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1.
PLoS Negl Trop Dis ; 14(1): e0008022, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971951

RESUMO

BACKGROUND: Chlamydia trachomatis is the most common bacterial sexually transmitted infection worldwide with some of the highest prevalence rates among Pacific Island Countries where syndromic management is practiced. However, little is known about the true prevalence and risk indicators for infection among neglected populations in these countries that suffer from health disparities. METHODOLOGY/PRINCIPAL FINDINGS: Consecutive sampling was used to enroll sexually active females, aged 18-40 years, attending 12 Fijian Ministry of Health and Medical Services Health Centers and outreach locations from February to December, 2018. A Behavioral Surveillance Survey was administered to assess risk indicators for infection. Signs and symptoms were recorded, and vaginal swabs were tested for C. trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida and bacterial vaginosis. Bivariate and multivariate logistic regression analyses were performed using R-Studio. Of 577 participants, 103 (17.85%) were infected with C. trachomatis of whom 80% were asymptomatic and only 11 met criteria for syndromic management; 38.8% of infected women were 18-24 years old with a prevalence of 30.5%. 91.7% of participants intermittently or did not use condoms. C. trachomatis infection was associated with iTaukei ethnicity (OR 21.41 [95% CI: 6.38-133.53]); two lifetime partners (OR 2.12 [95% CI: 1.08-4.18]); and N. gonorrhoeae co-infection (OR 9.56 [95% CI: 3.67-28.15]) in multivariate analyses. CONCLUSIONS: A disproportionately high burden of C. trachomatis is present among young asymptomatic women in Fiji of iTaukei ethnicity despite the low number of lifetime partners. Syndromic management and lack of barrier contraceptives contribute to hyperendemic levels. Strategic STI education and screening of at-risk adolescents, young women, and their partner(s) with appropriate treatment are urgently needed to control the epidemic.


Assuntos
Infecções por Chlamydia/microbiologia , Chlamydia trachomatis , Doenças Endêmicas , Doenças Sexualmente Transmissíveis/microbiologia , Vaginite/epidemiologia , Vaginite/microbiologia , Adolescente , Adulto , Feminino , Fiji/epidemiologia , Humanos , Grupo com Ancestrais Oceânicos , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
2.
PLoS One ; 15(1): e0224359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914129

RESUMO

Sexually transmitted infections (STIs) and vaginal dysbiosis (disturbed resident microbiota presenting with abnormal Nugent score or candidiasis) have been associated with mucosal inflammation and risk of HIV-1 infection, cancer and poor reproductive outcomes. To date, the temporal relationships between aberrant cervical innate immunity and the clinical onset of microbial disturbance have not been studied in a large population of reproductive age women. We examined data from a longitudinal cohort of 934 Ugandan and Zimbabwean women contributing 3,274 HIV-negative visits who had complete laboratory, clinical and demographic data. Among those, 207 women later acquired HIV, and 584 women were intermittently diagnosed with C. trachomatis (CT), N. gonorrhoeae (NG), genital herpes (HSV-2), T. vaginalis (TV), candidiasis, and abnormal intermediate (4-6) or high (7-10) Nugent score, i.e. bacterial vaginosis (BV). Immune biomarker concentrations in cervical swabs were analyzed by generalized linear and mixed effect models adjusting for site, age, hormonal contraceptive use (HC), pregnancy, breastfeeding, genital practices, unprotected sex and overlapping infections. High likelihood ratios (1.5-4.9) denoted the values of cervical immune biomarkers to predict onset of abnormal Nugent score and candidiasis at the next visits. When controlling for covariates, higher levels of ß-defensin-2 were antecedent to BV, CT and HSV-2, lower anti-inflammatory ratio IL-1RA:IL-1ß-to intermediate Nugent scores and candida, lower levels of the serine protease inhibitor SLPI-to candida, lower levels of the adhesion molecule ICAM-1 -to TV, and lower levels of the oxidative stress mitigator and endothelial activation marker VEGF-to NG. Changes in innate immunity following onset of dysbiosis and infections were dependent on HC use when controlling for all other covariates. In conclusion, imminent female genital tract dysbiosis or infection can be predicted by distinct patterns of innate immunity. Future research should characterize biotic and abiotic determinants of this pre-existing innate immunity state.


Assuntos
Disbiose/imunologia , Imunidade Inata/genética , Doenças Sexualmente Transmissíveis/imunologia , Vaginose Bacteriana/imunologia , Adolescente , Adulto , Biomarcadores/metabolismo , Colo do Útero/imunologia , Colo do Útero/microbiologia , Colo do Útero/patologia , Disbiose/epidemiologia , Disbiose/microbiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Molécula 1 de Adesão Intercelular/imunologia , Molécula 1 de Adesão Intercelular/metabolismo , Proteína Antagonista do Receptor de Interleucina 1/imunologia , Proteína Antagonista do Receptor de Interleucina 1/metabolismo , Interleucina-1beta/imunologia , Interleucina-1beta/metabolismo , Estresse Oxidativo/imunologia , Gravidez , Infecções do Sistema Genital/epidemiologia , Infecções do Sistema Genital/imunologia , Inibidor Secretado de Peptidases Leucocitárias/imunologia , Inibidor Secretado de Peptidases Leucocitárias/metabolismo , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Uganda/epidemiologia , Vagina/imunologia , Vagina/microbiologia , Vaginose Bacteriana/epidemiologia , Vaginose Bacteriana/microbiologia , Fator A de Crescimento do Endotélio Vascular/imunologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Zimbábue/epidemiologia
3.
Rev Chilena Infectol ; 36(3): 292-298, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859747

RESUMO

BACKGROUND: Pregnant woman is exposed to many sexual transmitted infections (STI). Many of these infections may produce diseases in the fetus and newborn, and also alteration in the normal course of the pregnancy. AIM: Screening of asymptomatic cervical infection in pregnant woman and its relationship with the vaginal microbiota. PATIENTS AND METHODS: 85 pregnant women without clinical cervicitis who consult in the routine pregnant control (47 patients) and women derived from STI service (38 patients). The samples were obtained from the vaginal fund sac and were analyzed with optic microscopy, cultures and PCR of Neisseria gonorrhoeae, Trichomonas vaginalis and Chlamydia trachomatis. RESULTS: 12,9% of the enrolled women were positive for C. trachomatis, 2,4% for T. vaginalis. In this study, we did not found N. gonorrhoeae. We observed 23,3% of patients with altered microbiota (bacterial vaginosis and intermediate microbiota) was positive for C. trachomatis. CONCLUSIONS: In this study, we found a high frequency of C. trachomatis infection, that correlates with the presence of altered microbiota. This high frequency would promote preventive strategies in the pregnant women routine controls.


Assuntos
Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/isolamento & purificação , Doenças Sexualmente Transmissíveis/diagnóstico , Tricomoníase/microbiologia , Trichomonas vaginalis/isolamento & purificação , Vagina/microbiologia , Adolescente , Adulto , Distribuição por Idade , Infecções Assintomáticas , Infecções por Chlamydia/diagnóstico , Feminino , Humanos , Programas de Rastreamento , Microbiota , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Doenças Sexualmente Transmissíveis/microbiologia , Fatores Socioeconômicos , Tricomoníase/diagnóstico , Adulto Jovem
5.
Infect Dis Obstet Gynecol ; 2019: 8639510, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31379424

RESUMO

Background: Sexually transmitted infections (STIs) are highly prevalent in sub-Saharan Africa. Genital self-sampling may facilitate the screening of STIs in hard-to-reach remote populations far from large health care centers and may increase screening rates. The cross-sectional GYNAUTO-STI study was carried out to assess the performance of a novel genital veil (V-Veil-Up Gyn Collection Device, V-Veil-Up Pharma, Ltd., Nicosia, Cyprus) as a genital self-sampling device to collect genital secretions to diagnose STIs by molecular biology as compared to reference clinician-collected genital specimens, in adult African women. Methods: Adult women living in N'Djamena, the capital city of Chad, were recruited from the community and referred to the clinic for women's sexual health "La Renaissance Plus". A clinician obtained an endocervical specimen using flocked swab. Genital secretions were also obtained by self-collection using veil. Both clinician- and self-collected specimens were tested for common curable STIs (including Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis) and genital Mycoplasma spp. by multiplex real-time PCR (Allplex™ STI Essential Assay, Seegene, Seoul, South Korea). Test positivities for both collection methods were compared by assessing methods agreement, sensitivity, and specificity. Results: A total of 251 women (mean age, 35.1 years) were prospectively enrolled. Only seven (2.8%) women were found to be infected with at least one common STIs [C. trachomatis: 3 (1.2%), N. gonorrhoeae: 1 (0.4%), M. genitalium: 4 (1.6%) and T. vaginalis: 1 (0.4%)], while the prevalence of genital mycoplasmas was much higher (54.2%) with a predominance of Ureaplasma parvum (42.6%). Self-collection by veil was non-inferior to clinician-based collection for genital microorganisms DNA molecular testing, with "almost perfect" agreement between both methods, high sensitivity (97.0%; 95%CI: 92.5-99.2%), and specificity (88.0%; 95%CI: 80.7-93.3%). Remarkably, the mean total number of genital microorganisms detected per woman was 1.14-fold higher in self-collected specimens compared to that in clinician-collected specimens. Conclusions: Veil-based self-collection of female genital secretions constitutes a convenient tool to collect in gentle way cervicovaginal secretions for accurate molecular detection of genital bacteria. Such sampling procedure could be easily implemented in STIs clinics in sub-Saharan Africa.


Assuntos
Reação em Cadeia da Polimerase Multiplex , Infecções por Mycoplasma/diagnóstico , Mycoplasma genitalium/isolamento & purificação , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/microbiologia , Manejo de Espécimes/instrumentação , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Idoso , Estudos Transversais , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium/genética , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/epidemiologia , Manejo de Espécimes/métodos , Adulto Jovem
7.
BMC Infect Dis ; 19(1): 494, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164096

RESUMO

BACKGROUND: A high proportion of men who have sex with men (MSM) use geosocial networking apps (Apps) to seek partners. However, the relationship of app use with HIV risk is unknown. Further, the risks of some sexually transmitted infection (STIs), including Mycoplasma genitalium, have seldom been studied among MSM. METHODS: MSM were enrolled at a community-based HIV testing site in Shenyang, China. After completing a questionnaire survey, we collected rectal swabs and venous blood specimens. We then simultaneously tested for ten STIs (Chlamydia trachomatis [CT], Neisseria gonorrhea [NG], Ureaplasma urealyticum [Uu], Ureaplasma parvum species [Up1, Up3, Up6, Up14), Mycoplasma hominis [Mh], Mycoplasma genitalium [Mg], and Herpes Simplex Virus Type 2 (HSV-2) using multiple PCR. We also performed blood tests for HIV, Syphilis, Hepatitis C antibody (HCV-Ab), Hepatitis B Surface Antigen (HBsAg), and Hepatitis A-IgM (HAV-IgM), etc. RESULTS: One hundred and eighty-three MSM participated in this study, of which 51.4% reported seeking partners through apps in the past year. The prevalence of HIV was 19.7%, Syphilis 12.0%, HAV 1.1%, rectal Mg 15.3% and Mh 7.1%. Multivariable logistic regression showed that HIV infection was independently correlated with app-using behavior (adjusted odds ratio[aOR] = 2.6), Mg infection (aOR = 3.2), Mh infection (aOR = 4.1) and Syphilis infection (aOR = 3.1) (each P < 0.05). CONCLUSIONS: App use, Mg, Mh and Syphilis infection were correlated with higher HIV Risk in MSM. Geosocial networking apps should be utilized for HIV interventions targeting MSM. There is a need for more expansive STIs screening, particularly for Mg, Mh and Syphilis in MSM.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium/isolamento & purificação , Mycoplasma hominis/isolamento & purificação , Minorias Sexuais e de Gênero/estatística & dados numéricos , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adolescente , Adulto , China/epidemiologia , Estudos Transversais , HIV , Infecções por HIV/microbiologia , Humanos , Masculino , Programas de Rastreamento , Infecções por Mycoplasma/microbiologia , Prevalência , Fatores de Risco , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/classificação , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Adulto Jovem
9.
Int J STD AIDS ; 30(6): 536-541, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31074362

RESUMO

A cross-sectional survey of 295 persons attending a major sexually transmitted infection clinic in Jamaica's capital city showed that the Ministry of Health's syndromic algorithm has moderate sensitivity and negative predictive value for diagnosing cervicitis. In the absence of diagnostic tests for sexually transmitted infections, a syndromic algorithm continues to be useful for diagnosing sexually transmitted infections.


Assuntos
Doenças Sexualmente Transmissíveis/microbiologia , Cervicite Uterina/diagnóstico , Cervicite Uterina/microbiologia , Adulto , Algoritmos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis , Estudos Transversais , Feminino , Gonorreia/diagnóstico , Gonorreia/microbiologia , Humanos , Jamaica/epidemiologia , Masculino , Neisseria gonorrhoeae , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Síndrome , Cervicite Uterina/epidemiologia
10.
BMC Public Health ; 19(Suppl 1): 606, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138228

RESUMO

BACKGROUND: Partner notification is an essential component of sexually transmitted infection (STI) management. The process involves identifying exposed sex partner(s), notifying these partner(s) about their exposure to a curable STI, and offering counselling and treatment for the STI as a part of syndromic management or after results from an STI test. When implemented effectively, partner notification services can prevent the index patient from being reinfected with a curable STI from an untreated partner, reduce the community burden of curable STIs, and prevent adverse health outcomes in both the index patient and his or her sex partner(s). However, partner notification and treatment rates are often low. This study seeks to explore experiences and preferences related to partner notification and treatment for curable STIs among pregnant women receiving care in an antenatal clinic with integrated HIV and curable STI testing. Results are intended to inform efforts to improve partner notification and treatment rates in Southern Africa. METHODS: We conducted qualitative interviews among women diagnosed with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and/or Trichomonas vaginalis (TV) infection while seeking antenatal care in Gaborone, Botswana. Semi-structured interviews were used to obtain women's knowledge about STIs and their experiences and preferences regarding partner notification. RESULTS: Fifteen women agreed to participate in the study. The majority of women had never heard of CT, NG, or TV infections prior to testing. Thirteen out of 15 participants had notified partners about the STI diagnosis. The majority of notified partners received some treatment; however, partner treatment was often delayed. Most women expressed a preference for accompanying partners to the clinic for treatment. Experiences and preferences did not differ by HIV infection status. CONCLUSIONS: The integration of STI, HIV, and antenatal care services may have contributed to most women's willingness to notify partners. However, logistical barriers to partner treatment remained. More research is needed to identify effective and appropriate strategies for scaling-up partner notification services in order to improve rates of partners successfully contacted and treated, reduce rates of STI reinfection during pregnancy, and ultimately reduce adverse maternal and infant outcomes attributable to antenatal STIs.


Assuntos
Busca de Comunicante/estatística & dados numéricos , Complicações Infecciosas na Gravidez/psicologia , Autorrevelação , Parceiros Sexuais/psicologia , Adulto , África Austral/epidemiologia , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Botsuana/epidemiologia , Chlamydia trachomatis , Busca de Comunicante/métodos , Feminino , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Neisseria gonorrhoeae , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Pesquisa Qualitativa , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Trichomonas vaginalis
11.
BMC Infect Dis ; 19(1): 360, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035953

RESUMO

BACKGROUND: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease affects all ages and both sexes but more prevalent among the sexually active age group of 15-49 years. The purpose of the current study was to determine the prevalence and factors associated with syphilis infection among outpatients 15-49 years in the Asikuma Odoben Brakwa District of Ghana where high levels of infection were earlier reported among antenatal women. METHODS: A descriptive cross-sectional study was carried out in 13 randomly selected health facilities. Blood samples were collected and tested for syphilis infection and a questionnaire administered to determine factors associated with the disease. RESULTS: A total 277 patients aged 15-49 years participated in the study. The overall prevalence of syphilis infection was 3.2% (9/277), with 5.7% (6/105) and 1.7% (3/172) among males and females respectively. Significant factors associated with syphilis infection included sub-district of residence, (χ2 (4) = 31.20, p < 0.001) and history of coerced sexual intercourse (χ2 (1) =7.49, p = 0.006). CONCLUSIONS: The prevalence of syphilis infection was high among male patients who lived in rural areas. Having a history of coerced sexual intercourse was a strong predictor for syphilis infection. Access to sexually transmitted infection control interventions in rural communities including health education may help control the disease.


Assuntos
Doenças Sexualmente Transmissíveis/diagnóstico , Sífilis/diagnóstico , Adolescente , Adulto , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pacientes Ambulatoriais , Prevalência , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Sífilis/epidemiologia , Sífilis/microbiologia , Treponema pallidum/isolamento & purificação , Adulto Jovem
12.
PLoS One ; 14(4): e0215606, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31002729

RESUMO

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.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Carga Bacteriana , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Sistema Urogenital/patologia , Adulto , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/transmissão , Chlamydia trachomatis/fisiologia , Feminino , Medicina Geral/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/terapia , Sistema Urogenital/microbiologia , Adulto Jovem
13.
Br J Cancer ; 120(8): 855-860, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30894687

RESUMO

BACKGROUND: Sexually transmitted infections (STIs) are associated with pelvic inflammatory disease and tubal pathologies. Given the tubal origin of a proportion of ovarian cancers, STIs may be relevant in their aetiology. METHODS: Antibodies indicating past infection with Chlamydia trachomatis, Mycoplasma genitalium, herpes simplex virus type 2, and against human papillomavirus oncogenes (L1 and E6+E7 oncoproteins of types 16, 18, 45) were measured in prediagnosis plasma samples in a nested case-control study in the Nurses' Health Studies (n = 337 cases 1:1 matched to controls). Logistic regression was used to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals [CIs] comparing women seropositive vs. seronegative among all cases (invasive and borderline), invasive (n = 257), and invasive serous ovarian cancers; n = 170), and borderline ovarian tumours (n = 80). RESULTS: C. trachomatis seropositivity was associated with higher risk of ovarian cancer overall (RR = 2.07 [1.25-3.43]); results were similar for invasive, invasive serous, and borderline tumours. We observed no associations for the other STIs. Relative to women seronegative to all infections, strongest associations were observed for seropositivity to C. trachomatis plus another STI (2.74 [1.20-6.27]; C. trachomatis alone, 1.88 [1.03-3.42]; all cases); however, the RRs were not significantly different. CONCLUSIONS: C. trachomatis infection may increase ovarian cancer risk; additional studies are required.


Assuntos
Carcinoma Epitelial do Ovário/epidemiologia , Invasividade Neoplásica/genética , Proteínas Oncogênicas/genética , Doenças Sexualmente Transmissíveis/epidemiologia , Carcinoma Epitelial do Ovário/complicações , Carcinoma Epitelial do Ovário/microbiologia , Carcinoma Epitelial do Ovário/virologia , Chlamydia trachomatis/patogenicidade , Feminino , Herpesvirus Humano 2/patogenicidade , Papillomavirus Humano 16/patogenicidade , Papillomavirus Humano 18/patogenicidade , Humanos , Mycoplasma genitalium/patogenicidade , Invasividade Neoplásica/patologia , Papillomaviridae/patogenicidade , Doença Inflamatória Pélvica , Fatores de Risco , Doenças Sexualmente Transmissíveis/complicações , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/virologia
14.
J Infect Dis ; 220(3): 476-483, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-30873541

RESUMO

BACKGROUND: Rectal Chlamydia trachomatis (CT) is common among clinic-attending women, but little is known about clearance and health implications of rectal CT. METHODS: At the municipal sexually transmitted disease clinic in Seattle, Washington, in 2017-2018, we enrolled women at high risk for urogenital CT into an 8-week prospective study. Women received standard CT treatment at enrollment. Women self-collected daily rectal and vaginal specimens for nucleic acid amplification tests (NAATs) and completed weekly sexual exposure diaries. We performed CT culture on the enrollment rectal specimen. RESULTS: We enrolled 50 women; 13 (26%) tested positive for vaginal (n = 11) and/or rectal (n = 11) CT. Sixty percent of women with rectal CT per NAAT were also culture positive. Median time to CT clearance after azithromycin treatment was 8.0 days for vaginal CT and 7.0 days for rectal CT. Eight women with rectal CT at enrollment had at least 1 rectal CT-positive NAAT after clearance of the initial infection; none reported anal sex. CONCLUSIONS: Most NAAT-positive rectal infections were culture positive, suggesting active infection. Time to NAAT clearance of rectal and genital tract CT was similar, and intermittent rectal CT positivity was common in the absence of anal sexual exposure. The cause of recurrent/intermittent rectal CT and the clinical implications of these infections require further study.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Reto/microbiologia , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/microbiologia , Vagina/microbiologia , Adulto , Azitromicina/uso terapêutico , Chlamydia trachomatis/efeitos dos fármacos , Feminino , Humanos , Técnicas de Amplificação de Ácido Nucleico/métodos , Estudos Prospectivos , Recidiva , Comportamento Sexual/efeitos dos fármacos , Washington , Adulto Jovem
15.
Gynecol Obstet Fertil Senol ; 47(5): 409-417, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-30878688

RESUMO

OBJECTIVES: To determine the microorganisms potentially involved in pelvic inflammatory diseases (PIDs) and the different diagnostic methods of PID. METHODS: PubMed and International Guidelines search. RESULTS: PIDs have various microbial causes. The pathogenic role of the main agents of sexually transmitted infections (STIs), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium is well demonstrated (NP1). C. trachomatis is the most commonly described bacterium in PID (NP1), especially in women under 30 years old. PIDs also occur in situations that decrease the effectiveness of the cervix microbiological lock, such as bacterial vaginosis, allowing facultative vaginal bacteria such as Escherichia coli, Streptococcus agalactiae and anaerobes to ascend to the uterine cavity. Nevertheless, participation of the diverse bacteria of the vaginal microbiota, in particular anaerobes, and the polymicrobial character of PIDs are still differently appreciated. In the case of uncomplicated PID, to obtain a microbiological diagnosis, endocervical sampling is recommended during gynecological examination under speculum (grade B). A first swab allows for a smear on a slide for direct examination (Gram, MGG). A second swab, in an adapted transport medium, is useful for standard culture with N. gonorrhoeae and facultative vaginal flora bacteria cultures, with antibiotic susceptibility testing. A third swab, in an appropriate transport medium, allows for the search for N. gonorrhoeae, C. trachomatis, and if possible M. genitalium by nucleic acid amplification techniques (NAATs), (NP1). It is possible to only use one swab in a transport medium suitable for (i) survival of bacteria and (ii) NAATs. When the diagnosis of PID is clinically compatible, a positive NAAT for one or more of the three STI-associated bacteria on a genital sample supports the PID diagnosis (NP1). On the other hand, a negative NAAT does not allow the exclusion of an STI agent for PID diagnosis (NP1). In situations where speculum use is not possible, vaginal sampling will be performed by default. In case of complicated IGH, tuboperitoneal samples can be performed either radiologically or surgically. Since these sites are sterile, any bacteria present will be considered pathogenic (NP2). C. trachomatis serology is not interesting as a first line diagnostic tool for PID diagnosis and is not useful for monitoring the evolution of PID (NP1).


Assuntos
Doença Inflamatória Pélvica/microbiologia , Adulto , Infecções Bacterianas/microbiologia , Colo do Útero/microbiologia , Chlamydia trachomatis/isolamento & purificação , Feminino , Humanos , Mycoplasma genitalium/isolamento & purificação , Neisseria gonorrhoeae/isolamento & purificação , Testes Sorológicos , Doenças Sexualmente Transmissíveis/microbiologia , Vagina/microbiologia
16.
Gynecol Obstet Fertil Senol ; 47(5): 418-430, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-30878689

RESUMO

This review of the treatment of uncomplicated pelvic inflammatory disease (PID) focuses on the susceptibility profile of the main microbiological causes as well as on the advantages and inconvenients of relevant antibiotics. As bacterial resistance is expanding in the community, the rules of adequate antibiotic prescribing are integrated in the treatment proposals. While the pathogenic role of anaerobic bacteria in uncomplicated PID remains discussed, the choice to provide anaerobes coverage is proposed. Thus, the antibiotic treatment has to cover Chamydia trachomatis, Neisseria gonorrhoeae, anaerobes as well as Streptococcus spp, gram negative bacteria and the ermerging Mycoplasma genitalium. On the basis of published trials and good practice antibiotic usage, the ceftriaxone-doxycycline-metronidazole combination has been selected as the first line regimen. Fluoroquinolones (moxifloxacin alone, or levofloxacin or ofloxacin combined with metronidazole) are proposed as alternatives because of their ecological impact and their side effects leading to restricted usage. When fluoroquinolone are used, ceftriaxone should be added in case of possible sexually transmitted infection. When detected, M. genitalium should be treated by moxifloxacin. Moreover, this review highlights the need to better describe the microbiological epidemiology of uncomplicated PID in France or Europe.


Assuntos
Doença Inflamatória Pélvica/tratamento farmacológico , Doença Inflamatória Pélvica/microbiologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Farmacorresistência Bacteriana , Feminino , França , Gonorreia/tratamento farmacológico , Humanos , Infecções por Mycoplasma/tratamento farmacológico , Mycoplasma genitalium , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/microbiologia , Infecções Estreptocócicas/tratamento farmacológico
17.
Ann Epidemiol ; 32: 20-27, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30799204

RESUMO

PURPOSE: Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota. METHODS: Using the 1999 Longitudinal Study of Vaginal Flora (n = 2439), a primarily African American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested bacterial vaginosis (measured by Nugent Score) and sexual behaviors (condom use, number of partners, and partner concurrence) as mediators using VanderWeele's difference method. RESULTS: Baseline perceived stress was associated with incident STIs both before and after adjusting for confounders (adjusted hazard ratio = 1.015; 95% confidence interval, 1.005-1.026). Nugent score and sexual behaviors significantly mediated 21% and 65% of this adjusted association, respectively, and 78% when included together in the adjusted model. CONCLUSIONS: This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of bacterial vaginosis-both known risk factors for STIs-as mechanisms underlying this association.


Assuntos
Microbiota , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Estresse Psicológico/complicações , Vagina/microbiologia , Adolescente , Adulto , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/isolamento & purificação , Feminino , Gonorreia/epidemiologia , Gonorreia/microbiologia , Humanos , Incidência , Estudos Longitudinais , Neisseria gonorrhoeae/isolamento & purificação , Estudos Prospectivos , Comportamento Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Tricomoníase/epidemiologia , Vaginite por Trichomonas/epidemiologia , Vaginite por Trichomonas/microbiologia , Trichomonas vaginalis , Vaginose Bacteriana/complicações , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/epidemiologia , Adulto Jovem
18.
Int J STD AIDS ; 30(6): 623-625, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30722752

RESUMO

Mycoplasma genitalium is an infection of increasing concern due to its potential to cause sequelae in the reproductive tract and the development of antimicrobial resistance. Its role as a cause of proctitis in people with high-risk sexual behaviour has not been properly defined yet but it seems to be less symptomatic than proctitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae. We present a case of a man who has sex with men with proctitis associated with M. genitalium after excluding other infections known to cause STI proctitis.


Assuntos
Infecções por Mycoplasma/diagnóstico , Mycoplasma genitalium/isolamento & purificação , Proctite/diagnóstico , Proctite/microbiologia , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Resistência Microbiana a Medicamentos , Infecções por HIV/complicações , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycoplasma/tratamento farmacológico , Proctite/tratamento farmacológico , Proctoscopia , Reto/diagnóstico por imagem , Doenças Sexualmente Transmissíveis/microbiologia , Resultado do Tratamento
19.
J Dtsch Dermatol Ges ; 17(5): 493-501, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30775844

RESUMO

BACKGROUND: A new genotype of the zoophilic fungal species Trichophyton (T.) mentagrophytes was recently described in two studies. It was isolated from three patients who had visited Southeast Asia and one patient who had visited Egypt. In contrast to these studies, we have observed a number of cases with the dimensions of an epidemic outbreak. PATIENTS AND METHODS: At the University Hospital Charité Berlin, 43 patients, mostly suffering from highly inflammatory, painful and persistent infections of the pubogenital region were observed between January 2016 and July 2017. Mycological examination was performed with fungal culture and sequencing of the ITS (internal transcribed spacer) region of the ribosomal DNA. Three additional genomic regions were spot-checked. RESULTS: In 37 of the cases, a new genotype of T. mentagrophytes (referred to here as T. mentagrophytes VII) was isolated as the etiological agent, and sequencing revealed identical sequences for all isolates. Most of the infected patients had no history of travel, and only two patients reported contact with animals. CONCLUSIONS: The new genotype clustered phylogenetically among the strains of the zoophilic species T. mentagrophytes with four different DNA markers. While human-to-human transmission of zoophilic dermatophytes is rare, transmission via sexual contact seemed to be quite effective here.


Assuntos
Doenças Sexualmente Transmissíveis/microbiologia , Tinha/microbiologia , Trichophyton/isolamento & purificação , Adulto , Animais , Antifúngicos/uso terapêutico , DNA Fúngico/análise , Quimioterapia Combinada , Feminino , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/microbiologia , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/microbiologia , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Pomadas , Filogenia , Prurido/microbiologia , Análise de Sequência de DNA , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/transmissão , Tinha/transmissão , Viagem , Resultado do Tratamento , Adulto Jovem , Zoonoses/tratamento farmacológico , Zoonoses/microbiologia , Zoonoses/transmissão
20.
Med. clín (Ed. impr.) ; 152(3): 98-101, feb. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181865

RESUMO

Introducción y objetivo: Las infecciones de transmisión sexual con afectación anorrectal (ITS-AR) afectan principalmente a hombres que tienen sexo con hombres (HSH). Material y métodos: Estudio retrospectivo realizado en pacientes diagnosticados de ITS-AR en una unidad de ITS entre 2014 y 2015. Se recogieron datos epidemiológicos, microbiológicos, clínicos y de conducta sexual. Resultados: Se analizaron 95 individuos, todos HSH. El 88,42% estaban infectados por el VIH; el 67,17% refirió que la última relación sexual fue desprotegida; el 17,91% tuvo sexo con trabajadores sexuales y, en el año previo, el 72,22% había consumido drogas previamente a las relaciones sexuales. El 32,92% presentaron sintomatología durante más de 30 días. El 54,73% de los diagnósticos fue linfogranuloma venéreo (LGV). Todos los pacientes que consultaron por úlcera asociada a proctitis presentaron infección por LGV. Todos los que consultaron por úlcera perianal sin proctitis asociada fueron diagnosticados de sífilis. Conclusiones: Todos los pacientes con ITS-AR fueron HSH, la mayoría positivos para el VIH, con conductas sexuales de riesgo y un tiempo de evolución largo. Las características clínicas, epidemiológicas y microbiológicas de las ITS-AR en nuestro entorno podrían ayudar a ajustar mejor el tratamiento empírico


Introduction and objective: Sexually transmitted infections of the rectum and anus (STI-RA) mainly affect men who have sex with men (MSM). The incidence of STI-RA among them has increased in recent years. Material and methods: Retrospective study in patients with diagnoses of STI-RA in an STI unit during the years 2014 and 2015. Epidemiological, clinical and microbiological data were collected. Results: We included 95 patients, all of whom were MSM; 88.42% were HIV+; 67.17% did not use a condom during their most recent sexual intercourse; 17.91% had had sex with sex workers and 72.22% had used drugs during sexual intercourse during the previous year. A percentage of 32.92 reported symptoms that had lasted longer than 30 days. Lymphogranuloma venereum (LGV) was diagnosed in 54.73% of the patients. All patients who presented with proctitis and perianal ulcers were diagnosed with LGV infection. All those who presented perianal ulcers without proctitis were diagnosed with syphilis. Conclusions: All the patients affected by STI-RA were MSM, most of them HIV+, had engaged in high-risk sexual behaviour and had suffered prolonged symptomatology. Clinical and microbiological characteristics of STI-AR could help adjust the empiric therapy


Assuntos
Humanos , Masculino , Adulto , Doenças Retais/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia , Linfogranuloma Venéreo/epidemiologia , Doenças do Ânus/diagnóstico , Doenças do Ânus/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Estudos Retrospectivos , Assunção de Riscos , Parceiros Sexuais
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