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Murray C, Rose SB. Improving partner notification for sexually transmitted infections: Interviews with key informants in Aotearoa New Zealand. Int J STD AIDS 2024; 35:397-404. [PMID: 38225809 DOI: 10.1177/09564624241226740] [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] [Indexed: 01/17/2024]
Abstract
BACKGROUND Partner notification is a vital part of sexually transmitted infection (STI) control but evidence suggests that its practice in Aotearoa New Zealand (NZ) is inconsistent. This study sought to explore barriers to partner notification for STIs, identify areas for improvement and draw on lessons learnt from Covid-19. METHODS Semi-structured interviews with key informants working in primary care, sexual health, public health, management, and research were undertaken between December 2021 and March 2022. Interviews were audiorecorded, transcribed, coded, and analysed using thematic analysis. RESULTS The overarching theme was that partner notification for STIs needs to be improved, and must be a more acceptable experience for providers, cases and their contacts. Four themes described how this could be achieved: (i) destigmatise and increase understanding of STIs, (ii) ensure engagement with services is easy and affirming, (iii) prioritise and resource evidence-based services and (iv) develop tools to optimise partner notification. CONCLUSIONS Sexually transmitted infection partner notification in NZ needs prioritisation, resourcing and innovation. The inadequate resourcing of STI management in NZ contrasts with the well-funded response to Covid-19. Without a well-resourced action plan, NZ's high rates of STIs will persist and continue to inequitably impact Māori, Pacific, gay and bisexual men and young people.
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Affiliation(s)
- Catriona Murray
- Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand
| | - Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington South, New Zealand
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2
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Minetti C, Rocha M, Duque LM, Meireles P, Correia C, Cordeiro D, João I, Manita C, Soeiro S, Santos JA, Matos R, Almeida C, Martins HC, Vinagre E, Lopo S, Borrego MJ. Orogenital and anal infection by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and other sexually transmitted infections in men who have sex with men in Lisbon. Int J STD AIDS 2024; 35:379-388. [PMID: 38166231 DOI: 10.1177/09564624231221591] [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] [Indexed: 01/04/2024]
Abstract
BACKGROUND Men who have sex with men (MSM) are at risk for sexually transmitted infections (STIs), but more data on extragenital carriage are needed. AIM We assessed the genital and extragenital prevalence of bacterial and other STIs in MSM in a Lisbon sexual health clinic. METHODS We screened oral, anal, and urine samples of MSM visiting the GAT-CheckpointLX clinic June 2017-December 2021 for Chlamydia trachomatis (including lymphogranuloma venereum, LGV), Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and U. parvum. Ano-oro-genital lesions were tested for LGV, Treponema pallidum, and Herpes Simplex Virus. Blood was tested for HIV and T. pallidum antibodies. RESULTS N. gonorrhoeae was found in 16.6% of the MSM followed by C. trachomatis (13.2%), M. genitalium (10.3%) and T. vaginalis (0.2%). The most frequent occurrence was anorectal (C. trachomatis, M. genitalium) and oral (N. gonorrhoeae). We found high carriage of U. urealyticum (36.1%) and M. hominis (22.1%). LGV was detected in 21.8% of chlamydia-positive anorectal swabs. Syphilis was detected in 22.6% of tested MSM, while 13.8% had HIV. Gonorrhoea and chlamydia were significantly more prevalent in MSM with concomitant HIV or syphilis. CONCLUSION The substantial extragenital prevalence of bacterial STIs in MSM, and HIV and syphilis coinfections, suggest screening has value in identifying hidden carriage and in contributing for providing better care.
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Affiliation(s)
- Corrado Minetti
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
- ECDC fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Miguel Rocha
- GAT-CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Luís Miguel Duque
- GAT-CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Cristina Correia
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Dora Cordeiro
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Inês João
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Carla Manita
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sofia Soeiro
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - João Almeida Santos
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Rita Matos
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Catarina Almeida
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Helena Cortes Martins
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Elsa Vinagre
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sílvia Lopo
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Maria José Borrego
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
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3
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Jonker L, Phillips M. Devices for the transport and microbiological detection of Neisseria gonorrhoeae in sexual health clinic samples: a prospective comparative study. Int J STD AIDS 2023; 34:146-151. [PMID: 36541190 DOI: 10.1177/09564624221136640] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Propagation and microbiological detection of N. gonorrhoeae can be challenging due to the fastidious nature of the bacterium outside the human host environment. Different sample transport options were evaluated in order to address this issue. METHODS Symptomatic and high-risk patients consented to take part. Standard practice in clinics involve using a guanine and cytosine selective (GC) plate for transport and incubation. Other devices were assessed in two different studies. MWE's Sigma VCM™-a transport device for use between clinic and laboratory-was used in one study (n = 166). In the other, (n = 102), Biomed's Intray™ plates were used, which can be used for both initial transport and incubation at the destination laboratory. RESULTS In the Sigma VCM™ study, positive results were obtained for 14% (Sigma VCM™), 21% (GC plates); the distribution of outcomes did not significantly differ between the two microbiological sampling methods (p-value 0.09, Chi-squared test). Concerning the InTray™ sub-study, N. gonorrhoeae was detected in 9% (InTray™), 13% (GC plating) of cases respectively, with again no significant difference between the microbiological sampling methods (p-value 0.25). Regression analysis identified a significant association between N. gonorrhoeae detection and male patients, absence of dysuria and previous gonorrhoea infection. CONCLUSION No significant difference in rate of microbiological detection of N. gonorrhoeae could be detected between different transport devices in a sexual health clinic setting. Performance appraisal of transport devices for bacterial sexually transmitted infection can inform practitioners' options regarding said devices.
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Affiliation(s)
- Leon Jonker
- Science & Innovation Manager, R&D Department, 2268North Cumbria Integrated Care NHS Foundation Trust, Penrith, UK
| | - Matt Phillips
- Sexual Health Consultant, Sexual Health Services, 2268North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
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4
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Sittig KR, Collin SM, Rosa R. Factors associated with non-guideline-adherent treatment for gonorrhea and chlamydia among outpatient prescriptions in the Unites States. Int J STD AIDS 2022; 33:694-700. [PMID: 35487037 DOI: 10.1177/09564624221097751] [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] [Indexed: 11/16/2022]
Abstract
Background: Patients at risk for sexually transmitted infections (STI) frequently receive care at non-specialized outpatient clinics staffed by physicians and advanced practice clinicians (APCs).Methods: Retrospective cohort study including adult patients diagnosed with chlamydia and/or gonorrhea at urgent care (UC), family medicine (FM), internal medicine (IM) or obstetrics and gynecology (Ob-Gyn) clinics. The effect of type of clinician on guideline-adherent treatment was estimated using logistic regression adjusted for age, type of clinic, type of infection, and (in female patients) pregnancy status.Results: A total of 1021 patients were identified, 654 (64.1%) females and 367 (35.9%) males. Overall, 12.8% (84/654) of female patients and 19.1% (70/367) of male patients received inadequate antibiotic therapy. Among females, 63.5% (415/654) were treated by APCs and 36.5% (239/654) by physicians. Odds of inadequate therapy did not differ when comparing APCs to physicians (OR 0.83 [95% CI 0.52-1.32; p = .42]). Variables independently associated with inadequate therapy were pregnancy (OR 3.80 [95% CI 1.55-6.10; p < .001]), infection with gonorrhea (OR 2.91 [95% CI 1.65-5.10; p < .0001]) and co-infection (OR 2.63 [95% CI 1.24-5.58; p = .01]) compared to infection with chlamydia alone. Compared to UC clinics, female patients treated at Ob-Gyn clinics had lower odds of inadequate therapy (OR 0.45 [95% CI 0.22-0.90; p = .02]). Among males, odds of inadequate therapy did not differ by clinician type.Conclusions: Inadequate antibiotic therapy for chlamydia and/or gonorrhea was not associated with type of clinician. These results can help guide educational strategies and resources towards the clinical settings with the greatest gaps in adequacy of management of chlamydia and gonorrhea.
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Affiliation(s)
- Katherine R Sittig
- Iowa Methodist Medical Center, 2946UnityPoint Health-Des Moines, Des Moines, IA, USA.,Internal Medicine Department, University of Iowa-Des Moines Campus, Des Moines, IA, USA
| | - Simon M Collin
- National Infection Service, 371011Public Health England, London, UK
| | - Rossana Rosa
- Internal Medicine Department, University of Iowa-Des Moines Campus, Des Moines, IA, USA.,Division of Infectious Diseases, UnityPoint Health, Des Moines, IA, USA.,Department of Quality and Patient Safety, 23215Jackson Health System, Miami, FL, USA
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5
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Wall KM, Nyombayire J, Parker R, Ingabire R, Bizimana J, Mukamuyango J, Mazzei A, Price MA, Unyuzimana MA, Tichacek A, Allen S, Karita E. Antibiotic-resistant Neisseria gonorrhoeae and changes to the 2019 Rwandan National STI Guidelines. Int J STD AIDS 2021; 33:315-317. [PMID: 34879755 DOI: 10.1177/09564624211053242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kristin M Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Jean Bizimana
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | | | - Amelia Mazzei
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Matt A Price
- IAVI, NY, NY, University of California San Francisco, San Francisco, CA, USA
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
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Jasper W, Macdonald M, Luxmanan D, Foley E, Patel R. Telephone-triage services do not lead to an increased wait time for assessment of gonorrhoea in symptomatic patients. Int J STD AIDS 2021; 32:852-855. [PMID: 33949223 PMCID: PMC8236663 DOI: 10.1177/0956462421999280] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In Spring 2017, Southampton and Portsmouth Sexual Health Services (SHSs) replaced an overstretched walk-in service with a telephone-triage service: patients calling that were symptomatic, vulnerable or at high risk of having an STI were invited into a clinic, whereas others were signposted to remote self-sample NHS postal testing services. This study aimed to establish whether patient care was disadvantaged by the introduction of the triage service. Electronic patient notes for all patients attending for treatment of gonorrhoea for two years before and for two years after the service change were interrogated; the site of infection and duration of symptoms before testing were compared. Of all patients attending for treatment of gonorrhoea in the study period, 499 patients (39% of cases) were symptomatic at testing: 364 had urethral symptoms, 45 had rectal symptoms and 18 had pharyngeal symptoms. 72.4% of patients with urethral symptoms were seen after the introduction of the triage system. Median wait times for patients with urethral symptoms rose from 6 (IQR = 3–7) to 7 (IQR = 3.75–14) days – although this increase was not statistically significant (p = 0.064). There was not a statistically significant difference between the rectal symptom groups (p = 0.422) and too few patients attended with pharyngeal symptoms to warrant analysis. Despite some outliers, the telephone-triage service did not increase wait times for patients attending STI services with symptomatic gonorrhoea and may have inadvertently increased access to services for those most at risk.
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Affiliation(s)
- William Jasper
- Genitourinary Medicine, Faculty of Medicine, 7423University of Southampton, Southampton, UK
| | - Madeleine Macdonald
- Genitourinary Medicine, Faculty of Medicine, 7423University of Southampton, Southampton, UK
| | - Danayan Luxmanan
- Genitourinary Medicine, Faculty of Medicine, 7423University of Southampton, Southampton, UK
| | - Elizabeth Foley
- Solent Sexual Health, 232267Royal South Hants Hospital, Southampton UK
| | - Rajul Patel
- Genitourinary Medicine, Faculty of Medicine, 7423University of Southampton, Southampton, UK.,Solent Sexual Health, 232267Royal South Hants Hospital, Southampton UK
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7
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Burton R, Duncan S, Wardle E, Patel C, Clarke E. Unintended consequences: the potential impacts of the British Association for Sexual Health and HIV (BASHH) 2019 gonorrhoea guidelines. Int J STD AIDS 2020; 32:344-351. [PMID: 33345746 DOI: 10.1177/0956462420967575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2019 the British Association for Sexual Health and HIV (BASHH) guidelines for the management of gonorrhoea were updated. Epidemiological treatment was reserved for sexual contacts presenting within 14 days of exposure only. The aim of this evaluation was to review the potential implications of the new guidelines on the management of gonorrhoea contacts. For this retrospective service evaluation, all gonorrhoea contacts presenting to two UK sexual health services in 2018 were identified using the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) code Partner notification: gonorrhoea contact (PNG). Demographics, clinical characteristics and outcome data were collected from the electronic patient records. The 2019 guidelines were retrospectively applied to evaluate impact. For 436 patients seen as gonorrhoea contacts, gonorrhoea prevalence was 36% (159/436), and chlamydia prevalence 19% (83/429). Gonorrhoea prevalence varied with sexual risk: women 57% (61/107), heterosexual men 20% (28/143), men who have sex with men (MSM) 38% (69/183, p < .001); and with time since exposure: prevalence 43% (114/267) in those presenting within 14 days, 28% (42/149) after 14 days (p = .003). Epidemiological treatment of contacts presenting within 14 days would result in the treatment of 73% (114/156) of confirmed cases, with 37% (153/416) contacts unnecessarily treated. The BASHH gonorrhoea guideline changes represent an opportunity to improve antibiotic stewardship by reducing unnecessary treatment of gonorrhoea negative contacts.
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Affiliation(s)
- Rachel Burton
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Sarah Duncan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, New Croft Clinic, Newcastle, UK
| | - Elizabeth Wardle
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster Royal Infirmary, Doncaster, UK
| | - Chandni Patel
- University Hospitals Birmingham NHS Foundation Trust, Solihull Hospital, Solihull, UK
| | - Emily Clarke
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
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8
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Forster RF, Smith M, Cooper G, Brokenshire M, Roberts SA, McAuliffe GN. Demographic and behavioural factors associated with antimicrobial susceptibility to azithromycin and ceftriaxone in Neisseria gonorrhoeae. Int J STD AIDS 2020; 32:67-74. [PMID: 33198606 DOI: 10.1177/0956462420959171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antimicrobial resistance of Neisseria gonorrhoeae (NG) is of global public health concern. The aim of this study was to explore demographic and behavioural factors associated with antimicrobial susceptibility of NG to ceftriaxone and azithromycin. Gonococcal isolates (n = 391) from clients attending the Auckland Sexual Health Service, New Zealand, from July 2014 - June 2015 (n = 206), and July 2017 - June 2018 (n = 185), were tested for susceptibility to ceftriaxone and azithromycin. Laboratory data were linked with behavioural and demographic data. Geometric mean azithromycin MICs increased across the two time periods (0.239 mg/L in 2014/15 to 0.347 mg/L in 2017/18, p < 0.001), and ceftriaxone MICs decreased (0.007 mg/L in 2014/15 to 0.005 mg/L in 2017/18, p < 0.001). Demographic and behavioural factors were not associated with differences in ceftriaxone MICs; however azithromycin MICs were higher in men who have sex with men (0.356 mg/L) compared with the heterosexual study population (0.192 mg/L, p < 0.001) and were lower in Pacific peoples (0.201 mg/L, p < 0.001) and Māori (0.244 mg/L, p = 0.05) compared with those of European ethnicity (0.321 mg/L). Our findings show that azithromycin MICs increased in our region between 2014 and 2018; associations were seen with sexual orientation and ethnicity.
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Affiliation(s)
- Rose F Forster
- Auckland Sexual Health Service, Greenlane Clinical Centre, Auckland, New Zealand
| | - Marian Smith
- Microbiology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Gavin Cooper
- Microbiology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Mike Brokenshire
- Microbiology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Sally A Roberts
- Microbiology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Gary N McAuliffe
- Microbiology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
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9
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Abstract
Screening for STIs in men who have sex with men receiving HIV pre-exposure prophylaxis resulted in high consumption of macrolides, extended spectrum cephalosporins, fluoroquinolones and tetracyclines. The consumption of macrolides was 52 times as high as that reported for community-level consumption in certain European countries.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium.,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Irith De Baetselier
- Department of Clinical Sciences, STI Reference Center, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- HIV/STI Unit, Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
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10
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Abstract
Pharyngeal testing for Neisseria gonorrhoeae (gonorrhoea) in heterosexual men is not currently recommended in UK guidelines; however, it was being undertaken in a service in the North East of England for those presenting with urethral infection or as contacts of gonorrhoea. This service evaluation was performed to see if this practice should continue, or cease in line with national recommendations. The results revealed that 10% of contacts were positive in the pharynx only. Had this test not been performed, it would have left these patients without any treatment, as the current guidelines now discourage epidemiological treatment of contacts. Twenty-seven per cent of all heterosexual men diagnosed with urethral infection also had oropharyngeal gonorrhoea, with implications for persistent infection, had testing not been performed followed by a test of cure.
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Affiliation(s)
- Melissa Dresser
- Sunderland Sexual Health Service, Sunderland Royal Hospital, Sunderland, UK
| | - Jane Hussey
- Sunderland Sexual Health Service, Sunderland Royal Hospital, Sunderland, UK
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Bergquist EP, Trolard A, Kuhlmann AS, Loux T, Liang SY, Stoner BP, Reno H. Undertreatment of chlamydia and gonorrhea among pregnant women in the emergency department. Int J STD AIDS 2019; 31:166-173. [PMID: 31865863 DOI: 10.1177/0956462419880379] [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] [Indexed: 11/16/2022]
Abstract
The objective of this study is to evaluate whether pregnant women receive appropriate treatment, undertreatment, or overtreatment in the emergency department (ED) when they are tested for chlamydia and gonorrhea as compared to non-pregnant women. In a retrospective cohort study, we analyzed visits made to an urban ED from 1 July 2012 to 30 June 2014, with testing for chlamydia and gonorrhea (n = 3908). Using multiple logistic regression, we compared undertreatment and overtreatment in women controlling for pregnancy, age, race, and sexually transmitted infection International Statistical Classifications of Diseases (ICD)-9 coded diagnosis. Pregnant women were significantly more likely to be undertreated when positive for infection as compared to non-pregnant women (OR 2.94; 95% CI, 1.47–5.95) and significantly less likely to be overtreated when negative for infection (OR 0.40; 95% CI, 0.31–0.53) as compared to non-pregnant women. Pregnant women may not be receiving appropriate treatment when they present to the ED with chlamydia or gonorrhea. Attention should be paid to this group when administering chlamydia and gonorrhea treatment to ensure appropriate care and follow-up.
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Affiliation(s)
- Eleanor P Bergquist
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Anne Trolard
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Anne S Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Travis Loux
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Stephen Y Liang
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Bradley P Stoner
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.,Department of Anthropology, Washington University in St. Louis, St. Louis, MO, USA
| | - Hilary Reno
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Rodriguez HP, Starling S, Kandel Z, Weech-Maldonado R, Moss NJ, Silver L. A taxonomy of the scope and organization of local sexually transmitted disease services for policy and practice. Int J STD AIDS 2018; 29:1375-1383. [PMID: 30071798 DOI: 10.1177/0956462418787621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Local health departments (LHDs) and their organizational partners play a critical role in controlling sexually transmitted diseases (STDs) in the United States. We examine variation in the differentiation, integration, and concentration (DIC) of STD services and develop a taxonomy describing the scope and organization of local STD services. LHD STD programs (n = 115) in Alabama (AL) and California (CA) responded to surveys assessing STD services available in 2014. K-means cluster analysis identified LHD groupings based on DIC variation. Discriminant analysis validated cluster solutions. Differences in organizational partnerships and scope of STD services were compared by taxonomy category. Multivariable regression models estimated the association of the STD services organization taxonomy and five-year (2010–2014) gonorrhea incidence rates, controlling for county-level sociodemographics and resources. A three-cluster solution was identified: (1) low DIC (n = 74), (2) moderate DIC (n = 31), and (3) high DIC (n = 10). In discriminant analysis, 95% of jurisdictions were classified into the same types as originally assigned through K-means cluster analysis. High DIC jurisdictions were more likely (p < 0.001) to partner with most organizations than moderate and low DIC jurisdictions, and more likely (p < 0.001) to conduct STD needs assessment, comprehensive sex education, and targeted screening. In contrast, contact tracing, case management, and investigations were conducted similarly across jurisdictions. In adjusted analyses, there were no differences in gonorrhea incidence rates by category. Jurisdictions in CA and AL can be characterized into three distinct clusters based on the DIC of STD services. Taxonomic analyses may aid in improving the reach and effectiveness of STD services.
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Affiliation(s)
- Hector P Rodriguez
- Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, CA, USA.,Division of Health Policy and Management, UC Berkeley School of Public Health, Berkeley, CA, USA
| | | | - Zosha Kandel
- Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, CA, USA
| | | | - Nicholas J Moss
- HIV STD Section, Alameda County Public Health Department, Oakland, CA, USA
| | - Lynn Silver
- Public Health Institute, Oakland, CA, USA.,Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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