Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016

A structure-optimized molecular beacon-based RPA assay for highly sensitive and rapid detection of Neisseria gonorrhoeae

Early detection of Neisseria gonorrhoeae (NG) is key to controlling its transmission and ensuring prevention and treatment. Recombinase polymerase amplification (RPA), combined with traditional fluorescent probe assays, is a promising method for NG detection. However, these traditional probes require four types of modifications involving cumbersome modification processes and high synthesis costs, and additional nucleic acid endonucleases are also needed for the reaction. In this paper, we propose a structure-optimized molecular beacon (SOMB) for RPA fluorescence detection in NG. We systematically investigated the effects of the length of the MB stem, base number of target recognition, and degree of partial closure of target recognition on the signal-to-noise ratio of the sensors, ultimately obtaining a SOMB with a unique secondary structure. The SOMB-based RPA assay platform provides rapid detection within 30 min at 37 °C with high specificity and detection limits as low as 0.96 copies/μL. In the detection of clinical samples, this method has good consistency with real-time PCR. Unlike conventional fluorescent probes, the SOMB for RPA proposed in this study has a simple and flexible design, requires few modifications, and does not require nucleic acid endonucleases.

High Prevalence of Sexually Transmitted Infections and Poor Sensitivity and Specificity of Screening Algorithms for Chlamydia and Gonorrhea Among Female Sex Workers in Zimbabwe: Analysis of Respondent-Driven Sampling Surveys in 3 Communities

BACKGROUND

Effective strategies to reduce sexually transmitted infection burden and transmission among female sex workers (FSWs) and their networks are needed. We report sexually transmitted infection prevalence among FSWs in Zimbabwe and investigate the performance of screening algorithms.

METHODS

Respondent-driven sampling (RDS) surveys, including blood sampling for syphilis serology, were conducted among FSWs in 3 communities in Zimbabwe in 2017. In addition, a random sample of one-third of participants were offered genital examination and sexually transmitted infection (STI) testing. Data on symptoms and clinical signs were analyzed to determine the proportion of asymptomatic and clinically inapparent STIs by HIV status, and the sensitivity, specificity, and predictive values of syndromic, clinical, and hybrid screening algorithms for chlamydia and gonorrhea. Analyses were RDS-II weighted.

RESULTS

Overall, 2507 women were included in the RDS surveys, and 661 of 836 (79.1%) of those randomly offered genital examination and STI testing accepted. The prevalence of STI by site ranged from 15.7% to 20.0% for syphilis (rapid plasma reagin + Treponema pallidum hemagglutination assay), 6.8% to 14.3% for gonorrhea, 8.4% to 10.1% for chlamydia, 26.6% to 35.5% for trichomonas, and 37.0% to 47.6% for any high-risk human papilloma virus. A high proportion of infections were both asymptomatic and clinically undetectable (gonorrhea: 41.2%, chlamydia: 51.7%, trichomonas: 62.8%). Screening algorithms performed poorly whether based on symptoms only (sensitivity: 53.3% gonorrhea, 43.3% chlamydia) or either symptoms or clinical signs (sensitivity: 58.7% gonorrhea, 48.3% chlamydia).

CONCLUSIONS

Sexually transmitted infection burden is high among FSWs in Zimbabwe. The low sensitivity and specificity of screening algorithms used to guide syndromic management mean that more effective approaches are required to strengthen STI control. As access to HIV-specific prevention methods like preexposure prophylaxis increases, support for consistent condom use needs to be strengthened.

German evidence- and consensus-based guideline on the management of penile urethritis

Urethritis is a common condition predominantly caused by sexually transmitted pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium. It is not possible to differentiate with certainty between pathogens on the basis of clinical characteristics alone. However, empirical antibiotic therapy is often initiated in clinical practice. The aim of this clinical practice guideline is to promote an evidence-based syndrome-orientated approach to the management of male adolescents and adults with symptoms of urethritis. Besides recommendations for the diagnosis, classification and choice of treatment, this guideline provides recommendations for the indication to empirically treat patients with penile urethritis. A novel feature compared to existing, pathogen-specific guidelines is the inclusion of a flowchart for the syndrome-orientated practical management. For suspected gonococcal urethritis requiring empirical treatment, ceftriaxone is recommended. Due to the risk of Chlamydia trachomatis co-infection, doxycycline should also be prescribed, unless follow-up for the treatment of possible co-infections is assured. For suspected non-gonococcal urethritis, doxycycline is the recommended empirical treatment. In the empiric treatment of both gonococcal and non-gonococcal penile urethritis, azithromycin is reserved for cases where doxycycline is contraindicated. This guideline also includes detailed recommendations on differential diagnosis, pathogen-specific treatments and specific situations, as well as patient counselling and follow-up.

Overview of point-of-care diagnostic options for detection of chlamydia trachomatis: current technology and implementation considerations

INTRODUCTION CHLAMYDIA TRACHOMATIS

continues to be the most common bacterial infection worldwide and rates continue to increase despite long-standing control efforts. Point of care (POC) testing options may offer improvements in case finding that lead to improved control of this sexually transmitted infection (STI).

AREAS COVERED

This review will provide information on the three tests that have US Food and Drug Administration (FDA) clearance and describe assays in the developmental pipeline. The review will also provide implementation evaluations of the existing tests and offer suggestions about factors to consider prior to adoption of these or newer tests as they become available.

EXPERT OPINION

Technology is developing rapidly and may soon offer many choices of rapid diagnostic tools which can be used in clinical settings to detect chlamydial infections, particularly in underserved populations. The key to successful deployment of new tests will rest on data generated by implementation research to identify the features that create barriers or facilitate adoption of a new clinical paradigm.

High rates of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis co-infection in people with HIV: a systematic review and meta-analysis

PURPOSE

People living with HIV (PWH) experience a disproportionate burden of sexually transmitted infections (STIs), leading to more severe health outcomes and increasing the risk of HIV transmission. The presence of untreated STIs can accelerate HIV disease progression, while HIV infection can complicate STI diagnosis and treatment. Despite this interconnectedness, comprehensive data on the global prevalence of specific STIs among PWH remain limited. This systematic review aims to synthesize existing data to provide a more accurate picture of the prevalence of co-infection with Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis or Trichomonas vaginalis in PWH, while also identifying critical knowledge gaps and informing future research priorities.

METHODS

We searched databases for eligible studies reporting the prevalence of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis among PWH, published from January 1, 2000, to February 1, 2023. From 22,290 identified articles, 127 independent studies meeting the inclusion criteria were included in this meta-analysis.

RESULTS

The overall global co-infection prevalence of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis in PWH, was 4.8% (95%CI: 4.7-5.0%), 0.8% (95%CI: 0.6-0.9%), 2.5% (95%CI: 2.2-2.7%), and 3.0% (95%CI: 2.7-3.3%), respectively. The global prevalence of these four STIs in PWH is high, especially in Africa and Southeast Asia and in MSM and TGW populations. Based on the subgroup analyses, we further found that there was a high prevalence of Treponema pallidum and Chlamydia trachomatis in Southeast Asia and a high infection of Trichomonas vaginalis in the whole of Africa. Treponema pallidum infection was more common in males than females, and Chlamydia trachomatis and Trichomonas vaginalis infections were more common in females than males. Besides, high infection rates of Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis were detected in men who have sex with men (MSM) + transgender women (TGW), while high infection rates of Trichomonas vaginalis were found in sex workers and pregnant women.

CONCLUSION

The study confirmed high prevalence of four sexually transmitted pathogens in PWH, noting regional, gender, and subpopulation-specific differences. It offered insights for targeted interventions and healthcare strategies. The research underscored the necessity for enhanced data collection and expanded screening/treatment for vulnerable populations and regions.

The impact of the National Syphilis Prevention Program on the prevalence of syphilis among people living with HIV in China: a systematic review and meta-analysis

INTRODUCTION

In 2010, China launched the 10-year National Syphilis Prevention and Control Program to curb the spread of syphilis by integrating syphilis screening and treatment with HIV services. Herein, we aimed to evaluate changes in the prevalence of syphilis among people living with HIV (PLHIV) in China.

METHODS

We conducted this systematic review and meta-analysis by searching the PubMed, Embase, Web of Science, China Biomedical Literature, China National Knowledge Infrastructure, Wanfang and CQVIP databases from inception to 1 June 2024 to obtain relevant articles. A total of 75 studies were ultimately included. We used a DerSimonian‒Laird random effects model to estimate the prevalence and 95% confidence interval of syphilis among PLHIV.

RESULTS

The overall prevalence of syphilis among PLHIV in China was 18.6% (95% CI 16.5-21.0). Regional differences (R2 = 15.29%) were observed in the prevalence rates: 22.2% (18.9-25.8) in the eastern region, 19.0% (15.1-23.8) in the central region and 14.0% (11.1-17.5) in the western region. The prevalence decreased from 22.8% (18.4-27.9) before 2010 to 17.0% (14.6-19.6) in 2010 and thereafter (R2 = 5.82%). Among PLHIV via homosexual transmission, the prevalence of syphilis was 24.9% (21.3-28.9), which significantly declined from 33.8% (27.5-40.8) to 21.4% (18.3-24.9) in 2010 and thereafter (R2 = 22.35%). The prevalence of syphilis was significantly higher in men living with HIV than in women living with HIV (pooled odds ratio 1.67, 95% CI 1.29-2.15), with the highest prevalence in the eastern region (2.55, 95% CI 1.80-3.59).

DISCUSSION

The prevalence of syphilis among PLHIV, particularly in cases of homosexual transmission, has declined. There was a correlation between the prevalence of syphilis and regional economic conditions, with a greater burden in developed eastern coastal areas. Additionally, the risk of syphilis differed across sexes, with men living with HIV having a higher risk.

CONCLUSIONS

There has been preliminary success in the control of syphilis among PLHIV, but there is still a long way to go to meet the WHO's 2030 syphilis prevention and control goal. Syphilis prevention measures should be integrated into broader health policies and development plans, particularly in high-burden regions and populations.

Exploring the diversity of sexual acts in Chinese men who have sex with men and its impacts on the risk of HIV and sexually transmitted infections

OBJECTIVES

High-risk sexual behaviour contributes to sexually transmitted infections (STIs), but the diversity of sexual acts in men who have sex with men (MSM) was understudied. We aimed to identify the diversity of sexual acts in Chinese MSM and its impacts on HIV/STI risk.

STUDY DESIGN

Cross-sectional study.

METHODS

Between January and September 2022, the study was conducted in Xi'an, China, to identify sexual acts performed during the last sexual episode, which was measured by the Shannon diversity index.

RESULTS

Of the 931 MSM, 2.9 % tested positive for HIV, 5.7 % for syphilis, 13.6 % for gonorrhoea and 12.9 % for chlamydia. The Shannon diversity index for individual sexual acts was 1.609 (IQR 0.693-1.946), whereas the index for sexual act pairs was 1.386 (IQR 0-1.792). MSM infected with gonorrhoea exhibited significantly greater diversity in individual sexual acts (1.792 vs. 1.609) and sexual act pairs (1.609 vs. 1.386) than otherwise. Compared with MSM having one partner over the past 3 months, MSM with 2-5 partners was 69.7 % more diverse in individual sexual acts (aOR = 1.697, 1.489-1.935) and 59.4 % more diverse in sexual act pairs (aOR = 1.594, 1.401-1.811). For MSM with >5 partners, the corresponding percentages were 84.8 % (aOR = 1.848, 1.624-2.104) and 56.2 % (aOR = 1.562, 1.368-1.782). Compared with those who did not use saliva as a lubricant, MSM who did were less diverse in individual sexual acts (aOR = 0.763, 0.662-0.878) and sexual act pairs (aOR = 0.752, 0.654-0.866).

CONCLUSION

MSM infected with gonorrhoea and those with multiple sexual partners are more diverse in sexual acts during sexual episodes.

Community pharmacies: Key players in point-of-care diagnostics for STI screening in Africa

BACKGROUND

Sexually Transmitted Infections (STIs) rank in the top 5 disease categories for which adults in developing countries seek healthcare services. Community pharmacies offer clients convenience, proximity, extended opening hours, privacy, and efficiency, which could make them desirable locations for HIV and STI screening and treatment. We examined the feasibility of using point-of-care (POC) STI tests for screening HIV and other STIs at community pharmacies.

METHODS

We conducted a prospective cohort study of persons seeking medication and other services at 18 purposively selected community pharmacies in Kampala, Uganda. Study participants comprised two broad categories: i) Symptomatic persons aged 18 years who presented with at least one STI sign or symptom and were purchasing treatment for themselves; ii) persons presenting with no STI symptom who had come to purchase any other medication, including family planning services such as emergency contraception. POC tests were used to test HIV, Chlamydia trachomatis (Ct), Neisseria gonorrhoeae (Ng), Trichomonas vaginalis (Tv), and Syphilis. Test results were returned on-site or via telephone within 48 to 72 hours. Descriptive statistics were used to estimate the prevalence of STIs.

RESULTS

Of the 450 participants enrolled, 235 (52.2%) were symptomatic, 215 (47.8%) were asymptomatic, and 280 (62.2%) were females. STI testing was feasible, with an acceptability rate of 99.8%. 135 (30%) of participants had at least one STI; HIV prevalence was 39 (8.7%), Syphilis prevalence was 14 (3.1%), 50 (11.1%) tested positive for Ng, 39 (8.7%) were positive for Ct while. The prevalence of Tv was 25 (8.9%) (tested among women). A total of 107 (23.8%) participants had used an antibiotic in the preceding month.

CONCLUSION

Our research underscores the potentially pivotal role of community pharmacies in deploying POC diagnostics for STIs and antimicrobial stewardship by decreasing unnecessary antibiotic dispensation across Africa.

Loss in Pluripotency Markers in Mesenchymal Stem Cells upon Infection with Chlamydia trachomatis

The intracellular pathogen Chlamydia trachomatis can inflict substantial damage on the host. Notably, Chlamydia infection is acknowledged for its precise modulation of diverse host signaling pathways to ensure cell survival, a phenomenon intricately connected to genetic regulatory changes in host cells. To monitor shifts in gene regulation within Chlamydia-infected cells, we employed mesenchymal stem cells (MSCs) as a naïve, primary cell model. Utilizing biochemical methods and imaging, our study discloses that acute Chlamydia infection in human MSCs leads to the downregulation of transcription factors Oct4, Sox2, and Nanog, suggesting a loss of pluripotency markers. Conversely, pluripotency markers in MSCs were sustained through treatment with conditioned medium from infected MSCs. Additionally, there is an augmentation in alkaline phosphatase activity, along with elevated Sox9 and CD44 mRNA expression levels observed during acute infection. A comprehensive screening for specific cell markers using touchdown PCR indicates an upregulation of mRNA for the early chondrogenesis gene Sox9 and a decrease in mRNA for the MSC marker vimentin. Real-time PCR quantification further corroborates alterations in gene expression, encompassing increased Sox9 and CD44 mRNA levels, alongside heightened alkaline phosphatase activity. In summary, the infection of MSCs with C. trachomatis induces numerous genetic deregulations, implying a potential trend towards differentiation into chondrocytes. These findings collectively underscore a targeted impact of Chlamydia on the gene regulations of host cells, carrying significant implications for the final fate and differentiation of these cells.

Long-term management of refractory vaginal trichomoniasis following initial metronidazole treatment failure: A case series

Guidelines for sexually transmitted infections recommend oral metronidazole (MNZ) as the first-line treatment option for vaginal trichomoniasis; however, there have been cases of prolonged symptoms or recurrence after treatment. To consider appropriate treatment strategies for refractory vaginal trichomoniasis, we conducted a retrospective cohort study. We reviewed the medical records of patients who tested positive for Trichomonas vaginalis (T. vaginalis) at the National Center for Global Health and Medicine between August 2011 and May 2023. Refractory vaginal trichomoniasis was defined as the failure after the initial MNZ treatment. During the study period, nine cases of vaginal trichomoniasis were identified, six of which were refractory to treatment for T. vaginalis. Four patients were cured with a combination of oral and vaginal tinidazole (TNZ) therapy, one with oral TNZ and one with two doses of MNZ. Possible causes of treatment failure include MNZ-resistant T. vaginalis, reinfection between partners, and infections of other sexual transmitted diseases. However, the fact that TNZ was effective suggests that MNZ-resistant T. vaginalis may have been the cause. Although MNZ resistance testing was not performed in this study, treatment with TNZ should be considered in cases of refractory vaginal trichomoniasis, possibly caused by MNZ-resistant T. vaginalis.

TtrAgo-mediated nucleic acid detection system and portable device for rapid detection of sexually transmitted diseases

The development of rapid and multiplexed point-of-care (POC) diagnostic tools is vital for the prevention and control of sexually transmitted diseases (STIs). Here, we developed a POC-comprehensive Thermococcus thioreducensArgonaute (TtrAgo)-mediated nucleic acid detection system (POC-CANDY) and palm-sized portable detection device "Owl-1" for the simultaneous detection of Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus types 16/18 and antibiotic resistance molecular markers [tetM, and gyrA mutation (S91F)]. Using recombinase polymerase amplification (RPA), the optimized POC-CANDY could finish the whole detection procedure within 55 min and achieve a limit of detection of 10 copies/μL. When validated by clinical STI samples, POC-CANDY showed 100% consistency with quantitative PCR. Additionally, compared with the PfAgo-based system, POC-CANDY significantly improved the sensitivity of distinguishing single nucleotide variations. The results demonstrated that POC-CANDY can be easily applied locally or on site. This study also promotes the utility of the TtrAgo-mediated technique in clinical diagnosis.

Preliminary clinical performance of a Cas13a-based lateral flow assay for detecting Neisseria gonorrhoeae in urine specimens

Nucleic acid amplification testing (NAAT) for N. gonorrhoeae is unavailable in resource-limited settings. We previously developed a CRISPR-based lateral flow assay for detecting N. gonorrhoeae. We aimed to pair that assay with point-of-care DNA extraction, assess performance in clinical urine specimens, and optimize assay kinetics. We collected urine specimens among men presenting with urethritis enrolling in a clinical trial at the Massachusetts General Hospital Sexual Health Clinic. We assessed the quantified DNA yield of detergent-based extractions with and without heat. We selected one detergent for extracting all specimens, paired with isothermal recombinase polymerase amplification for 90 minutes and lateral flow Cas13a detection, interpreted via pixel intensity analysis. We also trained a smartphone-based machine-learning model on 1,008 images to classify lateral flow results. We used the model to interpret lateral flow results from the clinical specimens. We also tested a modified amplification chemistry with a second forward primer lacking the T7-promoter to accelerate reaction kinetics. Extraction with 0.02% Triton X resulted in an average DNA yield of 2.6 × 106 copies/µL (SD ± 6.7 × 105). We treated 40 urine specimens (n = 12 positive) with 0.02% Triton X, and using quantified pixel intensity analysis, the Cas13a-based assay correctly classified all specimens (100% agreement; 95% CI 91.2%-100%). The machine-learning model correctly classified 45/45 strips in the validation data set and all 40 lateral flow strips from clinical specimens. Including the second forward primer reduced incubation time to 60 minutes. Using point-of-care DNA extraction, our Cas13a-based lateral flow N. gonorrhoeae assay demonstrated promising performance among clinical urine specimens.IMPORTANCEUsing a CRISPR-based assay we previously developed for Neisseria gonorrhoeae detection, we developed new techniques to facilitate point-of-care use. We then demonstrated the promising performance of that assay in clinical specimens. Furthermore, we developed a smartphone-based machine learning application for assisting interpretation of lateral flow strip results. Such an assay has the potential to transform the care of sexually transmitted infections in low-resource settings where diagnostic tests are unavailable. A point-of-care pathogen-specific assay, paired with the connectivity offered by a smartphone application, can also support public health surveillance efforts in such areas.

Prevalence of chlamydia, gonorrhoea, and trichomoniasis among male and female general populations in sub-Saharan Africa from 2000-2024: A systematic review and meta-regression analysis

Background

Sub-Saharan Africa (SSA) has the highest sexually transmitted infection (STI) prevalence globally, but information about trends and geographic variation is limited by sparse aetiologic studies, particularly among men. This systematic review assessed chlamydia, gonorrhoea, and trichomoniasis prevalence by sex, sub-region, and year, and estimated male-to-female prevalence ratios for SSA.

Methods

We searched Embase, MEDLINE, Global Health, PubMed, and African Index Medicus for studies measuring STI prevalence among general populations from January 1, 2000, to September 17, 2024. We adjusted observations for diagnostic test performance and used log-binomial mixed-effects meta-regressions to estimate prevalence trends and sex-prevalence ratios.

Findings

Of 5202 records identified, we included 211 studies from 28 countries. In 2020, estimated prevalence among 15-49-year-olds in SSA for chlamydia was 6.6% (95%CI: 5.0-8.2%, n=169 observations) among females and 4.7% (3.4-6.1%, n=33) among males, gonorrhoea was 2.4% (1.4-3.3%, n=171) and 1.7% (0.7-2.6%, n=31), and trichomoniasis was 6.8% (3.6-9.9%, n=188) and 1.7% (0.7-2.7%, n=19). Male-to-female ratio estimates were 0.61 (0.53-0.71) for chlamydia, 0.81 (0.61-1.09) for gonorrhoea, and 0.23 (0.18-0.28) for trichomoniasis. From 2010-2020, chlamydia prevalence increased by 34.5% (11.1-62.9%) in SSA, while gonorrhoea and trichomoniasis trends were not statistically significant. Chlamydia and gonorrhoea prevalence were highest in Southern and Eastern Africa, whereas trichomoniasis was similar across sub-regions.

Interpretation

SSA has a high, geographically varied STI burden, with increasing prevalence of chlamydia. Region-specific sex-prevalence ratios differed from existing global ratios and should be considered in future burden estimates. Enhanced sex-stratified surveillance is crucial to guide national programmes and reduce STI prevalence in SSA.

Funding

Gates Foundation, Imperial College London, NIH, UKRI.

The Significance of the Cell-Mediated Host Immune Response in Syphilis

Syphilis, caused by the highly invasive pathogen Treponema pallidum, remains one of the oldest and most significant public health challenges. According to the World Health Organization (WHO), the number of new syphilis cases among adults aged 15-49 years in 2022 was estimated at approximately 8 million, with notable increases observed in Europe, the Americas, and Africa. The cellular immune response plays a critical role in combating this infection, and its insufficient activity may contribute to chronic progression of the disease. T. pallidum effectively evades the host immune response, enabling its prolonged survival within the host and increasing the risk of late complications such as neurosyphilis and cardiovascular syphilis. This review article discusses the mechanisms of cellular immune responses in T. pallidum infection, including T lymphocyte activation, proinflammatory cytokine production, and the roles of macrophages and dendritic cells in pathogen recognition and elimination. Additionally, it examines the immune evasion strategies employed by T. pallidum, such as the low immunogenicity of its antigens and its ability to suppress the activation of effector cells. A comprehensive understanding of the current knowledge regarding cellular immune mechanisms may contribute to the development of more effective diagnostic and therapeutic approaches in syphilis management.

Ectopic pregnancy

Ectopic pregnancy, defined as the implantation of a developing pregnancy outside of the endometrial cavity of the uterus, is the leading cause of early-pregnancy maternal mortality. The majority of ectopic pregnancies implant in a fallopian tube. Acute complications may include rupture of the fallopian tube or rupture of ectopic pregnancy, haemorrhage and hypovolaemic shock, or occur secondary to treatments such as emergency surgery or blood transfusions, and ultimately increase the risk of maternal death. After ectopic pregnancy, patients may experience ongoing morbidity, including chronic pain, infertility and psychological distress. Assessment of ectopic pregnancy should focus on prompt diagnosis based on clinical and investigative findings but should also reflect a patient-centred approach with acknowledgement of potential psychological distress associated with pregnancy loss and reduced future fertility. Over the last four decades, the foundations of non-invasive diagnosis have been transvaginal sonography and serum β-human chorionic gonadotropin, with diagnostic laparoscopy as a confirmatory test if surgical treatment is planned. Once diagnosed, ectopic pregnancy can be managed expectantly, treated medically with methotrexate or managed surgically. Future fertility is an important but often overlooked aspect in the management of ectopic pregnancy.

Helichrysum populifolium Compounds Inhibit MtrCDE Efflux Pump Transport Protein for the Potential Management of Gonorrhoea Infection

The progressive development of resistance in Neisseria gonorrhoeae to almost all available antibiotics has made it crucial to develop novel approaches to tackling multi-drug resistance (MDR). One of the primary causes of antibiotic resistance is the over-expression of the MtrCDE efflux pump protein, making this protein a vital target for fighting against antimicrobial resistance (AMR) in N. gonorrhoeae. This study was aimed at evaluating the potential MtrCDE efflux pump inhibitors (EPIs) and their stability in treating gonorrhoea infection. This is significant because finding novel EPIs would allow for the longer maintenance of antibiotics at therapeutic levels, thereby prolonging the susceptibility of currently available antibiotics. A virtual screening of the selected Helichrysum populifolium compounds (4,5-dicaffeoylquinic acid, apigeninin-7-glucoside, and carvacrol) was conducted to evaluate their potential EPI activity. An integrated computational framework consisting of molecular docking (MD), molecular mechanics generalized born, and surface area solvation (MMGBSA) analysis, molecular dynamics simulations (MDS), and absorption, distribution, metabolism, and excretion (ADME) properties calculations were conducted. Of the tested compounds, 4,5-dicaffeoylquinic acid revealed the highest molecular docking binding energies (-8.8 kcal/mol), equivalent MMGBSA binding free energy (-54.82 kcal/mol), indicative of consistent binding affinity with the MtrD protein, reduced deviations and flexibility (root mean square deviation (RMSD) of 5.65 Å) and, given by root mean square fluctuation (RMSF) of 1.877 Å. Carvacrol revealed a docking score of -6.0 kcal/mol and a MMGBSA computed BFE of -16.69 kcal/mol, demonstrating the lowest binding affinity to the MtrD efflux pump compared to the remaining test compounds. However, the average RMSD (4.45 Å) and RMSF (1.638 Å) of carvacrol-bound MtrD protein showed no significant difference from the unbound MtrD protein, except for the reference compounds, implying consistent MtrD conformation throughout simulations and indicates a desirable feature during drug design. Additionally, carvacrol obeyed the Lipinski rule of five which confirmed the compound's drug-likeness properties making it the most promising EPI candidate based on its combined attributes of a reasonable binding affinity, sustained stability during MDS, its obedience to the Lipinski rule of five and compliance with drug-likeness criteria. An in vitro validation of the potential EPI activities of H. populifolium compounds confirmed that 4,5-dicaffeoylquinic acid reduced the expulsion of the bis-benzimide dye by MtrCDE pump, while carvacrol showed low accumulation compared to other compounds. While 4,5-dicaffeoylquinic acid demonstrated the highest binding affinity in computational analysis and an EPI activity in vitro, it showed lower stability compared to the other compounds, as indicated in MDS. This leaves carvacrol, as a better EPI candidate for the management of gonorrhoea infection.

Prospective evaluation of non-invasive saliva specimens for the diagnosis of syphilis and molecular surveillance of Treponema pallidum

The promising diagnostic performance of molecular testing for syphilis using saliva and urine samples has been reported; however, further evaluation of its possible application for diagnosis and molecular surveillance is required. In addition, the development of a rapid and easy-to-perform molecular test for syphilis is important for its use in the clinical setting. We comprehensively evaluated the diagnostic and surveillance performance of two novel loop-mediated isothermal amplification (LAMP) assays using saliva and urine samples. Saliva, urine, and whole blood were collected from patients who underwent serological testing for syphilis at outpatient clinics. Treponema pallidum DNA in specimens was detected using quantitative PCR (qPCR), nested PCR, and novel LAMP assays. T. pallidum genotyping was conducted by multi-locus sequence typing (MLST). Of the 163 patients recruited, 98 were diagnosed with syphilis (primary: n = 35; secondary: n = 40; latent: n = 23). qPCR showed the highest sensitivity among the molecular tests performed with a sensitivity of 54.1% and 30.3% for all syphilis patients using saliva and urine samples, respectively. A novel method of LAMP combined with dry reagents and crude DNA extraction (Dry-LAMP) showed a probit detection limit of 37.4 copies/reaction within 45 min. The agreement rate between Dry-LAMP and qPCR for saliva was 95.7% (κ coefficient 0.90). The T. pallidum genotype was identified in 48 patients by MLST using saliva samples. Molecular analysis of saliva could be used as a supplementary diagnostic test for syphilis and molecular surveillance of the T. pallidum genotype. Dry-LAMP is expected to be helpful in the clinical diagnosis of syphilis.

Estimated global and regional incidence and prevalence of herpes simplex virus infections and genital ulcer disease in 2020: mathematical modelling analyses

OBJECTIVES

Genital herpes simplex virus (HSV) type 1 and 2 infections are lifelong and can cause symptomatic genital ulcer disease (GUD). HSV-2 almost always causes sexually transmitted genital infection, while HSV-1 mainly causes oral infection but can be sexually transmitted to cause genital infection. This study estimated genital infection with both HSV types and associated GUD globally in 2020, breaking down the data by WHO region and sex for females and males.

METHODS

A calibrated mathematical model was employed to generate estimates for the incidence and prevalence of HSV-2 infection, genital HSV-1 infection, and GUD caused by both HSV types. Estimates for non-genital infections caused by HSV-1 were also generated. Model input was derived from a comprehensive systematic review and meta-analyses of HSV prevalence data for all WHO regions.

RESULTS

Globally in 2020 there were 25.6 million (95% uncertainty interval (UI) 23.1-29.4 million) people aged 15-49 years with new HSV-2 infections, and 519.5 million (95% UI 464.3-611.3 million), or 13.3% (95% UI 11.9-15.6%), with existing (prevalent) HSV-2 infections. In addition, there were 16.8 million (95% UI 10.6-22.4 million) people aged 15-49 years with new genital HSV-1 infections and 376.2 million (95% UI 235.6-483.5 million), or 10.2% (95% UI 6.4-13.1%), with prevalent genital HSV-1 infections. The estimated number of people aged 15-49 years with at least one episode of HSV-attributable GUD in 2020 was 187.9 million (95% UI 116.0-291.8 million) for HSV-2, and 16.7 million (95% UI 9.3-25.2 million) for HSV-1, totalling 204.6 million (95% UI 132.3-306.5 million).

CONCLUSION

Genital HSV infections have a high incidence and prevalence worldwide, contributing to a significant GUD disease burden. New prevention and treatment measures, such as prophylactic and therapeutic HSV vaccines, are needed critically to control HSV infections and reduce the associated disease burden.

Screening for STIs: Results of a Health-Promotion Programme in a Portuguese University

Sexually Transmitted Infections (STIs) are an important and growing public health concern. Implementation of screening programmes and awareness campaigns are crucial to mitigate this problem. A university in the central region of Portugal has devised a health-promotion programme, named Protection+, specifically directed towards the sexual health of the university community. The present study aimed to evaluate the results of the different actions undertaken as part of the health-promotion programme during the 2023-2024 academic year. Chlamydia, gonorrhoea, trichomoniasis and infection with Mycoplasma genitalium were assessed through real-time polymerase chain reaction protocols. Syphilis, infection with HIV, HBV and HCV were assessed through immunological assays. The adherence to the health-promotion programme after the awareness campaigns was also evaluated. STIs have been diagnosed in 13.7% of the 475 screened participants. Chlamydia was the STI most frequently diagnosed (8.4%), followed by infection with M. genitalium (2.3%), T. pallidum (2.0%) and N. gonorrhoeae (1.1%). HIV, HBV and HCV were diagnosed in a residual number of cases, and T. vaginalis was not detected in any of the screened participants. At the time of diagnosis, more than half of the infected patients were asymptomatic. After the implementation of awareness campaigns, an increase in the adherence to STI screening was observed, with the expected simultaneous increase in STI diagnoses. The high prevalence of STIs, particularly chlamydia, in the university population, along with the asymptomatic nature of these infections, demonstrated the importance of STI screenings and the implementation of campaigns that raise awareness on the prevention and consequences of untreated STIs.

Establishment of a programmatic detection method for Trichomonas vaginalis based on double antibody sandwich ELISA targeting TvCP39 antigen

BACKGROUND

Trichomonas vaginalis (T. vaginalis) is a common sexually transmitted parasite that colonizes the human urogenital tract. Programmed and precise detection of T. vaginalis is a key step in preventing and treating trichomoniasis. However, the current detection methods of T. vaginalis, including wet mount microscopy, culture, nested PCR, loop-mediated isothermal amplification, and recombinant enzyme polymerase amplification, have some shortcomings. Therefore, it is urgent to establish a programmed, sensitive, and specific method for detecting T. vaginalis.

METHODS

T. vaginalis cysteine protease 39 (TvCP39) was expressed in segments as TvCP39-1 and TvCP39-2, and the polyclonal antibodies were prepared by immunizing rats and rabbits. The concentration of the polyclonal antibodies of anti-rTvCP39-2 and anti-rTvCP39-1 was determined by square matrix titration. The sensitivity and specificity of double antibody sandwich ELISA were analyzed and evaluated by detecting rTvCP39 and T. vaginalis excretory-secretory proteins (TvESPs) diluted in multiple ratios and detecting excretory-secretory proteins of T. vaginalis and other pathogens, respectively. The detection efficiency of wet mount microscopy, nested PCR, and double antibody sandwich ELISA was compared by testing sixty-two clinical samples from vaginal secretions.

RESULTS

The natural TvCP39 protein could be specifically recognized by anti-rTvCP39-1 and anti-rTvCP39-2 antibodies. The concentrations of anti-rTvCP39-2 and anti-rTvCP39-1 polyclonal antibodies were determined to be 0.58 μg/mL and 0.45 μg/mL, respectively. The results of the sensitivity test showed that the detection limits of rTvCP39 and TvESPs by double antibody sandwich ELISA were 1.76 ng/mL and 107.125 μg/mL, respectively. The specificity test results showed that the double antibody sandwich ELISA had a high specificity for the detection of T. vaginalis and did not cross-react with Escherichia coli, Staphylococcus aureus, Candida albicans, and Lactobacillus. The positive detection rate of clinical samples by double antibody sandwich ELISA was higher than that by wet mount microscopy, and was the same as nested PCR. The sensitivity of double antibody sandwich ELISA was consistent with that of nested PCR. The coincidence rate between double antibody sandwich ELISA and nested PCR was 100% (Kappa=1, P < 0.001).

CONCLUSION

The double antibody sandwich ELISA detection method for T. vaginalis established in this study had the advantages of high sensitivity and specificity, and did not require the extraction of genomic DNA. This programmatic and simple detection method was suitable for batch testing of clinical samples and exhibited the potential value in the treatment and prevention of trichomoniasis.

Comparative proteomic analysis of metronidazole-sensitive and resistant Trichomonas vaginalis suggests a novel mode of metronidazole action and resistance

The microaerophilic parasite Trichomonas vaginalis occurs worldwide and causes inflammation of the urogenital tract, especially in women. With 156 million infections annually, trichomoniasis is the most prevalent non-viral sexually transmitted disease. Trichomoniasis is treated with 5-nitroimidazoles, especially metronidazole, which are prodrugs that have to be reduced at their nitro group to be activated. Resistance rates to metronidazole have remained comparably low, but they can be higher in certain areas leading to an increase of refractory cases. Metronidazole resistance in T. vaginalis can develop in vivo in clinical isolates, or it can be induced in the laboratory. Both types of resistance share certain characteristics but differ with regard to the dependence of ambient oxygen to become manifest. Although several candidate factors for metronidazole resistance have been described in the past, e.g. pyruvate:ferredoxin oxidoreductase and ferredoxin or thioredoxin reductase, open questions regarding their role in resistance have remained. In order to address these questions, we performed a proteomic study with metronidazole-sensitive and -resistant laboratory strains, as well as with clinical strains, in order to identify factors causative for resistance. The list of proteins consistently associated with resistance was surprisingly short. Resistant laboratory and clinical strains only shared the downregulation of flavin reductase 1 (FR1), an enzyme previously identified to be involved in resistance. Originally, FR1 was believed to be an oxygen scavenging enzyme, but here we identified it as a ferric iron reductase which produces ferrous iron. Based on this finding and on further experimental evidence as presented herein, we propose a novel mechanism of metronidazole activation which is based on ferrous iron binding to proteins, thereby rendering them susceptible to complex formation with metronidazole. Upon resolution of iron-protein-metronidazole complexes, metronidazole radicals are formed which quickly react with thiols or proteins in the direct vicinity, leading to breaks in the peptide backbone.

Sandwich enzyme-linked aptamer-based assay for the detection of Trichomonas vaginalis

Trichomoniasis is the most prevalent curable, non-viral sexually transmitted infection (STI), with an estimated 156 million new infections in 2020. It can potentially result in adverse birth outcomes as well as infertility in men, whilst it also increases the risk of acquiring HIV and contracting other vaginal infections. It is mostly prevalent among women in low-income countries and especially in Africa and the Americas. This STI is caused by Trichomonas vaginalis (TV) and a robust, cost-effective, sensitive, specific and rapid diagnostic test is urgently required. We report the screening of 6 full-length and 4 truncated aptamers previously selected in our group for use in a microplate-based sandwich assay. The combination of dual aptamers comprising a short 14-mer truncated capture aptamer (termed A1_14mer) and a full-length non-truncated reporter aptamer (A6) was elucidated to be the optimum pair for a sensitive sandwich enzyme-linked aptamer assay (ELAA) for the detection of TV achieving a detection limit of 3.02 × 104 TV cells/mL. The results obtained with the A1_14mer-A6 ELAA correlate excellently with wet-mount microscopy for the detection of TV in clinical specimens, cervicovaginal lavages and vaginal swabs, highlighting the potential clinical application of this assay for cost-effective population screening and subsequent prevention of the onset of complications associated with undiagnosed and untreated TV.

Syphilis Among U.S.-Bound Refugees, 2015 - 2018

We assessed syphilis screening data from overseas medical examinations among U.S.-bound refugees to characterize seropositive syphilis cases and treatment from January 1, 2015, to December 31, 2018. During this time period, all refugees 15 years and older were required to undergo syphilis screening prior to resettlement to the United States. Of the 160,381 refugee arrivals who had a syphilis screening performed, 697 (434 per 100,000) were diagnosed with any stage (infectious or non-infectious) of syphilis. Among the 697 persons with seropositive syphilis, a majority (63%) were from the Africa region and were male (58%), and 53 (7.6%) were diagnosed with an infectious stage of syphilis. All infectious cases were treated prior to resettlement. This information suggests a comparable risk of infection among U.S.-bound refugees compared to a report of syphilis among U.S.-bound refugees from 2009 to 2013, indicating low rates in this population for at least a decade.

Distinct substrate specificities of the three catalytic subunits of the Trichomonas vaginalis proteasome

The protozoan parasite Trichomonas vaginalis (Tv) causes trichomoniasis, the most common non-viral sexually transmitted infection in the world. Although Tv has been linked to significant health complications, only two closely related 5-nitroimidazole drugs are approved for its treatment. The emergence of resistance to these drugs and lack of alternative treatment options poses an increasing threat to public health, making development of novel anti-Trichomonas compounds an urgent need. The proteasome, a critical enzyme complex found in all eukaryotes has three catalytic subunits, β1, β2, and β5 and has been validated as a drug target to treat trichomoniasis. With the goal of developing tools to study the Tv proteasome, we isolated the enzyme complex and identified inhibitors that preferentially inactivate either one or two of the three catalytic subunits. Using a mass spectrometry-based peptide digestion assay, these inhibitors were used to define the substrate preferences of the β1, β2 and β5 subunits. Subsequently, three model fluorogenic substrates were designed, each specific for one of the catalytic subunits. This novel substrate profiling methodology will allow for individual subunit characterization of other proteasomes of interest. Using the new substrates, we screened a library of 284 peptide epoxyketone inhibitors against Tv and determined the subunits targeted by the most active compounds. The data show that inhibition of the Tv β5 subunit alone is toxic to the parasite. Taken together, the optimized proteasome subunit substrates will be instrumental for understanding the molecular determinants of proteasome specificity and for accelerating drug development against trichomoniasis.

Management and prevention of Neisseria meningitidis and Neisseria gonorrhoeae infections in the context of evolving antimicrobial resistance trends

PURPOSE

To describe the relationships between Neisseria meningitidis (NM) and Neisseria gonorrhoeae (NG) at genetic, population, and individual levels; to review historical trends in antimicrobial resistance (AMR); to review the treatment and preventive landscapes and explore their potential impact on AMR.

METHODS

A narrative literature search was conducted in PubMed, with searches restricted to 2003-2023 and additional articles included based on expertise.

RESULTS

NM and NG are closely related bacterial pathogens causing invasive meningococcal disease (IMD) and gonorrhea, respectively. NM can currently be treated with most antibiotics and generally has a wild-type susceptibility profile, whereas NG is increasingly resistant even in the first line of treatment. These pathogens share 80-90% genetic identity and can asymptomatically cohabit the pharynx. While AMR has historically been rare for NM, recent reports show this to be an emerging clinical concern. Extensively drug-resistant NG are reported globally, with data available from 73 countries, and can lead to treatment failure. Importantly, Neisseria commensals within the normal microbiota in the pharynx can act as a genetic reservoir of resistance to extended-spectrum cephalosporins. Novel oral antibiotics are urgently needed to treat a growing threat from antibiotic-resistant NG, recognized as a major global concern to public health by the World Health Organization. Numerous vaccines are available to prevent IMD, but none are approved for gonorrhea. Research to identify suitable candidates is ongoing.

CONCLUSION

Holistic management of AMR in IMD and gonorrhea should couple judicious use of existing antibiotics, optimization of vaccination programs, and development of novel antibiotics and vaccines.

Prevalence of syphilis infection among migrant workers in Qatar: a nationwide cross-sectional survey

OBJECTIVES

Scant data are available on syphilis infection within migrant populations worldwide and in the population of the Middle East and North Africa region. This study investigated the prevalence of both lifetime and recent syphilis infections among migrant craft and manual workers (MCMWs) in Qatar, a diverse demographic representing 60% of the country's population.

METHODS

Sera specimens collected during a nationwide cross-sectional survey of SARS-CoV-2 seroprevalence among the MCMW population, conducted between 26 July and 9 September 2020, were analysed. Treponema pallidum antibodies were detected using the Mindray CL-900i Chemiluminescence Immunoassay Analyzer. To differentiate recent infections, rapid plasma reagin (RPR) testing was performed, with an RPR titre of ≥1:8 considered indicative of recent infection. Logistic regression analyses were employed to identify factors associated with lifetime syphilis infection. Sampling weights were incorporated into all statistical analyses to obtain population-level estimates.

RESULTS

T. pallidum antibodies were identified in 38 of the 2528 tested sera specimens. Prevalence of lifetime infection was estimated at 1.3% (95% CI 0.9% to 1.8%). Among the 38 treponemal-positive specimens, 15 were reactive by RPR, with three having titres ≥1:8, indicating recent infection. Prevalence of recent infection was estimated at 0.09% (95% CI 0.01 to 0.3%). Among treponemal-positive MCMWs, the estimated proportion with recent infection was 8.1% (95% CI: 1.7 to 21.4%). The adjusted OR for lifetime infection increased with age, reaching 8.68 (95% CI 2.58 to 29.23) among those aged ≥60 years compared with those ≤29 years of age. Differences in prevalence were observed by nationality and occupation, but no differences were found by educational attainment or geographic location.

CONCLUSIONS

Syphilis prevalence among MCMWs in Qatar is consistent with global levels, highlighting a disease burden with implications for health and social well-being. These findings underscore the need for programmes addressing both sexually transmitted infections and the broader sexual health needs of this population.

Intranasal trivalent candidate vaccine induces strong mucosal and systemic immune responses against Neisseria gonorrhoeae

The spread of multidrug-resistant strains of Neisseria gonorrhoeae poses a great challenge in gonorrhea treatment. At present, vaccination is the best strategy for gonorrhea control. However, given the extensive antigenic variability of N. gonorrhoeae, the effectiveness of monovalent vaccines is limited. Therefore, increasing the coverage of vaccination by using a multivalent vaccine may be more effective. In this study, a trivalent vaccine comprising three conserved antigens, namely, the App passenger domain, MetQ, and neisserial heparin binding antigen (NHBA), was constructed, and its protective effect was evaluated. Trivalent vaccines induced stronger circulating IgG and IgA antibody responses in mice than monovalent vaccines, in addition to eliciting Th1, Th2, and Th17 immune responses. Antiserum generated by the trivalent vaccine killed N. gonorrhoeae strains (homologous FA1090 and heterologous FA19), exhibiting superior bactericidal capacity than NHBA and MetQ vaccine antisera against N. gonorrhoeae, but similar capacities to those of the App vaccine antiserum. In addition, the trivalent vaccine antiserum achieved greater inhibition of N. gonorrhoeae FA1090 strain adherence to ME-180 cells compared to that elicited by the monovalent vaccine antiserum. In a mouse vaginal infection model, the trivalent vaccine was modestly effective (9.2% decrease in mean area under curve compared to the pCold-TF control mice), which was somewhat better than the protection seen with the monovalent vaccines. Our findings suggest that recombinant multivalent vaccines targeting N. gonorrhoeae exhibit advantages in protective efficacy compared to monovalent vaccines, and future research on multivalent vaccines should focus on optimizing different antigen combinations.

Microscopic and molecular detection of Trichomonas vaginalis in outpatients seeking medical care in Upper Egypt

Introduction

Trichomoniasis remains one of the most significant sexually transmitted disease (STDs) for public health. The disease is caused by parasitic protozoa, Trichomonas vaginalis (T. vaginalis), which is often underestimated in tropical medicine. Despite its public health importance, the epidemiology and molecular characteristics of trichomoniasis in Egypt remains poorly understood, particularly in the southern part of the country (Upper Egypt). This study targeted exploring the genetic variability of T. vaginalis infections in Egyptian women living in Upper Egypt using restriction fragment length polymorphism (RFLP).

Patient and techniques

This cross-sectional study included 150 female patients, who visited the gynaecology and obstetrics outpatient clinics at Sohag General Hospital between 2019 and 2022, exhibiting symptoms of trichomoniasis. Vaginal washout samples were collected from each patient and analyzed using three diagnostic techniques: direct wet mount microscopy, culture on TYM Diamond's medium, and PCR amplification and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) targeting the actin gene, which was applied to all 16 samples that tested positive in culture. The PCR-RFLP results were then visualized through agarose gels electrophoresis to detect DNA fragments.

Results

Out of 150 vaginal washout samples, 12 cases (8%) tested positive for T. vaginalis trophozoites via direct wet mount microscopy, while 16 samples (10.6%) were positive in culture. Additionally, PCR-RFLP analysis of the 16 culture-positive samples revealed that 13 samples were confirmed positive using this molecular method. The amplified products were digested with the restriction enzyme Hind II, yielding three DNA fragments of 60, 213, and 827 bp, which were then detected by agarose gel electrophoresis. Digestion with RsaI produced five fragments measuring 87, 103/106, 236, and 568 bp, while MseI digestion resulted in three distinct fragments of 204, 315, and 581 bp.

Conclusion

This study provides robust baseline data on the prevalence and microscopic characteristics of T. vaginalis in Upper Egypt, while also presenting, for the first time, molecular detection and genotyping and revealed that genotype E is the only prevalent genotype in the region.

Risk factors for curable sexually transmitted infections among youth: findings from the STICH population survey in Zimbabwe

OBJECTIVES

Youth are at high risk of sexually transmitted infections (STIs) in Africa. We aimed to determine the risk factors for curable STIs in youth in Zimbabwe.

METHODS

A population-based survey was conducted among randomly selected 18-24 year-olds in 16 communities across two provinces in Zimbabwe to ascertain outcomes for a cluster randomised trial investigating the impact of community-based STI screening for youth on population prevalence of STIs. Participants underwent an interviewer-administered questionnaire, HIV testing and screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV). Risk factors for curable STIs were explored through multivariable logistic regression.

RESULTS

Of the 5601 participants, 62.5% (n=3500) were female, and the median age was 20 (IQR 19-22) years. HIV prevalence was 6.3% (351/5556), and 55.4% (1939/3501) reported condomless sex at last intercourse. Only 7.2% (401/5599) reported STI symptoms, but CT/NG/TV prevalence was 19.8% (1107/5601). On multivariable analysis, factors associated with STI diagnosis included being aged 21-24 years (adjusted OR (aOR) 1.37, 95% CI 1.17 to 1.61); female sex (aOR 2.11, 95% CI 1.76 to 2.53); being unemployed/informally employed (compared with in education/formal employment) (aOR 1.35, 95% CI 1.13 to 1.61); increasing number of sexual partners in the preceding 12 months (one partner: aOR 2.23, 95% CI 1.73 to 2.88; two partners: aOR 2.39, 95% CI 1.69 to 3.39); living with HIV (aOR 1.44, 95% CI 1.07 to 1.94); and previous attempted suicide (aOR 1.58, 95% CI 1.08 to 2.32).

CONCLUSIONS

The prevalence of STIs among youth in Zimbabwe is high, particularly among those with HIV. In addition to moving away from syndromic STI management and strengthening implementation of existing prevention tools, there is a need for a more holistic focus on broader risk factors such as mental health and employment opportunities, and of integration of HIV and STI programming.

TRIAL REGISTRATION NUMBER

ISRCTN15013425, NCT03719521.

Prevalence of gonococcal and chlamydial infections among men who have sex with men in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

Men who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STI) including Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct). The lack of robust data on STIs among African MSM has limited the development of evidence-based screening strategies. This study aimed at documenting the pooled prevalence of Ng/Ct among MSM in sub-Saharan Africa (SSA).

METHODS

This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) 2020 guidelines. Relevant articles from the following databases were searched: PubMed, Scopus, ISI Web of Science, and the Directory of Open Access Journals (DOAJ). Eligible studies reported on the prevalence of Ng/Ct among the MSM population in SSA. Publication bias was assessed using the Hoy tool, Doi plot, and LFK ratio. Due to heterogeneity among studies, subgroup analyses were performed using the MetaXL add-on tool for Microsoft Excel.

RESULTS

Of 525 articles screened, 20 were selected for inclusion. Six were cross-sectional, four had a prospective cohort study design, and one was an epidemiological study. The pooled prevalence of Ng/Ct in MSM was 27% (95% CI, 19-39%), with an I2 of 98% signifying heterogeneity among the studies. Subgroup analysis by country revealed South Africa had the highest prevalence (38%).

DISCUSSION

Interpretation The high prevalence of Ng/Ct infection among MSM in SSA is of concern. Limitations Due to limited data available on Ng/Ct prevalence, the true prevalence of SSA and its associated risk factors is uncertain.

CONCLUSION

As the first study to systematically review the available literature on STI prevalence among the MSM population in SSA, it showed the burden of Ng/Ct is higher than in other regions, warranting the strengthening of health systems to improve education, testing, and treatment in MSM population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022327095.

Interaction of human neutrophils with Trichomonas vaginalis protozoan highlights lactoferrin secretion

BACKGROUND

Neutrophils are vital constituents of the immune response in the vaginal environment, playing a pivotal role in the defense against trichomoniasis. Earlier studies have shown that Trichomonas vaginalis (T. vaginalis) can release leukotriene B4 (LTB4), a molecule that attracts and activates neutrophils. Additionally, secretory products from this parasite can induce the production of interleukin-8 (IL-8) in mast cells and neutrophils, which further recruits neutrophils to the infection site. The precise reasons behind T. vaginalis actively promoting interaction between parasites and neutrophils rather than inhibiting the inflammatory response remain unclear.

RESULTS

In this study, we collected conditioned medium to elucidate the intricate dynamics between T. vaginalis and human neutrophils. We conducted a comprehensive profiling of soluble excretory/secretory proteins (ESPs), identifying 192 protein spots, of which 94 were successfully characterized through mass spectrometry analysis. Notably, the majority of induced ESPs from co-cultivation exhibited consistency with the trichomonad and neutrophil standalone groups, except for lactoferrin, which was observed exclusively following the interaction between neutrophils and T. vaginalis. The secretion of lactoferrin was determined to be a contact-dependent process. It was interesting to identify the ability of the iron-loaded lactoferrin to extend the survival time of T. vaginalis under iron-deficient conditions.

CONCLUSIONS

This study represents the first to identify the origin of lactoferrin during T. vaginalis infection, shedding light on the potential reason for T. vaginalis's ability to attract neutrophils to the infection site: the acquisition of the iron source, lactoferrin.

Analysis of Neurosyphilis Imaging Methods and Treatment: A Focused Review

Neurosyphilis, a severe complication of syphilis caused by Treponema pallidum, progresses through multiple stages, including asymptomatic, meningeal, meningovascular, and late parenchymal forms such as syphilitic paresis and tabes dorsalis. Neurosyphilis spreads through sexual contact and from mother to child. Symptoms of neurosyphilis include nausea, cranial nerve deficiencies, and seizures. Diagnosing this condition is particularly challenging due to its varied symptoms, which frequently overlap with other neurological disorders. Current diagnostic approaches primarily rely on cerebrospinal fluid (CSF) analysis and neuroimaging techniques like magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT). The exploration of recent advances in neurosyphilis testing and the expanding role of imaging techniques in tracking treatment efficacy are seen. Penicillin G continues to be the primary treatment, with ceftriaxone serving as an alternative for patients with penicillin allergies. Even though ceftriaxone is less potent than penicillin G, it can still successfully eradicate neurosyphilis in patients. This review seeks to deepen the understanding of neurosyphilis pathophysiology, refine diagnostic accuracy, and inform evidence-based treatment approaches. This will ultimately contribute to improved patient outcomes.

Feasibility and Acceptability of Point-of-Care Testing for Sexually Transmitted Infections in Outpatient Clinics Offering Integrated Services in Eswatini

BACKGROUND

Lack of point-of-care testing (POCT) for sexually transmitted infections (STIs) is a continuing missed opportunity in Sub-Saharan Africa. We assessed feasibility and acceptability of STI POCT in Eswatini.

METHODS

Sexually transmitted infection POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was piloted among sexually active adults 18 to 45 years old attending 2 urban outpatient clinics offering integrated services. Women were randomized 1:1 to provide urine or vaginal swab, and all men provided urine samples for CT/NG testing using Cepheid CT/NG cartridges on existing GeneXpert platforms. Results were returned in-person or by telephone call. We assessed duration of procedures, participant and health care worker acceptability of services (5-point Likert scale), time spent on STI POCT services, and correlates of CT/NG infection.

RESULTS

Of 250 adults triaged, 99% (248 of 250) accepted STI POCT, including 44% (109 of 248) people living with HIV. Sexually transmitted infection POCT procedures took a median of 3:22 hours. Most adults (90% [224 of 248]) received results within a day (61% same day, 29% next day). CT/NG was detected among 22% (55 of 248): 31 of 55 CT, 21 of 55 NG, and 3 of 55 coinfections. Youth 18 to 25 years old, history of any sexual intercourse, and condomless sex within the previous 7 days were significantly associated with CT/NG detected ( P < 0.05). Most adults with CT/NG were treated (51 of 55 [93%]). Most participants were satisfied with STI POCT (217 of 241 [90%]) and would accept again/recommend it. All 32 health care workers who participated were satisfied with STI POCT.

CONCLUSIONS

Sexually transmitted infection POCT was feasible, acceptable, and identified a high prevalence of STIs, highlighting the urgent need for this testing.

Effects of cardanol-based phospholipid analogs on Trichomonas vaginalis

Trichomonas vaginalis is a protist parasite of the urogenital tract, responsible for human trichomoniasis, an infection sexually transmitted that affects approximately 156 million people worldwide. This pathology is more evident in females and can cause miscarriages, premature births, and infertility. The disease can also lead to a greater predisposition to HIV infection and cervical and prostate cancer. Metronidazole (MTZ) is a drug that treats human trichomoniasis. The data from studies involving human subjects are limited regarding MTZ use during pregnancy. In addition to the toxicity of the treatment, some isolates have become resistant to MTZ. Therefore, searching for new compounds active for treating trichomoniasis becomes necessary. In the present study, we report results obtained using new phospholipid analogs. Two cardanol-based compounds designated LDT117 and LDT134 were active against T. vaginalis with an IC50 of 4.58 and 10.24 μM, respectively. These compounds were not toxic to epithelial cells in culture. Scanning electron microscopy observations revealed a rounding of the cells, a shortening of the flagella, and protrusions on the surface of drug-treated cells. Transmission electron microscopy of treated cells revealed alterations in the plasma membrane with formations of blebs, protrusions, depressions, and vacuoles with myelin figures and vacuolization in the cytoplasm after incubation. Furthermore, after treatments with the compounds LDT117 and LDT134, the parasites presented a positive reaction for TUNEL, indicating death by a mechanism like apoptosis. Given the results obtained, further in vivo studies using animal experimental models are necessary to validate that these compounds are effective for treating human trichomoniasis.

Impact of the COVID-19 pandemic on sexually transmitted infection testing and diagnosis in Lebanon: A retrospective chart review

Background

Social distancing restrictions during the COVID-19 pandemic caused disruptions to sexual health services (SHS) worldwide. During the first year of the pandemic, Lebanon implemented multiple lockdowns during which SHS endured repetitive closures. We explore the impact of the pandemic on SHS delivery and the diagnosis rate of sexually transmitted infections (STIs) among attendees of a large sexual health clinic in Beirut, Lebanon.

Methods

This was a retrospective analysis of the clinic's database, including data on voluntary counseling and testing (VCT) for HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV). We compared the number and types of services provided, and the number and rate of positive VCT diagnoses pre- (Mar 2019-Feb 2020) and post- (Mar 2020-Feb 2021) COVID-19 onset.

Results

Men who have sex with men (MSM) comprised 35 % and 40 % of attendees pre- and post- COVID-19 onset, respectively. Post-COVID-19 onset, a total of 1350 VCT services and 406 medical consultations were provided, an overall 45 % decrease compared with pre-COVID-19 onset. The prevalence pre-COVID-19 onset of HIV, syphilis, HBV, and HCV was 0.8 %, 0.3 %, 0.2 %, and 0.1 %, respectively, and post-COVID-19 onset 1.2 %, 0.7 %, 0.3 %, and 0.3 %, respectively. Post-COVID-19 onset, 1.7 % of patients tested positive for any STI compared with 1.1 % pre-COVID-19 onset (OR: 1.5, 95%CI: 0.8-2.7). Close to 90 % of all positive diagnoses were among MSM. The prevalence of HIV, syphilis, HBV, and HCV among MSM in the total sample was 2.1 %, 1.2 %, 0.4 %, and 0.3 %, respectively.

Conclusion

COVID-19 related closures led to substantial reduction in SHS accessibility among clinic attendees. STI positivity rates increased post-COVID-19 onset, although this increase was not statistically significant. Findings suggest that sexual risk behavior was taking place during the pandemic despite the lockdowns and highlight the need to minimize disruptions in provision of SHS during similar crises, particularly to key populations.

Characterisation of Neisseria gonorrhoeae strain differences in patients with multisite infection

BACKGROUND

Neisseria gonorrhoeae, the aetiological agent of gonorrhoea, is an increasing global health priority due to high levels of antimicrobial resistance (AMR). It is estimated that up to 42% of patients are infected at multiple anatomical sites simultaneously. Previous studies identified that 7%-40% of those with multisite infection have different strains infecting different sites, with potentially different antimicrobial susceptibility profiles. This study aims to estimate the proportion of patients with multisite infection through differential antimicrobial susceptibility testing (AST) profiles and sequence-based molecular methods.

METHODS

This was a cross-sectional study of multisite gonococcal isolates provided by three National Health Service laboratories. Minimum inhibitory concentrations (MICs) for cefixime, ceftriaxone, azithromycin, ciprofloxacin, tetracycline and spectinomycin were determined. Possible multistrain infections were defined as isolates with a significant difference in MIC to at least one antimicrobial. Whole genome sequencing (WGS) was performed to determine multistrain infection through N. gonorrhoeae multiantigen sequence typing (NG-MAST), N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR), multilocus sequencing typing (MLST) and single nucleotide polymorphism (SNP) phylogeny, and to compare AST profiles with identified AMR genes.

RESULTS

Ninety-one isolates were collected from 41 patients with multisite infections. Of these 41 patients, 6 (14.6%) had N. gonorrhoeae isolates with discordant MICs. WGS-based typing confirmed that four out of six patients were infected with different gonococcal strains. The relatedness of isolates with the same MLST across multiple patients was differentiated using SNP-based analysis, and this included the identification of a potential transmission event. WGS-based AMR prediction for all antimicrobials tested correlated well with the phenotypic data.

CONCLUSION

This study demonstrates that potentially a significant proportion of patients with multisite infections are infected with multiple gonococcal strains, with differing AST profiles, at different anatomical sites. This has implications for patient sampling, susceptibility testing protocols, AMR surveillance and potentially appropriate antibiotic therapy.

Structural elucidation of recombinant Trichomonas vaginalis 20S proteasome bound to covalent inhibitors

The proteasome is a proteolytic enzyme complex essential for protein homeostasis in mammalian cells and protozoan parasites like Trichomonas vaginalis (Tv), the cause of the most common, non-viral sexually transmitted disease. Tv and other protozoan 20S proteasomes have been validated as druggable targets for antimicrobials. However, low yields and purity of the native proteasome have hindered studies of the Tv 20S proteasome (Tv20S). We address this challenge by creating a recombinant protozoan proteasome by expressing all seven α and seven β subunits of Tv20S alongside the Ump-1 chaperone in insect cells. The recombinant Tv20S displays biochemical equivalence to its native counterpart, confirmed by various assays. Notably, the marizomib (MZB) inhibits all catalytic subunits of Tv20S, while the peptide inhibitor carmaphycin-17 (CP-17) specifically targets β2 and β5. Cryo-electron microscopy (cryo-EM) unveils the structures of Tv20S bound to MZB and CP-17 at 2.8 Å. These findings explain MZB's low specificity for Tv20S compared to the human proteasome and demonstrate CP-17's higher specificity. Overall, these data provide a structure-based strategy for the development of specific Tv20S inhibitors to treat trichomoniasis.

Cyr SB, Schlanger K, Raphael BH, Kersh EN, Joseph SJ. Emergence and evolution of mosaic penA-60 and penA-237 alleles in a Neisseria gonorrhoeae core genogroup that was historically susceptible to extended spectrum cephalosporins

Introduction

Neisseria gonorrhoeae (Ng) has successively developed resistance to all previously recommended antimicrobial therapies, with ceftriaxone being the last option for monotherapy of gonorrhea. Global emergence and international spread of the FC428 clone derived mosaic penA-60 allele, associated with highlevel ceftriaxone minimum inhibitory concentrations (MICs) in non FC428 clone Ng lineages, has become an increasing concern. The penA-60 allele carrying Ng was first identified in the U.S. in Las Vegas, Nevada (2019; GCWGS-102723), with a multi-locus sequence type (MLST)-1901 strain, in a non FC428 clone Ng lineage, which is associated with a historically ceftriaxone susceptible core genogroup. Later in 2022, an allele genetically similar to penA-60, mosaic penA-237, was identified in the UK (H22-722) and France (F92) with high-level ceftriaxone MICs and both belonged to MLST-1901.

Methods

In this study, we assessed phylogenomic relatedness and antimicrobial resistance (AMR) determinant profiles of these three isolates with high-level ceftriaxone MICs among a global collection of 2,104 genomes belonging to the MLST-1901 core genome cluster group 31, which includes strains separated by a locus threshold of 200 or fewer differences (Ng_cgc_200). Recombination events in and around the penA coding region were catalogued and potential sources of inter species recombinant DNA were also inferred.

Results

The global population structure of MLST-1901 core genogroup falls into 4 major lineages. Isolates GCWGS-10723, F92, and H22-722 clustered within Lineage 1, which was dominated by non-mosaic penA-5 alleles. These three isolates formed a clade within Lineage 1 that consisted of isolates from North America and southeast Asia. Neisseria subflava and Neisseria sicca were identified as likely progenitors of two independent recombination events that may have led to the generation of mosaic penA-60 and penA-237, within a possible non-mosaic penA-5 background.

Discussions

Our study suggests that there are multiple evolutionary pathways that could generate concerning mosaic penA alleles via homologous recombination of historically susceptible Ng lineages with Neisseria commensals. Enhanced surveillance of gonococcal strains and Neisseria commensals is crucial for understanding of the evolution of AMR, particularly in less-studied regions (e.g., Asia), where high-level ceftriaxone MICs and multi-drug resistance are more prevalent.

Trichomonas vaginalis: comparison of primers for implementation as an in-house PCR in rural Vellore, South India

BACKGROUND

Trichomonas vaginalis (TV) accounts for the highest burden of curable, non-viral sexually transmitted infections worldwide. Prevalence in India ranges from 0.4 to 27.4% in women and 0.0-5.6% in men. In 2015, the prevalence of TV among pregnant women of rural Vellore was 3.11% using Sekisui OSOM® Trichomonas test and culture methods. Molecular methods are the most sensitive, rapid diagnostic tool for Sexually Transmitted Infection's (STI) albeit cost hinders implementation of commercial platforms. To determine a sensitive, sustainable molecular method, we compared three targets (Adhesin AP65, cytoskeleton Beta-tubulin BTUB 9/2 and TVK 3/7) with the highest published diagnostic accuracy against microscopy, culture and Real Time PCR (RT- PCR).

MATERIALS & METHODS

Six-hundred adult, sexually active women attending the Obstetrics-Gynaecology rural out-patient clinic the Rural Unit for Health and Social Affairs (RUHSA) from July 2020 - February 2021 were enrolled. A vaginal lateral and posterior fornix specimen was inoculated, onsite, into Biomed InPouch® TV culture and smeared onto a slide for fluorescence microscopy using Acridine orange. A flocked nylon swab specimen for PCR was used to determine the sensitivities of the Adhesin AP65, cytoskeleton Beta-tubulin BTUB 9/2 and TVK 3/7 gene targets. Seegene Allplex™ STI Essential Assay, S.Korea was used to confirm TV positives.

RESULTS

Nine specimens (9/600, 1.5%) were positive for TV. There was a 100% correlation between Biomed InPouch TV® culture, PCR with TVK 3/7 and RT-PCR while a correlation of 66.6% with BTUB 9/2 and AP65 gene targets. Clinically, 77.7% (n = 7) presented with white-greenish discharge per vagina, 11% (n = 1) with infertility, 22.2% (n = 2) were asymptomatic. Eight of nine patients (88.9%) had co-infections with other bacterial STIs. Prevalence of TV coinfection with Neisseria gonorrhoea was 1.1%.

CONCLUSION

Current hospital-based prevalence of TV in rural Vellore was 1.5%. Repetitive DNA target TVK 3/7 was more sensitive than AP65 and BTUB 9/2 primers.

An uncommon cause of persistent infection by Trichomonas vaginalis

Trichomonas vaginalis infection typically exhibits a favorable response to treatment. Nonetheless, there are instances where complete eradication proves challenging, necessitating multiple treatment cycles. Understanding patient history and conducting thorough examinations are crucial in identifying the reasons behind therapeutic failures. We present a case study involving a patient with persistent trichomoniasis despite multiple treatment cycles, attributed to the presence of an intrauterine device inserted several years prior. This case underscores the intricacies involved in managing recurrent Trichomonas vaginalis infections and the importance of a comprehensive evaluation.

Syphilis and pregnancy

•Although congenital syphilis has a known etiological agent, accessible diagnosis and low-cost, effective treatment with low fetal toxicity, it continues to challenge obstetric and antenatal care services. •The increasing rates of syphilis in the general population have direct repercussions on the increase in cases of congenital syphilis, a situation of objective interest for public health. •Although transforming the recording of syphilis and congenital syphilis into notifiable diseases improved the records and has made it possible to measure the occurrence of these diseases and create solutions, no effects on reducing their frequency have been reached yet. •The failure to control syphilis/congenital syphilis is multifactorial, and associates variables that range from the deficiency in teaching about these diseases in schools and in the training system of the various health professional segments, as well as the lack of rigid policies for quality control from antenatal care until the clinical follow-up of children exposed to Treponema pallidum during pregnancy. •To date, benzathine penicillin is the only antimicrobial accepted as effective by the main health authorities on the planet for the treatment of syphilis in pregnant women. •The fear of anaphylaxis in response to the treatment of syphilis with benzathine penicillin is an important factor hindering the prompt and correct treatment of pregnant women with syphilis, even though health authorities have made efforts to face the problem with solid arguments, still insufficient to resolve the question. •Although specific protocols are published, the failure to control the treatment of syphilis in pregnant women is still observed with high frequency, indicating and reinforcing a failure in the quality control of these care principles. The National Specialized Commission on Infectious Diseases of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. Content production is based on scientific evidence on the proposed topic and the results presented contribute to clinical practice.

Trends of chlamydia and gonorrhea infections by anatomic sites among men who have sex with men in south China: a surveillance analysis from 2018 to 2022

BACKGROUND

Chlamydia and gonorrhea notifications are rapidly rising in men who have sex with men (MSM). Currently, there are limited data on the prevalence of chlamydia and gonorrhea across various anatomical sites. Our study aimed to explore the prevalence, association and changing trends of urethral and rectal chlamydia and gonorrhea among MSM in Guangdong Province, China.

METHODS

We analyzed data among MSM attending sexually transmitted infections (STI) clinics in the Guangdong governmental sentinel network between 2018 and 2022. Chi-square tests were used to compare the difference, Join-point regressions for analyzing changing trends, and multivariate logistic regressions for examining associated factors.

RESULTS

We included 4856 men in the analysis. Rectal chlamydia significantly increased from 13.8% to 26.4% over the past 5 years (average annual percentage change [AAPC] 19.2%, 95%CI 1.0-40.6, p = 0.043). After adjusting for covariates, chlamydia infection positively associated with main venue used to seek sexual partners (aOR = 2.31, 95%CI 1.17-4.55), having regular sexual partners in the past 6 months (aOR = 3.32, 95%CI 1.95-5.64), receiving HIV counselling and testing services (aOR = 2.94, 95%CI 1.67-5.17), receiving peer education (aOR = 1.80, 95%CI 1.14-2.83), infection with syphilis (aOR = 2.02, 95%CI 1.02-4.01) and infection with gonorrhea (aOR 7.04, 95% CI 3.01-16.48). Gonorrhea infection positively associated with having regular sexual partners in the past 6 months (aOR = 3.48.95%CI 1.16-10.49), and infection with chlamydia (aOR 7.03, 95% CI 2.99-16.51).

CONCLUSIONS

To conclude, our findings reveal a high prevalence of chlamydia infections among MSM, particularly in the rectal area. Comprehensive chlamydia and gonorrhea health services are necessary for MSM to improve sexual health.

Seminal plasma inhibits Chlamydia trachomatis infection in vitro, and may have consequences on mucosal immunity

Seminal plasma (SP) is the main vector of C. trachomatis (CT) during heterosexual transmission from male to female. It has immunomodulatory properties and impacts the susceptibility to HIV-1 infection, but its role has not been explored during CT infection. In the female reproductive tract (FRT), CT infection induces cytokine production and neutrophil recruitment. The role of neutrophils during CT infection is partially described, they could be at the origin of the pathology observed during CT infection. During this study, we developed an experimental in vitro model to characterize the impact of CT infection and SP on endocervical epithelial cell immune response in the FRT. We also studied the impact of the epithelial cell response on neutrophil phenotype and functions. We showed that the production by epithelial cells of pro-inflammatory cytokines increased during CT infection. Moreover, the pool of SP as well as individuals SP inhibited CT infection in a dose-dependent manner. The pool of SP inhibited cytokine production in a dose-dependent manner. The pool of SP altered gene expression profiles of infected cells. The culture supernatants of cells infected or not with CT, in presence or not of the pool of SP, had an impact on neutrophil phenotype and functions: they affected markers of neutrophil maturation, activation and adhesion capacity, as well as the survival, ROS production and phagocytosis ability. This study proposes a novel approach to study the impact of the environment on the phenotype and functions of neutrophils in the FRT. It highlights the impact of the factors of the FRT environment, in particular SP and CT infection, on the mucosal inflammation and the need to take into account the SP component while studying sexually transmitted infections during heterosexual transmission from male to female.

The relationship between selected sexually transmitted pathogens, HPV and HIV infection status in women presenting with gynaecological symptoms in Maputo City, Mozambique

Sexually transmitted infections (STIs) have a profound impact on sexual and reproductive health worldwide. Syphilis, gonorrhea, chlamydia, and trichomoniasis are four currently curable STIs. However, most STI cases are asymptomatic and not detected without laboratory diagnostics. Hepatitis B virus, herpes simplex virus, human immunodeficiency virus (HIV), and human papillomavirus (HPV) are four viral and incurable infections, but they can be mitigated by treatment. We investigated the prevalence of selected sexually transmitted pathogens and their relationship with HPV and HIV infection in women from Maputo, the capital of Mozambique. A cross-sectional study was conducted on 233 non-pregnant women seeking health care relating to gynecological symptoms in Mavalane Health facilities in Maputo, between the 1st of February 2018 and the 30th of July 2019. Cervical brush samples were collected and DNA was extracted. Selected STIs including HPV were detected using multiplex STD and HPV Direct Flow Chip Kits through a manual Hybrispot platform (Vitro, Master Diagnostica, Sevilla, Spain). HIV testing was performed using rapid tests: Determine HIV 1/2 test (Alere Abbott Laboratories, Tokyo, Japan) for screening, and UniGold HIV (Trinity Biotech, Ireland) for confirmation. All women (n = 233) were negative for Haemophilus ducreyi and Herpes Simplex Virus-1 (HSV-1). Among the 233 women, a high prevalence of STIs was found (89%), 63% of the women were positive for HPV and 24% were HIV positive. Treponema pallidum (TP), Trichomonas vaginalis (TV), Herpes Simplex Virus-2 (HSV-2), and Chlamydia trachomatis (CT) were detected in 17%, 14%, 8%, and 8% of the women, respectively. As a common phenomenon, vaginal discharge (90%) was the lower genital tract symptom reported by the majority of the women. Co-infection with any STI and HPV was detected in 56% (130/233) while 45% (59/130) of the co-infections were with high-risk HPV (hrHPV) genotypes. Among the HPV-positive participants, infection by TP was the most prevalent (27%). In total, 28% (66/233) of the participants were positive for any hrHPV genotypes. Co-infection with any STI and HIV was found in 15% (34/233) of the study participants. There was a significant association between HPV infection and TP (p = 0.039) and HSV-2 (p = 0.005). TV, TP, and CT-S1-CT-S2 positivity were significantly more prevalent in HIV-positive participants. Pathobionts Ureaplasma urealyticum/parvum and Mycoplasma hominis were detected in 84.0% (195/233) and 45% (105/233), respectively. This present study describes a high prevalence of STIs. Co-infection between HPV and STIs was found in the majority of the study subjects. The high prevalence of HPV emphasizes the need for HPV vaccination to prevent cervical cancer in this population. Management of STIs is also important in women presenting with gynecological symptoms.

Antimicrobial activity of compounds identified by artificial intelligence discovery engine targeting enzymes involved in Neisseria gonorrhoeae peptidoglycan metabolism

BACKGROUND

Neisseria gonorrhoeae (Ng) causes the sexually transmitted disease gonorrhoea. There are no vaccines and infections are treated principally with antibiotics. However, gonococci rapidly develop resistance to every antibiotic class used and there is a need for developing new antimicrobial treatments. In this study we focused on two gonococcal enzymes as potential antimicrobial targets, namely the serine protease L,D-carboxypeptidase LdcA (NgO1274/NEIS1546) and the lytic transglycosylase LtgD (NgO0626/NEIS1212). To identify compounds that could interact with these enzymes as potential antimicrobials, we used the AtomNet virtual high-throughput screening technology. We then did a computational modelling study to examine the interactions of the most bioactive compounds with their target enzymes. The identified compounds were tested against gonococci to determine minimum inhibitory and bactericidal concentrations (MIC/MBC), specificity, and compound toxicity in vitro.

RESULTS

AtomNet identified 74 compounds that could potentially interact with Ng-LdcA and 84 compounds that could potentially interact with Ng-LtgD. Through MIC and MBC assays, we selected the three best performing compounds for both enzymes. Compound 16 was the most active against Ng-LdcA, with a MIC50 value < 1.56 µM and MBC50/90 values between 0.195 and 0.39 µM. In general, the Ng-LdcA compounds showed higher activity than the compounds directed against Ng-LtgD, of which compound 45 had MIC50 values of 1.56-3.125 µM and MBC50/90 values between 3.125 and 6.25 µM. The compounds were specific for gonococci and did not kill other bacteria. They were also non-toxic for human conjunctival epithelial cells as judged by a resazurin assay. To support our biological data, in-depth computational modelling study detailed the interactions of the compounds with their target enzymes. Protein models were generated in silico and validated, the active binding sites and amino acids involved elucidated, and the interactions of the compounds interacting with the enzymes visualised through molecular docking and Molecular Dynamics Simulations for 50 ns and Molecular Mechanics Poisson-Boltzmann Surface Area (MM-PBSA).

CONCLUSIONS

We have identified bioactive compounds that appear to target the N. gonorrhoeae LdcA and LtgD enzymes. By using a reductionist approach involving biological and computational data, we propose that compound Ng-LdcA-16 and Ng-LtgD-45 are promising anti-gonococcal compounds for further development.

Chlamydia Trachomatis Prevalence in Asymptomatic Women in Madrid: Study Findings and Their Association with Risk Factors and Mental Health

BACKGROUND

Chlamydia trachomatis (CT) is a sexually transmitted infection that requires early detection to prevent complications. This study aimed to evaluate the prevalence of CT among asymptomatic women in Spain and investigate the relationship between CT and risk factors associated with sexual practices, as well as factors such as stress and depression.

RESULTS

We found that 3.8% of asymptomatic women tested positive for CT. Our findings suggested that having more than five sexual partners increases the risk of sexually transmitted infections (STIs) by 3.87 times when compared with having fewer partners (p = 0.005, OR: 3.87, 95% CI 1.24-11.65). Additionally, 4.5% of participants admitted to using drugs. We found that there was a slightly higher proportion of anxiety and depression among women who tested positive for CT.

CONCLUSIONS

We aimed to establish a basis for the implementation of screening in asymptomatic women. Early identification and preventive measures are crucial in minimizing the long-term complications and transmission of the disease. Sexual behavior must be recognized as a risk factor, and women's psychological well-being should be given top priority as a vital aspect of their sexual health.

Māori and Pacific young people's perspectives on testing for sexually transmitted infections via an online service: a qualitative study

Introduction International research suggests free online postal self-sampling for sexually transmitted infection (STI) testing is an acceptable alternative to clinic-based testing. A user-pays online STI testing service exists in Aotearoa New Zealand, but acceptability among priority populations is unknown. Aim To explore Māori and Pacific young people's perspectives on online postal self-sampling for STI testing (as prospective service users). Methods Four wānanga (knowledge-sharing forum) were held between November 2022 and May 2023 with Māori and Pacific participants aged 15-24 years who were recruited via youth-focused community organisations. Three facilitators guided discussions about STI testing and use of an online service. Inductive thematic analysis was used to analyse data generated from audio-recorded discussions, group work notes and facilitator field notes. Results None of the 38 participants were aware of online STI testing and all considered it cost-prohibitive. Perceptions of online testing were mixed, and discussion about concerns outweighed perceived benefits. Three themes were identified: (i) potential to support autonomy (perceived benefits and positive features of self-sample collection kits); (ii) barriers and process-related concerns; and (iii) tailoring online STI testing to young people's needs (facilitating engagement with online testing). Discussion For online STI testing to be an accessible alternative to clinic-based testing for priority populations, cost, low awareness and other barriers in the testing pathway need to be addressed. Clinician follow-up on positive results and free treatment would be critical to ensure the cycle of best practice care is completed. Regardless of where testing is accessed, investment is needed to support young people's knowledge of when, why and how to access a sexual health check.

Analysis and mapping of global research publications on point-of-care testing for infectious diseases

RATIONALE

This study presents the first comprehensive analysis and mapping of scientific research on point-of-care testing (POCT) in infectious diseases, filling a gap in understanding the evolving landscape of this field. The identification of research themes and global contributions offers valuable insights.

AIMS AND OBJECTIVES

This manuscript aims to analyse and map scientific research on POCT in the context of infectious diseases.

METHODS

The study employed a comprehensive search strategy using terms related to POCT and infectious diseases. The search was conducted on the Scopus database, refining results based on inclusion and exclusion criteria. The dataset of 1719 research articles was then subjected to descriptive analysis and mapping using VOSviewer.

RESULTS

The research findings indicate an exponential growth in POCT-related publications, with 46.8% published post the COVID-19 pandemic. Plos One journal led in publication frequency, and Biosensors and Bioelectronics received the highest citations per article. North America and Western Europe dominated contributions, with notable participation from China, South Africa, and India. The research landscape revealed the following research themes: detection technologies, human immunodeficiency virus (HIV)/sexually transmitted infection (STI) diagnosis, antibiotic optimisation, and schistosomiasis. Clinical trials focused on antibiotic prescribing, HIV, STIs, and specific infections. The findings suggest a shifting landscape towards POCT, emphasising the need for future planning and investment in healthcare systems. The research identifies areas for future exploration, such as the impact of POCT on antibiotic prescribing and its role in combating infectious diseases in low- and middle-income countries.

CONCLUSION

Implementation of POCT has the potential to revolutionise infectious disease management, improve patient outcomes, and reduce the global burden of diseases. Better public awareness, healthcare team management, and planning for POCT at entry points are crucial for societal benefit. Results demonstrated the evolving role of POCT in infectious disease management and prevention.

Detection of Trichomonas vaginalis by microscopy and molecular methods in women referred to health centers in Tabriz, Northwest Iran

Trichomoniasis is a parasitic disease that affects the human reproductive and urinary systems, representing a substantial non-viral sexually transmitted infection worldwide. Given its impact on reproductive health, and the limited available information on the prevalence of Trichomonas vaginalis, this study aimed to evaluate the prevalence of T. vaginalis among women referred to health centers in Tabriz, Northwest Iran. Study was conducted on 448 suspicious women who attended to 29Bahman hospital in Tabriz, Northwest Iran, during September 2020 to September 2021. Demographic data were collected according to the study protocol. Vaginal discharges were obtained using sterile swabs, and the prevalence of T. vaginalis was determined using Papanicolauo staining and PCR method. Among the 448 cases studied, 48 (10.7%) samples were suspected as a T. vaginalis infection, while 4 (0.89%) confirmed using the PCR method. The mean age of infected individuals was 41.7 ± 9.4 years. No statistical correlation was observed between inflammation, method of contraception and infection (p = 0.8). The present study revealed a relatively low prevalence of T. vaginalis infection within the study population. Additionally, the utilization of the PCR method can be beneficial in confirming suspected samples.

The potential for bacteriophages and prophage elements in fighting and preventing the gonorrhea

Bacteriophages are the most numerous entities on earth and are found everywhere their bacterial hosts live. As natural bacteria killers, phages are extensively investigated as a potential cure for bacterial infections. Neisseria gonorrhoeae (the gonococcus) is the etiologic agent of a sexually transmitted disease: gonorrhea. The rapid increase of resistance of N. gonorrhoeae to antibiotics urges scientists to look for alternative treatments to combat gonococcal infections. Phage therapy has not been tested as an anti-gonococcal therapy so far. To date, no lytic phage has been discovered against N. gonorrhoeae. Nevertheless, gonococcal genomes contain both dsDNA and ssDNA prophages, and viral particle induction has been documented. In this review, we consider literature data about the attempts of hunting for a bacteriophage specific for gonococci - the gonophage. We also discuss the potential application of prophage elements in the fight against N. gonorrhoeae. Temperate phages may be useful in preventing and treating gonorrhea as a scaffold for anti-gonococcal vaccine development and as a source of lytic enzymes with anti-gonococcal activity.