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3.
Sex Transm Dis ; 2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33560092

RESUMEN

INTRODUCTION: Prophylactic administration of doxycycline is regarded as a potential new public health strategy to combat the rising rates of Chlamydial trachomatis infections and syphilis among men who have sex with men (MSM). We conducted a survey-based study to evaluate how community members and healthcare providers in Southern California would perceive doxycycline pre-exposure/post-exposure prophylaxis (PrEP/PEP) to predict its acceptability and identify potential areas of concern. METHODS: We conducted an online cross-sectional survey among community members who identify as MSM and healthcare providers with prescribing authority in Southern California to investigate the current attitudes toward doxycycline PrEP/PEP, including their willingness to accept. We analyzed the data using descriptive statistics and binary logistic regression. RESULTS: Among 212 enrolled community member participants, 67.5% indicated they would take doxycycline PrEP/PEP if offered by their provider. Higher acceptability was significantly associated with several characteristics, including recent history of bacterial sexually transmitted infection diagnosis and current use of HIV PrEP. For healthcare providers, 89.5% of 76 enrolled participants expressed willingness to prescribe doxycycline PrEP/PEP to their patients if recommended by the Centers for Disease Control and Prevention, but only 43.4% were willing if not. Both community members and healthcare providers demonstrated high levels of concern toward possible drug resistance. CONCLUSION: Doxycycline PrEP/PEP as a preventive strategy against chlamydial infections and syphilis would likely be accepted among community members and healthcare providers. Clear guidelines from public health officials and further clarification on the strategy's potential impact on developing drug resistance may be necessary to ensure successful implementation.

5.
AIDS ; 35(4): 691-692, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33620874
6.
J Clin Microbiol ; 2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33500362

RESUMEN

The US Food and Drug Administration currently uses the nasopharyngeal swab specimen as the reference standard for evaluation of SARS-CoV-2 assays. We propose that the patient-infected status algorithm is a superior way to classify whether an individual is infected or not infected.

7.
Public Health Rep ; : 33354920971719, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33440128

RESUMEN

OBJECTIVES: Male circumcision is linked to a reduction in the risk of HIV infection, sexually transmitted infections, penile inflammatory skin disorders, cancers, urinary tract infections, and other complications. We examined the extent to which the change in circumcision recommendation by the American Academy of Pediatrics in 1999 and Medicaid coverage status in states affected the total number of procedures performed. METHODS: We used data from the Nationwide Inpatient Sample for 1998-2011 collected annually by the Healthcare Cost and Utilization Project. We examined data on all male births in the United States with Medicaid and private health insurance. We then categorized births into 4 groups: (1) births with newborn male circumcision procedure, (2) births with Medicaid or private health insurance, (3) births that occurred in states where Medicaid coverage for newborn male circumcision was removed, and (4) births that occurred before or after the policy change. We used multivariable logistic regression to estimate the adjusted odds of newborn male circumcision. RESULTS: In the 10 states where a change in Medicaid policy occurred, circumcision frequency had a mean percentage-point decrease of 21.4% among Medicaid beneficiaries and 3.2% among private health insurance beneficiaries from before to after the policy change. In states where coverage was maintained, the change in circumcision frequency was negligible for Medicaid and private health insurance beneficiaries. These changes resulted in an estimated 163 456 potential circumcisions not performed. CONCLUSION: Decreases in newborn male circumcision frequency correlated with the Medicaid policy change for the procedure. Efforts should be made to reduce barriers for cost-effective preventive procedures that promote health, such as newborn male circumcision.

8.
Sex Transm Dis ; 48(2): e15-e17, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33448728

RESUMEN

ABSTRACT: We conducted an observational study of lymphogranuloma venereum (LGV) biovar Chlamydia trachomatis infection in HIV-infected women in South Africa. The LGV biovar was detected in vaginal specimens of 17 (20%) of 85 women with C. trachomatis infection; 29% were symptomatic. All cases were negative for the LGV biovar after single-dose azithromycin.

9.
PLoS Negl Trop Dis ; 15(1): e0008812, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33497377

RESUMEN

BACKGROUND: An effective syphilis vaccine should elicit antibodies to Treponema pallidum subsp. pallidum (T. p. pallidum) surface antigens to induce pathogen clearance through opsonophagocytosis. Although the combination of bioinformatics, structural, and functional analyses of T. p. pallidum genes to identify putative outer membrane proteins (OMPs) resulted in a list of potential vaccine candidates, still very little is known about whether and how transcription of these genes is regulated during infection. This knowledge gap is a limitation to vaccine design, as immunity generated to an antigen that can be down-regulated or even silenced at the transcriptional level without affecting virulence would not induce clearance of the pathogen, hence allowing disease progression. PRINCIPAL FINDINGS: We report here that tp1031, the T. p. pallidum gene encoding the putative OMP and vaccine candidate TprL is differentially expressed in several T. p. pallidum strains, suggesting transcriptional regulation. Experimental identification of the tprL transcriptional start site revealed that a homopolymeric G sequence of varying length resides within the tprL promoter and that its length affects promoter activity compatible with phase variation. Conversely, in the closely related pathogen T. p. subsp. pertenue, the agent of yaws, where a naturally-occurring deletion has eliminated the tprL promoter region, elements necessary for protein synthesis, and part of the gene ORF, tprL transcription level are negligible compared to T. p. pallidum strains. Accordingly, the humoral response to TprL is absent in yaws-infected laboratory animals and patients compared to syphilis-infected subjects. CONCLUSION: The ability of T. p. pallidum to stochastically vary tprL expression should be considered in any vaccine development effort that includes this antigen. The role of phase variation in contributing to T. p. pallidum antigenic diversity should be further studied.

10.
Clin Infect Dis ; 72(2): 364-365, 2021 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-33501965
12.
N Engl J Med ; 384(7): 681-682, 2021 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-33503338
13.
Trials ; 21(1): 1009, 2020 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-33298143

RESUMEN

BACKGROUND: Syphilis rates have been increasing both in the USA and internationally with incidence higher among men-who-have-sex-with-men and people living with human immunodeficiency virus (HIV) infection. Currently, benzathine penicillin is the recommended treatment for syphilis in all patients. Global shortages and cost increases in benzathine penicillin call for alternative treatment options. This study evaluates the efficacy of oral cefixime for the treatment of early syphilis. METHODS: We are conducting a randomized, multisite, open-label, non-comparative clinical trial in Los Angeles and Oakland, CA. Eligible participants are ≥ 18 years old, with primary, secondary, or early latent syphilis (rapid plasma reagin [RPR] titer ≥ 1:8). Patients with HIV infection must have a viral load ≤ 200 copies/mL and CD4+ T cell count ≥ 350 cells/µL during the past 6 months. Participants are randomized to receive either 2.4 M IU benzathine penicillin G intramuscularly once or cefixime 400 mg orally twice a day for 10 days. Participants return at 3, 6, and 12 months post-treatment for follow-up RPR serological testing. The primary outcome is the proportion of participants who achieve ≥ 4-fold RPR titer decrease at 3 or 6 months post-treatment. DISCUSSION: Clinical trials evaluating the efficacy of alternative antibiotics to penicillin are urgently needed. TRIAL REGISTRATION: Clinicaltrials.gov NCT03660488 . Registered on 4 September 2018.

14.
BJOG ; 2020 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-33277768

RESUMEN

OBJECTIVE: To measure the frequencies of sexually transmitted infections (STIs) and adverse pregnancy outcomes among women receiving either aetiologic testing or syndromic management for STIs. DESIGN: Non-randomised prospective cohort study. SETTING: Primary healthcare facilities in Tshwane, South Africa. POPULATION: HIV-infected pregnant women attending antenatal care services. METHODS: Participants were enrolled to receive aetiologic testing using Xpert® CT/NG and Xpert® TV assays or standard syndromic management. Outcome data were collected at postnatal care visit (≤30 days from delivery) and from maternity records. Enrolment gestational age-adjusted relative risk (aRR) was calculated. MAIN OUTCOME MEASURES: STI prevalence at postnatal visit, and frequency of adverse pregnancy outcomes (preterm birth, low birth weight). RESULTS: We enrolled 841 women. The prevalence of any STI at baseline was 40%; Chlamydia trachomatis= 30%, Neisseria gonorrhoeae= 5.6%, Trichomonas vaginalis= 20%. The prevalence of STIs at postnatal care was lower among those receiving aetiologic testing compared to those receiving syndromic management (14% vs. 23%; aRR 0.61; 95% CI 0.35-1.05). No difference was observed between study groups for frequency of preterm birth (23% vs. 23%; aRR 1.2 (95% CI 0.81-1.8) and low birth weight (15% vs. 13%; aRR 1.1 (0.66-1.7). CONCLUSIONS: Aetiologic testing provides an effective intervention to reduce the high burden of STIs in pregnant women in South Africa, however, the optimal implementation strategy remains to be determined.

15.
Clin Infect Dis ; 2020 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-33300564

RESUMEN

BACKGROUND: Public health organizations have inconsistent recommendations for screening adolescents and young adults for Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) infections. Guidelines suggest different combinations of anorectal, pharyngeal, and urogenital testing based on age, sex, and sexual activity. Further evaluation of how identity and behaviors impact the anatomic distribution of C. trachomatis and N. gonorrhoeae infection is needed to optimize future screening practices. METHODS: We assessed the positivity of C. trachomatis and N. gonorrhoeae infections at different anatomic sites in a cohort of at-risk sexually active adolescents and young adults between 12-24 years old in New Orleans, Louisiana and Los Angeles, California. Participants were tested for C. trachomatis and N. gonorrhoeae at three sites (anorectum, pharynx, and urethral/cervix) every four months using self-collected swabs. We stratified anatomic distributions of infection into four gender and sexual behavior categories: (i) cisgender men who have sex with men and transgender women (MSMTW), (ii) cis-heterosexual males, (iii) cis-heterosexual females, and (iv) gender minorities assigned female at birth. RESULTS: While three-site testing detected all infections, two-site (anorectum and urethra/cervix) testing identified 92-100% of C. trachomatis or N. gonorrhoeae infections in participants assigned female at birth and cis-heterosexual males. For MSMTW, two site anorectal and pharyngeal testing versus single site anorectal testing increased the proportion of individuals with either infection from 74 to 93%. CONCLUSION: Sexual behavioral and gender identity factors may influence detection of C. trachomatis and N. gonorrhoeae infections at specific anatomic testing sites. Testing guidelines should incorporate sexual behavior and gender identity.

17.
BMC Public Health ; 20(1): 1750, 2020 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-33225945

RESUMEN

BACKGROUND: The economic, psychological, and social impact of pandemics and social distancing measures prompt the urgent need to determine the efficacy of non-pharmaceutical interventions (NPIs), especially those considered most stringent such as stay-at-home and self-isolation mandates. This study focuses specifically on the impact of stay-at-home orders, both nationally and internationally, on the control of COVID-19. METHODS: We conducted an observational analysis from April to May 2020 and included both countries and US states with known stay-at-home orders. Our primary exposure was the time between the date of the first reported case of COVID-19 to an implemented stay-at-home mandate for each region. Our primary outcomes were the time from the first reported case to the highest number of daily cases and daily deaths. We conducted linear regression analyses, controlling for the case rate of the outbreak in each respective region. RESULTS: For countries and US states, a longer period of time between the first reported case and stay-at-home mandates was associated with a longer time to reach both the peak daily case and death counts. The largest effect was among regions classified as the latest 10% to implement a mandate, which in the US, predicted an extra 35.3 days (95% CI: 18.2, 52.5) to the peak number of cases, and 38.3 days (95% CI: 23.6, 53.0) to the peak number of deaths. CONCLUSIONS: Our study supports the association between the timing of stay-at-home orders and the time to peak case and death counts for both countries and US states. Regions in which mandates were implemented late experienced a prolonged duration to reaching both peak daily case and death counts.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Salud Global/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuarentena/legislación & jurisprudencia , Infecciones por Coronavirus/mortalidad , Humanos , Neumonía Viral/mortalidad , Factores de Tiempo , Estados Unidos/epidemiología
18.
Sex Transm Dis ; 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33229966

RESUMEN

INTRODUCTION: Neisseria (N.) gonorrhoeae infections are becoming increasingly resistant to recommended treatments. Resistance-guided therapy may mitigate the continued emergence of resistance by enabling the use of previously recommended treatments like ciprofloxacin. OBJECTIVES: To describe the effectiveness of ciprofloxacin to treat "susceptible" infections, we estimated the clinical efficacy of ciprofloxacin at various minimum inhibitory concentrations (MICs) and anatomic sites. METHODS: We reviewed publicly available reports using the PubMed.gov database and search terms "Gonorrhea/drug therapy"[Mesh] AND ciprofloxacin. We included clinical treatment studies in which ciprofloxacin was administered alone to treat N. gonorrhoeae, specimens were collected for N. gonorrhoeae culture from each infection, the MIC was determined for ≥ 90% of infective strains, and individual treatment outcomes were clearly defined. We recorded those data, ciprofloxacin dose and infection site. We calculated the frequency of treatment success and 95% confidence intervals. RESULTS: Twenty studies from 1985 to 2020 met our inclusion criteria. Ciprofloxacin at commonly used doses eliminated 99.2% [95% CI: (98.5-99.6%), (n = 1,439)] of gonococcal infections with MICs < 0.125 µg/mL, 76.3% [95% CI: (59.8-88.6%), (n = 38)] of infections with MICs from 0.125 µg/mL to 0.5 µg/mL, and 30.1% [95% CI: (20.5-41.2%), (n = 83)] of infections with MICs ≥ 1 µg/mL across anatomic sites. CONCLUSIONS: Ciprofloxacin reliably eliminated gonococcal infections with MICs < 0.125 µg/mL across anatomic sites. Molecular assays predicting MICs of ciprofloxacin < 0.125 µg/mL of gonococcal strains can allow for re-introduction of ciprofloxacin in gonorrhea treatment. Clinicians can confidently use ciprofloxacin to treat susceptible gonococcal infections.

19.
BMC Infect Dis ; 20(1): 809, 2020 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-33153450

RESUMEN

BACKGROUND: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is an emerging global health threat. Surveillance of AMR in N. gonorrhoeae in the Western Pacific Region is important, as resistant strains have typically emerged from this region. There are sparse data regarding antibiotic susceptibility of N. gonorrhoeae from Vietnam. This study aimed to provide updated data on antibiotic susceptibilities in N. gonorrhoeae isolates from Hanoi, Vietnam. METHODS: From 2017 to 2019, 409 N. gonorrhoeae clinical isolates were collected at the National Hospital for Venereology and Dermatology in Hanoi, Vietnam. Antibiotic susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) protocol. The zone diameters of inhibition were recorded and interpreted according to standard CLSI criteria, except for azithromycin, due to the absence of CLSI interpretation. Categorical variables were analyzed by Chi-square and Fisher's exact tests. Linear regression was used to evaluate zones of inhibition by year. RESULTS: Among the 409 isolates, no isolates were susceptible to penicillin, 98.3% were resistant to ciprofloxacin, and all isolates were susceptible to spectinomycin. There were 122/407 (30.0%) isolates resistant to azithromycin and there was an association between resistance and year (p <  0.01), ranging from 15.3% of isolates in 2017 to 46.7% of the isolates in 2018. Resistance to cefixime was found in 13/406 (3.2%) of isolates and there was no association by year (p = 0.30). Resistance to ceftriaxone occurred in 3/408 (0.7%) of isolates. Linear regression indicated the zone of inhibition diameters decreased by 0.83 mm each year for ceftriaxone (95% CI: - 1.3, - 0.4; p <  0.01) and decreased by 0.83 mm each year (95% CI: - 1.33, - 0.33; p <  0.01) for azithromycin; the association was not significant for cefixime (p = 0.07). CONCLUSIONS: We found decreasing susceptibility of N. gonorrhoeae to ceftriaxone and azithromycin, as well as a high prevalence of resistance to azithromycin, among isolates in Hanoi, Vietnam from 2017 to 2019. The trends of decreasing susceptibility to first-line treatments are concerning and highlight the urgency of addressing antimicrobial resistance in N. gonorrhoeae. Expanded surveillance efforts within the Western Pacific Region are critical to monitoring trends and informing treatment guidelines.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Ceftriaxona/uso terapéutico , Farmacorresistencia Bacteriana/efectos de los fármacos , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Adolescente , Adulto , Anciano , Femenino , Gonorrea/epidemiología , Gonorrea/microbiología , Humanos , Laboratorios , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Neisseria gonorrhoeae/aislamiento & purificación , Vietnam/epidemiología , Adulto Joven
20.
Lancet Infect Dis ; 2020 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-33242473

RESUMEN

BACKGROUND: Timely detection and treatment are important for the control of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. The objective of this study was to measure the performance of the Visby Medical Sexual Health Test, a single-use, point-of-care PCR device. METHODS: Women aged 14 years and older who presented consecutively to ten clinical sites across seven US states were enrolled for a cross-sectional, single-visit study. Patients who consented to participate, and who had not used any exclusionary products in the genital area in the previous 48 h, provided self-collected vaginal swabs for testing with the investigational device. Untrained operators received the specimens and ran the device using the guide provided. Specimens had to be run within 2 h of collection to be considered valid. For comparison, patient-infected status was derived by testing clinician-collected vaginal specimens with the Hologic Aptima Combo 2 Assay and Aptima Trichomonas vaginalis Assay, as well as the BD ProbeTec CT/GC Qx Amplified DNA Assay and BD ProbeTec Trichomonas vaginalis Qx Assay. If the results of those assays did not match, the BD MAX CT/GC/TV was used as a tiebreaker. The primary outcomes were the sensitivity and specificity of the investigational device for the detection of C trachomatis, N gonorrhoeae, and T vaginalis compared with patient-infected status. FINDINGS: Between Feb 25, 2019, and Jan 6, 2020, 1585 participants aged between 14 years and 80 years (mean 34·8 [SD 14·2]) were enrolled. 1555 participants had tests run with the investigational device, of whom 1532 (98·5%) had a valid result on either the first or repeat test. Among the patients with evaluable results (including a determinate patient-infected status), the device had a sensitivity of 97·6% (95% CI 93·2-99·2) and specificity of 98·3% (97·5-98·9) for C trachomatis (n=1457), sensitivity of 97·4% (86·5-99·5) and specificity of 99·4% (98·9-99·7) for N gonorrhoeae (n=1468), and sensitivity of 99·2% (95·5-99·9) and specificity of 96·9% (95·8-97·7) for T vaginalis (n=1449). INTERPRETATION: This innovative, rapid, easy-to-use, single-use, point-of-care device to detect C trachomatis, N gonorrhoeae, and T vaginalis infections showed excellent sensitivity and specificity, and could represent an important advance in the development of rapid diagnostics for sexually transmitted infections and other infectious diseases. FUNDING: Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases.

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