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Weng RX, Ning N, Luo YT, Zhang CL, Wen LZ, Ye JB, Li J, Chen XS, Cai YM. Using Self-Reported Sexual Positioning as an Indicator for Rectal Chlamydia and Gonorrhea Screening Among Men Who Have Sex With Men in China: A Missed Opportunity. Sex Transm Dis 2024; 51:400-406. [PMID: 38403298 DOI: 10.1097/olq.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) are escalating public health concerns. This study aimed to explore (1) the reliability of self-reported sexual positioning as an indicator for rectal CT and NG screening, and (2) factors associated with rectal CT and NG infections in Shenzhen, China. METHODS A cross-sectional study was conducted in 2 settings in Shenzhen, China, from April 1, 2021, to March 31, 2022. Data on sociodemographic characteristics, sexual behaviors, and basic CT knowledge were collected. Urine and self-collected rectal swabs were collected for CT and NG testing. RESULTS In total, 195 MSM participated in the study, and 5.1% tested positive for urogenital CT, 29.2% for rectal CT, 1.0% for urogenital NG, and 8.2% for rectal NG. Among those who reported exclusively insertive anal sex, 69.2% of CT infections and 85.7% of NG infections would have remained undetected with urine testing alone. Risk factors for rectal CT infection included engaging in both insertive and receptive anal sex, with a significant association found for coinfection with rectal NG. CONCLUSIONS Self-reported sexual positioning was found to be an unreliable indicator for CT and NG screening, as a substantial proportion of infections would have remained undetected. The findings suggest that CT and NG screening in China should be offered to all MSM regardless of self-reported sexual positioning, and that the dual CT/NG testing is recommended.
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Affiliation(s)
| | - Ning Ning
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Yi-Ting Luo
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Chun-Lai Zhang
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Li-Zhang Wen
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Jian-Bin Ye
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | - Jing Li
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
| | | | - Yu-Mao Cai
- From the Shenzhen Center for Chronic Disease Control, Shenzhen Institute of Dermatology, Shenzhen, Guangdong Province, China
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Dickson K, Zhou J, Lehmann C. Lower Urinary Tract Inflammation and Infection: Key Microbiological and Immunological Aspects. J Clin Med 2024; 13:315. [PMID: 38256450 PMCID: PMC10816374 DOI: 10.3390/jcm13020315] [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: 11/27/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
The urinary system, primarily responsible for the filtration of blood and waste, is affected by several infectious and inflammatory conditions. Focusing on the lower tract, this review outlines the physiological and immune landscape of the urethra and bladder, addressing key immunological and microbiological aspects of important infectious/inflammatory conditions. The conditions addressed include urethritis, interstitial cystitis/bladder pain syndrome, urinary tract infections, and urosepsis. Key aspects of each condition are addressed, including epidemiology, pathophysiology, and clinical considerations. Finally, therapeutic options are outlined, highlighting gaps in the knowledge and novel therapeutic approaches.
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Affiliation(s)
- Kayle Dickson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Juan Zhou
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Christian Lehmann
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Dighe K, Moitra P, Gunaseelan N, Alafeef M, Jensen T, Rafferty C, Pan D. Highly-Specific Single-Stranded Oligonucleotides and Functional Nanoprobes for Clinical Determination of Chlamydia Trachomatis and Neisseria Gonorrhoeae Infections. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2304009. [PMID: 37870167 PMCID: PMC10754082 DOI: 10.1002/advs.202304009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/18/2023] [Indexed: 10/24/2023]
Abstract
Early detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is the key to controlling the spread of these bacterial infections. An important step in developing biosensors involves identifying reliable sensing probes against specific genetic targets for CT and NG. Here, the authors have designed single-stranded oligonucleotides (ssDNAs) targeting mutually conserved genetic regions of cryptic plasmid and chromosomal DNA of both CT and NG. The 5'- and 3'- ends of these ssDNAs are differentially functionalized with thiol groups and coupled with gold nanoparticles (AuNP) to develop absorbance-based assay. The AuNPs agglomerate selectively in the presence of its target DNA sequence and demonstrate a change in their surface plasmon resonance. The optimized assay is then used to detect both CT and NG DNA extracted from 60 anonymized clinical samples with a clinical sensitivity of ∼100%. The limit of detection of the assays are found to be 7 and 5 copies/µL for CT and NG respectively. Furthermore, it can successfully detect the DNA levels of these two bacteria without the need for DNA extraction and via a lateral flow-based platform. These assays thus hold the potential to be employed in clinics for rapid and efficient monitoring of sexually transmitted infections.
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Affiliation(s)
- Ketan Dighe
- Department of PediatricsCentre of Blood Oxygen Transport & HemostasisUniversity of Maryland Baltimore School of MedicineBaltimoreMaryland21201USA
- Department of Chemical & Biochemical EngineeringUniversity of Maryland Baltimore CountyBaltimore CountyMaryland21250USA
- Department of Biomedical EngineeringThe Pennsylvania State UniversityUniversity ParkPA16802USA
| | - Parikshit Moitra
- Department of PediatricsCentre of Blood Oxygen Transport & HemostasisUniversity of Maryland Baltimore School of MedicineBaltimoreMaryland21201USA
- Department of Nuclear EngineeringThe Pennsylvania State UniversityUniversity ParkPA16802USA
| | - Nivetha Gunaseelan
- Department of PediatricsCentre of Blood Oxygen Transport & HemostasisUniversity of Maryland Baltimore School of MedicineBaltimoreMaryland21201USA
- Department of Chemical & Biochemical EngineeringUniversity of Maryland Baltimore CountyBaltimore CountyMaryland21250USA
- Department of Biomedical EngineeringThe Pennsylvania State UniversityUniversity ParkPA16802USA
| | - Maha Alafeef
- Department of PediatricsCentre of Blood Oxygen Transport & HemostasisUniversity of Maryland Baltimore School of MedicineBaltimoreMaryland21201USA
- Department of Chemical & Biochemical EngineeringUniversity of Maryland Baltimore CountyBaltimore CountyMaryland21250USA
- Department of Nuclear EngineeringThe Pennsylvania State UniversityUniversity ParkPA16802USA
| | - Tor Jensen
- Cancer Center at IllinoisUniversity of Illinois Urbana‐Champaign405 N. Mathews Ave.UrbanaIL61801‐2325USA
| | - Carla Rafferty
- Department of Family MedicineCarle Health1818 E Windsor Rd.UrbanaIL61802USA
| | - Dipanjan Pan
- Department of PediatricsCentre of Blood Oxygen Transport & HemostasisUniversity of Maryland Baltimore School of MedicineBaltimoreMaryland21201USA
- Department of Chemical & Biochemical EngineeringUniversity of Maryland Baltimore CountyBaltimore CountyMaryland21250USA
- Department of Biomedical EngineeringThe Pennsylvania State UniversityUniversity ParkPA16802USA
- Department of Nuclear EngineeringThe Pennsylvania State UniversityUniversity ParkPA16802USA
- Department of Materials Science and EngineeringThe Pennsylvania State UniversityUniversity ParkPA16802USA
- Huck Institutes of the Life Sciences101 Huck Life Sciences BuildingUniversity ParkPA16802USA
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Kuritzky L, Huynh Z, Arcenas R, Hansra A, Shah R, Yang B, Lillis R. Potential delayed and/or missed STI diagnoses among outpatients presenting with lower genitourinary tract symptoms: a real-world database study. Postgrad Med 2023; 135:809-817. [PMID: 37961909 DOI: 10.1080/00325481.2023.2280439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Sexually transmitted infection (STI) diagnosis is complicated as these infections can present with lower genitourinary tract symptoms (LGUTS) that overlap with other disorders, i.e. urinary tract infections (UTIs). The study's objective was to determine potential missed STI diagnoses from patients presenting with LGUTS in the US between January 2010 and December 2019. METHODS The de-identified insurance claims data from the IBM® MarketScan® Research Databases were collected from patients (14-64 years old) who presented with LGUTS, which could be caused by an STI. A 'GAP' cohort was created, consisting of episodes with potentially delayed STI (Chlamydia trachomatis [CT]/Neisseria gonorrhoeae [NG]) treatment. The intention was to capture episodes where an STI was not initially suspected. Four subgroups were defined depending on the treatment received (fluoroquinolone; azithromycin and/or doxycycline; cephalosporins; gentamicin and azithromycin). RESULTS The GAP cohort consisted of 833,574 LGUTS episodes from the original cohort (23,537,812 episodes). Post-index CT/NG testing was carried out for 4.6% and 5.4% of the episodes from men and women, respectively. There were ≥2 return visits for 16.1% and 15.8% of the episodes from men and women, respectively. A substantial percentage of episodes from men (52.1%) and women (68.3%) were diagnosed with a UTI and/or acute cystitis at the index prior to receiving post-index STI treatment. Other top conditions diagnosed at index for men were dysuria (25.8% of the episodes), orchitis/epididymitis (14.3% of the episodes), and acute prostatitis (10.1% of the episodes), and for women were dysuria (24.2% of the episodes), vaginitis/vulvitis/vulvovaginitis (11.7% of the episodes), and cervicitis (3.3% of the episodes). CONCLUSION These findings highlight delayed STI antibiotic treatment and low rates of CT/NG testing, suggesting late STI consideration and suboptimal diagnosis. Additionally, our study illustrates the importance of accurately diagnosing and treating STIs in patients with LGUTS and associated conditions, to avoid antibiotic misuse and complications from delayed administration of appropriate treatment.
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Affiliation(s)
- Louis Kuritzky
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
- Clinical Faculty, University of Central Florida/Hospital Corporation of America Family Medicine Residency, Gainesville, Florida, USA
| | - Zune Huynh
- Roche Molecular Systems, Inc, Pleasanton, California, USA
| | - Rodney Arcenas
- Roche Molecular Systems, Inc, Pleasanton, California, USA
| | - Avneet Hansra
- Roche Molecular Systems, Inc, Pleasanton, California, USA
| | - Roma Shah
- Roche Molecular Systems, Inc, Pleasanton, California, USA
| | - Baiyu Yang
- Roche Molecular Systems, Inc, Pleasanton, California, USA
| | - Rebecca Lillis
- Section of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Van Ommen CE, Malleson S, Grennan T. Approche pratique au diagnostic et à la prise en charge de la chlamydia et de la gonorrhée. CMAJ 2023; 195:E1189-E1195. [PMID: 37696558 PMCID: PMC10495173 DOI: 10.1503/cmaj.221849-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Affiliation(s)
- Clara E Van Ommen
- Division des maladies infectieuses (Van Ommen, Grennan), Université de la Colombie-Britannique; Centre britanno-colombien de contrôle des maladies (Malleson, Grennan), Vancouver, C.-B
| | - Sarah Malleson
- Division des maladies infectieuses (Van Ommen, Grennan), Université de la Colombie-Britannique; Centre britanno-colombien de contrôle des maladies (Malleson, Grennan), Vancouver, C.-B
| | - Troy Grennan
- Division des maladies infectieuses (Van Ommen, Grennan), Université de la Colombie-Britannique; Centre britanno-colombien de contrôle des maladies (Malleson, Grennan), Vancouver, C.-B
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Rodrigues R, Vieira-Baptista P, Catalão C, Borrego MJ, Sousa C, Vale N. Chlamydial and Gonococcal Genital Infections: A Narrative Review. J Pers Med 2023; 13:1170. [PMID: 37511783 PMCID: PMC10381338 DOI: 10.3390/jpm13071170] [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: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Sexually transmitted infections (STIs) constitute one of the leading causes of disease burden worldwide, leading to considerable morbidity, mortality, health expenditures, and stigma. Of note are the most common bacterial STIs, chlamydial and gonococcal infections, whose etiological agents are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), respectively. Despite being usually asymptomatic, in some cases these infections can be associated with long-term severe complications, such as pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, and increased risk of other STIs acquisition. As the symptoms, when present, are usually similar in both infections, and in most of the cases these infections co-occur, the dual-test strategy, searching for both pathogens, should be preferred. In line with this, herein we focus on the main aspects of CT and NG infections, the clinical symptoms as well as the appropriate state-of-the-art diagnostic tests and treatment. Cost-effective strategies for controlling CT and NG infections worldwide are addressed. The treatment for both infections is based on antibiotics. However, the continuing global rise in the incidence of these infections, concomitantly with the increased risk of antibiotics resistance, leads to difficulties in their control, particularly in the case of NG infections. We also discuss the potential mechanism of tumorigenesis related to CT infections. The molecular bases of CT and NG infections are addressed, as they should provide clues for control or eradication, through the development of new drugs and/or effective vaccines against these pathogens.
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Affiliation(s)
- Rafaela Rodrigues
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Pedro Vieira-Baptista
- Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Catalão
- Roche Sistemas de Diagnósticos, Estrada Nacional, 2720-413 Amadora, Portugal
| | - Maria José Borrego
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal
| | - Carlos Sousa
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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7
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Van Ommen CE, Malleson S, Grennan T. A practical approach to the diagnosis and management of chlamydia and gonorrhea. CMAJ 2023; 195:E844-E849. [PMID: 37336564 PMCID: PMC10281205 DOI: 10.1503/cmaj.221849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Affiliation(s)
- Clara E Van Ommen
- Division of Infectious Diseases (Van Ommen, Grennan), University of British Columbia; British Columbia Centre for Disease Control (Malleson, Grennan), Vancouver, BC
| | - Sarah Malleson
- Division of Infectious Diseases (Van Ommen, Grennan), University of British Columbia; British Columbia Centre for Disease Control (Malleson, Grennan), Vancouver, BC
| | - Troy Grennan
- Division of Infectious Diseases (Van Ommen, Grennan), University of British Columbia; British Columbia Centre for Disease Control (Malleson, Grennan), Vancouver, BC
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Obress L, Berke O, Fisman DN, Raju S, Tuite AR, Varia M, Greer AL. Estimating the test-adjusted incidence of Chlamydia trachomatis infections identified through Public Health Ontario Laboratories in Peel region, Ontario, 2010-2018: a population-based study. CMAJ Open 2023; 11:E62-E69. [PMID: 36693657 PMCID: PMC9876583 DOI: 10.9778/cmajo.20210236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Public health guidelines for chlamydia testing are not sex specific, but young females test at a disproportionally higher rate than males and other age groups. This study aims to describe testing trends across age and sex subgroups, then estimate a test-adjusted incidence of chlamydia in these subgroups to identify gaps in current testing practices. METHODS We used a population-based study to examine observed chlamydia rates by age and sex subgroups: 15-19 years, 20-29 years, 30-39 years and older than 40 years. The study included diagnostic test results recorded by Public Health Ontario Laboratories between Jan. 1, 2010, and Dec. 31, 2018, for individuals living in Peel region, Ontario. We then employed meta-regression models as a method of standardization to estimate the effect of sex and age on standardized morbidity ratio, testing ratio and test positivity, then calculate a test-adjusted incidence of chlamydia for each subgroup. RESULTS Over the study period, infection, testing and test positivity varied across age and sex subgroups. Observed incidence and testing were highest in females aged 20-29 years, whereas males had the highest standardized test positivity across all age groups. After estimating test-adjusted incidence for each age-sex subgroup, males in the 15-19-year and 30-39-year age groups had an increase in incidence of 60.2% and 9.7%, respectively, compared with the observed incidence. INTERPRETATION We found that estimated test-adjusted incidence was higher than observed incidence in males aged 15-19 years and 30-39 years. This suggests that infections in males are likely being missed owing to differential testing, and this may be contributing to the persistent increase in reported cases in Canada. Public health programming that targets males, especially in high-risk settings and communities, and use of innovative partner notification methods could be critical to curbing overall rates of chlamydia.
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Affiliation(s)
- Lindsay Obress
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Olaf Berke
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - David N Fisman
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Shilpa Raju
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Ashleigh R Tuite
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Monali Varia
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Amy L Greer
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont.
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9
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O’Toole D. Rapid recommendations: Updates from 2021 guidelines: part 2. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:754-756. [PMID: 36241397 PMCID: PMC9833129 DOI: 10.46747/cfp.6810754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Danielle O’Toole
- Practising family physician in Academic Family Medicine and Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
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10
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Ozua ML, Artaman A. A Retrospective Study of the Incidence of Bacterial Sexually Transmitted Infection (Chlamydia and Gonorrhea) in the Mississippi Delta Before and During the COVID-19 Pandemic. Cureus 2022; 14:e23712. [PMID: 35505759 PMCID: PMC9056590 DOI: 10.7759/cureus.23712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Sexually transmitted infections (STIs), such as gonorrhea and chlamydia infections, are prevalent worldwide, in the United States, and in Mississippi (MS). The COVID-19 pandemic has impacted the healthcare system, particularly in disadvantaged areas such as the MS Delta. Methods: A retrospective analysis of medical records of three clinics in the MS Delta was conducted during pre-COVID-19 (July 2019 to September 2019) and in the same months (July 2020 to September 2020) during COVID-19 in 2020. Patients tested for STIs were identified using infection diagnosis codes. We calculated percentages and means for demographic variables, changes between the two years, and computed the percentage of patients who tested positive for each year. Results: Out of the 25 patients tested for STIs, 11 were tested in 2019 and 14 in 2020. Among those tested in 2019 compared to 2020, patients were younger (average age: 34.3 years in 2019 vs. 29.6 years in 2020), had a larger percentage of females (81.2% in 2019 vs. 50.0% in 2020) and African Americans (72.7% in 2019 vs. 57.1% in 2020), and more were uninsured (27.3% in 2019 vs. 42.9% in 2020). Of the three clinics, clinic #1 tested most patients (72.7% in 2019 vs. 64.3% in 2020). Among the tested patients, 0% had confirmed positive results in 2019 and 21.4% in 2020. The incidence of positive results in 2020 was 7.1% for chlamydia and 14.3% for gonorrhea. Conclusion: The incidence of gonorrhea and chlamydia increased during COVID-19 in 2020. So, it is of paramount importance to encourage increased testing and targeted interventions for high-risk groups for STIs.
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11
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Dukers-Muijrers NHTM, Evers YJ, Hoebe CJPA, Wolffs PFG, de Vries HJC, Hoenderboom B, van der Sande MAB, Heijne J, Klausner JD, Hocking JS, van Bergen J. Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review. BMC Infect Dis 2022; 22:255. [PMID: 35287617 PMCID: PMC8922931 DOI: 10.1186/s12879-022-07171-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications. Strategies are not without controversy in asymptomatic women and men who have sex with men (MSM). Concerns are emerging to test and treat asymptomatic persons for urogenital CT (‘Controversy 1’) and pharyngeal or rectal CT (‘Controversy 2’), whereby testing symptomatic persons is not under debate. Opposed views in CT treatment involve using azithromycin versus doxycycline (‘Controversy 3’). The objective of this review is to provide coverage of these public health and clinical controversies by reviewing the current scientific evidence. Methods A literature search was performed using PubMed for relevant publications between 2018 and September 2021, and iterative retrieval of additional relevant publications. Results Controversy 1. In women, the majority of asymptomatic CT are at the urogenital site, and detections mostly include viable CT. CT easily transmits to a partner and potentially also between the vaginal and rectal areas; the clinical impact of urogenital CT is established, although risks for adverse outcomes are uncertain. Wide-scale testing in asymptomatic women has not resulted in reduced prevalence. In MSM, evidence for the clinical impact of asymptomatic urogenital CT is lacking. Controversy 2. Rectal CT is common in women diagnosed with urogenital CT, but the clinical impact of asymptomatic rectal CT is uncertain. In MSM, rectal CT is common, and most CT infections are at the rectal site, yet the risk of longer term complications is unknown. In both sexes, pharyngeal CT is uncommon and has no documented clinical impact. Controversy 3. In the treatment of rectal CT, doxycycline has superior effectiveness to azithromycin. Evidence has also accumulated on the harms of test-and-treat strategies. Conclusions Current practices vary widely, from widescale test-and-treat approaches to more individual patient- and partner-level case management. Choosing which asymptomatic people to test at what anatomic site, and whether to test or not, requires an urgent (re-)definition of the goals of testing and treating asymptomatic persons. Treatment guidelines are shifting toward universal doxycycline use, and clinical practice now faces the challenge of implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07171-2. Test-and-treat is a key strategy in the control of Chlamydia trachomatis (CT). We discuss recent controversies and present scientific evidence regarding urogenital, rectal, and pharyngeal CT test-and-treat strategies in women and in men who have sex with men (MSM). This should inform best practices for the prevention and management of the most common bacterial sexually transmitted infection (STI) worldwide.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands. .,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Ymke J Evers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Henry J C de Vries
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Bernice Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Institute for Public Health Genomics, Genetics & Cell Biology, Maastricht University, Faculty of Health and Medicine and Life Sciences, Maastricht, The Netherlands
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke Heijne
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jan van Bergen
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,STI AIDS Netherlands, Amsterdam, The Netherlands
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12
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Whellams D. Screening for chlamydia and gonorrhea in primary care in populations with low prevalence. CMAJ 2021; 193:E1307. [PMID: 34426450 PMCID: PMC8412425 DOI: 10.1503/cmaj.79560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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13
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Palmer LD, Heung T, Corral M, Boot E, Brooks SG, Bassett AS. Sexual knowledge and behaviour in 22q11.2 deletion syndrome, a complex care condition. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:966-975. [PMID: 34291536 DOI: 10.1111/jar.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/23/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited information about sexual knowledge and behaviours in adults with complex care needs, including those with 22q11.2 deletion syndrome (22q) which represents a group predisposed to intellectual disabilities. METHODS We conducted sexual health assessments with 67 adults with 22q, examining whether those with knowledge deficits and a history of engaging in sexual activities with others would be more likely to engage in high-risk behaviours. RESULTS The majority (65.7%) of adults with 22q were sexually active with others; most (70.1%) had sexual knowledge deficits. Those with intellectual disabilities were more likely (p = .0012) to have deficits in certain topics. In the sexually active subgroup, most (81.8%) engaged in high-risk sexual behaviours, regardless of intellectual disability or knowledge deficits. CONCLUSION The results suggest a need for increased dialogue, repeated education, genetic counselling and preventive healthcare measures related to sexuality in 22q and potentially in other complex care conditions.
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Affiliation(s)
- Lisa D Palmer
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada
| | - Tracy Heung
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Maria Corral
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Advisium, 's Heeren Loo, Amersfoort, The Netherlands.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Stephanie G Brooks
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, and Division of Cardiology, Department of Medicine and, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Grennan T, Tan DHS. Avantages du dépistage opportuniste des infections transmissibles sexuellement en médecine de soins primaires. CMAJ 2021; 193:E710-E712. [PMID: 33972232 PMCID: PMC8157998 DOI: 10.1503/cmaj.210604-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Troy Grennan
- Laboratoire de lutte contre la maladie de la Colombie-Britannique (Grennan); Département de médecine, Division d'infectiologie, Université de la Colombie-Britannique (Grennan), Vancouver, C.-B.; Division d'infectiologie (Tan), Hôpital St. Michael; Département de médecine (Tan), Université de Toronto, Toronto, Ont.
| | - Darrell H S Tan
- Laboratoire de lutte contre la maladie de la Colombie-Britannique (Grennan); Département de médecine, Division d'infectiologie, Université de la Colombie-Britannique (Grennan), Vancouver, C.-B.; Division d'infectiologie (Tan), Hôpital St. Michael; Département de médecine (Tan), Université de Toronto, Toronto, Ont
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15
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Grennan T, Tan DHS. Benefits of opportunistic screening for sexually transmitted infections in primary care. CMAJ 2021; 193:E566-E567. [PMID: 33875463 PMCID: PMC8084552 DOI: 10.1503/cmaj.210604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Troy Grennan
- British Columbia Centre for Disease Control (Grennan); Department of Medicine, Division of Infectious Diseases, University of British Columbia (Grennan), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.
| | - Darrell H S Tan
- British Columbia Centre for Disease Control (Grennan); Department of Medicine, Division of Infectious Diseases, University of British Columbia (Grennan), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont
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