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1.
BMC Infect Dis ; 24(1): 498, 2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38760682

RESUMEN

BACKGROUND: Antimicrobial resistance (AMR) represents a significant threat to global health with Neisseria gonorrhoea emerging as a key pathogen of concern. In Australia, the Australian Gonococcal Surveillance Program (AGSP) plays a critical role in monitoring resistance patterns. However, antibiotic susceptibility test (AST) uptake - a crucial component for effective resistance surveillance - remains to be a limiting factor. The study aims to model the processes involved in generating AST tests for N. gonorrhoea isolates within the Australian healthcare system and assess the potential impact of systematic and policy-level changes. METHODS: Two models were developed. The first model was a mathematical stochastic health systems model (SHSM) and a Bayesian Belief Network (BBN) to simulate the clinician-patient dynamics influencing AST initiation. Key variables were identified through systematic literature review to inform the construction of both models. Scenario analyses were conducted with the modification of model parameters. RESULTS: The SHSM and BBN highlighted clinician education and the use of clinical support tools as effective strategies to improve AST. Scenario analysis further identified adherence to guidelines and changes in patient-level factors, such as persistence of symptoms and high-risk behaviours, as significant determinants. Both models supported the notion of mandated testing to achieve higher AST initiation rates but with considerations necessary regarding practicality, laboratory constraints, and culture failure rate. CONCLUSION: The study fundamentally demonstrates a novel approach to conceptualising the patient-clinician dynamic within AMR testing utilising a model-based approach. It suggests targeted interventions to educational, support tools, and legislative framework as feasible strategies to improve AST initiation rates. However, the research fundamentally highlights substantial research gaps in the underlying understanding of AMR.


Asunto(s)
Antibacterianos , Gonorrea , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae , Neisseria gonorrhoeae/efectos de los fármacos , Humanos , Australia/epidemiología , Gonorrea/microbiología , Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Teorema de Bayes , Farmacorresistencia Bacteriana , Modelos Teóricos , Política de Salud
2.
Nat Commun ; 15(1): 3756, 2024 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-38704381

RESUMEN

The human pathogen Neisseria gonorrhoeae ascends into the upper female reproductive tract to cause damaging inflammation within the Fallopian tubes and pelvic inflammatory disease (PID), increasing the risk of infertility and ectopic pregnancy. The loss of ciliated cells from the epithelium is thought to be both a consequence of inflammation and a cause of adverse sequelae. However, the links between infection, inflammation, and ciliated cell extrusion remain unresolved. With the use of ex vivo cultures of human Fallopian tube paired with RNA sequencing we defined the tissue response to gonococcal challenge, identifying cytokine, chemokine, cell adhesion, and apoptosis related transcripts not previously recognized as potentiators of gonococcal PID. Unexpectedly, IL-17C was one of the most highly induced genes. Yet, this cytokine has no previous association with gonococcal infection nor pelvic inflammatory disease and thus it was selected for further characterization. We show that human Fallopian tubes express the IL-17C receptor on the epithelial surface and that treatment with purified IL-17C induces pro-inflammatory cytokine secretion in addition to sloughing of the epithelium and generalized tissue damage. These results demonstrate a previously unrecognized but critical role of IL-17C in the damaging inflammation induced by gonococci in a human explant model of PID.


Asunto(s)
Trompas Uterinas , Gonorrea , Inflamación , Interleucina-17 , Neisseria gonorrhoeae , Adulto , Femenino , Humanos , Citocinas/metabolismo , Epitelio/patología , Epitelio/microbiología , Trompas Uterinas/microbiología , Trompas Uterinas/patología , Trompas Uterinas/inmunología , Gonorrea/inmunología , Gonorrea/microbiología , Gonorrea/patología , Inflamación/patología , Inflamación/microbiología , Interleucina-17/metabolismo , Neisseria gonorrhoeae/inmunología , Neisseria gonorrhoeae/patogenicidad , Enfermedad Inflamatoria Pélvica/microbiología , Enfermedad Inflamatoria Pélvica/patología , Enfermedad Inflamatoria Pélvica/inmunología , Receptores de Interleucina-17/metabolismo , Receptores de Interleucina-17/genética
3.
JAMA ; 331(20): 1695-1697, 2024 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-38700901

RESUMEN

This Medical News article discusses approaches to slow the spread of antimicrobial resistance in Neisseria gonorrhoeae.


Asunto(s)
Antibacterianos , Farmacorresistencia Bacteriana Múltiple , Gonorrea , Neisseria gonorrhoeae , Humanos , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Neisseria gonorrhoeae/genética , Antibacterianos/uso terapéutico , Estados Unidos
4.
PLoS One ; 19(5): e0302785, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38768150

RESUMEN

INTRODUCTION: The rates of gonorrhea and chlamydia have been increasing in the years preceding the COVID19 pandemic. Because most gonorrhea and chlamydia infections are located in the oropharynx and rectum for men who have sex with men (MSM), and because at-home self-collected swabs for these infections are not licensed by Health Canada or the United States Food and Drug Administration, decreased accessed to in-person care during and since the COVID19 pandemic potentially means missed case findings. OBJECTIVES: To evaluate the performance of at-home self-collected pharyngeal and rectal swabs for gonorrhea and chlamydia nucleic acid amplification testing. METHODOLOGY: All persons who contacted our Sexual Health Clinic and who had a clinical indication to complete oral and/or rectal swabs for gonorrhea and chlamydia were invited to complete at-home swabs in advance of their scheduled appointments. We mailed swabs and instructions to those who consented. Participants brought these swabs to their scheduled in clinic appointments, where we repeated the same swabs. All matching swabs were sent to the laboratory for analysis to determine concordance. RESULTS: From September 8, 2022 to July 18, 2023, we enrolled 296 eligible participants who provided 1184 swabs. For analysis, cancelled specimens and specimens with invalid results were excluded, leaving 1032 swabs for comparison. We identified 66 STI diagnoses in 47 unique participants. Overall accuracy was high (exceeding 99%), except for rectal chlamydia, which was 96.0%. While the performance of self-swabs for chlamydia was lower compared to gonorrhea, at-home swabs identified six chlamydia infections that were missed by in-clinic collected swabs (two pharyngeal, four rectal). Removing these six cases as "false positives" increased overall accuracy for chlamydia detection to 99.7% (pharyngeal) and 97.8% (rectal). CONCLUSION: Self-collected at-home swabs had good performance acceptable for gonorrhea and chlamydia nucleic acid amplification testing.


Asunto(s)
Infecciones por Chlamydia , Chlamydia trachomatis , Gonorrea , Neisseria gonorrhoeae , Faringe , Recto , Manejo de Especímenes , Humanos , Chlamydia trachomatis/aislamiento & purificación , Chlamydia trachomatis/genética , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/microbiología , Gonorrea/diagnóstico , Gonorrea/microbiología , Masculino , Neisseria gonorrhoeae/aislamiento & purificación , Neisseria gonorrhoeae/genética , Recto/microbiología , Faringe/microbiología , Manejo de Especímenes/métodos , Adulto , Femenino , Técnicas de Amplificación de Ácido Nucleico/métodos , Homosexualidad Masculina , Persona de Mediana Edad , Autocuidado , Adulto Joven
5.
Sex Transm Dis ; 51(6): 388-392, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38733972

RESUMEN

BACKGROUND: Standard-of-care nucleic acid amplification tests (routine NAATs) for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) can take several days to result and therefore delay treatment. Rapid point-of-care GC/CT NAAT (rapid NAAT) could reduce the time to treatment and therefore onward transmission. This study evaluated the incremental cost per infectious day averted and overall cost of implementation associated with rapid compared with routine NAAT. METHODS: Prospective sexually transmitted infection (STI) treatment data from men who have sex with men and transgender women in San Diego who received rapid NAAT between November 2018 and February 2021 were evaluated. Historical time from testing to treatment for routine NAAT was abstracted from the literature. Costs per test for rapid and routine NAAT were calculated using a micro-costing approach. The incremental cost per infectious day averted comparing rapid to routine NAAT and the costs of rapid GC/CT NAAT implementation in San Diego Public Health STI clinics were calculated. RESULTS: Overall, 2333 individuals underwent rapid NAAT with a median time from sample collection to treatment of 2 days compared with 7 to 14 days for routine NAAT equating to a reduction of 5 to 12 days. The cost of rapid and routine GC/CT NAAT was $57.86 and $18.38 per test, respectively, with a cost-effectiveness of between $2.43 and $5.82 per infectious day averted. The incremental cost of rapid NAAT improved when at least 2000 tests were performed annually. CONCLUSIONS: Although rapid GC/CT NAAT is more expensive than routine testing, the reduction of infectious days between testing and treatment may reduce transmission and provide improved STI treatment services to patients.


Asunto(s)
Infecciones por Chlamydia , Chlamydia trachomatis , Gonorrea , Homosexualidad Masculina , Neisseria gonorrhoeae , Técnicas de Amplificación de Ácido Nucleico , Humanos , Masculino , Gonorrea/diagnóstico , Gonorrea/economía , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/economía , Técnicas de Amplificación de Ácido Nucleico/economía , Neisseria gonorrhoeae/aislamiento & purificación , Chlamydia trachomatis/aislamiento & purificación , Adulto , California/epidemiología , Análisis Costo-Beneficio , Estudios Prospectivos , Femenino , Pruebas en el Punto de Atención/economía , Personas Transgénero
7.
Diagn Microbiol Infect Dis ; 109(3): 116336, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38723452

RESUMEN

Current guideline recommends the use of two identification methods for Neisseria gonorrhoeae. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) is now used for primary identification and may be sufficient for definitive identification of N. gonorrhoeae. The performance of three secondary tests (BactiCard, RapID NH and NET test) were compared using 45 bacterial isolates, including 37 Neisseria species. These secondary tests demonstrated diminished specificity (67% - 88%) for N. gonorrhoeae compared with MALDI-TOF. Additionally, data from six clinical microbiology laboratories was used to compare confirmatory test costs and the agreement of results with MALDI-TOF. Discrepancies were documented for 9.4% of isolates, though all isolates (n= 288) identified by MALDI-TOF as N. gonorrhoeae were confirmed by the reference laboratory. These data demonstrate that MALDI-TOF alone is sufficient for N. gonorrhoeae identification, as secondary did not add diagnostic value but do add costs to the testing process.


Asunto(s)
Gonorrea , Neisseria gonorrhoeae , Sensibilidad y Especificidad , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Neisseria gonorrhoeae/aislamiento & purificación , Neisseria gonorrhoeae/clasificación , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/economía , Humanos , Gonorrea/diagnóstico , Gonorrea/microbiología , Técnicas Bacteriológicas/economía , Técnicas Bacteriológicas/métodos
8.
West J Emerg Med ; 25(3): 358-367, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38801042

RESUMEN

Introduction: Bacterial urinary tract infections (UTI) and some sexually transmitted infections (STI) can have overlapping signs and symptoms or nonspecific findings, such as pyuria on urinalysis. Furthermore, results from the urine culture and the nucleic acid amplification test for an STI may not be available during the clinical encounter. We sought to determine whether gonorrhea, chlamydia, and trichomoniasis are associated with bacteriuria, information that might aid in the differentiation of STIs and UTIs. Methods: We used multinomial logistic regression to analyze 9,650 encounters of female patients who were aged ≥18 years and who underwent testing for STIs. The ED encounters took place from April 18, 2014-March 7, 2017. We used a multivariable regression analysis to account for patient demographics, urinalysis findings, vaginal wet-mount results, and positive or negative (or no) findings from the urine culture and testing for Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis. Results: In multivariable analysis, infection with T vaginalis, N gonorrhoeae, or C trachomatis was not associated with having a urine culture yielding 10,000 or more colony-forming units per mililiter (CFU/mL) of bacteria compared with a urine culture yielding less than 10,000 CFU/mL or no urine culture obtained. The diagnosis of a UTI in the ED was not associated with having a urine culture yielding 10,000 or more CFU/mL compared with a urine culture yielding less than 10,000 CFU/mL. Conclusion: After adjusting for covariates, no association was observed between urine culture results and testing positive for trichomoniasis, gonorrhea, or chlamydia. Our results suggest that having a concurrent STI and bacterial UTI is unlikely.


Asunto(s)
Gonorrea , Enfermedades de Transmisión Sexual , Urinálisis , Infecciones Urinarias , Humanos , Femenino , Adulto , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Infecciones Urinarias/orina , Enfermedades de Transmisión Sexual/orina , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología , Gonorrea/diagnóstico , Gonorrea/orina , Urinálisis/métodos , Infecciones por Chlamydia/orina , Infecciones por Chlamydia/diagnóstico , Persona de Mediana Edad , Chlamydia trachomatis/aislamiento & purificación , Servicio de Urgencia en Hospital , Trichomonas vaginalis/aislamiento & purificación , Bacteriuria/diagnóstico , Bacteriuria/orina , Bacteriuria/microbiología , Adulto Joven , Neisseria gonorrhoeae/aislamiento & purificación , Orina/microbiología , Estudios Retrospectivos , Adolescente , Tricomoniasis/diagnóstico , Tricomoniasis/orina
9.
West J Emerg Med ; 25(3): 382-388, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38801045

RESUMEN

Introduction: The incidence of sexually transmitted infections (STI) increased in the United States between 2017-2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED. Methods: This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018-May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18-64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. We analyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics. Results: During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (<2%). Conclusion: Prevalence of STI co-testing was low among patients with clinical suspicion for STIs; however, co-infection prevalence was high in several co-infection pairings. Future efforts are needed to improve STI co-testing rates among high-risk individuals.


Asunto(s)
Coinfección , Servicio de Urgencia en Hospital , Gonorrea , Infecciones por VIH , Hepatitis C , Tamizaje Masivo , Enfermedades de Transmisión Sexual , Sífilis , Humanos , Estudios Transversales , Femenino , Estudios Retrospectivos , Adulto , Masculino , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Coinfección/epidemiología , Coinfección/diagnóstico , Gonorrea/diagnóstico , Gonorrea/epidemiología , Sífilis/diagnóstico , Sífilis/epidemiología , Prevalencia , Persona de Mediana Edad , Hepatitis C/epidemiología , Hepatitis C/diagnóstico , Tamizaje Masivo/métodos , Infecciones por VIH/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Adolescente , Adulto Joven
10.
JMIR Public Health Surveill ; 10: e46845, 2024 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-38767954

RESUMEN

BACKGROUND: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. OBJECTIVE: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. METHODS: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. RESULTS: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. CONCLUSIONS: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.


Asunto(s)
Gonorrea , Trabajadores Sexuales , Humanos , Gonorrea/epidemiología , Trabajadores Sexuales/estadística & datos numéricos , Trabajadores Sexuales/psicología , Factores de Riesgo , Femenino , Adulto , Estudios de Casos y Controles , Masculino , Nueva Gales del Sur/epidemiología , Victoria/epidemiología , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Salud Sexual/estadística & datos numéricos , Australia/epidemiología , Orofaringe/microbiología , Conducta Sexual/estadística & datos numéricos , Investigación Cualitativa
11.
Front Public Health ; 12: 1348686, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38770362

RESUMEN

Background: Men who have sex with men (MSM) face significant risks of Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) infection. Nevertheless, only limited studies have looked into the site-specific infection and clearance of CT/NG. In order to prevent transmission, it is essential to understand the underlying factors that drive infection and spontaneous clearance. Methods: A 12-week cohort study examined the association between CT/NG infection, self-clearance, and sexual behaviors among MSM. The Willingness Service recruited participants who completed weekly questionnaires and provided urine, throat, and rectal swab samples. Results: The study involved 151 men, in which 51 (33.8%) were diagnosed with CT/NG infection during the study period. HIV (OR = 11.31), kissing (OR = 1.59), receptive oral sex (OR = 36.64), and insertive anal sex (OR = 19.73) constituted significant risk factors. 100% condom use (OR = 5.78) and antibiotic (OR = 7.53) were more likely to cause spontaneous clearance. Discussion: MSM may engage in riskier sexual behaviors due to insufficient knowledge and awareness of STI prevention, leading to increased susceptibility to NG/CT. It is crucial to concentrate on enhancing health education for MSM. Conclusion: This study found that the rectum was the most prevalent site of CT/NG and sexual behavior can influence the infection. Additionally, the appropriate use of antibiotics and consistent condom use may contribute to clear spontaneously.


Asunto(s)
Infecciones por Chlamydia , Gonorrea , Homosexualidad Masculina , Conducta Sexual , Humanos , Masculino , Gonorrea/epidemiología , Infecciones por Chlamydia/epidemiología , China/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Estudios Prospectivos , Incidencia , Factores de Riesgo , Conducta Sexual/estadística & datos numéricos , Chlamydia trachomatis/aislamiento & purificación , Encuestas y Cuestionarios , Neisseria gonorrhoeae/aislamiento & purificación , Adulto Joven , Persona de Mediana Edad
12.
Przegl Epidemiol ; 77(4): 466-475, 2024 May 20.
Artículo en Inglés, Polaco | MEDLINE | ID: mdl-38783655

RESUMEN

BACKGROUND: The incidence of gonorrhoea at the European level increased over 2012-2019, decreased in 2020, and then reached higher values in 2021 than in 2019. OBJECTIVE: Analysis in the descriptive epidemiology scheme of gonorrhoea notification in surveillance in Poland in 2021 (being the second year of the COVID-19 pandemic). MATERIAL AND METHODS: Case-base data from surveillance of gonorrhoea were used: confirmed case (meeting laboratory criteria), probable (meeting clinical criteria and contact with confirmed case) and possible (only in Poland - physician diagnosed gonorrhoea, no information available for proper classification). Statistic Poland data was used to calculate the indicators. Data on patients treated in dermatology-venereology clinics between 2019-2021 were taken from the Bulletins of the Ministry of Health. RESULTS: The incidence of gonorrhoea in Poland in 2021 was only a fraction of recorded in the EU/EEA (0.74 vs. 13.7/100000)-similar to the first pandemic year and were about half of those notified in the 2019 (the peak year; 281 vs. 522 cases). There were 15.5 men per one female (incidence: 1.6/100000 men, 0.1/100000 women). Every second case was among aged 25-34 (49.62%), every fourth-aged 35-44 (23.11%). Under 15, no cases were reported. The predominant site was the genitourinary (excluding missing data: 85.3%). The cases with missing information on transmision increased (49.1%; aged 45+: 72.0%, women: 76.5%). Delays in reporting data were identified (greater than in 2019, however, less than in 2020), ~17% cases were from 2019-2020. Dermatology-venerology clinics treated 385 people - less than in 2020, however, more than reported in epidemiological surveillance (vs. 281). CONCLUSIONS: The COVID-19 pandemic has influenced on the surveillance system in Poland. There are difficulties in interpreting the epidemiological trend. It is necessary to: 1) intensify systemic solutions in the area of prevention, including sexual partners; 2) raise the awareness of healthcare professionals and sanitary inspection workers on the role of collecting epidemiological information.


Asunto(s)
COVID-19 , Gonorrea , Humanos , Polonia/epidemiología , Gonorrea/epidemiología , Gonorrea/diagnóstico , Masculino , Femenino , Adulto , Incidencia , COVID-19/epidemiología , Persona de Mediana Edad , Adulto Joven , SARS-CoV-2 , Adolescente , Distribución por Edad , Distribución por Sexo , Población Urbana/estadística & datos numéricos , Anciano , Población Rural/estadística & datos numéricos
13.
BMJ Open ; 14(5): e079144, 2024 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-38719318

RESUMEN

INTRODUCTION: The effectiveness of antibiotics for treating gonococcal infections is compromised due to escalating antibiotic resistance; and the development of an effective gonococcal vaccine has been challenging. Emerging evidence suggests that the licensed meningococcal B (MenB) vaccine, 4CMenB is effective against gonococcal infections due to cross-reacting antibodies and 95% genetic homology between the two bacteria, Neisseria meningitidis and Neisseria gonorrhoeae, that cause the diseases. This project aims to undertake epidemiological and genomic surveillance to evaluate the long-term protection of the 4CMenB vaccine against gonococcal infections in the Northern Territory (NT) and South Australia (SA), and to determine the potential benefit of a booster vaccine doses to provide longer-term protection against gonococcal infections. METHODS AND ANALYSES: This observational study will provide long-term evaluation results of the effectiveness of the 4CMenB vaccine against gonococcal infections at 4-7 years post 4CMenB programme implementation. Routine notifiable disease notifications will be the basis for assessing the impact of the vaccine on gonococcal infections. Pathology laboratories will provide data on the number and percentage of N. gonorrhoeae positive tests relative to all tests administered and will coordinate molecular sequencing for isolates. Genome sequencing results will be provided by SA Pathology and Territory Pathology/New South Wales Health Pathology, and linked with notification data by SA Health and NT Health. There are limitations in observational studies including the potential for confounding. Confounders will be analysed separately for each outcome/comparison. ETHICS AND DISSEMINATION: The protocol and all study documents have been reviewed and approved by the SA Department for Health and Well-being Human Research Ethics Committee (HREC/2022/HRE00308), and the evaluation will commence in the NT on receipt of approval from the NT Health and Menzies School of Health Research Human Research Ethics Committee. Results will be published in peer-reviewed journals and presented at scientific meetings and public forums.


Asunto(s)
Gonorrea , Vacunas Meningococicas , Neisseria gonorrhoeae , Humanos , Gonorrea/prevención & control , Gonorrea/epidemiología , Northern Territory/epidemiología , Vacunas Meningococicas/administración & dosificación , Vacunas Meningococicas/uso terapéutico , Neisseria gonorrhoeae/inmunología , Australia del Sur/epidemiología , Estudios Observacionales como Asunto , Femenino
14.
Sci Rep ; 14(1): 10496, 2024 05 07.
Artículo en Inglés | MEDLINE | ID: mdl-38714714

RESUMEN

The use of self-collected specimens as an alternative to healthcare worker-collected specimens for diagnostic testing has gained increasing attention in recent years. This systematic review aimed to assess the diagnostic accuracy of self-collected specimens compared to healthcare worker-collected specimens across different sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), human papillomavirus (HPV), Mycoplasma genitalium (MG), Neisseria gonorrhoea (NG), Treponema pallidum and Trichomonas vaginalis (TV) in females. A rigorous process was followed to screen for studies in various electronic databases. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. There were no studies on syphilis that met the criteria for inclusion in the review. A total of six studies for chlamydia, five studies for HPV, four studies for MG, and seven studies for gonorrhoea and trichomoniasis were included in the review. However, not all studies were included in the sub-group meta-analysis. The analysis revealed that self-collected specimens demonstrated comparable diagnostic accuracy to healthcare worker-collected specimens across most STIs. This indicates that the diagnostic accuracy of self-collected specimens can provide accurate results and enhance access to diagnostic testing, potentially improving healthcare service delivery. Future research should further explore the diagnostic accuracy of self-collected specimens in larger and more diverse populations.


Asunto(s)
Personal de Salud , Enfermedades de Transmisión Sexual , Manejo de Especímenes , Humanos , Femenino , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología , Manejo de Especímenes/métodos , Neisseria gonorrhoeae/aislamiento & purificación , Gonorrea/diagnóstico , Chlamydia trachomatis/aislamiento & purificación
15.
J Infect ; 88(6): 106168, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38670270

RESUMEN

OBJECTIVES: The utility of whole genome sequencing (WGS) to inform sexually transmitted infection (STI) patient management is unclear. Timely WGS data might support clinical management of STIs by characterising epidemiological links and antimicrobial resistance profiles. We conducted a systematic review of clinical application of WGS to any human pathogen that may be transposable to gonorrhoea. METHODS: We searched six databases for articles published between 01/01/2010-06/02/2023 that reported on real/near real-time human pathogen WGS to inform clinical intervention. All article types from all settings were included. Findings were analysed using narrative synthesis. RESULTS: We identified 12,179 articles, of which eight reported applications to inform tuberculosis (n = 7) and gonorrhoea (n = 1) clinical patient management. WGS data were successfully used as an adjunct to clinical and epidemiological data to enhance contact-tracing (n = 2), inform antimicrobial therapy (n = 5) and identify cross-contamination (n = 1). WGS identified gonorrhoea transmission chains that were not established via partner notification. Future applications could include insights into pathogen exposure detected within sexual networks for targeted patient management. CONCLUSIONS: While there was some evidence of WGS use to provide individualised tuberculosis and gonorrhoea treatment, the eight identified studies contained few participants. Future research should focus on testing WGS intervention effectiveness and examining ethical considerations of STI WGS use.


Asunto(s)
Gonorrea , Secuenciación Completa del Genoma , Humanos , Gonorrea/tratamiento farmacológico , Gonorrea/microbiología , Gonorrea/epidemiología , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/efectos de los fármacos , Trazado de Contacto , Tuberculosis/tratamiento farmacológico , Tuberculosis/microbiología , Tuberculosis/epidemiología , Genoma Bacteriano , Atención al Paciente
16.
JAMA ; 331(20): 1701-1702, 2024 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-38683579

RESUMEN

This Viewpoint discusses the US Food and Drug Administration's authorization of marketing an at-home testing system for chlamydia and gonorrhea as a good first step in boosting access to screening and treatment and in reducing infection rates.


Asunto(s)
Infecciones por Chlamydia , Gonorrea , Humanos , Gonorrea/diagnóstico , Infecciones por Chlamydia/diagnóstico , Neisseria gonorrhoeae/aislamiento & purificación , Chlamydia trachomatis/aislamiento & purificación , Femenino , Masculino , Autoevaluación
17.
Artículo en Inglés | MEDLINE | ID: mdl-38597520

RESUMEN

The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.


Asunto(s)
Gonorrea , Infecciones por VIH , Mpox , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Adulto , Humanos , Masculino , Brasil/epidemiología , Estudios Transversales , Demografía , Brotes de Enfermedades , Gonorrea/diagnóstico , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Homosexualidad Masculina , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología
18.
Sex Health ; 212024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38603545

RESUMEN

Background The incidence of sexual assault continues to rise in Australia. This study aimed to describe the nature of assault, HIV/STI positivity, and its management at a sexual health clinic. Methods We performed a chart review of 516 sexual assault cases presenting to Melbourne Sexual Health Centre between 2012 and 2021, collecting data on victim demographics, details of assault, HIV/STI testing and positivity, police involvement, and offer of counselling. Results We included 516 cases: 124 males (24.0%); 384 females (74.4%); and eight transgender (1.6%) victims. The proportion of assault cases presenting to Melbourne Sexual Health Centre increased from 0.1% (37/37,070) in 2012 to 0.2% (56/36,514) in 2021 (P trend =0.006). HIV post-exposure prophylaxis was prescribed for 64.5% (80/124) of males and 12.5% (48/384) of females. Among victims, 69.4% (358/516) were tested for HIV and no one tested positive, while 71.9% (371/516) were tested for syphilis, with 1.6% (6/371) positive. Gonorrhoea and chlamydia were tested at the oropharynx (44.8% [231/516] vs 28.7% [148/516]), genitals (83.7% [432/516] vs 92.4% [477/516]) and anorectum (35.3% [182/516] vs 35.3% [182/516]). Positivity for gonorrhoea and chlamydia were: 2.6% (6/231) vs 2.0% (3/148) at oropharynx, 1.4% (6/432) vs 2.9% (14/477) at genitals, and 5.5% (10/182) vs 7.1% (13/182) at anorectum. According to clinical records, 25.2% (130/516) of victims sought police involvement, and 71.7% (370/516) were offered counselling. Conclusions Sexual assault was an uncommon presentation at Melbourne Sexual Health Centre, with diverse circumstances surrounding assault; however, clinical documentation varied, indicating a need for a standard primary care protocol for clients presenting with acute sexual assault.


Asunto(s)
Chlamydia , Gonorrea , Infecciones por VIH , Delitos Sexuales , Salud Sexual , Enfermedades de Transmisión Sexual , Masculino , Femenino , Humanos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Estudios Retrospectivos , Australia/epidemiología , Auditoría Clínica
19.
Artículo en Inglés | MEDLINE | ID: mdl-38594799

RESUMEN

Abstract: The Australian National Neisseria Network (NNN) comprises reference laboratories in each state and territory that report data on antimicrobial susceptibility testing to an agreed group of antimicrobial agents for the Australian Gonococcal Surveillance Programme (AGSP). The AGSP data are presented quarterly in tabulated form, as well as in the AGSP annual report. This report presents national gonococcal antimicrobial resistance surveillance data from 1 January to 31 March 2023.


Asunto(s)
Antiinfecciosos , Gonorrea , Humanos , Australia/epidemiología , Neisseria gonorrhoeae , Gonorrea/epidemiología
20.
Artículo en Inglés | MEDLINE | ID: mdl-38594800

RESUMEN

Abstract: The Australian National Neisseria Network (NNN) comprises reference laboratories in each state and territory that report data on antimicrobial susceptibility testing to an agreed group of antimicrobial agents for the Australian Gonococcal Surveillance Programme (AGSP). The AGSP data are presented quarterly in tabulated form, as well as in the AGSP annual report. This report presents national gonococcal antimicrobial resistance surveillance data from 1 April to 30 June 2023.


Asunto(s)
Antiinfecciosos , Gonorrea , Humanos , Australia/epidemiología , Neisseria gonorrhoeae , Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología
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