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Quilter LAS, St Cyr SB, Barbee LA. The Management of Gonorrhea in the Era of Emerging Antimicrobial Resistance: What Primary Care Clinicians Should Know. Med Clin North Am 2024; 108:279-296. [PMID: 38331480 PMCID: PMC11150008 DOI: 10.1016/j.mcna.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Gonorrhea rates continue to rise in the United States and Neisseria gonorrhoeae's propensity to develop resistance to all therapies used for treatment has complicated the management of gonorrhea. Ceftriaxone is the only remaining highly effective recommended regimen for gonococcal treatment and few new anti-gonococcal antimicrobials are being developed. The 2021 CDC STI Treatment Guidelines increased the dose of ceftriaxone to 500 mg (1 g if ≥ 150 kg) for uncomplicated infections. It is recommended that all clinicians should be aware of antimicrobial resistant gonorrhea and be able to appropriately manage any suspected gonorrhea treatment failure case.
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Affiliation(s)
- Laura A S Quilter
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA.
| | - Sancta B St Cyr
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA
| | - Lindley A Barbee
- Division of STD Prevention, Centers of Disease Control and Prevention, 1600 Clifton Road Northeast, MS H24-4, Atlanta, GA 30329, USA
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Lee KS, Zaid M, Ong ELC. Disseminated Multidrug Resistant Neisseria gonorrhoea infection in a patient with vasculitic skin rash. Rev Soc Bras Med Trop 2023; 56:e02892023. [PMID: 37792836 PMCID: PMC10550086 DOI: 10.1590/0037-8682-0289-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/03/2023] [Indexed: 10/06/2023] Open
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Advances in Diagnostics of Sexually Transmitted Infections. Infect Dis Clin North Am 2023; 37:381-403. [PMID: 36931991 DOI: 10.1016/j.idc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Sexually transmitted infections (STIs) are caused by various pathogens, many of which have common symptoms. Diagnostic tests are critical to supporting clinical evaluations in making patient management decisions. Molecular diagnostics are the preferred test type when available, especially in asymptomatic patients for many STIs. However, for some infections, serology offers the best insight into infectious status. Clinicians should be aware of the performance characteristics of the available STI diagnostic tests and understand how to use them. Point-of-care tests are helpful to implement rapid and accurate treatment responses, which are particularly helpful in certain at-risk populations.
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Silver B, Kaldor JM, Rumbold A, Ward J, Smith K, Dyda A, Ryder N, Yip TW, Su JY, Guy RJ. Community and clinic-based screening for curable sexually transmissible infections in a high prevalence setting in Australia: a retrospective longitudinal analysis of clinical service data from 2006 to 2009. Sex Health 2018; 13:140-7. [PMID: 26678863 DOI: 10.1071/sh15077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/15/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background In response to the high prevalence of sexually transmissible infections (STIs) in many central Australian Aboriginal communities, a community-wide screening program was implemented to supplement routine primary health care (PHC) clinic testing. The uptake and outcomes of these two approaches were compared. METHODS Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) community and clinic screening data for Aboriginal people aged 15-34 years, 2006-2009, were used. Regression analyses assessed predictors of the first test occurring in the community screen, positivity and repeat testing. RESULTS A total of 2792 individuals had 9402 tests (median: four per person) over 4 years. Approximately half of the individuals (54%) were tested in the community and clinic approaches combined, 29% (n=806) in the community screen only and 18% (n=490) in the clinic only. Having the first test in a community screen was associated with being male and being aged 15-19 years. There was no difference between community and clinic approaches in CT or NG positivity at first test. More than half (55%) of individuals had a repeat test within 2-15 months and of these, 52% accessed different approaches at each test. The only independent predictor of repeat testing was being 15-19 years. CONCLUSIONS STI screening is an important PHC activity and the findings highlight the need for further support for clinics to reach young people. The community screen approach was shown to be a useful complementary approach; however, cost and sustainability need to be considered.
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Affiliation(s)
- Bronwyn Silver
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Alice Rumbold
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia
| | - Kirsty Smith
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Amalie Dyda
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Nathan Ryder
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Teem-Wing Yip
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Jiunn-Yih Su
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
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Gibbons CL, Mangen MJJ, Plass D, Havelaar AH, Brooke RJ, Kramarz P, Peterson KL, Stuurman AL, Cassini A, Fèvre EM, Kretzschmar MEE. Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods. BMC Public Health 2014; 14:147. [PMID: 24517715 PMCID: PMC4015559 DOI: 10.1186/1471-2458-14-147] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Efficient and reliable surveillance and notification systems are vital for monitoring public health and disease outbreaks. However, most surveillance and notification systems are affected by a degree of underestimation (UE) and therefore uncertainty surrounds the 'true' incidence of disease affecting morbidity and mortality rates. Surveillance systems fail to capture cases at two distinct levels of the surveillance pyramid: from the community since not all cases seek healthcare (under-ascertainment), and at the healthcare-level, representing a failure to adequately report symptomatic cases that have sought medical advice (underreporting). There are several methods to estimate the extent of under-ascertainment and underreporting. METHODS Within the context of the ECDC-funded Burden of Communicable Diseases in Europe (BCoDE)-project, an extensive literature review was conducted to identify studies that estimate ascertainment or reporting rates for salmonellosis and campylobacteriosis in European Union Member States (MS) plus European Free Trade Area (EFTA) countries Iceland, Norway and Switzerland and four other OECD countries (USA, Canada, Australia and Japan). Multiplication factors (MFs), a measure of the magnitude of underestimation, were taken directly from the literature or derived (where the proportion of underestimated, under-ascertained, or underreported cases was known) and compared for the two pathogens. RESULTS MFs varied between and within diseases and countries, representing a need to carefully select the most appropriate MFs and methods for calculating them. The most appropriate MFs are often disease-, country-, age-, and sex-specific. CONCLUSIONS When routine data are used to make decisions on resource allocation or to estimate epidemiological parameters in populations, it becomes important to understand when, where and to what extent these data represent the true picture of disease, and in some instances (such as priority setting) it is necessary to adjust for underestimation. MFs can be used to adjust notification and surveillance data to provide more realistic estimates of incidence.
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Affiliation(s)
- Cheryl L Gibbons
- Centre for Immunity, Infection and Evolution, Ashworth Laboratories, Kings Buildings, University of Edinburgh, Edinburgh, UK.
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Ao TTH, Sam NE, Masenga EJ, Seage GR, Kapiga SH. Human immunodeficiency virus type 1 among bar and hotel workers in northern Tanzania: the role of alcohol, sexual behavior, and herpes simplex virus type 2. Sex Transm Dis 2006; 33:163-9. [PMID: 16505740 DOI: 10.1097/01.olq.0000187204.57006.b3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOALS We assessed baseline prevalence of human immunodeficiency virus type 1 (HIV-1) and other STDs, as well as behavioral and biologic risk factors for HIV-1 in a population of female bar/hotel workers in Moshi, Tanzania. STUDY DESIGN Between 2002 and 2003, we enrolled 1042 female bar/hotel workers in an ongoing prospective cohort study. We analyzed data collected at baseline to assess the associations between alcohol, sexual behavior, STDs, and HIV-1 infection. RESULTS The prevalence of HIV-1 infection was 19.0% (95% confidence interval [CI] = 16.6%-21.4%). Consistent condom use was low (11.1%). HIV-1 was associated with genital ulcers on examination (adjusted odds ratio [AOR] = 2.08, 95% CI = 1.16-3.74), herpes simplex virus type 2 (HSV-2) (AOR = 3.80, 95% CI = 2.42-5.97), and problem drinking (AOR = 1.92, 95% CI = 1.06-3.47). Other independent predictors of HIV-1 were increasing age, number of sex partners, cohabitating, formerly married, location of employment, and having a husband with another wife. CONCLUSIONS These findings suggest that programs designed to control HSV-2, reduce the number of sexual partners and alcohol use, and promote condom use could be effective in reducing transmission of HIV-1 in this population.
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Affiliation(s)
- Trong T H Ao
- Department of Epidemiology, University of Washington, Seattle, 98145, USA.
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Raja NS, Singh NN. Bilateral orbital cellulitis due to Neisseria gonorrhoeae and Staphylococcus aureus: a previously unreported case. J Med Microbiol 2005; 54:609-611. [PMID: 15888472 DOI: 10.1099/jmm.0.46031-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cellulitis of the orbit is a common cause of proptosis in children, and also frequently arises in the elderly and the immunocompromised. The condition is characterized by infection and swelling of the soft tissues lining the eye socket, pushing the eye ball outwards and causing severe pain, redness, discharge of pus and some degree of blurred vision. There is a small risk of infection spreading to the meninges of the brain and causing meningitis. This paper reports the case of an adult in whom polymicrobial bilateral orbital cellulitis had developed due to Staphylococcus aureus and Neisseria gonorrhoeae infection. N. gonorrhoeae infections are acquired by sexual contact. Although the infection may disseminate to a variety of tissues, it usually affects the mucous membranes of the urethra in males and the endocervix and urethra in females. To the authors' knowledge this is the first report of polymicrobial bilateral orbital cellulitis due to S. aureus and N. gonorrhoeae in medical literature.
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Affiliation(s)
- N S Raja
- Department of Medical Microbiology, University of Malaya Medical Center, 59100 Kuala Lumpur, Malaysia 2School of Biosciences, Cardiff University, Museum Avenue, PO Box 911, Cardiff CF10 3US, UK
| | - N N Singh
- Department of Medical Microbiology, University of Malaya Medical Center, 59100 Kuala Lumpur, Malaysia 2School of Biosciences, Cardiff University, Museum Avenue, PO Box 911, Cardiff CF10 3US, UK
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Boonstra E, Lindbaek M, Klouman E, Ngome E, Romøren M, Sundby J. Syndromic management of sexually transmitted diseases in Botswana's primary health care: quality of care aspects. Trop Med Int Health 2003; 8:604-14. [PMID: 12828542 DOI: 10.1046/j.1365-3156.2003.01076.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the quality of care of the syndromic management of sexually transmitted diseases (STDs) in Botswana's primary health care. METHODS Participative observations of 224 consecutive consultations of patients with STDs (135 females and 89 males) by nurses. Twenty-one cases were excluded because no STD checklist was filled in. Criteria for acceptable history taking, physical examination and correct treatment were agreed upon. RESULTS The quality of history taking and physical examination was acceptable for 25% and 23% of the women and for 54% and 57% of the men, respectively. Approximately, 65% of the women and 81% of the men received appropriate treatment. On average, consultations took 5.4 min for women and 4.6 min for men. STD contacts comprised 11% of STD cases. Advice on partner notification was provided to 66% of the women and 86% of men, and 75% and 89%, respectively, were counselled on the use of condoms. In half of the health facilities the lack of a fixed light source was the main constraint in carrying out a vaginal speculum examination. The availability of antibiotics and condoms was excellent. In 40% of the health facilities, all STD algorithms were displayed in the consultation room. CONCLUSION One-third of women and one-fifth of men did not receive appropriate treatment for their STD, in spite of excellent provision of drugs. Although Botswana health workers perform relatively well on partner notification and counselling, there is considerable scope for improving the quality of medical history and clinical examination, especially in women. Emphasis should be given on training health workers in clinical examinations, in particular in pelvic examinations, and to supervision and in-service training.
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Affiliation(s)
- E Boonstra
- Department of General Practice and Community Medicine, University of Oslo, Norway.
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Bloomfield PJ, Kent C, Campbell D, Hanbrook L, Klausner JD. Community-based chlamydia and gonorrhea screening through the United States mail, San Francisco. Sex Transm Dis 2002; 29:294-7. [PMID: 11984447 DOI: 10.1097/00007435-200205000-00008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because gonococcal and chlamydial infections are often asymptomatic, disease control requires population-based screening. This report describes the feasibility of home-based testing for sexually transmitted diseases (STDs) and of specimen transport via the US mail. GOAL This project sought to establish the efficacy and acceptability to the public of screening by means of urine kits made available in public places and mailed in for STD testing. STUDY DESIGN Self-selected community participants obtained STD test kits from local businesses, collected urine specimens at home, and mailed kits to the health department for nucleic acid amplification testing. RESULTS Participants picked up 209 test kits and returned 80 (38%): 3 (3.8%) of 76 were positive for gonorrhea and 1 (1.3%) of 76 was positive for chlamydia. The majority (95%) of participants were white gay men. The cost of specimen collection and transport was similar to that of other population-based screening programs. CONCLUSION Using the mail for home-based testing for gonorrhea and chlamydia was feasible and may be a useful addition to STD control efforts.
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Kapiga SH, Sam NE, Shao JF, Renjifo B, Masenga EJ, Kiwelu IE, Manongi R, Fawzi W, Essex M. HIV-1 epidemic among female bar and hotel workers in northern Tanzania: risk factors and opportunities for prevention. J Acquir Immune Defic Syndr 2002; 29:409-17. [PMID: 11917247 DOI: 10.1097/00126334-200204010-00013] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted this study to determine the prevalence and risk factors for HIV-1 infection among women (N = 312) who were working in the bars and hotels in Moshi, a town in northern Tanzania. Study subjects were interviewed to obtain information about HIV-1 risk factors and examined to collect samples for the diagnosis of sexually transmitted diseases (STDs). The prevalence of HIV-1 was 26.3% (95% confidence interval [CI], 21.4%-31.2%). In multivariate analyses, the risk of HIV-1 increased with increasing age (p value, test for linear trend <.001) and the number of sexual partners during the last 5 years (p value, test for linear trend <.03). Other significant predictors were having a male partner with other sexual partners (Adjusted odds ratio [AOR], 1.92; 95% CI, 1.03-3.60), and consuming alcohol >2 days per week (AOR, 2.56; 95% CI, 1.12-5.88). The risk of HIV-1 was also significantly increased in women with bacterial vaginosis (AOR, 2.37; 95% CI, 1.09-5.13) and in study subjects with herpes simplex virus (HSV)-2 antibodies (AOR, 2.48; 95% CI, 1.24-4.98). These results indicate that women working in these settings were at increased risk of HIV-1. Programs aiming at promoting safer sexual practices and control of other STDs are urgently needed in this population. Such programs should address the underlying conditions that facilitate risk behaviors and create obstacles for these women who wish to protect themselves against HIV-1.
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Affiliation(s)
- Saidi H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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