RESUMO
Neisseria gonorrhoeae is a human-specific pathogen that causes the important sexually transmitted infection, gonorrhoea, an inflammatory condition of the genitourinary tract. The bacterium is closely related to the meningococcus, a leading cause of bacterial meningitis. Both these invasive bacterial species undergo autolysis when in the stationary phase of growth. Autolysis is a form of programmed cell death (PCD) which is part of the life cycle of remarkably few bacteria and poses an evolutionary conundrum as altruistic death provides no obvious benefit for single-celled organisms. Here, we searched for genes present in these 2 invasive species but not in other members of the Neisseria genus. We identified a ~3.4 kb horizontally acquired region, we termed the nap island, which is largely restricted to the gonococcus and meningococcus. The nap island in the gonococcus encodes 3 cationic, bacteriocin-like peptides which have no detectable antimicrobial activity. Instead, the gonococcal Neisseria autolysis peptides (Naps) promote autolytic cell death when bacteria enter the stationary phase of growth. Furthermore, strains lacking the Naps exhibit reduced autolysis in assays of PCD. Expression of Naps is likely to be phase variable, explaining how PCD could have arisen in these important human pathogens. NapC also induces lysis of human cells, so the peptides are likely to have multiple roles during colonisation and disease. The acquisition of the nap island contributed to the emergence of PCD in the gonococcus and meningococcus and potentially to the appearance of invasive disease in Neisseria spp.
Assuntos
Bacteriocinas , Transferência Genética Horizontal , Neisseria gonorrhoeae , Neisseria gonorrhoeae/metabolismo , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/patogenicidade , Neisseria gonorrhoeae/fisiologia , Bacteriocinas/metabolismo , Bacteriocinas/genética , Humanos , Bacteriólise , Ilhas Genômicas , Gonorreia/microbiologiaRESUMO
BACKGROUND: Gonorrhea is the second most common sexually transmitted disease notified in Singapore in 2023. Evidence suggests that the 4CMenB vaccine designed to protect against Neisseria meningitidis infection may offer partial cross-protection against gonorrhea. This generated interest in using 4CMenB for the purpose of staving gonorrhea transmission. We explored the efficacy of potential gonorrhea vaccination strategies in the context of historically declining gonorrhea incidence. METHODS AND FINDINGS: We employed an integrated transmission-dynamic model, calibrated using Bayesian methods to local surveillance data to understand the potential public health impact of 4CMenB in reducing gonorrhea acquisition and transmission in men who have sex with men (MSM) in Singapore. We explored the efficacy of implementing six vaccination programmes: (1) offering vaccination to all male adolescents in schools (vaccination before entry [VbE]), (2) offering vaccination to individuals attending sexual health clinics for testing (vaccination on attendance [VoA]), (3) offering vaccination to individuals attending sexual health clinics and who were diagnosed with gonorrhea (vaccination on diagnosis [VoD]), or (4) vaccination according to risk (VaR), by offering vaccination to patients who were diagnosed with gonorrhea plus individuals who tested negative, but report having more than five sexual partners per year. We further examined how altering (5) VoA and (6) VoD strategies changed if the strategies only targeted high risk groups (VoA(H),VoD(H)). We assessed efficacy by examining vaccination impact relative to no vaccination and when behavioral parameters were held constant. We further ascertained the effects of varying vaccine uptake (10%, 33%, 100%), vaccine efficacy (22%, 31%, 47%), and duration of protection (1.5, 4, 7.5 years) on the effectiveness of each vaccination strategy. For a hypothetical 10-year vaccination programme, VbE had 14.18% of MSM gonorrhea cases averted over the time the programme was implemented. VoA had the highest protective impact on the MSM population with 40.26% averted cases (95% credible interval (CrI): 18.32%-52.57%), but required more vaccine doses than any other strategy. VoD had a smaller impact (12.04% averted cases (95% CrI: 7.12%-15.00%)), but was three times more efficient than VoA in terms of averted cases per dose. VoA(H) and VoD(H) improved the efficiency of VoA and VoD strategies by increasing averted cases per dose to 0.22 and 0.24 respectively, but conferred similar protective effects as VoA (VoA(H): 40.10% averted cases (95% CrI: 18.14%-52.55%)) and VoD (VoD(H): 12.04% averted cases (95% CrI: 7.12%-15.00%)), respectively. VaR (40.10% averted cases (95% CrI: 18.14%-52.55%)) had almost the same impact as VoA, but was more efficient by requiring administration of fewer doses than VoA, with 0.21 (95% CrI: 0.12-0.27) averted cases per dose. Sensitivity analyses indicated that VaR had the greatest public health impact with the highest number of averted cases per dose for vaccines of any efficacy or duration of protection (or both), although VoD and VoD(H) saved more vaccine resource and had the highest number averted MSM cases per dose for highly protective vaccines of long protection. CONCLUSIONS: Vaccination of MSM against gonorrhea, according to risk in sexual health clinics in Singapore, can be considered to reduce gonorrhea acquisition and transmission. Development of gonorrhea-specific vaccines which focuses on protective efficacy and the implementation of efficient vaccination programmes can maximize public health impact.
Assuntos
Gonorreia , Saúde Pública , Humanos , Gonorreia/epidemiologia , Gonorreia/prevenção & controle , Masculino , Incidência , Adolescente , Singapura/epidemiologia , Programas de Imunização , Vacinação/tendências , Adulto , Adulto Jovem , Homossexualidade Masculina , Vacinas Meningocócicas/administração & dosagem , Teorema de BayesRESUMO
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.
Assuntos
Algoritmos , Infecções por Chlamydia , Gonorreia , Programas de Rastreamento , Sensibilidade e Especificidade , Profissionais do Sexo , Infecções Sexualmente Transmissíveis , Humanos , Feminino , Profissionais do Sexo/estatística & dados numéricos , Zimbábue/epidemiologia , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Prevalência , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Adulto , Programas de Rastreamento/métodos , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto Jovem , Adolescente , Inquéritos e Questionários , Sífilis/diagnóstico , Sífilis/epidemiologiaRESUMO
INTRODUCTION: The US state of Florida has the third highest rate of HIV and high rates of sexually transmitted infections (STIs) indicating critical HIV and STI prevention needs remain unmet. To address gaps in the STI care continuum in people with HIV (PWH), evidence-based interventions were implemented across 3 Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Florida between August 2020 and August 2021. Interventions included comprehensive sexual health history (SHH) taking using audio computer-assisted self-interview (ACASI) software, self-collected extragenital gonorrhea and chlamydia testing, and the introduction of a lesbian, gay, bisexual, transgender, and queer (LGBTQ+) welcoming environment. METHODS: We (1) assessed the acceptability of these interventions and examined if acceptability differed among youth and sexual, racial, and ethnic minorities; (2) determined the proportion of appropriate STI testing completed based on the SHH assessment; (3) examined whether STI at-risk individuals underwent STI screening 3-6 months after initial evaluation; and (4) determined the proportion of positive STI test results among priority intervention groups in Florida. RESULTS: Acceptability of all interventions was high. Youth, lesbian, gay, and bisexual, and Hispanic individuals were significantly more likely to notice and like LGTBQ+ welcoming measures. The proportion of recommended tests completed was high, although only a subset of at-risk individuals completed rescreening. About 11.9% of rectal samples were positive for chlamydia, and 6.5% of pharyngeal samples were positive for gonorrhea. CONCLUSIONS: Our study highlights the importance of incorporating comprehensive sexual health care protocols, including extragenital STI testing, into the overall care of PWH.
Assuntos
Infecções por HIV , Saúde Sexual , Infecções Sexualmente Transmissíveis , Humanos , Florida , Feminino , Masculino , Adulto , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto Jovem , Aceitação pelo Paciente de Cuidados de Saúde , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero , Gonorreia/diagnósticoRESUMO
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.
Assuntos
Antibacterianos , Medicina Baseada em Evidências , Uretrite , Humanos , Uretrite/tratamento farmacológico , Uretrite/diagnóstico , Uretrite/microbiologia , Masculino , Antibacterianos/uso terapêutico , Alemanha , Adulto , Adolescente , Gonorreia/tratamento farmacológico , Gonorreia/diagnóstico , Doxiciclina/uso terapêutico , Guias de Prática Clínica como Assunto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , ConsensoRESUMO
Background To gain an understanding of chlamydia (CT) and gonorrhoea (NG) testing conducted within an annual health check (AHC) and in standard clinical consultations for clients aged 15-29years attending an urban Aboriginal Community Controlled Health Service in the period 2016-2021. Methods De-identified electronic medical record data were extracted and analysed on CT and NG testing by sex, age, Indigenous status and the context of testing (conducted within an AHC or not). An access, testing, and diagnosis cascade for CT and NG, inclusive of an AHC, was constructed. Results Combined testing within an AHC and outside an AHC for CT and NG ranged between 30 and 50%, except for the year 2021. Males were twice as likely to receive a CT and NG test within an AHC consultation as females. Females were almost equally likely to have a CT and NG test, both as part of an AHC consult and during other clinical consultations. Females had the highest CT positivity in 2018 (11%) and 2019 (11%), with a dip in 2020 (5%), whereas NG diagnoses remained stable at 2%. Conclusion The study demonstrates the potential of the AHC to facilitate greater coverage of CT and NG testing in an urban Aboriginal Community Controlled Health Service. Screening conducted within an AHC alongside screening in clinical consultations might be enough to reduce CT prevalence over a sustained period.
Assuntos
Infecções por Chlamydia , Gonorreia , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Infecções por Chlamydia/diagnóstico , Serviços de Saúde Comunitária , Gonorreia/diagnóstico , Serviços de Saúde do Indígena/organização & administração , Programas de Rastreamento , População Urbana/estatística & dados numéricos , Povos Aborígenes Australianos e Ilhéus do Estreito de TorresRESUMO
Background This study describes chlamydia and gonorrhoea testing, positivity, treatment, and retesting among individuals aged ≥15years attending an urban Aboriginal Community Controlled Health Service during the period 2016-2021. Method Utilising routinely collected clinical data from the ATLAS program (a national sentinel surveillance network), a retrospective time series analysis was performed. The study assessed testing rates, positivity, treatment efficacy, retesting and trends over time within an urban Aboriginal Community Controlled Health Service. Results Testing rates for chlamydia and gonorrhoea varied between 10 and 30% over the study period, and were higher among clients aged 15-29years and among females. Positivity rates for both infections varied by age, with clients aged 15-24years having higher positivity than older clients. Gonorrhoea positivity rates decreased after 2016. Treatment and retesting practices also showed sex disparities, with men having a slightly higher treatment rate within 7days, whereas females had significantly higher retesting rates within 2-4months, indicating differences in follow-up care between sexes. Conclusion The study emphasises the need for clinical and public health interventions within urban Aboriginal and Torres Strait Islander populations to further reduce chlamydia and gonorrhoea. Prioritising improved access to testing, timely treatment and consistent retesting can significantly contribute to lowering STI prevalence and enhancing sexual health outcomes in these communities.
Assuntos
Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Infecções por Chlamydia , Gonorreia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Austrália/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Gonorreia/diagnóstico , Gonorreia/etnologia , Gonorreia/epidemiologia , Serviços de Saúde do Indígena , Estudos Retrospectivos , População Urbana/estatística & dados numéricosRESUMO
Background Gonorrhoea notification rates in Australia have more than doubled between 2014 and 2019. We explored gonorrhoea testing patterns and management of gonorrhoea infection in general practice. Methods We analysed de-identified electronic medical record data for individuals who attended 73 Australian general practices (72 in the state of Victoria) between January 2018 and December 2020. The 'care cascade' model was utilised to explore gonorrhoea detection and management. Descriptive analysis and logistic regression were used to investigate factors associated with gonorrhoea testing, treatment and retesting. Results During the study period, there were a total of 1,027,337 clinical episodes. Of these, 5.6% (n =57,847, 95% confidence interval [CI] 4.5-6.7) involved a gonorrhoea test and 1.1% (n =637, 95% CI 0.8-1.4) tested positive. Of the 637 gonorrhoea cases, 48.4% (n =308, 95% CI 29.8-67.0) had an Australian guideline-recommended dual antibiotic prescription (ceftriaxone and azithromycin) recorded. Of 329 cases without a dual antibiotic prescription, 84.2% (n =277, 95% CI 77.5-90.9) had reattended the clinic. Among the 206 gonorrhoea cases with dual antibiotic prescription recorded in 2018 and 2019, 32.0% (n =66, 95% CI 25.3-38.8) were retested from 6weeks to 6months post-treatment. Of the 140 gonorrhoea cases that were not retested, 54.3% (n =76, 95% CI 46.8-61.8) reattended the clinic within 6months of treatment. Conclusion The low proportion of gonorrhoea cases prescribed recommended antibiotics and retested within recommended timeframes suggests opportunities for integrating Australian STI guidelines into primary care. Further exploration of care pathways is warranted to determine if care was provided but not recorded, provided elsewhere or not provided.
Assuntos
Antibacterianos , Registros Eletrônicos de Saúde , Medicina Geral , Gonorreia , Humanos , Gonorreia/tratamento farmacológico , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Masculino , Feminino , Adulto , Antibacterianos/uso terapêutico , Medicina Geral/estatística & dados numéricos , Pessoa de Meia-Idade , Vitória/epidemiologia , Adulto Jovem , Adolescente , Azitromicina/uso terapêutico , Austrália , Ceftriaxona/uso terapêuticoRESUMO
Type 4 pili (T4P) are multifunctional filaments involved in adhesion, surface motility, biofilm formation, and horizontal gene transfer. These extracellular polymers are surface-exposed and, therefore, act as antigens. The human pathogen Neisseria gonorrhoeae uses pilin antigenic variation to escape immune surveillance, yet it is unclear how antigenic variation impacts most other functions of T4P. Here, we addressed this question by replacing the major pilin of a laboratory strain with pilins from clinical isolates. We reveal that the resulting strains vary substantially in their attractive forces. Strongly interacting bacteria form microcolonies while weakly interacting bacteria retain a planktonic lifestyle. In mixed microcolonies, different variant strains segregate in agreement with the differential strength of adhesion hypothesis. By combining structural predictions and laser tweezers experiments, we show that the C-terminal region of the pilin is crucial for attraction. Lifestyle affects growth kinetics and antibiotic tolerance. In the presence of ceftriaxone or ciprofloxacin, the killing kinetics indicate strongly increased tolerance of aggregating strains. We propose that pilin antigenic variation produces a mixed population containing variants optimized for growth, colonization, or survivability under external stress. Different environments select different variants, ensuring the survival and reproduction of the population as a whole.
Assuntos
Antibacterianos , Variação Antigênica , Proteínas de Fímbrias , Neisseria gonorrhoeae , Neisseria gonorrhoeae/imunologia , Neisseria gonorrhoeae/genética , Proteínas de Fímbrias/genética , Proteínas de Fímbrias/metabolismo , Proteínas de Fímbrias/imunologia , Antibacterianos/farmacologia , Humanos , Fímbrias Bacterianas/genética , Fímbrias Bacterianas/metabolismo , Fímbrias Bacterianas/imunologia , Aderência Bacteriana , Gonorreia/microbiologia , Gonorreia/imunologia , Farmacorresistência Bacteriana/genética , Biofilmes/crescimento & desenvolvimento , Biofilmes/efeitos dos fármacosRESUMO
Abstract: The Australian National Neisseria Network (NNN) comprises reference laboratories in each state and territory that report data on antimicrobial susceptibility testing to an agreed group of antimicrobial agents for the Australian Gonococcal Surveillance Programme (AGSP). The AGSP data are presented quarterly in tabulated form, as well as in the AGSP annual report. This report presents national gonococcal antimicrobial resistance surveillance data from 1 January to 31 March 2024.
Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Gonorreia , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae , Austrália/epidemiologia , Neisseria gonorrhoeae/efeitos dos fármacos , Humanos , Gonorreia/epidemiologia , Gonorreia/microbiologia , Gonorreia/tratamento farmacológico , Antibacterianos/farmacologia , Vigilância da PopulaçãoRESUMO
Abstract: The Australian National Neisseria Network (NNN) comprises reference laboratories in each state and territory that report data on antimicrobial susceptibility testing to an agreed group of antimicrobial agents for the Australian Gonococcal Surveillance Programme (AGSP). The AGSP data are presented quarterly in tabulated form, as well as in the AGSP annual report. This report presents national gonococcal antimicrobial resistance surveillance data from 1 April to 30 June 2024.
Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Gonorreia , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae , Austrália/epidemiologia , Neisseria gonorrhoeae/efeitos dos fármacos , Humanos , Gonorreia/epidemiologia , Gonorreia/microbiologia , Gonorreia/tratamento farmacológico , Antibacterianos/farmacologia , Vigilância da PopulaçãoRESUMO
INTRODUCTION: Bacterial sexually transmitted infections (STIs), specifically infection by Chlamydia trachomatis , Neisseria gonorrhoeae , and Treponema pallidum , have an important burden worldwide. The use of doxycycline as preexposure prophylaxis (PREP or doxy-PREP) or postexposure prophylaxis (PEP or doxy-PEP) might be effective as prophylaxis because it is effective against C. trachomatis and T. pallidum . AIMS: Our objective was to evaluate the efficacy of doxycycline as PREP or PEP against bacterial STIs ( C. trachomatis , N. gonorrhoeae , and T. pallidum ). METHODS: A systematic review and meta-analysis of randomized clinical trials of a high-risk group of individuals was conducted to evaluate whether doxycycline is as effective as PREP or PEP in preventing bacterial STIs. The PubMed-MEDLINE (MEDlars online), Cohrane, Scientific Electronic Library Online (SciELO), and Latin America and the Caribbean Literature on Health Sciences ( Literatura Latino-Americana e do Caribe em Ciências da Saúde -LILACS) databases were searched for randomized clinical trials published up to March 2024. Data were extracted from published reports. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence interval (CI) were pooled across trials. MAIN OUTCOME MEASURE: The primary end points were any incidence of bacterial STIs and individual STI infections. RESULTS: A total of 4 studies were included in the analysis, 3 of which evaluated doxy-PEP and 1 evaluated doxy-PREP. In the doxy-PEP group, a total of 1182 participants were evaluated. In the pooled analysis of doxy-PEP studies, the incidence of the first STI was lower in the doxy-PEP group (HR, 0.538 [95% CI, 0.337-0.859]; I2 = 77%; P < 0.05). Regarding individual infections, only 2 studies were included. In the doxy-PEP group, the incidence of individual infection of C. trachomatis was lower compared with controls (RR, 0.291 [95% CI, 0.093-0.911]) ( I2 = 89%; P < 0.05). Because only one study evaluated doxy-PREP, it was not possible to calculate a meta-analysis index; however, the use of doxycycline as PREP was associated with a decrease in the rate of any STI. CONCLUSIONS: The use of doxy-PEP might reduce the first STI, mainly C. trachomatis , if used within 72 hours after condomless sex. The use of doxy-PREP might also decrease the chance of any STI; however, only 1 study was evaluated.
Assuntos
Antibacterianos , Doxiciclina , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Humanos , Doxiciclina/administração & dosagem , Antibacterianos/administração & dosagem , Gonorreia/prevenção & controle , Feminino , Infecções Sexualmente Transmissíveis/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções por Chlamydia/prevenção & controle , Masculino , Chlamydia trachomatis/efeitos dos fármacos , Neisseria gonorrhoeae/efeitos dos fármacos , Treponema pallidum/efeitos dos fármacos , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , AdultoRESUMO
BACKGROUND: Men reporting same-sex behaviors are disproportionately impacted by sexually transmitted infections (STIs). Differences in clinical characteristics and STIs in men who have sex with men only (MSMO), with men and women (MSMW), and with women only (MSW) are not well described. METHODS: First visits to 2 Baltimore City STI clinics 2011-2016 from MSMO and MSMW compared with an age-matched random sample of MSW were analyzed. Acute STI (aSTI) included chlamydia, gonorrhea, nongonococcal urethritis, and primary or secondary syphilis. χ2 Tests and logistic regression examined associations. RESULTS: Among N = 1226 MSMO, N = 491 MSMW, and N = 1717 MSW, most identified as Black/African American; mean age (29.8 years) was similar across groups. The percentages of MSMW, MSMO, and MSW who reported ≥2 partners in the last 6 months were 73.5%, 67.2%, and 60.3%, respectively. "Always" condom use was reported by 20.4%, 17.4%, and 14.1% of MSMW, MSMO, and MSW. Overall HIV prevalence was 13.8%. Among those tested, urogenital chlamydia prevalence rates were 21.7%, 8.3%, and 3.9% ( P ≤ 0.01) in MSW, MSMW, and MSMO. Urogenital gonorrhea prevalence was 11.6%, 7.7%, and 8.3% in MSMW, MSW, and MSMO, respectively. Extragenital STI (range, 2.7%-21.9%), nongonococcal urethritis (25.2%), and primary or secondary syphilis (5.3%-5.7%) positivity was similar in MSMW and MSMO. Older age was inversely associated with STI diagnosis in MSW and MSMO only; consistent condom use was protective against aSTI in MSW (adjusted odds ratio, 0.60; P < 0.01) and MSMW (adjusted odds ratio, 0.54; P = 0.03) only. CONCLUSIONS: Differences in behaviors and clinical characteristics associated with aSTI suggest that MSMO, MSMW, and MSW have diverse sexual health needs and may require tailored interventions to improve sexual health outcomes.
Assuntos
Infecções por Chlamydia , Gonorreia , Homossexualidade Masculina , Parceiros Sexuais , Infecções Sexualmente Transmissíveis , Sífilis , Humanos , Masculino , Adulto , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia , Feminino , Homossexualidade Masculina/estatística & dados numéricos , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Baltimore/epidemiologia , Comportamento Sexual , Preservativos/estatística & dados numéricos , Adulto Jovem , Minorias Sexuais e de Gênero/estatística & dados numéricos , Uretrite/epidemiologia , Uretrite/microbiologia , Heterossexualidade/estatística & dados numéricos , Bissexualidade/estatística & dados numéricos , Prevalência , Adolescente , Instituições de Assistência Ambulatorial , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Young people are at particularly high risk of acquiring sexually transmitted infections (STIs). We conducted a trial to investigate the effect of a community-based intervention that included STI screening among youth on population-level prevalence of STIs in Zimbabwe. METHODS: STICH was a parallel-arm, cluster-randomised controlled trial nested within CHIEDZA, a trial of community-based integrated HIV and sexual and reproductive health services for youth in Zimbabwe. STICH was conducted in Harare and Bulawayo provinces with eight clusters in each province, randomised 1:1 to control (existing health services) or to the intervention: community-based screening and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae (males and females) and Trichomonas vaginalis (females only) offered over 12 months to intervention cluster residents aged 16-24 years who were attending CHIEDZA. Outcomes were ascertained through a population-level survey immediately after the intervention period, which included young people aged 18-24 years who lived in randomly selected households in each of the 16 clusters. The primary outcome was population prevalence of any (one or more) of the three STIs; secondary outcomes were prevalence of each of the three STIs. The STICH trial is registered with ISRCTN registry, ISRCTN15013425, and the CHIEDZA trial is registered with ClinicalTrials.gov, NCT03719521. FINDINGS: From Oct 6, 2021, to March 8, 2022, 6361 randomly sampled young people were recruited into the outcome survey (median age 20 years [IQR 19-22], 3500 female and 2101 male, 3066 in intervention clusters and 3295 in control clusters). 5601 participants were included in the primary outcome analysis (2756 in intervention clusters and 2845 in control clusters). In the intervention clusters, 612 (22·2%) of 2756 participants reported that they had attended CHIEDZA and 298 (10·8%) had been tested for C trachomatis and N gonorrhoeae. In the control clusters, 113 (4·0%) of 2845 participants had attended CHIEDZA and 40 (1·4%) had been tested for C trachomatis and N gonorrhoeae. In the outcome survey, the cluster-level geometric mean prevalence of the primary outcome (any of C trachomatis, N gonorrhoeae, and T vaginalis) was 19·07% (geometric standard deviation [GSD] 1·20) in the intervention arm versus 19·95% (GSD 1·10) in the control arm (risk ratio [RR] 0·93 [95% CI 0·78-1·10]; p=0·35). There was no difference between arms in geometric mean prevalence of C trachomatis (12·86% [GSD 1·14] in the intervention arm vs 12·94% [GSD 1·15] in the control arm, RR 0·97 [95% CI 0·84-1·11]; p=0·60) or T vaginalis (7·06% [GSD 1·48] vs 6·20% [1·38], RR 1·09 [95% CI 0·74-1·60]; p=0·66). N gonorrhoeae prevalence was significantly lower in the intervention arm, with a 43% risk reduction (geometric mean 1·65% [GSD 1·77] vs 2·87% [1·43], RR 0·57 [95% CI 0·34-0·96]; p=0·036). INTERPRETATION: Our study showed high population prevalence of curable STIs. Community-based STI screening appeared to reduce population-level prevalence of N gonorrhoeae, but not of C trachomatis or T vaginalis, probably due to low intervention coverage. Future research is needed on the effects of screening interventions on morbidity, antimicrobial resistance, and re-infection rates. FUNDING: Medical Research Council, Economic and Social Research Council, Department for International Development, National Institute for Health and Care Research, and the Wellcome Trust.
Assuntos
Infecções Sexualmente Transmissíveis , Humanos , Zimbábue/epidemiologia , Adolescente , Masculino , Feminino , Adulto Jovem , Prevalência , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Gonorreia/epidemiologia , Serviços de Saúde Comunitária , Programas de Rastreamento , Análise por ConglomeradosRESUMO
INTRODUCTION: Drug-resistant Neisseria gonorrhoeae is an urgent threat to public health. Novel prevention and treatment strategies are emerging, including immunizations, pharmacologic post-exposure prophylaxis, rapid molecular resistance assays, and novel antibiotics. However, where and how such strategies are optimally implemented remains unclear. METHODS: We conducted a retrospective interrupted time series analysis of gonorrhea cases reported to the Massachusetts Department of Public Health. We collected names of treating providers from 2011 (n = 100) and 2022 (n = 108), and cross-referenced provider names with publicly available records from the Massachusetts Boards of Registration in Medicine and Nursing to identify provider type, specialty, year of terminal degree or licensure, and clinic type. RESULTS: Of 208 providers, 111 (53.4%) were advanced care practitioners. Providers treated cases predominantly in community health centers (n = 65, 31.3%) and emergency departments or urgent care centers (n = 60, 28.8%). Only 11 (12.4%) of 89 physicians were trained in either adult or pediatric infectious diseases. CONCLUSION: Our results indicate that the majority of gonorrhea cases in the Massachusetts are treated in non-specialty settings. The time is now to plan for implementation of the emerging strategies to avoid underutilization and assure uptake of interventions in settings positioned to reach persons diagnosed with gonorrhea who will benefit most.
Assuntos
Gonorreia , Atenção Primária à Saúde , Humanos , Gonorreia/epidemiologia , Gonorreia/prevenção & controle , Estudos Retrospectivos , Massachusetts/epidemiologia , Neisseria gonorrhoeae , Análise de Séries Temporais Interrompida , Feminino , Masculino , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Antibacterianos/uso terapêutico , Farmacorresistência BacterianaRESUMO
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.
Assuntos
Administração Intranasal , Anticorpos Antibacterianos , Vacinas Bacterianas , Gonorreia , Imunidade nas Mucosas , Neisseria gonorrhoeae , Animais , Neisseria gonorrhoeae/imunologia , Camundongos , Feminino , Gonorreia/imunologia , Gonorreia/prevenção & controle , Vacinas Bacterianas/imunologia , Vacinas Bacterianas/administração & dosagem , Anticorpos Antibacterianos/imunologia , Anticorpos Antibacterianos/sangue , Camundongos Endogâmicos BALB C , Antígenos de Bactérias/imunologia , Antígenos de Bactérias/administração & dosagem , Humanos , Modelos Animais de Doenças , Imunoglobulina G/imunologia , Imunoglobulina G/sangue , Vacinação/métodosRESUMO
The STI CNM Real-Time PCR Kit from Vitro S.A. (Spain) demonstrates high sensitivity and specificity, is cost-effective, and can detect the three main etiological agents of urethritis/cervicitis in a single multiplex PCR. Sexually transmitted infections (STIs) are a significant public health problem and a significant burden of morbidity and mortality in hospitals. The World Health Organization (WHO) estimates the number of daily infections to be 1 million. Currently, the number of infections and antimicrobial-resistant strains is rising. A rapid and accurate etiologic diagnosis is critical to solving this problem. In this study, we compared the STI CNM Real-Time PCR Kit using the Xpert® CT/NG technique (Cepheid®, USA) as Gold Standard for the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae and EasyNAT® MG (Ustar Biotechnologies (Hangzhou) Ltd., China) as Gold Standard for the diagnosis of Mycoplasma genitalium infection. Regarding C. trachomatis and N. gonorrhoeae, out of 200 samples, there was a match in 199 cases, with only one positive sample not being detected by the STI CNM Real-Time PCR Kit. This results in a sensitivity of 96% and a specificity of 100% for this kit. Diagnosing M. genitalium infection, out of 200 samples, the STI CNM Real-Time PCR Kit correctly detected all negative and positive samples, with 100% agreement compared to the reference technique. In summary, the STI assay has a very high sensitivity and specificity, comparable to other commercial diagnostic kits. Furthermore, it has the advantage of bundling the detection of the three main bacterial agents of urethritis/cervicitis, resulting in better cost efficiency.
Assuntos
Chlamydia trachomatis , Neisseria gonorrhoeae , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Uretrite , Humanos , Uretrite/diagnóstico , Uretrite/microbiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Feminino , Cervicite Uterina/microbiologia , Cervicite Uterina/diagnóstico , Gonorreia/diagnóstico , Gonorreia/microbiologia , Kit de Reagentes para Diagnóstico , Masculino , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Mycoplasma genitalium/genética , Mycoplasma genitalium/isolamento & purificação , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/microbiologia , Infecções por Mycoplasma/diagnóstico , Infecções por Mycoplasma/microbiologiaRESUMO
BACKGROUND: The prevalence of syphilis, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) in men who have sex with men (MSM) is very high. As these bacterial sexually transmitted infections (bSTIs) are frequently asymptomatic, they are often undiagnosed and therefore untreated. We aimed to characterize the profile of MSM who reported bSTI screening and diagnosis in the previous 12 months, and to identify the factors associated with a diagnosis of a bSTI among MSM in France. METHODS: We used data from Enquête Rapport au Sexe (ERAS), a large French national anonymous cross-sectional online survey among MSM conducted from 26 February to 11 April 2021. After comparing MSM screened and diagnosed in the previous year with those who were not, a binary logistic regression model was used to compare MSM diagnosed with at least one bSTI with those who were not. RESULTS: Of the 13 300 survey respondents, 6 263 (47.1%) MSM reported screening for at least one bSTI in the previous 12 months. Of these, 1 060 (16.9%) were diagnosed for at least one bSTI during their most recent screening. Specifically, 446 (7.1%) MSM were diagnosed with NG, 427 (6.8%) with CT, and 402 (6.4%) for syphilis. The following self-reported factors were associated with a greater likelihood of bSTI diagnosis: younger age, a lower educational level, frequenting MSM meeting places, not currently using pre-exposure prophylaxis (PrEP) but willing to take preventive treatment against bSTIs (reference group: not using PrEP and not willing to take preventive treatment against bSTIs), low health literacy, more than one sexual male partner, practicing chemsex, and condomless anal intercourse with casual male partners (the latter three factors concerning the previous six months). CONCLUSIONS: A large proportion of MSM were diagnosed for at least one bSTI. This result provides an insight into bSTI screening uptake and diagnosis among MSM in France, and could inform future decisions about how to plan effective bSTI screening and diagnosis programs for this population.
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Homossexualidade Masculina , Programas de Rastreamento , Doenças Bacterianas Sexualmente Transmissíveis , Humanos , Masculino , França/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto , Estudos Transversais , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem , Prevalência , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Sífilis/diagnóstico , Sífilis/epidemiologia , Inquéritos e Questionários , Adolescente , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Fatores de RiscoRESUMO
Sexually transmitted infection rates are increasing in the United States, with significant increases in the rates of syphilis among patients of reproductive age and, subsequently, congenital syphilis. Syphilis screening is recommended in sexually active patients 15 to 44 years of age in communities with high syphilis rates and in all pregnant patients at the time of diagnosis or prenatal intake, in the third trimester, and at delivery. Screening for chlamydia and gonorrhea is currently recommended in asymptomatic, sexually active patients younger than 25 years, as well as in older patients with risk factors. When clinicians are diagnosing active infections, patients with anogenital ulcerations should be tested for syphilis and herpes and treated empirically while awaiting test results. Treatment of syphilis depends on the disease stage; first-line regimens all involve penicillin G. Patients with vaginal discharge and dysuria should be tested for gonorrhea and chlamydia using nucleic acid amplification testing. Doxycycline should be used to treat chlamydia because it is more effective in rectal chlamydia, which often coexists with vaginal infection. Single-dose azithromycin is an alternative in populations at risk for poor medication adherence or confidentiality concerns. Ceftriaxone should be used to treat gonorrhea. Increasing drug resistance to gonorrhea is a growing public health threat, and clinicians must work with public health departments in cases of suspected treatment failure.
Assuntos
Antibacterianos , Infecções Sexualmente Transmissíveis , Adolescente , Adulto , Feminino , Humanos , Gravidez , Antibacterianos/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Programas de Rastreamento/métodos , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Adulto Jovem , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Recombinase polymerase amplification (RPA) is a novel nucleic acid isothermal amplification technique that can achieve rapid detection of the target, under 37 to 42°C conditions, within 30 minutes. It has the advantage of extreme sensitivity, strong specificity, and low instrument dependency and is particularly suitable for real-time detection in the field. It can be widely used in fields such as in vitro diagnostics, biosafety, and agriculture. This study was based on RPA technology, targeting the gyrA gene of Neisseria gonorrhoeae (N. gonorrhoeae), to establish a quick, accurate, and easy to operate method for detecting N. gonorrhoeae and to evaluate its specificity, sensitivity, and clinical, practical value. METHODS: Specific primers and probes suitable for RPA and qPCR methods based on the specific conserved region of the gyrA gene of N. gonorrhoeae on GenBank (no. U08817.1) were designed An RPA method was developed and N. gonorrhoeae ATCC49226 and a number of clinical isolates were used as study subjects to validate the specificity and sensitivity of the RPA method for the detection of N. gonorrhoeae. A real-time fluorescence quantitative polymerase chain reaction (qPCR) method, with N. gonorrhoeae ATCC49226 as the research object, was established to verify the sensitivity of qPCR method for detecting N. gonorrhoeae. Finally, clinical samples were tested by using RPA and qPCR methods as performance validation experiments to determine the clinical utility of the RPA technique in detecting N. gonorrhoeae. RESULTS: The established RPA detection method showed excellent specificity, with a specific amplification curve for N. gonorrhoeae alone, no cross-reactivity with other bacteria, and excellent reproducibility. The detection results could be obtained within 30 minutes, under the condition of 39°C, which was significantly lower than the detection time of traditional methods. The sensitivity of the RPA method for detecting pathogenic bacteria samples was 4 × 102 CFU/mL, which is consistent with the detection limit of qPCR methods. RPA and qPCR methods were used to detect 121 clinical isolates, out of which 30 strains of N. gonorrhoeae showed a specific amplification curve, while the remaining 91 strains of non-N. gonorrhoeae did not. Both methods had 100% accuracy and specificity in detecting N. gonorrhoeae. CONCLUSIONS: The RPA method developed in this study has the characteristics of being quick, accurate, and easy to operate, which was of great value for the rapid detection of N. gonorrhoeae in clinical samples.