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1.
BMC Infect Dis ; 21(1): 95, 2021 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478403

RESUMEN

BACKGROUND: Recommendations for sexually transmitted infection (STI) screening vary significantly across countries. This study evaluated the prevalence of urogenital and extragenital infections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) in patients visiting a French STI clinic in the Indian Ocean region to determine whether current STI screening practices should be updated. METHODS: This cross-sectional study examined all patients who visited the STI clinic between 2014 and 2015. Triplex polymerase chain reaction screening for CT, NG, and MG was performed on urine, vaginal, pharyngeal, and anal specimens (FTD Urethritis Basic Kit, Fast Track Diagnostics, Luxembourg). RESULTS: Of the 851 patients enrolled in the study, 367 were women (367/851, 43.2%) and 484 were men (484/851, 56.0%). Overall, 826 urogenital specimens (826/851, 97.1%), 606 pharyngeal specimens (606/851, 71.2%), and 127 anal specimens (127/851, 14.9%) were taken from enrolled patients. The prevalence of urogenital CT and MG was high in women ≤25 years (19/186, 10.21%; 5/186, 2.69%) and in men who have sex with women ≤30 years (16/212, 7.54%; 5/212, 2.36%). Among patients with urogenital CT infection, 13.7% (7/51) had urethritis. All patients with urogenital MG infection were asymptomatic. Men who have sex with men had a high prevalence of pharyngeal CT (2/45, 4.44%) and NG (3/44, 6.81%) and a high prevalence of anal CT (2/27, 7.41%), NG (2/27, 7.40%), and MG (1/27, 3.70%). After excluding patients with concomitant urogenital infection, extragenital infections with at least 1 of the 3 pathogens were found in 20 swabs (20/91, 21.9%) taken from 16 patients (16/81, 19.7%), all of them asymptomatic. CONCLUSIONS: Routine multisite screening for CT, NG, and MG should be performed to mitigate the transmission of STIs in high-risk sexually active populations.


Asunto(s)
Chlamydia trachomatis/aislamiento & purificación , Mycoplasma genitalium/aislamiento & purificación , Neisseria gonorrhoeae/aislamiento & purificación , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/microbiología , Adolescente , Adulto , Anciano , Canal Anal/microbiología , Estudios Transversales , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Faringe/microbiología , Prevalencia , Reunión/epidemiología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/transmisión , Sistema Urogenital/microbiología , Adulto Joven
2.
BMC Pregnancy Childbirth ; 21(1): 98, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33516183

RESUMEN

BACKGROUND: This study estimated the prevalence of curable sexually transmitted and reproductive tract infections (STIs/RTIs) among pregnant women attending antenatal care (ANC) in rural Zambia, evaluated the effectiveness of syndromic management of STIs/RTIs versus reference-standard laboratory diagnoses, and identified determinants of curable STIs/RTIs during pregnancy. METHODS: A total of 1086 pregnant women were enrolled at ANC booking, socio-demographic information and biological samples were collected, and the provision of syndromic management based care was documented. The Piot-Fransen model was used to evaluate the effectiveness of syndromic management versus etiological testing, and univariate and multivariate logistic regression analyses were used to identify determinants of STIs/RTIs. RESULTS: Participants had a mean age of 25.6 years and a mean gestational age of 22.0 weeks. Of 1084 women, 700 had at least one STI/RTI (64.6%; 95% confidence interval [CI], 61.7, 67.4). Only 10.2% of infected women received any treatment for a curable STI/RTI (excluding syphilis). Treatment was given to 0 of 56 women with chlamydia (prevalence 5.2%; 95% CI, 4.0, 6.6), 14.7% of participants with gonorrhoea (prevalence 3.1%; 95% CI, 2.2, 4.4), 7.8% of trichomoniasis positives (prevalence 24.8%; 95% CI, 22.3, 27.5) and 7.5% of women with bacterial vaginosis (prevalence 48.7%; 95% CI, 45.2, 51.2). An estimated 7.1% (95% CI, 5.6, 8.7) of participants had syphilis and received treatment. Women < 20 years old were more likely (adjusted odds ratio [aOR] = 5.01; 95% CI: 1.23, 19.44) to have gonorrhoea compared to women ≥30. The odds of trichomoniasis infection were highest among primigravidae (aOR = 2.40; 95% CI: 1.69, 3.40), decreasing with each subsequent pregnancy. Women 20 to 29 years old were more likely to be diagnosed with bacterial vaginosis compared to women ≥30 (aOR = 1.58; 95% CI: 1.19, 2.10). Women aged 20 to 29 and ≥ 30 years had higher odds of infection with syphilis, aOR = 3.96; 95% CI: 1.40, 11.20 and aOR = 3.29; 95% CI: 1.11, 9.74 respectively, compared to women under 20. CONCLUSIONS: Curable STIs/RTIs were common and the majority of cases were undetected and untreated. Alternative approaches are urgently needed in the ANC setting in rural Zambia.


Asunto(s)
Coinfección/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones del Sistema Genital/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Coinfección/diagnóstico , Coinfección/parasitología , Estudios Transversales , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Modelos Logísticos , Análisis Multivariante , Embarazo , Atención Prenatal , Prevalencia , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/parasitología , Población Rural , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/parasitología , Factores Socioeconómicos , Sífilis/epidemiología , Tricomoniasis/epidemiología , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/parasitología , Adulto Joven , Zambia/epidemiología
3.
BMC Infect Dis ; 21(1): 59, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33435882

RESUMEN

BACKGROUND: Female adolescents and young women have the highest risk of curable sexually transmitted infections (STIs) globally. Data on the prevalence of STIs among young women in Uganda are limited. In this study, we investigated the time trends and correlates of STIs among adolescent girls and young women (15-24 years) in Uganda. METHODS: We estimated the percentage of women 15-24 years from three recent consecutive Uganda Demographic and Health Surveys (2006, 2011, and 2016), who reported suffering from genital sores, and or genital discharge or any other varginal complaints acquired after sexual intercourse within 12 months of the studies and examined the changes over time. A pooled multivariable logistic regression was used to examine the correlates of reporting an STI in the last 12 months preceding the study. Svyset command in Stata was used to cater for the survey sample design. RESULTS: The pooled self-reported STI prevalence was 26.0%. Among these young women, 22.0, 36.3, and 23.1% reported a sexually transmitted infection in 2006, 2011, and 2016 respectively. Between 2006 and 2011, there was evidence of change (+ 14.3%, p < 0.001) in STI prevalence before a significant reduction (- 12.0%, p< 0.001) in 2016. Youths aged 20-24 years reported a higher STI prevalence (27.3%) compared to young participants (23.6%). Correlates of reporting an STI among rural and urban young women were: having multiple total lifetime partners (adjusted odds ratio (aOR 1.6, 95% CI 1.4-1.6), being sexually active in the last 4 weeks (aOR 1.3, 95% CI 1.1-1.6), and being affiliated to Muslim faith (aOR 1.3, 95% CI 1.1-1.6) or other religions (aOR 1.8, 95% CI 1.1-2.9) as compared to Christian were more likely to report an STI. Living in Northern Uganda compared to living in Kampala city was found protective against STIs (aOR 0.5, 95% CI 0.3-0.7). CONCLUSION: The prevalence of STIs was high among female youths, 15-24 years. This highlights the need for a comprehensive STIs screening, surveillance, and treatment programme to potentially reduce the burden of STIs in the country.


Asunto(s)
Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Tamizaje Masivo , Prevalencia , Autoinforme , Parejas Sexuales , Enfermedades de Transmisión Sexual/diagnóstico , Uganda/epidemiología , Adulto Joven
4.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431534

RESUMEN

A man in his late 30s presented with a several-day history of rectal pain, discharge and bleeding associated with systemic upset. Sexual history revealed receptive anal sex with several male partners in the 2 weeks preceding his clinic visit. Examination of the perianal area was unremarkable. Proctoscopy showed evidence of non-ulcerative proctitis. Microscopy for Gram stain showed pus cells plus extracellular Gram-negative diplococci. The patient was treated for presumptive gonorrhoea and chlamydial infection with ceftriaxone, azithromycin and doxycycline. The patient failed to improve with this treatment regimen. Rectal swab results at 48 hours confirmed the causative agent to be herpes simplex virus (HSV) type 2. The patient was recalled and treated successfully with valaciclovir. This case serves as a useful reminder to clinicians to consider HSV in the differential diagnosis of sexually transmitted proctitis, in the absence of perianal or anorectal ulceration.


Asunto(s)
Herpes Simple/diagnóstico , Herpesvirus Humano 2/aislamiento & purificación , Proctitis/diagnóstico , Enfermedades de Transmisión Sexual/diagnóstico , Adulto , Antivirales/uso terapéutico , ADN Viral/aislamiento & purificación , Diagnóstico Diferencial , Gonorrea/diagnóstico , Herpes Simple/tratamiento farmacológico , Herpes Simple/transmisión , Herpes Simple/virología , Herpesvirus Humano 2/genética , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Mucosa Intestinal/virología , Masculino , Proctitis/tratamiento farmacológico , Proctitis/virología , Recto/virología , Conducta Sexual , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/transmisión , Enfermedades de Transmisión Sexual/virología , Valaciclovir/uso terapéutico
6.
Soc Sci Med ; 268: 113571, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33310396

RESUMEN

The value of digital healthcare has been lauded in Canada at local, provincial, and national levels. Digital medicine is purported to enhance patient access to care while promising cost savings. Using institutional ethnography, we examined the potential for publicly funded digital testing for HIV and other sexually transmitted infections (STI) in Ontario, Canada. Our analyses draw from 23 stakeholder interviews with healthcare professionals conducted between 2019 and 2020, and textual analyses of government documents and private, for-profit digital healthcare websites. We uncovered a "two-tiered" system whereby private digital STI testing services enable people with economic resources to "pay to skip the line" queuing at public clinics and proceed directly to provide samples for diagnostics at local private medical labs. In Ontario, private lab corporations compete for fee-for-service contracts with government, which in turn organises opportunities for market growth when more patient samples are collected vis-à-vis digital testing. However, we also found that some infectious disease specimens (e.g., HIV) are re-routed for analysis at government public health laboratories, who may be unable to manage the increase in testing volume associated with digital STI testing due to state budget constraints. Our findings on public-private laboratory funding disparities thus discredit the claims that digital healthcare necessarily generates cost savings, or that it enhances patients' access to care. We conclude that divergent state funding relations together with the creeping privatisation of healthcare within this "universal" system coordinate the conditions through which private corporations capitalise from digital STI testing, compounding patient access inequities. We also stress that our findings bring forth large scale implications given the context of the global COVID-19 pandemic, the rapid diffusion of digital healthcare, together with significant novel coronavirus testing activities initiated by private industry.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/economía , Política , Enfermedades de Transmisión Sexual/diagnóstico , /métodos , Humanos , Tamizaje Masivo/métodos , Ontario
8.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33370929

RESUMEN

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.


Asunto(s)
Infecciones por VIH , Obstrucción Intestinal , Penicilinas/administración & dosificación , Proctitis/diagnóstico , Neoplasias del Recto/diagnóstico , Recto , Treponema pallidum , Anciano , Antibacterianos/administración & dosificación , Diagnóstico Diferencial , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Masculino , Proctitis/etiología , Proctitis/fisiopatología , Proctitis/terapia , Recto/diagnóstico por imagen , Recto/microbiología , Recto/patología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/terapia , Sigmoidoscopía/métodos , Sífilis/complicaciones , Sífilis/diagnóstico , Sífilis/terapia , Tomografía Computarizada por Rayos X/métodos , Treponema pallidum/inmunología , Treponema pallidum/aislamiento & purificación
9.
JAMA Netw Open ; 3(12): e2030806, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33355675

RESUMEN

Importance: There have been concerns that HIV preexposure prophylaxis (PrEP) may be associated with increases in sexually transmitted infections (STIs) because of subsequent reductions in condom use and/or increases in sexual partners. Objective: To determine trends in STI test positivity among high-risk men who have sex with men (MSM) before and after the start of HIV PrEP. Design, Setting, and Participants: A before-after analysis was conducted using a subcohort of a single-group PrEP implementation study cohort in New South Wales, Australia (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]), from up to 1 year before enrollment if after January 1, 2015, and up to 2 years after enrollment and before December 31, 2018. STI testing data were extracted from a network of 54 sexual health clinics and 6 primary health care clinics Australia-wide, using software to deidentify, encrypt, and anonymously link participants between clinics. A cohort of MSM dispensed PrEP for the first time during the study, with 2 or more STI tests in the prior year and who tested during follow-up, were included from the EPIC-NSW cohort of HIV-negative participants with high-risk sexual behavior. Data analysis was performed from June to December 2019. Exposures: Participants were dispensed coformulated tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP. Main Outcomes and Measures: The main outcome was STI, measured using test positivity, defined as the proportion of participants testing positive for an STI at least once per quarter of follow-up. Outcomes were calculated for Chlamydia trachomatis and Neisseria gonorrhoea by site of infection (anorectal, pharyngeal, urethral, or any) and for syphilis. Results: Of the EPIC-NSW cohort of 9709 MSM, 2404 were included in the before-after analysis. The mean (SD) age of the participants was 36 (10.4) years, and 1192 (50%) were Australia-born. STI positivity was 52% in the year after PrEP (23.3% per quarter; 95% CI, 22.5%-24.2% per quarter) with no significant trend (mean rate ratio [RR] increase of 1.01 per quarter [95% CI, 0.99-1.02]; P = .29), compared with 50% positivity in the year prior to PrEP (20.0% per quarter [95% CI, 19.04%-20.95% per quarter]; RR for overall STI positivity, 1.17 [95% CI, 1.10-1.24]; P < .001), with an increase in quarterly STI positivity (mean RR of 1.08 per quarter, or an 8% increase per quarter [95% CI, 1.05-1.11]; P < .001; RR, 0.93 [95% CI, 0.90-0.96]; P < .001). Findings were similar when stratified by specific STIs and anatomical site. Conclusions and Relevance: STI rates were high but stable among high-risk MSM while taking PrEP, compared with a high but increasing trend in STI positivity before commencing PrEP. These findings suggest the importance of considering trends in STIs when describing how PrEP use may be associated with STI incidence.


Asunto(s)
Emtricitabina/uso terapéutico , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Tenofovir/uso terapéutico , Adulto , Fármacos Anti-VIH/uso terapéutico , Australia/epidemiología , Estudios de Cohortes , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Conductas de Riesgo para la Salud , Humanos , Incidencia , Masculino , Profilaxis Pre-Exposición/métodos , Profilaxis Pre-Exposición/estadística & datos numéricos , Conducta Sexual , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1509-1513, 2020 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-33076608

RESUMEN

Objective: To understand the detection capacities of the laboratories in medical institutions in national sexually transmitted disease (STD) surveillance areas in China. Methods: A cross-sectional study was conducted to investigate the applications of STD tests in laboratories of the medical institutions in 105 STD surveillance areas in China, the proportion of each STD test application was calculated and the differences among medical institutions were compared. Results: In 752 medical institutions, the proportions of Treponema pallidum serological test and non-Treponema pallidum serological test applications were 97.5% (733/752) and 91.4% (687/752), respectively. The proportions of gonococcal culture and Chlamydia trachomatis nucleic acid test applications were 48.4% (364/752) and 23.4% (176/752), respectively. The application proportions of all tests for herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) were less than 40%. In medical institutions at provincial, prefectural and county levels, the application proportions of serological tests of Treponema and non-Treponema were all more than 90%, and the application proportions of gonococcal culture were 66.9% (83/124), 46.9% (197/420) and 47.4% (82/173) respectively, the application proportions of Chlamydia trachomatis nucleic acid test were 29.0% (36/124), 25.0% (105/420) and 19.7% (34/173) respectively. The application proportions of syphilis and gonorrhea tests and chlamydia nucleic acid test in public medical institutions were higher than those in private/joint venture medical institutions and higher in dermatological specialized hospitals than those in general hospitals and maternal and child health centers. The application proportions of STD tests in medical institutions in eastern China and central southern China were generally higher than those in other areas, and the lowest was found in northwestern China. Conclusions: Serological tests for syphilis have been carried out widely in medical institutions in all STD surveillance areas in China, but there were insufficient use of tests for gonococcal culture and Chlamydia trachomatis nucleic acid. The application proportions of STD tests vary in medical institutions at different levels and with different types and ownerships, and the development of STD testing is unbalanced in different areas. It is necessary to strengthen the capacity building of gonococcal culture and Chlamydia trachomatis nucleic acid test, and strengthen the capacity building of STD testing in grassroots, private/joint venture medical institutions and those in underdeveloped western areas.


Asunto(s)
Laboratorios , Vigilancia de la Población , Enfermedades de Transmisión Sexual , China/epidemiología , Técnicas de Laboratorio Clínico , Estudios Transversales , Humanos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología
11.
Skinmed ; 18(4): 210-212, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33032683

RESUMEN

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an infectious disease of recent origin with high transmissibility and mortality. The resulting COVID-19 pandemic has impacted the United States the most, in terms of the number of confirmed cases and fatalities. How other aspects of public health will be impacted by this disease has yet to be fully realized. Sexually transmitted diseases (STDs), already a major public health crisis, will likely be significantly affected by this pandemic. We address some of the potential implications for STDs in the setting of widespread COVID-19, discussing the sexual transmission of COVID-19 itself, STD co-infection with COVID-19, and changes in STD prevalence secondary to COVID-19. (SKINmed. 2020;18:210-212).


Asunto(s)
Infecciones por Coronavirus/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Salud Pública , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Masculino , Pandemias/prevención & control , Neumonía Viral/prevención & control , Prevalencia , Medición de Riesgo , Estados Unidos/epidemiología
12.
PLoS One ; 15(10): e0239750, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33002013

RESUMEN

BACKGROUND: Swingers, heterosexuals who, as couples, practice mate swapping or group sex with other couples or heterosexual singles, are at risk for sexually transmitted infections (STIs). Therefore, the aim of this study was to assess changes in sexual behaviour and STI testing behaviour, as well as predictors of STI testing. METHODS: Two cross-sectional studies were performed, using the same internet survey in 2011 and 2018. For trend analysis, sexual behaviour and STI testing behaviour were used. Socio-demographics, swinger characteristics, sexual behaviour, and psycho-social variables were used to assess predictors of STI testing in the past year, using multivariable regression analysis. RESULTS: A total of 1173 participants completed the survey in 2011, and 1005 in 2018. Condom use decreased for vaginal (73% vs. 60%), oral (5% vs. 2%), and anal sex (85% vs. 75%). STI positivity was reported in 23% and 30% of the participants, respectively, although testing for STI was comparable between both years (~65%). The following predictors of STI testing were significant: being female (OR = 1.9, 95%CI: 1.2-2.9), having a high swinging frequency (>12 times a year, OR = 3.7, 95%CI: 1.9-7.3), swinging at home (OR = 1.6, 95%CI: 1.0-2.7), receiving a partner notification (OR = 1.7, 95%CI: 1.2-2.6), considering STI testing important (OR = 4.3, 95%CI: 2.2-8.5), experiencing no pressure from a partner to test (OR = 0.6, 95%CI: 0.3-0.9), partners test for STI regularly (OR = 10.0, 95%CI: 6.2-15.9), perceiving STI testing as an obligation (OR = 2.1, 95%CI: 1.3-3.5), experiencing no barriers such as being afraid of testing (OR = 1.9, 95%CI: 1.2-3.1), limited opening hours (OR = 1.6, 95%CI: 1.0-2.4), and forgetting to plan appointments (OR = 3.0, 95%CI: 2.0-4.6). CONCLUSIONS: Swingers exhibit self-selection for STI testing based on their sexual behaviour. However, STI prevention efforts are still important considering the increasing numbers of reported STIs, the decreased use of condom use, and the one-third of swingers who were not tested in the previous year.


Asunto(s)
Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Adulto , Trazado de Contacto/estadística & datos numéricos , Estudios Transversales , Escolaridad , Relaciones Extramatrimoniales/psicología , Femenino , Heterosexualidad/psicología , Heterosexualidad/estadística & datos numéricos , Humanos , Internet , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Conducta Sexual/psicología , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/etiología , Enfermedades de Transmisión Sexual/prevención & control , Encuestas y Cuestionarios , Adulto Joven
13.
Pediatr Rev ; 41(10): 522-537, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33004664

RESUMEN

Sexually transmitted infections (STIs) disproportionately affect young people, with more than half of the infections occurring in youth aged 15 to 25 years. (1)(2) This review, the second in a 2-part series on STIs, focuses on infections that may cause abnormal vaginal or penile discharge, including trichomonas, chlamydia, gonorrhea, and pelvic inflammatory disease (PID). Most infected persons, however, are asymptomatic. Nucleic acid amplification tests are the most sensitive and specific for the detection of chlamydia, gonorrhea, and trichomoniasis, and they can be performed on provider- or patient-collected swabs. Providers should have a low threshold for diagnosing and treating PID because untreated PID can have serious long-term complications for young women. Indications for hospitalization for PID include the presence of a tubo-ovarian abscess, severe illness with systemic symptoms, pregnancy, human immunodeficiency virus infection, and failure to respond to outpatient oral treatment (within 48-72 hours) or inability to tolerate the oral treatment.


Asunto(s)
Enfermedad Inflamatoria Pélvica/diagnóstico , Enfermedades de Transmisión Sexual/diagnóstico , Excreción Vaginal/microbiología , Adolescente , Candidiasis/complicaciones , Candidiasis/diagnóstico , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/diagnóstico , Femenino , Gonorrea/complicaciones , Gonorrea/diagnóstico , Humanos , Masculino , Enfermedad Inflamatoria Pélvica/etiología , Parejas Sexuales , Enfermedades de Transmisión Sexual/complicaciones , Vaginitis por Trichomonas/diagnóstico , Cervicitis Uterina/complicaciones , Vaginosis Bacteriana/complicaciones , Vaginosis Bacteriana/diagnóstico
14.
Actas urol. esp ; 44(8): 523-528, oct. 2020. tab
Artículo en Español | IBECS | ID: ibc-197142

RESUMEN

La uretritis masculina es una inflamación de la uretra y las glándulas periuretrales; a grandes rasgos, se clasifica como gonocócica o no gonocócica. Los microorganismos responsables más frecuentes son Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum y Ureaplasma parvum. En las últimos tres décadas, el diagnóstico de las enfermedades de transmisión sexual dependía casi exclusivamente de métodos tradicionales como el cultivo, el inmunoensayo enzimático, la tinción de anticuerpos fluorescentes y la hibridación, hasta la reciente aparición de técnicas moleculares. Los síndromes clínicos como la uretritis rara vez son específicos de un solo microorganismo, por lo que las estrategias de selección deben permitir que se consideren múltiples agentes. La PCR Múltiple es la técnica más rápida y sensible para el diagnóstico de la uretritis gonocócica y no gonocócica. La uretritis masculina no tratada es uno de los principales problemas de salud relacionados con la función reproductiva y sexual, constituyendo una de las principales causas de infertilidad. El objetivo de esta pequeña revisión es analizar la epidemiología, las causas, el diagnóstico y las complicaciones de la uretritis masculina


Male urethritis is an inflammation of the urethra and the periurethral glands; it is widely classified as gonococcal or non-gonococcal. The most frequent microorganisms responsible are Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum. In the last three decades, the diagnosis of sexually transmitted diseases depended almost exclusively on traditional methods, such as culture, enzyme immunoassay, fluorescent antibody staining, and hybridization, until the appearance of molecular techniques. Clinical syndromes such as urethritis are rarely specific for a single microorganism, so screening strategies should allow multiple agents to be considered. Multiplex PCR is the fastest and most sensitive technique for the diagnosis of gonococcal and non-gonococcal urethritis. Male urethritis without treatment is one of the main health problems related to reproductive and sexual function, constituting one of the main causes of infertility. The objective of this mini-review was to analyze the epidemiology, causes, diagnosis, and complications of male urethritis


Asunto(s)
Humanos , Masculino , Uretritis/diagnóstico , Uretritis/microbiología , Reacción en Cadena de la Polimerasa Multiplex , Sensibilidad y Especificidad , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología
15.
Artículo en Alemán | MEDLINE | ID: mdl-32930821

RESUMEN

In February 2019, the fourth expert meeting on rapid diagnostic tests (RDTs) for sexually transmitted infections (STI) was held at the Robert Koch Institute (RKI) in Berlin. Novel technical developments and new aspects of RDT applications were discussed by representatives from the German STI Society (DSTIG); RKI; the Paul Ehrlich Institute; national reference centers for HIV, HBV, and HCV; and reference laboratories for Chlamydia, gonococci, and Treponema pallidum.As a result of this meeting, we present a revision of the joint statement on STI diagnostics with RDTs from 2017. The Regulation (EU) 2017/746 of the European Parliament and of the Council on in vitro diagnostic medical devices became effective in May 2017 and includes more stringent regulatory requirements for RDTs, mainly concerning conformity of manufacturing processes and performance characteristics of class D in vitro diagnostics (detection of HIV, HBV, HCV, and T. pallidum). Some RDTs for HIV, HCV, and T. pallidum have been evaluated in clinical studies and/or were WHO prequalified and may be used in low-threshold services. Among them are some HIV RDTs available and approved for self-testing. In addition, some HBV RDTs based on detection of HBs antigen (HBsAg) received WHO prequalification. However, false negative results may occur in samples with low HBsAg levels, as for instance in HIV-coinfected patients receiving antiretroviral therapy. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), antigen-based RDTs still do not allow reliable detection of infection. Only PCR-based CT/NG RDTs possess sufficient diagnostic accuracy to be used as point-of-care tests. Rapid PCR tests for NG, however, do not provide any information about antimicrobial resistance.


Asunto(s)
Chlamydia , Infecciones por VIH/diagnóstico , Hepatitis C/diagnóstico , Enfermedades de Transmisión Sexual/diagnóstico , Berlin , Alemania , Virus de la Hepatitis B , Humanos , Neisseria gonorrhoeae , Treponema pallidum
16.
Public Health Rep ; 135(1_suppl): 82S-89S, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32735186

RESUMEN

OBJECTIVES: Correctional settings (prisons, jails, detention facilities) provide a unique opportunity to screen for sexually transmitted infections (STIs) among correctional populations with a high prevalence of infection. Immigrant detainees are a distinct and poorly described correctional population. The main objective of this study was to determine the feasibility of a national STI screening program for immigrant detainees. METHODS AND MATERIALS: We developed an opt-out STI testing program that included electronic health record integration, patient education, and staff member training. We piloted this program from June 22 through August 19, 2018, at 2 detention facilities with different operational requirements and detainee demographic characteristics. We assessed STI test positivity rates, treatment outcomes, estimated cost to conduct testing and counseling, and staff member perceptions of program value and challenges to implementation. RESULTS: Of 1041 immigrant detainees approached for testing, 526 (50.5%) declined. Of 494 detainees who were tested, 42 (8.5%) tested positive for at least 1 STI; the percentage positivity rates were 6.7% (n = 33) for chlamydia, 0.8% (n = 4) for syphilis, 0.8% (n = 4) for gonorrhea, 0.6% (n = 3) for hepatitis B, and 0.2% (n = 1) for HIV. The estimated cost to detect any STI ranged from $500 to $961; the estimated cost to identify 1 person infected with HIV ranged from $22 497 to $43 244. Forty of 42 persons who tested positive began treatment before release from custody. Medical staff members had positive views of the program but had concerns about workload. PRACTICE IMPLICATIONS: STIs are prevalent among immigrant detainees. A routine screening program is feasible if operational aspects are carefully considered and would provide counseling, education, and treatment for this vulnerable population.


Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Estado de Salud , Humanos , Masculino , Tamizaje Masivo/economía , Persona de Mediana Edad , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/etnología , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/etnología , Adulto Joven
17.
Public Health Rep ; 135(1_suppl): 75S-81S, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32735184

RESUMEN

Policies facilitating integration of public health programs can improve the public health response, but the literature on approaches to integration across multiple system levels is limited. We describe the efforts of the Massachusetts Department of Public Health to integrate its HIV, viral hepatitis, sexually transmitted infection (STI), and tuberculosis response through policies that mandated contracted organizations to submit specimens for testing to the Massachusetts State Public Health Laboratory; co-test blood specimens for HIV, hepatitis C virus (HCV), and syphilis; integrate HIV, viral hepatitis, and STI disease surveillance and case management in a single data system; and implement an integrated infectious disease drug assistance program. From 2014 through 2018, the number of tests performed by the Massachusetts State Public Health Laboratory increased from 16 321 to 33 674 for HIV, from 11 054 to 33 670 for HCV, and from 19 169 to 30 830 for syphilis. Service contracts enabled rapid response to outbreaks of HIV, hepatitis A, and hepatitis B. Key challenges included lack of a billing infrastructure at the Massachusetts State Public Health Laboratory; the need to complete negotiations with insurers and to establish a retained revenue account to receive health insurance reimbursements for testing services; and time to train testing providers in phlebotomy for required testing. Investing in laboratory infrastructure; creating billing mechanisms to maximize health insurance reimbursement; proactively engaging providers, community members, and other stakeholders; and building capacity to transform practices are needed. Using multilevel policy approaches to integrate the public health response to HIV, STI, viral hepatitis, and tuberculosis is feasible and adaptable to other public health programs.


Asunto(s)
Servicios Contratados/organización & administración , Seguro de Salud/organización & administración , Administración en Salud Pública/métodos , Vigilancia en Salud Pública/métodos , Enfermedades de Transmisión Sexual/diagnóstico , Servicios Contratados/economía , Servicios Contratados/normas , Política de Salud , Accesibilidad a los Servicios de Salud , Hepatitis/diagnóstico , Humanos , Seguro de Salud/economía , Seguro de Salud/legislación & jurisprudencia , Seguro de Salud/normas , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/legislación & jurisprudencia , Reembolso de Seguro de Salud/normas , Relaciones Interinstitucionales , Massachusetts , Estudios de Casos Organizacionales , Evaluación de Programas y Proyectos de Salud , Administración en Salud Pública/economía , Administración en Salud Pública/legislación & jurisprudencia , Administración en Salud Pública/normas , Sífilis/diagnóstico
18.
Public Health Rep ; 135(1_suppl): 128S-137S, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32735195

RESUMEN

OBJECTIVE: Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. METHODS: Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. RESULTS: Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. CONCLUSION: Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.


Asunto(s)
Programas de Intercambio de Agujas/legislación & jurisprudencia , Gobierno Estatal , Abuso de Sustancias por Vía Intravenosa/epidemiología , Estudios Transversales , Accesibilidad a los Servicios de Salud/organización & administración , Hepatitis/diagnóstico , Humanos , Tamizaje Masivo/organización & administración , Características de la Residencia , Enfermedades de Transmisión Sexual/diagnóstico , Servicio Social/organización & administración , Tuberculosis/diagnóstico , Estados Unidos
19.
AIDS Patient Care STDS ; 34(9): 373-379, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32799540

RESUMEN

Adolescents account for most undiagnosed HIV infections in the United States. Although the Centers for Disease Control and Prevention (CDC) recommends universal HIV screening for all patients ≥13 years, <10% of adolescents have been tested for HIV. To identify earlier opportunities for adolescent HIV prevention and diagnosis in a region of high HIV prevalence, we sought to describe pediatric emergency department (PED) visits made by a retrospective cohort of adolescents who were later diagnosed with HIV as young adults (<25 years) through an adult emergency department (ED) universal HIV screening program. CD4+ count was used to estimate the time of HIV infection before diagnosis and all PED visits in the 10 years before diagnosis were analyzed. Universal HIV screening in the adult ED diagnosed 193 young adults (median 22 years; 90% men; 29% stage 3); 70% had CD4+ at diagnosis that was used to estimate time of infection (mean 3.8 years). Thirty-eight HIV-infected young adults had a total of 109 PED visits in the 10 years before HIV diagnosis. Sexual history was documented in 12% of PED visits and a sexually transmitted infection test was sent in 6%. Ten HIV-infected young adults had 26 PED visits during the time in which they were likely already infected with HIV, each a potential missed opportunity for earlier diagnosis. HIV-infected and at-risk adolescents are underrecognized in PED visits. Implementation of CDC-recommended universal screening may lead to earlier diagnoses and improve outcomes; the PED may also be critical in identifying adolescents eligible for preexposure prophylaxis.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/métodos , Pediatría , Adolescente , Infecciones Asintomáticas/epidemiología , Niño , Servicio de Urgencia en Hospital , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos/epidemiología , Adulto Joven
20.
Nurs Clin North Am ; 55(3): 325-335, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32762853

RESUMEN

Sexually transmitted infections (STIs) are diseases that are transmitted from one person to another person through acts of vaginal, anal, or oral intercourse. The increased presence of STIs among men who have sex with men (MSM) results in a higher rate of STI-related diagnoses, such as proctitis. Proctitis is a common, but often misdiagnosed condition experienced by MSM who present to primary care, urgent care, and emergency settings. It is important that health care providers be knowledgeable of the pathophysiology, risk factors, and clinical presentation of proctitis among MSM for accurate and timely management.


Asunto(s)
Homosexualidad Masculina , Proctitis/complicaciones , Proctitis/diagnóstico , Enfermedades de Transmisión Sexual , Adulto , Cólico/etiología , Diarrea/etiología , Humanos , Masculino , Proctitis/fisiopatología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/transmisión
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