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1.
J Acquir Immune Defic Syndr ; 82 Suppl 2: S113-S117, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31658197

RESUMO

BACKGROUND: Tenofovir disoproxil fumarate coformulated with emtricitabine (TDF/FTC) was shown to be effective in preventing HIV acquisition when used for pre-exposure prophylaxis (PrEP), but questions have arisen regarding optimal PrEP implementation strategies. METHODS: A narrative review of literature since 2010 regarding PrEP effectiveness, implementation, and new prevention modalities was undertaken to summarize lessons learned, and to review potential benefits and challenges. RESULTS: Although daily TDF/FTC is safe, well tolerated, and highly effective in preventing HIV transmission, it has been initiated by only 200,000 Americans, and a comparable number of individuals in other countries, meaning that 80%-90% of those at greatest risk globally have not benefitted yet. Barriers to PrEP uptake have included medication and care costs, anticipated side effects, stigma, and unsupportive health care systems. Innovations to increase PrEP uptake and adherence have included engaging nonmedical staff (eg, pharmacists, social workers, and peer navigators), economic assistance programs, and new technologies (eg, text messaging support and dedicated apps). Pericoital PrEP dosing seems to be effective in preventing HIV transmission among men who have sex with men, but has not been evaluated in women. Investigational PrEP approaches include antiretrovirals delivered by injection, implant, vaginal rings, rectal douches, and immunoprophylaxis. Some of these approaches may allow for infrequent dosing, whereas others may be more congruent with patterns of sexual behavior. CONCLUSIONS: PrEP has been shown to be safe and effective when used consistently, but new approaches to enhance uptake, adherence, and convenience with less-frequent dosing are under study, suggesting that new models and modalities will evolve to optimize impact.

3.
J Antimicrob Chemother ; 74(10): 2913-2915, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31340021

RESUMO

BACKGROUND: The emergence of drug-resistant Neisseria gonorrhoeae has prompted the development of rapid molecular assays designed to determine antimicrobial susceptibility. One common assay uses high-resolution melt analysis to target codon 91 of the gyrase A gene (gyrA) to predict N. gonorrhoeae susceptibility to ciprofloxacin. METHODS: We extracted DNA from remnant clinical specimens that had previously tested positive for N. gonorrhoeae using the Aptima Combo 2 for CT/NG assay (Hologic, San Diego, CA, USA). We selected DNA extracts from specimens with indeterminate, WT and mutant gyrA genotype results from a previous study using high-resolution melt analysis to detect the gyrA codon 91 mutation. We re-tested those specimens using the recently CE-marked ResistancePlus GC (beta) assay (SpeeDx, Sydney, Australia). RESULTS: Of 86 specimens with indeterminate gyrA genotypes on high-resolution melt analysis, the ResistancePlus GC (beta) assay (SpeeDx) identified 30 (35%) WT, 22 (26%) mutant and 34 (40%) indeterminate gyrA genotypes. CONCLUSIONS: The ResistancePlus GC (beta) assay showed improved N. gonorrhoeae gyrA genotype determination compared with a prior gyrA genotypic high-resolution melt assay.

4.
Sex Health ; 16(5): 488-499, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31230613

RESUMO

BACKGROUND: In the last two decades, gonococcal strains with decreased cefixime susceptibility and cases of clinical treatment failure have been reported worldwide. Gonococcal strains with a cefixime minimum inhibitory concentration (MIC) ≥0.12 µg mL-1 are significantly more likely to fail cefixime treatment than strains with an MIC <0.12 µg mL-1. Various researchers have described the molecular characteristics of gonococcal strains with reduced cefixime susceptibility, and many have proposed critical molecular alterations that contribute to this decreased susceptibility. METHODS: A systematic review of all published articles in PubMed through 1 November 2018 was conducted that report findings on the molecular characteristics and potential mechanisms of resistance for gonococcal strains with decreased cefixime susceptibility. The findings were summarised and suggestions were made for the development of a molecular-based cefixime susceptibility assay. RESULTS: The penicillin-binding protein 2 (PBP2) encoded by the penA gene is the primary target of cefixime antimicrobial activity. Decreased cefixime susceptibility is conferred by altered penA genes with mosaic substitute sequences from other Neisseria (N.) species (identifiable by alterations at amino acid position 375-377) or by non-mosaic penA genes with at least one of the critical amino acid substitutions at positions 501, 542 and 551. Based on this review of 415 international cefixime decreased susceptible N. gonorrhoeae isolates, the estimated sensitivity for an assay detecting the aforementioned amino acid alterations would be 99.5% (413/415). CONCLUSIONS: Targeting mosaic penA and critical amino acid substitutions in non-mosaic penA are necessary and may be sufficient to produce a robust, universal molecular assay to predict cefixime susceptibility.

5.
AIDS Behav ; 23(4): 813-819, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30506350

RESUMO

Venue-based testing may improve screening efforts for HIV and syphilis, thereby reducing transmission. We offered onsite rapid dual HIV and syphilis testing at venues popular among MSM and/or transgender women in Lima, Peru. We used Poisson regression to calculate adjusted prevalence ratios (aPRs) for factors associated with each infection. Most (90.4%) of the 303 participants would test more frequently if testing was available at alternative venues. New cases of HIV (69) and syphilis infection (84) were identified. HIV was associated with recent sex work (aPR 1.11; 95% CI 1.02-1.22), sex with a partner of unknown serostatus (aPR 1.18; 95% CI 1.09-1.27), exclusively receptive anal sex role (aPR 1.16; 95% CI 1.03-1.30) or versatile sex role (aPR 1.17; 95% CI 1.06-1.30) compared to insertive. Syphilis was associated with reporting role versatility (aPR = 2.69; 95% CI 1.52-5.74). Sex work venues had higher syphilis prevalence 47% versus 28% in other venues, p value = 0.012. Venue-based testing may improve case finding.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Homossexualidade Masculina , Doenças Sexualmente Transmissíveis/prevenção & controle , Sífilis/diagnóstico , Pessoas Transgênero , Sorodiagnóstico da AIDS/métodos , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Peru/epidemiologia , Prevalência , Fatores de Risco , Trabalho Sexual , Parceiros Sexuais , Minorias Sexuais e de Gênero , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis , Sexo sem Proteção
6.
Sex Transm Dis ; 46(1): e3-e4, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30216232

RESUMO

Gyrase A genotyping reliably predicts Neisseria gonorrhoeae susceptibility to ciprofloxacin. It is unknown whether concurrent infections at different anatomic sites harbor different susceptibility profiles. We found a 3.2% frequency of discordant gyrase A genotypes among concurrent but anatomically separate N. gonorrhoeae infections diagnosed at 2 laboratories in Los Angeles.


Assuntos
DNA Girase/genética , Genótipo , Gonorreia/microbiologia , Neisseria gonorrhoeae/enzimologia , Neisseria gonorrhoeae/genética , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Ciprofloxacino/farmacologia , Farmacorresistência Bacteriana , Humanos , Los Angeles , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/efeitos dos fármacos , Estudos Retrospectivos
7.
Sex Transm Dis ; 46(6): e68-e69, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30516724

RESUMO

The incidence of syphilis is increasing. Syphilitic proctitis involving the rectal mucosa often presents with pain on defecation, rectal bleeding, or ulceration. We present a case of asymptomatic syphilitic proctitis diagnosed upon a routine screening colonoscopy.


Assuntos
Infecções Assintomáticas , Proctite/diagnóstico , Sífilis/diagnóstico , Antibacterianos/uso terapêutico , Colonoscopia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Proctite/tratamento farmacológico , Proctite/microbiologia , Proctite/patologia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Sífilis/tratamento farmacológico , Sífilis/microbiologia , Sífilis/patologia
8.
Sex Transm Infect ; 94(8): 589-593, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30126946

RESUMO

OBJECTIVE: Electronic (E) devices read and quantify lateral flow-based rapid tests, providing a novel approach to assay interpretation. We evaluated the performance of one E-reader for two dual HIV and syphilis immunoassays. METHODS: We enrolled men who have sex with men and transgender women >18 years of age seeking medical services at an STD clinic in Lima, Peru, between October 2016 and April 2017. Venous blood was tested using two dual HIV and syphilis antibody immunoassays (SD BIOLINE HIV/Syphilis Duo, Republic of Korea, and First Response HIV 1+2/Syphilis Combo, India). Reference testing included a fourth-generation ELISA for HIV antibodies and use of the Treponema pallidum particle agglutination assay for syphilis antibodies. Trained clinic staff visually inspected the immunoassay results, after which the immunoassays were read by the HRDR-200 E-reader (Cellmic, USA), an optomechanical smartphone attachment. We calculated the concordance of the E-reader with visual inspection, as well as the sensitivity of both rapid immunoassays, in detecting HIV and T. pallidum antibodies. RESULTS: On reference testing of 283 participant specimens, 34% had HIV antibodies and 46% had T. pallidum antibodies. Using First Response, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for T . pallidum and 97% (95% CI 95% to 99%) for HIV antibodies. Using SD BIOLINE, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for T. pallidum and 99% (95% CI 98% to 99%) for HIV antibodies. For both immunoassays, the sensitivity for HIV antibodies was 98% (95% CI 93% to 100%) and the sensitivity for T. pallidum antibodies was 81% (95% CI 73% to 87%). CONCLUSIONS: E-reader results correlated well with visual inspection. The sensitivities of both rapid assays were comparable with past reports. Further evaluation of the E-reader is warranted to investigate its utility in data collection, monitoring and documentation of immunoassay results.


Assuntos
Infecções por HIV/diagnóstico , Imunoensaio/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Smartphone , Sorodiagnóstico da Sífilis/instrumentação , Adulto , Anticorpos Antibacterianos/sangue , Feminino , Anticorpos Anti-HIV/sangue , Homossexualidade Masculina , Humanos , Imunoensaio/métodos , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Minorias Sexuais e de Gênero , Sífilis/sangue , Sorodiagnóstico da Sífilis/métodos , Pessoas Transgênero , Adulto Jovem
10.
Sex Health ; 15(3): 261-268, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30021680

RESUMO

Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis. METHODS: Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed. RESULTS: Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3-24.3). HIV infection (RR 2.22; 95% CI 1.54-3.21) and history of syphilis infection (RR 2.23; 95% 1.62-3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net. CONCLUSIONS: Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.


Assuntos
Homossexualidade Masculina/estatística & dados numéricos , Parceiros Sexuais/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Sífilis/transmissão , Pessoas Transgênero/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Internet , Masculino , Peru , Comportamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Sífilis/epidemiologia , Sexo sem Proteção , Adulto Jovem
11.
Sex Transm Dis ; 45(9): 632-635, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29509566

RESUMO

BACKGROUND: Mycoplasma genitalium is an important cause of bacterial sexually transmitted diseases. Diagnosis and susceptibility testing of M. genitalium are limited by the fastidious nature of the organism. Therefore, the prevalence of infection and azithromycin resistance are poorly studied. METHODS: We conducted an exploratory study on remnant clinical specimens. We collected remnant DNA from consecutive urine samples and clinical swabs (cervical/vaginal, rectal, and pharyngeal) previously tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the Cobas 4800 CT/NG assay (Roche Molecular Systems, Pleasanton, CA) between March-April 2017 from across the University of California, Los Angeles Health System. We then retrospectively tested all specimens with the ResistancePlus MG (550) kit, a molecular assay for the detection of M. genitalium and genetic mutations associated with azithromycin resistance. RESULTS: Among 500 specimens, the prevalence of M. genitalium was 1.1% (95% confidence interval [CI], 0.04%-3.0%) in urine samples (n = 362), 17.4% (95% CI, 5.7%-39.6%) in rectal swabs (n = 23), and 1.9% (95% CI, 0.3%-7.3%) in cervical/vaginal swabs (n = 106). The prevalence of N. gonorrhoeae was 0.6% in urine samples and 4.3% in rectal swabs, whereas the prevalence of C. trachomatis was 2.2% in urine samples, 4.3% in rectal swabs and 3.8% in cervical/vaginal swabs. Of the 10 M. genitalium positive specimens, 8 (80.0%) had a mutation associated with azithromycin resistance. CONCLUSIONS: The prevalence of M. genitalium infection in our population varied by anatomic site of infection. Most M. genitalium infections had at least 1 mutation associated with azithromycin resistance.


Assuntos
Antibacterianos/farmacologia , Azitromicina/farmacologia , Farmacorresistência Bacteriana/genética , Infecções por Mycoplasma/microbiologia , Mycoplasma genitalium/genética , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Colo do Útero/microbiologia , DNA Bacteriano/urina , Feminino , Humanos , Los Angeles/epidemiologia , Mutação , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium/efeitos dos fármacos , Faringe/microbiologia , Prevalência , Reto/microbiologia , Estudos Retrospectivos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia
13.
Sex Transm Dis ; 45(2): 87-91, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29329176

RESUMO

BACKGROUND: Novel approaches to combating drug-resistant Neisseria gonorrhoeae infections are urgently needed. Targeted therapy with ciprofloxacin has been made possible by a rapid assay for genotyping the gyrase A (gyrA) gene; a nonmutated gene reliably predicts susceptibility to ciprofloxacin. METHODS: We determined the costs of running the gyrA assay, 500 mg of ciprofloxacin, 250 mg of ceftriaxone injection, and 1000 mg of azithromycin. Cost estimates for gyrA testing included assay reagents and labor. Cost estimates for ceftriaxone included medication, injection, administration, supplies, and equipment. We measured the cost of using the gyrA assay and treatment based on genotype using previously collected data over a 13-month period between November 2015 and November 2016 for all N. gonorrhoeae cases diagnosed at UCLA. We subsequently developed 3 cost models, varying the frequency of testing and prevalence of N. gonorrhoeae infections with ciprofloxacin-resistant or genotype-indeterminate results. We compared those estimates with the cost of recommended 2-drug therapy (ceftriaxone and azithromycin). RESULTS: Based on a 65.3% prevalence of cases with ciprofloxacin-resistant or genotype indeterminate N. gonorrhoeae infections when running an average of 1.7 tests per day, the per-case cost of gyrA genotyping and targeted therapy was US $197.19. The per-case cost was US $155.16 assuming a 52.6% prevalence of ciprofloxacin-resistant or genotype-indeterminate infections when running an average of 17 tests per day. The per-case cost of 2-drug therapy was US $142.75. CONCLUSIONS: Direct costs of gyrA genotyping and targeted ciprofloxacin therapy depend on the prevalence of ciprofloxacin-resistant or genotype-indeterminate infections and testing frequency.


Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , DNA Girase/genética , Farmacorresistência Bacteriana , Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/enzimologia , Azitromicina/uso terapêutico , California/epidemiologia , Ceftriaxona/uso terapêutico , Custos e Análise de Custo , DNA Girase/efeitos dos fármacos , Genótipo , Técnicas de Genotipagem/economia , Gonorreia/microbiologia , Humanos , Neisseria gonorrhoeae/efeitos dos fármacos , Estudos Retrospectivos
14.
Int J STD AIDS ; 29(6): 568-576, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29183269

RESUMO

Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.


Assuntos
Canal Anal/microbiologia , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Faringe/microbiologia , Pessoas Transgênero , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/isolamento & purificação , Estudos de Coortes , Estudos Transversais , Feminino , Gonorreia/diagnóstico , Gonorreia/microbiologia , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Técnicas Microbiológicas/métodos , Neisseria gonorrhoeae/isolamento & purificação , Peru/epidemiologia , Prevalência , Estudos Prospectivos , Transexualidade , Adulto Jovem
15.
Emerg Infect Dis ; 23(9): 1581-1584, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28820375

RESUMO

We investigated the epidemiology of the mutant gyrase A gene, a reliable predictor of ciprofloxacin resistance, in Neisseria gonorrhoeae infections at UCLA Health in Los Angeles, California, USA, during November 1, 2015-August 31, 2016. Among 110 patients with N. gonorrhoeae infections, 48 (44%) had the mutant gyrase A gene.


Assuntos
DNA Girase/genética , Farmacorresistência Bacteriana/genética , Genótipo , Gonorreia/epidemiologia , Neisseria gonorrhoeae/genética , Adolescente , Adulto , Antibacterianos/farmacologia , Ciprofloxacino/farmacologia , DNA Girase/metabolismo , Feminino , Expressão Gênica , Gonorreia/diagnóstico , Gonorreia/microbiologia , Gonorreia/transmissão , Humanos , Los Angeles/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Epidemiologia Molecular , Mutação , Neisseria gonorrhoeae/classificação , Neisseria gonorrhoeae/isolamento & purificação , Prevalência
16.
Sex Transm Dis ; 44(5): 261-265, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28407640

RESUMO

Multidrug-resistant Neisseria gonorrhoeae infections have been declared 1 of the top 3 urgent threats to public health. Approaches to combat resistance include targeted therapy with antibiotics previously thought to be ineffective, made possible by rapid molecular assays to predict susceptibility. Previous studies have associated the gyrase A (gyrA) gene of N. gonorrhoeae with in vitro resistance to ciprofloxacin. We conducted a systematic review of studies comparing N. gonorrhoeae gyrA genotype results with conventional antimicrobial susceptibility testing results. We identified 31 studies meeting inclusion criteria, among which 7 different loci for mutations in the gyrA gene were identified, from 16 countries between the years of 1996 and 2016. We then performed a meta-analysis among those studies stratifying by use of real-time polymerase chain reaction (PCR) or non-real-time PCR technique, and compared the summary receiver operating characteristic curves between the 2 PCR methods. Among studies using real-time PCR, the pooled estimate of sensitivity and specificity of gyrA genotype results for the prediction of N. gonorrhoeae susceptibility to ciprofloxacin were 98.2% (95% confidence interval [CI], 96.5-99.1%) and 98.6% (95% CI, 97.0-99.3%), respectively. The summary operating characteristic curves for studies using real-time PCR techniques were well separated from those using non-real-time PCR techniques, with only slight overlap in the CIs, suggesting that real-time PCR techniques were a more accurate approach. GyrA genotype testing is a novel approach to combating the emergence of multidrug-resistant N. gonorrhoeae and is a sensitive and specific method to predict in vitro ciprofloxacin susceptibility.


Assuntos
Antibacterianos/farmacologia , Ciprofloxacino/farmacologia , DNA Girase/genética , Farmacorresistência Bacteriana/genética , Gonorreia/microbiologia , Neisseria gonorrhoeae/enzimologia , Genótipo , Gonorreia/tratamento farmacológico , Humanos , Mutação , Neisseria gonorrhoeae/efeitos dos fármacos , Neisseria gonorrhoeae/genética , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas
19.
Int J STD AIDS ; 28(2): 138-144, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-26846151

RESUMO

Chlamydia trachomatis and Neisseria gonorrhoeae are among the most common sexually transmitted bacterial infections in the world. Data are limited, however, on the burden of extra-genital chlamydial and gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Data were gathered from self-collected anal or pharyngeal swabs from participants in Lima, Peru, and analyzed via cross-sectional methods. Prevalence ratios for the association between extra-genital infection with socio-demographic and sexual behaviors were determined. Overall, 127 (32.8%) participants had anal or pharyngeal infections. On multivariate modeling, anal infection was positively associated with practicing both receptive and insertive anal sex, when compared to insertive alone (PR = 2.49; 95% CI = 1.32-4.71), and negatively associated with any antibiotic use in the prior three months (PR = 0.60; 95% CI = 0.39-0.91). Pharyngeal infection was negatively associated with age greater than 30 years compared to 18-30 years (PR = 0.54; 95% CI = 0.30-0.96), and positively associated with gender identity of transgender women (PR = 2.12; 95% CI = 1.20-3.73). This study demonstrates considerable burden of extra-genital chlamydial and gonococcal infections among men who have sex with men and transgender women in Lima, Peru.


Assuntos
Canal Anal/microbiologia , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Homossexualidade Masculina , Faringe/microbiologia , Pessoas Transgênero , Adolescente , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/isolamento & purificação , Estudos Transversais , Feminino , Gonorreia/diagnóstico , Gonorreia/microbiologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Peru/epidemiologia , Prevalência , Adulto Jovem
20.
Clin Infect Dis ; 64(9): 1268-1270, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28034887

RESUMO

Multidrug-resistant Neisseria gonorrhoeae is a top threat to public health. In November 2015, UCLA Health introduced a rapid gyrase A (gyrA) genotypic assay for prediction of Neisseria gonorrhoeae susceptibility to ciprofloxacin. We found a significant reduction in ceftriaxone use with a concomitant increase in targeted therapy.


Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Técnicas de Genotipagem/métodos , Gonorreia/tratamento farmacológico , Gonorreia/microbiologia , Testes de Sensibilidade Microbiana/métodos , Neisseria gonorrhoeae/genética , Ceftriaxona/uso terapêutico , DNA Girase/genética , Uso de Medicamentos , Feminino , Humanos , Masculino , Neisseria gonorrhoeae/classificação , Neisseria gonorrhoeae/isolamento & purificação
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