Survey of diagnostic resources for STI in Spain.

BACKGROUND: Scarce information is available on the resources to deal with the Sexually Transmitted Infections (STIs), both in the clinic and in the laboratory. The objective is to describe and know the reality of the clinics and laboratories that treat these infections in Spain. METHODS: Cross-sectional observational study with data collection through a survey aimed at the members of the GEITS Group. RESULTS: Responses were obtained from 24 centers (response rate 38.1%) belonging to 10 Autonomous Communities. Regarding STI consultations, 38% require that the patient present a health card to provide assistance, and 31.8% only provide it by referral from another doctor. The 52.4% perform diagnostic methods in the care center. Regarding laboratories, 18.2% do not offer immediate response diagnostic tests, although 100% have PCR against Neisseria gonorrhoeae and Chlamydia trachomatis, 47.8% against Mycoplasma genitalium and 65% detect lymphogranuloma venereum genotypes. All laboratories continue to perform culture and gonococcal sensitivity techniques, and 20% perform molecular methods for detection of MG antimicrobial resistance. CONCLUSION: There is great variability in the provision of human and material resources both in the clinics and in the laboratories that attend STIs. In a significant number of centers there are limitations for patient access. Although laboratories have molecular biology technologies, not all of them offer immediate response tests. All laboratories detect N. gonorrhoeae infection by PCR and also by culture, which allows sensitivity testing in all centers.

Survey of diagnostic resources for STI in Spain. / Encuesta de recursos diagnósticos de las ITS en España.

BACKGROUND: Scarce information is available on the resources to deal with the Sexually Transmitted Infections (STIs), both in the clinic and in the laboratory. The objective is to describe and know the reality of the clinics and laboratories that treat these infections in Spain. METHODS: Cross-sectional observational study with data collection through a survey aimed at the members of the GEITS Group. RESULTS: Responses were obtained from 24 centers (response rate 38.1%) belonging to 10Autonomous Communities. Regarding STI consultations, 38% require that the patient present a health card to provide assistance, and 31.8% only provide it by referral from another doctor. The 52.4% perform diagnostic methods in the care center. Regarding laboratories, 18.2% do not offer immediate response diagnostic tests, although 100% have PCR against Neisseria gonorrhoeae and Chlamydia trachomatis, 47.8% against Mycoplasma genitalium and 65% detect lymphogranuloma venereum genotypes. All laboratories continue to perform culture and gonococcal sensitivity techniques, and 20% perform molecular methods for detection of MG antimicrobial resistance. CONCLUSION: There is great variability in the provision of human and material resources both in the clinics and in the laboratories that attend STIs. In a significant number of centers there are limitations for patient access. Although laboratories have molecular biology technologies, not all of them offer immediate response tests. All laboratories detect N.gonorrhoeae infection by PCR and also by culture, which allows sensitivity testing in all centers.

Syphilis. / Sífilis.

Syphilis is an infectious disease caused by the spirochaete Treponema pallidum subsp. pallidum which is transmitted by sexual contact or vertical transmission during pregnancy. The incidence of syphilis has increased in the last years, mainly among men who have sex with men. Without treatment, the disease develops into different clinical stages, being able to present cardiovascular or irreversible neurological complications after a number of years. The disease is classified as early syphilis - primary, secondary and early latent syphilis (less than 12 months) - which is contagious, and as late syphilis - late latent and tertiary syphilis- which is rarely contagious. Diagnosis and management are often a challenge because of its diversity of manifestations and the difficulty of interpretation of serological tests. The treatment of syphilis is based on penicillin or doxycycline in allergic patients. Treatment failure because of resistance has been described with azithromycin. The follow up with a serological test is recommended in all patients with syphilis in order to ascertain cure after the treatment and to diagnose possible reinfections.

Rapid diagnosis of sexually transmitted infections. / Diagnóstico rápido de las infecciones de transmisión sexual.

Sexually transmitted infections (STIs) are responsible for an enormous burden of morbidity and mortality. Worldwide, millions of cases of STIs, such as syphilis, chlamydia, or gonorrhoea occur every year, and there is now an increase in antimicrobial resistance in pathogens, such as gonococcus. Delay in diagnosis is one of the factors that justifies the difficulty in controlling these infections. Rapid diagnostic tests allow the introduction of aetiological treatment at the first visit, and also leads to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. The World Health Organisation includes these tests in its global strategy against STIs.

Prevalence of genital Chlamydia trachomatis infection among young men and women in Spain.

BACKGROUND: There are no accurate data regarding the real prevalence of Chlamydia trachomatis infection in Spain. Our aim was to determine the prevalence of C. trachomatis infections and the risk factors for acquiring them among 1,048 young (15-24 years old) inhabitants of Laviana. METHODS: The study was completed in the period between 1st November 2010 and 31st December 2011. We conducted a capture strategy in the whole population, instead of only in a sample group, with a capture conducted in schools, in the local health centre, by post and by phone as a last resort. The design was based on the model used by Shafer to increase screening rates. C. trachomatis was identified by RT-PCR in urine samples. RESULTS: A total of 487 sexually active people underwent the test, which implies a response rate of 59.8% of the sexually active people (target population). The prevalence was 4.1% (CI 95%: 3.1-5.8): women: 4% ( CI 95%; 2.8-6.4) and men: 4.3% (CI 95%: 2.9-7.2). The circulating genotype was the E genotype. There was an increase in the risk of C. trachomatis infection when barrier contraceptives were not routinely used OR: 4.76 (CI 95%:1.30-17.36) p<0.05. CONCLUSIONS: In our study the prevalence in women resembles those found in other countries in Europe and the prevalence in men is similar to that in women. Screening for C. trachomatis infection in women would be cost-effective in Spain given the prevalence of C. trachomatis measured by this study. The use of a condom is the best preventative measure for avoiding STIs in sexually active people.

[Update on the epidemiology, diagnosis and treatment of sexually-transmitted infections]. / Panorama actual de la epidemiología, diagnóstico y tratamiento de las infecciones de transmisión sexual.

In the last decade, cases of sexually-transmitted infections (STIs) have progressively increased in Europe. The reasons for this increase are unclear, but may involve changes in social behavior, migration and international travel, coupled with the emergence of risk groups that have not been taken into sufficient consideration to date. The routine use of molecular diagnostic techniques for many of these infections has solved many problems of sensitivity and the suitability of samples for microbiological diagnosis: non-invasive samples can be used, which has undoubtedly contributed to the increase in the number of cases. Moreover, molecular methods have also been introduced for antibiotic and antiviral susceptibility testing, as well as for molecular characterization of clinical isolates. All of these factors, together with the approval of the vaccine against the human papillomavirus, have changed the landscape of STIs across Europe.

[Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections]. / Utilidad de las técnicas de biología molecular en el diagnóstico de las infecciones de transmisión sexual y otras infecciones genitales.

Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose.

[Transmission of hepatitis C virus in pregnant women]. / Transmisión del virus de la hepatitis C en gestantes.

BACKGROUND AND OBJECTIVE: Our goal was to determine the prevalence of hepatitis C virus infection in pregnant women from Asturias as well as the vertical transmission rate. PATIENTS AND METHOD: This was a prospective study of consecutive pregnant women from the 5th Health Area of Principado de Asturias (Northern Spain). We determined the prevalence of hepatitis C virus infection in the first trimester of pregnancy and the rate of mother-to-child transmission. Time period was August 1997-December 1998. Children were followed from birth to 18-24 months of age. Methods included anti-HVC, PCR-RNA-HVC, genotype and viral load at delivery of all positive women; and anti-HVC and PCR-RNA-HVC at birth, 3, 6, 12 and 18 months of age of their children. RESULTS: Out of 2442 consecutive pregnant women, 30 were anti-HVC positive (prevalence: 1.23% of pregnancies and 1.20% of women); 24 of them were PCR-RNA-HVC positive. There were 30 anti-HVC positive children. All but one lost their antibodies (vertical transmission rate 3.3%). CONCLUSIONS: The prevalence of hepatitis C virus infection was 1.20% of women from our Health Area. Vertical transmission rate was 3.3% among HVC infected, non-selected mothers.

[Varicella and parvovirus B19 immunity among pregnant women in Gijón, Spain]. / Prevalencia de inmunidad frente al virus de la varicela y al parvovirus B19 en gestantes de Gijón.

BACKGROUND: We aimed at determining the inmunological status regarding varicella and parvovirus B19 in pregnant women in Gijón, Spain, and its correlation with several clinical and epidemiological parameters. PATIENTS AND METHOD: Blood samples taken during the first trimester of pregnancy in the area of Gijón were analysed to determine the immunological status with respect to varicella and parvovirus B19. The study included 2 groups: 99 non-European (all tested for both varicella and parvovirus) and 2,188 Europeans (406 were randomly selected for varicella test and 287 for parvovirus test). All patients underwent a clinical-epidemiological survey. RESULTS: With regard to varicella, while 89% of pregnant women aged 14 to 35 years displayed immunity, this percentage reached 100% in those older than 35 years. Sensitivity was 73.8%, specificity 74.4%, positive predictive value 96.6% and negative predictive value was 22.6%. As for parvovirus B19, immunity was observed in 59.9% of Europeans and 67.7% of non-Europeans, without significant differences in the analysed parameters. CONCLUSIONS: Susceptibility to infection by varicella among pregnant women younger than 36 years reaches 10% in Gijón. Clinical surveys are useful to avoid a pre-vaccination serological study in an already immune population. Just over one third of these pregnant women are susceptible to infection by parvovirus B19.