Trends of Antimicrobial Susceptibility of Neisseria gonorrhoeae isolates between 2012 and 2023: results from an open Italian cohort.

BACKGROUND: Neisseria gonorrhoeae (Ng) is a public health priority due to the rapid evolution of antimicrobial resistance, the emergence of antibiotic resistance and the absence of a vaccine against Ng. The aim of this study was to investigate trends in the minimum inhibitory concentration (MIC) and resistance (R) or reduced susceptibility (DS) of Ng cases to ceftriaxone (CRO), azithromycin (AZM), tetracycline (TET), benzylpenicillin (PenG), ciprofloxacin (CIP) over a 10-year period. METHODS: Retrospective analysis on an open cohort of Ng cases diagnosed on rectal, urethral and pharyngeal samples at San Raffaele Scientific Institute, between September 2012-February 2023. MICs of antibiotics were determined by gradient-test strips. Bivariate linear regression models, applied on logarithmic MICs values; Cochran-Armitage test was used to determine a linear trend in the proportions of resistant strains. RESULTS: 436 Ng isolates from 352 individuals were analyzed. MICs of CRO and PenG reduced over time (p < 0.001, p = 0.030), AZM increased (p = 0.001), CIP and TET did not change (p = 0.473, p = 0.272). The percentages of resistant strains were: PenG 89.9%, TET 90.8%, CIP 48.2%, AZM 4.4%; CRO-DS strains were 8.7%, only one CRO-R. The proportion of resistant strains increased over time for AZM (p = 0.007), TET (p = 0.001), CIP (p < 0.001), whereas decreased for PenG (p < 0.001) and CRO-DS/R strains (p < 0.001). CONCLUSIONS: Ng strains showed high susceptibility to CRO, although we identified cases of DS/R and observed high levels of susceptibility to AZM. Overall, the recommended primary regimen for Ng treatment confirmed to be effective.

High Propensity to Switch to Long-acting Injectable HIV PrEP with Cabotegravir in a Cohort of Oral PrEP Experienced Men who Have Sex with Men in Italy.

Aim was to investigate the propensity to switch to long-acting injectable HIV pre-exposure prophylaxis (PrEP) with cabotegravir among oral PrEP-experienced men who have sex with men. Out of 377 PrEP users, 325 (86.2%) were interested (would like = 210) or considering (would consider = 115) switch to long-acting PrEP. At multivariable analysis, the odds ratio of interest in long-acting PrEP in non-adherent vs. adherent individuals to oral PrEP was 5.03 (95%CI = 1.73-14.61,p = 0.003) and of consideration 1.63 (95%CI = 0.51-5.23,p = 0.410). We observed very high propensity to switch to long-acting PrEP, particularly among non-adherent users. Rapid availability of long-acting PrEP might address unmet needs of PrEP users in Italy.

Detection of Mpox Virus in Seminal Fluids: Implications for Sexual Transmission.

The 2022 outbreak of the human mpox virus, formerly known as monkeypox, raised global health concerns with widespread transmission across multiple countries. Sexual transmission emerged as a significant mode of spread, particularly among high-risk groups like MSM and PLWH. This manuscript focuses on the implications of seminal fluids in the transmission of mpox. The virus has been detected in various bodily fluids, including semen, indicating the potential for sexual transmission. Studies have reported high positivity rates of mpox DNA in seminal fluids. Despite some concern about possible contamination due to genital lesions, the presence of replication-competent virus in seminal fluids has been confirmed and mpox virus was also detected in this specimen among people who engaged only in receptive sexual intercourse. Antiviral treatment with tecovirimat showed efficacy in reducing viral presence in semen with detection of the antiviral in this specimen. Virus clearance from semen is relatively rapid and parallels healing from infection, with no reported cases of seminal fluid relapses. The WHO recommendation to avoid condomless intercourse for 12 weeks after clinical healing still appears prudent. Continued research and surveillance are essential to understand viral dynamics and develop effective prevention measures to combat the spread of mpox through sexual transmission and protect key-populations.

Mpox DNA clearance in semen over 6-month follow-up.

Sexual intercourse is a well-established way of transmission of mpox infection. However, it is still uncertain whether semen may represent a viral reservoir. The aim of the study was to evaluate the clearance of viral DNA in semen samples from individuals diagnosed with mpox infection over 6-month follow-up. This prospective, observational, single-center study was conducted at IRCCS San Raffaele Scientific Institute, Milan, Italy, between May and October 2022 in 140 individuals who attended Sexual Health Clinic and diagnosed with mpox infection. Semen samples were collected and analyzed by real-time polymerase chain reaction assays. The baseline collection was performed in 64 (46%) of 140 men diagnosed with mpox infection. The viral DNA was detected in 43 (67%) with median cycle threshold (Ct) 34 (interquartile range [IQR] 31-36). The research was repeated in 32 (74%) and viral DNA clearance was observed in all within 6 months in a median time of 10.5 days (IQR 7-33). Viral clearance occurred in all tested individuals, mostly within 2 weeks since the first positive test. These findings suggest a transient presence of viral DNA in semen and do not support the hypothesis of reservoir. More studies on mpox DNA detection in semen with viral culture and extended follow-up are needed.

Association of high-risk sexual behaviours with sexually transmitted infections among men who have sex with men living with HIV.

OBJECTIVES: To explore different sexual behaviours as risk factors for STI among men who have sex with men (MSM) living with HIV. METHODS: This is a cross-sectional study on MSM living with HIV followed at the Infectious Diseases Unit of San Raffaele Hospital, Milan, with at least one diagnosis of gonorrhoea, syphilis, chlamydia or anal human papilloma virus (HPV), between July 2016 and February 2021. We conducted a survey on high-risk sexual behaviours with regard to (1) mean number of partners per month, (2) estimated percentage of condom use and (3) most frequent type of sexual intercourse during 2016-2021. Data on these variables were grouped as follows: (1a) ≤5 vs >5, (1b) >10 vs ≤10, (2a) 0% vs >0%, (2b) ≤50% vs >50%, (2c) 100% vs <100%, (3a) ≥50% vs <50% receptive, (3b) 100% vs <100% insertive, and (3c) 100% vs <100% receptive. A high-risk group was defined as >5 partners, <100% use of condom and ≥50% receptive intercourse. Univariate logistic regressions were applied to assess the association between sexual behaviours and the risk of each STI. RESULTS: Out of 1051 MSM with at least one STI diagnosis, 580 (55%) answered the survey. The risk of chlamydia was lower among individuals with ≤5 partners (≤5 partners vs >5 partners: OR=0.43, 95% CI 0.28 to 0.66, p=0.001) and among those using condoms more frequently (≤50% use of condom vs >50% use of condom: OR=1.55, 95% CI 1.06 to 2.27, p=0.025; 100% vs <100%: OR=0.35, 95% CI 0.20 to 0.59, p=0.001). Individuals using condoms more frequently also had lower risk of gonorrhoea (100% use of condom vs <100% use of condom: OR=0.37, 95% CI 0.17 to 0.79, p=0.011). The risks of chlamydia (OR=3.07, 95% CI 1.92 to 4.90, p<0.001) and gonorrhoea (OR=2.05, 95% CI 1.12 to 3.75, p=0.020) were higher among individuals belonging to the high-risk group. CONCLUSIONS: Chlamydia and gonorrhoea are more likely associated with high-risk sexual behaviours than syphilis and anal HPV among MSM living with HIV.

Meningococcus B Vaccination Effectiveness Against Neisseria gonorrhoeae Infection in People Living With HIV: A Case-Control Study.

BACKGROUND: We assessed the vaccination effectiveness (VE) of multicomponent meningococcal serogroup B (4CMenB) vaccine against gonorrhea among people living with HIV (PLWH) with a previous diagnosis of sexually transmitted infection. METHODS: Unmatched case-control study on men who have sex with men living with HIV, in care at San Raffaele Scientific Institute, Milan, Italy, with gonorrhea, syphilis, chlamydia, or anal human papillomavirus between July 2016 (beginning of 4CMenB vaccination) and February 2021 (date of freezing). For the analysis, cases were people with ≥1 gonorrhea infection since July 2016, and controls were people with ≥1 syphilis, chlamydia, or anal human papillomavirus infection since July 2016. Logistic regression was used to provide the estimate of 4CMenB VE against gonorrhea. RESULTS: Included people living with HIV were 1051 (103 cases, 948 controls); 349 of 1051 (33%) received 2 doses of 4CMenB vaccination. The median follow-up was 3.8 years (2.1-4.3 years). The unadjusted estimate for VE against gonorrhea was 42% (95% confidence interval, 6%-64%; P = 0.027). Logistic regression showed that VE against gonorrhea remained significant (44%; 95% confidence interval, 9%-65%; P = 0.020) after adjusting for some factors that might have a potential influence on VE or those with significant unbalanced distributions between cases and controls at univariable analysis. CONCLUSIONS: 4CMenB vaccination is associated with a lower risk of gonorrhea in the setting of men who have sex with men living with HIV with a previous sexually transmitted infection.

Vaccines against Emerging Sexually Transmitted Infections: Current Preventive Tools and Future Perspectives.

Vaccines have historically played a pivotal role in reducing the burden of infectious diseases andnow play a crucial role in the setting of sexually transmitted infections (STIs). However, there remainseveral unmet goals: vaccines are available only for viral STIs, vaccination accessibility anduptake remain disproportionate worldwide, and no effective vaccine has been developed for HCV.Moreover, there are no vaccines against bacterial STIs: fewer investments in research have beenmade, because vaccines are not a top priority due to the availability of effective treatments. However,higher rates of resistance to all available antibiotics has led to a shift in research priorities. Severalpromising vaccine candidates have been identified or are being investigated in pre-clinical or clinicaltrials, although further understanding of the immunogenicity, effectiveness and delivery strategiesof already licensed vaccines is needed. This paper focuses on current research efforts to developvaccines against bacterial (e.g. gonorrhoea, chlamydia and syphilis) and viral (e.g. HCV) STIs. Wealso review current indications and evidence of effectiveness of already available vaccines (e.g. HAV,HBV and HPV) and discuss open issues.

Early Diagnosis and Linkage to Care: an Experience over 14 years of Point of Care Rapid HIV Testing.

Point-of-care rapid testing is one of the strategies to increase HIV screening. We present data on over 14 years of the "EASY Test Program", an ongoing cross-sectional collaborative project that provides free and anonymous rapid HIV testing in the metropolitan city of Milan, Italy. Overall, 22,186 HIV tests were performed, with a 0.52% prevalence of HIV infection; 100% of those diagnosed with HIV were linked to care. The "EASY Test Program" is an appropriate test-and-treat strategy, allowing a fast HIV assessment (24 hours). Motivated clinicians, in partnership with community associations, can perform an easy HIV screening out of hospitals in alternative settings, among individuals who in the majority of cases had never tested for HIV, ultimately providing an effective linkage to care.