Infecciones de transmisión sexual con afectación anorrectal: agentes causales, coinfecciones, infección por el VIH y conductas de riesgo / Sexually transmitted diseases of the anus and rectum: Causal agents, coinfections, HIV infection and high-risk sexual behaviour

Introducción y objetivo: Las infecciones de transmisión sexual con afectación anorrectal (ITS-AR) afectan principalmente a hombres que tienen sexo con hombres (HSH). Material y métodos: Estudio retrospectivo realizado en pacientes diagnosticados de ITS-AR en una unidad de ITS entre 2014 y 2015. Se recogieron datos epidemiológicos, microbiológicos, clínicos y de conducta sexual. Resultados: Se analizaron 95 individuos, todos HSH. El 88,42% estaban infectados por el VIH; el 67,17% refirió que la última relación sexual fue desprotegida; el 17,91% tuvo sexo con trabajadores sexuales y, en el año previo, el 72,22% había consumido drogas previamente a las relaciones sexuales. El 32,92% presentaron sintomatología durante más de 30 días. El 54,73% de los diagnósticos fue linfogranuloma venéreo (LGV). Todos los pacientes que consultaron por úlcera asociada a proctitis presentaron infección por LGV. Todos los que consultaron por úlcera perianal sin proctitis asociada fueron diagnosticados de sífilis. Conclusiones: Todos los pacientes con ITS-AR fueron HSH, la mayoría positivos para el VIH, con conductas sexuales de riesgo y un tiempo de evolución largo. Las características clínicas, epidemiológicas y microbiológicas de las ITS-AR en nuestro entorno podrían ayudar a ajustar mejor el tratamiento empírico

Introduction and objective: Sexually transmitted infections of the rectum and anus (STI-RA) mainly affect men who have sex with men (MSM). The incidence of STI-RA among them has increased in recent years. Material and methods: Retrospective study in patients with diagnoses of STI-RA in an STI unit during the years 2014 and 2015. Epidemiological, clinical and microbiological data were collected. Results: We included 95 patients, all of whom were MSM; 88.42% were HIV+; 67.17% did not use a condom during their most recent sexual intercourse; 17.91% had had sex with sex workers and 72.22% had used drugs during sexual intercourse during the previous year. A percentage of 32.92 reported symptoms that had lasted longer than 30 days. Lymphogranuloma venereum (LGV) was diagnosed in 54.73% of the patients. All patients who presented with proctitis and perianal ulcers were diagnosed with LGV infection. All those who presented perianal ulcers without proctitis were diagnosed with syphilis. Conclusions: All the patients affected by STI-RA were MSM, most of them HIV+, had engaged in high-risk sexual behaviour and had suffered prolonged symptomatology. Clinical and microbiological characteristics of STI-AR could help adjust the empiric therapy

Sexually transmitted diseases of the anus and rectum: Causal agents, coinfections, HIV infection and high-risk sexual behaviour. / Infecciones de transmisión sexual con afectación anorrectal: agentes causales, coinfecciones, infección por el VIH y conductas de riesgo.

INTRODUCTION AND OBJECTIVE: Sexually transmitted infections of the rectum and anus (STI-RA) mainly affect men who have sex with men (MSM). The incidence of STI-RA among them has increased in recent years. MATERIAL AND METHODS: Retrospective study in patients with diagnoses of STI-RA in an STI unit during the years 2014 and 2015. Epidemiological, clinical and microbiological data were collected. RESULTS: We included 95 patients, all of whom were MSM; 88.42% were HIV+; 67.17% did not use a condom during their most recent sexual intercourse; 17.91% had had sex with sex workers and 72.22% had used drugs during sexual intercourse during the previous year. A percentage of 32.92 reported symptoms that had lasted longer than 30 days. Lymphogranuloma venereum (LGV) was diagnosed in 54.73% of the patients. All patients who presented with proctitis and perianal ulcers were diagnosed with LGV infection. All those who presented perianal ulcers without proctitis were diagnosed with syphilis. CONCLUSIONS: All the patients affected by STI-RA were MSM, most of them HIV+, had engaged in high-risk sexual behaviour and had suffered prolonged symptomatology. Clinical and microbiological characteristics of STI-AR could help adjust the empiric therapy.

Risk factors for antimicrobial-resistant Neisseria gonorrhoeaeand characteristics of patients infected with gonorrhea / Factores de riesgo para infección por Neisseria gonorrhoeae resistente a antimicrobianos y características de los pacientes con infección gonocócica

Background: There are very few data available regarding risk factors associated with antibiotic resistant-Neisseria gonorrhoeae. Methods: A study was conducted on 110 samples from 101 patients with gonococcal infection, in order to describe their characteristics and compare them with the antimicrobial susceptibility profile of their samples. Results: An association was observed between resistant infections and heterosexual men, older age, concurrent sexually transmitted infection, and unsafe sexual behaviors. Conclusion: There is a need for improved data on the risk factors associated with antibiotic resistant gonococcal infection in order to identify risk groups, and to propose public health strategies to control this infection (AU)

Introducción: Disponemos de poca información sobre los factores de riesgo asociados a la infección por gonococo resistente a antibióticos. Métodos: Estudiamos 110 muestras de 101 pacientes, describimos sus característica y las comparamos según el perfil de susceptibilidad antimicrobiana de sus muestras. Resultados: observamos una asociación significativa entre las infecciones por cepas resistentes y varones heterosexuales, edad avanzada, infección de transmisión sexual concurrente y comportamientos sexuales de riesgo. Conclusiones: es necesario ampliar el estudio sobre los factores de riesgo asociados a infecciones por gonococo resistente con el objetivo de implementar medidas estratégicas para controlar la infección (AU)

Risk factors for antimicrobial-resistant Neisseria gonorrhoeae and characteristics of patients infected with gonorrhea.

BACKGROUND: There are very few data available regarding risk factors associated with antibiotic resistant-Neisseria gonorrhoeae. METHODS: A study was conducted on 110 samples from 101 patients with gonococcal infection, in order to describe their characteristics and compare them with the antimicrobial susceptibility profile of their samples. RESULTS: An association was observed between resistant infections and heterosexual men, older age, concurrent sexually transmitted infection, and unsafe sexual behaviors. CONCLUSION: There is a need for improved data on the risk factors associated with antibiotic resistant gonococcal infection in order to identify risk groups, and to propose public health strategies to control this infection.

La infección neonatal tardía por Streptococcus agalactiae en el área de Barcelona (1996-2010) / Streptococcus agalactiae late-onset neonatal infections in Barcelona (1996-2010)

OBJETIVO: Analizar las características de la sepsis neonatal tardía (SNT) por estreptococo del grupo B (EGB) y la evolución de su incidencia en 8 hospitales del área de Barcelona a lo largo de los 15 años de consolidación de las medidas de prevención de la infección neonatal precoz. MÉTODOS: Revisión retrospectiva de los pacientes diagnosticados de SNT por EGB desde 1996 a 2010. RESULTADOS: Se diagnosticaron 143 pacientes, de los que 51 habían nacido en otros centros. La incidencia global fue del 0,4 2‰ de recién nacidos vivos (RNV), oscilando entre el 0,14‰ en 2000 y el 0,80‰ en 2009. Se observó una tendencia al incremento del riesgo discreta pero sostenida a lo largo de los años, del 6,9% en las SNT totales, aunque sin la suficiente significación estadística. El 63,6% de los pacientes presentaron sepsis/bacteriemia, el 32,8% meningitis y el 3,5% artritis/osteomielitis. De los casos en los que se pudo obtener información sobre los antecedentes obstétricos, el 53% de las madres presentaron cultivo positivo a EGB al final del embarazo, el 53,8% recibieron profilaxis antibiótica intraparto y el 41,2% presentaron algún factor de riesgo, principalmente parto prematuro en el 35,9% de los casos. La mortalidad fue del 2,8%, y los serotipos mayoritarios, el III y el Ia. CONCLUSIONES: La incidencia de SNT por EGB no ha disminuido a pesar de las medidas de prevención de la SNP, y la posibilidad de su aparición debe ser tenida en cuenta

OBJECTIVE: To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15 years in 8 hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections. METHODS: Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010. RESULTS: A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia. CONCLUSIONS: The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account

[Streptococcus agalactiae late-onset neonatal infections in Barcelona (1996-2010)]. / La infección neonatal tardía por Streptococcus agalactiae en el área de Barcelona (1996-2010).

OBJETIVE: To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15years in 8hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections. METHODS: Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010. RESULTS: A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia. CONCLUSIONS: The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account.

[Toxoplasmosis and pregnancy. Multicenter study of 16,362 pregnant women in Barcelona]. / Toxoplasmosis y embarazo. Estudio multicéntrico realizado en 16.362 gestantes de Barcelona.

BACKGROUND AND OBJECTIVE: The aim of this study was to know: 1) the prevalence of antibodies against toxoplasma in pregnant women, 2) the incidence of primary infection during pregnancy and 3) the prevalence of congenital toxoplasmosis. SUBJECTS AND METHOD: Seroprevalence was prospectively analyzed in 16,362 pregnant women visited in 8 hospitals and 2 day care centers in Barcelona during 1999. Each participant laboratory included their own assays to detect toxoplasma-specific immunoglobulins IgM, IgA, IgG and IgG avidity antibodies. In case of positive specific IgM, a second serum sample was requested, which was processed in parallel with the first one. Three infection stages were defined: acute, possible and past (latent). Congenital infection was determined prenatally by polymerase chain reaction (PCR) in amniotic fluid or postnatally by serology in the newborn. RESULTS: Seroprevalence was 28.6%. The incidence of primary infection during pregnancy was 1.02/1,000 susceptible pregnant women. Nine women out of 12 with an acute toxoplasma infection became seroconverted during their pregnancies and five of them had infants with congenital toxoplasmosis (vertical transmission: 41.6%). All four children born alive had no symptoms during their follow-up. CONCLUSIONS: In this study, the prevalence of toxoplasmosis was low. Acute toxoplasmosis was detected mainly by seroconversion during pregnancy. The frequency of maternal-fetal transmission was near half of cases.

[Comparative study of three culture media for detecting group B Streptococcus colonization in pregnant women]. / Estudio comparativo de tres medios de cultivo para detectar la colonización por estreptococo del grupo B en la mujer embarazada.

OBJECTIVE: To compare the efficacy of three culture media to detect vaginal and rectal colonization by group B streptococci (GBS) in pregnant women. METHODS: We processed 1334 samples from 861 pregnant women: in 388 patients only vaginal swab was cultured (Group A) and in 473 vaginal and rectal swabs were cultured (Group B). Samples were inoculated on blood agar with colistin-nalidixic acid (BA-CNA), on plates with Granada medium, and on Todd-Hewitt broth (THB) with amikacin followed by subculture in BA-CNA. RESULTS: GBS was isolated in 181 samples (13.6%): 114 vaginal swabs (13.2%) and 67 rectal swabs (14.2%). Among the positive samples, GBS was isolated on BA-CNA in 60.5% of vaginal swabs and in 59.7% of rectal swabs, on Granada medium in 80.7% of vaginal swabs and in 91% of rectal swabs, and on THB in 97.4% of vaginal swabs and in 97% of rectal swabs.We detected 130 GBS carriers, 54 (13.9%) in Group A and 76 (16.1%) in Group B. The percent of carriers detected in groups A and B, respectively, was 59.3% and 75% with BA-CNA, 77.8% and 93.4% with Granada medium, and 96.3% and 97.4% with THB. CONCLUSIONS: THB was the most reliable medium for the detection of GBS. Use of Granada medium allows fast detection of about 87% of carriers. The combination of THB and an initial plate of Granada medium or BA-CNA allows detection of more than 99% of GBS carriers.

Estudio comparativo de tres medios de cultivo para detectar la colonización por estreptococo del grupo Ben la mujer embarazada / Comparative study of three culture media for detecting group B Streptococcus colonization in pregnant women

OBJETIVO. Comparar la eficacia de tres medios de cultivo para detectar la colonización vaginal y rectal por Streptococcus agalactiae o estreptococo del grupo B (EGB) en mujeres gestantes. MÉTODOS. Se procesaron 1.334 muestras pertenecientes a 861 gestantes: en 388 pacientes se cultivó sólo frotis vaginal (grupo A) y en 473, frotis vaginal y rectal (grupo B).Las muestras se sembraron en agar sangre con colistina y ácido nalidíxico (AS-ANC), en medio de Granada en placa y en caldo Todd-Hewitt (CTH) con amikacina y posterior resiembra en AS-ANC.RESULTADOS. Se aisló EGB en 181 muestras (13,6 por ciento): 114 vaginales (13,2 por ciento) y 67 rectales (14,2 por ciento). De las muestras positivas, se aisló EGB en AS-ANC en un 60,5 por ciento de los frotis vaginales y en un 59,7 por ciento de los rectales; en medio de Granada en un 80,7 por ciento de los frotis vaginales y en un 91 por ciento de los rectales, y en CTH en un 97,4 por ciento de los frotis vaginales y en un 97 por ciento de los rectales. Se detectaron 130 portadoras de EGB: 54 (13,9 por ciento) en el grupo A (estudio vaginal) y 76 (16,1 por ciento) en el grupo B (estudio vaginal y rectal). En ambos grupos de estudio A y B, el porcentaje de portadoras detectadas fue respectivamente del 59,3 y 75 por ciento en AS-ANC, del 77,8 y 93,4 por ciento en medio de Granada y del 96,3 y 97,4 por ciento en CTH.CONCLUSIONES. El CTH fue el medio más eficaz para detectar EGB. La utilización del medio de Granada permitió la detección rápida de casi un 87 por ciento de las portadoras. La combinación del CTH con la placa inicial de medio de Granada o de AS-ANC permitió detectar más del 99 por ciento de las portadoras de EGB (AU)