mojas Díez I, de la Peña Trigueros M, Díaz de Tuesta Del Arco JL, Muñoz Sánchez J. Alarming incidence of reinfections after treatment for Chlamydia trachomatis and gonorrhoea: Can we predict and prevent them? ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:269-277. [PMID: 36610838 DOI: 10.1016/j.eimce.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/14/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are a public health problem, worsened by frequent reinfections, whose incidence rate is not known in Spain. The objective of this study is to estimate in patients diagnosed with NG, CT or mixed infection (NG and CT): (1) the incidence of reinfections by the same microorganism, (2) the total incidence of Sexually Transmitted Infections (STI), both by the same microorganism and by infections other than the initial one, and (3) to identify predictors of reinfection. METHODS Observational prospective case series involving 986 patients with CT and/or NG at specialized STI clinics in Biscay (Spain) between 2016 and 2019. RESULTS The six month cumulative incidence of reinfection by the same microorganism was 17.24% (CI95%: 14.9-19.7) and 24.65% (CI95%: 21.9-27.4) for any STI (reinfection or other). Being an immigrant (OR=1.8; CI95%: 1.3-2.6), men who have sex with men (OR=1.8; CI95%: 1.3-2.6), number of sexual partners (OR=4.3; CI95%: 2.7-6.8 for more than 5 partners), having a new partner (OR=1.7; CI95%: 1.08-2.6), not always using a condom (OR=1.4; CI95%: 1.02-1.9) and consumption of alcohol prior to sex (OR=3.8; CI95%: 1.5-9.5) were associated with reinfection by any STI. CONCLUSION These characteristics allow doctors to identify patients in whom to prioritize short-term rescreening for repeated infections with any STIs after initial treatment for NG or CT.
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Affiliation(s)
- Josefina López de Munain
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain; Biocruces-Bizkaia Research Institute, Barakaldo, Bizkaia, Spain.
| | - Maria Del Mar Cámara Pérez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Miriam López Martinez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Jose Angel Alava Menica
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Leonora Hernandez Ragpa
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Manuel Imaz Pérez
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Maria José Teijeiro Pulido
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Iker Mojas Díez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Mireia de la Peña Trigueros
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Jose Luis Díaz de Tuesta Del Arco
- Clinic Microbiology and Infection Control Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain
| | - Josefa Muñoz Sánchez
- Infectious Diseases Service, Bilbao-Basurto Integrated Care Organization (Osakidetza-Basque Health Service), Bilbao, Spain; Biocruces-Bizkaia Research Institute, Barakaldo, Bizkaia, Spain
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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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López de Munain J, Cámara Pérez MDM, López Martinez M, Alava Menica JA, Hernandez Ragpa L, Imaz Pérez M, Teijeiro Pulido MJ, Mojas Díez I, de la Peña Trigueros M, Díaz de Tuesta del Arco JL, Muñoz Sánchez J. Alarming incidence of reinfections after treatment for Chlamydia trachomatis and gonorrhoea: Can we predict and prevent them? Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hopkins D, Wilson C, Allard R. Sexually Transmitted Infections in U.S. Military Women: A Scoping Review 2000-2018. Womens Health Issues 2021; 31 Suppl 1:S43-S52. [PMID: 34454703 DOI: 10.1016/j.whi.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE High rates of sexually transmitted infections (STIs) have been documented among U.S. military servicemembers. The purpose of this scoping review is to evaluate the literature to determine what is known about the risk factors, preventive measures, and health outcomes regarding STIs among active duty servicewomen. METHODS A search of six bibliographic databases and the grey literature identified articles published from January 1, 2000, to December 31, 2018. A two-level review process was used to evaluate the inclusion of articles. RESULTS Fifty-six articles were included. The majority of studies (n = 47) were descriptive (95%). The primary STIs of focus were chlamydia (66%) and gonorrhea (38%), with a lesser focus on herpes simplex virus 1 and 2 (17%) and syphilis (11%). There were no studies on chancroid or pubic lice. Chlamydia and gonorrhea were highly prevalent. Age, race, and gender were nonmodifiable risk factors, whereas behaviors, beliefs, socioeconomic level, marital status, and concomitant or repeat infections were modifiable risk factors. Educational programs and studies evaluating efficacious STI prevention methods were lacking. STI diagnoses occurred in servicewomen at their home stations as well as in deployed settings. CONCLUSION STIs remain an ongoing public health challenge with insufficient research to guide military and health care leaders. Future research should focus on prospective designs that leverage identified risk factors and at-risk populations where the most impact can be made to promote reproductive health.
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Affiliation(s)
- Dawnkimberly Hopkins
- David Grant Medical Center, Clinical Investigation Facility, Travis AFB, Fairfield, California.
| | - Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland
| | - Rhonda Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resources Center, Bethesda, Maryland
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Garges E, Early J, Waggoner S, Rahman N, Golden D, Agan B, Jerse A. Biomedical Response to Neisseria gonorrhoeae and Other Sexually Transmitted Infections in the US Military. Mil Med 2020; 184:51-58. [PMID: 31778198 DOI: 10.1093/milmed/usy431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/13/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) continue to plague militaries and defense forces. While the historical recognition of the impact of STIs on operations is evident, contemporary surveillance and research activities are limited. As Neisseria gonorrhoeae and other sexually transmitted pathogens become increasingly resistant to antibiotics, the role of the Department of Defense (DoD) in disease surveillance and clinical research is essential to military Force Health Protection. METHODS The Infectious Disease Clinical Research Program (IDCRP) of the Uniformed Services University of the Health Sciences partnered with the DoD Global Emerging Infections Surveillance (GEIS) program to monitor the distribution of gonorrhea antimicrobial resistance (AMR) both domestically and abroad. The DoD gonococcal reference laboratory and repository was established in 2011 as a resource for confirmatory testing and advanced characterization of isolates collected from sites across the continental United States (CONUS) and GEIS-funded sites outside the continental United States (OCONUS). The IDCRP is currently implementing surveillance efforts at CONUS military clinics, including Madigan Army Medical Center, Naval Medical Center Camp Lejeune, Naval Medical Center Portsmouth, Naval Medical Center San Diego, and San Antonio Military Medical Center (efforts were also previously at Womack Army Medical Center). The reference laboratory and repository receives specimens from OCONUS collaborators, including Armed Forces Research Institute of Medical Sciences (AFRIMS; Bangkok, Thailand), Naval Medical Research Unit No. 3 (NAMRU-3), Ghana Detachment (Accra, Ghana), Naval Medical Research Unit No. 6 (NAMRU-6; Lima, Peru), U.S. Army Medical Research Unit - Georgia (USAMRD-G; Tbilisi, Republic of Georgia), and U.S. Army Medical Research Directorate - Kenya (USAMRD-K; Nairobi, Kenya). The gonococcal surveillance program, to include findings, as well as associated clinical research efforts are described. RESULTS Among N. gonorrhoeae isolates tested within the United States, 8% were resistant to tetracycline, 2% were resistant to penicillin, and 30% were resistant to ciprofloxacin. To date, only one of the 61 isolates has demonstrated some resistance (MIC=1 μg/ml) to azithromycin. No resistance to cephalosporins has been detected; however, reduced susceptibility (MIC=0.06-0.125 μg/ml) has been observed in 13% of isolates. Resistance is commonly observed in N. gonorrhoeae isolates submitted from OCONUS clinical sites, particularly with respect to tetracycline, penicillin, and ciprofloxacin. While no azithromycin-resistant isolates have been identified from OCONUS sites, reduced susceptibility (MIC=0.125-0.5 μg/ml) to azithromycin was observed in 23% of isolates. CONCLUSION Continued monitoring of circulating resistance patterns on a global scale is critical for ensuring appropriate treatments are prescribed for service members that may be infected in the U.S. or while deployed. Domestic surveillance for gonococcal AMR within the Military Health System has indicated that resistance patterns, while variable, are not dramatically different from what is seen in U.S. civilian data. Global patterns of gonococcal AMR have been described through the establishment of a central DoD gonococcal reference laboratory and repository. This repository of global isolates provides a platform for further research and development into biomedical countermeasures against gonococcal infections.
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Affiliation(s)
- Eric Garges
- Infectious Disease Clinical Research Program, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - June Early
- Infectious Disease Clinical Research Program, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Sandra Waggoner
- Infectious Disease Clinical Research Program, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Nazia Rahman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817.,Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Dana Golden
- Infectious Disease Clinical Research Program, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Ann Jerse
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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