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1.
BMC Infect Dis ; 20(1): 486, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641070

RESUMO

BACKGROUND: Asymptomatic screening for gonorrhoea in heterosexual men is currently not recommended in many countries including Australia, given the prevalence is relatively low in the heterosexual population. We aimed to determine the proportion of urethral gonorrhoea cases among heterosexual men attending a sexual health clinic that was asymptomatic and symptomatic, the time since last sexual contact to the onset of symptoms and the time to clinic presentation following the onset of symptoms. METHODS: This was a cross-sectional study that included heterosexual men aged 16 years or above attending the Melbourne Sexual Health Centre (MSHC) in Australia between August 2017 and August 2018. Gonorrhoea cases were diagnosed by nucleic acid amplification testing (NAAT) and/or culture. Descriptive analyses were conducted for all gonorrhoea cases including demographic characteristics, recent sexual practices, reported urethral symptoms and duration, sexual contact with a person diagnosed with gonorrhoea, investigations performed and laboratory results. RESULTS: There were 116 confirmed cases of urethral gonorrhoea in heterosexual men over the study period of which 6.0% (95% CI: 2.7-12.1%) were asymptomatic. Typical urethral discharge was present in 80.2% (95% CI: 71.9-86.5%) of men. The mean time between last sexual contact and the onset of symptoms was 7.0 days, and between the onset of symptoms to presentation to the clinic was 5.6 days. CONCLUSIONS: A small proportion of heterosexual men with urethral gonorrhoea do not have any symptoms. Heterosexual men with urethral symptoms usually seek for healthcare within a week, prompting rapid healthcare-seeking behaviour.


Assuntos
Infecções Assintomáticas/epidemiologia , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Heterossexualidade , Neisseria gonorrhoeae/genética , Saúde Sexual , Doenças Uretrais/diagnóstico , Doenças Uretrais/epidemiologia , Adolescente , Adulto , Austrália/epidemiologia , Estudos Transversais , Gonorreia/microbiologia , Gonorreia/fisiopatologia , Humanos , Masculino , Técnicas de Amplificação de Ácido Nucleico/métodos , Prevalência , Doenças Uretrais/microbiologia , Adulto Jovem
2.
Arch Gynecol Obstet ; 300(2): 261-267, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31175401

RESUMO

OBJECTIVE: The vaginal microbiota may modulate susceptibility to Neisseria gonorrhea (NG) infections. The objective of this meta-analysis was to evaluate the association between these NG infections and the vaginal microbiota. METHOD: A systematic review and meta-analysis was conducted to investigate the correlation of vaginal microbiota and NG risk. Primary sources of the reviewed studies were from inception through December 2018. Vaginal mucosa microflora were dichotomized into high-Lactobacillus vaginal microbiota and low-Lactobacillus vaginal microbiota (LL-VMB), using either Nugent score, Amsel's criteria, presence of clue cells or 16S rRNA gene sequencing. RESULTS: A total of 8 studies qualified for inclusion in this meta-analysis. LL-VMB could be regarded as worse prognostic factor, and the pooled OR was 1.33 (95% CI 1.02, 1.73; P = 0.04, I2 = 44%). LL-VMB was associated with a significantly higher susceptibility of NG. Trend for the sensitive analysis was consistence with the primary outcome. Significant publication bias was not detected by the funnel plot. CONCLUSION: In conclusion, the systematic review and meta-analysis has demonstrated that LL-VMB was significantly associated with a high NG susceptibility.


Assuntos
Gonorreia/fisiopatologia , Membrana Mucosa/virologia , Neisseria gonorrhoeae/patogenicidade , Vagina/virologia , Feminino , Humanos , RNA Ribossômico 16S
3.
PLoS Pathog ; 15(2): e1007495, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30753248

RESUMO

The Gram-negative human pathogen N. gonorrhoeae (Ngo) quickly attaches to epithelial cells, and large numbers of the bacteria remain on the cell surface for prolonged periods. Ngo invades cells but few viable intracellular bacteria are recovered until later stages of infection, leading to the assumption that Ngo is a weak invader. On the cell surface, Ngo quickly recruits CD46-cyt1 to the epithelial cell cortex directly beneath the bacteria and causes its cleavage by metalloproteinases and Presenilin/γSecretease; how these interactions affect the Ngo lifecycle is unknown. Here, we show Ngo induces an autophagic response in the epithelial cell through CD46-cyt1/GOPC, and this response kills early invaders. Throughout infection, the pathogen slowly downregulates CD46-cyt1 and remodeling of lysosomes, another key autophagy component, and these activities ultimately promote intracellular survival. We present a model on the dynamics of Ngo infection and describe how this dual interference with the autophagic pathway allows late invaders to survive within the cell.


Assuntos
Gonorreia/metabolismo , Proteína Cofatora de Membrana/fisiologia , Neisseria gonorrhoeae/patogenicidade , Autofagia/fisiologia , Aderência Bacteriana , Linhagem Celular , Colo do Útero , Regulação para Baixo , Células Epiteliais , Feminino , Fímbrias Bacterianas , Gonorreia/fisiopatologia , Humanos , Lisossomos , Proteína Cofatora de Membrana/imunologia , Glicoproteínas de Membrana , Proteínas de Membrana/metabolismo , Neisseria gonorrhoeae/metabolismo , Cultura Primária de Células , Isoformas de Proteínas
4.
Adv Emerg Nurs J ; 40(4): 304-311, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30365445

RESUMO

Urinary symptoms, such as dysuria, urinary urgency, frequency, and suprapubic pain, are frequent complaints made in the emergency department (ED; ). Although it is easy to relate urinary symptoms with a urinary tract infection (UTI), both UTI and sexually transmitted disease (STD) can share same urinary symptoms that mask each other from detection. It presents challenges for ED clinicians to precisely distinguish between two infections, causing misdiagnosis and mistreatment, resulting in patient morbidity and high health care costs. Clinician adherence to clinical guidelines for the treatment of urinary symptoms with presumed STD remains inconsistent in terms of culturing urine to rule out UTI but not for chlamydial and gonorrheal infections. Given the increasing prevalence of gonorrheal and chlamydial infections, an evidence-based education on STD-screening guideline among clinicians was implemented. A retrospective chart was reviewed before and after the implementation to compare improvement on STD screening among young adults with urinary complaints in the ED. When education was given to the clinicians, more patients with urinary symptoms were screened for chlamydia and gonorrhea (p ≤ 0.001) and more chlamydial and gonorrheal infections were detected (p = 0.042). Patients with a positive STD had concurrent positive urine cultures, which shows that patients can have both a UTI and an STD at the same time and urinary symptoms are imprecise in distinguishing between the two. An ongoing STD-screening education is essential in ensuring successful detection, treatment, and prevention of transmission.


Assuntos
Infecções por Chlamydia/diagnóstico , Serviço Hospitalar de Emergência , Gonorreia/diagnóstico , Infecções Urinárias/diagnóstico , Adolescente , Adulto , Infecções por Chlamydia/complicações , Infecções por Chlamydia/fisiopatologia , Diagnóstico Diferencial , Feminino , Gonorreia/complicações , Gonorreia/fisiopatologia , Fidelidade a Diretrizes , Humanos , Masculino , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Estudos Retrospectivos , Infecções Urinárias/complicações , Adulto Jovem
5.
Infect Immun ; 86(8)2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29760215

RESUMO

The gonococcal Opa proteins are an antigenically variable family of surface adhesins that bind human carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1), CEACAM3, CEACAM5, and/or CEACAM6, cell surface glycoproteins that are differentially expressed on a broad spectrum of human cells and tissues. While they are presumed to be important for infection, the significance of various Opa-CEACAM-mediated cellular interactions in the context of the genital tract has remained unclear. Here, we observed that CEACAM1 and CEACAM5 are differentially expressed on epithelia lining the upper and lower portions of the human female genital tract, respectively. Using transgenic mouse lines expressing human CEACAMs in a manner that reflects this differential pattern, we considered the impact of Opa-CEACAM interactions during uncomplicated lower genital tract infections versus during pelvic inflammatory disease. Our results demonstrate that Opa-CEACAM5 binding on vaginal epithelia facilitates the long-term colonization of the lower genital tract, while Opa protein binding to CEACAM1 on uterine epithelia enhances gonococcal association and penetration into these tissues. While these Opa-dependent interactions with CEACAM-expressing epithelial surfaces promote infection, Opa binding by neutrophil-expressed CEACAMs counterbalances this by facilitating more effective gonococcal clearance. Furthermore, during uterine infections, CEACAM-dependent tissue invasion aggravates disease pathology by increasing the acute inflammatory response. Together, these findings demonstrate that the outcome of infection is determined by both the cell type-specific expression of human CEACAMs and the CEACAM specificity of the Opa variants expressed, which combine to determine the level of gonococcal association with the genital mucosa versus the extent of CEACAM-dependent inflammation and gonococcal clearance by neutrophils.


Assuntos
Antígenos CD/metabolismo , Aderência Bacteriana , Proteínas da Membrana Bacteriana Externa/metabolismo , Antígeno Carcinoembrionário/metabolismo , Moléculas de Adesão Celular/metabolismo , Genitália Feminina/patologia , Gonorreia/fisiopatologia , Infecções do Sistema Genital/fisiopatologia , Animais , Modelos Animais de Doenças , Células Epiteliais/metabolismo , Feminino , Proteínas Ligadas por GPI/metabolismo , Perfilação da Expressão Gênica , Genitália Feminina/microbiologia , Gonorreia/microbiologia , Interações Hospedeiro-Patógeno , Humanos , Imuno-Histoquímica , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Neisseria gonorrhoeae/fisiologia , Infecções do Sistema Genital/microbiologia , Resultado do Tratamento , Útero/microbiologia , Útero/patologia , Vagina/microbiologia , Vagina/patologia
6.
BMJ Open ; 7(8): e016202, 2017 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-28801418

RESUMO

INTRODUCTION: Gonorrhoea is a common sexually transmitted disease caused by Neisseria gonorrhoeae (Ng) infection. Light microscopy of urogenital smears is used as a simple tool to diagnose urogenital gonorrhoea in many resource-limited settings. We aimed to evaluate the accuracy of light microscopy to diagnose urogenital gonorrhoea as compared with a PCR-based test. METHODS: In 2014, we examined 632 male urethral and 360 endocervical smears in clinic-based and outreach settings in Jakarta, Yogyakarta and Denpasar, Indonesia. Using the detection of Ng DNA by a validated PCR as reference test, we evaluated the accuracy of two light microscopic criteria to diagnose urogenital gonorrhoea in genital smears: (1) the presence of intracellular Gram-negative diplococci (IGND) and (2) ≥5 polymorphonuclear leucocytes (PMNL)/oil-immersion field (oif) in urethral or ≥20 PMNL/oif in endocervical smears. RESULTS: In male urethral smears, IGND testing had a sensitivity (95% CI), specificity (95% CI) and kappa±SE of 59.0% (50.1 to 67.4), 89.4% (86.3 to 91.9) and 0.49±0.04, respectively. For PMNL count, these were 59.0% (50.1 to 67.4), 83.7% (80.2 to 86.9) and 0.40±0.04, respectively. The accuracy of IGND in the clinic-based settings (72.0% (57.5 to 83.3), 95.2% (91.8 to 97.5) and 0.68±0.06, respectively) was better than in the outreach settings (51.2% (40.0 to 62.3), 83.4% (78.2 to 87.8) and 0.35±0.06, respectively). In endocervical smears, light microscopy performed poorly regardless of the setting or symptomatology, with kappas ranging from -0.09 to 0.24. CONCLUSION: Light microscopy using IGND and PMNL criteria can be an option with moderate accuracy to diagnose urethral gonorrhoea among males in a clinic-based setting. The poor accuracy in detecting endocervical infections indicates an urgent need to implement advanced methods, such as PCR. Further investigations are needed to identify the poor diagnostic outcome in outreach services.


Assuntos
Gonorreia/diagnóstico , Microscopia , Neisseria gonorrhoeae/isolamento & purificação , Adolescente , Adulto , Colo do Útero/microbiologia , Feminino , Gonorreia/fisiopatologia , Humanos , Indonésia , Masculino , Neutrófilos/microbiologia , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Uretra/microbiologia , Adulto Jovem
8.
Sex Transm Infect ; 93(7): 460-466, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28396556

RESUMO

OBJECTIVES: Genital herpes simplex virus-2 (HSV-2) shedding in pregnant women in association with neonatal herpes infection has been widely studied but there is limited evidence of its association with pregnancy outcomes. METHODS: In this retrospective observational study, we included a subgroup of pregnant women who were enrolled in a randomized control behavioural intervention study that was conducted in South Africa in 2008-2010. In pregnancy, women had a HIV rapid test done and a genital swab taken to test for curable STIs and HSV-2 DNA. Subsequent visits were scheduled for 6, 10, 14 weeks and 9 months post-delivery. Pregnancy outcomes were documented at the 6-week or 10-week postpartum visit. Women were treated syndromically for curable STIs. RESULTS: Among 615 women included in this data analysis, 36.6% (n=225) tested HIV positive and 8.3% (n=51) tested positive for genital HSV-2 shedding during pregnancy. Women <24 years and HIV-1 seropositive women were 1.5 and 2.5 times more likely to test positive for HSV-2 genital shedding respectively. STI treatment records were available for 158/205 (77.1%) women; all 87 women with symptomatic STIs were treated the same day, and 50/71 (70.4%) asymptomatic women received treatment at the subsequent visit. Remaining 21 (29.6%) asymptomatic women did not receive treatment because they failed to return for antenatal follow-up. In a multivariable regression analysis, genital HSV-2 shedding, HIV-1, Neisseria gonorrhoea, Chlamydia trachomatis and Trichomanas vaginalis were not associated with preterm deliveries, still births and low birth weight. However with stratification by treatment for a STI, asymptomatic women who were not treated were 3.3 times more likely to deliver prematurely (33.3%; n=6/18) when compared to women who were treated during pregnancy (13.2%; n=15/114) (p=0.042). CONCLUSIONS: Genital HSV-2 shedding in pregnancy does not appear to alter pregnancy outcomes. Untreated curable STIs (T.vaginalis, C.trachomatis, N.gonorrhoea) were more likely associated with preterm births.


Assuntos
Herpesvirus Humano 2/fisiologia , Complicações Infecciosas na Gravidez , Doenças Sexualmente Transmissíveis , Eliminação de Partículas Virais , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/fisiopatologia , Feminino , Gonorreia/epidemiologia , Gonorreia/microbiologia , Gonorreia/fisiopatologia , Infecções por HIV/epidemiologia , Infecções por HIV/fisiopatologia , Infecções por HIV/virologia , Herpes Genital/epidemiologia , Herpes Genital/fisiopatologia , Herpes Genital/virologia , Herpes Simples/epidemiologia , Herpes Simples/fisiopatologia , Herpes Simples/virologia , Herpesvirus Humano 2/crescimento & desenvolvimento , Humanos , Testes Imediatos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/virologia , África do Sul , Adulto Jovem
10.
Pan Afr Med J ; 17: 242, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25170386

RESUMO

Pregnancy is one of conditions that increase the risk of gonococcal arthritis which result from blood dissemination of neisseria gonorrhoeae. A 20-year-old africain female patient (in the second trimester of pregnancy), was admitted to hospital because of fever, asymmetric joint swollen affecting the hands, wrists, left ankle, and right sternoclavicular joint. Laboratory findings (erythrocyte sedimentation rate was 117 mm in first hour, The serum C-reactive protein level was 152 mg/L) the gram stain of genital sample was positif of neisseria gonorrhoeae and trichomonas vaginalis. With antibiotics, outcome of pregnancy was timely and uneventful. Patients should be educated about the mode of transmission of gonorrhea. Sexual partners should also be treated to prevent dissemination and gonococcal re-infection.


Assuntos
Artrite Infecciosa/complicações , Gonorreia/complicações , Complicações Infecciosas na Gravidez/fisiopatologia , Artrite Infecciosa/microbiologia , Artrite Infecciosa/fisiopatologia , Proteína C-Reativa/metabolismo , Feminino , Gonorreia/diagnóstico , Gonorreia/fisiopatologia , Humanos , Neisseria gonorrhoeae/isolamento & purificação , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez , Segundo Trimestre da Gravidez , Vaginite por Trichomonas/complicações , Vaginite por Trichomonas/diagnóstico , Trichomonas vaginalis/isolamento & purificação , Adulto Jovem
11.
Sex Transm Infect ; 90(1): 58-60, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24106338

RESUMO

OBJECTIVES: Current strategies for controlling non-urogenital chlamydia and gonorrhoea are not uniform. It is assumed that present anorectal/oropharyngeal infections are coincidentally treated with urogenital infections. However, it is not clear whether this control strategy is effective. To inform current debate, we evaluated the anatomical site distribution of chlamydia and gonorrhoea by routine testing in men who have sex with men (hereafter men) and in high-risk women (prostitutes and swingers, hereafter women). METHODS: Between January 2010 and November 2012, all men (n=2436) and women (n=1321) attending our sexually transmitted infection clinic were routinely tested for anorectal, oropharyngeal and urogenital Chlamydia trachomatis and Neisseria gonorrhoeae. Data were collected on demographics and sexual behaviour. RESULTS: Overall chlamydia positivity was 10.4% (254/2436) in men and 7.0% (92/1321) in women, for gonorrhoea this was 6.3% (154/2436) and 3.1% (41/1321), respectively. Isolated non-urogenital infections amounted to 76% of all infections in men and for up to 59% of all infections in women. For combined urogenital and anorectal infections, this amounted to 14% for men and up to 54% for women. CONCLUSIONS: Testing only for non-urogenital infections is insufficient, as it overlooks many infections. The use of coincidental treatment is therefore a suboptimal control strategy in high-risk groups for halting complications and transmission. There is an urgent need to optimise the testing guidelines for chlamydia and gonorrhoea at different anatomical sites.


Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Gonorreia/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Comportamento Sexual/fisiologia , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/fisiopatologia , Estudos Transversais , Feminino , Gonorreia/epidemiologia , Gonorreia/fisiopatologia , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Profissionais do Sexo
12.
J Infect Public Health ; 4(4): 175-9, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22000844

RESUMO

PURPOSE: Chlamydial non-gonococcal urethritis and gonorrhoea are the most common sexually transmitted bacterial infections worldwide. Data on these infections are scanty in the Islamic world, especially Kuwait. The objective of this study was to establish the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among men with symptomatic urethritis in Kuwait. METHODS: Men with urethral discharge seen and managed at eight governmental hospitals were recruited into the study. A pair of urethral swab and first-voided urine sample were taken from the patients and sent immediately to the laboratory where they were processed using strand displacement nucleic acid amplification kits (SDA; ProbeTec, Becton Dickinson); one pair per patient was studied. RESULTS: A total of 426 symptomatic men were studied, out of whom 155 (36.4%) were infected by either C. trachomatis or N. gonorrhoeae, or both. The overall prevalence rates of C. trachomatis and N. gonorrhoeae were 12.4% and 23.9%, respectively. There was no significant difference in chlamydial and gonococcal prevalence between Kuwaiti men and non-Kuwaitis (P>0.05). Infection rates were much lower in married men than unmarried men. Men in the age range of 21-35 years were more vulnerable to both infections. CONCLUSION: The findings show that N. gonorrhoeae and, to a lesser extent, C. trachomatis are common in men with urethritis in Kuwait. Appropriate preventive strategies that conform to Islamic rules and values should be of highest priority of the policymakers.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Gonorreia/epidemiologia , Neisseria gonorrhoeae/isolamento & purificação , Uretrite/epidemiologia , Adolescente , Adulto , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/fisiopatologia , Chlamydia trachomatis/genética , Gonorreia/microbiologia , Gonorreia/fisiopatologia , Humanos , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Prevalência , Uretrite/microbiologia , Uretrite/fisiopatologia , Adulto Jovem
13.
Expert Rev Anti Infect Ther ; 9(1): 61-70, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21171878

RESUMO

Pelvic inflammatory disease (PID) is one of the most common serious infections of nonpregnant women of reproductive age. Management of PID is directed at containment of infection. Goals of therapy include the resolution of clinical symptoms and signs, the eradication of pathogens from the genital tract and the prevention of sequelae including infertility, ectopic pregnancy and chronic pelvic pain. The choice of an antibiotic regimen used to treat PID relies upon the appreciation of the polymicrobial etiology of this ascending infection including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and other lower genital tract endogenous anaerobic and facultative bacteria, many of which are associated with bacterial vaginosis. Currently available evidence and the CDC treatment recommendations support the use of broad-spectrum antibiotic regimens that adequately cover the above named microorganisms. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens consisting of an extended-spectrum cephalosporin in conjunction with either azithromycin or doxycycline. Clinically severe PID should prompt hospitalization and imaging to rule out a tubo-ovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly Gram-negative aerobes and anaerobes, should be implemented.


Assuntos
Antibacterianos/uso terapêutico , Doença Inflamatória Pélvica/tratamento farmacológico , Doença Inflamatória Pélvica/microbiologia , Centers for Disease Control and Prevention, U.S. , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/fisiopatologia , Chlamydia trachomatis/efeitos dos fármacos , Feminino , Gonorreia/tratamento farmacológico , Gonorreia/microbiologia , Gonorreia/fisiopatologia , Humanos , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/microbiologia , Infecções por Mycoplasma/fisiopatologia , Mycoplasma genitalium/efeitos dos fármacos , Neisseria gonorrhoeae/efeitos dos fármacos , Doença Inflamatória Pélvica/fisiopatologia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos
14.
Sex Transm Dis ; 38(6): 503-9, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22256336

RESUMO

BACKGROUND: Asymptomatic Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infections pose diagnostic and control problems in developing countries. METHODS: Participants in China, India, Peru, Russia, and Zimbabwe were screened for C. trachomatis and N. gonorrhoeae infections and symptoms. RESULTS: A total of 18,014 participants were evaluated at baseline, 15,054 at 12 months, and 14,243 at 24 months. The incidence of chlamydia in men was 2.0 per 100 person years both from baseline to 12 months and from 12 to 24 months, and in women, 4.6 from baseline to 12 months and 3.6 from 12 to 24 months; a range of 31.2% to 100% reported no symptoms across the 5 countries. The incidence of gonorrhea in men was 0.3 per 100 person years both from baseline to 12 months and from 12 to 24 months, and in women, 1.4 from baseline to 12 months and 1.1 from 12 to 24 months; a range of 66.7% to 100% reported no symptoms. Being female, aged 18 to 24 years, and having more than 1 partner were associated with both the infections. In addition, being divorced, separated, or widowed was associated with gonorrhea. Being male, having 6+ years of education, and reporting only 1 partner were associated with having no symptoms among those infected with chlamydia. No variables correlated with asymptomatic gonorrhea among those infected. CONCLUSION: A high prevalence and incidence of asymptomatic sexually transmitted infections was identified among men and women in a wide variety of settings. More effective programs are needed to identify and treat chlamydia and gonorrhea infections, especially among women, young adults, those with multiple partners, those repeatedly infected, and particularly those at risk without symptoms. The risk of transmission from persons with no symptoms requires further study.


Assuntos
Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/fisiopatologia , Chlamydia trachomatis , Gonorreia/epidemiologia , Gonorreia/fisiopatologia , Neisseria gonorrhoeae , Adolescente , Adulto , China/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/isolamento & purificação , Chlamydia trachomatis/patogenicidade , Feminino , Gonorreia/diagnóstico , Gonorreia/microbiologia , Homossexualidade Masculina , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Neisseria gonorrhoeae/patogenicidade , Peru/epidemiologia , Prevalência , Federação Russa/epidemiologia , Profissionais do Sexo , Transexualidade , Adulto Jovem , Zimbábue/epidemiologia
15.
Rev Prat ; 60(4): 533-8, 2010 Apr 20.
Artigo em Francês | MEDLINE | ID: mdl-20465131

RESUMO

Gonococcal infections as well as other sexually transmited diseases have been increasing for several years. Short incubation period and rich symptomatology of gonococcal urethritis in man, make it an epidemiological indicator of high-risk sexual behavior. In women, cervicitis is often asymptomatic. Anorectitis is a classical form of gonococcal infection especially in men who have sex with men. Sepsis and conjunctivitis, while rare, are to be diagnosed as quickly as possible because of their severity. To limit the spread of gonococcal infections, prevention of sexually transmitted diseases must be strengthened, the screening of asymptomatic subjects can be improved by using the polymerase chain reaction technique and finally the latest therapeutic guidelines taking into account gonococcal antibiotic resistances must be applied.


Assuntos
Gonorreia/diagnóstico , Gonorreia/fisiopatologia , Antibacterianos/uso terapêutico , Feminino , Gonorreia/tratamento farmacológico , Humanos , Masculino
17.
AIDS Patient Care STDS ; 23(8): 585-8, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19591608
18.
BMC Med ; 7: 8, 2009 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-19284575

RESUMO

BACKGROUND: Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. METHODS: A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6%) were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. RESULTS: The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2) and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7). Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. CONCLUSION: The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.


Assuntos
Chlamydia trachomatis/isolamento & purificação , Gonorreia/diagnóstico , Pesquisa sobre Serviços de Saúde , Linfogranuloma Venéreo/diagnóstico , Programas de Rastreamento/métodos , Neisseria gonorrhoeae/isolamento & purificação , Adolescente , Brasil , Estudos Transversais , Feminino , Gonorreia/patologia , Gonorreia/fisiopatologia , Humanos , Linfogranuloma Venéreo/patologia , Linfogranuloma Venéreo/fisiopatologia , Exame Físico , Reação em Cadeia da Polimerase/métodos , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Sensibilidade e Especificidade , População Urbana , Adulto Jovem
19.
Arch. Soc. Esp. Oftalmol ; 84(3): 155-158, mar. 2009. ilus
Artigo em Espanhol | IBECS | ID: ibc-59688

RESUMO

Caso clínico: Varón de 46 años diagnosticado inicialmentede conjuntivitis adenovírica atípica conqueratolisis marginal avanzada y riesgo de perforaciónocular. El diagnóstico final fue queratoconjuntivitisgonocócica. El paciente fue tratado eficazmentecon recubrimiento de membrana amniótica,ceftriaxona tópica y sistémica (50 mg/ml y1 gr/12 h intravenosa).Discusión: La gonorrea debe ser sospechada encasos de conjuntivitis de evolución tórpida(AU)


Case report: We present a 46-year-old man diagnosedinitially with atypical adenoviral conjunctivitisand advanced marginal queratolysis with risk ofperforation. The final diagnosis was gonococcalkeratoconjunctivitis. The patient was successfullytreated with amniotic membrane transplant, topicand systemic ceftriaxone (50 mg/ml and 1 grame/12hours intravenous).Discussion: Gonorrhea must be suspected in casesof torpid evolution conjunctivitis(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Âmnio , Ceratoconjuntivite/complicações , Ceratoconjuntivite/diagnóstico , Ceratoconjuntivite/terapia , Gonorreia/complicações , Gonorreia/diagnóstico , Ceftriaxona/uso terapêutico , Cefotaxima/uso terapêutico , Doxiciclina/uso terapêutico , Eritromicina/uso terapêutico , Gonorreia/fisiopatologia , Âmnio/fisiopatologia , Conjuntivite Bacteriana/complicações , Conjuntivite Viral/complicações , Treponema pallidum/isolamento & purificação , Treponema pallidum/patogenicidade
20.
Sex Transm Dis ; 36(2 Suppl): S49-52, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19131909

RESUMO

BACKGROUND: Before April 2003, all male detainees were offered chlamydia (CT) and gonorrhea (GC) screening tests, after which services were limited to symptom-based testing. In 2003, male screening was discontinued at a large urban county jail. OBJECTIVE: To evaluate the impact of discontinuing universal male sexually transmitted disease screening in a large county jail. METHODS: We compared the number of male CT/GC cases during the periods of universal screening (April 2002 to March 2003) with symptom-based testing (April 2003 to March 2004). RESULTS: The number of reported CT/GC cases among male detainees declined by -91.7% (3329-277) and -90.5% (1133-108), respectively after universal screening was discontinued. Citywide, CT/GC cases among males and females declined by -9.3% (24,885-22,563) and -12.9% (13,249-11,541), respectively. CONCLUSIONS: Discontinuation of universal male CT/GC screening services at a large county jail represents a missed opportunity to screen a high-risk population and was associated with substantial declines in reported morbidity.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Programas de Rastreamento/métodos , Prisões/estatística & dados numéricos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Adulto , Chicago/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/fisiopatologia , Infecções por Chlamydia/prevenção & controle , Feminino , Gonorreia/diagnóstico , Gonorreia/fisiopatologia , Gonorreia/prevenção & controle , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Prisioneiros , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/fisiopatologia , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle , Adulto Jovem
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