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1.
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 METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers.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
2.
PLoS Med ; 17(4): e1003077, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32243443

RESUMEN

BACKGROUND: The rise of gonococcal antimicrobial resistance highlights the need for strategies that extend the clinically useful life span of antibiotics. Because there is limited evidence to support the current practice of switching empiric first-line antibiotic when resistance exceeds 5% in the population, our objective was to compare the impact of alternative strategies on the effective life spans of antibiotics and the overall burden of gonorrhea. METHODS AND FINDINGS: We developed and calibrated a mathematical model of gonorrhea transmission among men who have sex with men (MSM) in the United States. We calibrated the model to the estimated prevalence of gonorrhea, the rate of gonorrhea cases, and the proportion of cases presenting symptoms among MSM in the US. We used this model to project the effective life span of antibiotics and the number of gonorrhea cases expected under current and alternative surveillance strategies over a 50-year simulation period. We demonstrate that compared to the current practice, a strategy that uses quarterly (as opposed to yearly) surveillance estimates and incorporates both the estimated prevalence of resistance and the trend in the prevalence of resistance to determine treatment guidelines could extend the effective life span of antibiotics by 0.83 years. This is equivalent to successfully treating an additional 80.1 (95% uncertainty interval: [47.7, 111.9]) gonorrhea cases per 100,000 MSM population each year with the first-line antibiotics without worsening the burden of gonorrhea. If the annual number of isolates tested for drug susceptibility is doubled, this strategy could increase the effective life span of antibiotics by 0.94 years, which is equivalent to successfully treating an additional 91.1 (54.3, 127.3) gonorrhea cases per 100,000 MSM population each year without increasing the incidence of gonorrhea. Study limitations include that our conclusions might not be generalizable to other settings because our model describes the transmission of gonorrhea among the US MSM population, and, to better capture uncertainty in the characteristics of current and future antibiotics, we chose to model hypothetical drugs with characteristics similar to the antibiotics commonly used in gonorrhea treatment. CONCLUSIONS: Our results suggest that use of data from surveillance programs could be expanded to prolong the clinical effectiveness of antibiotics without increasing the burden of the disease. This highlights the importance of maintaining effective surveillance systems and the engagement of policy makers to turn surveillance findings into timely and effective decisions.


Asunto(s)
Antibacterianos/administración & dosificación , Gonorrea/tratamiento farmacológico , Homosexualidad Masculina , Longevidad/efectos de los fármacos , Modelos Teóricos , Guías de Práctica Clínica como Asunto/normas , Gonorrea/epidemiología , Gonorrea/transmisión , Humanos , Longevidad/fisiología , Masculino , Resultado del Tratamiento , Estados Unidos/epidemiología
3.
Lancet Infect Dis ; 20(4): 478-486, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31978353

RESUMEN

BACKGROUND: Characterising sexual networks with transmission of sexually transmitted infections might allow identification of individuals at increased risk of infection. We aimed to investigate sexual mixing in Neisseria gonorrhoeae transmission networks between women, heterosexual men, and men who report sex with men (MSM), and between people with and without HIV. METHODS: In this cross-sectional observational study, we whole-genome sequenced N gonorrhoeae isolates from the archive of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP).w Isolates that varied by five single nucleotide polymorphisms or fewer were grouped into clusters that represented sexual networks with N gonorrhoeae transmission. Clusters were described by gender, sexual risk group, and HIV status. FINDINGS: We sequenced 1277 N gonorrhoeae isolates with linked clinical and sociodemographic data that were collected in five clinics in England during 2013-16 (July 1 to Sept 30 in 2013-15; July 1 to Sept 9 in 2016). The isolates grouped into 213 clusters. 30 (14%) clusters contained isolates from heterosexual men and MSM but no women and three (1%) clusters contained isolates from only women and MSM. 146 (69%) clusters comprised solely people with negative or unknown HIV status and seven (3%) comprised only HIV-positive people. 60 (28%) clusters comprised MSM with positive and negative or unknown HIV status. INTERPRETATION: N gonorrhoeae molecular data can provide information indicating risk of HIV or other sexually transmitted infections for some individuals for whom such risk might not be known from clinical history. These findings have implications for sexual health care, including offering testing, prevention advice, and preventive treatment, such as HIV pre-exposure prophylaxis. FUNDING: National Institute for Health Research Health Protection Research Unit; Wellcome; Public Health England.


Asunto(s)
Gonorrea/epidemiología , Gonorrea/transmisión , Infecciones por VIH , Neisseria gonorrhoeae , Filogenia , Secuenciación Completa del Genoma , Adulto , Estudios Transversales , Inglaterra/epidemiología , Femenino , Gonorrea/microbiología , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Heterosexualidad/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Neisseria gonorrhoeae/clasificación , Neisseria gonorrhoeae/genética , Parejas Sexuales , Adulto Joven
4.
Sex Transm Infect ; 96(2): 106-109, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31662418

RESUMEN

OBJECTIVE: We aimed to characterise gonorrhoea transmission patterns in a diverse urban population by linking genomic, epidemiological and antimicrobial susceptibility data. METHODS: Neisseria gonorrhoeae isolates from patients attending sexual health clinics at Barts Health NHS Trust, London, UK, during an 11-month period underwent whole-genome sequencing and antimicrobial susceptibility testing. We combined laboratory and patient data to investigate the transmission network structure. RESULTS: One hundred and fifty-eight isolates from 158 patients were available with associated descriptive data. One hundred and twenty-nine (82%) patients identified as male and 25 (16%) as female; four (3%) records lacked gender information. Self-described ethnicities were: 51 (32%) English/Welsh/Scottish; 33 (21%) white, other; 23 (15%) black British/black African/black, other; 12 (8%) Caribbean; 9 (6%) South Asian; 6 (4%) mixed ethnicity; and 10 (6%) other; data were missing for 14 (9%). Self-reported sexual orientations were 82 (52%) men who have sex with men (MSM); 49 (31%) heterosexual; 2 (1%) bisexual; data were missing for 25 individuals. Twenty-two (14%) patients were HIV positive. Whole-genome sequence data were generated for 151 isolates, which linked 75 (50%) patients to at least one other case. Using sequencing data, we found no evidence of transmission networks related to specific ethnic groups (p=0.64) or of HIV serosorting (p=0.35). Of 82 MSM/bisexual patients with sequencing data, 45 (55%) belonged to clusters of ≥2 cases, compared with 16/44 (36%) heterosexuals with sequencing data (p=0.06). CONCLUSION: We demonstrate links between 50% of patients in transmission networks using a relatively small sample in a large cosmopolitan city. We found no evidence of HIV serosorting. Our results do not support assortative selectivity as an explanation for differences in gonorrhoea incidence between ethnic groups.


Asunto(s)
Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Neisseria gonorrhoeae/genética , Parejas Sexuales , Grupo de Ascendencia Continental Africana , Antibacterianos/uso terapéutico , Grupo de Ascendencia Continental Asiática , Grupos Étnicos , Grupo de Ascendencia Continental Europea , Femenino , Gonorrea/etnología , Gonorrea/microbiología , Gonorrea/transmisión , Seroclasificación por VIH , Humanos , Londres/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Neisseria gonorrhoeae/fisiología , Estudios Retrospectivos , Medicina Estatal , Reino Unido/epidemiología , Población Urbana , Secuenciación Completa del Genoma
5.
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
6.
Sex Transm Infect ; 96(2): 101-105, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31511394

RESUMEN

OBJECTIVES: Expedited partner therapy (EPT) is an effective strategy to reduce rates of chlamydia and gonorrhoea infection and ensure sexual partners are treated. Currently, EPT is provided to heterosexual patients; however, EPT is not routinely recommended for use with gay, bisexual and other men who have sex with men (GBMSM) because of concerns about HIV coinfection. The objective of the qualitative study was to understand provider and community views on the use of EPT with GBMSM. METHODS: Using convenience sampling methods, we recruited a sample of 18 healthcare providers and 21 GBMSM to participate in in-depth, semistructured interviews. Interviews were conducted over the phone and included questions about knowledge, experiences and potential barriers and facilitators to the use of EPT with GBMSM. RESULTS: Most providers wanted to provide EPT to GBMSM and believed that the potential barriers and concerns to EPT use were not unique to a patient's sexual orientation. Several providers noted that they were currently providing EPT to GBMSM as part of HIV prevention services. Community members were generally unaware of EPT as a service and most indicated that they would only use EPT if they were in a committed relationship. Barriers included partner allergies and resistance, pharmacy protocols, structural concerns (eg, insurance coverage, pharmacists onsite and transportation) and potential disclosure issues. Facilitators included cultural humility and telemedicine with patients' partners to overcome these barriers. CONCLUSIONS: Acceptability of EPT use for both chlamydia and gonorrhoea was high among providers and community members. Barriers to EPT use, including concerns about patients' partners' allergies and resistance, disclosure concerns and linkage to HIV prevention services can be overcome through cultural humility trainings and telemedicine. Changing EPT recommendations at the national level to be inclusive of GBMSM is critical to curtail the rising STI and HIV epidemic.


Asunto(s)
Actitud del Personal de Salud , Actitud Frente a la Salud , Infecciones por Chlamydia/tratamiento farmacológico , Gonorrea/tratamiento farmacológico , Aceptación de la Atención de Salud , Parejas Sexuales , Minorías Sexuales y de Género , Adulto , Bisexualidad , Infecciones por Chlamydia/transmisión , Trazado de Contacto , Hipersensibilidad a las Drogas , Femenino , Gonorrea/transmisión , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Humanos , Cobertura del Seguro , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Telemedicina , Adulto Joven
7.
Acta Med Port ; 32(12): 776-781, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31851887

RESUMEN

Over the last few decades, behavioral changes in sexual practices have made oral transmission of traditional sexually transmissible infections increasingly recognized. Patients harboring a sexually transmissible infection may first present lesions on the oral cavity, as these may be visible and interfere with basic functions such as speech or swallowing. Moreover, the oral cavity may function as a reservoir for future spread of these infections. In order to successfully control this problem, a greater focus on oral sex should be persued, along with promotion of the use of condom and education on safe oral sex practices. Furthermore, examination of the oral cavity should is essential when evaluating any patient suspected of harboring a sexually transmissible infection. In this article, oral transmission of several viral and bacterial infections is reviewed, including human papillomavirus infection, genital herpes, syphilis and gonorrhea, among others.


Asunto(s)
Enfermedades de la Boca/complicaciones , Sexo Seguro , Conducta Sexual , Enfermedades de Transmisión Sexual/transmisión , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis , Gonorrea/diagnóstico , Gonorrea/transmisión , Infecciones por VIH/diagnóstico , Infecciones por VIH/patología , Infecciones por VIH/transmisión , Herpes Simple/diagnóstico , Herpes Simple/transmisión , Humanos , Enfermedades de la Boca/diagnóstico , Enfermedades de la Boca/patología , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/transmisión , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/patología , Sífilis/diagnóstico , Sífilis/patología , Sífilis/transmisión
8.
Artículo en Inglés | MEDLINE | ID: mdl-31681634

RESUMEN

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) represent the most common agents of sexually transmitted rectal infections among men having sex with other men (MSM). In this study, we assessed the bacterial composition of the rectal microbiota associated with CT and/or NG infections in a cohort of men reporting unsafe rectal intercourse. A total of 125 rectal swabs were collected and four groups were compared: non-infected subjects (n = 53), patients with CT (n = 37), or NG rectal infection (n = 17) and patients with contemporary positivity for CT/NG (n = 18). CT and NG infections were detected by a real-time commercial test and the rectal microbiota composition was analyzed from rectal swabs through sequencing of the hypervariable V3-V4 regions of the 16S rRNA gene. The rectal microbiota of all subgroups was dominated by Prevotellaceae, Enterobacteriaceae, and Ruminococcaceae families. Irrespective of the analyzed subgroup, we found that the rectal environment of all the enrolled MSM was rich in Prevotella and Escherichia genera. Moreover, a shift in the bacterial composition between patients with sexually transmitted rectal infections and controls was noticed: infected patients were characterized by a depletion of Escherichia species, associated with an increase of anaerobic genera, including Peptoniphilus, Peptostreptococcus, and Parvimonas. Overall, the presence of rectal symptoms did not significantly modify the rectal microbiota profiles among the four groups of analyzed patients. We confirmed that HIV-positive patients are characterized by a lower bacterial richness than HIV-negative subjects. However, we found that the presence of HIV has a different impact on bacterial rectal communities compared to CT and NG infections, modifying the relative abundance of several genera, including Gardnerella, Lactobacillus, Corynebacterium, and Sutterella. Information about the rectal microbiota composition in CT and NG infections could shed light on the pathogenesis of these conditions and could contribute to the onset of new strategies for their control.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis , Gonorrea/epidemiología , Gonorrea/microbiología , Homosexualidad Masculina , Microbiota , Neisseria gonorrhoeae , Recto/microbiología , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/clasificación , Chlamydia trachomatis/aislamiento & purificación , Coinfección , Código de Barras del ADN Taxonómico , Femenino , Gonorrea/diagnóstico , Gonorrea/transmisión , Humanos , Italia/epidemiología , Masculino , Neisseria gonorrhoeae/clasificación , Neisseria gonorrhoeae/aislamiento & purificación
9.
Sex Health ; 16(5): 514-522, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31476277

RESUMEN

Background Antimicrobial-resistant (AMR) gonorrhoea is a global public health threat. Discriminatory point-of-care tests (POCT) to detect drug sensitivity are under development, enabling individualised resistance-guided therapy. METHODS: An individual-based dynamic transmission model of gonorrhoea infection in MSM living in London has been developed, incorporating ciprofloxacin-sensitive and resistant strains. The time-dependent sexual contact network is captured by periodically restructuring active connections to reflect the transience of contacts. Different strategies to improve treatment selection were explored, including discriminatory POCT and selecting partner treatment based on either the index case or partner susceptibility. Outcomes included population prevalence of gonorrhoea and drug dose counts. RESULTS: It is shown that using POCT to detect ciprofloxacin-sensitive infections could result in a large decrease in ceftriaxone doses (by 70% compared with the reference case in the simulations of this study). It also suggests that ceftriaxone use can be reduced with existing technologies, albeit to a lesser degree; either using index case sensitivity profiles to direct treatment of partners, or testing notified partners with strain discriminatory laboratory tests before treatment, reduced ceftriaxone use in our model (by 27% and 47% respectively). CONCLUSIONS: POCT to detect ciprofloxacin-sensitive gonorrhoea are likely to dramatically reduce reliance on ceftriaxone, but requires the implementation of new technology. In the meantime, the proportion of unnecessary ceftriaxone treatment by testing partners before treatment could be reduced significantly. Alternatively, index case sensitivity profiles could be used to select effective treatments for partners.


Asunto(s)
Antibacterianos/uso terapéutico , Gonorrea/transmisión , Homosexualidad Masculina/estadística & datos numéricos , Neisseria gonorrhoeae/efectos de los fármacos , Ceftriaxona/uso terapéutico , Ciprofloxacino/uso terapéutico , Farmacorresistencia Bacteriana , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Homosexualidad Masculina/psicología , Humanos , Londres/epidemiología , Masculino , Modelos Estadísticos , Pruebas en el Punto de Atención
10.
Nat Commun ; 10(1): 3988, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31488838

RESUMEN

Whole genome sequencing (WGS) has been used to investigate transmission of Neisseria gonorrhoeae, but to date, most studies have not combined genomic data with detailed information on sexual behaviour to define the extent of transmission across population risk groups (bridging). Here, through combined epidemiological and genomic analysis of 2,186N. gonorrhoeae isolates from Australia, we show widespread transmission of N. gonorrhoeae within and between population groups. We describe distinct transmission clusters associated with men who have sex with men (MSM) and heterosexuals, and men who have sex with men and women (MSMW) are identified as a possible bridging population between these groups. Further, the study identifies transmission of N. gonorrhoeae between HIV-positive and HIV-negative individuals receiving pre-exposure prophylaxis (PrEP). Our data highlight several groups that can be targeted for interventions aimed at improving gonorrhoea control, including returning travellers, sex workers, and PrEP users.


Asunto(s)
Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Neisseria gonorrhoeae/genética , Profilaxis Pre-Exposición , Conducta Sexual , Secuenciación Completa del Genoma , Adulto , Femenino , Gonorrea/transmisión , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Masculino , Factores de Riesgo , Trabajadores Sexuales , Parejas Sexuales , Minorías Sexuales y de Género , Victoria , Adulto Joven
12.
J Int AIDS Soc ; 22 Suppl 6: e25354, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31468730

RESUMEN

INTRODUCTION: Gonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade. The majority of cases are extragenital and occur at the oropharynx and anorectum. The aim of this narrative review was to review the risk factors and mode of transmission for gonorrhoea and chlamydia at the oropharynx and anorectum among MSM. RESULTS AND DISCUSSION: New evidence suggests that oropharyngeal gonorrhoea can be transmitted by kissing in addition to through the established route of condomless oral sex; and anorectal gonorrhoea can be acquired when saliva is used as a lubricant for anal sex and rimming in addition to the established route of condomless penile-anal sex in MSM. In contrast, condomless penile-anal sex remains the major route for chlamydia transmission. CONCLUSIONS: Substantial transmission of gonorrhoea may occur with practices other than the established routes of condomless oral and/or anal sex and hence condoms may not be effective in preventing gonorrhoea transmission to extragenital sites. In contrast, condoms are effective for chlamydia control because it is mainly transmitted through condomless penile-anal sex. Novel interventions for gonorrhoea that reduce the risk of transmission at extragenital site are required.


Asunto(s)
Infecciones por Chlamydia/transmisión , Gonorrea/transmisión , Saliva , Condones , Homosexualidad Masculina , Humanos , Masculino , Factores de Riesgo , Conducta Sexual , Minorías Sexuales y de Género , Encuestas y Cuestionarios
13.
Lancet Infect Dis ; 19(10): e360-e366, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31324517

RESUMEN

This Personal View argues for a new framework of gonorrhoea transmission in men who have sex with men in which the oropharynx plays a major role in transmitting gonorrhoea to, or acquiring gonorrhoea from, their partner's oropharynx, penis, or anorectum through either direct contact or via saliva. To avoid preconceived notions of transmission dynamics, we ask readers to imagine that they are investigating a new sexually transmitted infection. On the basis of the existing clinical and epidemiological data for gonorrhoea at the penis, oropharynx, and anorectum site, we develop two models for transmission: the so-called penile model and the so-called oropharyngeal model. We argue that the existing epidemiological data and behavioural data best fit the oropharyngeal model. Our argument rests on the observation that, at the population level, the prevalence of urethral gonorrhoea is too rare to explain the high incidence of oropharynx and anorectum infection. We describe studies of gonorrhoea detection in saliva, saliva use during sex, epidemiological studies of kissing and oropharyngeal gonorrhoea, as well as studies aided by mathematical models. Finally, we argue that the correlation between sexual acts (eg, kissing, oral sex, anal sex, and saliva use) is so high that any epidemiological study that does not measure these factors will be prone to confounding.


Asunto(s)
Gonorrea/epidemiología , Gonorrea/transmisión , Homosexualidad Masculina , Modelos Biológicos , Saliva/microbiología , Lengua/microbiología , Gonorrea/microbiología , Humanos , Incidencia , Masculino , Neisseria gonorrhoeae , Orofaringe/microbiología , Recto/microbiología , Factores de Riesgo , Parejas Sexuales , Minorías Sexuales y de Género
14.
Lancet Infect Dis ; 19(10): e367-e369, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31324518

RESUMEN

Data from mathematical models suggest that kissing and saliva exchange during sexual activity might be major contributors to community gonorrhoea morbidity. Although there is little evidence to support this, it provokes discussion of the potential role of the oropharynx in gonorrhoea control. Improved sensitivity and ease of diagnostic testing, as well as increased screening for extragenital infections among men who have sex with men, have increased awareness of the high frequency of oropharyngeal gonorrhoea. However, there are insufficient data to determine the mechanisms of transmission for these infections. Innovative studies that use quantitative microbiological techniques are needed to accurately assess how oral gonorrhoea or saliva exchange in infected people contribute to the morbidity of gonorrhoea in the community. More empirical data on pharyngeal gonorrhoea infections, and the role of transmission to and from the oropharynx, are needed to inform prevention planning.


Asunto(s)
Gonorrea/epidemiología , Gonorrea/transmisión , Homosexualidad Masculina , Neisseria gonorrhoeae/genética , Orofaringe/microbiología , Faringitis/epidemiología , Saliva/microbiología , Femenino , Gonorrea/microbiología , Humanos , Masculino , Modelos Biológicos , Faringitis/microbiología , Prevalencia , Riesgo , Parejas Sexuales , Minorías Sexuales y de Género
15.
Forensic Sci Int Genet ; 42: 141-146, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31319352

RESUMEN

Molecular epidemiology and phylogenetic analyses are frequently used in the investigation of viral transmission cases in forensic contexts. Here, we present the methods and results of the analysis of a bacterial transmission episode in an alleged child abuse case using complete genome sequences obtained by high-throughput sequencing (HTS) methods. We obtained genomes of Neisseria gonorrhoeae from the victim, the suspect, and 29 unrelated controls. The analysis of the genomes revealed that the victim and suspect isolates had identical sequences in both the bacterial chromosome and the single plasmid present in them. One of the local controls was very similar (differing in only 2 SNPs) to the case sequences, but the remaining controls were very divergent. Additional cases of identity and very high similarity among controls were observed occasionally, pointing at recent transmission cases. These results were more discriminative than the previous molecular epidemiology analyses performed at the hospital's Microbiology Service, as Multi-Locus Sequence Typing (MLST) could not distinguish between the suspect/victim and the controls isolates, and Pulse Field Gel Electrophoresis (PFGE) was not able to distinguish between the suspect/victim and one of the local controls. These results lead us to conclude that complete bacterial genome sequences obtained with HTS technologies may be a valuable tool for establishing recent transmission cases and, although more studies are needed, they have a great potential for being used in forensic analyses.


Asunto(s)
Abuso Sexual Infantil/diagnóstico , Gonorrea/transmisión , Neisseria gonorrhoeae/genética , Secuenciación Completa del Genoma , Niño , Electroforesis en Gel de Campo Pulsado , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Funciones de Verosimilitud , Masculino , Tipificación de Secuencias Multilocus , Reacción en Cadena de la Polimerasa , Polimorfismo de Nucleótido Simple , Análisis de Secuencia de ADN , Vagina/microbiología
17.
Emerg Infect Dis ; 25(7): 1373-1376, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31211673

RESUMEN

We describe a sexual network consisting of 1 nonbinary-gendered participant and 2 male and 4 female participants in Australia, 2018. Six of 7 participants had oropharyngeal gonorrhea in the absence of urogenital gonorrhea. This observation supports a new paradigm of gonorrhea transmission in which oropharyngeal gonorrhea can be transmitted through tongue kissing.


Asunto(s)
Gonorrea/epidemiología , Gonorrea/microbiología , Faringitis/epidemiología , Faringitis/microbiología , Trabajadores Sexuales , Adulto , Australia/epidemiología , Femenino , Genoma Bacteriano , Genómica/métodos , Gonorrea/historia , Gonorrea/transmisión , Historia del Siglo XXI , Humanos , Masculino , Neisseria gonorrhoeae/clasificación , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/aislamiento & purificación , Faringitis/historia , Vigilancia en Salud Pública
18.
Sex Transm Dis ; 46(6): 357-363, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31095100

RESUMEN

BACKGROUND: Sexually transmitted infections (STIs) are associated with an increased risk of human immunodeficiency virus (HIV) acquisition and transmission. We estimated the proportion of HIV incidence among men who have sex with men attributable to infection with the 2 most common bacterial STIs, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). METHODS: We used a stochastic, agent-based model of a sexual network of MSM with cocirculating HIV, NG, and CT infections. Relative risk (RR) multipliers, specific to anatomic site of infection, modified the risk of HIV transmission and acquisition based on STI status. We estimated the effect of NG and CT on HIV incidence overall and on HIV acquisition and HIV transmission separately. Each scenario was simulated for 10 years. The population attributable fraction (PAF) was determined for each combination of RRs by comparing the incidence in the final year of a scenario to a scenario in which the RRs associated with NG and CT were set to 1.0. RESULTS: Overall, 10.2% (interquartile range [IQR], 7.9-12.4) of HIV infections were attributable to NG/CT infection. Then in sensitivity analyses, the PAF for HIV transmission ranged from 3.1% (IQR, 0.5-5.2) to 20.4% (IQR, 17.8-22.5) and the PAF for HIV acquisition ranged from 2.0% (IQR, -0.7 to 4.3) to 13.8% (IQR, 11.7-16.0). CONCLUSIONS: Despite challenges in estimating the causal impact of NG/CT on HIV risk, modeling is an alternative approach to quantifying plausible ranges of effects given uncertainty in the biological cofactors. Our estimates represent idealized public health interventions in which STI could be maximally prevented, setting targets for real-world STI interventions that seek to reduce HIV incidence.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Minorías Sexuales y de Género , Infecciones por Chlamydia/transmisión , Gonorrea/transmisión , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Modelos Estadísticos , Riesgo , Conducta Sexual , Estados Unidos/epidemiología
19.
Sex Transm Infect ; 95(7): 516-521, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31073095

RESUMEN

OBJECTIVES: A mathematical model suggested that a significant proportion of oropharyngeal gonorrhoea cases are acquired via oropharynx-to-oropharynx transmission (ie, tongue-kissing), but to date, no empirical study has investigated this. This study aimed to examine the association between kissing and oropharyngeal gonorrhoea among gay and bisexual men who have sex with men (MSM). METHODS: MSM attending a public sexual health centre in Melbourne, Australia, between March 2016 and February 2017 were invited to participate in a brief survey that collected data on their number of male partners in the last 3 months, in three distinct categories: kissing-only (ie, no sex including no oral and/or anal sex), sex-only (ie, any sex without kissing), and kissing-with-sex (ie, kissing with any sex). Univariable and multivariable logistic regression analyses were performed to examine associations between oropharyngeal gonorrhoea positivity by nucleic acid amplification tests and the three distinct partner categories. RESULTS: A total of 3677 men completed the survey and were tested for oropharyngeal gonorrhoea. Their median age was 30 (IQR 25-37) and 6.2% (n=229) had oropharyngeal gonorrhoea. Men had a mean number of 4.3 kissing-only, 1.4 sex-only, and 5.0 kissing-with-sex partners in the last 3 months. Kissing-only and kissing-with-sex were associated with oropharyngeal gonorrhoea, but sex-only was not. The adjusted odds for having oropharyngeal gonorrhoea were 1.46-fold (95% CI 1.04 to 2.06) for men with ≥4 kissing-only partners and 1.81-fold (95% CI 1.17 to 2.79) for men with ≥4 kissing-with-sex partners. CONCLUSIONS: These data suggest that kissing may be associated with transmission of oropharyngeal gonorrhoea in MSM, irrespective of whether sex also occurs.


Asunto(s)
Transmisión de Enfermedad Infecciosa , Gonorrea/transmisión , Orofaringe/patología , Conducta Sexual , Adolescente , Adulto , Australia , Estudios Transversales , Homosexualidad Masculina , Humanos , Masculino , Medición de Riesgo , Adulto Joven
20.
Infect Dis Obstet Gynecol ; 2019: 6584101, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31057323

RESUMEN

Background: Sexually transmitted infections (STIs) are associated with adverse birth outcomes. Current prenatal STI screening guidelines define "risk" without explicit consideration of HIV status. Our objective was to test the hypothesis that HIV status is associated with bacterial STI in pregnant women. Methods: We designed a retrospective cohort study to identify pregnant women with HIV who delivered at our facility during 2000-2014. HIV+ women were compared to HIV- women with matching by year of delivery. Logistic regression was used to model adjusted odds of prevalent and incident STI. Prevalent STI was defined as chlamydia (CT), gonorrhea (GC), syphilis, or trichomoniasis detected on an initial prenatal screening test and incident STI as a newly positive result following a negative prenatal test. Results: The cohort included 432 women, 210 HIV+ and 222 HIV-. Most pregnant women were screened for STI (92% of HIV+ women and 74% of HIV- women). STI rates were high and particularly elevated in HIV+ women: 29% vs 18% (p=0.02), for prevalent STI and 11% vs 2% (p<0.001) for incident STI. Risk factors for prevalent STI were as follows: HIV status (aOR 3.0, CI: 1.4-6.4), Black race (aOR 2.7, 95% CI: 1.1-6.6), and more recent delivery (2007-2014 compared to 2000-2006) (aOR 2.3, CI: 1.1-4.7). HIV status was an independent risk factor for incident STI (aOR 7.2, CI: 2.1-25.0). Conclusion: Pregnant women who delivered in our center had high STI rates. Since HIV infection was independently associated with prevalent and incident STI, prenatal screening guidelines may need to incorporate HIV status as a high-risk group for repeat testing.


Asunto(s)
Infecciones por VIH/complicaciones , Complicaciones Infecciosas del Embarazo/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Alabama/epidemiología , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/transmisión , Estudios de Cohortes , Femenino , Gonorrea/epidemiología , Gonorrea/transmisión , Infecciones por VIH/epidemiología , Humanos , Incidencia , Embarazo , Complicaciones Infecciosas del Embarazo/etiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Enfermedades de Transmisión Sexual/etiología , Sífilis/epidemiología , Sífilis/transmisión , Tricomoniasis/epidemiología , Tricomoniasis/transmisión
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