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Barbee LA, St Cyr SB. Management of Neisseria gonorrhoeae in the United States: Summary of Evidence From the Development of the 2020 Gonorrhea Treatment Recommendations and the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Treatment Guidelines. Clin Infect Dis 2022; 74:S95-S111. [PMID: 35416971 DOI: 10.1093/cid/ciac043] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern given limited antibiotic options currently and an even smaller antimicrobial development pipeline. Since the release of the Centers for Disease Control and Prevention (CDC) 2015 STD Treatment Guidelines, azithromycin, part of the 2015 dual-drug treatment regimen, has had a rapid rise in resistance. The 2020 CDC Gonorrhea Treatment Recommendations and the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were developed weighing the priorities of treating the individual, protecting the population, and preventing antimicrobial resistance. METHODS Gonorrhea subject matter experts (SME) generated 8 key questions and conducted a literature review of updated data from 2013 to 2019 on gonorrhea antimicrobial resistance, treatment failures, clinical trials, and other key topics. More than 2200 abstracts were assessed, and 248 clinically relevant articles were thoroughly reviewed. SMEs also evaluated N gonorrhoeae antimicrobial resistance data from the Gonococcal Isolate Surveillance Project (GISP). EVIDENCE Although there have been reports of ceftriaxone treatment failures internationally, GISP data suggest that ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, with < 0.1% exhibiting an "alert value" MIC (> 0.25 mcg/mL). However, GISP documented a rapid rise in the proportion of isolates with an elevated MIC (≥ 2.0 mcg/mL) to azithromycin-nearly 5% in 2018. At the same time, new pharmacokinetic/pharmacodynamic data are available, and there is greater recognition of the need for antimicrobial stewardship. SUMMARY The 2021 CDC STI Treatment Guidelines now recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites. If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added. Few alternative therapies exist for persons with cephalosporin allergies; there are no recommended alternative therapies for N gonorrhoeae infection of the throat.
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Affiliation(s)
- Lindley A Barbee
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,University of Washington, Seattle, Washington, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, Washington, USA
| | - Sancta B St Cyr
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Evaluation of Text Message Reminders to Encourage Retesting for Chlamydia and Gonorrhea Among Female Patients at the Municipal Sexually Transmitted Disease Clinic in Seattle, Washington. Sex Transm Dis 2021; 47:458-463. [PMID: 32541305 DOI: 10.1097/olq.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND United States guidelines recommend retesting for chlamydia (CT) and gonorrhea (GC) approximately 3 months after treatment, but adherence to these guidelines is poor. METHODS In May 2016, the municipal sexually transmitted disease (STD) Clinic in Seattle, WA, integrated opt-in short message system (SMS) (text message) retesting reminders for female patients into our clinic's routine electronic intake. Women were asked if they wanted to receive an SMS reminder for retesting for GC/CT in 3 months. We used Fisher exact tests to compare the proportion who returned to the clinic for retesting and the proportion who retested GC/CT positive 3 to 6 months after their initial diagnosis. We used sexually transmitted disease surveillance data to ascertain repeat GC/CT diagnoses. RESULTS From May 2016 to December 2017, 743 (36%) of 2067 women opted to receive an SMS reminder. Overall, 95 of these women tested positive for GC or CT and provided a valid phone number; 31 (33%) had opted into SMS reminders. The percentage of women who returned to the clinic 3 to 6 months after their initial GC/CT diagnosis did not significantly differ for women who did and did not opt in to receive SMS reminders (23% vs 9%; P = 0.11). Repeat GC/CT diagnosis 3 to 6 months after the initial GC/CT diagnosis was not significantly different between women who did and did not opt in (7% vs 3%; P = 0.58). CONCLUSIONS Uptake of automated SMS reminders among women was low, and most women who received reminders did not return for retesting. Despite this, SMS reminders integrated into an existing clinic infrastructure may somewhat increase retesting among women with GC/CT.
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Pattanasin S, Holtz TH, Ungsedhapand C, Tongtoyai J, Chonwattana W, Sukwicha W, Sirivongrangson P, Mock PA, Chitwarakorn A, Dunne EF. Repeat symptomatic Neisseria gonorrhoeae infections among men who have sex with men in Bangkok, Thailand, 2006-2016. Int J STD AIDS 2020; 31:533-540. [PMID: 32228159 DOI: 10.1177/0956462420906763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyzed the incidence and predictors of symptomatic repeat Neisseria gonorrhoeae (NG) infection among men who have sex with men (MSM) enrolled in the Bangkok MSM Cohort Study. Thai MSM aged ≥18 years were enrolled during 2006–2010 and followed every four months. At baseline, participants were screened for rectal and urethral NG and Chlamydia trachomatis (CT) infections using nucleic acid amplification testing (NAAT), rectal and pharyngeal NG by culture, and pharyngeal CT by NAAT. During follow-up, symptomatic participants were tested for NG infection by NAAT and Gram stain of rectal or urethral specimens. Among 1464 participants without NG infection at the baseline visit and having at least one follow-up visit, 11.2% (164/1464) developed symptomatic NG infection, for a total of 251 infections. Symptomatic repeat NG infection occurred in 28.0% (46/164) of participants. The incidence rate was 3.9 cases per 100 person-years. Baseline predictors of repeat symptomatic NG were as follows: unknown human immunodeficiency virus (HIV) status despite history of HIV testing, previous sexually transmitted infection diagnosis by physician, insertive-only anal intercourse without a condom, amyl nitrate use at baseline, CT infection at baseline, age 18–24 years, and being a student; HIV infection at baseline or during the study period was also associated with repeat symptomatic NG infection.
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Affiliation(s)
- Sarika Pattanasin
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Timothy H Holtz
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Chaiwat Ungsedhapand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Jaray Tongtoyai
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wannee Chonwattana
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wichuda Sukwicha
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Philip A Mock
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Eileen F Dunne
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
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Burchell AN, Lisk R, Yeung A, Rana J, Bacon J, Brunetta J, Gilbert M, Gesink D, Grewal R, Guiang CB, Kwag M, Logie CH, Mitterni L, Shahin R, Tan DH. Community-Directed Bacterial Sexually Transmitted Infection Testing Interventions Among Men Who Have Sex With Men: Protocol for an E-Delphi Study in Toronto, Canada. JMIR Res Protoc 2019; 8:e13801. [PMID: 31274111 PMCID: PMC6637728 DOI: 10.2196/13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/17/2023] Open
Abstract
Background HIV-positive and HIV-negative (gay, bisexual, and other) men who have sex with men (MSM) have experienced a dramatic increase in bacterial sexually transmitted infections (STIs)—syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission; yet, testing rates remain below recommended levels. Innovation is needed to produce the required increases in testing levels, frequency, and the use of appropriate testing technologies in ways that are engaging, nonstigmatizing, and acceptable to men. Objective The aim of this study is to build consensus with regard to interventions with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada. Methods Following a literature review of evidence regarding the effectiveness of novel testing interventions, and focus groups, and surveys to describe local barriers and facilitators of testing among MSM, we will conduct a Web-based, modified Delphi study (e-Delphi). We will form expert panels of community members and STI test providers. Panelists will rate potential interventions in terms of their priority, using a 7-point Likert scale from definitely not a priority to definitely a priority. They will also rank their preferences by selecting their top 3 preferred interventions. Surveys will be distributed in 3 rounds, with feedback on the distribution of responses from preceding rounds provided in rounds 2 and 3. We will define consensus as having ≥60% (18/30) members indicate a preference within 2 adjacent response points. Qualitative data on disagreements will be obtained using open-ended text responses to explain for ratings and rankings that are different from the majority. Results On the basis of a literature review and identification of barriers and facilitators to STI testing among community members and test providers in Toronto, we have selected 8 potential interventions for inclusion in the e-Delphi panel surveys. These include 4 interventions that streamline STI testing for asymptomatic individuals, 2 interventions that are targeted at clients and 2 interventions that are targeted at providers. Conclusions Findings will provide community direction for informed decision making regarding the implementation of STI testing interventions in this setting. They will characterize the intervention climate for innovation to STI testing services, including perceived needs for changes to test delivery, relative priorities for change, and readiness for implementation. These methods may be transferable to other urban jurisdictions experiencing similar epidemics and for other contexts where stakeholder input is needed to manage sensitive areas of concern. International Registered Report Identifier (IRRID) PRR1-10.2196/13801
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Affiliation(s)
- Ann N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada
| | | | - Anna Yeung
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jayoti Rana
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ramandip Grewal
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Charlie B Guiang
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.,Hassle Free Clinic, Toronto, ON, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Darrell Hs Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
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