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1.
BMC Infect Dis ; 20(1): 925, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33276727

RESUMO

BACKGROUND: Not all men who have sex with men (MSM) at risk for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infection currently receive sexual healthcare. To increase the coverage of high-quality HIV/STI care for MSM, we developed a home-care programme, as extended STI clinic care. This programme included home sampling for testing, combined with treatment and sexual health counselling. Here, we pilot implemented the programme in a hospital setting (HIV-positive MSM) to determine the factors for the successful implementation of STI home sampling strategies. METHODS: Healthcare providers from the HIV hospital treatment centre (Maastricht) were invited to offer free STI sampling kits (syphilis, hepatitis B, [extra]genital chlamydia and gonorrhoea laboratory testing) to their HIV-positive MSM patients (March to May 2018). To evaluate implementation of the program, quantitative and qualitative data were collected to assess adoption (HIV care providers offered sampling kits to MSM), participation (MSM accepted the sampling kits) and sampling-kit return, STI diagnoses, and implementation experiences. RESULTS: Adoption was 85.3% (110/129), participation was 58.2% (64/110), and sampling-kit return was 43.8% (28/64). Of the tested MSM, 64.3% (18/28) did not recently (< 3 months) undergo a STI test; during the programme, 17.9% (5/28) were diagnosed with an STI. Of tested MSM, 64.3% (18/28) was vaccinated against hepatitis B. MSM reported that the sampling kits were easily and conveniently used. Care providers (hospital and STI clinic) considered the programme acceptable and feasible, with some logistical challenges. All (100%) self-taken chlamydia and gonorrhoea samples were adequate for testing, and 82.1% (23/28) of MSM provided sufficient self-taken blood samples for syphilis screening. However, full syphilis diagnostic work-up required for MSM with a history of syphilis (18/28) was not possible in 44.4% (8/18) of MSM because of insufficient blood sampled. CONCLUSION: The home sampling programme increased STI test uptake and was acceptable and feasible for MSM and their care providers. Return of sampling kits should be further improved. The home-care programme is a promising extension of regular STI care to deliver comprehensive STI care to the home setting for MSM. Yet, in an HIV-positive population, syphilis diagnosis may be challenging when using self-taken blood samples.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia/genética , Gonorreia/epidemiologia , Soropositividade para HIV/epidemiologia , HIV , Vírus da Hepatite B/imunologia , Hepatite B/epidemiologia , Homossexualidade Masculina , Programas de Rastreamento/métodos , Neisseria gonorrhoeae/genética , Minorias Sexuais e de Gênero , Manejo de Espécimes/métodos , Sífilis/epidemiologia , Treponema pallidum/imunologia , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Aconselhamento , Gonorreia/diagnóstico , Gonorreia/microbiologia , Soropositividade para HIV/virologia , Pessoal de Saúde , Hepatite B/diagnóstico , Hepatite B/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Parceiros Sexuais , Sífilis/diagnóstico , Sífilis/microbiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-33174978

RESUMO

Syphilis is a public health problem, especially in pregnant women, due to the risk of transmission to the fetus and the involvement of the central nervous system, causing neurosyphilis. A case-control study was carried out to analyze the variables associated with neurosyphilis in Brazilian newborns of pregnant women with syphilis admitted for childbirth. Newborns were submitted to treponemal and non-treponemal tests, cerebrospinal fluid analysis, and long bone radiography. Newborns diagnosed with neurosyphilis and congenital syphilis were defined as cases and controls, respectively. The length of hospitalization and mean cost of neurosyphilis treatment were also evaluated. Twenty-one cases of newborns with neurosyphilis and 42 controls with congenital syphilis were included in the study. Out of 63 pregnant women with syphilis, 95.2% (60/63) received prenatal care, 74.6% (47/63) were diagnosed with syphilis during this period, 31.9% (15/47) underwent treponemic tests, 80.8% (38/47) were treated with penicillin and only 46.8% (22/47) of the partners received the treatment. Clinical complications such as low birth weight were observed in 12.7% (8/63) of the newborns. About 50.8% (32/63) of the newborns were hospitalized due to syphilis complications and each case of neurosyphilis spent at least US$ 881.48 on treatment and hospitalization. The results showed that the prenatal coverage is not sufficient to prevent neurosyphilis. The late diagnosis of syphilis in pregnant women and inadequate follow-up of sexual partners may favor the vertical transmission of T. pallidum in pregnant Brazilian women. Thus, improving the quality of health services is important for a more effective control of neurosyphilis.


Assuntos
Neurossífilis/tratamento farmacológico , Penicilinas/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Sífilis Congênita/diagnóstico , Sífilis/tratamento farmacológico , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Neurossífilis/diagnóstico , Neurossífilis/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Gestantes , Sífilis/diagnóstico , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis , Sífilis Congênita/epidemiologia
3.
J Med Microbiol ; 69(12): 1339-1345, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33180016

RESUMO

Introduction. Macrolides could be a potential alternative treatment for Treponema pallidum infections in patients; however, macrolide-resistant T. pallidum is spreading rapidly worldwide.Hypothesis/Gap Statement. There are presently no alternatives to serological tests for syphilis that can be used to evaluate therapeutic effects due to the fact that T. pallidum cannot be cultured in vitro.Aim. In this study, we constructed a method for rapidly identifying T. pallidum and confirming macrolide resistance by using loop-mediated isothermal amplification (LAMP) with peptide nucleic acids (PNAs).Methodology. A set of LAMP primers was designed to span nucleotide positions 2058 and 2059 in 23S rRNA. A PNA clamping probe was also designed to be complementary to the wild-type sequence (A2058/A2059) and positioned to interfere with both the annealing of the 3' end of the backward inner primer and the concomitant extension. Prior to the LAMP assay, swab samples from suspected syphilitic lesions were boiled for DNA extraction.Results. The assay had an equivalent detection limit of 1.0×101 copies/reaction and showed specificity against 38 pathogens. In the presence of a 4 µM PNA probe, LAMP amplified up to 1.0×101 copies/reaction using plasmids harbouring the complementary mutant sequences (A2058G or A2059G), whereas amplification was completely blocked for the wild-type sequence up to a concentration of 1.0×103 copies/reaction. For the 66 PCR-positive clinical specimens, the overall detection rate via LAMP was 93.9 % (62/66). Amplification was successful for all 53 mutant samples and was incomplete for all nine WT samples by the PNA-mediated LAMP assays.Conclusion. We developed a PNA-mediated LAMP method that enabled us to rapidly identify T. pallidum and determine its macrolide susceptibility via a culture-independent protocol.


Assuntos
Técnicas de Diagnóstico Molecular/métodos , Mutação , Técnicas de Amplificação de Ácido Nucleico/métodos , RNA Bacteriano/genética , RNA Ribossômico 23S/genética , Treponema pallidum/genética , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Humanos , Macrolídeos/farmacologia , Ácidos Nucleicos Peptídicos , Testes Imediatos , Sensibilidade e Especificidade , Sífilis/diagnóstico , Sífilis/microbiologia , Treponema pallidum/efeitos dos fármacos
4.
Medicina (B Aires) ; 80(6): 714-717, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33254122

RESUMO

Malignant syphilis occurs frequently in patients infected with human immunodeficiency virus (HIV) and presents with cutaneous nodular lesions that tend to ulcerate. Non caseating granulomas are among the most conspicuous histopathological findings and require differential diagnosis with other infectious and non-infectious granulomatous conditions. The evolution of the disease is usually favourable with penicillin treatment. We present the case of an HIV-positive patient who meets diagnostic criteria for malignant syphilis and alert on this infrequent granulomatous entity.


Assuntos
Infecções por HIV , Sífilis , Administração Cutânea , Diagnóstico Diferencial , Granuloma , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico
5.
Orv Hetil ; 161(45): 1927-1935, 2020 11 08.
Artigo em Húngaro | MEDLINE | ID: mdl-33161392

RESUMO

Összefoglaló. Bevezetés és célkituzés: A syphiliseredetu uveitis szemészeti és általános tüneteinek ismertetése, a prognózis elemzése olyan esetek kapcsán, amelyekben az uveitis kivizsgálása során derült fény a syphilisre. Módszer: 2011 és 2019 között 14 uveitises beteg vizsgálata során derült fény syphilisre (13 férfi, 1 no), a tünetek 25 szemen jelentkeztek. A betegek adatait retrospektíven elemeztük. Eredmények: A betegek átlagéletkora 46 év volt (23-72 év). A szemészeti diagnózis felállítását követoen 2 beteg nem jelent meg a további borgyógyászati és szemészeti vizsgálaton, 1 beteget más intézetben kezeltek. A gondozott 11 betegnél a gyulladásban érintett szemeken az elso alkalommal észlelt átlagolt látóélesség a jobb szemen 0,71 (0,001-1,0), a bal szemen 0,53 (0,04-1,0) volt. A követési ido átlagosan 22 hónap (1-72) volt. A követési ido végén az átlagolt látóélesség a jobb szemen 0,9 (0,15-1,0), a bal szemen 0,82 (0,08-1,0) volt. A leggyakoribb szemészeti manifesztáció a hátsó uveitis volt, amely papillitis, chorioretinitis vagy kombinált formákban volt megfigyelheto, összesen 20 szemen. A neurosyphilis-protokoll alapján alkalmazott penicillinkezelés után a gyulladásos tünetek minden betegnél megszuntek, a követési ido végén a betegek többségénél a látóélesség teljes volt. A gyengébb látóélesség hátterében látóideg-atrophia, illetve a macula károsodása állt. Következtetés: Eseteinkben a betegek foként középkorú férfiak voltak. Bár jellemzo volt a hátsószegmentum-érintettség, megfelelo kezelés mellett a prognózis jónak volt mondható. Orv Hetil. 2020; 161(45): 1927-1935. INTRODUCTION AND OBJECTIVE: To describe the ocular and general characteristics and to assess prognosis of patients with uveitis, whose syphilis infection was revealed during uveitis workup. METHOD: Between 2011 and 2019, 14 uveitis patients were diagnosed with syphilis (13 males, 1 female) with symptoms in 25 eyes. Patients' clinical records were analyzed retrospectively. RESULTS: The mean age of patients was 46 years (range 23-72 years). 2 patients did not show up for further dermatological and ophthalmic examinations, and 1 patient was treated at another institute. In the 11 patients we treated, the mean visual acuity observed for the first time in the eyes affected by inflammation was 0.71 (0.001-1.0) in the right eye and 0.53 (0.04-1.0) in the left eye. The mean follow-up was 22 months (1-72). At the end of the follow-up period, the mean visual acuity was 0.9 (0.15-1.0) in the right eye and 0.82 (0.08-1.0) in the left eye. The most common ocular manifestation was posterior uveitis (papillitis, chorioretinitis, or in combined forms) in a total of 20 eyes. After receiving penicillin therapy according the neurosyphilis protocol, inflammatory symptoms resolved in all patients, and at the end of the follow-up, the majority of patients had complete visual recovery. Lower visual acuity was due to optic nerve atrophy and macular damage. CONCLUSION: In our case series, the patients were predominantly middle-aged men. Although most patients showed posterior segment involvement, with appropriate treatment the visual outcome was good. Orv Hetil. 2020; 161(45): 1927-1935.


Assuntos
Coriorretinite , Infecções Oculares Bacterianas , Neurossífilis , Sífilis , Uveíte , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Adulto Jovem
7.
BMC Infect Dis ; 20(1): 692, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32957955

RESUMO

BACKGROUND: Syphilis has seen an increased incidence in recent years and can have serious and irreversible consequences if left un-diagnosed and untreated. This case report describes a presentation of syphilis and acute kidney injury - a scenario sparsely described in existing literature. CASE PRESENTATION: This 43-year old Man who has Sex with Men (MSM) presented to the emergency department with a 3-week history of vomiting and headaches, progressing to include pyrexia. These symptoms started following his return from a 2-week cruise in Central America throughout which he had been well. He had a background of well-controlled human immunodeficiency virus (HIV). On admission he had an Acute Kidney Injury (AKI) stage 3, without hydronephrosis, presumed to be pre-renal. Leptospirosis, the main differential, was negative serologically. 'Pyrexia of unknown origin' testing was performed, and cefuroxime commenced. Later in the admission, syphilis testing indicated an acute infection and he completed a full treatment course of benzylpenicillin. This, alongside intravenous fluids, resulted in symptom and renal resolution in 9 days and restoration of renal function. CONCLUSIONS: Renal complications in syphilis are rare, furthermore the majority of those documented occur in latent syphilis and are irreversible. There are limited numbers of other documented cases of AKI in acute syphilis, which like the gentleman in this case were reversible and did not lead to permanent kidney damage. This case adds to the knowledge base of AKI in initial presentation of syphilis. It also demonstrates not only the importance of taking a sexual history in patients with new infective symptoms but that testing for syphilis in at-risk groups regardless of history should be performed given its rising incidence. These considerations by physicians can lead to prompt diagnosis and management of syphilis and improve patient care and long-term outcomes.


Assuntos
Lesão Renal Aguda/etiologia , Sífilis/complicações , Lesão Renal Aguda/microbiologia , Adulto , Antibacterianos/uso terapêutico , Febre/etiologia , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina , Humanos , Masculino , Penicilina G/uso terapêutico , Comportamento Sexual , Minorias Sexuais e de Gênero , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sorodiagnóstico da Sífilis , Viagem
10.
S Afr Med J ; 110(7): 642-645, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880340

RESUMO

We present an unusual case of syphilitic pancreatitis and ascending aortitis in a 41-year-old HIV-negative male patient presenting to a tertiary institution with obstructive jaundice. After a battery of investigations that included computed tomography (CT) and 18F-labelled fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) imaging, syphilis serology and histology, a diagnosis of tertiary syphilis was made. The patient responded favourably to antibiotics, with resolution of all lesions on FDG PET/CT 13 weeks after initiation of therapy. Even though tertiary syphilis is a rare entity, it should be earmarked as a mimicker of other pathological conditions, including, in this case, primary pancreatic malignancy.


Assuntos
Pancreatite/diagnóstico , Pancreatite/microbiologia , Sífilis/diagnóstico , Adulto , Aneurisma da Aorta Torácica/diagnóstico por imagem , Biópsia , Angiografia por Tomografia Computadorizada , Meios de Contraste , Diagnóstico Diferencial , Humanos , Icterícia Obstrutiva/microbiologia , Masculino , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico , Sífilis Cardiovascular/diagnóstico , Tomografia Computadorizada por Raios X
12.
Ned Tijdschr Geneeskd ; 1642020 05 25.
Artigo em Holandês | MEDLINE | ID: mdl-32749799

RESUMO

A 55-year-old man was evaluated at the outpatient rheumatology clinic with painful shins since 6 weeks. He also had a maculopapular rash on his trunk. Bone scintigraphy showed bilateral tibia periostitis. Serologic testing for syphilis was positive matching active infection. The diagnosis secondary syphilis with bilateral tibia periostitis was made.


Assuntos
Periostite/diagnóstico , Sífilis/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Periostite/microbiologia , Sífilis/complicações , Sorodiagnóstico da Sífilis , Tíbia/microbiologia
13.
PLoS One ; 15(8): e0237949, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817658

RESUMO

Syphilis, caused by Treponema pallidum ssp. pallidum (TPA), is a persisting global health problem. Although syphilis diagnostics relies mainly on serology, serological tests have some limitations, and it is recommended that the final diagnosis be supported by additional tests. The purpose of this study was to analyze the relationship between serology and PCR in syphilis diagnostics. From the year 2004 to May 2019, a total of 941 samples were taken from 833 patients suspected of having syphilis, in Czech Republic. In all these samples, both nested PCR detection of TPA and serology testing were performed. Of the 941 samples, 126 were seronegative, 651 were seropositive, and 164 were serodiscrepant. Among seronegative samples (n = 126), 11 were PCR-positive (8.7%). Among seropositive samples (n = 651; i.e., samples positive for both non-treponemal and treponemal serology tests), 368 samples were PCR-positive (56.5%). The remaining 164 serodiscrepant samples included RPR negative and treponemal serological test-positive samples (n = 154) and a set of 10 RPR-positive samples negative in treponemal serological tests. While the first group revealed 73 PCR-positive samples (47.4%), the second revealed 5 PCR positive samples (50.0%). PCR detection rates were highest in primary syphilis, with lower rates in the secondary and undetermined syphilis stages. As shown here, the nested PCR can improve diagnostics of syphilis, especially in seronegative patients and in patients with discrepant serology.


Assuntos
Reação em Cadeia da Polimerase , Sorodiagnóstico da Sífilis/métodos , Sífilis/diagnóstico , Treponema/isolamento & purificação , Humanos , Estudos Retrospectivos , Sífilis/sangue , Treponema/genética , Treponema/imunologia , Treponema/fisiologia
15.
Public Health Rep ; 135(1_suppl): 182S-188S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735204

RESUMO

OBJECTIVES: We evaluated the impact of a 2014 New York City health code change requiring laboratories to indicate if a patient is pregnant or probably pregnant in the electronic laboratory report (ELR) when reporting syphilis and hepatitis B virus (HBV) cases to the New York City Department of Health and Mental Hygiene (DOHMH). METHODS: We calculated the number of pregnant persons with syphilis or HBV infection reported to DOHMH from January 1, 2013, through June 30, 2018. We compared the proportion in which the first report to DOHMH was an ELR with pregnancy indicated before and after the policy change. We calculated time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR and the proportion of cases in which ELR with pregnancy indicated was the only report source. RESULTS: A total of 552 new syphilis and 8414 HBV-infected cases were reported to DOHMH. From January 2013-June 2014 (pre-change) to January 2017-June 2018 (post-change), the proportion of cases in which ELR with pregnancy indicated was the first report to DOHMH increased significantly (14.7% [23/156] to 46.2% [80/173] for syphilis; 8.0% [200/2498] to 45.3% [851/1879] for HBV infection [P < .001]). Median time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR was 9.0 days for syphilis and 51.0 days for HBV infection. ELR with pregnancy indicated was the only report for 43.1% (238/552) of syphilis cases and 23.4% (1452/6200) of HBV cases during the study period. CONCLUSION: Including pregnancy status with ELR can increase the ability of public health departments to conduct timely interventions to prevent mother-to-child transmission.


Assuntos
Hepatite B/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Vigilância em Saúde Pública/métodos , Sífilis/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Cidade de Nova Iorque , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto Jovem
16.
Klin Lab Diagn ; 65(8): 521-528, 2020 Jul 20.
Artigo em Russo | MEDLINE | ID: mdl-32762197

RESUMO

In medical organizations special forms (approved by orders of the Ministry of health and the Central statistical office) are used to present the results of laboratory examination of the population for syphilis. Currently, these forms include laboratory technologies that do not meet modern standards. In 2018-2019 the normative documents, regulating the use of accounting forms of medical documentation in the public health system, and the practice of using forms with the results of laboratory examination for syphilis were studied in 35 branches of 3 medical organizations of the Lyubertsy district of the Moscow region and in 18 branches of Moscow city was conducted. It is established that in the medical organizations of Moscow and the Moscow region are used the different forms of the registration forms approved by orders of the Ministry of health of the USSR which have now become invalid. The structure of the forms with the results of the population survey for syphilis does not correspond to the applied modern technologies and standards of the survey. On the basis of requirements of modern regulatory documents two new forms of registration forms for the presentation of results of laboratory researches have been developed, within 1,5 years tested and offered for application: one form at screening of the population for syphilis and another - for performing verification examinations for diagnostics and the subsequent clinical and serological supervision.


Assuntos
Sífilis , Humanos , Laboratórios , Programas de Rastreamento , Moscou , Inquéritos e Questionários , Sífilis/diagnóstico , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis
17.
Nurs Clin North Am ; 55(3): 361-377, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32762856

RESUMO

Despite the near-eradication of syphilis in the United States in the late 1990s, new infections have surged over the past 20 years. Dubbed, "the great imitator," syphilis infections often can be misdiagnosed and resultantly untreated. This leads to people inadvertently infecting others. This article reviews the history of syphilis, including the unethical studies undertaken in the past; current epidemiology; treatment guidelines; and strategies to reduce new infections.


Assuntos
Guias como Assunto/normas , Disparidades em Assistência à Saúde/estatística & dados numéricos , Sífilis/epidemiologia , Sífilis/história , Grupos Étnicos/estatística & dados numéricos , Disparidades em Assistência à Saúde/história , História do Século XIX , História do Século XX , História do Século XXI , Homossexualidade Masculina/psicologia , Humanos , Masculino , Profissionais de Enfermagem , Reação em Cadeia da Polimerase , Prevalência , Sífilis/diagnóstico , Pessoas Transgênero/psicologia , Estados Unidos/epidemiologia
18.
Public Health Rep ; 135(1_suppl): 75S-81S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735184

RESUMO

Policies facilitating integration of public health programs can improve the public health response, but the literature on approaches to integration across multiple system levels is limited. We describe the efforts of the Massachusetts Department of Public Health to integrate its HIV, viral hepatitis, sexually transmitted infection (STI), and tuberculosis response through policies that mandated contracted organizations to submit specimens for testing to the Massachusetts State Public Health Laboratory; co-test blood specimens for HIV, hepatitis C virus (HCV), and syphilis; integrate HIV, viral hepatitis, and STI disease surveillance and case management in a single data system; and implement an integrated infectious disease drug assistance program. From 2014 through 2018, the number of tests performed by the Massachusetts State Public Health Laboratory increased from 16 321 to 33 674 for HIV, from 11 054 to 33 670 for HCV, and from 19 169 to 30 830 for syphilis. Service contracts enabled rapid response to outbreaks of HIV, hepatitis A, and hepatitis B. Key challenges included lack of a billing infrastructure at the Massachusetts State Public Health Laboratory; the need to complete negotiations with insurers and to establish a retained revenue account to receive health insurance reimbursements for testing services; and time to train testing providers in phlebotomy for required testing. Investing in laboratory infrastructure; creating billing mechanisms to maximize health insurance reimbursement; proactively engaging providers, community members, and other stakeholders; and building capacity to transform practices are needed. Using multilevel policy approaches to integrate the public health response to HIV, STI, viral hepatitis, and tuberculosis is feasible and adaptable to other public health programs.


Assuntos
Serviços Contratados/organização & administração , Seguro Saúde/organização & administração , Administração em Saúde Pública/métodos , Vigilância em Saúde Pública/métodos , Doenças Sexualmente Transmissíveis/diagnóstico , Serviços Contratados/economia , Serviços Contratados/normas , Política de Saúde , Acesso aos Serviços de Saúde , Hepatite/diagnóstico , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/normas , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Reembolso de Seguro de Saúde/normas , Relações Interinstitucionais , Massachusetts , Estudos de Casos Organizacionais , Avaliação de Programas e Projetos de Saúde , Administração em Saúde Pública/economia , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/normas , Sífilis/diagnóstico
19.
Public Health Rep ; 135(1_suppl): 57S-64S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735188

RESUMO

OBJECTIVES: California is experiencing a syphilis and congenital syphilis epidemic, and many persons diagnosed with syphilis report a history of recent incarceration or sexual contact with a person who has recently been incarcerated. Fresno County's local health department and jail collaborated to implement a routine syphilis screening policy for male adults aged 18-30 and female adults aged 18-35 booked into the facility. We evaluated syphilis screening, case finding, and treatment rates after implementation of the new policy. METHODS: We linked jail census and laboratory data to syphilis surveillance data to assess screening coverage, positivity, and treatment rates for age-eligible persons who were booked into Fresno County Jail from April 1, 2016, through December 31, 2017. RESULTS: Of 24 045 age-eligible persons who were booked into the jail during the study period, 5897 (24.5%) were female and 18 148 (75.5%) were male. Of 7144 (29.7%) persons who were screened for syphilis, 611 (8.6%) had a reactive rapid plasma reagin blood test result (16.4% [253 of 1546] of female adults; 6.4% [358 of 5598] of male adults) and 238 (3.3%) were newly diagnosed with syphilis, as confirmed by matching to the surveillance system (6.9% [106 of 1546] of female adults; 2.4% [132 of 5598] of male adults). Of persons identified with syphilis, 51.7% (n = 123 of 238) received adequate recommended treatment (59.4% [63 of 106] of female adults; 45.5% [60 of 132] of male adults). CONCLUSIONS: The age-based syphilis screening policy adopted in this jail yielded high positivity, including newly identified syphilis infections among female adults of childbearing age. The targeted screening policy was formalized in the county-negotiated contract with the jail's private correctional health care company in 2018-a strategy that can be replicated.


Assuntos
Programas de Rastreamento/organização & administração , Prisões/organização & administração , Sífilis/diagnóstico , Sífilis/epidemiologia , Adolescente , Adulto , California/epidemiologia , Feminino , Humanos , Incidência , Masculino , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Adulto Jovem
20.
Arch Pathol Lab Med ; 144(11): 1344-1351, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32810868

RESUMO

CONTEXT.­: Sexually transmitted infections (STIs) are among the most common communicable diseases globally and are associated with significant morbidity and mortality worldwide. Point-of-care tests have the potential to revolutionize the prevention and control of STIs by enabling rapid diagnosis and early treatment of infections, thus interrupting transmission and preventing the sequelae of untreated infections. Currently, there are several point-of-care (POC) tests available for the diagnosis of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections, although these tests differ with regard to their performance, turnaround time, and cost. OBJECTIVE.­: To provide an updated review of the POC tests available and under development for the diagnosis of T pallidum, C trachomatis, N gonorrhoeae, and T vaginalis infections, to discuss the context for which these tests might be used, and to highlight future directions for test development. DATA SOURCES.­: We reviewed the literature pertaining to the recent development and performance evaluations of POC tests for the diagnosis of syphilis, chlamydia, gonorrhea, and trichomonas. CONCLUSIONS.­: Recently, there has been rapid development of new POC tests for STIs. Although there are inexpensive, rapid, and accurate POC tests available for syphilis, there are few such tests available for the diagnosis of chlamydia, gonorrhea, or trichomonas, and currently none with the ability to detect antimicrobial resistance in N gonorrhoeae. Research evaluating implementation strategies for the currently available tests and the development of additional POC tests that are rapid, accurate, and affordable are urgently needed to address the rising number of STIs worldwide.


Assuntos
Programas de Rastreamento/métodos , Testes Imediatos/normas , Doenças Sexualmente Transmissíveis/diagnóstico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/prevenção & controle , Diagnóstico Precoce , Gonorreia/diagnóstico , Gonorreia/prevenção & controle , Humanos , Programas de Rastreamento/economia , Testes Imediatos/economia , Testes Imediatos/estatística & dados numéricos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/prevenção & controle , Sífilis/diagnóstico , Sífilis/prevenção & controle
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