Neisseria gonorrhoeae: un patógeno díscolo: conceptos microbiológicos, resistencia a antimicrobianos y su vigilancia epidemiológica en Chile / Neisseria gonorrhoeae: a wayward pathogen: microbiological concepts, antimicrobial resistance and its epidemiological surveillance in Chile

Resumen Neisseria gonorrhoeae es un diplococo gramnegativo, no móvil, esporulado, aerobio o anaerobio facultativo, catalasa y oxidasa positivas. Las infecciones de transmisión sexual causadas por este microorganismo son un problema de salud pública definido como tal desde el siglo XIX, representando una gran amenaza para la salud humana debido a la su alta prevalencia y multirresistencia a antimicrobianos. En las últimas décadas han aumentado los reportes de cepas resistentes a penicilina, fluoroquinolonas, sulfonamidas, tetraciclina, macrólidos, y más recientemente a cefalosporinas y azitromicina. Tal panorama ha generado preocupación a nivel mundial, debido al aumento de casos de gonorrea asociados a cepas multirresistentes. En Chile se desarrolló desde el 2010 hasta el 2018 el Programa de Vigilancia de N. gonorrhoeae a nivel nacional con el objeto de caracterizar esta infección en las regiones y registrar la resistencia a los antimicrobianos. Esta revisión presenta un análisis sistemático bibliográfico, actualizado, de los principales aspectos de este microorganismo, su respuesta a antimicrobianos, y entrega pautas de diagnóstico y tratamiento, a la espera de avanzar en la comprensión del mecanismo molecular y las interacciones metabólicas e inmunológicas que determinan la infección, con miras a diseñar una vacuna efectiva.

Abstract Neisseria gonorrhoeae is a nonmotile, sporulated, aerobic or facultative anaerobic gram-negative diplococcus, catalase and oxidase positive. Sexually transmitted infections caused by this microorganism were established as public health problem since the 19th century, representing a great threat to human health due to its high prevalence and multi-resistance to antimicrobials. In recent decades, reports of strains resistant to penicillin, fluoroquinolones, sulfonamides, tetracycline, macrolides, and more recently to cephalosporins and azithromycin have increased. Such a panorama has generated concern worldwide, due to the increase in cases of gonorrhea associated with multi-resistant strains. In Chile, from 2010 to 2018, the National Surveillance Program for N. gonorrhoeae was developed in order to characterize this infection in the regions and record antimicrobial resistance. This review presents an updated, systematic bibliographic analysis of the main aspects of this microorganism, its response to antimicrobials, and provides diagnostic and treatment guidelines, while waiting to advance in the understanding of the molecular mechanism and the metabolic and immunological interactions that determine infection, with a view to designing an effective vaccine.

Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados / Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors / Enfermedades de transmisión sexual en mujeres afrodescendientes de comunidades quilombolas en Brasil: prevalencia y factores asociados

Resumo: O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

Abstract: The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

Resumen: El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Western French Guiana

ABSTRACT The purpose of this study was to estimate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in western French Guiana and to analyze associated factors with both infections. A retrospective study was conducted in a sexually transmitted infections clinic in 2017. Women (n = 338) were tested by real-time polymerase chain reaction for vaginal, anal and throat CT and NG infections. Men (n = 192) were evaluated using urine specimens. Socio-demographic and sexual behaviour data were collected by nurses with a structured questionnaire. The prevalence of CT and NG infections among women were 24.3% and 13.3%, respectively, and 12.0% and 7.3% among men. Women aged under 25 years had a higher risk of CT and NG infections than women aged 35 years or more. Another risk factor for CT infection was low educational level, and occasional unprotected sex for NG infection. CT and NG infections were associated with reporting symptoms among men. Very high prevalences of CT and NG infections among women and men were found, which suggest that a large-scale screening strategy should be implemented in French Guiana.

Prevalencia de Neisseria gonorrhoeae, en reclusos del Centro de Detención Preventiva de Arica / Prevalence of Neisseria gonorrhoeae, amongst inmates of the Preventive Reclusion Center in Arica

Resumen Introducción: Los/as trabajadores/as sexuales, personas con adicción a drogas, población de inicio sexual precoz y población penal son considerados los grupos de mayor riesgo de contraer infecciones de transmisión sexual (ITS). Objetivo: Determinar prevalencia de infección por Neisseria gonorrhoeae, en reclusos del Centro de Detención Preventiva (CDP) de la Región de Arica y Parinacota, Chile. Este estudio contó con la aprobación del Cómité Ético Científico de la Universidad de Tarapacá. Material y Método: Participaron 140 reclusos, que aceptaron ser parte del estudio en forma voluntaria y firmaron un consentimiento informado. Se tomó una muestra del meato uretral para pesquisa de N. gonorrhoeae y se aplicó una encuesta epidemiológica que consignó edad, consumo de drogas, hacinamiento, entre otros. Resultados: La prevalencia del agente fue de 16,4% en reclusos del CDP de Arica, resultado menor a lo reportado en otros estudios similares. Conclusiones: Conocer la realidad de la prevalencia de esta ITS y algunos factores de riesgo asociados a la situación de privación de la libertad en una zona tri-fronteriza del norte de Chile, contribuye a las propuestas de programas de prevención en esta población vulnerable y de riesgo.

Abstract Background: Sex workers, people with drug addiction, early onset of sexual activity population, and criminal population, are considered the groups most at risk of contracting sexually transmitted infections (STIs). Aim: To determine the prevalence of infection by Neisseria gonorrhoeae in inmates of the Preventive Detention Center (CDP) at Arica and Parinacota Region, Chile. The Scientific Ethical Committee of Universidad de Tarapacá approved this study. Method: 140 inmates participated, who voluntarily agreed to be part of the study and signed an informed consent. A sample of urethral meatus was taken to investigate N. gonorrhoeae, and an epidemiological survey was applied, which included age, drug use, overcrowding, among others. Results: The prevalence of the agent was 16.4% in inmates of the Arica CDP, a result lower than that reported in other similar studies. Conclusion: Knowing the reality of the prevalence of this STI and some risk factors associated with the situation of deprivation of freedom in a tri-border area of northern Chile, contributes to the proposals for prevention programs in this vulnerable and at-risk population.

Informe: situación epidemiológica de las infecciones de transmisión sexual en Chile, 2017 / Report: epidemiological situation of sexually transmitted infections in Chile, 2017

Resumen Las infecciones de transmisión sexual (ITS) son una de las principales causas de enfermedad aguda, infertilidad, discapacidad a largo plazo y muerte en el mundo1. Este informe presenta la situación epidemiológica preliminar de las ITS hasta el año 2017 en Chile. Sífilis es la ITS de mayor tasa de notificación, seguido de la infección por VIH. En términos generales, todas las ITS presentan una relativa estabilización de sus tasas en el período 2014 y 2015, excepto gonorrea que muestra un incremento en estos años, el que se focaliza en el grupo de 15 a 24 años. El año 2017, sífilis y la infección por VIH presentaron un aumento de sus tasas en relación al año 2016. En todas estas ITS la tasa de hombres supera a la de mujeres y el grupo de edad más afectado es el de 15 a 39 años. Según distribución geográfica, las regiones de Arica-Parinacota a Antofagasta, Metropolitana, Valparaíso, Los Lagos y Aysén, presentan los mayores riesgos.

Sexually transmitted infections (STIs) are one of the main causes of acute illness, infertility, long-term disability and death in the world1. This report presents the preliminary epidemiological situation of STIs up to the year 2017 in Chile. Syphilis is the STI with the highest reporting rate, followed by HIV infection. In general terms, all STIs present a relative stabilization of their rates in the 2014 and 2015 periods, except for gonorrhea that shows an increase in these years, which focuses on the group of 15 to 24 years. In 2017, syphilis and HIV infection showed an increase in their rates in relation to 2016. In all these STIs the rate of men exceeds that of women and the most affected age group is 15 to 39 years. According to geographical distribution, the regions of Arica-Parinacota to Antofagasta, Metropolitana, Valparaíso, Los Lagos and Aysén, present the greatest risks.

Prevalencia de disfunción vaginal en mujeres de la ciudad de Bahía Blanca (Argentina) / Vaginal dysfunction prevalence in women of the city of Bahía Blanca (Argentina) / A prevalência de disfunção vaginal em mulheres da cidade de Bahía Blanca (Argentina)

La disfunción vaginal (vaginosis/vaginitis) es la patología genital hoy reconocida más prevalente. El objetivo del trabajo fue generar información sobre la prevalencia de Disfunción vaginal y los factores de riesgo asociados en mujeres sintomáticas y asintomáticas. Se incorporó además la detección de C. trachomatis y N. gonorrhoeae. Se consolida la validez del Balance del Contenido Vaginal (BACOVA) en el diagnóstico integral de disfunción vaginal y de la amplificación génica en la detección de C. trachomatis. Se estudiaron 295 mujeres que asistieron al Hospital Municipal de Bahía Blanca. La mayor prevalencia correspondió a vaginosis bacteriana (21,36%), luego levaduras (13,90%), T. vaginalis (3,73%) y C. trachomatis (3,05%). No se detectó ningún caso de gonococia. Los factores de riesgo encuadran en el marco de valores de la región centro sur del país, pero se debe destacar la frecuencia significativa de alteraciones de la función vaginal (68,87%) y la infección por clamidias (4,35%) detectadas en mujeres asintomáticas. Esto impone la necesidad de revisar y optimizar la política de cumplimiento de las Normas Ministeriales de prevención y control con la aplicación de una metodología de laboratorio normatizada en el protocolo de control de mujeres en edad fértil, embarazadas o no.

Vaginal dysfunction (vaginosis/vaginitis) is the most prevalent genital pathology recognized today. The objective of the work was to generate information on the prevalence of vaginal dysfunction and the associated risk factors in symptomatic and asymptomatic women. The detection of C. trachomatis and N. gonorrhoeae was also incorporated. The validity of the Vaginal Content Balance (BACOVA) in the comprehensive diagnosis of vaginal dysfunction and of gene amplification in the detection of C. trachomatis is consolidated. A total of 295 women who attended the Municipal Hospital of Bahía Blanca were studied. The highest prevalence corresponded to bacterial vaginosis (21.36%), then yeasts (13.90%), T. vaginalis (3.73%) and C. trachomatis (3.05%). No cases of gonorrhea were detected. The risk factors fit within the framework of values of the south central region of the country, but the significant frequency of alterations of vaginal function (68.87%) and chlamydial infection (4.35%) detected in asymptomatic women should be noted. This imposes the need to review and optimize the compliance policy of the Ministerial Standards of prevention and control, with the application of a standardized laboratory methodology, in the control protocol for women of childbearing age, pregnant or not.

A disfunção vaginal (vaginose/vaginite) é a patologia genital mais prevalente hoje reconhecida. O objetivo do trabalho foi gerar informações sobre a prevalência de disfunção vaginal e os fatores de risco associados em mulheres sintomáticas e assintomáticas. A detecção de C. trachomatis e N. gonorrhoeae também foi incorporada. A validade do Equilíbrio do Conteúdo Vaginal (BACOVA) no diagnóstico integral da Disfunção Vaginal e da amplificação gênica na detecção de C. trachomatis está consolidada. Estudamos 295 mulheres que freqüentaram o Hospital Municipal de Bahía Blanca. A maior prevalência correspondeu à vaginose bacteriana (21,36%), depois leveduras (13,90%), T. vaginalis (3,73%) e C. trachomatis (3,05%). Nenhum caso de gonorreia foi detectado. Os fatores de risco enquadram-se no quadro de valores da região centro-sul do país, mas deve-se notar a frequência significativa de alterações da função vaginal (68,87%) e infecção por clamídia (4,35%), detectadas em mulheres assintomáticas. Isso impõe a necessidade de rever e otimizar a política de compliance das Normas Ministeriais de prevenção e controle, com a aplicação de metodologia laboratorial padronizada, no protocolo de controle para mulheres em idade fértil, gestantes ou não.

Informe Anual 2016 Situación epidemiológica de gonorrea (CIE 10: A54) / Anual Report Epidemiology of gonorrohea (CIE 10: A54)

Resumen La gonorrea producida por Neisseria gonorrhoeae, es capaz de infectar diferentes tipos de mucosas dependiendo de las prácticas sexuales. Se ubica de preferencia en la uretra del hombre y en el cuello uterino de la mujer, también en el recto y la faringe. Su principal forma de transmisión es por relaciones sexuales no protegidas y, ocasionalmente, a través del conducto del parto en los recién nacidos. Este informe presenta la situación epidemiológica de la gonorrea hasta el año 2016 en Chile. Se realizó un análisis descriptivo de los casos que ingresaron a la vigilancia. Desde el año 2000, se observa una tendencia progresiva a la disminución de las tasas de gonorrea; sin embargo, en el año 2015 y 2016 se produjo un aumento de la tasa con relación al año 2014. En el año 2016 se presentaron 2.039 casos, lo que representa un incremento de 38% con respecto a la mediana del quinquenio anterior (1.473 casos). En relación con la edad de los casos, el mayor riesgo se encontró en el grupo de 15 a 24 años, destacándose que, a partir del año 2013, la tasa del grupo de 15 a 19 años superó al grupo de 25 a 29 años. Según distribución geográfica, las mayores tasas de notificación se presentaron en las regiones del extremo norte y sur del país, siendo las de mayor riesgo las regiones de Tarapacá, Antofagasta, Los Lagos y Aysén.

Gonorrhea is produced by the bacterium Neisseria gonorrhoeae, which is capable of infecting different types of mucous membranes depending on sexual practices. It is located preferably in the man's urethra and in the woman's cervix, also in the rectum and pharynx. Its main form of transmission is through unprotected sex and, occasionally, through the birth canal in newborns. This report presents the epidemiological situation of gonorrhea until 2016 in Chile. A descriptive analysis of the cases that entered the surveillance was carried out. Since 2000, there has been a progressive trend towards decreasing gonorrhea rates; However, in 2015 and 2016 there was an increase in the rate in relation to 2014. In 2016, 2,039 cases were presented, representing an increase of 38% with respect to the median of the previous five-year period (1,473 cases). Regarding the age of the cases, the greatest risk was found in the group of 15 to 24 years, highlighting that, as of 2013, the group rate of 15 to 19 years exceeded the group of 25 to 29 years. According to geographical distribution, the highest reporting rates were in the regions of the extreme north and south of the country, with the highest risk regions being Tarapacá, Antofagasta, Los Lagos and Aysén.

Resistência de Neisseria gonorrhoeae a antimicrobianos na prática clínica: como está o Brasil? / Antimicrobials resistance of Neisseria gonorrhoeae in clinical practice: where Brazil stands?

Estima-se que um milhão de infecções sexualmente transmissíveis (IST) sejam adquiridas por dia no mundo, segundo a Organização Mundial da Saúde. Elas podem ser causadas por diversos micro-organismos pelo contato sexual. Embora tratáveis, as infecções, como a clamidiana, sífilis, tricomoníase e gonorreia, são responsáveis por 350 milhões de novos casos de IST anualmente no mundo. A gonorreia é a segunda IST bacteriana mais prevalente no planeta e tem chamado atenção nos últimos anos em decorrência da baixa eficácia em seu tratamento. O agente etiológico é a Neisseria gonorrhoeae. Na maioria das mulheres, a infecção por esse micro-organismo é assintomática, dificultando ainda mais seu diagnóstico e tratamento e, portanto, aumentando o risco de desenvolvimento de suas complicações associadas. Mesmo quando diagnosticada, essa infecção está sujeita a um alto índice de insucesso terapêutico que se deve, principalmente, à grande plasticidade genética da N. gonorrhoeae para aquisição de genes cromossômicos ou plasmidiais de resistência. O aumento da resistência desse micro-organismo a antimicrobianos comumente utilizados no tratamento, como penicilina, tetraciclina e ciprofloxacina, tem sido relatado em diversos países. No Brasil, poucos estudos estão disponíveis, mas em alguns estados já foram relatadas linhagens resistentes à ciprofloxacina. Dessa forma, deve-se ressaltar a importância de novos estudos que visem descrever o perfil da resistência da N. gonorrhoeae a antimicrobianos. Tais achados certamente nortearão a implementação de sistemas de vigilância epidemiológica no país visto que, até o momento, as infecções por N. gonorrhoeae sequer estão incluídas na lista nacional de doenças e agravos de notificação compulsória.(AU)

According to the World Health Organization, approximately one million sexually transmitted infections (STI) are acquired daily in the world. These infections can be caused by several microorganisms via contact. The treatable STI, such as chlamydia, syphilis, trichomoniasis and gonorrhea, account for 350 million new cases of STI each year worldwide. Gonorrhoea is caused by Neisseria gonorrhoeae and is the second most common bacterial STI in the world. It has drawn more attention in the last years due to the low efficacy in its treatment. Most women with this infection are asymptomatic, which makes its diagnosis and treatment troublesome increasing the risk for its associated complications. Even when diagnosed, this infection is subject to a high rate of therapeutic failure mainly due to the great genetic plasticity of N. gonorrhoeae for the acquisition of chromosomal or resistance plasmid enes. Increased resistance of this microorganism to antimicrobials commonly used in treatment such as penicillin, tetracycline and ciprofloxacin has been reported in several countries. In Brazil, few studies are available, but in some states strains resistant to ciprofloxacin were alreadyreported. The refore, it is important to highlight the importance of new studies aimed at describing the resistance profile of N. gonorrhoeae to antimicrobials in Brazil context. These findings will certainly guide the implementation of epidemiological surveillance systems in the country, since until now N. gonorrhoeae infections do not figure into the national list of compulsorily notifiable diseases.(AU)

Antimicrobial resistance in Neisseria gonorrhoeae: history, molecular mechanisms and epidemiological aspects of an emerging global threat

ABSTRACT Neisseria gonorrhoeae is the agent of gonorrhea, a sexually transmitted infection with an estimate from The World Health Organization of 78 million new cases in people aged 15-49 worldwide during 2012. If left untreated, complications may include pelvic inflammatory disease and infertility. Antimicrobial treatment is usually effective; however, resistance has emerged successively through various molecular mechanisms for all the regularly used therapeutic agents throughout decades. Detection of antimicrobial susceptibility is currently the most critical aspect for N. gonorrhoeae surveillance, however poorly structured health systems pose difficulties. In this review, we compiled data from worldwide reports regarding epidemiology and antimicrobial resistance in N. gonorrhoeae, and highlight the relevance of the implementation of surveillance networks to establish policies for gonorrhea treatment.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhea and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study

Abstract Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. Methods: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. Results: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. Conclusions: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

Anogenital infection by Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected men and women in Salvador, Brazil

ABSTRACT Background: Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. Methods: Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). Results: The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age <29 years (p = 0.033), report of anal intercourse (p = 0.029), pain during anal intercourse (p = 0.028). On the other hand, no association between genital infection and other variables were detected in bivariate analysis. Among women, we detected an association between Chlamydia trachomatis genital infection and age <29 years (p < 0.001), younger age at first sexual intercourse (p = 0.048), pregnancy (p < 0.001), viral load >50 copies/mL (p = 0.020), and no antiretroviral use (p = 0.008). Anal infection in women was associated with age <29 years old (p < 0.001) and pregnancy (p = 0.023), and was not associated with report of anal intercourse (p = 0.485). Conclusion: Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.

Estado actual de la gonorrea / Current state of gonorrhea

La gonorrea es una infección de transmisión sexual conocida desde la antigüedad que se ha perpetuado en el tiempo. Su agente etiológico, Neisseria gonorrhoeae, fue adquiriendo resistencia a la mayoría de los antimicrobianos utilizados para su tratamiento empírico. Las resistencias emergentes en los últimos años son a fluorquinolonas, macrólidos y cefalosporinas orales y parenterales. Hay aislamientos multirresistentes que plantean un desafío para su tratamiento. En países donde estos hallazgos ocurrieron precedentemente, la experiencia de tratamientos con antibióticos no convencionales, por ejemplo aminoglucósidos, es limitada y también emergieron cepas resistentes. Una de las estrategias utilizadas frente a la sensibilidad disminuida a ceftriaxona es aumentar la dosis o utilizar tratamientos combinados. En el marco actual de la multirresistencia de este microorganismo es importante promover la prevención de la infección, realizar vigilancia epidemiológica y buscar nuevas estrategias para su tratamiento.

Gonorrhea is a sexually transmitted infection known since antiquity that has been perpetuated over time. Its etiologic agent, Neisseria gonorrhoeae, was becoming resistant to most antimicrobials agents used for empiric therapy. Emerging resistance in recent years are fluoroquinolones, macrolides, oral and parenteral cephalosporins. There are multiresistant isolates that represent a challenge for its treatment. In countries where these findings occurred previously, the experience with unconventional treatments such as aminoglycosides is limited and resistant strains have emerged. One of the strategies used against the reduced susceptibility to ceftriaxone is to increase the dose or use combined treatments. In the current context of multidrug resistance of this organism it is important to promote the prevention of infection, epidemiological surveillance and look for new strategies for treatment.

Prevalencia de infecciones por Chlamydia trachomatis y Neisseria gonorrhoeae en adolescentes de colegios de la provincia de Sabana Centro, Cundinamarca, Colombia / Prevalence of infections by Chlamydia trachomatis and Neisseria gonorrhoeae among high school students in the Sabana Central area of Cundinamarca, Colombia

Introducción. Las infecciones por Chlamydia trachomatis y Neisseria gonorrhoeae son las dos infecciones bacterianas de transmisión sexual más frecuentes en el mundo, principalmente en menores de 25 años, en cuya salud sexual, reproductiva y materno-infantil producen secuelas. Objetivo. Estimar la prevalencia de las infecciones por C. trachomatis y N. gonorrhoeae entre adolescentes en colegios de la provincia de Sabana Centro, Cundinamarca, Colombia. Materiales y métodos. Se hizo un estudio de corte transversal en adolescentes de 14 a 19 años matriculados en colegios ubicados en los 11 municipios de la zona de estudio. Después de obtener el consentimiento informado, los participantes llenaron una encuesta y recolectaron una muestra de orina para la detección de C. trachomatis y N. gonorrhoeae mediante la técnica de reacción en cadena de la polimerasa en tiempo real. Resultados. En una muestra de 972 adolescentes sexualmente activos, se encontró una prevalencia de infección por C. trachomatis del 2,24 % y, por N. gonorrhoeae , del 0,10 %. No se detectaron infecciones concomitantes. De las estudiantes positivas para C. trachomatis , el 21,4 % eran asintomáticas. Se encontró una relación significativa entre la infección por C. trachomatis y el sexo femenino, el consumo de alcohol u otras sustancias durante la última relación sexual, el tener una o varias parejas y la presencia de alguna infección de transmisión sexual. Conclusiones. La prevalencia de infecciones por C. trachomatis fue inferior a la reportada en grupos similares y se presentaron menos casos asintomáticos en comparación con la tendencia general. Se recomienda implementar en el país un sistema de vigilancia epidemiológica para estas dos infecciones de transmisión sexual mediante la tamización con técnicas moleculares no invasivas, para priorizar estrategias preventivas en las poblaciones de mayor riesgo.

Introduction: Infections by Chlamydia trachomatis and Neisseria gonorrhoeae are the two most common bacterial sexually transmitted infections in the world. These infections affect principally less than 25-year-old individuals with sexual, reproductive and maternal and child health consequences. Objective: This study sought to estimate the prevalence of C. trachomatis and N. gonorrhoeae among high school students in the 11 municipalities of the Sabana Central area of Cundinamarca, Colombia. Materials and methods: A cross-sectional study was conducted among 14 to 19-year old adolescents attending schools in the study area. After signing their consent, participants completed a questionnaire and provided a urine sample for the detection of C. trachomatis and N. gonorrhoeae by real-time polymerase chain reaction. Results: In the sample of 972 sexually active adolescents, the prevalence of C. trachomatis and N. gonorrhoeae was 2.24% and 0.10%, respectively. No co-infections were detected. Overall, 21.4% of women who tested positive for C. trachomatis were asymptomatic. Significant relationships were found between C. trachomatis infection and female gender, the consumption of alcohol or other substances during the previous sexual relationship, having one or more partners and the presence of sexually transmitted infections. Conclusions: The prevalence of C. trachomatis detected in this study was lower than the prevalence reported for similar groups; besides, contrary to the general trends, fewer asymptomatic cases were identified in this study. To prioritize preventive strategies in high-risk populations, an epidemiological surveillance system for C. trachomatis and N. gonorrhoeae should be implemented in Colombia, with screening performed using non-invasive molecular techniques.

Infecção por Chlamydia trachomatis e Neisseria gonorrhoeae: fatores associados à infertilidade em mulheres atendidas em um serviço público de reprodução humana / Chlamydia trachomatis and Neisseria gonorrhoeae infection: factors associated with infertility in women treated at a human reproduction public service

OBJETIVO: Avaliar a prevalência de infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres submetidas à reprodução assistida em um serviço público de referência da região Centro-Oeste do Brasil. MÉTODOS: Estudo transversal com 340 mulheres com idade entre 20 e 47 anos, histórico de infertilidade, submetidas às técnicas de reprodução assistida. Foram analisadas as infecções por Chlamydia trachomatis e Neisseria gonorrhoeae detectadas em amostras de urina pela técnica de PCR e o perfil da infertilidade. Utilizou-se o teste do χ2 ou o teste exato de Fisher para avaliar a associação entre a infecção e as variáveis. RESULTADOS: Observou-se prevalência de 10,9% das mulheres com infecção por Chlamydia trachomatis, sendo que houve coinfecção por Neisseria gonorrhoeae em 2 casos. Mulheres infectadas por Chlamydia trachomatis apresentaram mais de 10 anos de infertilidade (54,1%; p<0,0001). O fator tubário foi a principal causa nos casos com infecção (56,8%; p=0,047). A obstrução tubária foi encontrada em 67,6% dos casos com infecção positiva (p=0,004). CONCLUSÃO: Houve associação da obstrução tubária com a infecção por Chlamydia trachomatis e Neisseria gonorrhoeae, reforçando a necessidade de estratégias efetivas para detecção precoce das doenças sexualmente transmissíveis, principalmente em mulheres assintomáticas em idade fértil. .

PURPOSE: To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil. METHODS: A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χ2 test or Fisher's exact test to evaluate the association between infection and variables. RESULTS: The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004). CONCLUSION: There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age. .

Experiencia con un método de autotoma de muestra vaginal para la detección de infección por Chlamydia trachomatis y Neisseria gonorrhoeae en mujeres jóvenes / Screening of Neisseria gonorrhoeae and Chlamydia trachomatis using techniques of self collected vaginal sample in young women

Chlamydia trachomatis and Neisseria gonorrhoeae are responsible for 3-10% of sexually transmitted diseases in adolescents. 75% are asymptomatic. International standards recommend annual screening for C. trachomatis in sexually active women under 26 years. Self-collected vaginal swab is one of the less invasive screening methods, it is well accepted by patients and rarely used in our country. Aim: To determine the frequency of C. trachomatis and N. gonorrhoeae by a self-sampling method of vaginal swab and its acceptability in a group of adolescents and young adults. Patients and Methods: Women 18 to 25 years old. Vaginal samples were processed by nucleic acid amplification tests, Gen Probe APTIMA Combo2. Data were collected on sexual behavior and perception of self-sampling by survey. Results: We studied 344 patients with an average age of 21.7 years. Detection of C. trachomatis was positive in 7.9% women and it was not found in any of the patients studied for N. gonorrhoeae. 98% considered self-sampling instructions easy to understand, 87.5% felt comfortable taking the sample. Conclusions: Prevalence of C. trachomatis in the study population was similar to that described in other national and international studies. N. gonorrhoeae was not found in this series, which is consistent with literature reports. The self-sampling technique of vaginal sample was well accepted by the patients. However, they were anxious about the quality of the sample. According to our results, it is important to emphasize the importance of annual detection of these pathogens and that self-sampling technique is a valid alternative.

Chlamydia trachomatis y Neisseria gonorrhoeae son causantes de 3 a 10% de las infecciones de transmisión sexual en adolescentes. Las normas internacionales recomiendan su detección anual en mujeres sexualmente activas menores de 26 años. La adherencia a este tamizaje en mujeres jóvenes está limitada por el temor al examen ginecológico y alto costo del examen. Objetivo: Determinar la frecuencia de detección de C. trachomatis y N. gonorrhoeae por un método de auto-toma de muestra vaginal y su aceptabilidad en un grupo de adolescentes y jóvenes adultas. Pacientes y Método: Se incluyeron mujeres de 18 a 25 años atendidas en Clínica Las Condes y el Servicio de Salud Estudiantil de la Universidad de Chile, que fueron instruidas para autotoma de muestra vaginal. Luego de dar su consentimiento, las muestras fueron estudiadas mediante reacción de polimerasa en cadena para la detección de C. trachomatis y N. gonorrhoeae. Se recopilaron datos sobre conductas sexuales y percepción de la autotoma mediante encuesta. Se determinó la relación entre estos factores y la aceptabilidad del método. Resultados: Se reclutaron 344 mujeres, con una edad promedio de 21,7 años. La detección de C. trachomatis fue de 7,9% y no se encontró muestra positiva para N. gonorrhoeae. El reporte de flujo vaginal por la paciente se asoció a 1,5 veces mayor riesgo de C. trachomatis. El 98% consideró las instrucciones de la autotoma fáciles de entender, 87,5% se sintió cómoda al tomar la muestra. Conclusiones: La prevalencia de C. trachomatis en la población estudiada fue similar a lo descrito en otras series nacionales e internacionales; no se encontró N. gonorrhoeae en esta serie, lo que coincide con lo reportado en el extranjero. La técnica de autotoma de muestra vaginal fue bien aceptada por las pacientes; sin embargo, manifestaron ansiedad acerca de la seguridad de una toma adecuada. De acuerdo a nuestros resultados, es importante insistir en la detección anual de estos patógenos siendo la técnica de autotoma una alternativa válida.

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from patients attending a public referral center for sexually transmitted diseases in Belo Horizonte, State of Minas Gerais, Brazil

Introduction The aim of this study was to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates obtained from patients attending a public referral center for sexually transmitted diseases and specialized care services (STD/SCS) in Belo Horizonte, Brazil. Methods Between March 2011 and February 2012, 201 specimens of Neisseria gonorrhoeae were consecutively obtained from men with symptoms of urethritis and women with symptons of cervicitis or were obtained during their initial consultation. The strains were tested using the disk diffusion method, and the minimum inhibitory concentrations of azithromycin, cefixime, ceftriaxone, ciprofloxacin, chloramphenicol, penicillin, tetracycline and spectinomycin were determined using the E-test. Results The specimens were 100% sensitive to cefixime, ceftriaxone and spectinomycin and exhibited resistances of 4.5% (9/201), 21.4% (43/201), 11.9% (24/201), 22.4% (45/201) and 32.3% (65/201) to azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. Intermediate sensitivities of 17.9% (36/201), 4% (8/201), 16.9% (34/201), 71.1% (143/201) and 22.9% (46/201) were observed for azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. The specimens had plasmid-mediated resistance to penicillin PPNG 14.5% (29/201) and tetracycline TRNG 11.5% (23/201). Conclusions The high percentage of detected resistance to penicillin, tetracycline, chloramphenicol and ciprofloxacin indicates that these antibiotics are not appropriate for gonorrhea treatment at the Health Clinic and possibly in Belo Horizonte. The resistance and intermediate sensitivity of these isolates indicates that caution is recommended in the use of azithromycin and emphasizes the need to establish mechanisms for the surveillance of antimicrobial resistance for the effective control of gonorrhea. .

High HIV prevalence among men who have sex with men in Jamaica is associated with social vulnerability and other sexually transmitted infections / La alta prevalencia del VIH entre hombres que tienen relaciones sexuales con hombres en Jamaica se halla asociada con vulnerabilidad social e infecciones de transmisión sexual

BACKGROUND: Human immunodeficiency virus (HIV) prevalence among men who have sex with men (MSM) is thought to be high in Jamaica. The objective of this study was to estimate HIV prevalence and identify risk factors in order to improve prevention approaches. METHODS: With the help of influential MSM, an experienced research nurse approached MSM in four parishes to participate in a cross-sectional survey in 2007. Men who have sex with men were interviewed and blood taken for HIV and syphilis tests, and urine taken for gonorrhoea, chlamydia and trichomonas testing using transcription-mediated amplification assays. A structured questionnaire was administered by the nurse. RESULTS: One third (65 of 201; 32%, 95% Confidence Interval (CI) 25.2, 47.9) of MSM were HIV positive. Prevalence of other sexually transmitted infections (STI) was: chlamydia 11%, syphilis 6%, gonorrhoea 3.5% and trichomonas 0%. One third (34%) of MSM identified themselves as being homosexual, 64% as bisexual and 1.5% as heterosexual. HIV positive MSM were significantly more likely to have ever been told by a doctor that they had an STI (48% vs 27%, OR 2.48 CI 1.21, 5.04, p = 0.01) and to be the receptive sexual partner at last sex (41% vs 23%, OR 2.41 CI 1.21, 4.71, p = 0.008). Men who have sex with men who were of low socio-economic status, ever homeless and victims of physical violence were twice as likely to be HIV positive. The majority (60%) of HIV positive MSM had not disclosed their status to their partner and over 50% were not comfortable disclosing their status to anyone. CONCLUSIONS: The high HIV prevalence among MSM is an important factor driving the HIV epidemic in Jamaica. More effective ways need to be found to reduce the high prevalence of HIV among MSM including measures to reduce their social vulnerability, combat stigma and discrimination and empower them to practice safe sex.

ANTECEDENTES: Se piensa que la prevalencia del virus de inmunodeficiencia humana (VIH) entre hombres que tienen sexo con hombres (HSH) es alta en Jamaica. El objetivo de este estudio fue estimar la prevalencia del VIH e identificar los factores de riesgo a fin de mejorar las estrategias de prevención. MÉTODOS: Con la ayuda de HSH influyentes, una enfermera investigadora experimentada abordó a HSH en cuatro distritos, recabando su participación en una encuesta transversal en 2007. Se entrevistó a hombres que tienen sexo con hombres, y se tomaron muestras de sangre para realizar pruebas de VIH. Asimismo se tomaron muestras de orina para hacer pruebas de gonorrea, clamidia y trichomonas, usando ensayos de amplificación mediada por transcripción. Un cuestionario estructurado fue aplicado por la enfermera. RESULTADOS: Un tercio (65 de 201; 32%, 95% intervalo de confianza (IC) 25.2, 47.9) de los HSH fueron VIH positivos. La prevalencia de otras infecciones de transmisión sexual (ITS) fue como sigue: clamidia 11%, sífilis 6%, gonorrea 3.5%, y trichomonas 0%. Un tercio (34%) de los HSH se identificaron como homosexuales, 64% como bisexuales, y un 1.5% como heterosexuales. Los HSH que resultaron VIH positivos presentaron una probabilidad significativamente mayor de haber recibido un diagnóstico de ITS por parte de un médico (48% vs 27%, OR 2.48 IC 1.21, 5.04, p = 0,01), y de haber sido la pareja sexual receptora en el último intercambio sexual (41% frente a 23%, OR 2.41 IC 1.21, 4.71, p = 0.008). Los hombres que tuvieron sexo con hombres tenían un bajo nivel socio-económico, y alguna vez estuvieron sin hogar, fueron víctimas de violencia física, y tenían una probabilidad dos veces más alta de ser VIH positivos. La mayoría (60%) de los MSM VIH positivos no habían revelado su condición a sus parejas, y más del 50% no se sentían cómodos revelando su estatus a otras personas. CONCLUSIONES: La alta prevalencia de VIH entre HSH es un factor importante en el desarrollo de la epidemia de VIH en Jamaica. Se necesita hallar formas más eficaces de reducir la alta prevalencia de VIH entre los HSH, incluidas las medidas para reducir su vulnerabilidad social, combatir el estigma y la discriminación, y capacitarles para practicar sexo seguro.

Prevalencia de infecciones de transmisión sexual en mujeres embarazadas atendidas en un hospital público de Chile / Prevalence of sexually transmitted infections in pregnant women attending a public hospital in Chile

Introduction: The epidemiologic rates of gonorrhea have declined steadily in Chile, while the incidence of infections with Trichomonas vaginalis and Chlamydia trachomatis is not well known. Aim: Since these sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes and perinatal infections, this study aimed to update their prevalence in a public hospital in the Metropolitan Region of Chile. Patients and Methods: Between April and October 2010 and April and October 2011, pregnant women attending the antenatal Service, Hospital San Borja Arriarán, were randomly selected for detection of T. vaginalis, N. gonorrhoeae and C. tra-chomatis by culture in modified Diamond's broth, Thayer-Martin agar, and by omp1 gene amplification by nested PCR, respectively. We excluded pregnant women who received antibiotics within the past 30 days. Results: Two hundred and fifty five cervicovaginal samples were analyzed. C. trachomatis was detected in 15 (5.9%) and T. vaginalis in 6 (2.4%). N. gonorrhoeae was not found. Conclusion: The results show low prevalence of C. tracho-matis and T. vaginalis and absence of N. gonorrhoeae. These rates have remained stable at this medical center since the 1990s, with a slight increase in C. trachomatis.

Introducción: Las tasas epidemiológicas de gonorrea han disminuido constantemente en Chile, mientras que la incidencia de infecciones por Trichomonas vaginalis y Chlamydia trachomatis no es bien conocida. Estas infecciones de transmisión sexual (ITSs) están asociadas con resultados adversos del embarazo e infecciones peri-natales. Objetivo: Actualizar su prevalencia en un hospital público de la Región Metropolitana de Chile. Pacientes y Métodos: Entre abril y octubre de 2010 y desde abril a octubre de 2011, fueron seleccionadas al azar mujeres embarazadas atendidas en el Servicio de atención prenatal del Hospital San Borja Arriarán para detección de T. vaginalis, N. gonorrhoeae y C. trachomatis, por cultivo en caldo Diamond modificado, cultivo en Thayer-Martin y mediante amplificación del gen omp1, por RPC anidada, respectivamente. Se excluyeron mujeres embarazadas que recibieron antimicrobianos los 30 días previos. Resultados: Se analizaron 255 muestras cérvico-vaginales. C. trachomatis fue detectada en 15 (5,9%) de las mujeres embarazadas. T. vaginalis se aisló en 6 (2,4%) de ellas, mientras que N. gonorrhoeae no se encontró en las gestantes. Conclusión: Los resultados muestran prevalencia baja de C. trachomatis y de T. vaginalis y ausencia de N. gonorrhoeae, proporción que se mantiene estable en este establecimiento desde la década de 1990s, con leve aumento de C. trachomatis.