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1.
PLoS One ; 15(5): e0232777, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379802

RESUMO

BACKGROUND: The surveillance of emm types and macrolide susceptibility of group A streptococcus (GAS) in various areas and time periods enhances the understanding of the epidemiology of GAS infections and may guide treatment strategies and the formulation of type-specific vaccines. Greece has emerged as a country with high macrolide use. However, studies suggest a gradual reduction in macrolide consumption after 2007. METHODS: During a 7-year period (2011-2017), 604 GAS isolates were recovered from consecutive children presenting with pharyngeal or nonpharyngeal infections in Central Greece; 517 viable isolates underwent molecular analysis, including emm typing. RESULTS: Isolates belonged to 20 different emm types (in decreasing order of prevalence: 1, 89, 4, 12, 28, 3, 75 and 6, accounting for 88.2% of total isolates). The emm types comprised 10 emm clusters (five most common clusters: E4, A-C3, E1, A-C4 and A-C5). The emm89 isolates were acapsular ('new clade'). Overall macrolide resistance rate was 15.4%, and cMLSB emerged as the predominant resistance phenotype (56.4%). The lowest annual resistance rates occurred in 2014 (13.1%), 2016 (5.5%) and 2017(8.0%) (P for trend = 0.002). Consumption of macrolide/lincosamide/streptogramin B declined by 22.6% during 2011-2017. Macrolide resistance and emm28 and emm77 types were associated (both P<0.001). The most frequently identified genetic lineages of macrolide-resistant GAS included emm28/ST52, emm77/ST63, emm12/ST36, emm89/ST101 and emm4/ST39. We estimated that 98.8% of the isolates belonged to emm types incorporated into a novel 30-valent M protein vaccine. CONCLUSIONS: In Central Greece during 2011-2017, the acapsular emm89 isolates comprised the second most prevalent type. Susceptibility testing and molecular analyses revealed decreasing GAS macrolide resistance rates, which may be attributed to the reduction in the consumption of macrolides and/or the reduced circulation of macrolide-resistant clones in recent years. Such data may provide valuable baseline information in targeting therapeutic intervention and the formulation of type-specific GAS vaccines.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Macrolídeos/uso terapêutico , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Adolescente , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Criança , Pré-Escolar , Feminino , Grécia/epidemiologia , Humanos , Lactente , Masculino , Tipagem de Sequências Multilocus , Doenças Faríngeas/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/genética
2.
PLoS One ; 15(1): e0227985, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945133

RESUMO

Pharyngeal gonorrhoea is a common sexually transmitted infection among 'men having sex with other men' (MSM). Neisseria gonorrhoeae (NG) pharyngeal infections are usually characterized by the absence of symptoms, acting as an important reservoir for their further spread. To the best of our knowledge, no information about the composition of the pharyngeal microbiome during an ongoing NG infection is currently available. Therefore, in this study, we characterized the pharyngeal bacterial community profiles associated with NG infection in a well-selected cohort of HIV-negative MSM reporting unsafe oral intercourse. A total of 70 pharyngeal swabs were considered, comparing non-infected subjects (n = 45) versus patients with pharyngeal gonorrhoea (n = 25) whose microbiota composition was analyzed from pharyngeal swabs through sequencing of hypervariable V3-V4 regions of the 16S rRNA gene. The pharyngeal microbiome of all subjects was dominated by Prevotellaceae, Veillonellaceae and Streptococcaceae families. Patients with pharyngeal gonorrhoea harboured a pharyngeal microbiome quite similar to negative subjects. Nevertheless, when looking to less-represented bacterial species (relative abundance approximately 1% or less), an imbalance between aerobe and anaerobe microorganisms was observed in NG-infected patients. In particular, the pharyngeal microbiome of NG-positive individuals was richer in several anaerobes (e.g. Treponema, Parvimonas, Peptococcus, Catonella, Filifactor) and poorer in various aerobe genera (i.e. Pseudomonas, Escherichia), compared to non-infected controls. No significant differences were noticed in the distribution of commensal Neisseria species of the oropharynx between NG-positive and negative subjects. Metabolic variations induced by changes in the microbiome abundance were assessed by a functional prediction of the bacterial metabolic pathways: a more abundant involvement of D-glutamine and D-glutamate metabolism, carbohydrate metabolism, as well as a greater activation of the energy metabolism was observed in patients with pharyngeal gonorrhoea compared to non-infected individuals. Information about the bacterial composition of the pharyngeal microbiome in case of gonorrhoea could shed light on the pathogenesis of the infection and open new perspectives for the prevention and control of this condition.


Assuntos
Gonorreia/microbiologia , Microbiota/genética , Doenças Faríngeas/microbiologia , Faringe/microbiologia , RNA Ribossômico 16S , Estudos de Coortes , Humanos , Itália , Masculino , Minorias Sexuais e de Gênero , Sexo sem Proteção
3.
BMJ Case Rep ; 12(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31494583

RESUMO

Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Francisella tularensis 1 Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.


Assuntos
Francisella tularensis/isolamento & purificação , Linfonodos/patologia , Linfadenite/cirurgia , Doenças Faríngeas/cirurgia , Tularemia/microbiologia , Abscesso , Antibacterianos/uso terapêutico , Pré-Escolar , Drenagem , Febre/microbiologia , Gentamicinas/uso terapêutico , Humanos , Linfadenite/microbiologia , Masculino , Doenças Faríngeas/microbiologia , Faringite/microbiologia , Resultado do Tratamento , Tularemia/fisiopatologia , Tularemia/terapia
4.
Lancet ; 393(10190): 2511-2520, 2019 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-31056291

RESUMO

BACKGROUND: Gonorrhoea is a common sexually transmitted infection for which ceftriaxone is the current first-line treatment, but antimicrobial resistance is emerging. The objective of this study was to assess the effectiveness of gentamicin as an alternative to ceftriaxone (both combined with azithromycin) for treatment of gonorrhoea. METHODS: G-ToG was a multicentre, parallel-group, pragmatic, randomised, non-inferiority trial comparing treatment with gentamicin to treatment with ceftriaxone for patients with gonorrhoea. The patients, treating physician, and assessing physician were masked to treatment but the treating nurse was not. The trial took place at 14 sexual health clinics in England. Adults aged 16-70 years were eligible for participation if they had a diagnosis of uncomplicated genital, pharyngeal, or rectal gonorrhoea. Participants were randomly assigned to receive a single intramuscular dose of either gentamicin 240 mg (gentamicin group) or ceftriaxone 500 mg (ceftriaxone group). All participants also received a single 1 g dose of oral azithromycin. Randomisation (1:1) was stratified by clinic and performed using a secure web-based system. The primary outcome was clearance of Neisseria gonorrhoeae at all initially infected sites, defined as a negative nucleic acid amplification test 2 weeks post treatment. Primary outcome analyses included only participants who had follow-up data, irrespective of the baseline visit N gonorrhoeae test result. The margin used to establish non-inferiority was a lower confidence limit of 5% for the risk difference. This trial is registered with ISRCTN, number ISRCTN51783227. FINDINGS: Of 1762 patients assessed, we enrolled 720 participants between Oct 7, 2014, and Nov 14, 2016, and randomly assigned 358 to gentamicin and 362 to ceftriaxone. Primary outcome data were available for 306 (85%) of 362 participants allocated to ceftriaxone and 292 (82%) of 358 participants allocated to gentamicin. At 2 weeks after treatment, infection had cleared for 299 (98%) of 306 participants in the ceftriaxone group compared with 267 (91%) of 292 participants in the gentamicin group (adjusted risk difference -6·4%, 95% CI -10·4% to -2·4%). Of the 328 participants who had a genital infection, 151 (98%) of 154 in the ceftriaxone group and 163 (94%) of 174 in the gentamicin group had clearance at follow-up (adjusted risk difference -4·4%, -8·7 to 0). For participants with a pharyngeal infection, a greater proportion receiving ceftriaxone had clearance at follow-up (108 [96%] in the ceftriaxone group compared with 82 [80%] in the gentamicin group; adjusted risk difference -15·3%, -24·0 to -6·5). Similarly, a greater proportion of participants with rectal infection in the ceftriaxone group had clearance (134 [98%] in the ceftriaxone group compared with 107 [90%] in the gentamicin group; adjusted risk difference -7·8%, -13·6 to -2·0). Thus, we did not find that a single dose of gentamicin 240 mg was non-inferior to a single dose of ceftriaxone 500 mg for the treatment of gonorrhoea, when both drugs were combined with a 1 g dose of oral azithromycin. The side-effect profiles were similar between groups, although severity of pain at the injection site was higher for gentamicin (mean visual analogue pain score 36 of 100 in the gentamicin group vs 21 of 100 in the ceftriaxone group). INTERPRETATION: Gentamicin is not appropriate as first-line treatment for gonorrhoea but remains potentially useful for patients with isolated genital infection, or for patients who are allergic or intolerant to ceftriaxone, or harbour a ceftriaxone-resistant isolate. Further research is required to identify and test new alternatives to ceftriaxone for the treatment of gonorrhoea. FUNDING: UK National Institute for Health Research.


Assuntos
Azitromicina/administração & dosagem , Ceftriaxona/administração & dosagem , Gentamicinas/administração & dosagem , Gonorreia/tratamento farmacológico , Doenças Faríngeas/tratamento farmacológico , Doenças Faríngeas/microbiologia , Adolescente , Adulto , Idoso , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Inglaterra , Feminino , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
5.
Intern Med ; 58(15): 2251-2255, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996173

RESUMO

We herein report a patient with syphilitic cervicitis and cervical cancer presenting as oropharyngeal syphilis. A 31-year-old Japanese woman with a history of unprotected vaginal and oral sex visited our hospital with right submandibular adenomas and erythema in the extremities. The fornix uteri was red, with a nodule noted. The rapid plasma reagin ratio was 1:3. She was diagnosed with syphilitic cervicitis and treated with amoxicillin for four weeks. Initial cervical cytology showed cells with mild nuclear enlargement, which was thought to be metaplasia associated with syphilis. Repeated cytology a month later showed a high-grade squamous intraepithelial lesion. A punch biopsy of the lesion led to the pathological diagnosis of cervical carcinoma in situ. We performed cervical conization, and no recurrence occurred. Human papillomavirus (HPV) immunostaining was positive in the lesion. Mucosal lesions are an infrequently reported symptom of syphilis. When oropharyngeal lesions are found, the sexual history should be ascertained, and the patient should be screened for sexually transmitted diseases. HPV is especially significant because of its association with cervical cancer. Coinfection of HPV with cervical cancer must be ruled out during follow-up for women when oropharyngeal syphilis involves genital lesions.


Assuntos
Doenças da Boca/complicações , Doenças Faríngeas/complicações , Sífilis/complicações , Neoplasias do Colo do Útero/complicações , Cervicite Uterina/complicações , Adulto , Amoxicilina , Biópsia , Citodiagnóstico , Feminino , Humanos , Doenças da Boca/microbiologia , Recidiva Local de Neoplasia/patologia , Infecções por Papillomavirus/complicações , Doenças Faríngeas/microbiologia , Sífilis/tratamento farmacológico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Cervicite Uterina/microbiologia
6.
Dan Med J ; 66(2)2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30722825

RESUMO

INTRODUCTION: We aimed to investigate doctors' ad-herence to the local antibiotic guidelines for treatment of patients admitted with acute pharyngeal infections and to identify patient-related risk factors for non-adherence. METHODS: All patients with acute tonsillitis, peritonsillar abscess (PTA), and parapharyngeal abscess admitted to the Ear-Nose-Throat Department, Aarhus University Hospital, in the 2001-2014 period were included in the study. RESULTS: In total, 2,567 patients were hospitalised with acute pharyngeal infection. In non-allergic patients, penicillin was prescribed to 81%, either alone (48%) or in combination with metronidazole (33%). Macrolides (54%) and cefuroxime (44%) were the drugs of choice in 85 (98%) patients who were allergic to penicillin. Patients were prescribed antibiotics according to guidelines in 63% of cases. The addition of metronidazole to penicillin was the main (75% of cases) reason for non-adherence. Increasing patient age and male gender were independent risk factors for non-adherence. PTA patients treated according to the guidelines had a significantly shorter hospital stay than patients treated with additional metronidazole or broad-spectrum antibiotics. CONCLUSIONS: A significant (37%) proportion of patients with acute pharyngeal infections were treated non-adherently to antibiotic guidelines, mainly because of (inappropriate) addition of metronidazole to penicillin. FUNDING: This work was supported by the Lundbeck Foundation (Grant number R185-2014-2482). TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency.


Assuntos
Antibacterianos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Penicilinas/uso terapêutico , Doenças Faríngeas/tratamento farmacológico , Doença Aguda , Adulto , Antibacterianos/normas , Dinamarca , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Metronidazol/normas , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Penicilinas/normas , Abscesso Peritonsilar/tratamento farmacológico , Abscesso Peritonsilar/microbiologia , Doenças Faríngeas/microbiologia , Tonsilite/tratamento farmacológico
7.
Br J Oral Maxillofac Surg ; 56(10): 962-967, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30470621

RESUMO

We retrospectively studied the clinical features, complications, and outcomes of deep neck infections in 31 adult patients with the human immunodeficiency virus (HIV) (HIV group) and 192 patients without (non-HIV group). In the HIV group, the cause was more likely to be odontogenic (21 (68%) compared with 90 (47%); odds ratio (OR) 2.38; 95% CI 1.06 to 5.32). In both groups, the parapharyngeal, submandibular, and masticator spaces, were those most often involved. However, in the HIV group, Ludwig's angina was common, and was the main cause of airway obstruction. Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were most often isolated in the HIV group. Upper airway obstruction tended to be more common in the HIV group (5/31 compared with 13/192). These patients also had a higher risk of other complications (sepsis, mediastinitis, jugular vein thrombosis, and pneumonia) (6/31 compared with 12/192; OR 3.60; 95% CI 1.24 to 10.45), a higher mortality rate (3/31 compared with 2/192), and longer hospital stay (19days compared with 16 days). Factors associated with an increased risk of complications in this group were an age of 55 years or over and a CD4 count of less than 350 cells/mm3. Deep neck infections in these patients are more severe. Dental health care, appropriate empirical antibiotics, early detection, and management of the airway and complications, may improve outcomes.


Assuntos
Infecções Bacterianas/patologia , Infecções por HIV/complicações , Pescoço , Infecções Bacterianas/etiologia , Infecções Bacterianas/microbiologia , Estudos de Casos e Controles , Feminino , HIV , Infecções por HIV/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cistos Odontogênicos/etiologia , Cistos Odontogênicos/microbiologia , Cistos Odontogênicos/patologia , Doenças Faríngeas/etiologia , Doenças Faríngeas/microbiologia , Doenças Faríngeas/patologia , Estudos Retrospectivos , Fatores de Risco , Sialadenite/etiologia , Sialadenite/microbiologia , Sialadenite/patologia
9.
Med Clin North Am ; 102(6): 1109-1120, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30342612

RESUMO

Infections of the head and neck are common and appropriately managed by primary care providers in most cases. However, some infections are associated with significant morbidity and require urgent recognition and management by specialty services. These include deep neck space infections originating in the oral cavity, pharynx, and salivary glands, as well as complicated otologic and sinonasal infection. This article provides a review of these conditions, including the pathophysiology, presenting features, and initial management strategy.


Assuntos
Infecções Bacterianas/diagnóstico , Cabeça/microbiologia , Pescoço/microbiologia , Atenção Primária à Saúde/métodos , Humanos , Doenças Faríngeas/microbiologia , Infecções Respiratórias/microbiologia , Sinusite/microbiologia , Tonsilite/microbiologia
11.
Sex Health ; 15(4): 342-349, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29973330

RESUMO

Background Mathematical models have demonstrated that the majority of gonococcal transmission is from oropharynx to oropharynx (i.e. kissing) among men who have sex with men (MSM). The aim of this study is to investigate the association between the number of partners within specific time periods and gonorrhoea and chlamydia positivity. METHODS: This was a retrospective data analysis of MSM attending the Melbourne Sexual Health Centre between 2007 and 2016. Univariable and multivariable logistic regression analyses, with generalised estimating equations (GEE), were performed to determine if the number of partners within specified time periods was associated with site-specific gonorrhoea and chlamydia positivity. RESULTS: There were 45933 consultations which included 15197 MSM. Oropharyngeal gonorrhoea positivity was associated with the number of partners in the past 3 months, but not the number of partners 4-12 months ago; men who had ≥6 partners in the past 3 months had significantly higher odds of acquiring oropharyngeal gonorrhoea (aOR 1.93; 95% CI 1.61-2.31), but this was not the case for men who had ≥6 partners 4-12 months ago. Anorectal gonorrhoea and chlamydia and urethral chlamydia were associated with the number of partners in both time periods after adjusting for age and condom use. CONCLUSIONS: The association of oropharyngeal gonorrhoea with the number of recent partners, but not partners from an earlier period, unlike anorectal gonorrhoea and anorectal and urethral chlamydia, could be explained by a shorter duration of oropharyngeal gonococcal infection. Annual screening for gonorrhoea may be insufficient to materially reduce oropharyngeal prevalence.


Assuntos
Infecções por Chlamydia/metabolismo , Gonorreia/microbiologia , Homossexualidade Masculina/estatística & dados numéricos , Doenças da Boca/microbiologia , Doenças Faríngeas/microbiologia , Parceiros Sexuais/psicologia , Adulto , Humanos , Masculino , Orofaringe/microbiologia , Estudos Retrospectivos , Comportamento Sexual , Saúde Sexual , Adulto Jovem
12.
Acta Med Port ; 31(5): 247-253, 2018 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-29916355

RESUMO

INTRODUCTION: Recent studies worldwide reveal a significant prevalence of extragenital infections by Neisseria gonorrhoeae among men who have sex with men. We aimed to analyse the frequency and characteristics of extragenital gonococcal infections diagnosed in men who have sex with men in a walk-in Sexually Transmitted Infection clinic in Lisbon, Portugal. MATERIAL AND METHODS: We conducted a cross-sectional, retrospective study of the anorectal and/or oropharyngeal Neisseria gonorrhoeae infections in men who have sex with men, diagnosed in our Sexually Transmitted Infection clinic between January 2014 and December 2016. RESULTS: We found extragenital infection in 87 cases of gonorrhoea identified in men who have sex with men in this period, including: 49 cases of anorectal disease, 9 of oropharyngeal disease, 13 cases of infection at both extragenital sites, and 16 of simultaneous extragenital and urogenital gonorrhoea. Patients' ages ranged from 17 to 64 years (median: 28 years). Forty-seven (54%) of the patients did not present with any extragenital symptoms. Thirty (35%) were human immunodeficiency virus-1-positive. DISCUSSION: Since most extragenital Neisseria gonorrhoeae infections are asymptomatic, they may be missed and go untreated unless actively investigated. Current international guidelines recommend the screening of gonorrhoea at extragenital sites in men who have sex with men because anorectal and oropharyngeal infections constitute a potential disease reservoir, and may facilitate transmission and/or acquisition of human immunodeficiency virus infection. CONCLUSION: Our results highlight the relevance of testing men who have sex with men for Neisseria gonorrhoeae at extragenital sites, regardless of the existence of local complaints. The implementation of adequate screening programmes in Portugal should be considered. We also reinforce the need to raise awareness in the population regarding the adoption of prophylactic measures against transmission of sexually transmitted infections during anal and/or oral sexual exposure.


Assuntos
Gonorreia , Orofaringe , Doenças Faríngeas/microbiologia , Doenças Retais/microbiologia , Adolescente , Adulto , Estudos Transversais , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Instalações de Saúde , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/epidemiologia , Portugal , Doenças Retais/diagnóstico , Doenças Retais/epidemiologia , Estudos Retrospectivos , Saúde da População Urbana , Adulto Jovem
13.
Clin Infect Dis ; 67(4): 504-512, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29617982

RESUMO

Background: In this phase 2 study, we evaluated the efficacy and safety of oral gepotidacin, a novel triazaacenaphthylene bacterial type II topoisomerase inhibitor, for the treatment of uncomplicated urogenital gonorrhea. Methods: Adult participants with suspected urogenital gonorrhea were enrolled and completed baseline (day 1) and test-of-cure (days 4-8) visits. Pretreatment and posttreatment urogenital swabs were collected for Neisseria gonorrhoeae (NG) culture and susceptibility testing. Pharyngeal and rectal swab specimens were collected if there were known exposures. Participants were stratified by gender and randomized 1:1 to receive a 1500-mg or 3000-mg single oral dose of gepotidacin. Results: The microbiologically evaluable population consisted of 69 participants, with NG isolated from 69 (100%) urogenital, 2 (3%) pharyngeal, and 3 (4%) rectal specimens. Microbiological eradication of NG was achieved by 97%, 95%, and 96% of participants (lower 1-sided exact 95% confidence interval bound, 85.1%, 84.7%, and 89.1%, respectively) for the 1500-mg, 3000-mg, and combined dose groups, respectively. Microbiological cure was achieved in 66/69 (96%) urogenital infections. All 3 failures were NG isolates that demonstrated the highest observed gepotidacin minimum inhibitory concentration of 1 µg/mL and a common gene mutation. At the pharyngeal and rectal sites, 1/2 and 3/3 NG isolates, respectively, demonstrated microbiological cure. There were no treatment-limiting adverse events for either dose. Conclusions: This study demonstrated that single, oral doses of gepotidacin were ≥95% effective for bacterial eradication of NG in adult participants with uncomplicated urogenital gonorrhea. Clinical Trials Registration: NCT02294682.


Assuntos
Acenaftenos/administração & dosagem , Antibacterianos/administração & dosagem , Doenças Urogenitais Femininas/tratamento farmacológico , Gonorreia/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Doenças Urogenitais Masculinas/tratamento farmacológico , Acenaftenos/farmacologia , Administração Oral , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Esquema de Medicação , Feminino , Doenças Urogenitais Femininas/microbiologia , Compostos Heterocíclicos com 3 Anéis/farmacologia , Humanos , Masculino , Doenças Urogenitais Masculinas/microbiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neisseria gonorrhoeae/efeitos dos fármacos , Neisseria gonorrhoeae/isolamento & purificação , Doenças Faríngeas/microbiologia , Doenças Retais/microbiologia , Adulto Jovem
14.
Sex Transm Dis ; 45(9): 588-593, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29485543

RESUMO

BACKGROUND: The objective of this study was to examine the proportion of missed infections and correlates of pharyngeal gonorrhea among young people attending public sexually transmitted disease (STD) clinics. METHODS: We conducted a case-control study of 245 young men and women between April 2012 and May 2014. Participants were eligible for inclusion if they (1) were 15 to 29 years of age, (2) reported giving oral sex to a partner of the opposite sex in the past 90 days, and (3) attended 1 of 12 public STD clinics in Los Angeles County. Computer-assisted self-interviews were used to collect information on sexual behaviors and tests were conducted for pharyngeal and urogenital gonorrhea. RESULTS: Most participants were younger than 25 years (69%) and more than half were female (56%). We identified a total of 64 cases (27%) of gonorrhea, of which 29 (45%) were a urogenital only infection, 18 (28%) were a pharyngeal only, and 17 (27%) were dually infected at both sites. Pharyngeal testing increased case finding by 39% from 46 to 64 cases. After adjusting for age, sex, and number of sex partners, those who reported consistent pharyngeal exposure to ejaculate/vaginal fluids were 3 times as likely to have pharyngeal gonorrhea as compared with those without this exposure (adjusted odds ratio, 3.1; 95% confidence interval, 1.3-7.5). CONCLUSIONS: A large proportion of gonorrhea cases among young people would be missed in the absence of pharyngeal testing. These results have implications for those who provide medical care to clients at STD clinics and highlight the need for pharyngeal screening recommendations and counseling messages related to strategies to reduce exposure to infected fluids.


Assuntos
Doenças Urogenitais Femininas/diagnóstico , Gonorreia/diagnóstico , Doenças Urogenitais Masculinas/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Doenças Faríngeas/diagnóstico , Adolescente , Adulto , Instituições de Assistência Ambulatorial , California/epidemiologia , Estudos de Casos e Controles , Feminino , Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Femininas/microbiologia , Doenças Urogenitais Femininas/prevenção & controle , Gonorreia/epidemiologia , Gonorreia/microbiologia , Gonorreia/prevenção & controle , Humanos , Masculino , Doenças Urogenitais Masculinas/epidemiologia , Doenças Urogenitais Masculinas/microbiologia , Doenças Urogenitais Masculinas/prevenção & controle , Programas de Rastreamento , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/microbiologia , Doenças Faríngeas/prevenção & controle , Faringe/microbiologia , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Adulto Jovem
15.
Sex Transm Dis ; 45(3): 195-198, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29419710

RESUMO

Neisseria gonorrhoeae and Chlamydia trachomatis screening was performed in a cohort of 100 men who have sex with men. A nucleic acid amplification test on a pooled sample of first-pass urine, pharyngeal, and anorectal specimens was compared with results on nonpooled samples. Despite an excellent agreement (Cohen κ, 0.932), pooling specimens reduced test sensitivity to 89.5%.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Doenças Faríngeas/diagnóstico , Doenças Retais/diagnóstico , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Confiabilidade dos Dados , Gonorreia/microbiologia , Homossexualidade Masculina , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico , Doenças Faríngeas/microbiologia , Faringe/microbiologia , Doenças Retais/microbiologia , Sensibilidade e Especificidade , Adulto Jovem
16.
Sex Transm Dis ; 45(9): 594-599, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29465642

RESUMO

INTRODUCTION: Pharyngeal Neisseria gonorrhoeae infections are mostly asymptomatic, yet sustain ongoing gonococcal transmission. We assessed the proportion of pharyngeal gonorrhea that spontaneously clears and identified determinants of clearance. METHODS: At the sexually transmitted infections clinic Amsterdam, at-risk women and men who have sex with men were routinely screened for pharyngeal N. gonorrhoeae using an RNA-based nucleic acid amplification test (NAAT; Aptima Combo 2).We retrospectively examined medical records of pharyngeal gonorrhea patients (January 2012-August 2015). We included patients who returned for antibiotic treatment and had a new sample taken for NAAT before treatment. Spontaneous clearance was defined as a negative NAAT result at the follow-up visit. RESULTS: During the study period, 1266 cases with a pharyngeal gonorrhea were not treated at the first consultation and returned for a follow-up visit. Median (interquartile range) time between the first consultation and follow-up was 10 (7-14) days. Spontaneous clearance was found in 139 cases (11.0%) and was associated with age at least 45 years (vs. 16-24 years; adjusted odds ratio, 2.02 [95% confidence interval, 1.09-3.75]) and with time from the first consultation to follow-up (adjusted odds ratio, 1.08 [1.06-1.10], per extra day). CONCLUSIONS: Eleven percent of pharyngeal gonorrhea cases cleared spontaneously. Spontaneous clearance of pharyngeal gonorrhea was more often seen among older patients.


Assuntos
Antibacterianos/uso terapêutico , Gonorreia/microbiologia , Neisseria gonorrhoeae/isolamento & purificação , Doenças Faríngeas/microbiologia , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Feminino , Seguimentos , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Países Baixos/epidemiologia , Técnicas de Amplificação de Ácido Nucleico , Doenças Faríngeas/tratamento farmacológico , Doenças Faríngeas/epidemiologia , Faringe/microbiologia , Estudos Retrospectivos , Adulto Jovem
17.
Sex Transm Infect ; 94(5): 359-364, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29358525

RESUMO

OBJECTIVES: Oropharyngeal gonorrhoea is common among men who have sex with men (MSM). We aimed to clarify which oral sex practices were independent risk factors for oropharyngeal gonorrhoea: tongue kissing, receptive oro-penile sex (fellatio) or insertive oro-anal sex (rimming), and whether daily use of mouthwash and recent antibiotic use was protective. METHODS: In 2015, we conducted an age-matched case-control study of MSM who attended the Melbourne Sexual Health Centre. Cases had tested positive for oropharyngeal gonorrhoea by nucleic acid amplification testing, and controls had tested negative. Questionnaire items included tongue kissing, oral sex practices, condom use, recent antibiotic use, mouthwash use and alcohol consumption. RESULTS: We identified 177 cases, age matched to 354 controls. In univariable analyses, cases were 1.90 times (95% CI 1.13 to 3.20) more likely than controls to have had casual sexual partners (CSP) in the preceding 3 months, were 2.17 times (95% CI 1.31 to 3.59) more likely to have kissed CSP and were 2.04 times (95% CI 1.26 to 3.30) more likely to have had receptive oro-penile sex with CSP. Oropharyngeal gonorrhoea was not associated with insertive oro-anal sex or mouthwash use. The number of CSP for tongue kissing and receptive oral sex and total CSP were highly correlated, and in multivariable analysis neither kissing nor receptive oro-penile sex was significantly associated with having oropharyngeal gonorrhoea, after adjusting for total number of CSP. CONCLUSIONS: The finding that oropharyngeal gonorrhoea was associated with a higher number of sexual partners but not specific sexual practices highlights the need for further research in the area of gonorrhoea transmission to define the probability of transmission from specific sex acts.


Assuntos
Gonorreia/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Doenças da Boca/epidemiologia , Doenças da Boca/microbiologia , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Estudos de Casos e Controles , Gonorreia/complicações , Gonorreia/prevenção & controle , Gonorreia/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/prevenção & controle , Antissépticos Bucais/uso terapêutico , Doenças Faríngeas/prevenção & controle , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Inquéritos e Questionários , Adulto Jovem
18.
Sex Transm Infect ; 94(1): 3-8, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28698211

RESUMO

OBJECTIVES: To describe a series of extrarectal lymphogranuloma venereum (LGV) cases diagnosed in France. METHODS: Consecutive LGV cases confirmed at the French Reference Centre for chlamydiae with an extrarectal sample from January 2010 to December 2015 were included. The first part of the study consisted of a retrospective case note review and analysis. In a second part, the complete ompA gene sequence of our samples was determined. RESULTS: There were 56 cases overall: 50 cases of genital LGV and six cases of pharyngeal LGV. Subjects were all men, median age 39 years, 27/53 were HIV-positive, 47/51 reported having sex with other men, 43/49 reported multiple sexual partners (a mean 25 in the last 6 months). Median time from symptom onset to diagnosis was 21 days. Subjects most commonly presented with inguinal adenopathy alone (19 of 50 genital cases) and adenopathy with genital ulcer (17 of 50). Three pharyngeal cases were symptomatic. Fever was reported in 11 cases. Inguinal abscess was reported in 22 of 42 cases presenting with lymphadenopathy. Co-infections were frequent: eight cases of syphilis, four non-LGV Chlamydia trachomatis infections, one case of gonorrhoea. Cure was always achieved with doxycycline therapy but prolonged treatment was necessary in eight cases with inguinal abscess. Genotyping according to ompA sequencing showed the co-circulation of genovars L2 (16 of 42 strains successfully typed) and L2b (24 of 42). There was no association between HIV status and disease severity or genovar distribution. CONCLUSION: In the span of 6 years, 56 extrarectal LGV cases were confirmed through genotyping in France. Extrarectal LGV seemed to share a common epidemiological background with rectal disease in terms of affected population and genovar distribution. HIV prevalence was lower than expected.


Assuntos
Chlamydia trachomatis/genética , Linfogranuloma Venéreo/epidemiologia , Linfogranuloma Venéreo/microbiologia , Doenças Faríngeas/microbiologia , Doenças Retais/microbiologia , Adulto , Antibacterianos/uso terapêutico , Proteínas da Membrana Bacteriana Externa/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção/diagnóstico , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/virologia , Doxiciclina/uso terapêutico , França/epidemiologia , Genótipo , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Linfadenopatia/diagnóstico , Linfadenopatia/epidemiologia , Linfadenopatia/microbiologia , Linfogranuloma Venéreo/complicações , Linfogranuloma Venéreo/diagnóstico , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/epidemiologia , Faringe/microbiologia , Prevalência , Doenças Retais/epidemiologia , Reto/microbiologia , Estudos Retrospectivos , Análise de Sequência de DNA , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Adulto Jovem
19.
Sex Transm Infect ; 94(4): 293-297, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29066627

RESUMO

OBJECTIVES: Screening of men who have sex with men (MSM) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) requires sampling from anorectal and pharyngeal sites in addition to urogenital sampling. Due to the cost of testing multiple anatomical sites individually testing of pooled specimens has potential merit. The Cepheid GeneXpert CT/NG assay (GeneXpert), which also has potential for point-of-care nucleic acid testing in the sexual health clinic, has not been assessed for pooled specimen testing. METHODS: We prospectively compared GeneXpert testing of pooled pharyngeal and rectal swabs with urine samples to standard of care testing of individual specimens from 107 participants using the Roche cobas 4800 CT/NG assay (cobas) for CT and NG in high-risk MSM attending an inner city sexual health clinic. RESULTS: We found testing of pooled pharyngeal, rectal and urine samples by the GeneXpert to have 100% agreement for NG and 94% overall agreement for CT when compared with individual specimen testing by cobas. For CT testing, 14 cases were detected for both tests, 4for cobas only, 2 for GeneXpert only and 89 participants were negative for both tests. CONCLUSIONS: Pooled specimen CT and NG testing by the GeneXpert was accurate when compared with single specimen testing and has potential for screening MSM for CT and NG. The role of pooled specimen testing with the GeneXpert as a point-of-care nucleic acid test in MSM requires further investigation.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Homossexualidade Masculina/estatística & dados numéricos , Doenças Faríngeas/diagnóstico , Doenças Retais/diagnóstico , Adolescente , Adulto , Idoso , Infecções por Chlamydia/urina , Chlamydia trachomatis/isolamento & purificação , Gonorreia/urina , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico/métodos , Doenças Faríngeas/microbiologia , Doenças Faríngeas/urina , Estudos Prospectivos , Doenças Retais/microbiologia , Doenças Retais/urina , Manejo de Espécimes/métodos , Adulto Jovem
20.
Clin Infect Dis ; 66(4): 570-575, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29028971

RESUMO

Background: Anal sex is a common sexual behavior among women that increases their risk of acquiring rectal infection with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Methods: We estimated the frequency and positivity of rectal CT and GC tests for women aged 15-60 years performed by a large US commercial laboratory between November 2012 and September 2015. We also estimated the frequency and positivity of pharyngeal and genital specimens also performed on the same date. Among women with a positive CT or GC result, we estimated the frequency and positivity of recommended repeat testing within 12 months. Results: Of 5499 women who had rectal CT and GC tests, positivity was 10.8%. On the same date, approximately 80% also had genital CT tests, genital GC tests, and pharyngeal GC tests, while 40% had pharyngeal CT tests. Rectal CT or GC infection was associated with genital CT or GC infection, but 46.5% of rectal CT and GC infections would not have been identified with genital testing alone. Among women with a rectal CT or GC infection, only 20.0% had a recommended repeat rectal test. Of those who had a repeat test, 17.7% were positive. Conclusions: Testing women for rectal CT and GC was infrequent, but positive tests were often found in women with negative genital tests. Most women with positive rectal tests were not retested. Interventions are needed to increase extragenital CT and GC testing of at-risk women.


Assuntos
Infecções por Chlamydia/diagnóstico , Técnicas de Laboratório Clínico/estatística & dados numéricos , Gonorreia/diagnóstico , Faringe/microbiologia , Reto/microbiologia , Adolescente , Adulto , Chlamydia trachomatis/isolamento & purificação , Feminino , Humanos , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/microbiologia , Doenças Retais/diagnóstico , Doenças Retais/microbiologia , Comportamento Sexual , Estados Unidos , Adulto Jovem
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