Gardnerella vaginalis in urinary tract infections, are men spared?

Gardnerella vaginalis in association with anaerobes has been linked to bacterial vaginosis in women, while urinary tract infections (UTIs) in men have rarely been reported. The aim of the review was to reveal the significance of G. vaginalis UTIs in men. Prevalence of G. vaginalis UTIs in men varied from 0.5 to >27% according to patients' groups. Most patients had comorbidity such as urolithiasis or stents, transplants, tumors and diabetes, however, infections can also affect immunocompetent patients. We observed G. vaginalis-associated bacteriuria and leukocyturia in a kidney transplant man. Complications of the UTIs such as bacteremia (in 9/11 cases), hydronephrosis (4/11) and abscesses or septic emboli have been reported. Bacterial vaginosis in female partners has been a risk factor for UTIs in males. In women, biofilm Gardnerella phenotype, stabilized by Atopobium vaginae and Prevotella bivia was linked to ≥6-fold higher antibiotic resistance rates compared with the planktonic phenotype. Non-susceptibility to metronidazole and levofloxacin was found also in males. Therefore, if aerobic urine cultures are negative, urine and blood samples from male patients with predisposing factors and clinical signs of UTIs and bacteremia, can be taken. Plates should be incubated for 2-4 days in capnophilic/microaerophilic conditions, however only anaerobic incubation can help with detecting G. vaginalis strains which grow only anaerobically. Susceptibility testing of the isolates is highly important. Briefly, adherent G. vaginalis phenotype can be sexually transmissible. Despite the infrequency of G. vaginalis UTIs in men, the infections should be considered since they are often linked to severe complications.

Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men-is it time to re-evaluate STI-screening as a control strategy?

BACKGROUND/OBJECTIVES: Many European countries reported increased numbers of syphilis, gonorrhoea and chlamydia diagnoses among men who have sex with men (MSM) in recent years. Behaviour changes and increased testing are thought to drive these increases. METHODS: In 2010 and 2017, two large online surveys for MSM in Europe (EMIS-2010, EMIS-2017) collected self-reported data on STI diagnoses in the previous 12 months, diagnostic procedures, STI symptoms when testing, number of sexual partners, and sexual behaviours such as condom use during the last intercourse with a non-steady partner in 46 European countries. Multivariate regression models were used to analyse factors associated with diagnoses of syphilis, gonorrhoea/chlamydia, and respective diagnoses classified as symptomatic and asymptomatic. If applicable, they included country-level screening rates. RESULTS: Questions on STI diagnoses and sexual behaviours were answered by 156,018 (2010) and 125,837 (2017) participants. Between 2010 and 2017, overall diagnoses with gonorrhoea/chlamydia and syphilis increased by 76% and 83% across countries. Increases were more pronounced for asymptomatic compared to symptomatic infections. The proportion of respondents screened and the frequency of screening grew considerably. Condomless anal intercourse with the last non-steady partner rose by 62%; self-reported partner numbers grew. Increased syphilis diagnoses were largely explained by behavioural changes (including more frequent screening). Gonorrhoea/chlamydia increases were mainly explained by more screening and a change in testing performance. A country variable representing the proportion of men screened for asymptomatic infection was positively associated with reporting symptomatic gonorrhoea/chlamydia, but not syphilis. DISCUSSION/CONCLUSION: The positive association of country-level screening rates with the proportion of symptomatic infections with gonorrhoea/chlamydia may indicate a paradoxical effect of screening on incidence of symptomatic infections. Treatment of asymptomatic men might render them more susceptible to new infections, while spontaneous clearance may result in reduced susceptibility. Before expanding screening programmes, evidence of the effects of screening and treatment is warranted.

Mycoplasma genitalium and Macrolide Resistance-associated Mutations in the Skåne Region of Southern Sweden 2015.

Mycoplasma genitalium is a sexually transmitted infection ordinarily treated with azithromycin. Emerging resistance to macrolide is linked to mutations in the 23S rRNA gene. We analysed the frequency of such mutations of M. genitalium isolates from patients that were symptomatic, and from sexual partners of symptomatic individuals, from October to December of 2015, in the Skåne Region of Sweden. Mutations were analysed by the use of DNA sequencing. Overall, 11.9% (145/1,311) and 17.0% (116/704) of females and males were positive for M. genitalium, respectively. Macrolide resistant mutations were detected in 13% (31/239) of M. genitalium isolates from first-test patient samples. Twenty-one (8.8%) and 10 (4.2%) of the isolates had point mutations of the 23S-gene at position 2072 and 2071, respectively. Two different M. genitalium isolates were detected simultaneously in two cases. In summary, we found a relatively low rate of macrolide-resistant M. genitalium in the region of Southern Sweden.

Prevalencia de la infección por Chlamydia trachomatis y factores de riesgo de infecciones transmisibles sexualmente en estudiantes universitarios / Prevalence of Chlamydia trachomatis infection and factors with the risk of acquiring sexually transmitted infections in college students

La infección genital por Chlamydia trachomatis es considerada en la actualidad una de las causas más frecuentes de infecciones transmisibles sexualmente (ITS) a nivel mundial y afecta principalmente al grupo de jóvenes menores de 25 años. El objetivo de este estudio fue determinar la prevalencia de la infección por C. trachomatis en alumnos ingresantes a la Universidad Nacional del Sur (Bahía Blanca, Argentina) y evaluar los factores de riesgo para la adquisición de ITS. Participaron en el estudio 204 jóvenes de edad media de 19 años, que remitieron una muestra de orina de primera micción y respondieron a una encuesta anónima. La investigación de C. trachomatis se realizó sobre 114 muestras válidas mediante una técnica de amplificación génica, cuyo blanco molecular es el gen ompA. Se detectaron 4 casos de infección por C. trachomatis, lo que implicó una prevalencia del 3,5 %. Los factores de riesgo que demostraron estar asociados con la adquisición de esta ITS fueron un historial de 7 o más parejas desde el comienzo de las relaciones sexuales y el contacto con una nueva pareja sexual en los últimos 4 meses. La prevalencia de infección por C. trachomatis reflejó una moderada circulación de este microorganismo en la población estudiada. Si bien algunos aspectos revelados en las encuestas sugieren una población de bajo riesgo para la adquisición de ITS en general, otros datos evidencian lo contrario y alertan sobre la necesidad de incrementar la vigilancia y desarrollar acciones de concienciación y prevención en esta población.

Chlamydia trachomatis genital infection is nowadays considered one of the most frequent causes of sexually transmitted infections (STI) in the world, mainly affecting the group of young people under 25 years old. The aim of this study was to determine the prevalence of C. trachomatis infection in newly admitted students to Universidad Nacional del Sur, Bahía Blanca, Argentina, and to evaluate the risk factors to acquire STI. For that purpose, 204 young college students with a mean age of 19 were involved in this study. Each participant delivered a sample of first-void urine and completed a questionnaire which was then submitted anonymously. The research for C. trachomatis was done on 114 valid samples through a technique of DNA amplification, whose molecular target was the gene ompA. Four cases of infection by C. trachomatis were detected with a prevalence of 3.5 %. The risks factors associated to the infection were a history of 7 or more partners since the start of sexual activity and contact with a new sexual partner in the last 4 months. The prevalence of such infection reflects a moderate circulation of this microorganism in the studied population. This fact, along with some aspects shown by the questionnaire results, would characterize a population having a low risk profile for acquiring STIs. However, some other information obtained from the questionnaires gave some opposite evidence, which would alert us on the need of keeping watch, raising awareness and implementing preventive actions in this population.

Sex, lies, and gastrointestinal tract biopsies: a review of selected sexually transmitted proctocolitides.

There are many insults that result in gastrointestinal tract inflammation. Infections can be particularly challenging because (1) only a limited number of organisms provoke a specific endoscopic and/or histologic appearance; and (2) although some organisms may be present on biopsies, the findings may be so subtle or organisms so few that they are easily missed if the reviewer is not performing a specific search for the offender. Sexually transmitted infections (STI) are rarely a consideration at the time of GI biopsy examination and clinicians rarely inquire about sexual behavior at the time of initial patient interview. Although establishing a definitive STI diagnosis is not possible on histology alone, these infections are associated with inflammatory patterns that may help raise this diagnostic possibility. Becoming familiar with these patterns is necessary as worldwide outbreaks of these infections are being reported. This review aims to provide the pathologist with histologic clues associated with the most frequently encountered bacterial pathogens in the setting of STI proctitis, namely, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum.

Is the recall of men who have sex with men (MSM) diagnosed as having bacterial sexually transmitted infections (STIs) for re-screening a feasible and effective strategy?

OBJECTIVES: To assess the feasibility and outcomes of recalling men who have sex with men (MSM) diagnosed as having a bacterial sexually transmitted infection (STI) for re-screening. METHODS: This evaluation was conducted from December 2008 for a 9-month period. MSM diagnosed as having a bacterial STI in that period were offered recall for re-screening 3 months after their diagnosis. Re-screening rates and infection incidence were calculated. Differences in baseline characteristics by re-screening status and factors predictive of infection at re-screening were assessed using the Mann-Whitney test, χ(2) test and logistic regression. RESULTS: Of the 337 MSM diagnosed as having a bacterial STI, 301 were offered recall. Of these, 206 (68.4%) re-screened after 3 months, 30 (10%) declined and the remainder did not re-attend despite giving verbal consent. Compared with those not re-screening, those re-screening were less likely to be HIV positive (p=0.001), but there was no difference in baseline risk behaviours. There were 15 diagnoses of bacterial STIs at re-screening (29 per 100 person-year follow-up (pyfu); 95% CI 14.3 to 43.7) and five new HIV diagnoses of whom three had a negative test at baseline, one tested negative 6 months earlier and one never tested. Among those testing at both time points, the HIV incidence was 8.3 per 100 pyfu (95% CI 0.0 to 17.7). CONCLUSIONS: This evaluation demonstrates a 'recall for re-screening' strategy is feasible in terms of high re-screening rates and incidence of new infections diagnosed. Experimental evidence is needed to assess cost-effectiveness and whether it achieves its aim of reducing transmission of STIs and HIV.

Establishing a linked sentinel surveillance system for blood-borne viruses and sexually transmissible infections: methods, system attributes and early findings.

OBJECTIVE: To describe the attributes and key findings from implementation of a new blood-borne virus (BBV) and sexually transmissible infection (STI) sentinel surveillance system based on routine testing at clinical sites in Victoria, Australia. METHODS: The Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) on BBV and STI was established in 2006 at 17 sites. Target populations included men who have sex with men (MSM), young people and injecting drug users (IDU). Sites collected demographic and risk behaviour information electronically or using paper surveys from patients undergoing routine HIV or STI (syphilis, chlamydia (Chlamydia trachomatis)) or hepatitis C virus (HCV) testing. These data were linked with laboratory results. RESULTS: Between April 2006 and June 2008, data were received for 67 466 tests and 52 042 questionnaires. In clinics providing electronic data, >90% of individuals tested for HIV, syphilis and chlamydia had risk behaviour information collected. In other clinics, survey response rates were >85% (HIV), 43.5% (syphilis), 42.7-66.5% (chlamydia) and <20% (HCV). Data completeness was >85% for most core variables. Over time, HIV, syphilis and chlamydia testing increased in MSM, and chlamydia testing declined in females (P = 0.05). The proportion of positive tests among MSM was 1.9% for HIV and 2.1% for syphilis. Among 16-24-year-olds, the proportion positive for chlamydia was 10.7% in males and 6.9% in females. Among IDU, 19.4% of HCV tests were antibody positive. CONCLUSIONS: The VPCNSS has collected a large, rich dataset through which testing, risk behaviours and the proportion positive can be monitored in high-risk groups, offering a more comprehensive BBV and STI surveillance system for Victoria. Building system sustainability requires an ongoing focus.

Gardnerella biofilm involves females and males and is transmitted sexually.

OBJECTIVE: To study the incidence and distribution of adherent Gardnerella vaginalis. METHODS: Bacteria adherent to desquamated epithelial cells in the urine were detected using fluorescence in situ hybridization (FISH). Urine from patients with bacterial vaginosis (BV, n = 20), their partners (n = 10) and different control populations (n = 344) including pregnant women and their partners, randomly selected populations of hospitalized man, women and children as also healthy controls was investigated. RESULTS: Gardnerella was found in two different forms: cohesive and dispersed. In the cohesive form, Gardnerella were attached to the epithelial cells in groups of highly concentrated bacteria. In the dispersed form, solitary Gardnerella were intermixed with other bacterial groups. Cohesive Gardnerella was present in all patients with proven BV and their partners, in 7% of men and 13% of women hospitalized for reasons other than BV, in 16% of pregnant women and 12% of their male partners, and in none of the healthy laboratory staff or children. In sexual partners, occurrence of cohesive Gardnerella was clearly linked. Dispersed Gardnerella were found in 10-18% of randomly selected females, 3-4% of males and 10% of children and not sexually linked. In daily longitudinal investigations over 4 weeks no transition between cohesive and dispersed Gardnerella and vice versa was observed. Transmission of a cohesive Gardnerella strain could be followed retrospectively over 15 years using molecular genetic methods. CONCLUSIONS: Cohesive Gardnerella biofilm is a distinct, clearly definable entity which involves both genders and is sexually transmitted. The correct name distinguishing it from symptom-defined conditions like BV should be gardnerellosis and for the bacterium Gardnerella genitalis.

Identifying individuals engaging in risky sexual behaviour for chlamydia infection in the UK: a latent class approach.

Chlamydia trachomitis is the most common sexually transmitted infection in the UK and the number of cases diagnosed each year continues to rise. Although much is known about the risk factors for chlamydia from previous observational studies, less is known about how individuals put themselves at risk. Do they engage in just one risky type of behaviour or are certain individuals 'risky', engaging in multiple risky behaviours? This paper uses latent class analysis, applied to the National Survey of Sexual Attitudes and Lifestyles II (2000-2001), to determine whether a subgroup of high-risk individuals can be identified and explores which features of their behaviour distinguish them from other groups of lower risk individuals. A 3-class solution was obtained, splitting the sample on the basis of the number of sexual partners in the past year. Those with no sexual partners in the past year (8%) and one sexual partner in the past year (71%) were much less likely to have engaged in any of the other behaviours known to increase chlamydia risk. However, the group who had two or more sexual partners in the past year (21%) were much more likely to have also engaged in other risky behaviours. The number of partners in the past year is therefore a useful marker for identifying those at increased risk of chlamydia infection. Individuals under 25 years old, males and those who were single or previously married were more likely to be allocated to the risky group. However, in spite of observed higher incidence of chlamydia infection, individuals in the black ethnic minority groups did not show an increased prevalence of risky behaviour, after controlling for age, sex and marital status.

The Philadelphia High-School STD Screening Program: key insights from dynamic transmission modeling.

BACKGROUND: The Philadelphia high-school STD Screening Program (PHSSP) represents an innovative approach to screening-based control of Chlamydia trachomatis infection. The program has been associated with significant reductions in Chlamydia trachomatis prevalence in young females in Philadelphia. We sought to assess program cost-effectiveness in a manner that allowed us to quantify the impact of including males students in the screened population. METHODS: We created a dynamic transmission model using a susceptible-infectious-resistant-susceptible framework. The model was parameterized using PHSSP program data, supplemented by available data from the medical and public health literature, and was used to project the impact of screening on disease burden, quality adjusted survival, and costs. RESULTS: A well-calibrated model suggests that high-school based screening is highly cost-effective in the Philadelphia context. Five important insights are gained through dynamic transmission modeling of the PHSSP: (i) the importance of screening males can be appreciated using a dynamic transmission model; (ii) the attractiveness of screening males is inversely related to equilibrium prevalence in males; (iii) including males enhances both effectiveness and economic attractiveness of screening; (iv) rebound in prevalence does not greatly diminish the cost-effectiveness of screening; and (v) increasing program expenditures via increased screening coverage decreases net societal costs, due to diminished disease transmission. CONCLUSIONS: The current PHSSP is highly cost-effective relative to other commonly accepted interventions. Effectiveness and cost-effectiveness of this program are enhanced by including males. This, and other important attributes of the program, is best appreciated when a dynamic transmission model is used for program evaluation.

Bacterial vaginosis. Transmission, role in genital tract infection and pregnancy outcome: an enigma.

Whether bacterial vaginosis (BV) is acquired from an endogenous or an exogenous source is subject to controversy. Despite findings of an association between sexual behaviour and BV, some data indicate that BV is not a sexually transmitted infection in the traditional sense, while other data indicate that BV is an exogenous infection. A third aspect of BV is its tendency to go unnoticed by affected women. All of this will have a strong impact on how physicians view the risks of asymptomatic BV. This review focuses on whether or not BV should be regarded as a sexually transmitted infection (STI), its role in postoperative infections and pelvic inflammatory disease (PID), and on whether or not treatment of BV during pregnancy to reduce preterm delivery should be recommended. The reviewed studies do not lend unequivocal support to an endogenous or exogenous transmission of the bacteria present in BV. For women undergoing gynaecological surgery such as therapeutic abortion, the relative risk of postoperative infection is clearly elevated (approx. 2.3-2.8). A weaker association exists between BV and pelvic inflammatory disease. Data on treatment of BV as a way of reducing preterm delivery are inconclusive and do not support recommendations for general treatment of BV during pregnancy. The discrepant associations between BV and preterm birth found in recent studies may be explained by variations in immunological response to BV. Genetic polymorphism in the cytokine response--both regarding the TNF alleles and in interleukin production--could make women more or less susceptible to BV, causing different risks of preterm birth. Thus, studies on the vaginal inflammatory response to microbial colonization should be given priority.

[Diagnosis of major sexually transmitted infections in the doctor's office: bacterial infections]. / Diagnostik sexuell übertragener Krankheiten: Bakterielle Infektionen. Kennen Sie die "Kieler Masern"?

Bacterial infections that can be transmitted by sexual contact are usually caused by the following organisms: Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum and Klebsiella granulomatis. These pathogens can be detected with the aid of specific nutrient media, stained microscopic sections and serological and molecular biological methods.

Non-effective partner notification system: a missed opportunity for the reduction of sexually transmitted infections in sub-Saharan Africa.

UNLABELLED: It is well know that common sexually transmitted infections (STI) promote HIV/AIDS infections in the community. Partner notification is one of the recommended strategies used for STI control. Antenatal syphilis screening, treatment of syphilis-positive pregnant women and their partner (partners) treatment may decrease the number of new syphilis cases, cases of congenital syphilis and diminish maternal morbidity and mortality. OBJECTIVE: The aim of the study was to assess the adequacy and effectiveness of partner notification and treatment system of rapid plasma reagin (RPR) positive patients of antenatal clinics (ANC) in Swaziland as an example of a country in sub-Saharan Africa. MATERIAL AND METHODS: It was a prospective study of the incidence of syphilis in the group of pregnant women attending antenatal clinics (ANC), and a study of the results of their partners' notification. The data for this study were collected prospectively from routine records of ANC attendees. RESULTS: The positive Rapid Plasma Reagin (RPR) test was established in 19% (n = 2034) screened patients. 38% out of all RPR-positive patients were not informed of their RPR status. The typical syphilis treatment was given in 42% of all RPR-positive pregnant women. Only 5% of partners of the RPR-positive pregnant women were traced, checked and correctly treated. CONCLUSIONS: The usual way of syphilis screening and partner notification in a country like Swaziland is not effective, and there is a need to develop other, African-specific methods of syphilis screening and partners' notification. Most probably without the effective STI management in Africa the battle against HIV/AIDS epidemic will be extremely difficult if not impossible.

Cutaneous tuberculosis of the penis and sexual transmission of tuberculosis confirmed by molecular typing.

A case of culture-positive primary cutaneous Mycobacterium tuberculosis infection of the penis was diagnosed in a male patient; 1 year later, endometrial tuberculosis was diagnosed in the patient's wife. These organisms were confirmed to be indistinguishable by use of molecular techniques.

Seropositivity to multiple sexually transmitted infections is not common.

BACKGROUND: Seropositivity for several sexually transmitted infections (STIs) is often used as a surrogate measure of sexual behavior. The authors assessed the concomitant seropositivity for STIs in women. GOAL: To estimate the excess of concomitant seropositivity for four STIs among fertile-aged women assuming no coinfections above what would be expected at random. STUDY DESIGN: Antibodies to herpes simplex virus type 2, human papillomavirus type 16, HIV, Chlamydia trachomatis, and Treponema pallidum were determined from a random sample of 1110 pregnant women in Tallinn, Estonia. RESULTS: A total of 310 combinations of the concomitant seropositivity were observed, whereas only 193 were expected by chance. Among persons seropositive for two STIs, 78 extra combinations were observed, whereas for three STIs, 35 extra combinations were observed. For four STIs, 3.8 extra combinations were found. CONCLUSIONS: Seropositivity to multiple STIs is not common. This fits the concept of different transmission probabilities and the spread of the STIs, and suggests that seropositivity alone should be used with caution as a surrogate to sexual behavior in women.