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1.
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
3.
BMC Infect Dis ; 19(1): 991, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752720

RESUMO

BACKGROUND: Male urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU). METHODS: A retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls. RESULTS: Among n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predictors of GU were any abnormalities on genital examination (aOR 10.4, 95% CI 2.1 to 50.8) and a history of urethral discharge (aOR 5.7, 95% CI 1.4 to 22.6). Aboriginal patients (aOR 3.0, 95% CI 0.9 to 9.6) and those over 30 years of age (aOR 1.4, 95% CI 0.3 to 7.0) were more likely to have GU in the unadjusted analysis, but not in the adjusted model. CONCLUSION: This is the first study looking at patterns of male urethritis in urban NT and the results support a move towards adopting national guidelines to use ceftriaxone for empiric management of syndromic urethritis only in high-risk patients. In addition to traditional demographic risk factors, clinical features remain an important component of risk stratification.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Uretrite/epidemiologia , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Azitromicina/uso terapêutico , Estudos de Casos e Controles , Ceftriaxona/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Gonorreia/tratamento farmacológico , Gonorreia/microbiologia , Humanos , Masculino , Neisseria gonorrhoeae/efeitos dos fármacos , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Northern Territory/epidemiologia , Estudos Retrospectivos , Uretrite/diagnóstico , Uretrite/tratamento farmacológico , Uretrite/microbiologia
4.
Medicine (Baltimore) ; 98(40): e17233, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577714

RESUMO

RATIONALE: The pathology of gouty arthritis and reactive arthritis (ReA) partially overlaps, and both diseases are characterized by the production of inflammatory cytokines associated with the activation of monocytes and macrophages. However, the precise cytokine profile of cases with a coexistence of both diseases is unknown, and there are few reports on the course of treatment in patients with both gouty arthritis and ReA. PATIENT CONCERNS: A 39-year-old man with a recurrent episode of gouty arthritis presented prednisolone-resistant polyarthritis with high level of C-reactive protein (CRP). He had the features of gouty arthritis such as active synovitis of the first manifestation of metatarsophalangeal (MTP) joints and the presence of monosodium urate (MSU) crystals from synovial fluid. But he also had the features of ReA such as the presence of tenosynovitis in the upper limb, the positivity of human leukocyte antigen (HLA)-B27, a history of sexual contact and positive findings of anti-Chlamydia trachomatis-specific IgA and IgG serum antibodies. DIAGNOSES: He was diagnosed with HLA-B27 associated Chlamydia-induced ReA accompanied by gout flares. INTERVENTIONS: He was treated with 180 mg/day of loxoprofen, 1 mg/day of colchicine, and 10 mg/day of prednisolone for gout flares. However, his polyarthritis worsened with an increased level of CRP (23.16 mg/dL). Accordingly, we added 500 mg/day of salazosulfapyridine followed by adalimumab (ADA) 40 mg once every 2 weeks. OUTCOMES: After starting ADA, the patient's symptoms and laboratory findings showed rapid improvement and he achieved clinical remission 1 month after initiation of ADA treatment. As of this writing, the patient's clinical remission has been maintained for >1 year. LESSONS: This case suggests that with exacerbation of arthritis during gouty arthritis, coexistence with other pathologies such as peripheral spondyloarthritis should be considered, and early intensive treatment including tumor necrosis factor inhibitors may be necessary.


Assuntos
Artrite Reativa/etiologia , Infecções por Chlamydia/complicações , Gota/complicações , Adulto , Artrite Reativa/tratamento farmacológico , Proteína C-Reativa/análise , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Citocinas/metabolismo , Gota/tratamento farmacológico , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Fator de Necrose Tumoral alfa/antagonistas & inibidores
6.
Res Vet Sci ; 126: 199-206, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31539797

RESUMO

The obligate intracellular bacterium Chlamydia abortus causes abortion and constitutes a worldwide threat for livestock. Plant-derived flavonoids have antimicrobial effects against veterinary and human pathogens and may be of help in the fight against C. abortus. The anti-infective efficacy against C. abortus of the flavonoids apigenin and naringenin, and of four of their derived metabolites was explored using an in vitro model of ovine trophoblast cells. Overall, the anti-infective effectiveness was apigenin > naringenin > benzoic acid > 3-(4-hydroxyphenyl) propionic acid ~ 4-hydroxyphenyl acetic acid ~ 4-hydroxybenzoic. At the lowest concentration tested (10 µM), apigenin, naringenin and benzoic acid inhibited the formation of C. abortus inclusions by 80%, 67%, and 39%, respectively. The cytotoxicity and anti-proliferative effects on the trophoblast host cells also differed greatly between the tested compounds. Our findings suggest that flavonoids may be of therapeutic value against C. abortus infection but metabolic conversion has a substantial and variable effect on their anti-chlamydial activity. Our results also support the notion that the mechanisms of anti-infective action may involve combined effects of the compounds against the host cells and the bacteria.


Assuntos
Antibacterianos/farmacologia , Apigenina/farmacologia , Infecções por Chlamydia/veterinária , Chlamydia/efeitos dos fármacos , Flavanonas/farmacologia , Doenças dos Ovinos/tratamento farmacológico , Animais , Antibacterianos/metabolismo , Apigenina/metabolismo , Linhagem Celular , Infecções por Chlamydia/tratamento farmacológico , Feminino , Flavanonas/metabolismo , Ovinos , Carneiro Doméstico , Trofoblastos
7.
J Infect Chemother ; 25(10): 832-834, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31255523

RESUMO

OBJECTIVES: Chlamydia trachomatis is one of the major pathogens causing acute epididymitis. Azithromycin (AZM) has a good efficacy against C. trachomatis; however, the ability of AZM to penetrate into human epididymal tissue has not yet been fully elucidated. Here, we examined the appropriate dosage of oral AZM for human epididymal tissue by site-specific pharmacokinetic/pharmacodynamic (PK/PD) analysis. METHODS: Patients with prostate cancer who underwent orchiectomy were included in this study. All patients received a 1-g dose of AZM before orchiectomy. Both epididymal tissue and blood samples were collected during surgery, and the drug concentrations were measured by high-performance liquid chromatography. All concentration-time data were analyzed with a three-compartment model with first-order absorption and elimination processes to simulate AZM concentrations in serum and epididymal tissue. RESULTS: A total of 10 patients were enrolled in the current study. For the observed values, the ratio of the epididymal concentration to the serum concentration was 5.13 ± 3.71 (mean ± standard deviation). For the simulated values, the maximum concentrations were 0.64 µg/mL at 2.42 h in serum and 1.96 µg/g at 4.10 h in epididymal tissue. The 24-h concentrations were 0.239 µg/mL in serum and 0.795 µg/g in epididymal tissue. CONCLUSIONS: The penetration of oral AZM into human epididymal tissue was examined to assess the potential application of AZM for the treatment of acute epididymitis. Based on the previous reports mentioning drug-susceptibility of C. trachomatis, multiple doses of oral AZM 1 g would be recommended for epididymitis based on the site-specific PK/PD.


Assuntos
Antibacterianos/farmacocinética , Azitromicina/farmacocinética , Epididimo/metabolismo , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/patogenicidade , Relação Dose-Resposta a Droga , Farmacorresistência Bacteriana , Epididimo/microbiologia , Epididimite/tratamento farmacológico , Epididimite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Orquiectomia , Neoplasias da Próstata/cirurgia , Distribuição Tecidual
10.
Ophthalmic Epidemiol ; 26(4): 231-237, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30957594

RESUMO

Purpose: The clinical sign trachomatous inflammation - follicular (TF) is used to monitor indication for and response to mass azithromycin distribution in trachoma-endemic communities. Here, we assess the relationship between TF, trachomatous inflammation - intense (TI), and infection with ocular Chlamydia trachomatis over time during annual mass azithromycin distribution. Methods: We used data from a cluster-randomized trial of mass azithromycin distribution for trachoma control in a mesoendemic region of Niger. This study includes 24 communities that received 3 years of annual mass azithromycin distribution. TF, TI, and ocular chlamydia infection were monitored among children aged 0-5 years. We assessed the correlation between the prevalence of ocular chlamydia infection and 1) TF and 2) TI prevalence over time. Results: At baseline, ocular chlamydia prevalence was 21.2% (95% CI 14.3-28.1%), TF prevalence was 27.7% (95% CI 21.2-34.2%), and TI prevalence was 8.3% (95% CI 5.2-11.5%). The prevalence of all three measures decreased significantly over time (P < 0.001). At baseline, ocular chlamydia infection prevalence was strongly correlated with both TF (rho = 0.78, P < 0.0001) and TI (rho = 0.76, P < 0.0001). The correlation between ocular chlamydia infection and both TF and TI was weak at months 12 and 24. At 36 months, when TF prevalence had dropped below 10%, ocular chlamydia infection and TF were moderately correlated (rho = 0.70, P= 0.0002). Conclusions: Both TF and TI are good indicators of infection prevalence prior to mass azithromycin distribution. However, this relationship may be affected by repeated rounds of mass azithromycin distribution.


Assuntos
Azitromicina/uso terapêutico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Infecções Oculares Parasitárias/epidemiologia , Administração Massiva de Medicamentos/métodos , Tracoma/epidemiologia , Antibacterianos/uso terapêutico , Pré-Escolar , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/microbiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Níger/epidemiologia , Prevalência , Tracoma/tratamento farmacológico , Tracoma/microbiologia
11.
Emerg Med Clin North Am ; 37(2): 165-192, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940365

RESUMO

Sexually transmitted diseases (STDs) continue to be underrecognized leading to devastating health and economic consequences. Emergency clinicians play an important role in diagnosing and managing STDs and in improving health care outcomes for both the patient and their partners. In addition, antibiotic resistance and emerging infections continue to challenge providers in clinical practice. This review focuses on the cause, history, physical examination, diagnostic studies, and treatment strategies for bacterial vaginosis, chlamydia, genital herpes, gonorrhea, human papillomavirus, granuloma inguinale, Lymphogranuloma Venereum, Mycoplasma genitalium, syphilis, and trichomoniasis.


Assuntos
Serviço Hospitalar de Emergência , Doenças Sexualmente Transmissíveis/diagnóstico , Anti-Infecciosos/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Feminino , Gonorreia/diagnóstico , Gonorreia/terapia , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Humanos , Masculino , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/tratamento farmacológico , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/tratamento farmacológico
12.
BMC Infect Dis ; 19(1): 218, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832593

RESUMO

BACKGROUND: Chlamydia trachomatis infections in women continue to be a major public health concern due to their high prevalence and consequent reproductive morbidities. While antibiotics are usually efficient to clear the Chlamydia, repeat infections are common and may contribute to pathological outcomes. Interferon-gamma (IFN-γ)-mediated immunity has been suggested to be protective against reinfection, and represent an important anti-chlamydial agent, primarily via the induction of indoleamine-2,3 dioxygenase 1 (IDO1) enzyme. IDO1 catalyzes the degradation of tryptophan, which can eliminate C. trachomatis infection in vitro. Here, we sought to measure IDO1 expression levels and related immune markers during different C. trachomatis infection statuses (repeated vs single infection vs post antibiotic treatment), in vitro and in vivo. METHODS: In this study, we measured the expression levels of IDO1 and immune regulatory markers, transforming growth factor ß1 (TGF-ß1) and forkhead box P3 (FoxP3), in vaginal swab samples of C. trachomatis-infected women, with either single or repeated infection. In addition, we used an in vitro co-culture model of endometrial carcinoma cell-line and peripheral blood mononuclear cells (PBMCs) to measure the same immune markers. RESULTS: We found that in women with repeated C. trachomatis infections vaginal IDO1 and TGF-ß1 expression levels were significantly increased. Whereas, women who cleared their infection post antibiotic treatment, had increased levels of IDO1 and TGF-ß1, as well as FoxP3. Similarly, using the in vitro model, we found significant upregulation of IDO1 and TGF-ß1 levels in the co-culture infected with C. trachomatis. Furthermore, we found that in PBMCs infected with C. trachomatis there was a significant upregulation in IDO1 levels, which was independent of IFN-γ. In fact, C. trachomatis infection in PBMCs failed to induce IFN-γ levels in comparison to the uninfected culture. CONCLUSIONS: Our data provide evidence for a regulatory immune response comprised of IDO1, TGF-ß1 and FoxP3 in women post antibiotic treatment. In this study, we demonstrated a significant increase in IDO1 expression levels in response to C. trachomatis infection, both in vivo and in vitro, without elevated IFN-γ levels. This study implicates IDO1 and TGF-ß1 as part of the immune response to repeated C. trachomatis infections, independently of IFN-γ.


Assuntos
Infecções por Chlamydia/diagnóstico , Indolamina-Pirrol 2,3,-Dioxigenase/metabolismo , Interferon gama/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Adulto , Antibacterianos/uso terapêutico , Linhagem Celular , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/patogenicidade , Técnicas de Cocultura , Feminino , Fatores de Transcrição Forkhead/genética , Fatores de Transcrição Forkhead/metabolismo , Humanos , Indolamina-Pirrol 2,3,-Dioxigenase/genética , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/metabolismo , Recidiva , Fator de Crescimento Transformador beta1/genética , Regulação para Cima , Vagina/metabolismo , Vagina/microbiologia , Adulto Jovem
13.
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
14.
PLoS One ; 14(3): e0212874, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822328

RESUMO

Chlamydia is a common pathogen that can causes serious complications in the reproductive system and eyes. Lack of vaccine and other effective prophylactic measures coupled with the largely asymptomatic nature and unrare clinical treatment failure calls for development of new antichlamydials, particularly selective antichlamydials without adverse effects on humans and the beneficial microbiota. We previously reported that benzal-N-acylhydrazones (BAH) can inhibit chlamydiae without detectable adverse effects on host cells and beneficial lactobacilli that dominate the human vaginal microbiota among reproductive-age women. However, the antichlamydial mechanism of BAH is not known. Whereas 4 single nucleotide polymorphisms (i.e., SNP1-4) were identified in a rare Chlamydia variant with a low level of BAH resistance, termed MCR, previous studies failed to establish a causal effect of any particular SNP(s). In the present work, we performed recombination to segregate the four SNPs. Susceptibility tests indicate that the R51G GrgA allele is both necessary and sufficient for the low level of BAH resistance. Thus, the Chlamydia-specific transcription factor GrgA either is a direct target of BAH or regulates BAH susceptibility. We further confirm an extremely low rate of BAH resistance in Chlamydia. Our findings warrant exploration of GrgA as a therapeutic and prophylactic target for chlamydial infections.


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Chlamydia muridarum/genética , Farmacorresistência Bacteriana/genética , Fatores de Transcrição/genética , Animais , Antibacterianos/uso terapêutico , Proteínas de Bactérias/antagonistas & inibidores , Compostos de Benzilideno/farmacologia , Compostos de Benzilideno/uso terapêutico , Linhagem Celular , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia muridarum/efeitos dos fármacos , Farmacorresistência Bacteriana/efeitos dos fármacos , Humanos , Hidrazonas/farmacologia , Hidrazonas/uso terapêutico , Camundongos , Testes de Sensibilidade Microbiana , Polimorfismo de Nucleotídeo Único , Fatores de Transcrição/antagonistas & inibidores
15.
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
16.
Sex Transm Dis ; 46(3): 199-205, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30742592

RESUMO

BACKGROUND: Presumptive antibiotic treatment is common for suspected chlamydia (CT) and gonorrhea (GC) infections before laboratory confirmation to prevent complications, reduce loss-to-follow-up, and interrupt transmission. We assessed this practice in sexually transmitted disease (STD) and family planning clinics. METHODS: We performed a retrospective analysis of data from clinics in Virginia in 2016 using administrative data merged with electronic laboratory reporting data. After stratifying by patient and clinic characteristics, we calculated how often patients with positive CT/GC tests were treated presumptively or during a follow-up visit, and how many patients with negative tests were treated presumptively. RESULTS: Of 63,889 patient visits with valid laboratory results from 131 clinics, 13% tested positive for CT or GC. Overall, presumptive treatment was given to 45.2% of persons with positive tests and 10.1% of persons with negative tests. Among the 9443 patients presumptively treated, 40.7% had positive test results. Presumptive treatment was more common in STD clinics compared with family planning clinics (22% vs. 4%) and for males with positive tests compared to females (65% vs. 24%); smaller variations were observed across age, race/ethnicity, and diagnosis categories. Twenty-six percent of patients with positive tests who were not treated presumptively had no treatment recorded within 30 days. CONCLUSIONS: Presumptive treatment for CT/GC was commonly used in this clinic population. It improved treatment coverage and reduced time to treatment, though some uninfected persons were treated. The impact of presumptive treatment on partner notification and treatment requires further study.


Assuntos
Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/epidemiologia , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologia , Saúde Pública , Tempo para o Tratamento , Adolescente , Adulto , Chlamydia/genética , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Estudos Transversais , Feminino , Seguimentos , Gonorreia/diagnóstico , Gonorreia/microbiologia , Humanos , Incidência , Perda de Seguimento , Masculino , Neisseria gonorrhoeae/genética , Estudos Retrospectivos , Resultado do Tratamento , Virginia/epidemiologia , Adulto Jovem
17.
Medicine (Baltimore) ; 98(7): e14572, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762806

RESUMO

BACKGROUND: Chlamydia trachomatis can lead to a persistent infection in the lower gastrointestinal tract, suggesting a potential role of autoinoculation of cervical chlamydial infection from the rectal site, contributing to repeat infections. Moreover, around 75% of women with urogenital C. trachomatis have concurrent anorectal infection. Current treatment guidelines for urogenital C. trachomatis infection recommend either a single 1 g dose of azithromycin or doxycycline 100 mg twice daily for 7 days. Doxycycline appears to be more effective in treating anorectal infections as suggested in a population of men who have sex with men, but no randomized controlled trial (RCT) had directly compared azithromycin with doxycycline for the treatment of rectal infections. We propose an open-label RCT to compare the microbial cure obtained with a single 1 g dose of azithromycin versus 100 mg of doxycycline twice daily for 7 days, for the treatment of anorectal C. trachomatis infection concurrent to urogenital infection in women. METHODS AND STUDY DESIGN: A total of 460 women with C. trachomatis urogenital infection will be enrolled in the study. Women will be asked to provide self-collected anorectal swabs and will be randomized to receive either a 1 g single dose of azithromycin or doxycycline 100 mg twice daily for 7 days. Clinical and biological data will be collected and patients will complete questionnaires about their sexual behavior. The primary outcome is the microbial cure rate, defined as a C. trachomatis negative nucleic acid amplification test (NAAT) result in the anorectal specimens 6 weeks after treatment initiation among women with a C. trachomatis positive urogenital and anorectal NAAT result at the baseline. The secondary outcome is autoinoculation from the rectum to the vagina, which will be evaluated based on the number of women with the same C. trachomatis genotype profile that will be identified in an anorectal-positive specimen obtained 6 weeks after treatment initiation and in a vaginal-positive specimen obtained four months after treatment. DISCUSSION: The results of this trial will establish which treatment is more efficacious against anorectal infection and could affect recommendations for the treatment of urogenital C. trachomatis infection, taking into account concurrent anorectal infection. TRIAL REGISTRATION NUMBERS: EudraCT number: 2017-002595-15. CLINICALTRIALS. GOV IDENTIFIER: NCT03532464. Date of registration: May 31, 2018. WORLD HEALTH ORGANISATION INTERNATIONAL CLINICAL TRIALS REGISTRY: NTC03532464. Secondary ID: CHUBX 2016/26. Date of registration: May 09, 2018.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Doxiciclina/uso terapêutico , Doenças Retais/tratamento farmacológico , Doenças Vaginais/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Azitromicina/administração & dosagem , Azitromicina/efeitos adversos , Chlamydia trachomatis , Doxiciclina/administração & dosagem , Doxiciclina/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Doenças Retais/complicações , Doenças Retais/microbiologia , Projetos de Pesquisa , Doenças Vaginais/complicações , Doenças Vaginais/microbiologia
19.
Obstet Gynecol ; 133(3): 416-422, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30741802

RESUMO

Sexually transmitted infections (STI), including Chlamydia trachomatis and Neisseria gonorrhoeae, have reached record high rates in the United States. Sexually transmitted infections disproportionately affect reproductive-aged females aged 15-44 years, who account for 65% and 42% of the total reported C trachomatis and N gonorrhoeae cases, respectively. Undiagnosed STIs can result in serious health complications that put women at an increased risk for pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. Many of these women are seen by physicians (eg, obstetrician-gynecologists, family medicine doctors, pediatricians) or other clinicians (eg, nurse practitioners, midwives, physician assistants) who care for women. These clinicians have the opportunity to help curb the continued increase in STI incidence rates with the implementation and use of expedited partner therapy. Expedited partner therapy is a proven effective health care practice that allows clinicians to give patients medications or prescriptions to distribute to their partners. Despite expedited partner therapy's proven effectiveness, there are barriers to its implementation that must be understood to enhance STI treatment and prevention efforts. In this commentary, we discuss these barriers, and appeal to women's health clinicians to implement or increase use of expedited partner therapy for the treatment of women with STIs and their sexual partners.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/transmissão , Busca de Comunicante , Gonorreia/tratamento farmacológico , Gonorreia/transmissão , Antibacterianos/economia , Infecções por Chlamydia/prevenção & controle , Revelação , Prescrições de Medicamentos , Feminino , Gonorreia/prevenção & controle , Humanos , Responsabilidade Legal , Masculino , Guias de Prática Clínica como Assunto , Prevenção Secundária/métodos , Parceiros Sexuais , Saúde da Mulher
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