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1.
Ann Epidemiol ; 47: 13-18, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32713502

RESUMEN

PURPOSE: Adolescents aged 13-18 years bear a large burden of sexually transmitted infections (STIs) and changing adolescent sexual risk behavior is a key component of reducing this burden. We demonstrate a novel publicly available modeling tool (teen-SPARC) to help state and local health departments predict the impact of behavioral change on gonorrhea, chlamydia, and HIV burden among adolescents. METHODS: Teen-SPARC is built in Excel for familiarity and ease and parameterized using data from CDC's Youth Risk Behavior Surveillance System. We present teen-SPARC's methods, including derivation of national parameters and instructions to obtain local parameters. We model multiple scenarios of increasing condom use and estimate the impact on gonorrhea, chlamydia, and HIV incidence, comparing national and New York State (NYS) results. RESULTS: A 1% annual increase in condom use (consistent with Healthy People 2020 goals) could prevent nearly 10,000 cases of STIs nationwide. Increases in condom use of 17.1%, 2.2%, and 25.5% in NYS would be necessary to avert 1000 cases of gonorrhea, 1000 cases of chlamydia, and 10 cases of HIV infection, respectively. Additional results disaggregate outcomes by age, sex, partner sex, jurisdiction, and pathogen. CONCLUSION: Teen-SPARC may be able to assist health departments aiming to tailor behavioral interventions for STI prevention among adolescents.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Conducta de Reducción del Riesgo , Sexo Seguro , Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Infecciones por Chlamydia/prevención & control , Condones , Femenino , Gonorrea/prevención & control , Infecciones por VIH/prevención & control , Humanos , Masculino , Modelos Teóricos , New York/epidemiología , Asunción de Riesgos , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos/epidemiología
2.
Rev Chilena Infectol ; 37(1): 32-36, 2020 Feb.
Artículo en Español | MEDLINE | ID: mdl-32730397

RESUMEN

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


Asunto(s)
Gonorrea , Prisioneros , Enfermedades de Transmisión Sexual , Chile/epidemiología , Gonorrea/epidemiología , Gonorrea/prevención & control , Humanos , Neisseria gonorrhoeae/aislamiento & purificación , Prevalencia , Prisioneros/estadística & datos numéricos , Factores de Riesgo , Trabajadores Sexuales/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control
3.
Sex Transm Infect ; 96(5): 342-347, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32241905

RESUMEN

OBJECTIVES: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration. METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers. RESULTS: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care. CONCLUSION: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Pruebas en el Punto de Atención/organización & administración , Enfermedades de Transmisión Sexual/diagnóstico , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/prevención & control , Infecciones por Chlamydia/transmisión , Femenino , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/prevención & control , Gonorrea/transmisión , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Ciencia de la Implementación , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/prevención & control , Infecciones por Mycoplasma/transmisión , Mycoplasma genitalium , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/transmisión , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/transmisión , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/prevención & control , Sífilis/transmisión , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginitis por Trichomonas/prevención & control , Vaginitis por Trichomonas/transmisión
5.
Obstet Gynecol ; 135(4): 799-807, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32168225

RESUMEN

OBJECTIVE: To describe factors associated with not being tested for Chlamydia trachomatis and Neisseria gonorrhea infection during pregnancy and for testing positive and to describe patterns of treatment and tests of reinfection. METHODS: We conducted a retrospective cohort study of women who delivered at an urban teaching hospital from July 1, 2016 to June 30, 2018. Women with at least one prenatal care or triage visit were included. The index delivery was included for women with multiple deliveries. We used logistic regression to analyze factors associated with not being tested and for testing positive for these infections in pregnancy. Cox proportional hazards models were used to examine factors associated with time to treatment and tests of reinfection. We reviewed medical records to determine reasons for delays in treatment longer than 1 week. RESULTS: Among 3,265 eligible deliveries, 3,177 (97%) women were tested during pregnancy. Of these, 370 (12%) tested positive (287 chlamydia, 35 gonorrhea, 48 both), and 15% had repeat infections. Prenatal care adequacy and insurance status were risk factors for not being tested. Age, race and ethnicity, alcohol use, and sexually transmitted infection history were associated with testing positive. Time to treatment ranged from 0 to 221 days, with the majority (55%) of patients experiencing delays of more than 1 week. Common reasons for delays included lack of clinician recognition and follow-up of abnormal results (65%) and difficulty contacting the patient (33%). CONCLUSION: Traditional risk factors are associated with increased risk of infection during pregnancy. Prenatal care adequacy and insurance status were associated with the likelihood of being tested. Delays in treatment and tests of reinfection were common. Point-of-care testing and expedited partner therapy should be explored as ways to improve the management of these infections in pregnancy.


Asunto(s)
Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis , Gonorrea/prevención & control , Neisseria gonorrhoeae , Complicaciones Infecciosas del Embarazo/prevención & control , Diagnóstico Prenatal , Adulto , Estudios de Cohortes , Femenino , Georgia/epidemiología , Hospitales de Enseñanza , Humanos , Tamizaje Masivo , Registros Médicos , Área sin Atención Médica , Embarazo , Resultado del Embarazo , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Población Urbana , Adulto Joven
6.
Int J STD AIDS ; 31(3): 221-229, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31996095
7.
Sex Transm Infect ; 96(5): 358-360, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-31628249

RESUMEN

OBJECTIVES: Oropharyngeal gonorrhoea is increasing among men who have sex with men and is commonly found in the tonsils and at the posterior pharyngeal wall. To address this rise, investigators are currently trialling mouthwash to prevent oropharyngeal gonorrhoea. We aimed to determine which parts of the oropharynx were reached by different methods of mouthwash use (oral rinse, oral gargle and oral spray). METHODS: Twenty staff at Melbourne Sexual Health Centre participated in the study from March to May 2018. Participants were asked to use mouthwash mixed with food dye, by three application methods on three separate days: oral rinse (15 s and 60 s), oral gargle (15 s and 60 s) and oral spray (10 and 20 times). Photographs were taken after using each method. Three authors assessed the photographs of seven anatomical areas (tongue base, soft palate, uvula, anterior tonsillar pillar, posterior tonsillar pillar, tonsil, posterior pharyngeal wall) independently and scored the dye coverage from 0% to 100%. Scores were then averaged. RESULTS: The mean coverage at the sites ranged from 2 to 100. At the posterior pharyngeal wall, spraying 10 times had the highest mean coverage (29%) and was higher than a 15 s rinse (2%, p=0.001) or a 15 s gargle (8%, p=0.016). At the tonsils, there was no difference in mean coverage between spray and gargle at any dosage, but spraying 20 times had a higher mean coverage than a 15 s rinse (42% vs 12%, p=0.012). CONCLUSION: Overall, spray is more effective at reaching the tonsils and posterior pharyngeal wall compared with rinse and gargle. If mouthwash is effective in preventing oropharyngeal gonorrhoea, application methods that have greater coverage may be more efficacious.


Asunto(s)
Gonorrea/prevención & control , Antisépticos Bucales , Vaporizadores Orales , Orofaringe , Enfermedades Faríngeas/prevención & control , Irrigación Terapéutica/métodos , Femenino , Colorantes de Alimentos , Humanos , Masculino , Paladar Blando , Tonsila Palatina , Lengua , Úvula
8.
Sex Transm Dis ; 47(1): 19-23, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31688719

RESUMEN

BACKGROUND: Gay, bisexual, transgender, and homeless youth are at risk of sexually transmitted infections. As part of an adolescent human immunodeficiency virus prevention study, we provided same-day Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing and treatment. We aimed to evaluate the feasibility and effectiveness of same-day CT and NG treatment on the proportion of participants receiving timely treatment. METHODS: We recruited adolescents with high sexual risk behaviors aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, and community health centers in Los Angeles, California, and New Orleans, Louisiana from May 2017 to June 2019. Initially, participants were offered point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and referral to another clinic for treatment. After March 2018 in Los Angeles and November 2018 in New Orleans, we provided same-day treatment (and partner treatment packs) for study participants. We measured the proportion of participants who received same-day treatment and the median time to treatment. We collected frequency of partner treatment and any reported adverse treatment-related events. RESULTS: The proportion of participants receiving same-day CT and NG treatment increased from 3.6% (5/140) to 21.1% (20/95; Δ17.5%; 95% confidence interval, 9.2%-26.9%) after implementation of same-day testing and treatment. The median time to treatment decreased from 18.5 to 3 days. Overall, 36 participants took a total of 48 partner treatment packs. There were no reported treatment-related adverse events. CONCLUSIONS: Providing sexually transmitted infection treatment to adolescents at the same visit as testing is feasible and safe, and can increase the proportion of individuals receiving timely treatment.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Prestación de Atención de Salud , Gonorrea/diagnóstico , Tamizaje Masivo , Pruebas en el Punto de Atención , Enfermedades de Transmisión Sexual/prevención & control , Adolescente , Instituciones de Atención Ambulatoria , Niño , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis , Femenino , Gonorrea/tratamiento farmacológico , Gonorrea/prevención & control , Jóvenes sin Hogar/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Los Angeles , Masculino , Neisseria gonorrhoeae , Nueva Orleans , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/microbiología , Factores de Tiempo , Personas Transgénero/estadística & datos numéricos , Adulto Joven
9.
Sex Transm Dis ; 47(1): 24-27, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31856072

RESUMEN

INTRODUCTION: Neisseria gonorrhoeae has developed resistance to all classes of antimicrobials used against it. Current strategies to prevent the emergence of pan-resistance include increased gonorrhea screening in high-prevalence populations such as men who have sex with men taking HIV preexposure prophylaxis. By increasing antimicrobial exposure, others have argued that intensive screening may inadvertently promote the emergence of antimicrobial resistance. AIM/METHODOLOGY: To contribute to this discussion, we conducted a historical review of the effect of a mass gonorrhea treatment campaign in Greenland from 1965 to 1968 on the incidence of gonorrhea and antimicrobial resistance. We conducted a literature review using PubMed and Google Scholar to find relevant studies. Data on the incidence of gonorrhea, antimicrobial susceptibility, and antimicrobials dispensed were extracted and analyzed. RESULTS: Eight articles were found with relevant information. The cornerstone of the campaign involved the repeated treatment for all persons with a diagnosis of gonorrhea in the past 6 months as well as all remaining unmarried persons between 15 and 30 years of age. There was a small and temporary decline in the incidence of gonorrhea during the campaign. The campaign was, however, associated with an increase in the proportion of gonococci that were not susceptible to penicillin. Gonococcal incidence continued to climb after the campaign ended but did decline dramatically after reductions in risk behavior after the global AIDS epidemic. DISCUSSIONS: The mass gonorrhea treatment campaign in Greenland was associated with only a temporary decline in the incidence of gonorrhea. It was, however, followed by an increase in penicillin nonsusceptibility. Intense gonorrhea screening and treatment strategies should be aware of the risk of inducing antimicrobial resistance.


Asunto(s)
Infecciones por Chlamydia/prevención & control , Chlamydia/efectos de los fármacos , Programas de Detección Diagnóstica , Farmacorresistencia Bacteriana , Gonorrea/prevención & control , Neisseria gonorrhoeae/efectos de los fármacos , Profilaxis Pre-Exposición , Adolescente , Adulto , Antibacterianos/administración & dosificación , Infecciones por Chlamydia/epidemiología , Estudios de Cohortes , Femenino , Gonorrea/epidemiología , Groenlandia/epidemiología , Humanos , Masculino , Administración Masiva de Medicamentos , Pruebas de Sensibilidad Microbiana , Adulto Joven
10.
Sex Transm Infect ; 96(5): 361-367, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-31801895

RESUMEN

OBJECTIVES: To investigate the impact and efficiency of combined testing for HIV and other STIs on HIV and STI transmission among men who have sex with men (MSM) and to assess what subgroups of MSM should be targeted for frequent testing. METHODS: We developed an agent-based transmission model that simulates infection with HIV or Neisseria gonorrhoeae (NG) among MSM. We examined scenarios with increased percentages of MSM getting tested six monthly, among all MSM or only specific subgroups of MSM (defined according to recent gonorrhoea, number of partners and engagement in condomless anal intercourse (CAI)) and scenarios with reduced intervals between HIV/STI tests. RESULTS: The most efficient strategies were those with increased percentage of MSM getting tested every 6 months among MSM with a recent gonorrhoea diagnosis; or among MSM who had CAI and ≥10 partners; or MSM who had ≥10 partners. Over 10 years, these strategies resulted in 387-718 averted HIV infections and required 29-164 additional HIV tests per averted HIV infection or one to seven additional gonorrhoea tests per averted NG infection. The most effective strategy in reducing HIV transmission was the one where the intervals between tests were reduced by half, followed by the strategy with increased percentage of MSM getting tested every 6 months among all MSM. Over 10 years, these strategies resulted in 1362 and 1319 averted HIV infections, but required 663 and 584 additional HIV tests per averted HIV infection, respectively. CONCLUSIONS: Targeting MSM with recent gonorrhoea diagnosis or MSM with many partners is efficient in terms of HIV/STI tests needed to prevent new HIV or NG infections. Major reductions in HIV incidence can be achieved with consistent HIV/STI testing every 6 months among larger groups, including low-risk MSM. To impede HIV transmission, frequent testing should be combined with other prevention measures.


Asunto(s)
Gonorrea/diagnóstico , Infecciones por VIH/diagnóstico , Tamizaje Masivo/métodos , Minorías Sexuales y de Género , Adolescente , Adulto , Condones , Gonorrea/prevención & control , Gonorrea/transmisión , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Conducta Sexual , Adulto Joven
12.
Front Immunol ; 10: 2417, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31681305

RESUMEN

The concept of immunizing against gonorrhea has received renewed interest because of the recent emergence of strains of Neisseria gonorrhoeae that are resistant to most currently available antibiotics, an occurrence that threatens to render gonorrhea untreatable. However, despite efforts over many decades, no vaccine has yet been successfully developed for human use, leading to pessimism over whether this goal was actually attainable. Several factors have contributed to this situation, including extensive variation of the expression and specificity of many of the gonococcal surface antigens, and the ability of N. gonorrhoeae to resist destruction by complement and other innate immune defense mechanisms. The natural host restriction of N. gonorrhoeae for humans, coupled with the absence of any definable state of immunity arising from an episode of gonorrhea, have also complicated efforts to study gonococcal pathogenesis and the host's immune responses. However, recent findings have elucidated how the gonococcus exploits and manipulates the host's immune system for its own benefit, utilizing human-specific receptors for attachment to and invasion of tissues, and subverting adaptive immune responses that might otherwise be capable of eliminating it. While no single experimental model is capable of providing all the answers, experiments utilizing human cells and tissues in vitro, various in vivo animal models, including genetically modified strains of mice, and both experimental and observational human clinical studies, have combined to yield important new insight into the immuno-pathogenesis of gonococcal infection. In turn, these have now led to novel approaches for the development of a gonococcal vaccine. Ongoing investigations utilizing all available tools are now poised to make the development of an effective human vaccine against gonorrhea an achievable goal within a foreseeable time-frame.


Asunto(s)
Vacunas Bacterianas/inmunología , Gonorrea/inmunología , Gonorrea/prevención & control , Neisseria gonorrhoeae/inmunología , Inmunidad Adaptativa , Animales , Variación Antigénica , Antígenos Bacterianos/genética , Antígenos Bacterianos/inmunología , Modelos Animales de Enfermedad , Gonorrea/microbiología , Interacciones Huésped-Patógeno/inmunología , Humanos , Inmunidad Innata , Inmunización , Neisseria gonorrhoeae/genética , Investigación , Vacunación
13.
Sex Health ; 16(5): 426-432, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31476278

RESUMEN

Efforts to develop vaccines against Neisseria gonorrhoeae have become increasingly important, given the rising threat of gonococcal antimicrobial resistance (AMR). Recent data suggest vaccines for gonorrhoea are biologically feasible; in particular, epidemiological evidence shows that vaccines against a closely related pathogen, serogroup B Neisseria meningitidis outer membrane vesicle (OMV) vaccines, may reduce gonorrhoea incidence. Vaccine candidates using several approaches are currently in preclinical development, including meningococcal and gonococcal OMV vaccines, a lipooligosaccharide epitope and purified protein subunit vaccines. The Global STI Vaccine Roadmap provides action steps to build on this technical momentum and advance gonococcal vaccine development. Better quantifying the magnitude of gonorrhoea-associated disease burden, for outcomes like infertility, and modelling the predicted role of gonococcal vaccines in addressing AMR will be essential for building a full public health value proposition, which can justify investment and help with decision making about future vaccine policy and programs. Efforts are underway to gain consensus on gonorrhoea vaccine target populations, implementation strategies and other preferred product characteristics that would make these vaccines suitable for use in low- and middle-income, as well as high-income, contexts. Addressing these epidemiological, programmatic and policy considerations in parallel to advancing research and development, including direct assessment of the ability of meningococcal B OMV vaccines to prevent gonorrhoea, can help bring about the development of viable gonococcal vaccines.


Asunto(s)
Vacunas Bacterianas/uso terapéutico , Gonorrea/prevención & control , Neisseria gonorrhoeae/inmunología , Vacunas Bacterianas/inmunología , Investigación Biomédica , Gonorrea/inmunología , Humanos
14.
mBio ; 10(5)2019 09 10.
Artículo en Inglés | MEDLINE | ID: mdl-31506309

RESUMEN

The human pathogens Neisseria gonorrhoeae and Neisseria meningitidis share high genome identity. Retrospective analysis of surveillance data from New Zealand indicates the potential cross-protective effect of outer membrane vesicle (OMV) meningococcal serogroup B vaccine (MeNZB) against N. gonorrhoeae A licensed OMV-based MenB vaccine, MenB-4C, consists of a recombinant FHbp, NhbA, NadA, and the MeNZB OMV. Previous work has identified several abundantly expressed outer membrane proteins (OMPs) as major components of the MenB-4C OMV with high sequence similarity between N. gonorrhoeae and N. meningitidis, suggesting a mechanism for cross-protection. To build off these findings, we performed comparative genomic analysis on 970 recent N. gonorrhoeae isolates collected through a U.S surveillance system against N. meningitidis serogroup B (NmB) reference sequences. We identified 1,525 proteins that were common to both Neisseria species, of which 57 proteins were predicted to be OMPs using in silico methods. Among the MenB-4C antigens, NhbA showed moderate sequence identity (73%) to the respective gonococcal homolog, was highly conserved within N. gonorrhoeae, and was predicted to be surface expressed. In contrast, the gonococcal FHbp was predicted not to be surface expressed, while NadA was absent in all N. gonorrhoeae isolates. Our work confirmed recent observations (E. A. Semchenko, A. Tan, R. Borrow, and K. L. Seib, Clin Infect Dis, 2018, https://doi.org/10.1093/cid/ciy1061) and describes homologous OMPs from a large panel of epidemiologically relevant N. gonorrhoeae strains in the United States against NmB reference strains. Based on our results, we report a set of OMPs that may contribute to the previously observed cross-protection and provide potential antigen targets to guide the next steps in gonorrhea vaccine development.IMPORTANCE Gonorrhea, a sexually transmitted disease, causes substantial global morbidity and economic burden. New prevention and control measures for this disease are urgently needed, as strains resistant to almost all classes of antibiotics available for treatment have emerged. Previous reports demonstrate that cross-protection from gonococcal infections may be conferred by meningococcal serogroup B (MenB) outer membrane vesicle (OMV)-based vaccines. Among 1,525 common proteins shared across the genomes of both N. gonorrhoeae and N. meningitidis, 57 proteins were predicted to be surface expressed (outer membrane proteins [OMPs]) and thus preferred targets for vaccine development. The majority of these OMPs showed high sequence identity between the 2 bacterial species. Our results provide valuable insight into the meningococcal antigens present in the current OMV-containing MenB-4C vaccine that may contribute to cross-protection against gonorrhea and may inform next steps in gonorrhea vaccine development.


Asunto(s)
Proteínas de la Membrana Bacteriana Externa/genética , Proteínas de la Membrana/genética , Vacunas Meningococicas/genética , Neisseria gonorrhoeae/genética , Neisseria meningitidis Serogrupo B/genética , Neisseria meningitidis/genética , Adhesinas Bacterianas/genética , Secuencia de Aminoácidos , Proteínas de la Membrana Bacteriana Externa/clasificación , Proteínas de la Membrana Bacteriana Externa/inmunología , Vacunas Bacterianas , Secuencia de Bases , Protección Cruzada/inmunología , Gonorrea/prevención & control , Humanos , Proteínas de la Membrana/inmunología , Infecciones Meningocócicas/inmunología , Infecciones Meningocócicas/microbiología , Vacunas Meningococicas/clasificación , Vacunas Meningococicas/inmunología , Nueva Zelanda , Filogenia , Porinas , Análisis de Secuencia , Homología de Secuencia de Ácido Nucleico
15.
Sex Transm Dis ; 46(9): 608-616, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31415335

RESUMEN

BACKGROUND: The US Preventive Services Task Force recommends annual chlamydia and gonorrhea screening for sexually active women <25 and ≥25 years old with associated risk factors. We sought to determine self-reported chlamydia and gonorrhea testing and diagnosis rates in the past 12 months in a community-based sample of heterosexual women at high risk of HIV infection. METHODS: We used National HIV Behavioral Surveillance data from 2013 when surveillance was conducted in heterosexual adults with low social economic status. Our analysis was restricted to 18- to 44-year-old women who answered questions regarding chlamydia/gonorrhea testing and diagnosis in the previous 12 months. We calculated the percentage reporting testing and diagnosis. Poisson regressions with generalized estimating equations clustered on recruitment chain were used to assess factors associated with testing and diagnosis. RESULTS: Among 18- to 24-year-old women (n = 1017), 61.0% self-reported chlamydia testing and 57.6% gonorrhea testing in the past 12 months. Among 25- to 44-year-old women (n = 2322), 49.0% and 47.0% reported chlamydia and gonorrhea testing, respectively. Among the subset of 25- to 44-year-old women who met screening criteria, 51.2% reported chlamydia testing. Having seen a medical provider and HIV testing (past 12 months) were associated with chlamydia/gonorrhea testing in both age groups. Self-reported chlamydia (18-24 years, 21.4%; 25-44 years, 12.2%) and gonorrhea diagnoses (18-24 years, 8.4%; 25-44 years, 6.6%) were common. CONCLUSIONS: A substantial number of eligible women may not have been screened for chlamydia/gonorrhea. Renewed efforts to facilitate screening may prevent sequelae and support disease control activities.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Gonorrea/diagnóstico , Infecciones por VIH/epidemiología , Conductas de Riesgo para la Salud , Heterosexualidad , Autoinforme/estadística & datos numéricos , Adolescente , Adulto , Infecciones por Chlamydia/prevención & control , Femenino , Gonorrea/prevención & control , Humanos , Prevalencia , Vigilancia en Salud Pública , Factores de Riesgo , Parejas Sexuales , Encuestas y Cuestionarios , Adulto Joven
16.
Biosci Trends ; 13(3): 273-275, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31327795

RESUMEN

Acquired immune deficiency syndrome (AIDS), hepatitis B virus (HBV), hepatitis C virus (HCV), gonorrhea and syphilis are the major sexually transmitted diseases (STDs) in the world, which are the focus of epidemic prevention and control in China. The epidemiological trend analysis of STDs in Shanghai could reflect the epidemic situation of these diseases in high-income areas of China, providing a reference for how to control their epidemic. Although the overall incidence rate of infectious diseases levelled off after 2009, Shanghai still faces many new obstacles in the fight against STDs. Without effective prevention and control strategies for high-risk behaviors, such as active sexual activity without protection, for key susceptible populations, there may be a more serious epidemic of STDs in the future. Given these situations, strategies for controlling STDs in Shanghai should be more targeted with the development of epidemics, focusing on the following key areas for future work: i) attaching importance to health education; ii) strengthening epidemic surveillance; and iii) developing Community Health Service Centers (CHSC) as intervention subjects.


Asunto(s)
Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , China/epidemiología , Femenino , Gonorrea/epidemiología , Gonorrea/prevención & control , Hepacivirus/patogenicidad , Virus de la Hepatitis B/patogenicidad , Hepatitis C/epidemiología , Hepatitis C/prevención & control , Humanos , Masculino , Sífilis/epidemiología , Sífilis/prevención & control
17.
Sex Health ; 16(5): 433-441, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31099331

RESUMEN

The gonorrhoea rate among gay and bisexual men who have sex with men (MSM) has been increasing rapidly in many Western countries. Furthermore, gonorrhoea is becoming increasingly resistant to antibiotics and only limited options remain for treatment. Recent evidence suggests that the oropharynx may play an important role in gonorrhoea transmission. It is hypothesised that reducing the prevalence of oropharyngeal gonorrhoea will also reduce the population incidence of gonorrhoea. Mouthwash has been proposed as a novel non-antibiotic intervention to prevent oropharyngeal gonorrhoea; hence, reducing the probability of antibiotic resistance developing. However, its efficacy is yet to be confirmed by a randomised controlled trial - the findings of which will be available in 2019. If the trial shows mouthwash is effective in preventing gonorrhoea, this finding could potentially be translated into a public health campaign to increase the mouthwash use in the MSM population. This article summarises the current evidence of the effectiveness of mouthwash against gonorrhoea and discusses the potential literature gaps before implementing the mouthwash intervention at a population level.


Asunto(s)
Gonorrea/prevención & control , Promoción de la Salud , Antisépticos Bucales/uso terapéutico , Neisseria gonorrhoeae/efectos de los fármacos , Investigación Biomédica , Promoción de la Salud/métodos , Humanos , Orofaringe/microbiología
19.
Sex Transm Infect ; 95(5): 336-341, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31010954

RESUMEN

OBJECTIVE: While men who have sex with men (MSM) are disproportionately affected by Peru's overlapping HIV and STI epidemics, there are few data on how partnership-level and network-level factors affect STI transmission in Peru. We explored partnership-level and network-level factors associated with gonorrhoea/chlamydia (Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT)) and/or syphilis infection among MSM in Peru. METHODS: We present the results of a cross-sectional secondary analysis of MSM (n=898) tested for syphilis and NG/CT infection as part of the screening process for two STI control trials in Lima, Peru. Participants completed questionnaires on demographics, sexual identity and role, characteristics of their three most recent sexual partners (partner sexual orientation, gender, role, partnership type, partner-specific sexual acts) and 30-day sexual network characteristics (number of sexual partners, partnership types, frequency of anal/vaginal intercourse). Participants were tested for syphilis and urethral, rectal and oropharyngeal NG/CT. Differences in network characteristics were analysed with χ2 and Kruskal-Wallis tests. RESULTS: Approximately 38.9% of participants had a new STI diagnosis (syphilis (rapid plasma reagin ≥16): 10.6%; NG/CT: 22.9%; syphilis-NG/CT coinfection: 5.4%). Condomless anal intercourse (CAI) was not significantly associated with an STI diagnosis. Gay-identified participants with exclusively homosexual networks had a higher prevalence of STIs (47.4%) than gay-identified MSM with only heterosexual/bisexual partners (34.6%, p=0.04), despite reporting fewer sexual partners (any partners: 2, 1-4 vs 3, 2-6; p=0.001; casual partners: 1, 0-3 vs 2, 1-4; p=0.001) and more stable partnerships (1, 0-1 vs 0, 0-1; p=0.003) in the last month. CONCLUSIONS: Network size and the number of casual sexual partners were associated with NG/CT infection among MSM in Peru. Despite reporting fewer sexual risk behaviours (smaller network size, more stable partnerships, less CAI), MSM with homosexual-only sexual networks had a higher prevalence of NG/CT and syphilis. These findings suggest network composition among MSM in Peru plays an important role in the risk for STI acquisition.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Minorías Sexuales y de Género/estadística & datos numéricos , Sífilis/epidemiología , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/prevención & control , Infecciones por Chlamydia/psicología , Estudios Transversales , Femenino , Gonorrea/diagnóstico , Gonorrea/prevención & control , Gonorrea/psicología , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Trabajadores Sexuales/estadística & datos numéricos , Conducta Sexual , Parejas Sexuales , Sífilis/diagnóstico , Sífilis/prevención & control , Sífilis/psicología , Adulto Joven
20.
Front Immunol ; 10: 321, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30873172

RESUMEN

The increasing incidence of gonorrhea worldwide and the global spread of multidrug-resistant strains of Neisseria gonorrhoeae, constitute a public health emergency. With dwindling antibiotic treatment options, there is an urgent need to develop safe and effective vaccines. Gonococcal lipooligosaccharides (LOSs) are potential vaccine candidates because they are densely represented on the bacterial surface and are readily accessible as targets of adaptive immunity. Less well-understood is whether LOSs evoke protective immune responses. Although gonococcal LOS-derived oligosaccharides (OSs) are major immune targets, often they undergo phase variation, a feature that seemingly makes LOS less desirable as a vaccine candidate. However, the identification of a gonococcal LOS-derived OS epitope, called 2C7, that is: (i) a broadly expressed gonococcal antigenic target in human infection; (ii) a virulence determinant, that is maintained by the gonococcus and (iii) a critical requirement for gonococcal colonization in the experimental setting, circumvents its limitation as a potential vaccine candidate imposed by phase variation. Difficulties in purifying structurally intact OSs from LOSs led to "conversion" of the 2C7 epitope into a peptide mimic that elicited cross-reactive IgG anti-OS antibodies that also possess complement-dependent bactericidal activity against gonococci. Mice immunized with the 2C7 peptide mimic clear vaginal colonization more rapidly and reduce gonococcal burdens. 2C7 vaccine satisfies criteria that are desirable in a gonococcal vaccine candidate: broad representation of the antigenic target, service as a virulence determinant that is also critical for organism survival in vivo and elicitation of broadly cross-reactive IgG bactericidal antibodies when used as an immunogen.


Asunto(s)
Vacunas Bacterianas , Lipopolisacáridos/inmunología , Neisseria gonorrhoeae/inmunología , Animales , Proteínas del Sistema Complemento/inmunología , Epítopos/inmunología , Gonorrea/prevención & control , Humanos , Lipopolisacáridos/química , Péptidos/inmunología
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