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2.
MMWR Morb Mortal Wkly Rep ; 69(50): 1911-1916, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332296

RESUMO

Sexually transmitted infections (STIs) caused by the bacteria Neisseria gonorrhoeae (gonococcal infections) have increased 63% since 2014 and are a cause of sequelae including pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate transmission of human immunodeficiency virus (HIV) (1,2). Effective treatment can prevent complications and transmission, but N. gonorrhoeae's ability to acquire antimicrobial resistance influences treatment recommendations and complicates control (3). In 2010, CDC recommended a single 250 mg intramuscular (IM) dose of ceftriaxone and a single 1 g oral dose of azithromycin for treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum as a strategy for preventing ceftriaxone resistance and treating possible coinfection with Chlamydia trachomatis (4). Increasing concern for antimicrobial stewardship and the potential impact of dual therapy on commensal organisms and concurrent pathogens (3), in conjunction with the continued low incidence of ceftriaxone resistance and the increased incidence of azithromycin resistance, has led to reevaluation of this recommendation. This report, which updates previous guidelines (5), recommends a single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea. If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended. Continuing to monitor for emergence of ceftriaxone resistance through surveillance and health care providers' reporting of treatment failures is essential to ensuring continued efficacy of recommended regimens.


Assuntos
Gonorreia/tratamento farmacológico , Guias de Prática Clínica como Assunto , Administração Oral , Ceftriaxona/administração & dosagem , Centers for Disease Control and Prevention, U.S. , Infecções por Chlamydia/complicações , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Coinfecção/tratamento farmacológico , Doxiciclina/administração & dosagem , Medicina Baseada em Evidências , Gonorreia/complicações , Humanos , Injeções Intramusculares , Estados Unidos
5.
PLoS One ; 15(7): e0236036, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722712

RESUMO

The human vagina harbor a rich microbiota. The optimal state is dominated by lactobacilli that help to maintain health and prevent various diseases. However, the microbiota may rapidly change to a polymicrobial state that has been linked to a number of diseases. In the present study, the temporal changes of the vaginal microbiota in patients treated for sexually transmitted diseases or bacterial vaginosis (BV) and in untreated controls were studied for 26 days. The patients included 52 women treated with azithromycin, tetracyclines or moxifloxacin for present or suspected infection with Chlamydia trachomatis or Mycoplasma genitalium. Women with concurrent BV were also treated with metronidazole. The controls were 10 healthy women of matching age. The microbiota was analyzed by 16S rRNA gene deep sequencing, specific qPCRs and microscopy. There was generally good correlation between Nugent score and community state type (CST) and qPCR confirmed the sequencing results. By sequencing, more than 600 different taxa were found, but only 33 constituted more than 1 ‰ of the sequences. In both patients and controls the microbiota could be divided into three different community state types, CST-I, CST-III and CST-IV. Without metronidazole, the microbiota remained relatively stable regarding CST although changes were seen during menstrual periods. Administration of metronidazole changed the microbiota from CST-IV to CST-III in approximately 50% of the treated patients. In contrast, the CST was generally unaffected by azithromycin or tetracyclines. In 30% of the BV patients, Gardnerella vaginalis was not eradicated by metronidazole. The majority of women colonized with Ureaplasma parvum remained positive after azithromycin while U. urealyticum was eradicated.


Assuntos
Antibacterianos/farmacologia , Infecções por Chlamydia/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Microbiota/efeitos dos fármacos , Infecções por Mycoplasma/microbiologia , Vagina/microbiologia , Vaginose Bacteriana/microbiologia , Adolescente , Adulto , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/isolamento & purificação , Feminino , Gardnerella vaginalis/efeitos dos fármacos , Gardnerella vaginalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Infecções por Mycoplasma/tratamento farmacológico , Mycoplasma genitalium/efeitos dos fármacos , Mycoplasma genitalium/isolamento & purificação , Vagina/efeitos dos fármacos , Vaginose Bacteriana/tratamento farmacológico , Adulto Jovem
6.
PLoS One ; 15(7): e0236758, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730301

RESUMO

Chlamydiosis is the most significant infectious disease of koalas (Phascolarctos cinereus). It is primarily a systemic sexually transmitted disease caused by Chlamydia pecorum and was responsible for 46% of the 2348 koala admissions to Australia Zoo Wildlife Hospital between 2013 and 2017. Treatment of chlamydiosis in koalas is complicated by three major factors. Firstly, koalas rely on bacterial fermentation of their high fibre diet making antibiotic therapy a risk. Secondly, they possess efficient metabolic pathways for the excretion of plant toxins and potentially of therapeutic agents. Thirdly, wild koalas, often present to rehabilitation facilities with chronic and severe disease. Traditional anti-chlamydial antibiotics used in other species may cause fatal dysbiosis in koalas or be excreted before they can be effective. We compared five anti-chlamydial antibiotics, azithromycin, chloramphenicol, doxycycline, enrofloxacin and florfenicol, which were used to treat 86 wild koalas with chlamydiosis presented to Australia Zoo Wildlife Hospital under consistent conditions of nutrition, housing, husbandry and climate. Response to treatment was assessed by recovery from clinical signs, and clearance of detectable Chlamydia via quantitative PCR. Doxycycline was the most effective anti-chlamydial antibiotic of the five, producing a 97% cure rate, followed by chloramphenicol (81%), enrofloxacin (75%), florfenicol (66%) and azithromycin (25%). The long-acting injectable preparation of doxycycline was well tolerated by koalas when administered via the subcutaneous route, and the weekly dosing requirement is a major advantage when treating wild animals. These findings indicate that doxycycline is the current drug of choice for the treatment of chlamydiosis in koalas, with chloramphenicol being the best alternative.


Assuntos
Antibacterianos/farmacologia , Infecções por Chlamydia/tratamento farmacológico , Chlamydia/efeitos dos fármacos , Phascolarctidae/microbiologia , Animais , Austrália , Azitromicina/farmacologia , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/patologia , Cloranfenicol/farmacologia , Doxiciclina/farmacologia , Enrofloxacina/farmacologia , Feminino , Masculino , Tianfenicol/análogos & derivados , Tianfenicol/farmacologia
7.
Adv Clin Exp Med ; 29(6): 707-713, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32589825

RESUMO

BACKGROUND: Chlamydia trachomatis (C. trachomatis) and Streptococcus agalactiae (GBS) may be present in the female cervical canal without any symptoms of infection. Chronic chlamydial infections lead to many serious complications and perinatal infections, while the presence of GBS is a reservoir for infections of newborns or invasive streptococcal infection in adults. OBJECTIVES: To examine healthy women for C. trachomatis without symptoms from the reproductive system, assess the frequency of asymptomatic infections, detect GBS in the cervical canal, demonstrate differences in drug susceptibility, and determine the serotype of S. agalactiae strains and correlations among the ones present in the cervical canal. MATERIAL AND METHODS: A total of 315 cervical swabs were collected for genetic and microbiological analysis for the presence of C. trachomatis and S. agalactiae. Latex and diffusion-disk methods were used to determine the serotype and susceptibility of streptococci. RESULTS: Ten out of 315 women (3.2%) were C. trachomatis-positive. Using traditional methods of microscopy, culture and serology, 42 strains (13.3% of the subjects) obtained from patients were identified as S. agalactiae and further analyzed. The most common serotypes identified were II (18/42, 42.9%), V (11/42, 26.2%) and III (10/42, 23.8%). The less common serotypes found were VII (2/10, 4.8%), and Ib (1/10, 2.4%); no Ia, IV or VII serotypes were found. All the strains were susceptible to penicillin, while 71.4% of them were susceptible to erythromycin and 81.0% were susceptible to clindamycin. Seven isolates (16.7%) were concomitantly resistant to erythromycin and clindamycin. CONCLUSIONS: Chlamydia trachomatis was confirmed in 3.2% of the respondents, and GBS was found in 13.3%, despite a lack of symptoms of infection. The incidence of C. trachomatis infections and GBS colonization in Poland is similar to those in other European countries.


Assuntos
Infecções por Chlamydia , Chlamydia trachomatis , Infecções Estreptocócicas , Streptococcus agalactiae , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Farmacorresistência Bacteriana , Feminino , Humanos , Recém-Nascido , Testes de Sensibilidade Microbiana , Polônia/epidemiologia , Gravidez , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação
8.
Sex Transm Infect ; 96(6): 402-407, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32447324

RESUMO

OBJECTIVES: Test of cure (TOC) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection is an important tool in the public health management of STIs. However, there are limited data about the optimal time to perform TOC using nucleic acid amplification tests (NAATs) for NG and CT infections. A study was performed to assess the feasibility of a larger study to determine the optimal time to TOC using NAATS. METHODS: The Sexually Transmitted Bacteria Reference Unit at Public Health England undertook testing of gonococcal and chlamydial nucleic acids within neat urine stored in different conditions over 25 days to provide evidence of the stability of the nucleic acid prior to recruitment. Individuals diagnosed with uncomplicated NG or CT infection were recruited from three sexual health clinics. Individuals were asked to return nine self-taken samples from the site of infection over a course of 35 days. Survival analyses of time to first negative NAAT result for NG and CT infection and univariate regression analysis of factors that affect time to clearance were undertaken. RESULTS: At room temperature, chlamydial DNA in urine is stable for up to 3 weeks and gonococcal DNA for up to 11 days. We analysed data for 147 infections (81 NG and 66 CT). The median time to clearance of infection was 4 days (IQR 2-10 days) for NG infection and 10 days (IQR 7-14 days) for CT infection. Vaginal CT infections took longer to clear (p=0.031). NG infection in men who have sex with men took longer to clear (p=0.052). CONCLUSION: Chlamydial and gonococcal nucleic acids are stable in urine before addition of preservatives, longer than recommended by the manufacturer. The TOC results suggest that it may be possible to undertake TOC for NG and CT infections earlier than current guidelines suggest and that anatomical site of infection may affect time to clearance of infection.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Adulto , Idoso , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Chlamydia trachomatis/genética , Doxiciclina/uso terapêutico , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Técnicas de Amplificação de Ácido Nucleico , Faringite/diagnóstico , Faringite/tratamento farmacológico , Proctite/diagnóstico , Proctite/tratamento farmacológico , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Tempo , Resultado do Tratamento , Uretrite/diagnóstico , Uretrite/tratamento farmacológico , Vulvovaginite/diagnóstico , Vulvovaginite/tratamento farmacológico , Adulto Jovem
9.
Int J STD AIDS ; 31(7): 627-636, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32403988

RESUMO

Partner notification and treatment are essential components of sexually transmitted infection (STI) management, but little is known about such practices among adolescents and young adults. Using data from a prospective cohort study (AYAZAZI) of youth aged 16-24 years in Durban, South Africa, we assessed the STI care cascade across participant diagnosis, STI treatment, partner notification, and partner treatment; index recurrent STI and associated factors; and reasons for not notifying partner of STI. Participants completed laboratory-based STI screening (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis) at enrollment and at 12 months. Of the 37/216 participants with STI (17%), 27/37 (73%) were women and 10/37 (27%) were men. Median age was 19 years (IQR: 18-20). Of the participants with STI, 23/37 (62%) completed a Treatment and Partner Tracing Survey within 6 months of diagnosis. All survey participants reported completing STI treatment (100%), 17/23 (74%) notified a partner, and 6/23 (35%) reported partner treatment. Overall, 4/23 (11%) participants had 12-month recurrent C. trachomatis infection, with no association with partner notification or treatment. Stigma and lack of STI knowledge were reasons for not notifying partner of STI. STI partner notification and treatment is a challenge among youth. Novel strategies are needed to overcome barriers along the STI care cascade.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Busca de Comunicante/estatística & dados numéricos , Gonorreia/tratamento farmacológico , Parceiros Sexuais , Adolescente , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Feminino , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Neisseria gonorrhoeae , Estudos Prospectivos , Doenças Sexualmente Transmissíveis , Estigma Social , África do Sul/epidemiologia , Resultado do Tratamento , Adulto Jovem
10.
BMC Infect Dis ; 20(1): 314, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345231

RESUMO

BACKGROUND: Mycoplasma genitalium is an emerging sexually transmitted infection, with increasing rates of resistance to fluroquinolones and macrolides, the recommended treatments. Despite this, M. genitalium is not part of routine screening for Sexually Transmitted Infections (STIs) in many countries and the prevalence of infection and patterns of disease remain to be determined in many populations. Such data is of particular importance in light of the reported rise in antibiotic resistance in M. genitalium isolates. METHODS: Urine and urethral swab samples were collected from the primary public sexual health clinic in Singapore and tested for C. trachomatis (CT) or N. gonorrhoeae (NG) infection and for the presence of M. genitalium. Antibiotic resistance in M. genitalium strains detected was determined by screening for genomic mutations associated with macrolide and fluroquinolone resistance. RESULTS: We report the results of a study into M. genitalium prevalence at the national sexual health clinic in Singapore. M. genitalium was heavily associated with CT infection (8.1% of cases), but present in only of 2.4% in CT negative cases and not independently linked to NG infection. Furthermore, we found high rates of resistance mutations to both macrolides (25%) and fluoroquinolones (37.5%) with a majority of resistant strains being dual-resistant. Resistance mutations were only found in strains from patients with CT co-infection. CONCLUSIONS: Our results support targeted screening of CT positive patients for M. genitalium as a cost-effective strategy to reduce the incidence of M. genitalium in the absence of comprehensive routine screening. The high rate of dual resistance also highlights the need to ensure the availability of alternative antibiotics for the treatment of multi-drug resistant M. genitalium isolates.


Assuntos
Antibacterianos/farmacologia , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Infecções por Mycoplasma/diagnóstico , Mycoplasma genitalium/efeitos dos fármacos , Instituições de Assistência Ambulatorial , Antibacterianos/uso terapêutico , Infecções por Chlamydia/complicações , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Farmacorresistência Bacteriana Múltipla/genética , Fluoroquinolonas/farmacologia , Fluoroquinolonas/uso terapêutico , Humanos , Macrolídeos/farmacologia , Macrolídeos/uso terapêutico , Infecções por Mycoplasma/complicações , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium/genética , Mycoplasma genitalium/isolamento & purificação , Prevalência , RNA Ribossômico 23S/química , RNA Ribossômico 23S/genética , RNA Ribossômico 23S/metabolismo , Análise de Sequência de DNA , Singapura/epidemiologia , Uretra/microbiologia
11.
Sex Transm Infect ; 96(5): 342-347, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32241905

RESUMO

OBJECTIVES: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration. METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers. RESULTS: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care. CONCLUSION: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.


Assuntos
Assistência à Saúde/organização & administração , Testes Imediatos/organização & administração , Doenças Sexualmente Transmissíveis/diagnóstico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/prevenção & controle , Infecções por Chlamydia/transmissão , Feminino , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Gonorreia/prevenção & controle , Gonorreia/transmissão , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Ciência da Implementação , Masculino , Infecções por Mycoplasma/diagnóstico , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/prevenção & controle , Infecções por Mycoplasma/transmissão , Mycoplasma genitalium , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/transmissão , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/transmissão , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/prevenção & controle , Sífilis/transmissão , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/tratamento farmacológico , Vaginite por Trichomonas/prevenção & controle , Vaginite por Trichomonas/transmissão
12.
Am J Obstet Gynecol ; 223(3): 417.e1-417.e8, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32135143

RESUMO

BACKGROUND: The rising incidence rates of sexually transmitted infections in the United States highlight the need for concurrent treatment of patients and their sexual partners. Expedited partner therapy allows healthcare providers to offer antibiotic prescriptions or medications to an index patient for distribution to their sexual partner(s) without evaluating the partner. We hypothesized that there was a gap between expedited partner therapy policy at the state level and its downstream implementation by community pharmacists. OBJECTIVE: The objectives of our study were to evaluate pharmacists' expedited partner therapy knowledge and practices in 41 expedited partner therapy-permissible US states, to determine whether there were differences in practice based on the length of time expedited partner therapy was permissible in the state and chlamydia incidence rates, and to measure the cost of expedited partner therapy treatment. STUDY DESIGN: A randomized cohort of pharmacists (n=335) was invited to complete a telephone interview from November 2017 through January 2018. Descriptive statistics were calculated and stratified by early, mid, and late expedited partner therapy-adopter status based on the year of the state's expedited partner therapy enactment and the state's chlamydia incidence rate. Fisher's exact test and 1-way analyses of variance were used to compare measures across strata. RESULTS: We had 143 pharmacists (42.7%) agree to complete the survey. Among our respondents, 40.6% (n=58/143) indicated that they were aware of expedited partner therapy; 14.7% (n=21/143) reported that they had ever received an expedited partner therapy prescription, and 97% (n=139/143) reported that they would dispense an expedited partner therapy prescription if they received 1 in the future. These findings were stable across the 6 strata defined by early, mid, or late expedited partner therapy-adopter and high or low incidence rates of chlamydia status. Mean cost of azithromycin 1000 mg and cefixime 400 mg for treatment of chlamydia and gonorrhea was $22.17 (95% confidence interval, 20.29-24.05) and $30.46 (95% confidence interval, 28.65-32.26), respectively. CONCLUSION: Fewer than one-half of the pharmacists were aware of expedited partner therapy. A small minority of pharmacists reported ever having received an expedited partner therapy prescription, regardless of the length of time expedited partner therapy had been legal in their states and the incidence of chlamydia. However, almost all pharmacists reported that they would dispense an expedited partner therapy prescription if they received 1. Additionally, costs were high for expedited partner therapy for self-pay patients. These data suggest that there are opportunities to increase expedited partner therapy utilization by healthcare providers, patients, and pharmacists.


Assuntos
Infecções por Chlamydia/epidemiologia , Pessoal de Saúde , Farmacêuticos , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Antibacterianos/economia , Antibacterianos/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/prevenção & controle , Estudos de Coortes , Feminino , Humanos , Entrevistas como Assunto , Masculino , Distribuição Aleatória , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/prevenção & controle , Estados Unidos/epidemiologia , Adulto Jovem
13.
Int J Infect Dis ; 96: 121-127, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32173573

RESUMO

OBJECTIVE: The aim of this study was to investigate the relationships between treatment outcomes of patients with urogenital Chlamydia trachomatis infections and minimum inhibitory concentrations (MICs) and drug resistance genes. METHODS: The clinical data of 92 patients diagnosed with Chlamydia trachomatis (C. trachomatis) infections were collected. Of these patients, 28 received regular treatment with azithromycin and 64 received minocycline. All patients underwent three monthly follow-ups after the completion of treatment. The microdilution method was used for the in vitro susceptibility tests. The acquisition of 23S rRNA mutations and presence of the tet(M) gene were detected by gene amplification and sequencing. RESULTS: The MICs of azithromycin, clarithromycin, erythromycin, tetracycline, doxycycline, and minocycline were comparable for isolates from the treatment failure and treatment success groups. Higher detection rates of 23S rRNA gene mutations and tet(M) were found in the treatment failure group (57.14% and 71.43%, respectively) than in the treatment success group (14.29% and 30.23%, respectively) (p < 0.05). The A2057G, C2452A, and T2611C gene mutations of 23S rRNA were detected in eight clinical isolates from the azithromycin treatment failure group, while the T2611C gene mutation was detected in one clinical strain from the treatment success group. CONCLUSIONS: The detection of resistance genes could better explain the high treatment failure rate than the MIC results in patients with urogenital C. trachomatis infections, highlighting the need for genetic antimicrobial resistance testing in infected patients.


Assuntos
Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Azitromicina/farmacologia , Azitromicina/uso terapêutico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Feminino , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/microbiologia , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Minociclina/farmacologia , Minociclina/uso terapêutico , RNA Ribossômico 23S/genética , Falha de Tratamento , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Adulto Jovem
14.
Praxis (Bern 1994) ; 109(2): 79-85, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019451

RESUMO

Recurrent Urogynecological Infections Abstract. Changes in the urogenital microbiome of the bladder, urethra, vagina and cervix can cause recurrent infections. We distinguish between obligate and facultative pathogens. In the case of facultative pathogens, treatment with antibiotic, antiviral or antifungal drugs should only be considered in cases with attributable symptoms. Sexually transmitted diseases (STD) manifest either urogenitally alone or in association with an ascending infection of the adnexa as a pelvic inflammatory disease. STD may be asymptomatic, as in cases of chlamydia, or may cause a high burden of symptoms, impairment of quality of life or infertility. The aim of this minireview is to give an overview of the pathogenicity of the different germs and their treatment.


Assuntos
Infecções por Chlamydia , Doença Inflamatória Pélvica , Doenças Sexualmente Transmissíveis , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Feminino , Humanos , Doença Inflamatória Pélvica/microbiologia , Qualidade de Vida , Recidiva , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico
15.
Vet Microbiol ; 240: 108499, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31902484

RESUMO

Following the occurrence of sudden death cases in a zoo reptile collection, histological analyses conducted on tissues from two common adders suggested an infection due to Chlamydia. The survey was extended to 22 individual snakes from the same collection and a PCR analysis targeting a conserved gene in Chlamydiaceae revealed bacterial shedding in six of them. The infection resolved spontaneously in one snake whereas another one succumbed one month later. The antibiotic treatment administered (marbofloxacin) to the remaining four PCR positive animals stopped the mortalities and the shedding. Analysis of the 16S and 23S ribosomal gene sequences identified C. serpentis, a recently described novel chlamydial species in snakes. A PCR tool for a quick and specific identification of this new chlamydial species was developed in this study.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Chlamydia/veterinária , Chlamydia/classificação , Chlamydia/efeitos dos fármacos , Fluoroquinolonas/uso terapêutico , Serpentes/microbiologia , Animais , Animais de Zoológico/microbiologia , Infecções por Chlamydia/tratamento farmacológico , Fezes/microbiologia , Feminino , Masculino , Filogenia
16.
Int J STD AIDS ; 31(3): 221-229, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31996095
18.
J Infect Dis ; 221(4): 627-635, 2020 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-31573603

RESUMO

We characterized the composition and structure of the vaginal microbiota in a cohort of 149 women with genital Chlamydia trachomatis infection at baseline who were followed quarterly for 9 months after antibiotic treatment. At time of diagnosis, the vaginal microbiota was dominated by Lactobacillus iners or a diverse array of bacterial vaginosis-associated bacteria including Gardnerella vaginalis. Interestingly, L. iners-dominated communities were most common after azithromycin treatment (1 g monodose), consistent with the observed relative resistance of L. iners to azithromycin. Lactobacillus iners-dominated communities have been associated with increased risk of C. trachomatis infection, suggesting that the impact of antibiotic treatment on the vaginal microbiota could favor reinfections. These results provide support for the dual need to account for the potential perturbing effect(s) of antibiotic treatment on the vaginal microbiota, and to develop strategies to protect and restore optimal vaginal microbiota.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/genética , Microbiota/efeitos dos fármacos , Vagina/microbiologia , Vaginose Bacteriana/tratamento farmacológico , Adolescente , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Azitromicina/administração & dosagem , Azitromicina/efeitos adversos , Azitromicina/farmacologia , Infecções por Chlamydia/microbiologia , Estudos Transversais , Feminino , Seguimentos , Gardnerella vaginalis/efeitos dos fármacos , Gardnerella vaginalis/genética , Humanos , Lactobacillus/efeitos dos fármacos , Lactobacillus/genética , Microbiota/genética , Estudos Prospectivos , RNA Ribossômico 16S , Resultado do Tratamento , Vaginose Bacteriana/microbiologia , Adulto Jovem
19.
Sex Transm Infect ; 96(2): 101-105, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31511394

RESUMO

OBJECTIVES: Expedited partner therapy (EPT) is an effective strategy to reduce rates of chlamydia and gonorrhoea infection and ensure sexual partners are treated. Currently, EPT is provided to heterosexual patients; however, EPT is not routinely recommended for use with gay, bisexual and other men who have sex with men (GBMSM) because of concerns about HIV coinfection. The objective of the qualitative study was to understand provider and community views on the use of EPT with GBMSM. METHODS: Using convenience sampling methods, we recruited a sample of 18 healthcare providers and 21 GBMSM to participate in in-depth, semistructured interviews. Interviews were conducted over the phone and included questions about knowledge, experiences and potential barriers and facilitators to the use of EPT with GBMSM. RESULTS: Most providers wanted to provide EPT to GBMSM and believed that the potential barriers and concerns to EPT use were not unique to a patient's sexual orientation. Several providers noted that they were currently providing EPT to GBMSM as part of HIV prevention services. Community members were generally unaware of EPT as a service and most indicated that they would only use EPT if they were in a committed relationship. Barriers included partner allergies and resistance, pharmacy protocols, structural concerns (eg, insurance coverage, pharmacists onsite and transportation) and potential disclosure issues. Facilitators included cultural humility and telemedicine with patients' partners to overcome these barriers. CONCLUSIONS: Acceptability of EPT use for both chlamydia and gonorrhoea was high among providers and community members. Barriers to EPT use, including concerns about patients' partners' allergies and resistance, disclosure concerns and linkage to HIV prevention services can be overcome through cultural humility trainings and telemedicine. Changing EPT recommendations at the national level to be inclusive of GBMSM is critical to curtail the rising STI and HIV epidemic.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Infecções por Chlamydia/tratamento farmacológico , Gonorreia/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde , Parceiros Sexuais , Minorias Sexuais e de Gênero , Adulto , Bissexualidade , Infecções por Chlamydia/transmissão , Busca de Comunicante , Hipersensibilidade a Drogas , Feminino , Gonorreia/transmissão , Infecções por HIV/diagnóstico , Homossexualidade Masculina , Humanos , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Telemedicina , Adulto Jovem
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