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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 METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers.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 Negl Trop Dis ; 14(3): e0008120, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32130213

RESUMEN

BACKGROUND: Trachoma elimination efforts are hampered by limited understanding of Chlamydia trachomatis (Ct) transmission routes. Here we aimed to detect Ct DNA at non-ocular sites and on eye-seeking flies. METHODS: A population-based household survey was conducted in Oromia Region, Ethiopia. Ocular and non-ocular (faces, hands, clothing, water containers and sleeping surfaces) swabs were collected from all individuals. Flies were caught from faces of children. Flies, ocular swabs and non-ocular swabs were tested for Ct by quantitative PCR. RESULTS: In total, 1220 individuals in 247 households were assessed. Active trachoma (trachomatous inflammation-follicular) and ocular Ct were detected in 10% and 2% of all-ages, and 21% and 3% of 1-9-year-olds, respectively. Ct was detected in 12% (95% CI:8-15%) of tested non-ocular swabs from ocular-positive households, but in none of the non-ocular swabs from ocular-negative households. Ct was detected on 24% (95% CI:18-32%) of flies from ocular-positive households and 3% (95% CI:1-6%) of flies from ocular-negative households. CONCLUSION: Ct DNA was detected on hands, faces and clothing of individuals living in ocular-positive households suggesting that this might be a route of transmission within Ct infected households. In addition, we detected Ct on flies from ocular-positive households and occasionally in ocular-negative households suggesting that flies might be a vector for transmission within and between Ct infected and uninfected households. These potential transmission routes may need to be simultaneously addressed to suppress transmission.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/aislamiento & purificación , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/transmisión , Transmisión de Enfermedad Infecciosa , Adolescente , Adulto , Animales , Niño , Preescolar , Chlamydia trachomatis/genética , Vestuario , Estudios Transversales , Dípteros/microbiología , Etiopía , Heces/microbiología , Femenino , Fómites/microbiología , Mano/microbiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Adulto Joven
3.
Sex Transm Infect ; 96(5): 375-379, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-31586947

RESUMEN

OBJECTIVES: A new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden in 2006. The nvCT has a plasmid deletion, which escaped detection by two nucleic acid amplification tests (Abbott-Roche, AR), which were used in 14 of 21 Swedish counties. The objectives of this study were to assess when and where nvCT emerged in Sweden, the proportion of nvCT in each county and the role of a potential fitness difference between nvCT and co-circulating wild-type strains (wtCT). METHODS: We used a compartmental mathematical model describing the spatial and temporal spread of nvCT and wtCT. We parameterised the model using sexual behaviour data and Swedish spatial and demographic data. We used Bayesian inference to fit the model to surveillance data about reported diagnoses of chlamydia infection in each county and data from four counties that assessed the proportion of nvCT in multiple years. RESULTS: Model results indicated that nvCT emerged in central Sweden (Dalarna, Gävleborg, Västernorrland), reaching a proportion of 1% of prevalent CT infections in late 2002 or early 2003. The diagnostic selective advantage enabled rapid spread of nvCT in the presence of high treatment rates. After detection, the proportion of nvCT decreased from 30%-70% in AR counties and 5%-20% in counties that Becton Dickinson tests, to around 5% in 2015 in all counties. The decrease in nvCT was consistent with an estimated fitness cost of around 5% in transmissibility or 17% reduction in infectious duration. CONCLUSIONS: We reconstructed the course of a natural experiment in which a mutant strain of C. trachomatis spread across Sweden. Our modelling study provides support, for the first time, of a reduced transmissibility or infectious duration of nvCT. This mathematical model improved our understanding of the first nvCT epidemic in Sweden and can be adapted to investigate the impact of future diagnostic escape mutants.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Teorema de Bayes , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/microbiología , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/genética , Epidemias , Humanos , Modelos Teóricos , Mutación , Técnicas de Amplificación de Ácido Nucleico , Plásmidos/genética , Prevalencia , Suecia/epidemiología
4.
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
5.
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
6.
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
8.
Phys Rev E ; 100(3-1): 032310, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31640028

RESUMEN

During epidemic control, containment of the disease is usually achieved through increasing a devoted resource to reduce the infectiousness. However, the impact of this resource expenditure has not been studied quantitatively. For disease spread, the recovery rate can be positively correlated with the average amount of resource devoted to infected individuals. By incorporating this relation we build a novel model and find that insufficient resource leads to an abrupt increase in the infected population size, which is in marked contrast with the continuous phase transitions believed previously. Counterintuitively, this abrupt phase transition is more pronounced in less contagious diseases. Furthermore, we find that even for a single infection source, the public resource needs to be available in a significant amount, which is proportional to the total population size, to ensure epidemic containment. Our findings provide a theoretical foundation for efficient epidemic containment strategies in the early stage.


Asunto(s)
Epidemias/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Modelos Estadísticos , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/fisiología , Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles/transmisión , Susceptibilidad a Enfermedades , Humanos , Factores de Tiempo
9.
Indian J Med Res ; 149(5): 662-670, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31417035

RESUMEN

Background & objectives: Limited data are available on the typing of Chlamydia trachomatis in India. Serovars D to K of C. trachomatis are chiefly responsible for urogenital infections. Thus, this study was conducted to determine the distribution of C. trachomatis serovars in patients with urogenital infections and to characterize omp A gene of the detected C. trachomatis isolates by sequence analysis. Presence of other co-infections was also evaluated. Methods: Endocervical swabs were collected from 324 women and urethral swabs/urine were collected from 193 men attending the sexually transmitted diseases outpatient clinic. The samples were screened for C. trachomatis by cryptic plasmid PCR and omp A gene PCR. Genotyping was performed by PCR-restriction fragment length polymorphism (RFLP) and sequencing of the omp A gene. Samples were screened for genital mycoplasmas, Neisseria gonorrhoeae, Treponema pallidum and human immunodeficiency virus (HIV). Results: C. trachomatis was found in 15.0 per cent men and 10.8 per cent women. Serovar D was the most prevalent followed by serovars E, F, I and G. Twenty two C. trachomatis isolates were selected for omp A gene sequencing. No mixed infection was found. Variability in omp A sequences was seen in 31.8 per cent cases. Both PCR-RFLP and omp A gene sequencing showed concordant results. The presence of Ureaplasma spp. and Mycoplasma hominis was observed in 18.7 and 9.5 per cent patients, respectively. Co-infection of C. trachomatis was significantly associated with Ureaplasma urealyticum and HIV. Interpretation & conclusions: The high occurence of C. trachomatis infections warrants its screening in addition to other sexually transmitted infections namely U. urealyticum and HIV. Genotyping of the omp A gene may provide additional information for vaccine development.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Infecciones Urinarias/epidemiología , Adulto , Instituciones de Atención Ambulatoria , Infecciones por Chlamydia/genética , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/patogenicidad , Femenino , Genotipo , Humanos , Masculino , Neisseria gonorrhoeae/aislamiento & purificación , Neisseria gonorrhoeae/patogenicidad , Enfermedades Bacterianas de Transmisión Sexual/genética , Enfermedades Bacterianas de Transmisión Sexual/microbiología , Infecciones Urinarias/genética , Infecciones Urinarias/microbiología
10.
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
11.
Sci Rep ; 9(1): 10659, 2019 07 23.
Artículo en Inglés | MEDLINE | ID: mdl-31337777

RESUMEN

Wildlife that exploit human-made habitats hosts and spreads bacterial pathogens. This shapes the epidemiology of infectious diseases and facilitates pathogen spill-over between wildlife and humans. This is a global problem, yet little is known about the dissemination potential of pathogen-infected animals. By combining molecular pathogen diagnosis with GPS tracking of pathogen-infected gulls, we show how this knowledge gap could be filled at regional scales. Specifically, we generated pathogen risk maps of Salmonella, Campylobacter and Chlamydia based on the spatial movements of pathogen-infected yellow-legged gulls (Larus michahellis) equipped with GPS recorders. Also, crossing this spatial information with habitat information, we identified critical habitats for the potential transmission of these bacteria in southern Europe. The use of human-made habitats by infected-gulls could potentially increase the potential risk of direct and indirect bidirectional transmission of pathogens between humans and wildlife. Our findings show that pathogen-infected wildlife equipped with GPS recorders can provide accurate information on the spatial spread risk for zoonotic bacteria. Integration of GPS-tracking with classical epidemiological approaches may help to improve zoonosis surveillance and control programs.


Asunto(s)
Migración Animal/fisiología , Infecciones por Campylobacter/transmisión , Infecciones por Chlamydia/transmisión , Infecciones por Salmonella/transmisión , Zoonosis/transmisión , Animales , Animales Salvajes , Charadriiformes , Europa (Continente) , Sistemas de Información Geográfica , Humanos
12.
mBio ; 10(4)2019 07 16.
Artículo en Inglés | MEDLINE | ID: mdl-31311884

RESUMEN

Clinical persistence of Chlamydia trachomatis (Ct) sexually transmitted infections (STIs) is a major public health concern. In vitro persistence is known to develop through interferon gamma (IFN-γ) induction of indoleamine 2,3-dioxygenase (IDO), which catabolizes tryptophan, an essential amino acid for Ct replication. The organism can recover from persistence by synthesizing tryptophan from indole, a substrate for the enzyme tryptophan synthase. The majority of Ct strains, except for reference strain B/TW-5/OT, contain an operon comprised of α and ß subunits that encode TrpA and TrpB, respectively, and form a functional αßßα tetramer. However, trpA mutations in ocular Ct strains, which are responsible for the blinding eye disease known as trachoma, abrogate tryptophan synthesis from indole. We examined serial urogenital samples from a woman who had recurrent Ct infections over 4 years despite antibiotic treatment. The Ct isolates from each infection episode were genome sequenced and analyzed for phenotypic, structural, and functional characteristics. All isolates contained identical mutations in trpA and developed aberrant bodies within intracellular inclusions, visualized by transmission electron microscopy, even when supplemented with indole following IFN-γ treatment. Each isolate displayed an altered αßßα structure, could not synthesize tryptophan from indole, and had significantly lower trpBA expression but higher intracellular tryptophan levels compared with those of reference Ct strain F/IC-Cal3. Our data indicate that emergent mutations in the tryptophan operon, which were previously thought to be restricted only to ocular Ct strains, likely resulted in in vivo persistence in the described patient and represents a novel host-pathogen adaptive strategy for survival.IMPORTANCE Chlamydia trachomatis (Ct) is the most common sexually transmitted bacterium with more than 131 million cases occurring annually worldwide. Ct infections are often asymptomatic, persisting for many years despite treatment. In vitro recovery from persistence occurs when indole is utilized by the organism's tryptophan synthase to synthesize tryptophan, an essential amino acid for replication. Ocular but not urogenital Ct strains contain mutations in the synthase that abrogate tryptophan synthesis. Here, we discovered that the genomes of serial isolates from a woman with recurrent, treated Ct STIs over many years were identical with a novel synthase mutation. This likely allowed long-term in vivo persistence where active infection resumed only when tryptophan became available. Our findings indicate an emerging adaptive host-pathogen evolutionary strategy for survival in the urogenital tract that will prompt the field to further explore chlamydial persistence, evaluate the genetics of mutant Ct strains and fitness within the host, and their implications for disease pathogenesis.


Asunto(s)
Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/genética , Mutación , Operón , Triptófano Sintasa/genética , Secuencia de Aminoácidos , Secuencia de Bases , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/clasificación , Chlamydia trachomatis/ultraestructura , Mutación del Sistema de Lectura , Regulación Bacteriana de la Expresión Génica , Humanos , Modelos Moleculares , Filogenia , Conformación Proteica , Eliminación de Secuencia , Enfermedades Bacterianas de Transmisión Sexual/microbiología , Triptófano Sintasa/química
13.
Ann Agric Environ Med ; 26(2): 222-226, 2019 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-31232049

RESUMEN

INTRODUCTION AND OBJECTIVES: Chlamydia (C.) felis can cause infection which may be associated with conjunctivitis and/or respiratory tract disease, particularly in kittens, but could also be the cause of the disease in adult cats. Infection is more common in multi-cat environments. The zoonotic potential of C. felis appears low, but exposure to this microorganism is possible by handling the affected cats, by contact with their aerosol, and also via fomites. MATERIAL AND METHODS: In the study, 140 cats of various breeds from Kosice region in Slovakia were studied. Conjunctival samples were obtained from 71 clinically healthy cats (50.7%) and 69 cats with clinical signs of conjunctivitis and upper respiratory tract impairment (49.3%). Cats were divided into 4 groups according to breed and type of environment in which they lived. In the 1st group were cats kept inside only (n=33), in the 2nd group, free-roaming cats (n=50), the 3rd group comprised stray cats, taken from the streets (n=28), and the 4th group included cats kept in shelters or deposit devices (n=29). Molecular method PCR and DNA sequencing was used as the diagnostic method. RESULTS: Overall positivity was 17.1%. Of the 24 positive cats, the highest positivity was detected in the population of stray cats (35.7%) and shelter cats (31%). In the group of free-roaming cats, 10% had positivity. No positive animals were detected in the group of cats kept inside only. It was also found that the risk of C. felis in cats with clinical signs of disease was more than 7-fold higher than in cats without clinical signs of conjunctivitis and respiratory tract. CONCLUSIONS: The obtained results show that cats, especially stray and shelter cats, can be important sources of feline chlamydiosis, and due to their close contact with people they can present a risk for transmission.


Asunto(s)
Enfermedades de los Gatos/transmisión , Infecciones por Chlamydia/transmisión , Infecciones por Chlamydia/veterinaria , Chlamydia/fisiología , Zoonosis/transmisión , Animales , Enfermedades de los Gatos/microbiología , Gatos , Chlamydia/clasificación , Chlamydia/genética , Chlamydia/aislamiento & purificación , Infecciones por Chlamydia/microbiología , Ambiente , Humanos , Filogenia , Reacción en Cadena en Tiempo Real de la Polimerasa , Zoonosis/microbiología
15.
Sex Health ; 16(4): 332-339, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31122336

RESUMEN

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). METHODS: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. RESULTS: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. CONCLUSIONS: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Prestación de Atención de Salud , Política de Salud , Infecciones del Sistema Genital/tratamiento farmacológico , Parejas Sexuales , Instituciones de Atención Ambulatoria , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis , Trazado de Contacto , Heterosexualidad , Humanos , Ciencia de la Implementación , Legislación de Medicamentos , Nueva Gales del Sur , Proyectos Piloto , Infecciones del Sistema Genital/transmisión
16.
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
17.
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
18.
BMC Infect Dis ; 19(1): 425, 2019 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-31096920

RESUMEN

BACKGROUND: Understanding the underlying epidemiology that shapes Neisseria gonorrhoeae (GC), and Chlamydia trachomatis (CT) infections can contribute to data driven policies directed towards curbing the proliferation of these pathogens in Ghana. Information on the symptoms and risk factors for STIs will help to identify high-risk individuals which will in turn inform STI syndromic management and tailor the use of public health resources. METHODS: Participants were from 4 military clinics and 1 civilian STI clinic in Ghana and eligible if they had symptoms suggestive of STI. First void urine samples were collected and tested with Nucleic Acid Amplification Test (NAAT). A structured questionnaire was administered to all participants. Multivariate logistic regression identified factors associated with infection, separately for NG and for CT and for men and women. RESULTS: A total of 950 patients, 58% of whom were females were enrolled, 28% had gonorrhea and 11% had chlamydia with more males testing positive than females. Reported symptoms that were more common among patients who tested positive for gonorrhea were painful urination and urethral discharge (all P values < 0.05). Additionally, multiple sexual partners and alcohol use were statistically associated with higher rates of gonorrhea in males while only the frequency of condom use was associated with gonorrhea for females. None of the symptoms or risk factors except marital status was associated with testing positive for chlamydia. CONCLUSION: Identifying these symptoms and risk factors help inform health care delivery systems for STIs in Ghana. Furthermore, men and women presenting with these symptoms and risk factors are a prime target for public health education campaigns, aimed at curbing the spread of gonorrhea and chlamydia infections.


Asunto(s)
Infecciones por Chlamydia/transmisión , Gonorrea/transmisión , Adolescente , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Condones , Femenino , Ghana/epidemiología , Gonorrea/diagnóstico , Gonorrea/epidemiología , Instituciones de Salud/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Técnicas de Amplificación de Ácido Nucleico , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven
19.
PLoS One ; 14(4): e0215606, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31002729

RESUMEN

BACKGROUND: The bacterial load of Chlamydia trachomatis (CT) is assumed to play a role in transmission and sequelae. We assessed urogenital CT cycle quantification (Cq) values, as an indicator for CT load, of men and women diagnosed by general practitioners (GPs), hospital physicians and the STI clinic. METHODS: Urogenital CT-positive samples (n = 2,055 vaginal swabs, n = 77 cervical swabs, n = 1,519 urine samples and n = 19 urethral swabs) diagnosed by GPs, hospital physicians and the STI clinic from the Maastricht Medical Microbiology Laboratory were included (2012-2016). The outcome measure 'urogenital Cq values' was used as an inversely proportional measure for CT load. Among all patients, multivariate linear regression analyses were used to assess primary determinants for mean urogenital Cq values, stratified by sex. Additional clinical determinants were assessed among STI clinic patients. RESULTS: In men, mean urogenital Cq values were similar between GPs, hospital physicians and the STI clinic (32.7 and 33.5 vs. 32.7; p>0.05). Women visiting the GP had lower urogenital Cq values than women visiting the STI clinic (30.2 vs. 30.9; p = <0.001). Women visiting the hospital had higher urogenital Cq values than women visiting the STI clinic (32.4 vs. 30.9; p = <0.001). Among STI clinic women, urogenital Cq values were lower in women with concurrent anorectal CT and in rectally untested women compared to anorectal CT-negative women (30.7 and 30.6 vs. 33.9; p = <0.001). CONCLUSION: Men visiting different STI care providers had similar urogenital Cq values, which could be an indicator for similar CT loads. The lower Cq values of women visiting the GP compared to women visiting the STI clinic could be an indicator for higher CT loads and likely higher transmission potential. Notably, urogenital Cq values of STI clinic women were much lower (>3 Cq) when STI clinic women also had anorectal CT. This finding could indicate higher urogenital CT loads and likely higher chances of transmission and sequelae.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Carga Bacteriana , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Sistema Urogenital/patología , Adulto , Infecciones por Chlamydia/microbiología , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/fisiología , Femenino , Medicina General/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología , Enfermedades de Transmisión Sexual/terapia , Sistema Urogenital/microbiología , Adulto Joven
20.
Ann Agric Environ Med ; 26(1): 51-54, 2019 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-30922029

RESUMEN

INTRODUCTION AND OBJECTIVE: Urogenital Chlamydia trachomatis is one of the most common sexually transmitted bacterial pathogens. The aim of the study was to present the current occurrence of chlamydial infections among Polish soldiers, sexually-active men and women at reproductive age. MATERIAL AND METHODS: The research involved 253 active duty soldiers from the Polish Special Forces, 237 men and 16 women aged 26-57, stationed in Warsaw between October - November 2016. The study participants were asked to fill a socio-demographic questionnaire and then subjected to diagnostic tests. These included a urine test for the presence of Chlamydia trachomatis DNA using the Real-Time PCR assay with fluorescently labeled markers and probes, complementary to plasmid DNA of the bacteria (DNA isolated from urine samples was used as matrix). RESULTS: Chlamydia trachomatis infection was detected in two male soldiers, non-commissioned officers, at mean age 40.5 years (total: 38.0 years); reporting sexual contacts with 2-3 partners in the last 12 months (total: 141 soldiers - 1 partner, 66 - 2-3 partners, 46 - >4 partners), with no UTI symptoms. CONCLUSIONS: Among all the study participants, of whom more than 40% reported sexual contacts with 2-4 or more partners within the last 12 months, only 0.8% were found to be infected. The low prevalence of Chlamydia trachomatis infection can be associated with a regular or frequent use of STI prevention measures during casual sex, or having a single sexual partner.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Personal Militar , Adulto , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis/genética , ADN/orina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plásmidos/genética , Polonia/epidemiología , Prevalencia , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Conducta Sexual/estadística & datos numéricos
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