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Mason LCE, Charles H, Thorley K, Chong CE, De Silva PM, Jenkins C, Baker KS. The re-emergence of sexually transmissible multidrug resistant Shigella flexneri 3a, England, United Kingdom. NPJ ANTIMICROBIALS AND RESISTANCE 2024; 2:20. [PMID: 39100870 PMCID: PMC11296952 DOI: 10.1038/s44259-024-00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/30/2024] [Indexed: 08/06/2024]
Abstract
Shigellosis is an enteric infection that transmits through the faecal-oral route, which can occur during sex between men who have sex with men (MSM). Between 2009 and 2014, an epidemic of sexually transmissible Shigella flexneri 3a occurred in England that subsequently declined. However, from 2019 to 2021, despite SARS-CoV-2 restrictions, S. flexneri 3a continued to re-emerge. We explored possible drivers of re-emergence by comparing host demography and pathogen genomics. Cases were primarily among 35-64 year old men in London. Genomic analyses of 502 bacterial isolates showed that the majority (58%) of re-emerging MSM strains were a clonal replacement of the original, with reduced antimicrobial resistance, conservation of plasmid col156_1, and two SNPs with 19 predicted effects. The absence of major changes in the pathogen or host demographics suggest that other factors may have driven the re-emergence of S. flexneri 3a and highlight the need for further work in the area.
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Affiliation(s)
- Lewis C. E. Mason
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
- Department of Clinical Infection, Microbiology, and Immunology; Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Charlotte E. Chong
- Department of Clinical Infection, Microbiology, and Immunology; Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - P. Malaka De Silva
- Department of Clinical Infection, Microbiology, and Immunology; Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Claire Jenkins
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
- UK Health Security Agency (UKHSA), London, UK
| | - Kate S. Baker
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
- Department of Clinical Infection, Microbiology, and Immunology; Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Department of Genetics, University of Cambridge, Cambridge, CB2 3EH UK
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Jensen JS, Unemo M. Antimicrobial treatment and resistance in sexually transmitted bacterial infections. Nat Rev Microbiol 2024; 22:435-450. [PMID: 38509173 DOI: 10.1038/s41579-024-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/22/2024]
Abstract
Sexually transmitted infections (STIs) have been part of human life since ancient times, and their symptoms affect quality of life, and sequelae are common. Socioeconomic and behavioural trends affect the prevalence of STIs, but the discovery of antimicrobials gave hope for treatment, control of the spread of infection and lower rates of sequelae. This has to some extent been achieved, but increasing antimicrobial resistance and increasing transmission in high-risk sexual networks threaten this progress. For Neisseria gonorrhoeae, the only remaining first-line treatment (with ceftriaxone) is at risk of becoming ineffective, and for Mycoplasma genitalium, for which fewer alternative antimicrobial classes are available, incurable infections have already been reported. For Chlamydia trachomatis, in vitro resistance to first-line tetracyclines and macrolides has never been confirmed despite decades of treatment of this highly prevalent STI. Similarly, Treponema pallidum, the cause of syphilis, has remained susceptible to first-line penicillin.
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Affiliation(s)
- Jorgen S Jensen
- Department of Bacteria, Parasites and Fungi, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, UK
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Salmerón P, Buckley C, Arando M, Alcoceba E, Romero B, Clavo P, Whiley D, Serra-Pladevall J. Genome-based epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in Spain: A prospective multicentre study. J Eur Acad Dermatol Venereol 2023; 37:2575-2582. [PMID: 37620291 DOI: 10.1111/jdv.19458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Whole-genome sequencing (WGS) of Neisseria gonorrhoeae isolates combined with epidemiological and phenotypic data provides better understanding of population dynamics. AIM The objective of this study was to investigate the molecular epidemiology of N. gonorrhoeae isolates from three centres in Spain and determine associations of antimicrobial resistance. METHODS Genetic characterization was performed in 170 N. gonorrhoeae isolates. WGS was carried out with the HiSeq platform (Illumina). Genome assemblies were submitted to the PubMLST Neisseria database website to determine NG-MAST, MLST and NG-STAR. Antimicrobial resistance genes and point mutations were identified with PubMLST. Phylogenomic comparison was based on whole-genome single nucleotide polymorphism analysis. RESULTS Twenty-six MLST, 49 NG-MAST and 41 NG-STAR sequence types were detected, the most prevalent being MLST-ST9363 (27.1%), NG-MAST ST569 (12.4%) and NG-STAR ST193 (14.7%). Phylogenetic analysis identified 13 clusters comprising 69% of the isolates, with two of note: one involved cefixime-resistant isolates from Barcelona presenting a mosaic penA X and belonging to MLST-ST7363 and the other involved azithromycin-resistant isolates from Mallorca that possessed the C2611T mutation in the four 23S rRNA alleles belonging to MLST-ST1901. CONCLUSION The population of N. gonorrhoeae is quite heterogeneous in Spain. Our results agree with previous data published in Europe, albeit with some differences in distribution between regions. This study describes the circulation of two gonococcal populations with a specific resistance profile and sequence type in a specific geographic area. WGS is an effective tool for epidemiological surveillance of gonococcal infection and detection of resistance genes.
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Affiliation(s)
- P Salmerón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - C Buckley
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - M Arando
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - E Alcoceba
- Microbiology Department, Son Espases Hospital Universitari, Mallorca, Spain
| | - B Romero
- Microbiology Department, Ramón y Cajal Hospital Universitario, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - P Clavo
- Sandoval Health Centre, San Carlos Hospital Clínico, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - D Whiley
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - J Serra-Pladevall
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Clinical Laboratory, Hospital Universitari de Vic, Catalonia, Spain
- Faculty of Health Sciences, Universitat de Vic - Universitat Central de Catalunya (UVIC -UCC), Vic, Spain
- Multidisciplinary Inflammation Research Group (MIRG), Fundació Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central, Vic, Spain
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Mensah E, Fourie PB, Peters RPH. Antimicrobial effects of Medicines for Malaria Venture Pathogen Box compounds on strains of Neisseria gonorrhoeae. Antimicrob Agents Chemother 2023; 67:e0034823. [PMID: 37791750 PMCID: PMC10648949 DOI: 10.1128/aac.00348-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/02/2023] [Indexed: 10/05/2023] Open
Abstract
Therapeutic options for Neisseria gonorrhoeae are limited due to emerging global resistance. New agents and treatment options to treat patients with susceptible and multi-extensively drug-resistant N. gonorrhoeae is a high priority. This study used an in vitro approach to explore the antimicrobial potential, as well as synergistic effects of Medicine for Malaria Venture (MMV) Pathogen Box compounds against ATCC and clinical N. gonorrhoeae strains. Microbroth dilution assay was used to determine pathogen-specific minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the Pathogen Box compounds against susceptible and resistant N. gonorrhoeae strains, with modification, by adding PrestoBlue HS Cell Viability Reagent. A checkerboard assay was used to determine synergy between the active compounds and in conjunction with ceftriaxone. Time-kill kinetics was performed to determine if the compounds were either bactericidal or bacteriostatic. The Pathogen Box compounds: MMV676501, MMV002817, MMV688327, MMV688508, MMV024937, MMV687798 (levofloxacin), MMV021013, and MMV688978 (auranofin) showed potent activity against resistant strains of N. gonorrhoeae at an MIC and MBC of ≤10 µM. Besides the eight compounds, MMV676388 and MMV272144 were active against susceptible N. gonorrhoeae strains, also at MIC and MBC of ≤10 µM. All the compounds were bactericidal and were either synergistic or additive with fractional inhibitory concentration index ranging between 0.40 and 1.8. The study identified novel Pathogen Box compounds with potent activity against N. gonorrhoeae strains and has the potential to be further investigated as primary or adjunctive therapy to treat gonococcal infections.
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Affiliation(s)
- Eric Mensah
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - P. Bernard Fourie
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Remco P. H. Peters
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Foundation for Professional Development, Research Unit, East London, South Africa
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Kravtsov D, Gryadunov D, Shaskolskiy B. Gonococcal Genetic Island in the Global Neisseria gonorrhoeae Population: A Model of Genetic Diversity and Association with Resistance to Antimicrobials. Microorganisms 2023; 11:1547. [PMID: 37375049 DOI: 10.3390/microorganisms11061547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this work was to study the genetic diversity of the gonococcal genetic island (GGI) responsible for the type IV secretion system (T4SS) and the association of a functionally active GGI with antimicrobial resistance. An analysis of the GGI in a sample of 14,763 genomes of N. gonorrhoeae isolates from the Pathogenwatch database collected in 1996-2019 from 68 countries was performed. A model of GGI's genetic diversity that divides the global gonococcal population into fifty-one GGI clusters and three GGI superclusters based on the allele type of the traG gene and substitutions of the atlA and ych genes for eppA and ych1 has been proposed, reflecting differences among isolates in the T4SS functionality. The NG-MAST and MLST typing schemes (with accuracies of 91% and 83%, respectively) allowed the determination of both the presence of a GGI and the GGI cluster and, correspondingly, the structure of the GGI and the ability to secrete DNA. A statistically significant difference in the proportion of N. gonorrhoeae isolates resistant to ciprofloxacin, cefixime, tetracycline, and penicillin was found when comparing populations with a functional and a non-functional GGI. The presence of a functional GGI did not affect the proportion of azithromycin-resistant isolates.
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Affiliation(s)
- Dmitry Kravtsov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Dmitry Gryadunov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Boris Shaskolskiy
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
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Test-of-Cure after Treatment of Pharyngeal Gonorrhea in Durham, North Carolina, 2021 - 2022. Sex Transm Dis 2022; 49:677-681. [PMID: 35858472 DOI: 10.1097/olq.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In December 2020 the Centers for Disease Control and Prevention updated its treatment guidelines for gonococcal infection and, for the first time, recommended universal test-of-cure for all individuals treated for pharyngeal gonorrhea. Following the release of these guidelines, data is lacking on rates of return for the test-of-cure, particularly in populations other than men who have sex with men (MSM). METHODS We analyzed the demographic characteristics, clinical characteristics, rate of return for the recommended test-of-cure, and percent positivity for Neisseria gonorrhoeae on repeat pharyngeal specimens at a local public health department in Durham, North Carolina. RESULTS Of 101 individuals treated for pharyngeal gonorrhea between 03/2021 - 04/2022, 54.5% were male, 71.2% Black or African American, and 58.4% between the ages of 20 to 29 years. Most identified as either women who have sex with men (38.6%), MSM (24.8%), or men who have sex with women (22.8%). Of these individuals, 41 (40.6%) returned for a test-of-cure, with LGBTQ+ individuals more likely to return than men who have sex with women and women who have sex with men. Of those who returned for the test-of-cure, 4.9% of pharyngeal samples were equivocal and 2.4% positive for N. gonorrhoeae by nucleic acid amplification testing, likely reflecting false positive tests. CONCLUSION Despite recommendations to perform a test-of-cure 7-14 days following treatment of pharyngeal gonorrhea, rates of return continue to be low. Alternative strategies should be investigated to increase test-of-cure rates.
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Wenang S, Kurniawan M, Lelle RJ, Inayati I, Rismawati I. Neisseria gonorrhoeae Cases at AMC Muhammadiyah Hospital Indonesia: The Importance of Screening and Health Service Improvement to Prevent its Transmission and Complications. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Gonorrhoeae is a type of sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae (NG) bacteria. It is a commonly reported bacterial STD with rising cases in men and women in Indonesia. Gonorrhoeae is commonly asymptomatic. Therefore, the disease is often left undiagnosed, untreated, and causes further complications.
AIM: This study aims to describe the incidence and distribution of gonorrhoeae in AMC Muhammadiyah Hospital, Yogyakarta, Indonesia. The importance of screening and health service improvement toward preventing transmission and complications are also discussed.
METHODS: It is a descriptive observational study and aims to identify the percentage of NG in patients with clinical symptoms of STDs. The non-randomized sampling technique was used with 710 respondents. The inclusion criteria were women aged 15-44 years with STD symptoms who underwent vaginal smear examinations for NG, Bacterial Vaginosis (BV), yeast cells-pseudohyphae Candida sp, and were willing to be respondents. The exclusion criteria were women with STDs and HIV. Microscopic characteristics of NG were examined by Gram staining the vaginal swab samples from the respondents.
RESULTS: It was found that 623 (87.7%) out of 710 respondents had NG with clinical symptoms of leukorrhea and itchiness. The vaginal smear results also found bacterial vaginosis and candidiasis.
CONCLUSIONS: Screening and health facilities providing STI-related services are essential to prevent the transmission of gonorrhoeae and reduce the high incidence and severity of gonorrhoeae in reproductive health.
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Jespers V, Stordeur S, Berghe WV, Mokrane S, Libois A, Kenyon C, Jones C, Dekker N, De Cannière AS, De Baetselier I, Crucitti T. Diagnosis and treatment of gonorrhoea: 2019 Belgian National guideline for primary care. Acta Clin Belg 2022; 77:186-194. [PMID: 32484428 DOI: 10.1080/17843286.2020.1773111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Gonorrhoea continues to be a public health concern in Belgium with pharyngeal and rectal infections increasing in persons with high-risk sexual behaviour. Belgian health care practitioners rely on international guidance when managing gonorrhoea resulting in non-adapted suboptimal care for the Belgian patient. This guideline will rectify this situation. METHODS This guideline was developed following an evidence-based approach and involving a guideline development group (GDG). Research questions were prioritised by the GDG and researchers conducted a systematic review of the evidence that was assessed using GRADE approach. RESULTS The guideline offers recommendations for gonorrhoea diagnosis, treatment and management for primary care professionals in Belgium and applies a risk group approach. This approach aims for improved identification of at-risk persons and targeted testing of at-risk groups; it includes behavioural questioning when deciding on diagnostic sampling and provides clear advice on treatment. The guideline defines when to add surveillance testing for antibiotic resistance, and what consists of good follow-up. RESULTS A concerted application of this guideline by all stakeholders in Belgium may result in improving the diagnosis of infections and eventually addressing the emerging multi-drug resistance.
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Affiliation(s)
- Vicky Jespers
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | | | - Saphia Mokrane
- Département de Médecine Générale, Université Libre De Bruxelles (ULB), Brussels, Belgium
| | - Agnes Libois
- Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Clare Jones
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Nicole Dekker
- Centre for General Practice, University of Antwerp, Antwerp, Belgium
| | | | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Xiridou M, Heijne J, Adam P, Op de Coul E, Matser A, de Wit J, Wallinga J, van Benthem B. How the Disruption in Sexually Transmitted Infection Care Due to the COVID-19 Pandemic Could Lead to Increased Sexually Transmitted Infection Transmission Among Men Who Have Sex With Men in The Netherlands: A Mathematical Modeling Study. Sex Transm Dis 2022; 49:145-153. [PMID: 34475357 DOI: 10.1097/olq.0000000000001551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, the disruption in care for sexually transmitted infections (STIs) and the social distancing measures have led to reductions in STI testing and sexual behavior. We assessed the impact of these COVID-19-related changes on transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among men who have sex with men (MSM) in The Netherlands. METHODS We developed a mathematical model for CT and NG transmission among MSM, accounting for COVID-19-related changes in sexual behavior and testing in 2020 to 2021. Changes in 2020 were estimated from data from the Dutch COVID-19, Sex, and Intimacy Survey among MSM and the National Database of STI Clinics. Because of the lack of data for 2021, we examined several scenarios covering a range of changes. RESULTS A reduction of 10% and 40% in STI testing of symptomatic and asymptomatic, respectively, individuals with a 10% to 20% reduction in numbers of casual partners (according to partner status and activity level) during the second lockdown, resulted in a 2.4% increase in CT prevalence, but a 2.8% decline in NG prevalence in 2021. A 5% and 30% reduction in STI testing of symptomatic and asymptomatic, respectively, individuals with the same reduction in casual partners resulted in a 0.6% increase in CT prevalence and a 4.9% decrease in NG prevalence in 2021. CONCLUSIONS The disruption in STI care due to COVID-19 might have resulted in a small increase in CT prevalence, but a decrease in NG prevalence. Scaling up STI care is imperative to prevent increases in STI transmission.
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Affiliation(s)
- Maria Xiridou
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Janneke Heijne
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Eline Op de Coul
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | | | | | | | - Birgit van Benthem
- From the Centre for Infectious Diseases Control, Department of Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in Neisseria gonorrhoeae: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10091027. [PMID: 34572609 PMCID: PMC8471969 DOI: 10.3390/antibiotics10091027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neisseria gonorrhoeae (N. gonorrhoeae) is now recognized as a commonly reported sexually transmitted pathogen, and the increasing drug resistance of N. gonorrhoeae has become a serious public health problem. The accuracy of molecular detection for detecting moderate-level azithromycin resistance is not well-established. We summarized the data from studies of the N. gonorrhoeae 23S rRNA mutation at position 2611 with azithromycin resistance to determine the relationship between the mutation and resistance. METHODS AND FINDINGS In this systematic review and meta-analysis, two researchers independently searched six databases for studies with data for the azithromycin minimum inhibitory concentrations (MICs) and the 23S rRNA mutation C2611T of each N. gonorrhoeae isolate. Since the breakpoint of moderate-level resistance to azithromycin (ML-AzmR) was not determined, we divided the moderate level into two groups according to the range of MICs (moderate resistance limited to 2-128 mg/L or 4-128 mg/L) for data extraction. A random-effects model was used to calculate the pooled sensitivity rate, the specificity rate, the pooled positive likelihood ratio (PLR), the negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR). Meta-regression analyses by detection method, isolates sampling (a random sample or not), location, and sample size were performed to explore the possible causes of heterogeneity. The potential publication bias of the included studies was conducted by the Deeks' test. We included 20 studies in our study: 20 studies have data of N. gonorrhoeae with MICs between 2 and 128 mg/L with mutation or without mutation at position 2611(4759 samples), and 14 studies have data of N. gonorrhoeae with MICs between 4 and 128 mg/L (3367 samples). In the group with the moderate level of 2-128 mg/L, the pooled sensitivity rate of the molecular assays was determined to be 71.9% (95% CI, 67.6-74%), the pooled specificity rate was 98.7% (95% CI, 98.2-99.0%), and the DOR ranged from 55.0 to 351.3 (mean, 139.1). In the 4-128 mg/L group, the pooled sensitivity rate was 91.9% (95% CI, 88.9-94.2%), the pooled specificity rate was 95.9% (95% CI, 95.1-96.6%), and the DOR ranged from 41.9 to 364.1 (mean, 123.6). CONCLUSION Through this meta-analysis, we found that the C2611T mutation of 23S rRNA is valuable for the molecular diagnostic of moderate-level azithromycin resistance (ML-AzmR) in N. gonorrhoeae, especially when the moderate level is set at 4-128 mg/L. This rapid molecular detection method can be used for the rapid identification of ML-AzmR isolates in the clinic.
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Stalteri Mastrangelo R, Santesso N, Bognanni A, Darzi A, Karam S, Piggott T, Baldeh T, Schünemann F, Ventresca M, Morgano GP, Moja L, Loeb M, Schunemann H. Consideration of antimicrobial resistance and contextual factors in infectious disease guidelines: a systematic survey. BMJ Open 2021; 11:e046097. [PMID: 34330853 PMCID: PMC8327810 DOI: 10.1136/bmjopen-2020-046097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Guidelines that include antimicrobial recommendations should explicitly consider contextual factors that influence antimicrobial resistance and their downstream effects on resistance selection. The objectives were to analyse (1) how, and to what extent, tuberculosis, gonorrhoea and respiratory tract infection guidelines are considering antimicrobial resistance; (2) are of acceptable quality and (3) if they can be easily contextualised to fit the needs of specific populations and health systems. METHODS We conducted a systematic review and searched Ovid MEDLINE and Embase from 1 January 2007 to 7 June 2019 for tuberculosis, gonorrhoea and respiratory tract infection guidelines published in English. We also searched guideline databases, key websites and reference lists. We identified guidelines and recommendations that considered contextual factors including antimicrobial resistance, values, resource use, equity, acceptability and feasibility. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool focusing on the domains scope and purpose, rigour of development, and editorial independence. RESULTS We screened 10 365 records, of which 74 guidelines met inclusion criteria. Of these guidelines, 39% (n=29/74) met acceptable quality scores. Approximately two-thirds of recommendations considered antimicrobial resistance at the population and/or outcome level. Five of the 29 guidelines reported all factors required for recommendation contextualisation. Equity was the least considered across guidelines. DISCUSSION Relatively few guidelines for highly prevalent infectious diseases are considering resistance at a local level, and many do not consider contextual factors necessary for appropriate antimicrobial use. Improving the quality of guidelines targeting specific regional areas is required. PROSPERO REGISTRATION NUMBER CRD42020145235.
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Affiliation(s)
- Rosa Stalteri Mastrangelo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Samer Karam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Tejan Baldeh
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthew Ventresca
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schunemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
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12
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Salmerón P, Moreno-Mingorance A, Trejo J, Amado R, Viñado B, Cornejo-Sanchez T, Alberny M, Barbera MJ, Arando M, Pumarola T, Hoyos-Mallecot Y, Serra-Pladevall J, González-López JJ. Emergence and dissemination of three mild outbreaks of Neisseria gonorrhoeae with high-level resistance to azithromycin in Barcelona, 2016-18. J Antimicrob Chemother 2021; 76:930-935. [PMID: 33367806 DOI: 10.1093/jac/dkaa536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/02/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Neisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy. OBJECTIVES This study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018. METHODS WGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records. RESULTS Twelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour. CONCLUSIONS Our findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.
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Affiliation(s)
- P Salmerón
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - A Moreno-Mingorance
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J Trejo
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - R Amado
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - B Viñado
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - T Cornejo-Sanchez
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - M Alberny
- Institut Català de Salut (ICS), Barcelona, Spain
| | - M J Barbera
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - M Arando
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - T Pumarola
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Y Hoyos-Mallecot
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J Serra-Pladevall
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J J González-López
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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13
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Moreno-Mingorance A, Espinal P, Rodriguez V, Goterris L, Fàbrega A, Serra-Pladevall J, Barberà MJ, Alberny M, Martín-González H, Cornejo-Sánchez T, Armas M, Mir-Cros A, Raventós A, Viñado B, Pumarola T, Larrosa MN, González-López JJ. Circulation of multi-drug-resistant Shigella sonnei and Shigella flexneri among men who have sex with men in Barcelona, Spain, 2015-2019. Int J Antimicrob Agents 2021; 58:106378. [PMID: 34157402 DOI: 10.1016/j.ijantimicag.2021.106378] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/20/2021] [Accepted: 06/13/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND In high-income countries, shigellosis is mainly found in travellers to high-risk regions or in men who have sex with men (MSM). This study investigated the genomic characteristics and the features of antimicrobial resistance of MSM-associated Shigella flexneri and Shigella sonnei circulating in Barcelona, Spain, elucidating their connectivity with contemporaneous Shigella spp. from other countries. METHODS Antimicrobial susceptibility, whole-genome sequencing, genomic characterization and phylogenetic analysis were performed in MSM-associated Shigella spp. recovered from 2015 to 2019. Reference genomes of MSM-associated Shigella spp. were included for contextualization and to determine their connection with international outbreaks. RESULTS In total, 44 S. flexneri and 26 S. sonnei were identified among MSM. Overall, 80% showed resistance to azithromycin, 65.7% showed resistance to trimethoprim-sulphamethoxazole and 32.8% showed resistance to ciprofloxacin; 27.1% were resistant to all three antimicrobials. mphA and/or ermB, and qnrS and mutations in the quinolone resistance determining regions were found in the azithromycin- and ciprofloxacin-resistant isolates, respectively. Additionally, two isolates carried blaCTX-M-27. Single-nucleotide-polymorphism-based analysis revealed that the isolates were organized into different lineages, most of which were closely related to dominant MSM-associated lineages described previously in the UK and Australia. CONCLUSIONS This study investigated the circulation of lineages of S. flexneri and S. sonnei among MSM in Spain that were mainly resistant to first-/second-line oral treatments, and closely related to dominant MSM-associated lineages described previously in the UK and Australia. These data reinforce the urgent need for the implementation of public health measures focusing on the early detection and prevention of transmission of this emerging pathogen, which is contributing to the antimicrobial resistance crisis in sexually transmitted infections.
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Affiliation(s)
- Albert Moreno-Mingorance
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula Espinal
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Virginia Rodriguez
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Lidia Goterris
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Anna Fàbrega
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Judit Serra-Pladevall
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - M Jesús Barberà
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Mireia Alberny
- Primary Healthcare Division, Catalan Institute of Health, Barcelona, Spain
| | - Héctor Martín-González
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Thais Cornejo-Sánchez
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mayuli Armas
- Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Alba Mir-Cros
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Raventós
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Belén Viñado
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Tomàs Pumarola
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - M Nieves Larrosa
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
| | - Juan José González-López
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
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14
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Cole MJ, Tan W, Fifer H, Brittain C, Duley L, Hepburn T, Lawrence T, Montgomery AA, Sprange K, Thandi S, Churchward C, Tripodo F, Woodford N, Ross JDC. Gentamicin, azithromycin and ceftriaxone in the treatment of gonorrhoea: the relationship between antibiotic MIC and clinical outcome. J Antimicrob Chemother 2021; 75:449-457. [PMID: 31670808 DOI: 10.1093/jac/dkz436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To investigate the relationship between MIC and clinical outcome in a randomized controlled trial that compared gentamicin 240 mg plus azithromycin 1 g with ceftriaxone 500 mg plus azithromycin 1 g. MIC analysis was performed on Neisseria gonorrhoeae isolates from all participants who were culture positive before they received treatment. METHODS Viable gonococcal cultures were available from 279 participants, of whom 145 received ceftriaxone/azithromycin and 134 received gentamicin/azithromycin. Four participants (6 isolates) and 14 participants (17 isolates) did not clear infection in the ceftriaxone/azithromycin and gentamicin/azithromycin arms, respectively. MICs were determined by Etest on GC agar base with 1% Vitox. The geometric mean MICs of azithromycin, ceftriaxone and gentamicin were compared using logistic and linear regression according to treatment received and N. gonorrhoeae clearance. RESULTS As the azithromycin MIC increased, gentamicin/azithromycin treatment was less effective than ceftriaxone/azithromycin at clearing N. gonorrhoeae. There was a higher geometric mean MIC of azithromycin for isolates from participants who had received gentamicin/azithromycin and did not clear infection compared with those who did clear infection [ratio 1.95 (95% CI 1.28-2.97)], but the use of categorical MIC breakpoints did not accurately predict the treatment response. The geometric mean MIC of azithromycin was higher in isolates from the pharynx compared with genital isolates. CONCLUSIONS We found that categorical resistance to azithromycin or ceftriaxone in vitro, and higher gentamicin MICs in the absence of breakpoints, were poorly predictive of treatment failure.
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Affiliation(s)
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Clare Brittain
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Trish Hepburn
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Tessa Lawrence
- University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Birmingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sukhwinder Thandi
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | | | | | - Jonathan D C Ross
- University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Birmingham, UK
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15
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Harding-Esch EM, Huntington SE, Harvey MJ, Weston G, Broad CE, Adams EJ, Sadiq ST. Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics. ACTA ACUST UNITED AC 2021; 25. [PMID: 33124553 PMCID: PMC7596918 DOI: 10.2807/1560-7917.es.2020.25.43.1900402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Widespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin). Aim Assess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use. Methods The five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained). Results All strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706). Conclusions AMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving.
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Affiliation(s)
- Emma M Harding-Esch
- National Infection Service, Public Health England, London, United Kingdom.,Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | | | | | - Claire E Broad
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | - S Tariq Sadiq
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom.,National Infection Service, Public Health England, London, United Kingdom.,Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
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16
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McIver R, Low S, Varma R, Vickers T, McNulty A. Empirical treatment of asymptomatic contacts of gonorrhoea: patient views. Sex Health 2021; 17:462-466. [PMID: 33497601 DOI: 10.1071/sh20072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
Abstract
Background The prevalence of Neisseria gonorrhoeae (gonorrhoea) in sexual contacts of gonorrhoea has not been established, but limited data suggest that the majority of contacts are not infected. Contacts of gonorrhoea who receive empirical treatment at the point of testing may receive unnecessary antimicrobial treatment for an infection that is known to have multidrug resistance. This study evaluated patient acceptability of non-empirical treatment.? METHODS We conducted an anonymous cross-sectional survey of patients attending sexual health centres in New South Wales, Australia, on the acceptability of empirical and non-empirical treatment models and patients' concerns about antimicrobial resistance. RESULTS Most of the 823 survey participants were willing to wait for treatment until their results were reported; 77% and 53% would agree to wait for treatment if results were available in 2 and 7 days respectively. Participants were less likely to agree to non-empirical treatment if they lived in regional and remote areas compared with those in a major city (odds ratio (OR) 0.5; 95% confidence interval (CI) 0.35-0.73). Most participants (70%) were worried about infections becoming resistant to antibiotics, with heterosexual men and women being less likely than gay and bisexual men to be worried (heterosexual men: OR 0.64, 95% CI 0.44-0.94; women: OR 0.64 95%, CI 0.44-0.92). CONCLUSIONS Non-empirical treatment was acceptable to most participants, but patient preference, ability to return for treatment and timeliness of results are factors that should inform individual treatment decisions.
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Affiliation(s)
- Ruthy McIver
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia; and Corresponding author.
| | - Sheina Low
- School of Public Health and Community Medicine, UNSW, High Street, Kensington, NSW 2052, Australia
| | - Rick Varma
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia; and The Kirby Institute, UNSW, High Street, Kensington, NSW 2052, Australia
| | - Tobias Vickers
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia; and The Kirby Institute, UNSW, High Street, Kensington, NSW 2052, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia; and School of Public Health and Community Medicine, UNSW, High Street, Kensington, NSW 2052, Australia
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17
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Kennedy R, Winter AJ. Reducing time to treatment of bacterial sexually transmitted infections in an HIV cohort. BMJ Open Qual 2021; 9:bmjoq-2018-000603. [PMID: 32253192 PMCID: PMC7170538 DOI: 10.1136/bmjoq-2018-000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/24/2020] [Accepted: 03/23/2020] [Indexed: 11/04/2022] Open
Abstract
Sexually transmitted infections (STIs) are known to increase the risk of transmission of HIV and care of sexual health needs should form part of routine HIV care. Delayed treatment of STIs can lead to complications and avoidable onward transmission. Management of acute STIs in UK specialist sexual health services usually involves a multidisciplinary approach to ensure patient recall, antimicrobial treatment and partner notification. While this works well in dedicated sexual health clinics, we found this was less optimal in our hospital-based HIV care unit. We describe a quality improvement project to improve interdisciplinary pathways by using electronic shared worklists that reduced time to treatment for chlamydia and gonorrhoea infections. Use of electronic shared worklists could be applied to other settings where rapid treatment is required or has transmission implications.
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Affiliation(s)
- Richard Kennedy
- Brownlee Centre, Gartnavel General Hospital, Glasgow, Glasgow, UK
| | - Andrew J Winter
- Brownlee Centre, Gartnavel General Hospital, Glasgow, Glasgow, UK
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18
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Han Y, Yin Y, Dai X, Chen S, Yang L, Zhu B, Zhong N, Cao W, Zhang X, Wu Z, Yuan L, Zheng Z, Feng L, Liu J, Chen X. Widespread Use of High-dose Ceftriaxone Therapy for Uncomplicated Gonorrhea Without Reported Ceftriaxone Treatment Failure: Results From 5 Years of Multicenter Surveillance Data in China. Clin Infect Dis 2021; 70:99-105. [PMID: 30838398 DOI: 10.1093/cid/ciz170] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Antimicrobial resistance to Neisseria gonorrhoeae has emerged for each of the antibiotics recommended as first-line therapies following their introduction into clinical practice. To improve rational and effective clinical antibiotic treatment, we analyzed the prescription patterns of antibiotics and their therapeutic effect in the treatment of uncomplicated gonorrhea in China. METHODS We obtained data from a follow-up multicenter surveillance program. Multinomial logistic regression analyses were conducted to explore the associations between demographic/clinical variables with the levels of sensitivity to ceftriaxone and prescription of high-dose ceftriaxone. RESULTS In this study, 1686 patients infected with N. gonorrhoeae were recruited in a surveillance network during 1 January 2013 through 31 December 2017 in 7 hospitals distributed in 5 provinces. The prevalence of isolates with decreased susceptibility to ceftriaxone was 9.8% (131/1333), fluctuating between 5.6% and 12.1%. Injectable ceftriaxone was chosen as the first-line treatment among 83.1% of patients, and most of them (72.7% [1018/1401]) received >1000 mg dosage. Patients who were previously infected with gonorrhea or other sexually transmitted infections (adjusted odds ratio [AOR], 1.618 [95% confidence interval {CI}, 1.11-2.358]; AOR, 2.08 [95% CI, 1.41-3.069]) or who already used antibiotics for this infection (AOR, 1.599 [95% CI, 1.041-2.454]) were associated with a higher prescribed ceftriaxone dosage. All of the patients recruited in this study were cured regardless of the isolates' susceptibility to ceftriaxone or the dosage of ceftriaxone they received. CONCLUSIONS No ceftriaxone treatment failure for uncomplicated gonorrhea was reported in China; however, high-dose ceftriaxone was widely used in China. Its impacts need further study.
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Affiliation(s)
- Yan Han
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Center for Sexually Transmitted Disease (STD) Control, Chinese Center for Disease Control and Prevention, Nanjing
| | - Yueping Yin
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Center for Sexually Transmitted Disease (STD) Control, Chinese Center for Disease Control and Prevention, Nanjing
| | - Xiuqin Dai
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Center for Sexually Transmitted Disease (STD) Control, Chinese Center for Disease Control and Prevention, Nanjing
| | - Shaochun Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Center for Sexually Transmitted Disease (STD) Control, Chinese Center for Disease Control and Prevention, Nanjing
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University.,Guangdong Provincial Dermatology Hospital, Guangzhou
| | - Bangyong Zhu
- Institute of Dermatology, Guangxi Autonomous Region, Nanning
| | - Na Zhong
- Hainan Provincial Center for STD/Skin Disease Control and Prevention, Haikou
| | | | - Xiaohui Zhang
- Dermatology Hospital, Southern Medical University.,Guangdong Provincial Dermatology Hospital, Guangzhou
| | | | - Liufeng Yuan
- Beijing Ditan Hospital Capital Medical University
| | - Zhongjie Zheng
- Tianjin Center for Disease Control and Prevention, China
| | | | - Jun Liu
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Xiangsheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Center for Sexually Transmitted Disease (STD) Control, Chinese Center for Disease Control and Prevention, Nanjing
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19
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Burton R, Duncan S, Wardle E, Patel C, Clarke E. Unintended consequences: the potential impacts of the British Association for Sexual Health and HIV (BASHH) 2019 gonorrhoea guidelines. Int J STD AIDS 2020; 32:344-351. [PMID: 33345746 DOI: 10.1177/0956462420967575] [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] [Indexed: 11/17/2022]
Abstract
In 2019 the British Association for Sexual Health and HIV (BASHH) guidelines for the management of gonorrhoea were updated. Epidemiological treatment was reserved for sexual contacts presenting within 14 days of exposure only. The aim of this evaluation was to review the potential implications of the new guidelines on the management of gonorrhoea contacts. For this retrospective service evaluation, all gonorrhoea contacts presenting to two UK sexual health services in 2018 were identified using the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) code Partner notification: gonorrhoea contact (PNG). Demographics, clinical characteristics and outcome data were collected from the electronic patient records. The 2019 guidelines were retrospectively applied to evaluate impact. For 436 patients seen as gonorrhoea contacts, gonorrhoea prevalence was 36% (159/436), and chlamydia prevalence 19% (83/429). Gonorrhoea prevalence varied with sexual risk: women 57% (61/107), heterosexual men 20% (28/143), men who have sex with men (MSM) 38% (69/183, p < .001); and with time since exposure: prevalence 43% (114/267) in those presenting within 14 days, 28% (42/149) after 14 days (p = .003). Epidemiological treatment of contacts presenting within 14 days would result in the treatment of 73% (114/156) of confirmed cases, with 37% (153/416) contacts unnecessarily treated. The BASHH gonorrhoea guideline changes represent an opportunity to improve antibiotic stewardship by reducing unnecessary treatment of gonorrhoea negative contacts.
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Affiliation(s)
- Rachel Burton
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Sarah Duncan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, New Croft Clinic, Newcastle, UK
| | - Elizabeth Wardle
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster Royal Infirmary, Doncaster, UK
| | - Chandni Patel
- University Hospitals Birmingham NHS Foundation Trust, Solihull Hospital, Solihull, UK
| | - Emily Clarke
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
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20
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Horwood J, Brangan E, Manley P, Horner P, Muir P, North P, Macleod J. Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation. BMC FAMILY PRACTICE 2020; 21:265. [PMID: 33302884 PMCID: PMC7731735 DOI: 10.1186/s12875-020-01329-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme's centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care. METHODS Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care. RESULTS One thousand one hundred fifty-four Chlamydia/gonorrhoea tests took place during the 6-month study, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn't negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results. CONCLUSION Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primacy care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.
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Affiliation(s)
- Jeremy Horwood
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
- NIHR Health Protection Research Unit (HPRU) in in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Emer Brangan
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Petra Manley
- Field Service, National Infection Service, Public Health England, Bristol, UK
| | - Paddy Horner
- NIHR Health Protection Research Unit (HPRU) in in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- UNITY Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Peter Muir
- Public Health England South West Regional Laboratory, Bristol, UK
| | - Paul North
- Public Health England South West Regional Laboratory, Bristol, UK
| | - John Macleod
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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21
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Kenyon C, Laumen J, Van Dijck C, De Baetselier I, Abdelatti S, Manoharan-Basil SS, Unemo M. Gonorrhoea treatment combined with population-level general cephalosporin and quinolone consumption may select for Neisseria gonorrhoeae antimicrobial resistance at the levels of NG-MAST genogroup: An ecological study in Europe. J Glob Antimicrob Resist 2020; 23:377-384. [PMID: 33207228 DOI: 10.1016/j.jgar.2020.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/28/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The prevalence of Neisseria gonorrhoeae NG-MAST genogroup G1407, associated with decreased susceptibility to extended-spectrum cephalosporins and fluoroquinolone resistance, has declined in Europe and it switched from circulating predominantly in men who have sex with men (MSM) in 2009-2010 to heterosexuals in 2013. We hypothesise that changes to gonorrhoea treatment guidelines combined with differences in country-level consumption of cephalosporins and quinolones contributed to this shift. METHODS Linear regression was used to evaluate the association between changes in prevalence of G1407 between 2009-2010 and 2013 and country-level consumption of quinolones and cephalosporins in 2011/12 in 20 European countries. RESULTS Whilst the prevalence of G1407 declined between 2009-2010 and 2013 in the EU/EEA, its absolute prevalence increased by 10% or more in three countries. The national prevalence of G1407 in 2013 was positively associated with population-level general cephalosporin and quinolone consumption in the preceding 2 years. The association between the prevalence of G1407 and proportion of the national sample derived from MSM was non-significant in 2009-2010 and was negative in 2013. CONCLUSIONS Our results are broadly compatible with the hypothesis that changes in gonorrhoea therapy to the more efficacious ceftriaxone (plus azithromycin) from 2010 to 2011 onwards resulted in a reduced prevalence of the resistance-associated G1407 overall but in MSM in particular. High population-level consumption of quinolones and cephalosporins in certain countries then contributed to the selection of G1407 predominantly in heterosexuals in these countries.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium; Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory 7700, South Africa.
| | - Jolein Laumen
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Saïd Abdelatti
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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22
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Frackelton R, Jones K, Hamer B, Jones S, Hitchings E, Harrison J, Hughes-McGreal C, Clarke E. Managing contacts of chlamydia: should clinics implement a test and wait process? Int J STD AIDS 2020; 32:38-44. [PMID: 33121362 DOI: 10.1177/0956462420956852] [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] [Indexed: 12/24/2022]
Abstract
British guidelines recommend epidemiological treatment for all chlamydia contacts during the look back period. Some UK sexual health clinics follow a test and wait process for chlamydia contacts presenting after 14 days of exposure. The aim of this retrospective service evaluation was to determine the potential impact of implementing such a process for chlamydia contacts at our clinic. We reviewed the patient records of 548 chlamydia contacts over a 1-year period, and 588 patients with chlamydia over a 5-month period. Demographic and clinical characteristics data were collected.Chlamydia prevalence was 46% (254/548) in contacts, with prevalence varying by age (p=.008) and sexual risk (p=.04), but not by time since exposure (p=.29). For patients with chlamydia, there was a mean of 1.9 days between results notification and attending for treatment; a mean of 2.2 attempts were required to contact patients to return for treatment. Chlamydia prevalence in contacts is high. Not giving empirical treatment to contacts presenting after 14 days of exposure would result in 13.1% of the cohort needing to return for treatment. Patients found to have chlamydia returned promptly once informed of positive results.
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Affiliation(s)
| | - Kathy Jones
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Beth Hamer
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Sian Jones
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Elizabeth Hitchings
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Joanne Harrison
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Catherine Hughes-McGreal
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Emily Clarke
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
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23
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Alqahtani F, Aleanizy F, El Tahir E, Alhabib H, Alsaif R, Shazly G, AlQahtani H, Alsarra I, Mahdavi J. Antibacterial Activity of Chitosan Nanoparticles Against Pathogenic N. gonorrhoea. Int J Nanomedicine 2020; 15:7877-7887. [PMID: 33116506 PMCID: PMC7568623 DOI: 10.2147/ijn.s272736] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The emergence of Neisseria gonorrhoeae strains that are resistant to the most commonly used antibiotics represents a great concern for global public health. This challenges the effectiveness of clinical treatment regimens and demands the development of alternative antigonococcal agent. In this regard, chitosan nanoparticles (CNPs) are known to have antimicrobial activity against a wide range of pathogens. Thus, they have become a potential candidate for combatting this era of multi-drug resistance. This study aims to formulate CNPs, characterize their physicochemical properties, and examine their antimicrobial activity against gonococcus. Materials and Methods The ionic gelation method was used to prepare CNPs of different concentrations. Characterization for their particle size (PZ), polydispersity index (PDI), and zeta potential (ZP) was performed. The anti-microbial activity of CNPs was investigated against 13 WHO N. gonorrhoeae reference strains, using the broth dilution method. Cytotoxicity of CNPs and their effect on bacterial adhesion to HeLa cells were investigated. Results The average PZ and ZP of the prepared NPs were increased when the concentration of chitosan was increased from 1 to 5 mg/mL and found to be in the range of 193 nm ± 1.9 to 530 nm ± 13.3, and 14 mV ± 0.5 to 20 mV ± 1, respectively. Transmission electron microscopes (TEM) images revealed spherical NPs, and the NPs had a low PDI value of ≤0.27. The formed CNPs produced antibacterial activity against all tested strains, including those resistant to multiple antibiotics, with a minimum inhibitory concentration (MIC90) of 0.16 to 0.31 mg/mL and a minimum bactericidal concentration (MBC) of 0.31 to 0.61 mg/mL. Of note, at all MIC90 and MBC, the CNPs had no significant cytotoxic effect on HeLa cells and reduced bacterial adhesion to these cells at MBC doses. Conclusion The present work findings suggest the potential of the CNPs for the treatment of gonorrhoea.
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Affiliation(s)
- Fulwah Alqahtani
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fadilah Aleanizy
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Eram El Tahir
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hiba Alhabib
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Raghad Alsaif
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Gamal Shazly
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Department of Industrial Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Hajar AlQahtani
- Department of Pharmacy Services, King Abdul-Aziz Medical City, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Ibrahim Alsarra
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jafar Mahdavi
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, University Park, Nottingham, UK
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24
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Foerster S, Drusano G, Golparian D, Neely M, Piddock LJV, Alirol E, Unemo M. In vitro antimicrobial combination testing of and evolution of resistance to the first-in-class spiropyrimidinetrione zoliflodacin combined with six therapeutically relevant antimicrobials for Neisseria gonorrhoeae. J Antimicrob Chemother 2020; 74:3521-3529. [PMID: 31730160 DOI: 10.1093/jac/dkz376] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Resistance in Neisseria gonorrhoeae to all gonorrhoea therapeutic antimicrobials has emerged. Novel therapeutic antimicrobials are imperative and the first-in-class spiropyrimidinetrione zoliflodacin appears promising. Zoliflodacin could be introduced in dual antimicrobial therapies to prevent the emergence and/or spread of resistance. We investigated the in vitro activity of and selection of resistance to zoliflodacin alone and in combination with six gonorrhoea therapeutic antimicrobials against N. gonorrhoeae. METHODS The international gonococcal reference strains WHO F (WT) and WHO O, WHO V and WHO X (strains with different AMR profiles) were examined. Zoliflodacin was evaluated alone or combined with ceftriaxone, cefixime, spectinomycin, gentamicin, tetracycline, cethromycin or sitafloxacin in chequerboard assays, time-kill curve analysis and selection-of-resistance studies. RESULTS Zoliflodacin alone or in combination with all six antimicrobials showed rapid growth inhibition against all examined strains. The time-kill curve analysis indicated that tetracycline or cethromycin combined with zoliflodacin can significantly decrease the zoliflodacin kill rate in vitro. The frequency of selected zoliflodacin-resistance mutations was low when evaluated as a single agent and further reduced for all antimicrobial combinations. All resistant mutants contained the GyrB mutations D429N, K450T or K450N, resulting in zoliflodacin MICs of 0.5-4 mg/L. CONCLUSIONS Zoliflodacin, alone or in combination with sexually transmitted infection therapeutic antimicrobials, rapidly kills gonococci with infrequent resistance emergence. Zoliflodacin remains promising for gonorrhoea oral monotherapy and as part of dual antimicrobial therapy with low resistance emergence potential. A Phase III trial evaluating efficacy and safety of zoliflodacin for uncomplicated gonorrhoea treatment is planned in 2019.
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Affiliation(s)
- Sunniva Foerster
- WHO Collaborating Centre for Gonorrhoea and other STIs, Swedish Reference Laboratory for STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - George Drusano
- Institute for Therapeutic Innovation, Department of Medicine, College of Medicine, University of Florida, Orlando, FL, USA
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and other STIs, Swedish Reference Laboratory for STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Michael Neely
- Children's Hospital of Los Angeles, Department of Pediatrics, Division of Infectious Diseases, University of Southern California, CA, USA
| | - Laura J V Piddock
- Global Antibiotic Research & Development Partnership (GARDP), Geneva, Switzerland
| | - Emilie Alirol
- Global Antibiotic Research & Development Partnership (GARDP), Geneva, Switzerland
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Swedish Reference Laboratory for STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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25
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Mensforth S, Ross JDC. Should we still use azithromycin for gonorrhoea treatment? Sex Health 2020; 16:442-448. [PMID: 31207203 DOI: 10.1071/sh19016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/07/2019] [Indexed: 11/23/2022]
Abstract
This review presents the evidence for azithromycin in the treatment of gonorrhoea, both as monotherapy and as a component of dual therapy. Uncertainties are explored regarding the efficacy of a dual treatment strategy, combining ceftriaxone and azithromycin, in the context of resistance trends and extra-genital infections. The association between microbiological testing and clinical outcome for the individual patient, and the effect of azithromycin use on other sexually transmissible infections, are considered. Finally, in the absence of imminent new antimicrobials, optimising the dose of azithromycin while maintaining tolerability is discussed.
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Affiliation(s)
- Sarah Mensforth
- Department of Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK; and Corresponding author.
| | - Jonathan D C Ross
- Department of Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
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26
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Ross JD, Harding J, Duley L, Montgomery AA, Hepburn T, Tan W, Brittain C, Meakin G, Sprange K, Thandi S, Jackson L, Roberts T, Wilson J, White J, Dewsnap C, Cole M, Lawrence T. Gentamicin as an alternative to ceftriaxone in the treatment of gonorrhoea: the G-TOG non-inferiority RCT. Health Technol Assess 2020; 23:1-104. [PMID: 31099330 DOI: 10.3310/hta23200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Gonorrhoea is a common sexually transmitted infection that can cause pain and discomfort, affect fertility in women and lead to epididymo-orchitis in men. Current treatment is with ceftriaxone, but there is increasing evidence of antimicrobial resistance reducing its effectiveness. Gentamicin is a potential alternative treatment requiring further evaluation. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of gentamicin as an alternative treatment to ceftriaxone in the treatment of gonorrhoea. DESIGN A multicentre, parallel-group, blinded, non-inferiority randomised controlled trial. SETTING Fourteen sexual health clinics in England. PARTICIPANTS Adults aged 16-70 years with a diagnosis of uncomplicated, untreated genital, pharyngeal or rectal gonorrhoea based on a positive Gram-stained smear on microscopy or a positive nucleic acid amplification test (NAAT). RANDOMISATION AND BLINDING Participants were randomised using a secure web-based system, stratified by clinic. Participants, investigators and research staff assessing participants were blinded to treatment allocation. INTERVENTIONS Allocation was to either 240 mg of gentamicin (intervention) or 500 mg of ceftriaxone (standard treatment), both administered as a single intramuscular injection. All participants also received 1 g of oral azithromycin. MAIN OUTCOME MEASURE The primary outcome measure was clearance of Neisseria gonorrhoeae at all infected sites, confirmed by a negative Aptima Combo 2® (Hologic Inc., Marlborough, MA, USA) NAAT, at 2 weeks post treatment. RESULTS We randomised 720 participants, of whom 81% were men. There were 358 participants in the gentamicin group and 362 in the ceftriaxone group; 292 (82%) and 306 (85%) participants, respectively, were included in the primary analysis. Non-inferiority of gentamicin to ceftriaxone could not be demonstrated [adjusted risk difference for microbiological clearance -6.4%, 95% confidence interval (CI) -10.4% to -2.4%]. Clearance of genital infection was similar in the two groups, at 94% in the gentamicin group and 98% in the ceftriaxone group, but clearance of pharyngeal infection and rectal infection was lower in the gentamicin group (80% vs. 96% and 90% vs. 98%, respectively). Reported pain at the injection site was higher for gentamicin than for ceftriaxone. The side-effect profiles were comparable between the groups. Only one serious adverse event was reported and this was deemed not to be related to the trial medication. The economic analysis found that treatment with gentamicin is not cost neutral compared with standard care, with average patient treatment costs higher for those allocated to gentamicin (£13.90, 95% CI £2.47 to £37.34) than to ceftriaxone (£6.72, 95% CI £1.36 to £17.84). LIMITATIONS Loss to follow-up was 17% but was similar in both treatment arms. Twelve per cent of participants had a negative NAAT for gonorrhoea at their baseline visit but this was balanced between treatment groups and unlikely to have biased the trial results. CONCLUSIONS The trial was unable to demonstrate non-inferiority of gentamicin compared with ceftriaxone in the clearance of gonorrhoea at all infected sites. Clearance at pharyngeal and rectal sites was lower for participants allocated to gentamicin than for those allocated to ceftriaxone, but was similar for genital sites in both groups. Gentamicin was associated with more severe injection site pain. However, both gentamicin and ceftriaxone appeared to be well tolerated. FUTURE WORK Exploration of the genetic determinants of antibiotic resistance in N. gonorrhoeae will help to identify accurate markers of decreased susceptibility. Greater understanding of the immune response to infection can assist gonococcal vaccine development. TRIAL REGISTRATION Current Controlled Trials ISRCTN51783227. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 20. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jonathan Dc Ross
- Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jan Harding
- Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Trish Hepburn
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Clare Brittain
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Garry Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sukhwinder Thandi
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Louise Jackson
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - John White
- Burrell Street Clinic, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Michelle Cole
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), National Infection Service, Public Health England, London, UK
| | - Tessa Lawrence
- Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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27
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Ayinde O, Ross JDC. Time to resolution of genital symptoms for uncomplicated gonorrhoea: a prospective cohort study. Sex Transm Infect 2020; 97:368-374. [PMID: 32829308 DOI: 10.1136/sextrans-2020-054626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/10/2020] [Accepted: 07/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the time to resolution of symptoms (TTR) following treatment of uncomplicated gonorrhoea and to identify factors associated with TTR in a cohort of sexual health clinic attendees. METHODS Participants were recruited from 14 clinics across England into the 'Gentamicin for the Treatment of Gonorrhoea (GToG)' trial between October 2014 and November 2016. We analysed demographic, behavioural and clinical data in a subset of the GToG study cohort presenting with genital discharge and/or dysuria, who subsequently experienced microbiological clearance of Neisseria gonorrhoeae 2 weeks after treatment. Testing for gonorrhoea was performed using a nucleic acid amplification test. The results were expressed as median TTR (IQR) and HRs with 95% CIs for resolution of symptoms. RESULTS 216 participants (89% male) with a mean age of 32 years reported genital discharge (204/216 (94%)) or dysuria (173/216 (80%)) at their baseline visit. Symptom resolution occurred in 202/216 (94%) at the 2-week follow-up appointment. The median TTR was 2 days (IQR 1-3 days). 50/216 (23%) patients presented with gonorrhoea-chlamydia coinfection at their baseline attendance and in this group symptom resolution was slower (3 days for gonorrhoea-chlamydia coinfection compared with 2 days for gonorrhoea only, HR 0.68 (95% CI 0.48 to 0.95)). TTR was also longer in women (4 days for females compared with 2 days for males, HR 0.47 (95% CI 0.29 to 0.77)). CONCLUSIONS The time to resolution of genital symptoms following effective treatment of gonorrhoea is variable, but 90% of patients report symptom resolution within 1 week. Concurrent chlamydia infection and being female were associated with prolonged TTR.
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Affiliation(s)
- Oluseyi Ayinde
- Department of Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Fan W, Zhang Q, Wang L, Jiang T. Is Gonococcal Paraurethral Duct Infection a Local Complication of Urethral Gonorrhea in Men? Am J Mens Health 2020; 13:1557988319849134. [PMID: 31068083 PMCID: PMC6509980 DOI: 10.1177/1557988319849134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Gonococcal paraurethral duct infection in males has previously been regarded as a local complication of urethral gonorrhea. To verify this, pathogens were investigated in urethral secretions from 81 male patients with gonococcal paraurethral duct infection. In patients with gonococcal infections of both the urethra and the paraurethral duct, the times of onset of the first symptoms associated with urethral gonorrheal and gonococcal paraurethral duct infection were compared. Among 81 male patients with gonococcal paraurethral duct infection, gonococci were detected in the urethras of 76 patients and no pathogens were detected in the urethras of the remaining 5 patients. The first symptom associated with urethral gonorrhea and gonococcal paraurethral duct infection occurred simultaneously in 10 cases. In 7 cases, the first symptom of gonococcal paraurethral duct infection occurred 2–4 days (2.29 ± 0.76 days) earlier than that of urethral gonorrhea and in 59 cases, the first symptom of urethral gonorrhea occurred 1–6 days (3.07 ± 1.19 days) earlier than that of gonococcal paraurethral duct infection. This study shows that gonococcal paraurethral duct infection in males can be caused by primary infection of Neisseria gonorrhoeae.
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Affiliation(s)
- Wenge Fan
- 1 Department of Dermatology, First People's Hospital of Changshu City, Changshu Hospital Affiliated to Soochow University, PR China
| | - Qingsong Zhang
- 2 Department of Dermatology, Traditional Chinese Medical Hospital of Changshu City, PR China
| | - Ling Wang
- 1 Department of Dermatology, First People's Hospital of Changshu City, Changshu Hospital Affiliated to Soochow University, PR China
| | - Tingwang Jiang
- 3 Department of Clinical Laboratory, First People's Hospital of Changshu City, Changshu Hospital Affiliated to Soochow University, PR China
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Machalek DA, Tao Y, Shilling H, Jensen JS, Unemo M, Murray G, Chow EPF, Low N, Garland SM, Vodstrcil LA, Fairley CK, Hocking JS, Zhang L, Bradshaw CS. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 20:1302-1314. [PMID: 32622378 DOI: 10.1016/s1473-3099(20)30154-7] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/17/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mycoplasma genitalium is now recognised as an important bacterial sexually transmitted infection. We summarised data from studies of mutations associated with macrolide and fluoroquinolone resistance in M genitalium to establish the prevalence of resistance. We also investigated temporal trends in resistance and aimed to establish the association between resistance and geographical location. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and MEDLINE for studies that included data for the prevalence of mutations associated with macrolide and fluoroquinolone resistance in M genitalium published in any language up to Jan 7, 2019. We defined prevalence as the proportion of M genitalium samples positive for key mutations associated with azithromycin resistance (23S rRNA gene, position 2058 or 2059) or moxifloxacin resistance (S83R, S83I, D87N, or D87Y in parC), or both, among all M genitalium samples that were successfully characterised. We used random-effects meta-analyses to calculate summary estimates of prevalence. Subgroup and meta-regression analyses by WHO region and time period were done. This study was registered with PROSPERO, number CRD42016050370. RESULTS Overall, 59 studies from 21 countries met the inclusion criteria for our study: 57 studies of macrolide resistance (8966 samples), 25 of fluoroquinolone resistance (4003 samples), and 22 of dual resistance to macrolides and fluoroquinolones (3280 samples). The summary prevalence of mutations associated with macrolide resistance among M genitalium samples was 35·5% (95% CI 28·8-42·5); prevalence increased from 10·0% (95% CI 2·6-20·1%) before 2010, to 51·4% (40·3-62·4%) in 2016-17 (p<0·0001). Prevalence of mutations associated with macrolide resistance was significantly greater in samples in the WHO Western Pacific and Americas regions than in those from the WHO European region. The overall prevalence of mutations associated with fluoroquinolone resistance in M genitalium samples was 7·7% (95% CI 4·5-11·4%). Prevalence did not change significantly over time, but was significantly higher in the Western Pacific region than in the European region. Overall, the prevalence of both mutations associated with macrolide resistance and those associated with fluoroquinolone resistance among M genitalium samples was 2·8% (1·3-4·7%). The prevalence of dual resistance did not change significantly over time, and did not vary significantly by geographical region. INTERPRETATION Global surveillance and measures to optimise the efficacy of treatments-including resistance-guided strategies, new antimicrobials, and antimicrobial combination approaches-are urgently needed to ensure cure in a high proportion of M genitalium infections and to prevent further spread of resistant strains. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Dorothy A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; The Kirby Institute, University of New South Wales, Kensington, Sydney, NSW, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
| | - Yusha Tao
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hannah Shilling
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jørgen S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gerald Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Catriona S Bradshaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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30
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Liakos W, Schaffler B, Rajan S, Hagmann SHF. Gonococcal osteomyelitis in a pediatric patient with disseminated gonococcal infection: Implications for antimicrobial management. IDCases 2020; 21:e00875. [PMID: 32637320 PMCID: PMC7327928 DOI: 10.1016/j.idcr.2020.e00875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
Cases of gonococcal osteomyelitis are rare but potentially debilitating, with little consensus on risk factors or treatment. We present a case of septic arthritis complicated by gonococcal osteomyelitis in an adolescent. Prolonged treatment relative to gonococcal arthritis might be needed for ideal outcomes in secondary osteomyelitis.
We report a case of a female teenager with gonococcal septic arthritis of the right shoulder that also caused osteomyelitis of the humeral head. Infection with Neisseria gonorrhoeae is a frequently diagnosed sexually transmitted infection in the sexually active teenage population and disseminated gonococcal infection (DGI) is the most common systemic manifestation of acute gonorrhea. DGI commonly involves acute arthritis, tenosynovitis and dermatitis with less common complications of endocarditis, hepatitis and meningitis. In contrast, osteomyelitis has only rarely been reported as a result of gonococcal infection. Clinicians need to be aware of this unusual manifestation of DGI as a prolonged duration of antimicrobial treatment may be needed to assure complete resolution of this infection.
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Affiliation(s)
- William Liakos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, New York, 11549, United States
| | - Benjamin Schaffler
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, New York, 11549, United States
| | - Sujatha Rajan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, New York, 11549, United States.,Steven and Alexandra Cohen Children's Medical Center, Northwell Health, Division of Pediatric Infectious Diseases, 269-01 76thAve, Queens, New York, 11040, United States
| | - Stefan H F Hagmann
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, New York, 11549, United States.,Steven and Alexandra Cohen Children's Medical Center, Northwell Health, Division of Pediatric Infectious Diseases, 269-01 76thAve, Queens, New York, 11040, United States
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31
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Fisk KM, Derouin A, Holm G, Hicks L. Getting it Right: The Impact of Point-of-Care Testing for Gonorrhea and Chlamydia in the Urgent Care Setting. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Dresser M, Hussey J. Testing for pharyngeal gonorrhoea in heterosexual men: should we revisit national guidelines? Int J STD AIDS 2020; 31:593-595. [PMID: 32295478 DOI: 10.1177/0956462420913442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pharyngeal testing for Neisseria gonorrhoeae (gonorrhoea) in heterosexual men is not currently recommended in UK guidelines; however, it was being undertaken in a service in the North East of England for those presenting with urethral infection or as contacts of gonorrhoea. This service evaluation was performed to see if this practice should continue, or cease in line with national recommendations. The results revealed that 10% of contacts were positive in the pharynx only. Had this test not been performed, it would have left these patients without any treatment, as the current guidelines now discourage epidemiological treatment of contacts. Twenty-seven per cent of all heterosexual men diagnosed with urethral infection also had oropharyngeal gonorrhoea, with implications for persistent infection, had testing not been performed followed by a test of cure.
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Affiliation(s)
- Melissa Dresser
- Sunderland Sexual Health Service, Sunderland Royal Hospital, Sunderland, UK
| | - Jane Hussey
- Sunderland Sexual Health Service, Sunderland Royal Hospital, Sunderland, UK
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33
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Elkashif A, Seleem MN. Investigation of auranofin and gold-containing analogues antibacterial activity against multidrug-resistant Neisseria gonorrhoeae. Sci Rep 2020; 10:5602. [PMID: 32221472 PMCID: PMC7101410 DOI: 10.1038/s41598-020-62696-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/20/2020] [Indexed: 12/02/2022] Open
Abstract
Neisseria gonorrhoeae represents an urgent public health threat due to the rapid emergence of resistance to current antibiotics and the limited number of anti-gonococcal agents currently in clinical trials. This study utilized a drug repositioning strategy to investigate FDA-approved gold-containing drugs against N. gonorrhoeae. Auranofin, sodium aurothiomalate and aurothioglucose inhibited 48 clinical isolates of N. gonorrhoeae including multidrug-resistant strains at a concentration as low as 0.03 µg/mL. A time-kill assay revealed that auranofin exhibited rapid bactericidal activity against N. gonorrhoeae. Moreover, both sodium aurothiomalate and aurothioglucose did not inhibit growth of vaginal protective commensal lactobacilli. Auranofin, in combination with azithromycin, ceftriaxone, cefixime or tetracycline showed an additive effect against four N. gonorrhoeae strains, suggesting the possibility of using auranofin in dual therapy. Moreover, auranofin reduced the burden of intracellular N. gonorrhoeae by over 99% outperforming the drug of choice ceftriaxone. Auranofin was found superior to ceftriaxone in reducing the secretion of the pro-inflammatory cytokine IL-8 by endocervical cells infected with N. gonorrhoeae. Furthermore, auranofin exhibited a prolonged post-antibiotic effect over 10 h, as well as inability to generate resistant mutants. Overall, the current study suggests that repurposing gold-containing drugs, like auranofin, for treatment of gonorrhea warrants further investigation.
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Affiliation(s)
- Ahmed Elkashif
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA
| | - Mohamed N Seleem
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA. .,Purdue Institute of Inflammation, Immunology, and Infectious Disease, West Lafayette, IN, 47907, USA.
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34
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Chen XS, Yin YP, Li XY. A ROADMAP Plan to Address Research Needs for Gonococcal Antimicrobial Resistance in China. Clin Infect Dis 2020; 68:505-510. [PMID: 29985996 DOI: 10.1093/cid/ciy566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/08/2018] [Indexed: 12/30/2022] Open
Abstract
Gonococcal antimicrobial resistance (AMR) has become a global threat significantly hampering the control of gonorrhea. Many socioeconomic, biological, behavioral, and programmatic factors have played an important role in driving the emergence, transmission and spread of gonococcal AMR. However, research to address these scientific and programmatic questions is limited in China. Here we propose a ROADMAP (acronym for resistance surveillance, outcomes due to AMR, antibiotic stewardship and application, diagnostic tools, mechanisms of AMR, antimicrobial assessment, and population pharmacokinetics and pharmacodynamics) plan for expanding interdisciplinary collaborations to address the research needs in China.
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Affiliation(s)
- Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Yue-Ping Yin
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China.,National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Xin-Yu Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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35
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Fairhead CE, Hampson A, Dwyer-Hemmings L, Vasdev N. Is Non-Chlamydial Non-Gonococcal Urethritis Associated with Significant Clinical Complications in Men? A Systematic Review. Curr Urol 2020; 14:1-13. [PMID: 32398991 PMCID: PMC7206600 DOI: 10.1159/000499266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND It is estimated that between 50 and 89% of non-gonococcal urethritis is not caused by Chlamydia trachomatis. Associations between non-chlamydial non-gonococcal urethritis (NCNGU) with balanoposthitis, epididymo-orchitis and reactive arthritis have been suggested, but evidence to support these often-theoretical relationships is sparse and further investigation is called for. Concerns over increasing antimicrobial resistance has rendered the need for clarity over this question ever more pressing in recent years. A review of the current evidence on the complications of NCNGU in men is therefore urgently warranted. OBJECTIVE This systematic review summarizes and evaluates the available evidence that NCNGU, whether symptomatic or asymptomatic, causes the significant complications that are already well-recognized to be associated with non-gonococcal urethritis. These significant complications are epididymo-orchitis, balanoposthitis, and sexually-acquired reactive arthritis (Reiter's syndrome) including arthritis or conjunctivitis. SUMMARY We conducted a systematic review and qualitative synthesis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Five databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and British Nursing Index) were searched. We included studies that measured clinical outcome after diagnosis of NCNGU in men. Bias was assessed using variations of the Newcastle-Ottawa scale. Data were extracted and entered into a pre-written data abstraction proforma. Seven peer-review studies were included. This included 2 retrospective cohort studies, 1 case series, 2 case reports and 2 cross-sectional studies. The studies described and analyzed 3 types of complication: balanitis, posthitis and/or meatitis; reactive arthritis and/or conjunctivitis; and epididymitis. All studies reported one or more complications. KEY MESSAGES This review identifies an important avenue for future research: while the available evidence suggests that NCNGU has the potential to cause significant complications in men, with the strongest evidence existing for balanitis, posthitis and/or meatitis, the nature and significance of these relationships is far from clear. The findings of this review suggest that prospective, adequately powered research into whether there is a causal link between NCNGU and significant clinical complications in men would be highly worthwhile. The findings of this review raise important questions about the utility of the term NCNGU in research and clinical practice.
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Affiliation(s)
- Cassandra E.L. Fairhead
- University College London Medical School, London
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
| | - Alexander Hampson
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
| | - Louis Dwyer-Hemmings
- University College London Medical School, London
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
| | - Nikhil Vasdev
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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36
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Cristaudo A, Orsini D. Neisseria gonorrhoeae Infections. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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37
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Unemo M, Clarke E, Boiko I, Patel C, Patel R. Adherence to the 2012 European gonorrhoea guideline in the WHO European Region according to the 2018-19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group gonorrhoea survey. Int J STD AIDS 2019; 31:69-76. [PMID: 31842695 DOI: 10.1177/0956462419879278] [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: 01/30/2023]
Abstract
Gonorrhoea is a major public health problem globally. Increasing incidence in many particularly developed countries and the emergence of resistance to the extended-spectrum cephalosporin ceftriaxone, the last option for empiric first-line monotherapy, are of serious concern. This paper evaluates the results of the 2018–19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group survey on the diagnosis and treatment of gonorrhoea in Europe. Although high quality clinical care was reported in many European settings, in several countries the testing, diagnostics, antimicrobial treatment, and follow-up of gonorrhoea patients were evidently suboptimal. Increased adherence to evidence-based European and/or nationally-adapted management guidelines is essential in controlling the increasing incidence of gonorrhoea in many European settings and the spread of ceftriaxone-resistant, multidrug-resistant, and extensively drug-resistant gonorrhoea.
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Affiliation(s)
- M Unemo
- Department of Laboratory Medicine, Faculty of Medicine and Health, World Health Organization Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Örebro University, Örebro, Sweden
| | - E Clarke
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - I Boiko
- Department of Laboratory Medicine, Faculty of Medicine and Health, World Health Organization Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Örebro University, Örebro, Sweden.,Department of Functional and Laboratory Diagnostics, I. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
| | - C Patel
- University of Liverpool, Liverpool, UK
| | - R Patel
- Department of Genitourinary Medicine, Southampton Medical School, University of Southampton, Southampton, UK.,Solent NHS Trust, Southampton, UK
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38
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Clarke E, Patel C, Patel R, Unemo M. The 2018-19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group report on the diagnosis and treatment of gonorrhoea in Europe. Int J STD AIDS 2019; 31:77-81. [PMID: 31793388 DOI: 10.1177/0956462419879270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The European Collaborative Clinical Group (ECCG) has been surveying clinical management of sexually transmitted infections (STIs) in Europe since its inauguration in 2011. The ECCG is a network of nearly 130 STI specialists from 34 European countries who conduct questionnaire-based research across the European region. The research of ECCG focuses on providing data regarding clinical practice to inform European STI guideline development and revisions. The present paper describes the results of the 2018–19 ECCG survey regarding diagnosis and treatment of gonorrhoea in Europe.
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Affiliation(s)
- E Clarke
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - C Patel
- Solihull Hospital, Solihull, UK
| | - R Patel
- Department of Genitourinary Medicine, Southampton Medical School, University of Southampton, Southampton, UK.,Solent NHS Trust, Southampton, UK
| | - M Unemo
- Department of Laboratory Medicine, Faculty of Medicine and Health, World Health Organization Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Örebro University, Örebro, Sweden
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39
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Llata E, Braxton J, Asbel L, Huspeni D, Hsu K, Kerani RP, Nguyen TQ, Pathela P, Schumacher C, Toevs K, Torrone E. Pharyngeal Gonococcal Infections: A Cross-Sectional Study in a Network of Sexually Transmitted Disease Clinics; Sexually Transmitted Disease Surveillance Network-January 2016 to June 2018. Sex Transm Dis 2019; 46:777-779. [PMID: 31764766 PMCID: PMC11334052 DOI: 10.1097/olq.0000000000001073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted a cross-sectional analysis using sexually transmitted disease clinic data to determine test of cure rates among persons diagnosed with pharyngeal gonococcal infections who were treated with a nonceftriaxone, nonazithromycin therapy. Less than 10% returned for a test of cure, highlighting the need to understand factors that can lead to improved compliance.
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Affiliation(s)
- Eloisa Llata
- From the Centers for Disease Control and Prevention, Surveillance and Data Management Branch, Division of STD Prevention (NCHHSTP)
| | - Jim Braxton
- From the Centers for Disease Control and Prevention, Surveillance and Data Management Branch, Division of STD Prevention (NCHHSTP)
| | - Lenore Asbel
- Philadelphia Department of Public Health, Philadelphia, PA
| | - Dawn Huspeni
- Minnesota Department of Health, Minneapolis/St. Paul, MN
| | - Katherine Hsu
- Massachusetts Department of Public Health, Boston, MA
| | - Roxanne P Kerani
- Public Health-Seattle and King County and Department of Medicine, University of Washington, Seattle, WA
| | | | - Preeti Pathela
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Christina Schumacher
- Johns Hopkins University School of Medicine, Baltimore, MD
- Baltimore City Health Department, Baltimore, MD
| | - Kim Toevs
- Multnomah County Health Department, Portland, OR
| | - Elizabeth Torrone
- From the Centers for Disease Control and Prevention, Surveillance and Data Management Branch, Division of STD Prevention (NCHHSTP)
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40
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Abstract
The bacterium Neisseria gonorrhoeae causes the sexually transmitted infection (STI) gonorrhoea, which has an estimated global annual incidence of 86.9 million adults. Gonorrhoea can present as urethritis in men, cervicitis or urethritis in women, and in extragenital sites (pharynx, rectum, conjunctiva and, rarely, systemically) in both sexes. Confirmation of diagnosis requires microscopy of Gram-stained samples, bacterial culture or nucleic acid amplification tests. As no gonococcal vaccine is available, prevention relies on promoting safe sexual behaviours and reducing STI-associated stigma, which hinders timely diagnosis and treatment thereby increasing transmission. Single-dose systemic therapy (usually injectable ceftriaxone plus oral azithromycin) is the recommended first-line treatment. However, a major public health concern globally is that N. gonorrhoeae is evolving high levels of antimicrobial resistance (AMR), which threatens the effectiveness of the available gonorrhoea treatments. Improved global surveillance of the emergence, evolution, fitness, and geographical and temporal spread of AMR in N. gonorrhoeae, and improved understanding of the pharmacokinetics and pharmacodynamics for current and future antimicrobials in the treatment of urogenital and extragenital gonorrhoea, are essential to inform treatment guidelines. Key priorities for gonorrhoea control include strengthening prevention, early diagnosis, and treatment of patients and their partners; decreasing stigma; expanding surveillance of AMR and treatment failures; and promoting responsible antimicrobial use and stewardship. To achieve these goals, the development of rapid and affordable point-of-care diagnostic tests that can simultaneously detect AMR, novel therapeutic antimicrobials and gonococcal vaccine(s) in particular is crucial.
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41
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Zienkiewicz AK, Verschueren van Rees N, Homer M, Ong JJ, Christensen H, Hill D, Looker KJ, Horner P, Hughes G, Turner KME. Agent-based modelling study of antimicrobial-resistant Neisseria gonorrhoeae transmission in men who have sex with men: towards individualised diagnosis and treatment. Sex Health 2019; 16:514-522. [PMID: 31476277 DOI: 10.1071/sh18235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
Background Antimicrobial-resistant (AMR) gonorrhoea is a global public health threat. Discriminatory point-of-care tests (POCT) to detect drug sensitivity are under development, enabling individualised resistance-guided therapy. METHODS An individual-based dynamic transmission model of gonorrhoea infection in MSM living in London has been developed, incorporating ciprofloxacin-sensitive and resistant strains. The time-dependent sexual contact network is captured by periodically restructuring active connections to reflect the transience of contacts. Different strategies to improve treatment selection were explored, including discriminatory POCT and selecting partner treatment based on either the index case or partner susceptibility. Outcomes included population prevalence of gonorrhoea and drug dose counts. RESULTS It is shown that using POCT to detect ciprofloxacin-sensitive infections could result in a large decrease in ceftriaxone doses (by 70% compared with the reference case in the simulations of this study). It also suggests that ceftriaxone use can be reduced with existing technologies, albeit to a lesser degree; either using index case sensitivity profiles to direct treatment of partners, or testing notified partners with strain discriminatory laboratory tests before treatment, reduced ceftriaxone use in our model (by 27% and 47% respectively). CONCLUSIONS POCT to detect ciprofloxacin-sensitive gonorrhoea are likely to dramatically reduce reliance on ceftriaxone, but requires the implementation of new technology. In the meantime, the proportion of unnecessary ceftriaxone treatment by testing partners before treatment could be reduced significantly. Alternatively, index case sensitivity profiles could be used to select effective treatments for partners.
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Affiliation(s)
- Adam K Zienkiewicz
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1UB, UK; and School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - Nicolás Verschueren van Rees
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1UB, UK; and School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - Martin Homer
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1UB, UK
| | - Jason J Ong
- Clinical Research and Development, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; and Central Clinical School, Monash University, Clayton, Vic. 3800, Australia; and Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Hannah Christensen
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Darryl Hill
- School of Cellular and Molecular Medicine, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
| | - Katharine J Looker
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Paddy Horner
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Gwenda Hughes
- Instituto de Medicina Tropical, Universidade de São Paulo, Avenuenida Dr Enéas Carvalho de Aguiar, 470, CEP 05403-000, São Paulo, Brasil; and Blood Safety, Hepatitis, STI & HIV Division, National Infection Service, Public Health England, NW9 5EQ, UK
| | - Katy M E Turner
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK; and Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK; and Corresponding author.
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Emergence and Spread of Neisseria gonorrhoeae Strains with High-Level Resistance to Azithromycin in Taiwan from 2001 to 2018. Antimicrob Agents Chemother 2019; 63:AAC.00773-19. [PMID: 31235631 DOI: 10.1128/aac.00773-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/17/2019] [Indexed: 01/17/2023] Open
Abstract
A total of 598 Neisseria gonorrhoeae isolates obtained from patients in Taiwan from 2001 to 2018 were evaluated. The MICs of ceftriaxone (CRO) and azithromycin (AZM) against the isolates were determined by the agar dilution method. N. gonorrhoeae isolates with AZM MICs of ≥1 μg/ml were identified and characterized by the presence of AZM resistance determinants. For high-level AZM-resistant (AZM-HLR) isolates (MIC ≥ 256 μg/ml), genotyping was performed using multilocus sequence typing (MLST) and N. gonorrhoeae multiantigen sequence typing (NG-MAST). Among the N. gonorrhoeae isolates studied, 8.7% (52/598) exhibited AZM MICs of ≥1 μg/ml. Thirteen of the 52 isolates contained A2059G (23S rRNA NG-STAR type 1) or C2611T (23S rRNA NG-STAR type 2) mutations. The prevalence of the A2059G mutation was higher in AZM-HLR isolates (P < 0.001). The -35A deletion in the promoter region of the mtrR gene did not differ between AZM-HLR isolates (100%, 10/10) and the isolates with AZM MICs of 1 μg/ml to 64 μg/ml (95.2%, 40/42) (P = 1.000). The presence of mutations in the mtrR coding region was significantly different between these two groups at 90% (9/10) and 26.2% (11/42), respectively (P < 0.001). The AZM-HLR isolates, all carrying four mutated A2059G alleles, a -35A deletion, and G45D, were classified as MLST 12039/10899 and NG-MAST 1866/16497. In conclusion, Taiwan is among the countries reporting gonococci with high-level resistance to AZM so that a single dose of 1 g ceftriaxone intramuscularly as the first choice for management of N. gonorrhoeae infection should be evaluated.
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Stenger MR, Baral S, Stahlman S, Wohlfeiler D, Barton JE, Peterman T. As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men. Sex Health 2019; 14:18-27. [PMID: 27585033 DOI: 10.1071/sh16104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/28/2016] [Indexed: 12/24/2022]
Abstract
The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM.
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Affiliation(s)
- Mark Richard Stenger
- US Centers for Disease Control and Prevention - Division of STD Prevention, Mail Stop E-63 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Shauna Stahlman
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Dan Wohlfeiler
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Jerusha E Barton
- US Centers For Disease Control and Prevention - Division of STD Prevention (ORISE Fellow), Mailstop E-63, Atlanta, GA 30333, USA
| | - Thomas Peterman
- Centers for Disease Control and Prevention - Division of STD Prevention, Mailstop E-02 CDC, Atlanta, GA 30333, USA
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Chen MY, McNulty A, Avery A, Whiley D, Tabrizi SN, Hardy D, Das AF, Nenninger A, Fairley CK, Hocking JS, Bradshaw CS, Donovan B, Howden BP, Oldach D. Solithromycin versus ceftriaxone plus azithromycin for the treatment of uncomplicated genital gonorrhoea (SOLITAIRE-U): a randomised phase 3 non-inferiority trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:833-842. [PMID: 31196813 DOI: 10.1016/s1473-3099(19)30116-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Antibiotic-resistant gonorrhoea represents a global public health threat, and new therapies are needed. We aimed to compare the efficacy and safety of solithromycin, a fourth generation macrolide, with ceftriaxone plus azithromycin for the treatment of gonorrhoea. METHODS We did an open-label, multicentre, non-inferiority trial of patients aged 15 years or older with uncomplicated untreated genital gonorrhoea at two sites in Australia and one site in the USA. Patients were randomly assigned (1:1) to receive single dose oral solithromycin 1000 mg or intramuscular ceftriaxone 500 mg plus oral azithromycin 1000 mg. Neisseria gonorrhoeae cultures were obtained at baseline and test of cure (day 7 ± 2). The primary outcome was the proportion of patients with eradication of genital N gonorrhoeae based on culture at test of cure, assessed in the microbiological intention-to-treat (mITT) population, which included all randomly assigned patients who received any dose of study drug and had a positive genital culture for N gonorrhoeae at baseline. Non-inferiority of solithromycin was to be concluded if the lower limit of the 95% CI for the between-group differences was greater than -10%. Safety was analysed in all patients who received any dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT02210325. FINDINGS Between Sept 3, 2014, and Aug 27, 2015, 262 patients were randomly assigned and 261 received treatment (130 in the solithromycin group and 131 in the ceftriaxone plus azithromycin group). In the mITT population, 99 (80%) of 123 patients in the solithromycin group and 109 (84%) of 129 patients in the ceftriaxone plus azithromycin group had N gonorrhoeae eradication at test of cure (difference -4·0%, 95% CI -13·6 to 5·5), thus solithromycin did not meet the criterion for non-inferiority at the prespecified -10% margin. The frequency of adverse events was higher in the solithromycin group than the ceftriaxone plus azithromycin group (69 [53%] of 130 patients vs 45 [34%] of 131 patients), the most common of which were diarrhoea (31 [24%] of 130 patients vs 20 [15%] of 131 patients), and nausea (27 [21%] of 130 patients vs 15 [11%] of 131 patients). INTERPRETATION Solithromycin as a single 1000 mg dose is not a suitable alternative to ceftriaxone plus azithromycin as first-line treatment for gonorrhoea. If insufficient duration of solithromycin exposure at the infection site in a subset of individuals was the reason for treatment failures, this might be adequately addressed with dose adjustment. However, any further trials with longer dosing need to consider the potential risk of gastrointestinal effects and liver enzyme elevations. FUNDING Cempra Pharmaceuticals.
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Affiliation(s)
- Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ann Avery
- MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David Whiley
- Queensland Children's Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Dwight Hardy
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Basil Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia; Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
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Factors That Influence Confirmation of Neisseria gonorrhoeae Positivity by Molecular Methods. J Clin Microbiol 2019; 57:JCM.02068-18. [PMID: 30944196 DOI: 10.1128/jcm.02068-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/26/2019] [Indexed: 11/20/2022] Open
Abstract
Several Neisseria gonorrhoeae nucleic acid amplification tests (NAATs) with high sensitivity exist. However, the specificity of N. gonorrhoeae NAATs may be suboptimal, particularly for extragenital biospecimens. Consequently, confirmation with a second NAAT is common, although this represents a burden on resources. Furthermore, the rationale for confirmation is contentious. The objective of this work was to assess N. gonorrhoeae confirmation in over 13,000 N. gonorrhoeae screen-positive samples representing various biospecimens and three separate screening assays, the Abbott RealTime CT/NG (Abbott Molecular, Inc., Des Plaines, IL), the Cobas CT/NG test (Roche Molecular Systems Inc., Alameda, CA), and the BD ProbeTec ET CT/GC amplified DNA assay (BD Diagnostics, Sparks, MD). Factors predictive of confirmation were determined via logistic regression involving sex, year, whether the sample was formally validated, and sample site. Level of confirmation varied according to screening assay (96.2%, 86.0%, and 73.9% for the Abbott, Roche, and BD tests, respectively) in sample types formally included according to the manufacturers' instructions (i.e., validated). Sex did not affect confirmation for 2/3 assays, and the likelihood of confirmation of samples not formally included in manufacturer instructions (i.e., nonvalidated) was 89.1%, 82.1%, and 59.2% for the Abbott, Roche, and BD tests, respectively. Rectal swabs, which are nonvalidated samples, confirmed in 91.5%, 90.1%, and 87.4% of samples initially tested with the respective assays. The requirement to confirm N. gonorrhoeae in validated samples is not required for all NAATs, although initial assay-specific evaluation is justified given observed variability. Rectal samples represent robust biospecimens for N. gonorrhoeae NAAT testing and may not require confirmation when screened with the assays described.
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46
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Clifton S, Bolt H, Mohammed H, Town K, Furegato M, Cole M, Campbell O, Fifer H, Hughes G. Prevalence of and factors associated with MDR Neisseria gonorrhoeae in England and Wales between 2004 and 2015: analysis of annual cross-sectional surveillance surveys. J Antimicrob Chemother 2019; 73:923-932. [PMID: 29394396 DOI: 10.1093/jac/dkx520] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/08/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives To describe trends in prevalence, susceptibility profile and risk factors for MDR Neisseria gonorrhoeae (MDR-NG) in England and Wales. Methods Isolates from 16 242 gonorrhoea episodes at sexual health clinics within the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) underwent antimicrobial susceptibility testing. MDR-NG was defined as resistance to ceftriaxone, cefixime or azithromycin, plus at least two of penicillin, ciprofloxacin and spectinomycin. Trends in resistance are presented for 2004-15; prevalence and logistic regression analyses for MDR-NG cover the period of the most recent treatment guideline (ceftriaxone plus azithromycin), 2011-15. Results Between 2004 and 2015, the proportion of N. gonorrhoeae isolates fully susceptible to all antimicrobial classes fell from 80% to 46%, with the proportion resistant to multiple (two or more) classes increasing from 7.3% to 17.5%. In 2011-15, 3.5% of isolates were MDR-NG, most of which were resistant to cefixime (100% in 2011, decreasing to 36.9% in 2015) and/or azithromycin (4.2% in 2011, increasing to 84.3% in 2015). After excluding azithromycin-resistant isolates, modal azithromycin MICs were higher in MDR versus non-MDR isolates (0.5 versus 0.125 mg/L), with similar results for ceftriaxone (modal MICs 0.03 versus ≤0.002 mg/L). After adjustment for confounders, MDR-NG was more common among isolates from heterosexual men, although absolute differences in prevalence were small [4.6% versus 3.3% (MSM) and 2.5% (women)]. Conclusions N. gonorrhoeae is becoming less susceptible to available antimicrobials. Since 2011, a minority of isolates were MDR-NG; however, MICs of azithromycin or ceftriaxone (first-line therapies) for many of these were elevated. These findings highlight the importance of continued antimicrobial stewardship for gonorrhoea.
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Affiliation(s)
- Soazig Clifton
- Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, London WC1E 6JB, UK
| | - Hikaru Bolt
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Hamish Mohammed
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Katy Town
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | | | - Michelle Cole
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Oona Campbell
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Helen Fifer
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gwenda Hughes
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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47
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Smolarchuk C, Mohammed H, Furegato M, Town K, Fifer H, Wilson J, Nardone A, Lee A, Hughes G. Just Google it! Impact of media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae on online searches, and attendances, testing and diagnoses at sexual health clinics in England between 2015 and 2016: an interrupted time series analysis using surveillance data. Sex Transm Infect 2019; 95:594-601. [PMID: 31040249 DOI: 10.1136/sextrans-2019-053986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine if media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae (HL-AziR) impacted online search interest or was temporally associated with health-seeking behaviours in several English cities. METHODS A descriptive analysis of outbreak-related online media articles and relative search interest (RSI) using Google and an interrupted time series analysis using routine surveillance data from sexual health clinics (SHCs) in England (GUMCAD STI surveillance system). The main outcomes were adjusted incidence rate ratios (IRRs) of weekly attendances, gonorrhoea tests and diagnoses of gonorrhoea or 'any STI' in selected cities after media coverage of the outbreak in 2015 and 2016. RESULTS RSI for outbreak-related terms peaked during media coverage in September 2015 with smaller peaks coinciding with subsequent coverage. The greatest increase in RSI was in Leeds, which coincided with a 63% rise (n=1932; IRR 1.26, 95% CI 1.12 to 1.43) in SHC attendances by women. There was only a 7% (n=1358; IRR 1.01, 95% CI 0.91 to 1.11) increase in attendances by men. Modest increases in outcomes occurred in four other cities with a high RSI. There was no evidence of increases in outcomes in cities, other than Leeds, after subsequent media coverage of the outbreak. CONCLUSIONS National and local media coverage of the HL-AziR outbreak coincided with peak RSI for related terms, and a transient increase in attendances, gonorrhoea tests and diagnoses of gonorrhoea or 'any STI' in some cities with a high RSI. Our analysis demonstrates the potential for media coverage to influence health-seeking behaviours during high-profile STI outbreaks.
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Affiliation(s)
- Christa Smolarchuk
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK
| | - Martina Furegato
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK
| | - Katy Town
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK.,Centre for Sexual Health & HIV Research, University College London, London, UK
| | - Helen Fifer
- Bacteriology Reference Department, Public Health England Colindale, London, UK
| | - Janet Wilson
- Leeds Sexual Health, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anthony Nardone
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Andrew Lee
- Yorkshire & the Humber Health Protection Team, Public Health England, Leeds, UK
| | - Gwenda Hughes
- Blood Safety, Hepatitis, Sexually Transmitted Infections & HIV Division, Public Health England, London, UK
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Harding-Esch EM, Fuller SS, Chow SLC, Nori AV, Harrison MA, Parker M, Piepenburg O, Forrest MS, Brooks DG, Patel R, Hay PE, Fearnley N, Pond MJ, Dunbar JK, Butcher PD, Planche T, Lowndes CM, Sadiq ST. Diagnostic accuracy of a prototype rapid chlamydia and gonorrhoea recombinase polymerase amplification assay: a multicentre cross-sectional preclinical evaluation. Clin Microbiol Infect 2019; 25:380.e1-380.e7. [PMID: 29906594 PMCID: PMC6420679 DOI: 10.1016/j.cmi.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Rapid and accurate sexually transmitted infection diagnosis can reduce onward transmission and improve treatment efficacy. We evaluated the accuracy of a 15-minute run-time recombinase polymerase amplification-based prototype point-of-care test (TwistDx) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). METHODS Prospective, multicentre study of symptomatic and asymptomatic patients attending three English sexual health clinics. Research samples provided were additional self-collected vulvovaginal swab (SCVS) (female participants) and first-catch urine (FCU) aliquot (female and male participants). Samples were processed blind to the comparator (routine clinic CT/NG nucleic acid amplification test (NAAT)) results. Discrepancies were resolved using Cepheid CT/NG GeneXpert. RESULTS Both recombinase polymerase amplification and routine clinic NAAT results were available for 392 male and 395 female participants. CT positivity was 8.9% (35/392) (male FCU), 7.3% (29/395) (female FCU) and 7.1% (28/395) (SCVS). Corresponding NG positivity was 3.1% (12/392), 0.8% (3/395) and 0.8% (3/395). Specificity and positive predictive values were 100% for all sample types and both organisms, except male CT FCU (99.7% specificity (95% confidence interval (CI) 98.4-100.0; 356/357), 97.1% positive predictive value (95% CI 84.7-99.9; 33/34)). For CT, sensitivity was ≥94.3% for FCU and SCVS. CT sensitivity for female FCU was higher (100%; 95% CI, 88.1-100; 29/29) than for SCVS (96.4%; 95% CI, 81.7-99.9; 27/28). NG sensitivity and negative predictive values were 100% in FCU (male and female). CONCLUSIONS This prototype test has excellent performance characteristics, comparable to currently used NAATs, and fulfils several World Health Organization ASSURED criteria. Its rapidity without loss of performance suggests that once further developed and commercialized, this test could positively affect clinical practice and public health.
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Affiliation(s)
- E M Harding-Esch
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - S S Fuller
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - S-L C Chow
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | - A V Nori
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - M A Harrison
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | | | | | | | | | - R Patel
- Department of Sexual Health, University of Southampton, Southampton, UK
| | - P E Hay
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - N Fearnley
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - M J Pond
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | - J K Dunbar
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - P D Butcher
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK
| | - T Planche
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - C M Lowndes
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - S T Sadiq
- Applied Diagnostic Research & Evaluation Unit (ADREU), Institute for Infection & Immunity, St George's University of London, London, UK; HIV/STI Department, National Infection Service, Public Health England, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK.
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49
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Whittles LK, White PJ, Didelot X. A dynamic power-law sexual network model of gonorrhoea outbreaks. PLoS Comput Biol 2019; 15:e1006748. [PMID: 30849080 PMCID: PMC6426262 DOI: 10.1371/journal.pcbi.1006748] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 03/20/2019] [Accepted: 01/04/2019] [Indexed: 11/26/2022] Open
Abstract
Human networks of sexual contacts are dynamic by nature, with partnerships forming and breaking continuously over time. Sexual behaviours are also highly heterogeneous, so that the number of partners reported by individuals over a given period of time is typically distributed as a power-law. Both the dynamism and heterogeneity of sexual partnerships are likely to have an effect in the patterns of spread of sexually transmitted diseases. To represent these two fundamental properties of sexual networks, we developed a stochastic process of dynamic partnership formation and dissolution, which results in power-law numbers of partners over time. Model parameters can be set to produce realistic conditions in terms of the exponent of the power-law distribution, of the number of individuals without relationships and of the average duration of relationships. Using an outbreak of antibiotic resistant gonorrhoea amongst men have sex with men as a case study, we show that our realistic dynamic network exhibits different properties compared to the frequently used static networks or homogeneous mixing models. We also consider an approximation to our dynamic network model in terms of a much simpler branching process. We estimate the parameters of the generation time distribution and offspring distribution which can be used for example in the context of outbreak reconstruction based on genomic data. Finally, we investigate the impact of a range of interventions against gonorrhoea, including increased condom use, more frequent screening and immunisation, concluding that the latter shows great promise to reduce the burden of gonorrhoea, even if the vaccine was only partially effective or applied to only a random subset of the population.
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Affiliation(s)
- Lilith K. Whittles
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Peter J. White
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Modelling and Economics Unit, National Infection Service, Public Health England, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- NIHR Health Protection Research Unit in Modelling Methodology, School of Public Health, Imperial College London, London, United Kingdom
| | - Xavier Didelot
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Department of Statistics, University of Warwick, Coventry, United Kingdom
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50
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Martin I, Sawatzky P, Allen V, Lefebvre B, Hoang LMN, Naidu P, Minion J, Van Caeseele P, Haldane D, Gad RR, Zahariadis G, Corriveau A, German G, Tomas K, Mulvey MR. Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae in Canada, 2012-2016. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2019; 45:45-53. [PMID: 31015818 PMCID: PMC6461123 DOI: 10.14745/ccdr.v45i23a01] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Neisseria gonorrhoeae have acquired resistance to many antimicrobials, including third generation cephalosporins and azithromycin, which are the current gonococcal combination therapy recommended by the Canadian Guidelines on Sexually Transmitted Infections. OBJECTIVE To describe antimicrobial susceptibilities for N. gonorrhoeae circulating in Canada between 2012 and 2016. METHODS Antimicrobial resistance profiles were determined using agar dilution of N. gonorrhoeae isolated in Canada 2012-2016 (n=10,167) following Clinical Laboratory Standards Institute guidelines. Data were analyzed by applying multidrug-resistant gonococci (MDR-GC) and extensively drug-resistant gonococci (XDR-GC) definitions. RESULTS Between 2012 and 2016, the proportion of MDR-GC increased from 6.2% to 8.9% and a total of 19 cases of XDR-GC were identified in Canada (0.1%, 19/18,768). The proportion of isolates with decreased susceptibility to cephalosporins declined between 2012 and 2016 from 5.9% to 2.0% while azithromycin resistance increased from 0.8% to 7.2% in the same period. CONCLUSION While XDR-GC are currently rare in Canada, MDR-GC have increased over the last five years. Azithromycin resistance in N. gonorrhoeae is established and spreading in Canada, exceeding the 5% level at which the World Health Organization states an antimicrobial should be reviewed as an appropriate treatment. Continued surveillance of antimicrobial susceptibilities of N. gonorrhoeae is necessary to inform treatment guidelines and mitigate the impact of resistant gonorrhea.
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Affiliation(s)
- I Martin
- Bacterial Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - P Sawatzky
- Bacterial Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - V Allen
- Public Health Ontario Laboratories, Toronto, ON
| | - B Lefebvre
- Laboratoire de santé publique du Québec, Ste-Anne-de-Bellevue, QC
| | - LMN Hoang
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC
| | - P Naidu
- Provincial Laboratory for Public Health, Edmonton, AB
| | - J Minion
- Roy Romanow Provincial Laboratory, Regina, SK
| | | | - D Haldane
- Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - RR Gad
- New Brunswick Department of Health, Fredericton, NB
| | - G Zahariadis
- Newfoundland and Labrador Public Health Laboratory, St. John’s, NL
| | - A Corriveau
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, NT
| | | | - K Tomas
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - MR Mulvey
- Bacterial Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
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