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Ayerdi O, Orviz E, Valls Carbó A, Fernández Piñeiro N, Vera García M, Puerta López T, Ballesteros Martín J, Rodríguez Martín C, Baza Caraciolo B, Lejarraga Cañas C, Pérez-García JA, Carrió D, García Lotero M, Ferreras Forcada M, González Polo M, Raposo Utrilla M, Delgado-Iribarren A, Del Romero-Guerrero J, Estrada Pérez V. Incidence of sexually transmitted infections and screening models among pre-exposure prophylaxis users. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00065-0. [PMID: 38492988 DOI: 10.1016/j.eimce.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/02/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION There is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyse the incidence of STIs and to evaluate different screening models in order to optimise the follow-up. METHODOLOGY A prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR). RESULTS The overall CI by quarterly screening was 8.3 (95% CI: 7.6-9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68-0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5-0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73-0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32-0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25-0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24-0.42). CONCLUSIONS The incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimised reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.
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Affiliation(s)
- Oskar Ayerdi
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Eva Orviz
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain.
| | - Adrián Valls Carbó
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Fernández Piñeiro
- Servicio de Farmacia, Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Mar Vera García
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Teresa Puerta López
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Jorge-Alfredo Pérez-García
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain; Servicio Microbiología Clínica, Instituto Medicina del Laboratorio, Hospital Clínico San Carlos, Madrid, Spain
| | - Dulce Carrió
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Alberto Delgado-Iribarren
- Servicio Microbiología Clínica, Instituto Medicina del Laboratorio, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Vicente Estrada Pérez
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Madrid, Spain
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Pérez-García JA, Vera-García M, Arriaza-Rubio R, Del Romero-Guerrero J. Atypical urethritis and proctitis in a heterosexual couple. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 41:305-306. [PMID: 36588029 DOI: 10.1016/j.eimce.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Jorge A Pérez-García
- Servicio de Microbiología Clínica, Hospital Clínico San Carlos/Centro Sanitario Sandoval, IdISSC, Madrid, Spain.
| | - Mar Vera-García
- Unidad VIH/otras ITS, Centro Sanitario Sandoval, HCSC, IdISSC, Madrid, Spain.
| | - Rocío Arriaza-Rubio
- Medicina Familiar y Comunitaria, C.S Reyes Magos, Alcalá de Henares, Madrid, Spain.
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Pérez-García JA, Vera-García M, Arriaza-Rubio R, Del Romero-Guerrero J. Uretritis y proctitis atípica en pareja heterosexual. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lejarraga-Cañas C, Ayerdi-Aguirrebengoa O, Menéndez-Prieto B, Tello-Romero E, Rodríguez-Martín C, Del Romero-Guerrero J. Is dark-field microscopy still useful for the primary syphilis diagnosis in the 21 ST century? Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:32-34. [PMID: 34732343 DOI: 10.1016/j.eimce.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/08/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis. MATERIALS/METHODS Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR). RESULTS Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA. CONCLUSIONS DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.
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Affiliation(s)
| | | | | | - Estela Tello-Romero
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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Otero-Guerra L, Gil-Alonso L, López-de Munain J, Del Romero-Guerrero J, Serra-Pladevall J, Vazquez F. Survey of diagnostic resources for STI in Spain. ACTA ACUST UNITED AC 2021; 39:390-394. [PMID: 34362706 DOI: 10.1016/j.eimce.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Scarce information is available on the resources to deal with the Sexually Transmitted Infections (STIs), both in the clinic and in the laboratory. The objective is to describe and know the reality of the clinics and laboratories that treat these infections in Spain. METHODS Cross-sectional observational study with data collection through a survey aimed at the members of the GEITS Group. RESULTS Responses were obtained from 24 centers (response rate 38.1%) belonging to 10 Autonomous Communities. Regarding STI consultations, 38% require that the patient present a health card to provide assistance, and 31.8% only provide it by referral from another doctor. The 52.4% perform diagnostic methods in the care center. Regarding laboratories, 18.2% do not offer immediate response diagnostic tests, although 100% have PCR against Neisseria gonorrhoeae and Chlamydia trachomatis, 47.8% against Mycoplasma genitalium and 65% detect lymphogranuloma venereum genotypes. All laboratories continue to perform culture and gonococcal sensitivity techniques, and 20% perform molecular methods for detection of MG antimicrobial resistance. CONCLUSION There is great variability in the provision of human and material resources both in the clinics and in the laboratories that attend STIs. In a significant number of centers there are limitations for patient access. Although laboratories have molecular biology technologies, not all of them offer immediate response tests. All laboratories detect N. gonorrhoeae infection by PCR and also by culture, which allows sensitivity testing in all centers.
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Affiliation(s)
- Luis Otero-Guerra
- Servicio de Microbiología, Hospital Universitario de Cabueñes, Gijón, Asturias; Grupo de Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, Spain.
| | - Leire Gil-Alonso
- Unidad de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, Spain
| | - Josefina López-de Munain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Basurto (OSI Bilbao-Basurto, Osakidetza), Bilbao; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, Spain
| | - Jorge Del Romero-Guerrero
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid; Universidad Complutense de Madrid, Madrid; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, Spain
| | - Judit Serra-Pladevall
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona; Universidad Autónoma de Barcelona, Barcelona; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, Spain
| | - Fernando Vazquez
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Asturias; Área de Microbiología, Facultad de Medicina, Universidad de Oviedo; Grupo de Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Instituto Universitario Fernández Vega (IUFV) y Fundación de Investigación Oftalmológica (FIO), Oviedo; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, Spain
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Lejarraga-Cañas C, Ayerdi-Aguirrebengoa O, Menéndez-Prieto B, Tello-Romero E, Rodríguez-Martín C, Del Romero-Guerrero J. Is dark-field microscopy still useful for the primary syphilis diagnosis in the 21 ST century? Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30295-0. [PMID: 33268187 DOI: 10.1016/j.eimc.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis. MATERIALS/METHODS Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR). RESULTS Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA. CONCLUSIONS DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.
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Affiliation(s)
| | | | | | - Estela Tello-Romero
- Centro Sanitario Sandoval, Hospital Clínico San Carlos; IdISSC, Madrid, España
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Otero-Guerra L, Gil-Alonso L, López-de Munain J, Del Romero-Guerrero J, Serra-Pladevall J, Vazquez F. Survey of diagnostic resources for STI in Spain. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30255-X. [PMID: 32826099 DOI: 10.1016/j.eimc.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scarce information is available on the resources to deal with the Sexually Transmitted Infections (STIs), both in the clinic and in the laboratory. The objective is to describe and know the reality of the clinics and laboratories that treat these infections in Spain. METHODS Cross-sectional observational study with data collection through a survey aimed at the members of the GEITS Group. RESULTS Responses were obtained from 24 centers (response rate 38.1%) belonging to 10Autonomous Communities. Regarding STI consultations, 38% require that the patient present a health card to provide assistance, and 31.8% only provide it by referral from another doctor. The 52.4% perform diagnostic methods in the care center. Regarding laboratories, 18.2% do not offer immediate response diagnostic tests, although 100% have PCR against Neisseria gonorrhoeae and Chlamydia trachomatis, 47.8% against Mycoplasma genitalium and 65% detect lymphogranuloma venereum genotypes. All laboratories continue to perform culture and gonococcal sensitivity techniques, and 20% perform molecular methods for detection of MG antimicrobial resistance. CONCLUSION There is great variability in the provision of human and material resources both in the clinics and in the laboratories that attend STIs. In a significant number of centers there are limitations for patient access. Although laboratories have molecular biology technologies, not all of them offer immediate response tests. All laboratories detect N.gonorrhoeae infection by PCR and also by culture, which allows sensitivity testing in all centers.
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Affiliation(s)
- Luis Otero-Guerra
- Servicio de Microbiología, Hospital Universitario de Cabueñes, Gijón, Asturias; Grupo de Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, España.
| | - Leire Gil-Alonso
- Unidad de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, España
| | - Josefina López-de Munain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Basurto (OSI Bilbao-Basurto, Osakidetza), Bilbao; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, España
| | - Jorge Del Romero-Guerrero
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid; Universidad Complutense de Madrid, Madrid; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, España
| | - Judit Serra-Pladevall
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona; Universidad Autónoma de Barcelona, Barcelona; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, España
| | - Fernando Vazquez
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Asturias; Área de Microbiología, Facultad de Medicina, Universidad de Oviedo; Grupo de Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Instituto Universitario Fernández Vega (IUFV) y Fundación de Investigación Oftalmológica (FIO), Oviedo; Grupo de Estudio de Infecciones de Transmisión Sexual, GEITS, SEIMC, España
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Del Romero-Guerrero J, Ayerdi-Aguirrebengoa O, Rodríguez-Martín C. Jóvenes y VIH. Conocimientos y conductas de riesgo en un grupo de residentes en España. Enferm Infecc Microbiol Clin 2019; 37:149-150. [DOI: 10.1016/j.eimc.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 11/16/2022]
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Ayerdi-Aguirrebengoa O, Vera-García M, Puerta-López T, Raposo-Utrilla M, Rodríguez-Martín C, Del Romero-Guerrero J. To whom is HIV pre-exposure prophylaxis proposed? Enferm Infecc Microbiol Clin 2016; 35:299-302. [PMID: 27445176 DOI: 10.1016/j.eimc.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION HIV Pre-Exposure Prophylaxis (PrEP) consists of administering antiretroviral drugs to seronegative individuals with high risk practices. The aim of the study was to describe the characteristics of recent seroconverted HIV patients in order to determine the profile of the appropriate candidates for PrEP. METHODS A descriptive study of all patients diagnosed with HIV infection in 2014, and who had achieved a documented negative serology over the previous 12 months. A specific form was completed to determine the sociodemographic, behavioural, and clinical features, with complementary tests being performed for other sexually transmitted infections. RESULTS Almost all (98.4%) of the 61 recent seroconverted were men who have sex with men, and aged between 20 to 39 years (88.5%). They also had a background of sexually transmitted infections (80.3%), performed multiple and unprotected sexual practices (82.7%), and under the effect of recreational drugs (87%). CONCLUSIONS The evaluation of the risk factors for HIV infection in seronegative patients should enable the appropriate candidates for PrEP to be identified.
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Affiliation(s)
- Oskar Ayerdi-Aguirrebengoa
- Servicio de Urgencias, Hospital Fundación Jiménez Díaz, Madrid, España; Unidad de ITS/VIH, Centro Sanitario Sandoval IdISSC, Madrid, España.
| | - Mar Vera-García
- Unidad de ITS/VIH, Centro Sanitario Sandoval IdISSC, Madrid, España
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Campo-Trapero J, Del Romero-Guerrero J, Cano-Sánchez J, Rodríguez-Martín C, Martínez-González JM, Bascones-Martínez A. Relationship between oral Kaposi 's sarcoma and HAART: contribution of two case reports. Med Oral Patol Oral Cir Bucal 2008; 13:E709-E713. [PMID: 18978711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Two HIV infected patients not receiving Highly Active Antiretroviral Treatment (HAART) presented with epidemic Kaposi's sarcoma of the oral cavity. One patient initially refused HAART, but when the lesion became large enough to be noticeable he agreed to HAART associated with excision of the intraoral lesion by CO2 laser. The other patient developed KS and progressed to AIDS at two years after ceasing HAART due to adverse effects; he was referred to hospital for renewed administration of HAART. In both cases, the lesions observed in the oral cavity were the first clinical manifestation of AIDS. These reports underline the close relationship between the use of HAART and the control of KS lesions, highlighting the important role of the dentist in the identification and early diagnosis of these oral lesions.
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Affiliation(s)
- Julián Campo-Trapero
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, UCM. Avda Complutense s/n, 28080 Madrid, Spain.
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