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Riera-Monroig J, Feltes-Ochoa RA, Quiles-Melero I, Martin-Gorgojo A. [Translated article] AEDV Expert Consensus Document on the Organization of a Multidisciplinary Unit for Patients With or at Risk of Venereal Infections. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T583-T591. [PMID: 38648930 DOI: 10.1016/j.ad.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Abstract
Over the past few years, venereal or sexually transmitted infections (STIs) have been on the rise worldwide requiring additional specialized monographic consultations to specifically treat STIs. Therefore, the Spanish Academy of Dermatology and Venereology (AEDV) Research Working Group on STIs and HIV has drafted this document with the necessary requirements in terms of infrastructure, personnel, technology, specific materials for sample collection, and needs for current therapeutic options. Strict emphasis is placed on the protection of patient privacy. A health care circuit model is outlined too. Additionally, a section has been included on contact tracking and reporting, key elements for the effective prevention and control of STIs. These clinical practice guidelines seek to establish a clinical action framework adapted to the current challenges posed by STIs and HIV in the dermatology, venereology, and multidisciplinary settings.
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Affiliation(s)
- J Riera-Monroig
- Programa de Salud Sexual, Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - R A Feltes-Ochoa
- Consulta monográfica de Detección precoz del cáncer anal, Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
| | - I Quiles-Melero
- Servicio de Microbiología Clínica, Hospital Universitario La Paz, Madrid, Spain
| | - A Martin-Gorgojo
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain.
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Riera-Monroig J, Feltes-Ochoa RA, Quiles-Melero I, Martin-Gorgojo A. AEDV Expert Consensus Document on the Organization of a Multidisciplinary Unit for Patients With or at Risk of Venereal Infections. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:583-591. [PMID: 38373604 DOI: 10.1016/j.ad.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
Over the past few years, venereal or sexually transmitted infections (STIs) have been on the rise worldwide requiring additional specialized monographic consultations to specifically treat STIs. Therefore, the Spanish Academy of Dermatology and Venereology (AEDV) Research Working Group on STIs and HIV has drafted this document with the necessary requirements in terms of infrastructure, personnel, technology, specific materials for sample collection, and needs for current therapeutic options. Strict emphasis is placed on the protection of patient privacy. A health care circuit model is outlined too. Additionally, a section has been included on contact tracking and reporting, key elements for the effective prevention and control of STIs. These clinical practice guidelines seek to establish a clinical action framework adapted to the current challenges posed by STIs and HIV in the dermatology, venereology, and multidisciplinary settings.
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Affiliation(s)
- J Riera-Monroig
- Programa de Salud Sexual, Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - R A Feltes-Ochoa
- Consulta monográfica de Detección precoz del cáncer anal, Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - I Quiles-Melero
- Servicio de Microbiología Clínica, Hospital Universitario La Paz, Madrid, España
| | - A Martin-Gorgojo
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, España.
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Gravett RM, Marrazzo J. An Ulcer by Any Other Name. Infect Dis Clin North Am 2023; 37:369-380. [PMID: 37005160 DOI: 10.1016/j.idc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The myriad presentations of ulcerative sexually transmitted infections, other than genital herpes and syphilis, challenge even the most astute clinician given the considerable overlap in clinical presentation and lack of widely available diagnostic resources, such as nucleic acid testing, to confirm the diagnosis. Even so, case prevalence is relatively low, and incidence of chancroid and granuloma inguinale are declining. These diseases still cause substantial morbidity and increased chance for HIV acquisition, and with the recent advent of mpox as a cause, it remains imperative to identify and treat accurately.
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Affiliation(s)
- Ronnie M Gravett
- Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, THT 215, 1900 University Boulevard, Birmingham, AL 35294, USA.
| | - Jeanne Marrazzo
- Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, THT 215, 1900 University Boulevard, Birmingham, AL 35294, USA
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Cunha Ramos M, Nicola MRC, Bezerra NTC, Sardinha JCG, Sampaio de Souza Morais J, Schettini AP. Genital ulcers caused by sexually transmitted agents. An Bras Dermatol 2022; 97:551-565. [PMID: 35868971 PMCID: PMC9453525 DOI: 10.1016/j.abd.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/11/2022] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.
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Affiliation(s)
- Mauro Cunha Ramos
- Sanitary Dermatology Outpatient Clinic, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Maria Rita Castilhos Nicola
- Sanitary Dermatology Outpatient Clinic, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | - José Carlos Gomes Sardinha
- Fundação Alfredo da Matta, Instituição ligada à Secretaria de Estado de Saúde do Governo do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Antônio Pedro Schettini
- Fundação Alfredo da Matta, Instituição ligada à Secretaria de Estado de Saúde do Governo do Estado do Amazonas, Manaus, AM, Brazil
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Potential for Phages in the Treatment of Bacterial Sexually Transmitted Infections. Antibiotics (Basel) 2021; 10:antibiotics10091030. [PMID: 34572612 PMCID: PMC8466579 DOI: 10.3390/antibiotics10091030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Abstract
Bacterial sexually transmitted infections (BSTIs) are becoming increasingly significant with the approach of a post-antibiotic era. While treatment options dwindle, the transmission of many notable BSTIs, including Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum, continues to increase. Bacteriophage therapy has been utilized in Poland, Russia and Georgia in the treatment of bacterial illnesses, but not in the treatment of bacterial sexually transmitted infections. With the ever-increasing likelihood of antibiotic resistance prevailing and the continuous transmission of BSTIs, alternative treatments must be explored. This paper discusses the potentiality and practicality of phage therapy to treat BSTIs, including Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Haemophilus ducreyi, Calymmatobacterium granulomatis, Mycoplasma genitalium, Ureaplasma parvum, Ureaplasma urealyticum, Shigella flexneri and Shigella sonnei. The challenges associated with the potential for phage in treatments vary for each bacterial sexually transmitted infection. Phage availability, bacterial structure and bacterial growth may impact the potential success of future phage treatments. Additional research is needed before BSTIs can be successfully clinically treated with phage therapy or phage-derived enzymes.
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Ramos MC, Sardinha JC, Alencar HDRD, Aragón MG, Lannoy LHD. Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause genital ulcers. Rev Soc Bras Med Trop 2021; 54:e2020663. [PMID: 34008730 PMCID: PMC8210487 DOI: 10.1590/0037-8682-663-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (lymphogranuloma venereum), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections and guidelines for their diagnosis and treatment are presented, including strategies for surveillance, prevention, and control actions to support health managers and professionals in the qualification of care. Approximately 70% of the genital ulcers attended in specialized clinics are due to sexually transmitted infections, particularly in adolescents and young adults.
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Affiliation(s)
| | - José Carlos Sardinha
- Fundação de Dermatologia Tropical e Venerologia Alfredo da Matta, Manaus, AM, Brasil
| | | | - Mayra Gonçalves Aragón
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.,Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
| | - Leonor Henriette de Lannoy
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.,Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
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Ramos MC, Sardinha JC, Alencar HDRD, Aragón MG, Lannoy LHD. [Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause genital ulcers]. ACTA ACUST UNITED AC 2021; 30:e2020663. [PMID: 33729413 DOI: 10.1590/s1679-4974202100010.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections, and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (venereal lymphogranuloma), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections are presented, as well as guidelines for their diagnosis and treatment, in addition to strategies for surveillance, prevention and control actions, with the purpose of supporting health managers and professionals in the qualification of care.
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Affiliation(s)
- Mauro Cunha Ramos
- Secretaria de Estado de Saúde do Rio Grande do Sul, Ambulatório de Dermatologia Sanitária, Porto Alegre, RS, Brasil
| | - José Carlos Sardinha
- Fundação de Dermatologia Tropical e Venerologia Alfredo da Matta, Manaus, AM, Brasil
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González-Beiras C, Kapa A, Vall-Mayans M, Paru R, Gavilán S, Houinei W, Bieb S, Sanz S, Martins R, Mitjà O. Single-Dose Azithromycin for the Treatment of Haemophilus ducreyi Skin Ulcers in Papua New Guinea. Clin Infect Dis 2018; 65:2085-2090. [PMID: 29020192 DOI: 10.1093/cid/cix723] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/11/2017] [Indexed: 01/09/2023] Open
Abstract
Background Haemophilus ducreyi (HD) and Treponema pallidum subspecies pertenue (TP) are major causative agents of cutaneous ulcer (CU) in the tropics. Azithromycin is recommended to treat sexually transmitted HD infections and has good in vitro activity against HD strains from both genital and skin ulcers. We investigated the efficacy of oral single-dose azithromycin on HD-CU. Methods We conducted a community-based cohort study in Lihir Island, Papua New Guinea, from October 2014 through May 2016. Consenting patients with skin ulcers >1 cm in diameter were eligible for this study and had collected a lesional swab for polymerase chain reaction (PCR). All participants were treated with single-dose azithromycin (30 mg/kg) and were followed up for assessment of clinical resolution. We retrospectively classified patients according to PCR results into HD, TP, and PCR-negative groups. The primary endpoint was healing rates of HD-CU at 14 days after treatment. Results We obtained full outcome data from 246 patients; 131 (53.3%) were HD PCR positive, 37 (15.0%) were TP positive, and 78 (31.7%) were negative for all tests. Healing rates were 88.5% (95% confidence interval [CI], .82-.93) in the HD group, 78.4% [95% CI, .63-.89] in the TP group, and 74.4% (95% CI, .64-.83) in the PCR-negative group. If we included the participants with improved ulcers, the healing rates increased to 94.7%, 97.3%, and 89.7% respectively. HD cases classified as not healed all converted to HD-negative PCR. Conclusions Based upon clinical resolution and PCR conversion to HD negative, a single oral dose of azithromycin is efficacious for the treatment of HD-CU. These results have implications for the treatment of individual patients and for the use of antibiotics in public health strategies to control CU in the tropics.
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Affiliation(s)
- Camila González-Beiras
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain.,Global Public Health PhD Program, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Portugal
| | - August Kapa
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Marti Vall-Mayans
- Sexually Transmitted Infections Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Raymond Paru
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sergi Gavilán
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
| | - Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Sibauk Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
| | - Rosario Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Portugal
| | - Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain.,Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea.,School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby
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Rob F, Jilich D, Lásiková Š, Křížková V, Hercogová J. First reported case of chancroid in the Czech Republic. Int J STD AIDS 2018; 29:1127-1129. [PMID: 29749871 DOI: 10.1177/0956462418774700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the first case of chancroid seen in the Czech Republic, diagnosed in a 40-year-old heterosexual HIV-positive man. Despite genital localization of the ulcer, the transmission of Haemophilus ducreyi infection in our patient remains unclear, as he denied having sexual intercourse and he did not travel outside the Czech Republic for several months before the ulcer appeared. The correct diagnosis has been revealed by a multiplex nucleic acid amplification test. Physicians in countries in the eastern and central Europe region should be aware that chancroid can occur in their patients.
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Affiliation(s)
- Filip Rob
- 1 Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - David Jilich
- 2 Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Šárka Lásiková
- 3 Department of Microbiology, Na Bulovce Hospital, Prague, Czech Republic
| | - Veronika Křížková
- 1 Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Jana Hercogová
- 1 Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
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van Hattem JM, Langeveld TJC, Bruisten SM, Kolader M, Grobusch MP, de Vries HJC, de Bree GJ. Haemophilus ducreyi cutaneous ulcer contracted at Seram Island, Indonesia, presented in the Netherlands. PLoS Negl Trop Dis 2018; 12:e0006273. [PMID: 29649298 PMCID: PMC5896912 DOI: 10.1371/journal.pntd.0006273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Overview We describe the first case of a cutaneous ulcer caused by Haemophilus ducreyi imported from Indonesia to the Netherlands. Skin infections caused by H. ducreyi are uncommon in travellers and have been described in just a few case reports and were all contracted on the Pacific Islands. The case A 22-year-old healthy male visited the Center of Tropical Medicine and Travel Medicine in February 2017 with a cutaneous ulcer of the right lateral malleolus 4 weeks after returning from Indonesia (Seram and Ambon Islands). He had noticed a small skin abrasion on the right ankle after slipping on a rock during a jungle trip on Seram Island. Back in the Netherlands, a painful ulcer developed at the same body location, and despite treatment with flucloxacillin, his complaints worsened. A swab that was taken for culture showed growth of small grey colonies that were characterised as H. ducreyi with matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry. Treatment with ciprofloxacin for the diagnosis of H. ducreyi cutaneous ulcer was started, and the ulcer clearly diminished, leaving only a small healing ulcer. Discussion H. ducreyi is normally the causative agent of genital ulcers but is increasingly recognised as a cause of chronic skin ulcers, e.g., in Papua New Guinea. In our patient, the infection was very likely contracted in the Maluku province of Indonesia and imported into the Netherlands. No reports of infection with H. ducreyi from Indonesia could be found in literature, but this case indicates that H. ducreyi is present in at least one of the northeastern islands of Indonesia, which is important for local healthcare. Additionally, it illustrates the role of this agent as a cause of cutaneous ulcers in previously healthy travellers.
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Affiliation(s)
- Jarne M. van Hattem
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Tessa J. C. Langeveld
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Sylvia M. Bruisten
- Public Health Laboratory (PHL), Department of Infectious Diseases, GGD/Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam, the Netherlands
| | - Marion Kolader
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Henry J. C. de Vries
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam, the Netherlands
- STI Outpatient Clinic, Department of Infectious Diseases, GGD/Public Health Service Amsterdam, Amsterdam, the Netherlands
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Godelieve J. de Bree
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Mitjà O, González-Beiras C, Godornes C, Kolmau R, Houinei W, Abel H, Kapa A, Paru R, Bieb SV, Wangi J, Sanz S, Asiedu K, Lukehart SA, Bassat Q. Effectiveness of single-dose azithromycin to treat latent yaws: a longitudinal comparative cohort study. LANCET GLOBAL HEALTH 2017; 5:e1268-e1274. [PMID: 29107621 DOI: 10.1016/s2214-109x(17)30388-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/04/2017] [Accepted: 09/15/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment of latent yaws is a crucial component of the WHO yaws eradication strategy to prevent relapse and the resulting transmission to uninfected children. We assessed the effectiveness of single-dose azithromycin to treat patients with latent yaws. METHODS This population-based cohort study included children (age <20 years) living on Lihir Island, Papua New Guinea, with high-titre (rapid plasma reagin titre ≥1:8) latent or active yaws, between April, 2013, and May, 2015. Latent yaws was defined as lack of suspicious skin lesions or presence of ulcers negative for Treponema pallidum subsp pertenue on PCR, and active yaws was defined as ulcers positive for T pertenue on PCR. All children received one oral dose of 30 mg/kg azithromycin. The primary endpoint was serological cure, defined as a two-dilution decrease in rapid plasma reagin titre by 24 months after treatment. Treatment of latent yaws was taken to be non-inferior to that of active yaws if the lower limit of the two-sided 95% CI for the difference in rates was higher than or equal to -10%. This study is registered with ClinicalTrials.gov, number NCT01955252. FINDINGS Of 311 participants enrolled, 273 (88%; 165 with latent yaws and 108 with active yaws) completed follow-up. The primary endpoint was achieved in 151 (92%) participants with latent yaws and 101 (94%) with active yaws (risk difference -2·0%, 95% CI -8·3 to 4·3), meeting the prespecified criteria for non-inferiority. INTERPRETATION On the basis of decline in serological titre, oral single-dose azithromycin was effective in participants with latent yaws. This finding supports the WHO strategy for the eradication of yaws based on mass administration of the entire endemic community irrespective of clinical status. FUNDING Newcrest Mining Limited and ISDIN laboratories.
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Affiliation(s)
- Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea.
| | - Camila González-Beiras
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Lisbon Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
| | - Charmie Godornes
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Reman Kolmau
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Haina Abel
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - August Kapa
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Raymond Paru
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sibauk V Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - James Wangi
- Office of the WHO Representative for Papua New Guinea, WHO, Port Moresby, Papua New Guinea
| | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Biostatistics Unit, Department of Public Health, Faculty of Medicine, University of Barcelona, Spain
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Sheila A Lukehart
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Quique Bassat
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Paediatric Infectious Diseases Unit, Paediatric Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
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