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Rodrigues R, Vieira-Baptista P, Catalão C, Borrego MJ, Sousa C, Vale N. Chlamydial and Gonococcal Genital Infections: A Narrative Review. J Pers Med 2023; 13:1170. [PMID: 37511783 PMCID: PMC10381338 DOI: 10.3390/jpm13071170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Sexually transmitted infections (STIs) constitute one of the leading causes of disease burden worldwide, leading to considerable morbidity, mortality, health expenditures, and stigma. Of note are the most common bacterial STIs, chlamydial and gonococcal infections, whose etiological agents are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), respectively. Despite being usually asymptomatic, in some cases these infections can be associated with long-term severe complications, such as pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, and increased risk of other STIs acquisition. As the symptoms, when present, are usually similar in both infections, and in most of the cases these infections co-occur, the dual-test strategy, searching for both pathogens, should be preferred. In line with this, herein we focus on the main aspects of CT and NG infections, the clinical symptoms as well as the appropriate state-of-the-art diagnostic tests and treatment. Cost-effective strategies for controlling CT and NG infections worldwide are addressed. The treatment for both infections is based on antibiotics. However, the continuing global rise in the incidence of these infections, concomitantly with the increased risk of antibiotics resistance, leads to difficulties in their control, particularly in the case of NG infections. We also discuss the potential mechanism of tumorigenesis related to CT infections. The molecular bases of CT and NG infections are addressed, as they should provide clues for control or eradication, through the development of new drugs and/or effective vaccines against these pathogens.
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Affiliation(s)
- Rafaela Rodrigues
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Pedro Vieira-Baptista
- Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Catalão
- Roche Sistemas de Diagnósticos, Estrada Nacional, 2720-413 Amadora, Portugal
| | - Maria José Borrego
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal
| | - Carlos Sousa
- Molecular Diagnostics Laboratory, Unilabs Portugal, Centro Empresarial Lionesa Porto, Rua Lionesa, 4465-671 Leça do Balio, Portugal
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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Xavier P, Dantas S, Almeida-Santos T, Soares SR, Imhoff RJ, Genovez V, Modesto C, Gens H, Correia I, Catalão C. Screening for diminished ovarian reserve in Portugal: a cost-saving answer to shorten the fertility journey. J Comp Eff Res 2023; 12:e230003. [PMID: 37345566 PMCID: PMC10508297 DOI: 10.57264/cer-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023] Open
Abstract
Aim: Assess the budget impact of nationwide screening for diminished ovarian reserve (OR), via anti-Müllerian hormone (AMH) levels, to the Portugal National Health System (NHS). Patients & methods: The clinical journey was determined using literature and the family planning decision-making process/response using survey results. A panel of four local clinicians validated all assumptions/inputs. Results: Screening for OR led to an expected savings of € 9.4 million for the NHS, driven by a 24% reduction in medically assisted reproduction (MAR) use. When needed, referral for MAR was earlier and more women used first-line versus second-line techniques. The model estimated a 12% decrease in failure. Conclusion: This model shows AMH screening may allow more informed decisions, leading to a shorter fertility journey, more efficient use of treatments, and substantial cost-savings for the NHS.
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Affiliation(s)
- Pedro Xavier
- President of the Portuguese Society of Reproductive Medicine (SPMR); Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, Centre for Reproduction Genetics Prof. Alberto Barros, 4100-021, Portugal
| | - Sofia Dantas
- Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, Hospital Senhora da Oliveira, Guimarães, 4835-044, Portugal
| | - Teresa Almeida-Santos
- Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, Centro Hospitalar Universitário de Coimbra (CHUC), Coimbra, 3004-561, Portugal
| | - Sérgio Reis Soares
- Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, IVI (Instituto Valenciano de Infertilidade), Lisbon, 1800-282, Portugal
| | - Ryan J Imhoff
- Research Scientist II, CTI Clinical Trial & Consulting Services, Covington, KY 41011, USA
| | - Victória Genovez
- Market Access Associate II, CTI Clinical Trial & Consulting Services Portugal, Lisbon, 1072-274, Portugal
| | - Cátia Modesto
- HTA & Market Access Associate II, CTI Clinical Trial & Consulting Services Portugal, Lisbon, 1070-274, Portugal
| | - Helena Gens
- Medical Affairs Lead, Roche Sistemas de Diagnósticos, Amadora, 2720-413, Portugal
| | - Inês Correia
- Medical Science Liaison, Roche Sistemas de Diagnósticos, Amadora, 2720-413, Portugal
| | - Carlos Catalão
- Access & Innovation Director, Roche Sistemas de Diagnósticos, Amadora, 2720-413, Portugal
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