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Stewart J, Oware K, Donnell D, Violette LR, Odoyo J, Soge OO, Scoville CW, Omollo V, Mogaka FO, Sesay FA, McClelland RS, Spinelli M, Gandhi M, Bukusi EA, Baeten JM. Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women. N Engl J Med 2023; 389:2331-2340. [PMID: 38118022 PMCID: PMC10805625 DOI: 10.1056/nejmoa2304007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Doxycycline postexposure prophylaxis (PEP) has been shown to prevent sexually transmitted infections (STIs) among cisgender men and transgender women, but data from trials involving cisgender women are lacking. METHODS We conducted a randomized, open-label trial comparing doxycycline PEP (doxycycline hyclate, 200 mg taken within 72 hours after condomless sex) with standard care among Kenyan women 18 to 30 years of age who were receiving preexposure prophylaxis against human immunodeficiency virus (HIV). The primary end point was any incident infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or Treponema pallidum. Hair samples were collected quarterly for objective assessment of doxycycline use. RESULTS A total of 449 participants underwent randomization; 224 were assigned to the doxycycline-PEP group and 225 to the standard-care group. Participants were followed quarterly over 12 months. A total of 109 incident STIs occurred (50 in the doxycycline-PEP group [25.1 per 100 person-years] and 59 in the standard-care group [29.0 per 100 person-years]), with no significant between-group difference in incidence (relative risk, 0.88; 95% confidence interval [CI], 0.60 to 1.29; P = 0.51). Among the 109 incident STIs, chlamydia accounted for 85 (78.0%) (35 in the doxycycline-PEP group and 50 in the standard-care group; relative risk, 0.73; 95% CI, 0.47 to 1.13). No serious adverse events were considered by the trial investigators to be related to doxycycline, and there were no incident HIV infections. Among 50 randomly selected participants in the doxycycline-PEP group, doxycycline was detected in 58 of 200 hair samples (29.0%). All N. gonorrhoeae-positive isolates were resistant to doxycycline. CONCLUSIONS Among cisgender women, the incidence of STIs was not significantly lower with doxycycline PEP than with standard care. According to hair-sample analysis, the use of doxycycline PEP among those assigned to receive it was low. (Funded by the National Institutes of Health; dPEP ClinicalTrials.gov number, NCT04050540.).
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Affiliation(s)
- Jenell Stewart
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Kevin Oware
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Deborah Donnell
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Lauren R Violette
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Josephine Odoyo
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Olusegun O Soge
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Caitlin W Scoville
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Victor Omollo
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Felix O Mogaka
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Fredericka A Sesay
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - R Scott McClelland
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Matthew Spinelli
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Monica Gandhi
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Elizabeth A Bukusi
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
| | - Jared M Baeten
- From the Division of Infectious Diseases, Hennepin Healthcare Research Institute, and the Department of Medicine, University of Minnesota - both in Minneapolis (J.S.); Kenya Medical Research Institute, Kisumu (K.O., J.O., V.O., F.O.M., E.A.B.); Fred Hutchinson Cancer Research Center (D.D.) and the Departments of Epidemiology (L.R.V., F.A.S., R.S.M.), Global Health (O.O.S., C.W.S., R.S.M., E.A.B., J.M.B.), Medicine (Infectious Diseases) (L.R.V., O.O.S., R.S.M., J.M.B.), and Obstetrics and Gynecology (E.A.B.), University of Washington, Seattle; and the Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco (M.S., M.G.)
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Kivata MW, Mbuchi M, Eyase F, Bulimo WD, Kyanya CK, Oundo V, Mbinda WM, Sang W, Andagalu B, Soge OO, McClelland RS, Distelhorst J. Plasmid mediated penicillin and tetracycline resistance among Neisseria gonorrhoeae isolates from Kenya. BMC Infect Dis 2020; 20:703. [PMID: 32977759 PMCID: PMC7517623 DOI: 10.1186/s12879-020-05398-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Treatment of gonorrhea is complicated by the development of antimicrobial resistance in Neisseria gonorrhoeae (GC) to the antibiotics recommended for treatment. Knowledge on types of plasmids and the antibiotic resistance genes they harbor is useful in monitoring the emergence and spread of bacterial antibiotic resistance. In Kenya, studies on gonococcal antimicrobial resistance are few and data on plasmid mediated drug resistance is limited. The present study characterizes plasmid mediated resistance in N. gonorrhoeae isolates recovered from Kenya between 2013 and 2018. METHODS DNA was extracted from 36 sub-cultured GC isolates exhibiting varying drug resistance profiles. Whole genome sequencing was done on Illumina MiSeq platform and reads assembled de-novo using CLC Genomics Workbench. Genome annotation was performed using Rapid Annotation Subsystem Technology. Comparisons in identified antimicrobial resistance determinants were done using Bioedit sequence alignment editor. RESULTS Twenty-four (66.7%) isolates had both β-lactamase (TEM) and TetM encoding plasmids. 8.3% of the isolates lacked both TEM and TetM plasmids and had intermediate to susceptible penicillin and tetracycline MICs. Twenty-six (72%) isolates harbored TEM encoding plasmids. 25 of the TEM plasmids were of African type while one was an Asian type. Of the 36 isolates, 31 (86.1%) had TetM encoding plasmids, 30 of which harbored American TetM, whereas 1 carried a Dutch TetM. All analyzed isolates had non-mosaic penA alleles. All the isolates expressing TetM were tetracycline resistant (MIC> 1 mg/L) and had increased doxycycline MICs (up to 96 mg/L). All the isolates had S10 ribosomal protein V57M amino acid substitution associated with tetracycline resistance. No relation was observed between PenB and MtrR alterations and penicillin and tetracycline MICs. CONCLUSION High-level gonococcal penicillin and tetracycline resistance in the sampled Kenyan regions was found to be mediated by plasmid borne blaTEM and tetM genes. While the African TEM plasmid, TEM1 and American TetM are the dominant genotypes, Asian TEM plasmid, a new TEM239 and Dutch TetM have emerged in the regions.
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Affiliation(s)
- Mary Wandia Kivata
- Institute for Biotechnology Research, Jomo Kenyatta University of Agriculture and Technology (JKUAT), P. O Box 62,000-00200, Thika, Kenya
- Department of Biological and Physical Science, Karatina University (KarU), P. O Box 1957-10101, Karatina, Kenya
| | - Margaret Mbuchi
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
- Kenya Medical Research Institute (KEMRI), P. O Box 54840-00200, Nairobi, Kenya
| | - Fredrick Eyase
- Institute for Biotechnology Research, Jomo Kenyatta University of Agriculture and Technology (JKUAT), P. O Box 62,000-00200, Thika, Kenya
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
| | - Wallace Dimbuson Bulimo
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
- School of Medicine, Department of Biochemistry, University of Nairobi, P. O Box 30197, GPO, Nairobi, 00100 Kenya
| | - Cecilia Katunge Kyanya
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
| | - Valerie Oundo
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
| | - Wilton Mwema Mbinda
- Department of Chemistry and Biochemistry, Pwani University, P. O Box 195-80108, Mombasa, Kenya
| | - Willy Sang
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
- Kenya Medical Research Institute (KEMRI), P. O Box 54840-00200, Nairobi, Kenya
| | - Ben Andagalu
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
| | - Olusegun O. Soge
- Departments of Global Health and Medicine, University of Washington, 325 9th Avenue, Box 359931, Seattle, WA 98104 USA
| | - Raymond Scott McClelland
- Departments of Medicine, Epidemiology, and Global Health, University of Washington, 325 9th Avenue, Box 359931, Seattle, WA 98104 USA
| | - John Distelhorst
- U.S. Army Medical Research Directorate-Africa, P. O Box 606, Village Market, Nairobi, 00621 Kenya
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