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Chambers LC, Tapia KA, Srinivasan S, Proll S, Morgan JL, Hoffman NG, Lowens MS, Glick SN, Khosropour CM, Golden MR, Hughes JP, Manhart LE, Fredricks DN. The Relationship Between Insertive Oral and Anal Sex and Select Measures of the Composition of the Urethral Microbiota Among Men Who Have Sex With Men. Sex Transm Dis 2024; 51:407-414. [PMID: 38403292 PMCID: PMC11088528 DOI: 10.1097/olq.0000000000001959] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Sexual behavior may influence the composition of the male urethral microbiota, but this hypothesis has not been tested in longitudinal studies of men who have sex with men (MSM). METHODS From December 2014 to July 2018, we enrolled MSM with nongonococcal urethritis (NGU) attending a sexual health clinic. Men attended 5 in-clinic visits at 3-week intervals, collected weekly urine specimens at home, and reported daily antibiotics and sexual activity on weekly diaries. We applied broad-range 16S rRNA gene sequencing to urine. We used generalized estimating equations to estimate the association between urethral sexual exposures in the prior 7 days (insertive oral sex [IOS] only, condomless insertive anal intercourse [CIAI] only, IOS with CIAI [IOS + CIAI], or none) and Shannon index, number of species (observed, oral indicator, and rectal indicator), and specific taxa, adjusting for recent antibiotics, age, race/ethnicity, HIV, and preexposure prophylaxis. RESULTS Ninety-six of 108 MSM with NGU attended ≥1 follow-up visit. They contributed 1140 person-weeks of behavioral data and 1006 urine specimens. Compared with those with no urethral sexual exposures, those with IOS only had higher Shannon index ( P = 0.03 ) but similar number of species and presence of specific taxa considered, adjusting for confounders; the exception was an association with Haemophilus parainfluenzae . CIAI only was not associated with measured aspects of the urethral microbiota. IOS + CIAI was only associated with presence of H. parainfluenzae and Haemophilus . CONCLUSIONS Among MSM after NGU, IOS and CIAI did not seem to have a substantial influence on measured aspects of the composition of the urethral microbiota.
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Affiliation(s)
- Laura C. Chambers
- Department of Epidemiology, University of Washington,
Seattle, Washington
| | - Kenneth A. Tapia
- Department of Global Health, University of Washington,
Seattle, Washington
| | - Sujatha Srinivasan
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Center, Seattle, Washington
| | - Sean Proll
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Center, Seattle, Washington
| | - Jennifer L. Morgan
- HIV/STI/HCV Program, Public Health – Seattle and
King County, Seattle, Washington
| | - Noah G. Hoffman
- Department of Laboratory Medicine and Pathology, University
of Washington, Seattle, Washington
| | - M. Sylvan Lowens
- HIV/STI/HCV Program, Public Health – Seattle and
King County, Seattle, Washington
| | - Sara N. Glick
- Department of Epidemiology, University of Washington,
Seattle, Washington
- HIV/STI/HCV Program, Public Health – Seattle and
King County, Seattle, Washington
- Department of Medicine, University of Washington, Seattle,
Washington
| | | | - Matthew R. Golden
- Department of Epidemiology, University of Washington,
Seattle, Washington
- HIV/STI/HCV Program, Public Health – Seattle and
King County, Seattle, Washington
- Department of Medicine, University of Washington, Seattle,
Washington
| | - James P. Hughes
- Department of Biostatistics, University of Washington,
Seattle, Washington
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington,
Seattle, Washington
- Department of Global Health, University of Washington,
Seattle, Washington
| | - David N. Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Center, Seattle, Washington
- Department of Medicine, University of Washington, Seattle,
Washington
- Department of Microbiology, University of Washington,
Seattle, Washington
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Brase PR, Dombrowski JC, Berzkalns A, Manhart LE, Golden MR, Khosropour CM. Trends in Chlamydia trachomatis Treatment Prescribing Practices in King County, Washington, 2010-2018. Sex Transm Dis 2024; 51:305-312. [PMID: 38301622 PMCID: PMC11018497 DOI: 10.1097/olq.0000000000001940] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND In 2021, national Chlamydia trachomatis (CT) treatment guidelines changed from recommending either azithromycin (1 g; single dose) or doxycycline (100 mg twice daily for 7 days) to recommending only doxycycline as first-line treatment. The distribution and trends in CT prescribing practices before the guidelines change is largely unknown. METHODS We conducted a trends analysis using Washington STD surveillance data. We included all female cases of urogenital CT 15 years or older who resided in King County and were diagnosed between 2010 and 2018. Surveillance data included information on demographics, sexual history, clinical features, diagnosing facility (eg, emergency department, family planning), and treatment regimen. We conducted descriptive analyses to examine trends in prescribing practices over time and by facility type. We used Poisson regression to examine the association between CT case characteristics and receipt of receipt of azithromycin. RESULTS There were 36,830 cases of female urogenital CT during the study period. The percent of cases receiving azithromycin increased significantly from 86% in 2010 to 94% in 2018; the percent receiving doxycycline decreased from 13% to 5%. Five of the 8 facility types prescribed azithromycin to >95% of CT cases by 2018. Cases who were younger or cases of color were more likely to receive azithromycin (versus doxycycline) compared with older and White cases, respectively. CONCLUSIONS A substantial shift in CT prescribing practices will be needed to adhere to new CT treatment guidelines. Our findings highlight the need for targeted provider education and training to encourage the transition to doxycycline use.
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Affiliation(s)
- Piper R. Brase
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Anna Berzkalns
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
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Waters MB, Hybiske K, Ikeda R, Kaltenboeck B, Manhart LE, Kreisel KM, Khosropour CM. Chlamydia trachomatis seroassays used in epidemiologic research: a narrative review and practical considerations. J Infect Dis 2024:jiae199. [PMID: 38640957 DOI: 10.1093/infdis/jiae199] [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: 11/30/2023] [Revised: 03/20/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024] Open
Abstract
Chlamydia trachomatis (CT) is a sexually transmitted infection that can lead to adverse reproductive health outcomes. CT prevalence estimates are primarily derived from screening using nucleic acid amplification tests (NAATs). However, screening guidelines in the United States only include particular subpopulations, and NAATs only detect current infections. In contrast, seroassays identify past CT infections which are important for understanding the public health impacts of CT, including pelvic inflammatory disease and tubal factor infertility. Older seroassays have been plagued by low sensitivity and specificity and have not been validated using a consistent reference measure, making it challenging to compare studies, define the epidemiology of CT and determine the effectiveness of control programs. Newer seroassays have better performance characteristics. This narrative review summarizes the "state of the science" for CT seroassays that have been applied in epidemiologic studies and provides practical considerations for interpreting the literature and employing seroassays in future research.
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Affiliation(s)
- Mary Bridget Waters
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | - Kevin Hybiske
- Department of Medicine, University of Washington, Seattle, WA, 98195 USA
| | - Ren Ikeda
- Department of Medicine, University of Washington, Seattle, WA, 98195 USA
| | - Bernhard Kaltenboeck
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, 36832 USA
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | - Kristen M Kreisel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329 USA
| | - Christine M Khosropour
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
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Manhart LE, Leipertz G, Soge OO, Jordan SJ, McNeil C, Pathela P, Reno H, Wendel K, Parker A, Geisler WM, Getman D, Golden MR. Mycoplasma genitalium in the US (MyGeniUS): Surveillance Data From Sexual Health Clinics in 4 US Regions. Clin Infect Dis 2023; 77:1449-1459. [PMID: 37402645 PMCID: PMC10654846 DOI: 10.1093/cid/ciad405] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) is on the CDC Watch List of Antimicrobial Resistance Threats, yet there is no systematic surveillance to monitor change. METHODS We initiated surveillance in sexual health clinics in 6 cities, selecting a quota sample of urogenital specimens tested for gonorrhea and/or chlamydia. We abstracted patient data from medical records and detected MG and macrolide-resistance mutations (MRMs) by nucleic acid amplification testing. We used Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% CIs, adjusting for sampling criteria (site, birth sex, symptom status). RESULTS From October-December 2020 we tested 1743 urogenital specimens: 57.0% from males, 46.1% from non-Hispanic Black persons, and 43.8% from symptomatic patients. MG prevalence was 16.6% (95% CI: 14.9-18.5%; site-specific range: 9.9-23.5%) and higher in St Louis (aPR: 1.9; 1.27-2.85), Greensboro (aPR: 1.8; 1.18-2.79), and Denver (aPR: 1.7; 1.12-2.44) than Seattle. Prevalence was highest in persons <18 years (30.4%) and declined 3% per each additional year of age (aPR: .97; .955-.982). MG was detected in 26.8%, 21.1%, 11.8%, and 15.4% of urethritis, vaginitis, cervicitis, and pelvic inflammatory disease (PID), respectively. It was present in 9% of asymptomatic males and 15.4% of asymptomatic females, and associated with male urethritis (aPR: 1.7; 1.22-2.50) and chlamydia (aPR: 1.7; 1.13-2.53). MRM prevalence was 59.1% (95% CI: 53.1-64.8%; site-specific range: 51.3-70.6%). MRMs were associated with vaginitis (aPR: 1.8; 1.14-2.85), cervicitis (aPR: 3.5; 1.69-7.30), and PID cervicitis (aPR: 1.8; 1.09-3.08). CONCLUSIONS MG infection is common in persons at high risk of sexually transmitted infections; testing symptomatic patients would facilitate appropriate therapy. Macrolide resistance is high and azithromycin should not be used without resistance testing.
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Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology and Center for AIDS and STD, University of Washington, Seattle, Washington, USA
| | - Gina Leipertz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Olusegun O Soge
- Department of Global Health, and Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Stephen J Jordan
- Division of Infectious Diseases, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Candice McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Preeti Pathela
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Hilary Reno
- Division of Infectious Diseases, Washington University, St Louis, Missouri, USA
| | - Karen Wendel
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Anika Parker
- Department of Epidemiology and Center for AIDS and STD, University of Washington, Seattle, Washington, USA
| | - William M Geisler
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Matthew R Golden
- Center for AIDS and STD, University of Washington, Seattle, Washington, USA
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Lokken EM, Kabare E, Oyaro B, Nyaigero M, Kinuthia J, Jaoko W, Mandaliya K, McClelland RS, Manhart LE. A prospective preconception cohort study of the association between Mycoplasma genitalium and fecundability in Kenyan women trying to conceive. Hum Reprod 2023; 38:2020-2027. [PMID: 37634090 PMCID: PMC10546078 DOI: 10.1093/humrep/dead172] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/04/2023] [Indexed: 08/28/2023] Open
Abstract
STUDY QUESTION Is Mycoplasma genitalium-infection associated with reduced fecundability? SUMMARY ANSWER Preconception M. genitalium-infection was associated with 27% lower fecundability though confidence intervals were wide, and the association between M. genitalium and fecundability may be dependent on concurrent bacterial vaginosis (BV). WHAT IS KNOWN ALREADY M. genitalium has been associated with cervicitis, pelvic inflammatory disease, infertility, and preterm birth, but the extent to which M. genitalium is causally related to adverse reproductive sequelae in women is debated. STUDY DESIGN, SIZE, DURATION Kenyan women enrolled in a prospective preconception cohort provided vaginal fluid specimens and underwent monthly pregnancy testing. Stored samples from 407 women who had been trying to conceive for ≤6 months were tested for M. genitalium using a nucleic acid amplification test. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on first day of last menstrual period, sexual behavior, pregnancy status, and vaginal specimens were collected at monthly preconception visits. The association between M. genitalium detected at the visit prior to each pregnancy test and fecundability was estimated using discrete time proportional probabilities models. Secondary analyses explored the influence of concurrent BV on the association between M. genitalium and fecundability. MAIN RESULTS AND THE ROLE OF CHANCE The 407 participants experienced 1220 menstrual cycles and 213 pregnancies. The prevalence of M. genitalium at enrollment was 7.7%. After adjustment for age, frequency of condomless sex in the last 4 weeks, and study site, M. genitalium was associated with a 27% lower fecundability, but confidence intervals were wide (adjusted fecundability ratio (aFR) 0.73, 95% CI 0.44, 1.23). In secondary analyses, when compared to cycles without M. genitalium or BV at the visit prior, women with both M. genitalium and BV at the visit prior had a 51% lower fecundability (aFR = 0.49, 95% CI 0.22, 1.09) whereas there was no association of M. genitalium alone (aFR = 0.98 (95% CI 0.54, 1.76)), and a smaller reduction in fecundability for women with BV only (aFR = 0.80 (95% CI 0.60, 1.07)). LIMITATIONS, REASONS FOR CAUTION Results should be interpreted cautiously given the relatively low prevalence of M. genitalium and wide confidence intervals. WIDER IMPLICATIONS OF THE FINDINGS In this cohort of Kenyan women trying to conceive, the association between M. genitalium and fecundability was influenced by concurrent BV status, suggesting there may be a synergistic effect of M. genitalium and BV on fecundability. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-RSM). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were completed using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation and consulting fees from Lupin Pharmaceuticals. L.E.M. receives research funding and material for research studies, paid to the University of Washington, from Hologic Corporation and Nabriva Therapeutics, travel support from Hologic, and consulting fees from Health Advances. E.M.L.'s contributions to this study primarily occurred while affiliated with the University of Washington; at the time of submission, E.M.L. was an employee of and holds stock or stock grants for AbbVie, Inc. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Erica M Lokken
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Emmanuel Kabare
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Brenda Oyaro
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Maureen Nyaigero
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics & Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | | | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lisa E Manhart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Kim CM, Manhart LE, Wood GE. Serum and Urethral Antibody Response in Mycoplasma genitalium -Infected Men. Sex Transm Dis 2023; 50:e26-e29. [PMID: 37432986 PMCID: PMC10527067 DOI: 10.1097/olq.0000000000001845] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
ABSTRACT The antibody response to Mycoplasma genitalium in serum and urethral secretions of men with nongonococcal urethritis was examined longitudinally. Serum and urethral antibodies reacted primarily with the MgpB and MgpC adhesins. Serum antibodies persisted throughout follow-up, whereas urethral antibodies waned despite organism persistence. Declining antibodies may facilitate chronic infection.
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Affiliation(s)
- Caroline M. Kim
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | - Lisa E. Manhart
- Center for AIDS and STD and Department of Epidemiology, University of Washington, Seattle, WA
| | - Gwendolyn E. Wood
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
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Rowlinson E, Hughes JP, Khosropour CM, Manhart LE, Golden MR, Barbee LA. Inadequate performance of a risk score to predict asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infection among cisgender men who have sex with men. Sex Transm Infect 2023; 99:380-385. [PMID: 36609346 PMCID: PMC10323043 DOI: 10.1136/sextrans-2022-055608] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Epidemiological treatment of persons who are sexual contacts to partners with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) often results in treatment of uninfected persons, which may increase the risk of antibiotic-resistant infections. We sought to identify the predictors of NG and/or CT infections to develop a risk score that could be used to limit epidemiological treatment to persons most likely to have these infections. METHODS We included visits to the Public Health - Seattle & King County Sexual Health Clinic by asymptomatic cisgender men who have sex with men (MSM) aged ≥18 who presented as a sexual contact to partner(s) with CT or NG infection between 2011 and 2019. We used logistic regression to estimate the odds of CT and/or NG infections associated with demographic and clinical predictors, selecting the final set of predictors using the Akaike information criteria and obtaining score weights from model coefficients. We used a cross-validation approach to obtain average model discrimination from each of 10 models, leaving out 10% of the data, and evaluated sensitivity and specificity at various score cut-offs. RESULTS The final model for predicting NG or CT infection included seven predictors (age <35 years, HIV status, receptive oral sex in the prior 2 months, CT diagnosis, condomless receptive anal intercourse, condomless insertive anal intercourse and methamphetamine use in the prior 12 months). Model discrimination, as measured by the receiver operating curve, was 0.60 (95% CI 0.54 to 0.66). Sensitivity for detection of infection was ≥90% for scores ≥3, ≥5 and ≥7; specificity for these cut-offs was <16%. At scores ≥9, ≥12 and ≥14, specificity increased but sensitivity decreased to ≤76%. CONCLUSIONS Our risk score did not sufficiently discriminate between asymptomatic MSM with and without NG/CT infection. Additional studies evaluating epidemiological treatment as a standard of care in diverse populations are needed to guide best practices in the management of contacts to NG/CT infection.
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Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Biostatistics, University of Washington, Seattle, Washington, USA
| | | | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Lindley A Barbee
- Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD, Public Health - Seattle & King County, Seattle, Washington, USA
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Abstract
Mycoplasma genitalium is a frequent cause of urogenital syndromes in men and women and is associated with adverse sequelae in women. M genitalium also infects the rectum, and may cause proctitis, but rarely infects the pharynx. Diagnosis requires nucleic acid amplification testing. Antibiotic resistance is widespread: more than half of infections are resistant to macrolides and fluoroquinolone resistance is increasing. Resistance-guided therapy is recommended for symptomatic patients, involving initial treatment with doxycycline to reduce organism load followed by azithromycin for macrolide-sensitive infections or moxifloxacin for macrolide-resistant infections. Neither screening nor tests of cure are recommended in asymptomatic persons.
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Affiliation(s)
- Gwendolyn E Wood
- Division of Infectious Diseases, University of Washington, Center for AIDS and STD, Box 359779, 325 9th Avenue, Seattle, WA 98104, USA.
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Center for AIDS and STD, Box 359931, 325 9th Avenue, Seattle, WA 98104, USA
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Rowlinson E, Soge OO, Hughes JP, Berzkalns A, Thibault C, Kerani RP, Khosropour CM, Manhart LE, Golden MR, Barbee LA. Prior Exposure to Azithromycin and Azithromycin Resistance Among Persons Diagnosed With Neisseria gonorrhoeae Infection at a Sexual Health Clinic: 2012-2019. Clin Infect Dis 2023; 76:e1270-e1276. [PMID: 36001447 PMCID: PMC10169409 DOI: 10.1093/cid/ciac682] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is conflicting evidence on whether prior azithromycin (AZM) exposure is associated with reduced susceptibility to AZM (AZMRS) among persons infected with Neisseria gonorrhoeae (NG). METHODS The study population included Public Health-Seattle and King County Sexual Health Clinic (SHC) patients with culture-positive NG infection at ≥1 anatomic site whose isolates were tested for AZM susceptibility in 2012-2019. We used multivariate logistic regression to examine the association of time since last AZM prescription from the SHC in ≤12 months with subsequent diagnosis with AZMRS NG (minimum inhibitory concentration [MIC], ≥2.0 µg/mL) and used linear regression to assess the association between the number of AZM prescriptions in ≤12 months and AZM MIC level, controlling for demographic, behavioral, and clinical characteristics. RESULTS A total of 2155 unique patients had 2828 incident NG infections, 156 (6%) of which were caused by AZMRS NG. AZMRS NG was strongly associated with receipt of AZM from the SHC in the prior 29 days (adjusted odds ratio, 6.76; 95% confidence interval [CI], 1.76 to 25.90) but not with receipt of AZM in the prior 30-365 days. Log AZM MIC level was not associated with the number of AZM prescriptions within ≤12 months (adjusted correlation, 0.0004; 95% CI, -.04 to .037) but was associated with number of prescriptions within <30 days (adjusted coefficient, 0.56; 95% CI, .13 to .98). CONCLUSIONS Recent individual-level AZM treatment is associated with subsequent AZMRS gonococcal infections. The long half-life and persistence of subtherapeutic levels of AZM may result in selection of resistant NG strains in persons with recent AZM use.
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Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Olusegun O Soge
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Neisseria Reference Laboratory, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Anna Berzkalns
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Christina Thibault
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Roxanne P Kerani
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Lindley A Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
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Chambers LC, Morgan JL, Lowens MS, Robinson TS, Romano SS, Leipertz GL, Glick SN, Khosropour CM, Hughes JP, Golden MR, Fredricks DN, Manhart LE. The Incidence Rate of Sexual Behaviors Among Cisgender Men Who Have Sex with Men Attending a Sexual Health Clinic. Arch Sex Behav 2023; 52:751-759. [PMID: 35930134 PMCID: PMC9892175 DOI: 10.1007/s10508-022-02370-z] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/27/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Although nuanced parameterization of sexual behavior may improve estimates from mathematical models of human immunodeficiency virus and sexually transmitted infection transmission, prospective estimates of the incidence of specific sexual behaviors among men who have sex with men (MSM) are limited. From December 2014 to July 2018, MSM with and without nongonococcal urethritis (NGU) completed weekly diaries over 3-12 weeks. Incidence rates of any sex, receptive anal sex, insertive anal sex, insertive oral sex, receptive rimming, and receptive hand-penile contact were 1.19, 0.28, 0.66, 0.90, 0.24, and 0.85 episodes per person-week, respectively, among 104 MSM with NGU at baseline, and 1.33, 0.54, 0.32, 0.95, 0.44, and 0.88 episodes per person-week, respectively, among 25 MSM without NGU at baseline. Most receptive anal sex (NGU + 83%, NGU - 86%) and insertive anal sex (NGU + 85%, NGU - 76%) episodes were condomless. MSM engaged in sex just over once per week, and condom use was infrequent. Insertive oral sex and receptive hand-penile contact were the most common behaviors.
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Affiliation(s)
- Laura C Chambers
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA.
| | - Jennifer L Morgan
- HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA
| | - M Sylvan Lowens
- HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA
| | - Tashina S Robinson
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA
| | - Sarah S Romano
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA
| | - Gina L Leipertz
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA
| | - Sara N Glick
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA
- HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christine M Khosropour
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA
- HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - David N Fredricks
- Department of Medicine, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Microbiology, University of Washington, Seattle, WA, USA
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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11
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Zinsli KA, Srinivasan S, Balkus JE, Chambers LC, Lowens MS, Morgan J, Rowlinson E, Robinson TS, Romano SS, Munch MM, Manhart LE, Fredricks DN. Bacterial vaginosis-associated bacteria in cisgender men who have sex with women: prevalence, association with non-gonococcal urethritis and natural history. Sex Transm Infect 2022:sextrans-2022-055494. [PMID: 36601742 DOI: 10.1136/sextrans-2022-055494] [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: 04/07/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Bacterial vaginosis-associated bacterium 2 (BVAB2), Mageeibacillus indolicus and Sneathia spp are highly predictive of bacterial vaginosis (BV) in cisgender women. They have been associated with non-gonococcal urethritis (NGU) in cisgender men in some but not all populations. We evaluated this association in a cross-sectional study of cisgender men who have sex with women only (MSW). METHODS MSW without gonorrhoea attending a sexual health clinic (SHC) from 2014 to 2018 completed a computer-assisted self-interview, clinical interview and examination. NGU was defined as ≥5 polymorphonuclear leucocytes/high-power field in urethral exudates plus either urethral symptoms or visible discharge. Urine was tested for Chlamydia trachomatis and Mycoplasma genitalium using Aptima (Hologic) and for BVAB2, M. indolicus, Sneathia spp, Trichomonas vaginalis, Ureaplasma urealyticum, Haemophilus influenzae, herpes simplex virus and adenovirus using quantitative PCR. RESULTS Of 317 MSW age 17-71, 67 (21.1%) had Sneathia spp, 36 (11.4%) had BVAB2, and 17 (5.4%) had M. indolicus at enrolment. Having ≥3 partners in the past 2 months was the only characteristic that was more common among MSW with than those without these bacteria (BVAB2: 47% vs 23%, M. indolicus: 53% vs 24%, Sneathia spp: 42% vs 22%; p≤0.03 for all). One-hundred seventeen men (37%) were diagnosed with NGU at enrolment. There was no significant association of BVAB2, M. indolicus or Sneathia spp with NGU (adjusted OR=0.59, 95% CI 0.14 to 2.43; aOR=3.40, 95% CI 0.68 to 17.06; aOR=0.46, 95% CI 0.16 to 1.27). Of 109 MSW with monthly samples, 34 (31.2%) had one of the bacteria at one or more follow-up visits, 22 of which were co-colonised with >1. Median persistence over 6 months did not differ significantly (BVAB2=30.5 days, IQR=28-87; M. indolicus=87 days, IQR=60-126; Sneathia spp=70 days, IQR=30-135; p≥0.20 for each comparison). CONCLUSIONS Neither BVAB2, M. indolicus nor Sneathia spp were associated with increased risk of prevalent NGU in MSW attending an SHC.
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Affiliation(s)
- Kaitlin A Zinsli
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Sujatha Srinivasan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jennifer E Balkus
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Laura C Chambers
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - M Sylvan Lowens
- HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Jennifer Morgan
- HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Emily Rowlinson
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Tashina S Robinson
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Sarah S Romano
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Matthew M Munch
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - David N Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
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12
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Manhart LE, Geisler WM, Bradshaw CS, Jensen JS, Martin DH. Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches. Emerg Infect Dis 2022; 28. [PMID: 35876565 PMCID: PMC9328920 DOI: 10.3201/eid2808.220094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This systematic review demonstrates increasing antimicrobial resistance and incomplete understanding of the bacterium’s natural history. Since Mycoplasma genitalium was identified 40 years ago, much of the epidemiology has been described, diagnostic tests have been developed and approved, and recommended treatment approaches have been identified. However, the natural history remains incompletely understood, and antimicrobial resistance has rapidly increased. This review summarizes evidence published since the US Centers for Disease Control and Prevention 2015 Sexually Transmitted Diseases Treatment Guidelines. Data on sequelae remain insufficient, macrolide resistance is common, and fluoroquinolone resistance is increasing. Potential benefits of testing and treatment include resolving symptoms, interrupting transmission, and preventing sequelae. Potential harms include cost, patient anxiety, and increasing antimicrobial resistance.
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13
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Lokken EM, Jisuvei C, Hughes JP, Mandaliya K, Manhart LE, Mwinyikai K, Muller CH, Jaoko W, Kinuthia J, Scott McClelland R. Cultivable vaginal Lactobacillus is not associated with fecundability in Kenyan women attempting to conceive. Fertil Steril 2022; 117:603-611. [PMID: 35058047 PMCID: PMC8885891 DOI: 10.1016/j.fertnstert.2021.11.032] [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: 07/29/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association between cultivable vaginal Lactobacillus and fecundability in Kenyan women attempting nonmedically assisted conception. DESIGN Prospective preconception cohort. SETTING Nairobi and Mombasa, Kenya. PATIENT(S) Women trying to conceive who reported ≤3 months of pre-enrollment conception attempt time. INTERVENTION(S) Cultivable Lactobacillus (primary), Lactobacillus morphotypes on Gram stain (secondary). MAIN OUTCOME MEASURE(S) Participants reported the first day of their last menstrual period and recent sexual behavior, underwent pregnancy testing, and provided vaginal specimen samples for Lactobacillus culture and Gram stain at ≤6 monthly preconception visits. The outcome was fecundability-the per-menstrual cycle probability of pregnancy. Associations between cultivable Lactobacillus and Lactobacillus morphotypes on Gram stain at the visit before each pregnancy test and fecundability were estimated using proportional probabilities models to generate fecundability ratios (FRs). RESULT(S) A total of 458 women contributed 1,376 menstrual cycles. At enrollment, 65.3% (n = 299) of participants had cultivable Lactobacillus, 47.4% (n = 217) had cultivable hydrogen peroxide producing Lactobacillus, and 64.6% (n = 296) had Lactobacillus detected on Gram stain. In unadjusted analysis, there was no association between cultivable Lactobacillus at the prior visit and fecundability (FR, 0.92; 95% CI, 0.73-1.16); results were similar after adjustment for age, frequency of condomless sex, and study site (adjusted FR, 0.92; 95% CI, 0.72-1.18). Lactobacillus on Gram stain at the visit prior was associated with modestly higher fecundability (adjusted FR, 1.18; 95% CI, 0.92-1.51). CONCLUSION(S) Cultivable Lactobacillus was not associated with fecundability, although Lactobacillus morphotypes detected on Gram stain were somewhat associated with increased fecundability. The relationship between vaginal Lactobacillus and fecundity may be species-specific.
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Affiliation(s)
- Erica M Lokken
- Department of Global Health, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| | - Clayton Jisuvei
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | - Lisa E Manhart
- Department of Global Health, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington, Seattle, WA
| | - Khamis Mwinyikai
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | | | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya,Obstetrics & Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington, Seattle, WA,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya,Department of Medicine, University of Washington, Seattle, WA
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14
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Mitchell CM, Anyalechi GE, Cohen CR, Haggerty CL, Manhart LE, Hillier SL. Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia. J Infect Dis 2021; 224:S29-S35. [PMID: 34396407 PMCID: PMC8365120 DOI: 10.1093/infdis/jiab067] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pelvic inflammatory disease (PID) is a clinical syndrome that has been associated with a wide range of potential causal pathogens. Three broad groups of organisms have been isolated from the genital tract of people with PID: sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis; bacterial vaginosis (BV)-associated species and genera such as Atopobium vaginae, Sneathia, and Megasphaera; and genera and species usually associated with the gastrointestinal or respiratory tracts such as Bacteroides, Escherichia coli, Streptococcus, or Haemophilus influenza. Although PID is often considered to be synonymous with gonorrhea or chlamydia, these pathogens are found in only one quarter to one third of people with PID, suggesting that broader screening and diagnostic and treatment strategies need to be considered to reduce the burden of PID and its associated sequelae.
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Affiliation(s)
- Caroline M Mitchell
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston Massachusetts
| | - Gloria E Anyalechi
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California
| | - Catherine L Haggerty
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa E Manhart
- Departments of Epidemiology and Global Health, School of Public Health, University of Washington, Seattle, Washington
| | - Sharon L Hillier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh and the Magee Women’s Research Institute, Pittsburgh, Pennsylvania
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15
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Lokken EM, Manhart LE, Kinuthia J, Hughes JP, Jisuvei C, Mwinyikai K, Muller CH, Mandaliya K, Jaoko W, McClelland RS. Association between bacterial vaginosis and fecundability in Kenyan women planning pregnancies: a prospective preconception cohort study. Hum Reprod 2021; 36:1279-1287. [PMID: 33594429 DOI: 10.1093/humrep/deab002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/27/2020] [Revised: 12/22/2020] [Indexed: 01/03/2023] Open
Abstract
STUDY QUESTION Is bacterial vaginosis (BV) associated with fecundability? SUMMARY ANSWER Women with BV may be at increased risk for sub-fecundity. WHAT IS KNOWN ALREADY While BV has been associated with poor IVF outcomes, the association between vaginal microbiota disruption and non-medically assisted conception has not been thoroughly explored. STUDY DESIGN, SIZE, DURATION Kenyan women with fertility intent were enrolled in prospective cohort that included monthly preconception visits with vaginal fluid specimen collection and pregnancy testing. Four hundred fifty-eight women attempting pregnancy for ≤3 menstrual cycles at enrollment were eligible for this fecundability analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS At monthly preconception visits, participants reported the first day of last menstrual period and sexual behavior, underwent pregnancy testing and provided vaginal specimens. Discrete time proportional probabilities models were used to estimate fecundability ratios (FRs) and 95% CI in menstrual cycles with and without BV (Nugent score ≥ 7) at the visit prior to each pregnancy test. We also assessed the association between persistent BV (BV at two consecutive visits) and fecundability. MAIN RESULTS AND THE ROLE OF CHANCE Participants contributed 1376 menstrual cycles; 18.5% (n = 255) resulted in pregnancy. After adjusting for age, frequency of condomless sex and study site, BV at the visit prior to pregnancy testing was associated with a 17% lower fecundability (adjusted FR (aFR) 0.83, 95% CI 0.6-1.1). Persistent BV was associated with a 43% reduction in fecundability compared to cycles characterized by optimal vaginal health (aFR 0.57, 95% CI 0.4-0.8). LIMITATIONS, REASONS FOR CAUTION Detection of vaginal microbiota disruption using Gram stain and a point-of-care test for elevated sialidase identified a non-optimal vaginal environment, but these non-specific methods may miss important relationships that could be identified by characterizing individual vaginal bacteria and bacterial communities using molecular methods. In addition, results may be subject to residual confounding by condomless sex as this was reported for the prior month rather than for the fertile window during each cycle. WIDER IMPLICATIONS OF THE FINDINGS Given the high global prevalence of BV and infertility, an association between BV and reduced fecundability could have important implications for a large number of women who wish to conceive. Multi-omics approaches to studying the vaginal microbiota may provide key insights into this association and identify potential targets for intervention. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-R.S.M.). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were made possible using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for consulting from Lupin Pharmaceuticals. L.E.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for service on scientific advisory boards from Hologic and Nabriva Therapeutics. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Erica M Lokken
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lisa E Manhart
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Obstetrics & Gynaecology, Kenyatta National Hospital, Nairobi, Kenya.,Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Clayton Jisuvei
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Khamis Mwinyikai
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Charles H Muller
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,Department of Medicine, University of Washington, Seattle, WA, USA
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16
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Rowlinson E, Hughes JP, Chambers LC, Lowens MS, Morgan JL, Robinson TS, Romano SS, Leipertz GL, Soge OO, Golden MR, Manhart LE. Incidence of Nongonococcal Urethritis in Men Who Have Sex With Women and Associated Risk Factors. Sex Transm Dis 2021; 48:341-346. [PMID: 33044377 PMCID: PMC8893602 DOI: 10.1097/olq.0000000000001314] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Incidence and risk factors for nongonococcal urethritis (NGU) remain poorly defined. We conducted a cohort study to estimate the incidence of NGU and identify risk factors in men who have sex with women. METHODS We enrolled cisgender male sexually transmitted disease clinic attendees 16 years or older who reported exclusively female partners. At enrollment and 6 monthly follow-up visits, men underwent a clinical examination, provided urethral swab and urine specimens, completed a sexual behavior survey and biweekly diaries, and were tested for Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) using Aptima assays (Hologic, Inc). Nongonococcal urethritis was defined as ≥5 polymorphonuclear leukocytes per high-power field plus either urethral symptoms or visible discharge. We estimated the incidence of NGU overall, asymptomatic and symptomatic NGU, non-CT/non-MG NGU, and CT/MG-associated NGU using Poisson regression for clustered outcomes. We performed relative risk binomial regression for clustered data to identify characteristics associated with incident NGU. RESULTS From August 2014 to July 2018, 307 participants at risk for NGU contributed 109.4 person-years. Median age was 32 years, and 52% were White. At enrollment, 107 men had NGU; of these, 88% were symptomatic, 27% had CT, and 22% had MG. Fifty men had 60 cases of incident NGU (incidence rate, 56 per 100 person-years; 95% confidence interval, 43-74). Unlike prevalent NGU at enrollment, CT/MG-associated incident NGU was rare (incidence rate, 7; 95% confidence interval [CI], 4-15), and most (78%) incident NGU was asymptomatic. Risk factors for incident NGU were ≤ high school education (adjusted rate ratio [ARR], 2.45; 95% CI, 1.19-5.00), history of CT (ARR, 2.15; 95% CI, 1.08-4.27), history of NGU (ARR, 2.67; 95% CI, 1.27-5.62), and NGU at enrollment (ARR, 2.03; 95% CI, 1.04-3.98). Neither condom use nor having a new partner was associated with incident NGU; Black race was only associated with incident symptomatic and non-CT/non-MG NGU. CONCLUSIONS Incidence of NGU was high, predominantly non-CT/non-MG and asymptomatic. Future studies should investigate the etiology and clinical significance of asymptomatic NGU.
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Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Laura C. Chambers
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - M. Sylvan Lowens
- Public Health – Seattle and King County, Seattle, Washington, USA
| | | | - Tashina S. Robinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sarah S. Romano
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gina L. Leipertz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Olusegun O. Soge
- Department of Global Health, University of Washington, Seattle Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew R. Golden
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Bachmann LH, Kirkcaldy RD, Geisler WM, Wiesenfeld HC, Manhart LE, Taylor SN, Seña AC, McNeil CJ, Newman L, Myler N, Fuchs R, Bowden KE. Prevalence of Mycoplasma genitalium Infection, Antimicrobial Resistance Mutations, and Symptom Resolution Following Treatment of Urethritis. Clin Infect Dis 2021; 71:e624-e632. [PMID: 32185385 DOI: 10.1093/cid/ciaa293] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 12/06/2019] [Accepted: 03/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antimicrobial resistance in Mycoplasma genitalium (MG), a cause of urethritis, is a growing concern. Yet little is known about the geographic distribution of MG resistance in the United States or about its associated clinical outcomes. We evaluated the frequency of MG among men with urethritis, resistance mutations, and posttreatment symptom persistence. METHODS We enrolled men presenting with urethritis symptoms to 6 US sexually transmitted disease (STD) clinics during June 2017-July 2018; men with urethritis were eligible for follow-up contact and, if they had persistent symptoms or MG, a chart review. Urethral specimens were tested for MG and other bacterial STDs. Mutations in 23S ribosomal ribonucleic acid (rRNA) loci (macrolide resistance-associated mutations [MRMs]) and in parC and gyrA (quinolone-associated mutations) were detected by targeted amplification/Sanger sequencing. RESULTS Among 914 evaluable participants, 28.7% (95% confidence interval [CI], 23.8-33.6) had MG. Men with MG were more often Black (79.8% vs 66%, respectively), <30 years (72.9% vs 56.1%, respectively), and reported only female partners (83.7% vs 74.2%, respectively) than men without MG. Among MG-positive participants, 64.4% (95% CI, 58.2-70.3%) had MRM, 11.5% (95% CI, 7.9-16.0%) had parC mutations, and 0% had gyrA mutations. Among participants treated with azithromycin-based therapy at enrollment and who completed the follow-up survey, persistent symptoms were reported by 25.8% of MG-positive/MRM-positive men, 13% of MG-positive/MRM-negative men, and 17.2% of MG-negative men. CONCLUSIONS MG infection was common among men with urethritis; the MRM prevalence was high among men with MG. Persistent symptoms following treatment were frequent among men both with and without MG.
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Affiliation(s)
- Laura H Bachmann
- Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert D Kirkcaldy
- Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William M Geisler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Harold C Wiesenfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Stephanie N Taylor
- Department of Medicine, Louisiana State University Health Sciences, New Orleans, Louisiana, USA
| | - Arlene C Seña
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Candice J McNeil
- Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
| | - Lori Newman
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | | | - Katherine E Bowden
- Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Wood GE, Iverson-Cabral SL, Gillespie CW, Lowens MS, Manhart LE, Totten PA. Sequence variation and immunogenicity of the Mycoplasma genitalium MgpB and MgpC adherence proteins during persistent infection of men with non-gonococcal urethritis. PLoS One 2020; 15:e0240626. [PMID: 33045031 PMCID: PMC7549776 DOI: 10.1371/journal.pone.0240626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
Mycoplasma genitalium is a sexually transmitted bacterial pathogen that infects men and women. Antigenic variation of MgpB and MgpC, the immunodominant adherence proteins of M. genitalium, is thought to contribute to immune evasion and chronic infection. We investigated the evolution of mgpB and mgpC sequences in men with non-gonococcal urethritis persistently infected with M. genitalium, including two men with anti-M. genitalium antibodies at enrollment and two that developed antibodies during follow-up. Each of the four patients was persistently infected with a different strain type and each patient produced antibodies targeting MgpB and MgpC. Amino acid sequence evolution in the variable regions of MgpB and MgpC occurred in all four patients with changes observed in single and multiple variable regions over time. Using the available crystal structure of MgpC of the G37 type strain we found that predicted conformational B cell epitopes localize predominantly to the variable region of MgpC, amino acids that changed during patient infection lie in these epitopes, and variant amino acids are in close proximity to the conserved sialic acid binding pocket. These findings support the hypothesis that sequence variation functions to avoid specific antibodies thereby contributing to persistence in the genital tract.
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Affiliation(s)
- Gwendolyn E. Wood
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Stefanie L. Iverson-Cabral
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Catherine W. Gillespie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - M. Sylvan Lowens
- Public Health - Seattle & King County Sexual Health Clinic, Seattle, Washington, United States of America
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Patricia A. Totten
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, Pathobiology Interdisciplinary Program, University of Washington, Seattle, Washington, United States of America
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Romano SS, Jensen JS, Lowens MS, Morgan JL, Chambers LC, Robinson TS, Totten PA, Soge OO, Golden MR, Manhart LE. Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis. Clin Infect Dis 2020; 69:113-120. [PMID: 30281079 DOI: 10.1093/cid/ciy843] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/14/2018] [Accepted: 09/28/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although Mycoplasma genitalium (MG) is an acknowledged cause of nongonococcal urethritis (NGU), access to diagnostic testing is limited. Syndromic management is common, yet little is known about natural history. METHODS Between August 2014 and April 2016, 13 heterosexual men aged ≥16 years with MG were identified within a cohort study of men with and without NGU attending an urban sexually transmitted diseases clinic. Men had 6-7 monthly visits. NGU was defined as ≥5 polymorphonuclear leukocytes per high-power field on urethral Gram stain plus either visible urethral discharge or urethral symptoms. Men with NGU received 1 g of azithromycin. Men with persistent NGU received moxifloxacin 400 mg for 14 days. First-void urine was retrospectively tested for MG using transcription-mediated amplification. Resistance-associated mutations were detected by polymerase chain reaction (PCR) and sequencing. Organism load was determined by quantitative PCR. RESULTS Sixty-two percent of MG-positive men had macrolide resistance-mediating mutations (MRMM) at enrollment; 31% had parC mutations (all outside the quinolone resistance-determining region). MG persisted after azithromycin in 7 men, 6 of whom had MRMM. The median duration of persistence in the absence of curative therapy was 143 days (range, 21-228). Five men experienced symptom resolution after azithromycin, but MG persisted for another 89-186 days before moxifloxacin. Organism load was somewhat lower in MRMM than wild-type infections (P = .16). CONCLUSIONS The high prevalence of macrolide resistance and long duration of infection after symptom resolution highlights the need for diagnostic MG testing of men with NGU to direct therapy.
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Affiliation(s)
- Sarah S Romano
- Department of Epidemiology, University of Washington, Seattle.,Center for AIDS and STD, University of Washington, Seattle
| | | | - M Sylvan Lowens
- Public Health-Seattle & King County, University of Washington, Seattle
| | - Jennifer L Morgan
- Public Health-Seattle & King County, University of Washington, Seattle
| | - Laura C Chambers
- Department of Epidemiology, University of Washington, Seattle.,Center for AIDS and STD, University of Washington, Seattle
| | - Tashina S Robinson
- Department of Epidemiology, University of Washington, Seattle.,Center for AIDS and STD, University of Washington, Seattle
| | - Patricia A Totten
- Center for AIDS and STD, University of Washington, Seattle.,Department of Global Health, University of Washington, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Olusegun O Soge
- Center for AIDS and STD, University of Washington, Seattle.,Department of Global Health, University of Washington, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle.,Center for AIDS and STD, University of Washington, Seattle.,Public Health-Seattle & King County, University of Washington, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle.,Center for AIDS and STD, University of Washington, Seattle.,Department of Global Health, University of Washington, Seattle
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20
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Srinivasan S, Chambers LC, Tapia KA, Hoffman NG, Munch MM, Morgan JL, Domogala D, Sylvan Lowens M, Proll S, Huang ML, Soge OO, Jerome KR, Golden MR, Hughes JP, Fredricks DN, Manhart LE. Urethral Microbiota in Men: Association of Haemophilus influenzae and Mycoplasma penetrans With Nongonococcal Urethritis. Clin Infect Dis 2020; 73:e1684-e1693. [PMID: 32750107 DOI: 10.1093/cid/ciaa1123] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/30/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Nongonococcal urethritis (NGU) is a common syndrome with no known etiology in ≤50% of cases. We estimated associations between urethral bacteria and NGU in men who have sex with men (MSM) and men who have sex with women (MSW). METHODS Urine was collected from NGU cases (129 MSM, 121 MSW) and controls (70 MSM, 114 MSW) attending a Seattle STD clinic. Cases had ≥5 polymorphonuclear leukocytes on Gram stain plus symptoms or discharge; controls had <5 PMNs, no symptoms, no discharge. NGU was considered idiopathic when Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, adenovirus, and herpes simplex virus were absent. The urethral microbiota was characterized using 16S rRNA gene sequencing. Compositional lasso analysis was conducted to identify associations between bacterial taxa and NGU and to select bacteria for targeted qPCR. RESULTS Among NGU cases, 45.2% were idiopathic. Based on compositional lasso analysis, we selected Haemophilus influenzae (HI) and Mycoplasma penetrans (MP) for targeted qPCR. Compared with 182 men without NGU, the 249 men with NGU were more likely to have HI (14% vs 2%) and MP (21% vs 1%) (both P ≤ .001). In stratified analyses, detection of HI was associated with NGU among MSM (12% vs 3%, P = .036) and MSW (17% vs 1%, P < .001), but MP was associated with NGU only among MSM (13% vs 1%, P = .004). Associations were stronger in men with idiopathic NGU. CONCLUSIONS HI and MP are potential causes of male urethritis. MP was more often detected among MSM than MSW with urethritis.
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Affiliation(s)
- Sujatha Srinivasan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laura C Chambers
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Kenneth A Tapia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Noah G Hoffman
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew M Munch
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jennifer L Morgan
- Public Health-Seattle & King County HIV/STD Program, Seattle, Washington, USA
| | - Daniel Domogala
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - M Sylvan Lowens
- Public Health-Seattle & King County HIV/STD Program, Seattle, Washington, USA
| | - Sean Proll
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Meei-Li Huang
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Olusegun O Soge
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Public Health-Seattle & King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - David N Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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21
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Chambers LC, Jensen JS, Morgan JL, Lowens MS, Romano SS, Totten PA, Soge OO, Hughes JP, Golden MR, Manhart LE. Lack of Association Between the S83I ParC Mutation in Mycoplasma genitalium and Treatment Outcomes Among Men Who Have Sex With Men with Nongonococcal Urethritis. Sex Transm Dis 2020; 46:805-809. [PMID: 31259853 DOI: 10.1097/olq.0000000000001035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
From February 2015 to October 2017, among 20 men who have sex with men with Mycoplasma genitalium-associated nongonococcal urethritis, 15% had macrolide resistance and S83I ParC mutations. Azithromycin followed by moxifloxacin cleared Mycoplasma genitalium in 2 of 2 with and 11 of 13 without S83I mutations. Dual failures were cleared after doxycycline. S83I mutations were not associated with moxifloxacin failure.
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Affiliation(s)
- Laura C Chambers
- From the Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | | | - Sarah S Romano
- From the Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Matthew R Golden
- From the Department of Epidemiology, University of Washington, Seattle, WA.,HIV/STD Program, Public Health-Seattle and King County.,Department of Medicine
| | - Lisa E Manhart
- From the Department of Epidemiology, University of Washington, Seattle, WA.,Department of Global Health
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22
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Manhart LE, Gaydos CA, Taylor SN, Lillis RA, Hook EW, Klausner JD, Remillard CV, Love M, McKinney B, Getman DK. Characteristics of Mycoplasma genitalium Urogenital Infections in a Diverse Patient Sample from the United States: Results from the Aptima Mycoplasma genitalium Evaluation Study (AMES). J Clin Microbiol 2020; 58:e00165-20. [PMID: 32321783 PMCID: PMC7315021 DOI: 10.1128/jcm.00165-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/17/2020] [Indexed: 01/12/2023] Open
Abstract
Data from a large prospective multicenter clinical validation study of a nucleic acid amplification in vitro diagnostic test for Mycoplasma genitalium were analyzed to describe the prevalence of M. genitalium infection, risk factors, and disease associations in female and male patients seeking care in diverse geographic regions of the United States. Among 1,737 female and 1,563 male participants, the overall prevalence of M. genitalium infection was 10.3% and was significantly higher in persons ages 15 to 24 years than in persons ages 35 to 39 years (for females, 19.8% versus 4.7% [odds ratio {OR} = 5.05; 95% confidence interval {CI} = 3.01 to 8.46]; for males, 16.5% versus 9.4% [OR = 1.91; 95% CI = 1.20 to 3.02]). The risk for M. genitalium infection was higher in black than in white participants (for females, 12.0% versus 6.8% [OR = 1.88; 95% CI = 1.30 to 2.72]; for males, 12.9% versus 6.9% [OR = 2.02; 95% CI = 1.38 to 2.96]) and higher in non-Hispanic than in Hispanic participants (for females, 11.2% versus 6.0% [OR = 1.97; 95% CI = 1.25 to 3.10]; for males, 11.6% versus 6.8% [OR = 1.80; 95% CI = 1.14 to 2.85]). Participants reporting urogenital symptoms had a significantly elevated risk of M. genitalium infection compared to that for asymptomatic individuals (for females, OR = 1.53 [95% CI = 1.09 to 2.14]; for males, OR = 1.42 [95% CI = 1.02 to 1.99]). Women diagnosed with vaginitis and cervicitis had a higher prevalence of M. genitalium infection than women without those diagnoses, although this was statistically significant only for vaginitis (for vaginitis, OR = 1.88 [95% CI = 1.37 to 2.58]; for cervicitis, OR = 1.42 [95% CI = 0.61 to 2.96]). A diagnosis of urethritis in men was also significantly associated with M. genitalium infection (OR = 2.97; 95% CI = 2.14 to 4.13). Few characteristics distinguished asymptomatic from symptomatic M. genitalium infections. These results from persons seeking care in the United States suggest that M. genitalium infection should be considered in young persons presenting with urogenital symptoms.
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Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Center for AIDS and STD, University of Washington, Seattle, Washington, USA
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephanie N Taylor
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rebecca A Lillis
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Edward W Hook
- Department of Medicine, University of Alabama, Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, University of Alabama, Birmingham, Birmingham, Alabama, USA
- Department of Microbiology, University of Alabama, Birmingham, Birmingham, Alabama, USA
| | - Jeffrey D Klausner
- UCLA Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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23
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Chambers LC, Srinivasan S, Lukehart SA, Ocbamichael N, Morgan JL, Lowens MS, Fredricks DN, Golden MR, Manhart LE. Primary Syphilis in the Male Urethra: A Case Report. Clin Infect Dis 2020; 68:1231-1234. [PMID: 30202933 DOI: 10.1093/cid/ciy771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 01/05/2023] Open
Abstract
We documented urethral Treponema pallidum infection in a man with nongonococcal urethritis and a negative syphilis serology using broad-range bacterial polymerase chain reaction (PCR) and sequencing, targeted PCR, and immunofluorescence microscopy. He subsequently seroconverted for syphilis. Early syphilis may present as urethritis. Urethral T. pallidum shedding can occur before seroconversion.
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Affiliation(s)
| | | | - Sheila A Lukehart
- Department of Medicine, University of Washington.,Department of Global Health, University of Washington
| | | | | | - M Sylvan Lowens
- Public Health-Seattle & King County HIV/STD Program, Washington
| | - David N Fredricks
- Fred Hutchinson Cancer Research Center.,Department of Medicine, University of Washington
| | - Matthew R Golden
- Department of Medicine, University of Washington.,Public Health-Seattle & King County HIV/STD Program, Washington
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24
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Khosropour CM, Soge OO, Suchland R, Leipertz G, Unutzer A, Pascual R, Hybiske K, Barbee LA, Manhart LE, Dombrowski JC, Golden MR. Recurrent/Intermittent Vaginal and Rectal Chlamydial Infection Following Treatment: A Prospective Cohort Study Among Female Sexually Transmitted Disease Clinic Patients. J Infect Dis 2020; 220:476-483. [PMID: 30873541 DOI: 10.1093/infdis/jiz113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rectal Chlamydia trachomatis (CT) is common among clinic-attending women, but little is known about clearance and health implications of rectal CT. METHODS At the municipal sexually transmitted disease clinic in Seattle, Washington, in 2017-2018, we enrolled women at high risk for urogenital CT into an 8-week prospective study. Women received standard CT treatment at enrollment. Women self-collected daily rectal and vaginal specimens for nucleic acid amplification tests (NAATs) and completed weekly sexual exposure diaries. We performed CT culture on the enrollment rectal specimen. RESULTS We enrolled 50 women; 13 (26%) tested positive for vaginal (n = 11) and/or rectal (n = 11) CT. Sixty percent of women with rectal CT per NAAT were also culture positive. Median time to CT clearance after azithromycin treatment was 8.0 days for vaginal CT and 7.0 days for rectal CT. Eight women with rectal CT at enrollment had at least 1 rectal CT-positive NAAT after clearance of the initial infection; none reported anal sex. CONCLUSIONS Most NAAT-positive rectal infections were culture positive, suggesting active infection. Time to NAAT clearance of rectal and genital tract CT was similar, and intermittent rectal CT positivity was common in the absence of anal sexual exposure. The cause of recurrent/intermittent rectal CT and the clinical implications of these infections require further study.
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Affiliation(s)
| | - Olusegun O Soge
- Department of Medicine, University of Washington, Washington.,Department of Global Health, University of Washington, Washington
| | - Robert Suchland
- Department of Medicine, University of Washington, Washington
| | - Gina Leipertz
- Department of Epidemiology, University of Washington, Washington
| | - Anna Unutzer
- Department of Epidemiology, University of Washington, Washington
| | | | - Kevin Hybiske
- Department of Medicine, University of Washington, Washington
| | - Lindley A Barbee
- Department of Medicine, University of Washington, Washington.,HIV/STD Program, Public Health-Seattle & King County, Washington
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Washington.,Department of Global Health, University of Washington, Washington
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Washington.,Department of Medicine, University of Washington, Washington.,HIV/STD Program, Public Health-Seattle & King County, Washington
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Washington.,Department of Medicine, University of Washington, Washington.,HIV/STD Program, Public Health-Seattle & King County, Washington
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25
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Munch MM, Chambers LC, Manhart LE, Domogala D, Lopez A, Fredricks DN, Srinivasan S. Optimizing bacterial DNA extraction in urine. PLoS One 2019; 14:e0222962. [PMID: 31550285 PMCID: PMC6759279 DOI: 10.1371/journal.pone.0222962] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/10/2019] [Indexed: 01/07/2023] Open
Abstract
Urine is an acceptable, non-invasive sample for investigating the human urogenital microbiota and for the diagnosis of sexually transmitted infections. However, low quantities of bacterial DNA and PCR inhibitors in urine may prevent efficient PCR amplification for molecular detection of bacteria. Furthermore, cold temperatures used to preserve DNA and bacteria in urine can promote precipitation of crystals that interfere with DNA extraction. Saline, Dulbecco’s Phosphate Buffered Saline, or Tris-EDTA buffer were added to urine from adult men to determine if crystal precipitation could be reversed without heating samples beyond ambient temperature. Total bacterial DNA concentrations and PCR inhibition were measured using quantitative PCR assays to compare DNA yields with and without buffer addition. Dissolution of crystals with Tris-EDTA prior to urine centrifugation was most effective in increasing bacterial DNA recovery and reducing PCR inhibition. DNA recovery using Tris-EDTA was further tested by spiking urine with DNA from bacterial isolates and median concentrations of Lactobacillus jensenii and Escherichia coli 16S rRNA gene copies were found to be higher in urine processed with Tris-EDTA. Maximizing bacterial DNA yield from urine may facilitate more accurate assessment of bacterial populations and increase detection of specific bacteria in the genital tract.
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Affiliation(s)
- Matthew M. Munch
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United states of America
| | - Laura C. Chambers
- Department of Epidemiology, University of Washington, Seattle, Washington, United states of America
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, United states of America
- Department of Global Health, University of Washington, Seattle, Washington, United states of America
| | - Dan Domogala
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United states of America
| | - Anthony Lopez
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United states of America
| | - David N. Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United states of America
- Department of Medicine, University of Washington, Seattle, Washington, United states of America
- Department of Microbiology, University of Washington, Seattle, Washington, United states of America
| | - Sujatha Srinivasan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United states of America
- * E-mail:
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26
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Ulrich AK, Sanchez J, Lama JR, Manhart LE, Goodreau SM, Duerr AC. Correlates of concurrent partnerships and patterns of condom use among men who have sex with men and transgender women in Peru. PLoS One 2019; 14:e0222114. [PMID: 31525225 PMCID: PMC6746369 DOI: 10.1371/journal.pone.0222114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/21/2019] [Indexed: 01/02/2023] Open
Abstract
Background In Peru, there is an ongoing high-incidence HIV epidemic among men who have sex with men (MSM) and transgender women (TW). Sexual concurrency, or having sex with a partner in between two acts of sex with another partner, may be a key factor in onward HIV transmission. In this study, we quantify concurrency, evaluate factors associated with concurrency, and assess condom use with concurrent partners among MSM and TW in Peru. Methods We conducted a secondary analysis of data from the 2011 Peruvian Biobehavioral Survey. Pearson’s Chi-squared test was used to identify individual-level characteristics associated with concurrency. We estimated the association between participant characteristics, concurrent partnerships, partnership type (stable vs. non-stable), and CLAI within the context of concurrent partnerships using multivariate and repeated-measure Poisson regression. Results 3-month cumulative prevalence of concurrency was higher among TW compared to MSM (30.7% vs 25.2%, p = 0.014). Among those with concurrent stable and non-stable partners, 45% used condoms with both partners (95% CI: 40%-50%) and 30% preferentially had CLAI with the stable partner only (95%CI: 26%-35%). Factors associated with CLAI within the context of concurrent partnerships varied between MSM and TW. Conclusions Although concurrency is common among TW and MSM in Peru, patterns of concurrency and differential condom use may vary between TW and MSM. Future research may explore differential condom use with stable and non-stable partners to better understand behavioral factors that may alter vulnerability to HIV in TW compared to MSM.
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Affiliation(s)
- Angela K. Ulrich
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Callao, Peru
| | | | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Steven M. Goodreau
- Department of Anthropology, University of Washington, Seattle, WA, United States of America
| | - Ann C. Duerr
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
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27
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Montaño MA, Dombrowski JC, Dasgupta S, Golden MR, Duerr A, Manhart LE, Barbee LA, Khosropour CM. Changes in Sexual Behavior and STI Diagnoses Among MSM Initiating PrEP in a Clinic Setting. AIDS Behav 2019; 23:548-555. [PMID: 30117076 DOI: 10.1007/s10461-018-2252-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined changes in sexual behavior and sexually transmitted infection (STI) prevalence among 183 men who have sex with men (MSM) initiating pre-exposure prophylaxis (PrEP) at an STD Clinic in Seattle, WA. We used generalized estimating equations to measure changes in sexual behavior during PrEP use, and linked PrEP patient data with STI surveillance data to compare the prevalence of chlamydia, gonorrhea, and early syphilis in the periods prior to and during PrEP use. Reporting never using condoms in the prior 30 days increased (adjusted relative risk = 1.46; 95% confidence interval 1.13, 1.88) at 12 months after PrEP initiation compared to the initial PrEP visit. Reporting unknown status partners in the prior 30 days decreased at 12 months compared to the initial PrEP visit, but there was no change in number of sexual partners or reporting HIV-positive or HIV-negative partners. The percentage of patients diagnosed with any STI while using PrEP (49.2%) was higher than the percentage diagnosed in the 12 months prior to PrEP use (35.0%), likely driven in part by increased STI screening during PrEP use. Among MSM on PrEP, we observed decreases in condom use, and a higher prevalence of STIs during PrEP use compared to prior to PrEP initiation.
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28
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Meisner J, Curtis K, Graham TW, Apamaku MB, Manhart LE, Rabinowitz PM. Cattle‐associated risk factors for human tuberculosis in rural livestock‐keeping communities, Uganda. Zoonoses Public Health 2018; 66:73-82. [DOI: 10.1111/zph.12530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 09/06/2018] [Accepted: 09/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Julianne Meisner
- Department of Epidemiology University of Washington Seattle Washington
- Center for One Health Research University of Washington Seattle Washington
| | | | | | | | - Lisa E. Manhart
- Department of Epidemiology University of Washington Seattle Washington
| | - Peter M. Rabinowitz
- Center for One Health Research University of Washington Seattle Washington
- Department of Global Health University of Washington Seattle Washington
- Department of Environmental and Occupational Health Sciences University of Washington Seattle Washington
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Chambers LC, Morgan JL, Lowens MS, Robinson TS, Romano SS, Leipertz GL, Hughes JP, Golden MR, Khosropour CM, Fredricks DN, Manhart LE. Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients. Sex Transm Infect 2018; 95:212-218. [PMID: 30181326 DOI: 10.1136/sextrans-2018-053634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/22/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Although Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are major causes of non-gonococcal urethritis (NGU), up to 50% of cases are of unknown aetiology. We sought to identify urethral exposures at last sexual episode associated with NGU and non-CT/non-MG NGU to identify anatomical sites from which aetiologically relevant micro-organisms may be acquired. METHODS We enrolled STD clinic patients with and without NGU assigned male sex at birth and age ≥16 into a cross-sectional study. NGU was urethral symptoms or visible discharge plus ≥5 polymorphonuclear leucocytes without Neisseria gonorrhoeae. Urine was tested for CT and MG (Aptima). We used logistic regression to estimate the association between urethral exposures at last sex and NGU separately among cisgender men and transgender women who have sex with men (MSM/TGWSM) and cisgender men who have sex with women (MSW). RESULTS Between 8 August 2014 and 1 November 2017, we enrolled 432 patients, including 183 MSM/TGWSM (118 NGU+, 65 NGU-) and 249 MSW (126 NGU+, 123 NGU-). The mean age was 34; 59% were white. CT and MG were detected in 72 (30%) and 49 (20%) NGU+ participants, respectively. Compared with MSM/TGWSM reporting only non-urethral exposures at last sex, those reporting insertive anal intercourse (IAI) only (adjusted OR (AOR)=4.46, 95% CI 1.09 to 18.19) and IAI with insertive oral sex (IOS) (AOR=7.88, 95% CI 2.67 to 23.26) had higher odds of NGU. MSM/TGWSM reporting IOS only had no significant increased odds (AOR=1.67, 95% CI 0.58 to 4.85). Compared with MSW whose only urethral exposure at last sex was vaginal sex (VS), MSW reporting IOS and VS had similar odds of NGU (OR=0.84, 95% CI 0.50 to 1.41). The results were similar for non-CT/non-MG NGU. CONCLUSIONS Among MSM/TGWSM, IAI may lead to transmission of yet-unidentified rectal micro-organisms that cause non-CT/non-MG NGU, in addition to transmission of known pathogens. Sites of urethral exposure appear less important for understanding NGU risk among MSW due to minimal variation in behaviour.
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Affiliation(s)
- Laura C Chambers
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jennifer L Morgan
- HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA
| | - M Sylvan Lowens
- HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Tashina S Robinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sarah S Romano
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gina L Leipertz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - David N Fredricks
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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Balkus JE, Manhart LE, Jensen JS, Anzala O, Kimani J, Schwebke J, Shafi J, Rivers C, Kabare E, McClelland RS. Mycoplasma genitalium Infection in Kenyan and US Women. Sex Transm Dis 2018; 45:514-521. [PMID: 29465649 PMCID: PMC6043389 DOI: 10.1097/olq.0000000000000799] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Little is known about the natural history of Mycoplasma genitalium (MG) infection in women. We retrospectively tested archived vaginal fluid samples to assess MG prevalence, incidence, persistence, recurrence and antimicrobial resistance markers among women participating in the Preventing Vaginal Infections trial, a randomized trial of monthly presumptive treatment to reduce vaginal infections. METHODS High-risk, nonpregnant, HIV-negative women aged 18 to 45 years from Kenya and the United States were randomized to receive metronidazole 750 mg + miconazole 200 mg intravaginal suppositories or placebo for 5 consecutive nights each month for 12 months. Clinician-collected swabs containing cervicovaginal fluid were tested for MG using Hologic nucleic acid amplification testing at enrollment and every other month thereafter. Specimens that were MG+ underwent additional testing for macrolide resistance-mediating mutations by DNA sequencing. RESULTS Of 234 women enrolled, 221 had available specimens and 25 (11.3%) had MG at enrollment. Among 196 women without MG at enrollment, there were 52 incident MG infections (incidence, 33.4 per 100 person-years). Smoking was independently associated with incident MG infection (adjusted hazard ratio, 3.02; 95% confidence interval, 1.32-6.93), and age less than 25 years trended toward an association (adjusted hazard ratio, 1.70; 95% confidence interval, 0.95-3.06). Median time to clearance of incident MG infections was 1.5 months (interquartile range, 1.4-3.0 months). Of the 120 MG+ specimens, 16 specimens from 15 different women were macrolide resistance-mediating mutation positive (13.3%), with no difference by country. CONCLUSIONS M. genitalium infection is common among sexually active women in Kenya and the Southern United States. Given associations between MG and adverse reproductive health outcomes, this high burden of MG in reproductive-aged women could contribute to substantial morbidity.
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Affiliation(s)
| | | | | | | | - Joshua Kimani
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Jane Schwebke
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Juma Shafi
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Charles Rivers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Emanuel Kabare
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
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Chambers LC, Khosropour CM, Katz DA, Dombrowski JC, Manhart LE, Golden MR. Racial/Ethnic Disparities in the Lifetime Risk of Chlamydia trachomatis Diagnosis and Adverse Reproductive Health Outcomes Among Women in King County, Washington. Clin Infect Dis 2018; 67:593-599. [PMID: 29420716 PMCID: PMC6070060 DOI: 10.1093/cid/ciy099] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/03/2018] [Indexed: 11/14/2022] Open
Abstract
Background Chlamydia trachomatis is the most common reportable infection in the United States and can cause pelvic inflammatory disease (PID) and tubal factor infertility (TFI). Methods We created life tables to estimate the "lifetime" risk of chlamydia diagnosis among women aged 15-34 years in King County, Washington, between 1992 and 2014. We estimated the lifetime risk of chlamydia-associated PID and TFI incorporating published estimates of the risk of sequelae. Results There were 51464 first chlamydia diagnoses in 1992-2014. For women born between 1980 and 1984, the lifetime risk of chlamydia diagnosis was 19.8% overall and 14.0% for non-Hispanic white, 64.9% for non-Hispanic black, and 32.6% for Hispanic women. The cumulative risk of chlamydia by age 24 increased overall from 13.9% to 17.3% among women born between 1975 and 1994 but declined among non-Hispanic black women, among whom risk by age 24 declined from 57.3% among women born between 1980 and 1984 to 38.6% among women born between 1990 and 1994. The lifetime risk of chlamydia-associated PID among women born between 1980 and 1984 ranged from 0.33% to 1.14%. Among non-Hispanic white, non-Hispanic black, and Hispanic women, the lifetime risk of chlamydia-associated TFI was 0.04%, 0.20%, and 0.10%, respectively. Conclusions Over 60% of non-Hispanic black women had at least 1 chlamydia diagnosis by age 34 in the birth cohorts most affected, a risk almost 5 times that in non-Hispanic whites. An estimated 1 in 500 non-Hispanic black women develops chlamydia-associated TFI. More effective control measures are needed.
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Affiliation(s)
| | | | - David A Katz
- Department of Medicine, University of Washington, University of Washington, Seattle
- Public Health-Seattle and King County HIV/STD Program, University of Washington, Seattle
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle
- Department of Medicine, University of Washington, University of Washington, Seattle
- Public Health-Seattle and King County HIV/STD Program, University of Washington, Seattle
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle
- Department of Medicine, University of Washington, University of Washington, Seattle
- Public Health-Seattle and King County HIV/STD Program, University of Washington, Seattle
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Reinius M, Rao D, Manhart LE, Wiklander M, Svedhem V, Pryor J, Mayer R, Gaddist B, Kumar S, Mohanraj R, Jeyaseelan L, Wettergren L, Eriksson LE. Differential item functioning for items in Berger's HIV Stigma Scale: an analysis of cohorts from the Indian, Swedish, and US contexts. Qual Life Res 2018; 27:1647-1659. [PMID: 29574526 PMCID: PMC5951887 DOI: 10.1007/s11136-018-1841-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine whether items in Berger's HIV Stigma Scale function differently with persons of different age, gender, and cultural backgrounds. METHODS Secondary data from cohorts, collected in South India (n = 250), Sweden (n = 193), and the US (n = 603) were reanalyzed to evaluate DIF within, between, and across these cohorts. All participants had answered the revised version of the HIV stigma scale consisting of 32 items forming the subscales Personalized stigma, Disclosure concerns, Concerns about public attitudes, and Negative self-image. Differential Item Functioning (DIF) for these items was assessed using hybrid ordinal regression-IRT technique. When DIF was detected, the cumulative impact of DIF on individual subscale scores was evaluated. RESULTS DIF was detected for 9 items within, between, or across cohorts, but the DIF was negligible in general. Detected DIF between the Swedish and Indian cohorts had a cumulative salient impact on individual scores for the subscale Disclosure Concerns; Disclosure concerns were overestimated in the Swedish cohort and both over- and underestimated in the Indian cohort. CONCLUSIONS The items in the 32-item version of the HIV stigma scale did not seem to be particularly prone to present DIF. The DIF between the Indian and Swedish cohort for items in the subscale Disclosure Concerns could, however, result in both type I and type II errors if scores should be compared between the Indian and Swedish cohort.
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Affiliation(s)
- Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Solna, Sweden.
| | - Deepa Rao
- Department of Global Health and Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 9th Ave, UW Campus Mailbox Number 359931, Seattle, WA, 98104, USA
| | - Lisa E Manhart
- Department of Epidemiology, Harborview Medical Center, University of Washington, 325 9th Ave, UW Campus Mailbox Number 35993, Seattle, WA, 98104, USA
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, SE-141 86, Huddinge, Sweden
- Department of Medicine, Huddinge, Unit of Infectious Diseases, Karolinska Institutet, 141 86, Huddinge, Sweden
| | - John Pryor
- Department of Psychology, Illinois State University, Normal, IL, USA
| | - Randall Mayer
- Iowa Department of Public Health, 321 E. 12th St, Des Moines, IA, 50319-0075, USA
| | - Bambi Gaddist
- Joseph H. Neal Wellness Center Dba SC HIV Council, 1813 Laurel Street, Columbia, SC, 29201, USA
| | - Shuba Kumar
- Department of Social Sciences, Samarth, Chennai, India
| | - Rani Mohanraj
- Department of Social Sciences, Samarth, Chennai, India
| | | | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Solna, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, SE-141 86, Huddinge, Sweden
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
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Khosropour CM, Bell TR, Hughes JP, Manhart LE, Golden MR. A Population-Based Study to Compare Treatment Outcomes Among Women With Urogenital Chlamydial Infection in Washington State, 1992 to 2015. Sex Transm Dis 2018; 45:319-324. [PMID: 29465681 PMCID: PMC5895502 DOI: 10.1097/olq.0000000000000764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND United States guidelines recommend azithromycin or doxycycline for chlamydia (Chlamydia trachomatis [CT]) treatment. These therapies are similarly efficacious for urogenital infections when outcomes are measured 7 to 42 days after treatment, although doxycycline may be superior for rectal infections. Some investigators have suggested that persistent rectal infections may lead to autoinfection of the urogenital tract, potentially resulting in higher rates of recurrent infection in azithromycin-treated women. METHODS We used Washington State surveillance data to identify women 14 years or older with urogenital CT (1992-2015) treated with azithromycin or doxycycline. We defined persistent/recurrent CT as a repeat positive CT test result 14 to 180 days after treatment of the initial infection. We used log binomial regression to estimate the adjusted relative risk (aRR) of persistent/recurrent infection associated with treatment with azithromycin versus doxycycline. RESULTS From 1992 to 2015, there were 268,596 reported cases of urogenital CT, including 168,301 (63%) who received azithromycin and 66,432 (25%) who received doxycycline. The risk of persistent/recurrent urogenital CT was 6.7% and 4.7% in azithromycin- and doxycycline-treated cases, respectively (P < 0.001). Adjusting for age, race/ethnicity, year, pregnancy status, jurisdiction reporting, reason for examination, and gonorrhea coinfection, azithromycin-treated women were significantly more likely to have persistent/recurrent urogenital CT than doxycycline-treated women (aRR, 1.24; 95% confidence interval [CI], 1.19-1.30). Adjusting the retesting window to 21 to 180 days (aRR, 1.24; 95% CI, 1.19-1.30) and 28 to 180 days (aRR, 1.25; 95% CI, 1.19-1.30) did not alter our primary findings. CONCLUSIONS Persistent/recurrent urogenital CT may be more common among women treated with azithromycin than with doxycycline. The reason for this difference is uncertain and is an important area of future investigation.
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Affiliation(s)
| | - Teal R. Bell
- Washington State Department of Health, Olympia, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
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D'Silva S, Frey S, Kumar S, Mohanraj R, Manhart LE, Kaysen D, Andu E, Rao D. Sociocultural and structural perpetuators of domestic violence in pregnancy: A qualitative look at what South Indian women believe needs to change. Health Care Women Int 2017; 39:243-260. [DOI: 10.1080/07399332.2017.1375505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sahana D'Silva
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Sarah Frey
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | - Lisa E. Manhart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Eaden Andu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Khosropour CM, Dombrowski JC, Hughes JP, Manhart LE, Simoni JM, Golden MR. Operationalizing the Measurement of Seroadaptive Behaviors: A Comparison of Reported Sexual Behaviors and Purposely-Adopted Behaviors Among Men who have Sex with Men (MSM) in Seattle. AIDS Behav 2017; 21:2935-2944. [PMID: 28097616 DOI: 10.1007/s10461-017-1682-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Seroadaptive behaviors are traditionally defined by self-reported sexual behavior history, regardless of whether they reflect purposely-adopted risk-mitigation strategies. Among MSM attending an STD clinic in Seattle, Washington 2013-2015 (N = 3751 visits), we used two seroadaptive behavior measures: (1) sexual behavior history reported via clinical computer-assisted self-interview (CASI) (behavioral definition); (2) purposely-adopted risk-reduction behaviors reported via research CASI (purposely-adopted definition). Pure serosorting (i.e. only HIV-concordant partners) was the most common behavior, reported (behavioral and purposely-adopted definition) by HIV-negative respondents at 43% and 60% of visits, respectively (kappa = 0.24; fair agreement) and by HIV-positive MSM at 30 and 34% (kappa = 0.25; fair agreement). Agreement of the two definitions was highest for consistent condom use [HIV-negative men (kappa = 0.72), HIV-positive men (kappa = 0.57)]. Overall HIV test positivity was 1.4 but 0.9% for pure serosorters. The two methods of operationalizing behaviors result in different estimates, thus the choice of which to employ should depend on the motivation for ascertaining behavioral information.
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Martin DH, Manhart LE, Workowski KA. Mycoplasma genitalium From Basic Science to Public Health: Summary of the Results From a National Institute of Allergy and Infectious Disesases Technical Consultation and Consensus Recommendations for Future Research Priorities. J Infect Dis 2017; 216:S427-S430. [PMID: 28838075 DOI: 10.1093/infdis/jix147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 12/17/2022] Open
Abstract
This article lays out the research priorities for Mycoplasma genitalium research agreed upon by the participants in a 2016 National Institutes of Allergy and Infectious Diseases-funded Technical Consultation focused on this organism. The state of current knowledge concerning the microbiology, epidemiology, clinical manifestations of infection, treatment, and public health significance of M. genitalium reviewed at the meeting is described in detail in the individual articles included in this supplemental edition of the Journal of Infectious Diseases. Here we summarize the points made in these articles most relevant to the formulation of the research priorities listed in this article. The most important recommendation resulting from this Technical Consultation is the initiation of clinical trials designed to determine definitively whether screening for and treatment of M. genitalium infections in women and their sexual partners improve reproductive health in women and/or prevent human immunodeficiency virus transmission.
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Affiliation(s)
- David H Martin
- Department of Epidemiology, Tulane University School of Public Health.,Department of Internal Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans
| | - Lisa E Manhart
- Departments of Epidemiology.,Global Health, Center for AIDS and STD, University of Washington, Seattle
| | - Kimberly A Workowski
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia
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Lokken EM, Balkus JE, Kiarie J, Hughes JP, Jaoko W, Totten PA, McClelland RS, Manhart LE. Association of Recent Bacterial Vaginosis With Acquisition of Mycoplasma genitalium. Am J Epidemiol 2017; 186:194-201. [PMID: 28472225 DOI: 10.1093/aje/kwx043] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/19/2016] [Indexed: 11/14/2022] Open
Abstract
We assessed the association between recent bacterial vaginosis (BV) and incident Mycoplasma genitalium, a sexually transmitted bacterium associated with adverse female reproductive health outcomes. Female sex workers in Mombasa, Kenya, completed a monthly sexual behavior interview and clinical examination. During February 2005-February 2006, vaginal fluid specimens collected from women every other month were tested for M. genitalium by nucleic acid amplification testing. Vaginal microbiota were assessed monthly and categorized by Nugent score (0-3 = normal microbiota, 4-6 = intermediate microbiota disruption, and 7-10 = BV). A discrete failure time analysis for multiple events using logistic regression was employed to estimate the odds of incident M. genitalium infection at follow-up visits among women with BV (vs. normal microbiota) at the preceding visit. Among the 280 women, 54.3% were positive for human immunodeficiency virus. At baseline, 16.1% had prevalent M. genitalium infection and 40.4% had prevalent BV. There were 59 incident M. genitalium infections among 50 women, for an incidence rate of 34.6 cases per 100 person-years. Following adjustment for age, human immunodeficiency virus status, and time, prior BV was associated with a 3.5-fold increase in odds of incident M. genitalium (adjusted odds ratio = 3.49, 95% confidence interval: 1.86, 6.56). This strong association suggests that BV may enhance susceptibility to M. genitalium infection.
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Abstract
Health consequences of sexually transmitted diseases disproportionately affect women, making it important to determine whether newly emerged pathogens cause sequelae. Although the pathogenic role of Mycoplasma genitalium in male urethritis is clear, fewer studies have been conducted among women to determine its pathogenic role in the female reproductive tract. Pelvic inflammatory disease (PID) is an important cause of infertility and ectopic pregnancy, and Chlamydia trachomatis and Neisseria gonorrhoeae are recognized microbial causes. Emerging data demonstrate an association between M. genitalium and PID, and limited data suggest associations with infertility and preterm birth, yet the attributable risk for female genital tract infections remains to be defined. Further investigations are needed to better define the impact of M. genitalium on women's reproductive health. Importantly, prospective studies evaluating whether screening programs and targeted treatment of M. genitalium improve reproductive outcomes in women are necessary to guide public health policy for this emerging pathogen.
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Affiliation(s)
- Harold C Wiesenfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, and Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Lisa E Manhart
- Departments of Epidemiology and Global Health, Center for AIDS and STD, University of Washington, Seattle
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Khosropour CM, Dombrowksi JC, Hughes JP, Manhart LE, Golden MR. Evaluation of a Computer-Based Recruitment System for Enrolling Men Who Have Sex With Men Into an Observational HIV Behavioral Risk Study. Am J Epidemiol 2016; 184:477-83. [PMID: 27608663 DOI: 10.1093/aje/kww020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/19/2016] [Indexed: 12/25/2022] Open
Abstract
Enrolling large numbers of high-risk men who have sex with men (MSM) into human immunodeficiency virus (HIV) prevention studies is necessary for research with an HIV outcome, but the resources required for in-person recruitment can be prohibitive. New methods with which to efficiently recruit large samples of MSM are needed. At a sexually transmitted disease clinic in Seattle, Washington, in 2013-2014, we used an existing clinical computer-assisted self-interview that collects patients' medical and sexual history data to recruit, screen, and enroll MSM into an HIV behavioral risk study and compared enrollees with men who declined to enroll. After completing the clinical computer-assisted self-interview, men aged ≥18 years who reported having had sex with men in the prior year were presented with an electronic study description and consent statement. We enrolled men at 2,661 (54%) of 4,944 visits, including 1,748 unique individuals. Enrolled men were younger (mean age = 34 years vs. 37 years; P < 0.001) and reported more male sex partners (11 vs. 8; P < 0.001) and more methamphetamine use (15% vs. 8%; P < 0.001) than men who declined to enroll, but the HIV test positivity of the two groups was similar (1.9% vs. 2.0%; P = 0.80). Adapting an existing computerized clinic intake system, we recruited a large sample of MSM who may be an ideal population for an HIV prevention study.
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Bachmann LH, Manhart LE, Martin DH, Seña AC, Dimitrakoff J, Jensen JS, Gaydos CA. Advances in the Understanding and Treatment of Male Urethritis. Clin Infect Dis 2016; 61 Suppl 8:S763-9. [PMID: 26602615 DOI: 10.1093/cid/civ755] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 11/12/2022] Open
Abstract
Neisseria gonorrhoeae and Chlamydia trachomatis are well-documented urethral pathogens, and the literature supporting Mycoplasma genitalium as an etiology of urethritis is growing. Trichomonas vaginalis and viral pathogens (herpes simplex virus types 1 and 2 and adenovirus) can cause urethritis, particularly in specific subpopulations. New data are emerging regarding the potential role of bacterial vaginosis-associated bacteria in urethritis, although results are inconsistent regarding the pathogenic role of Ureaplasma urealyticum in men. Mycoplasma hominis and Ureaplasma parvum do not appear to be pathogens. Men with suspected urethritis should undergo evaluation to confirm urethral inflammation and etiologic cause. Although nucleic acid amplification testing would detect N. gonorrhoeae and C. trachomatis (or T. vaginalis if utilized), there is no US Food and Drug Administration-approved clinical test for M. genitalium available in the United States at this time. The varied etiologies of urethritis and lack of diagnostic options for some organisms present treatment challenges in the clinical setting.
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Affiliation(s)
- Laura H Bachmann
- Division of Infectious Diseases, Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Lisa E Manhart
- Departments of Epidemiology and Global Health, University of Washington, Seattle
| | - David H Martin
- Division of Infectious Diseases, Department of Medicine, Louisiana State University, New Orleans
| | - Arlene C Seña
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Jordan Dimitrakoff
- Division of Obstetrics/Gynecology and Reproductive Biology, Beth Israel Deaconess Hospital Harvard School of Public Health, Boston, Massachusetts Division of Bone, Reproductive and Urologic Products, United States Food and Drug Administration, Silver Spring, Maryland
| | - Jørgen Skov Jensen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Manhart LE, Jensen JS, Bradshaw CS, Golden MR, Martin DH. Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections. Clin Infect Dis 2016; 61 Suppl 8:S802-17. [PMID: 26602619 DOI: 10.1093/cid/civ785] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 11/13/2022] Open
Abstract
Mycoplasma genitalium has been causally linked with nongonococcal urethritis in men and cervicitis, pelvic inflammatory disease, preterm birth, spontaneous abortion, and infertility in women, yet treatment has proven challenging. To inform treatment recommendations, we reviewed English-language studies describing antimicrobial susceptibility, resistance-associated mutations, and clinical efficacy of antibiotic therapy, identified via a systematic search of PubMed supplemented by expert referral. Minimum inhibitory concentrations (MICs) from some contemporary isolates exhibited high-level susceptibility to most macrolides and quinolones, and moderate susceptibility to most tetracyclines, whereas other contemporary isolates had high MICs to the same antibiotics. Randomized trials demonstrated poor efficacy of doxycycline and better, but declining, efficacy of single-dose azithromycin therapy. Treatment failures after extended doses of azithromycin similarly increased, and circulating macrolide resistance was present in high levels in several areas. Moxifloxacin remains the most effective therapy, but treatment failures and quinolone resistance are emerging. Surveillance of M. genitalium prevalence and antimicrobial resistance patterns is urgently needed.
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Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology Department of Center for AIDS and STD, University of Washington, Seattle
| | | | | | - Matthew R Golden
- Department of Medicine Department of Center for AIDS and STD, University of Washington, Seattle
| | - David H Martin
- Division of Infectious Diseases, Louisiana State University, New Orleans
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Colombara DV, Manhart LE, Carter JJ, Hawes SE, Weiss NS, Hughes JP, Qiao YL, Taylor PR, Smith JS, Galloway DA. Absence of an association of human polyomavirus and papillomavirus infection with lung cancer in China: a nested case-control study. BMC Cancer 2016; 16:342. [PMID: 27246610 PMCID: PMC4888628 DOI: 10.1186/s12885-016-2381-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 01/08/2016] [Accepted: 05/24/2016] [Indexed: 12/18/2022] Open
Abstract
Background Studies of human polyomavirus (HPyV) infection and lung cancer are limited and those regarding the association of human papillomavirus (HPV) infection and lung cancer have produced inconsistent results. Methods We conducted a nested case–control study to assess the association between incident lung cancer of various histologies and evidence of prior infection with HPyVs and HPVs. We selected serum from 183 cases and 217 frequency matched controls from the Yunnan Tin Miner’s Cohort study, which was designed to identify biomarkers for early detection of lung cancer. Using multiplex liquid bead microarray (LBMA) antibody assays, we tested for antibodies to the VP1 structural protein and small T antigen (ST-Ag) of Merkel cell, KI, and WU HPyVs. We also tested for antibodies against HPV L1 structural proteins (high-risk types 16, 18, 31, 33, 52, and 58 and low-risk types 6 and 11) and E6 and E7 oncoproteins (high risk types 16 and 18). Measures of antibody reactivity were log transformed and analyzed using logistic regression. Results We found no association between KIV, WUV, and MCV antibody levels and incident lung cancer (P-corrected for multiple comparisons >0.10 for all trend tests). We also found no association with HPV-16, 18, 31, 33, 52, and 58 seropositivity (P-corrected for multiple comparisons >0.05 for all). Conclusions Future studies of infectious etiologies of lung cancer should look beyond HPyVs and HPVs as candidate infectious agents. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2381-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danny V Colombara
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA. .,Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Lisa E Manhart
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | | | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Noel S Weiss
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - James P Hughes
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Beijing, China
| | - Philip R Taylor
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Balkus JE, Manhart LE, Lee J, Anzala O, Kimani J, Schwebke J, Shafi J, Rivers C, Kabare E, Scott McClelland R. Periodic Presumptive Treatment for Vaginal Infections May Reduce the Incidence of Sexually Transmitted Bacterial Infections. J Infect Dis 2016; 213:1932-7. [PMID: 26908758 DOI: 10.1093/infdis/jiw043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 11/18/2015] [Accepted: 01/23/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) may increase women's susceptibility to sexually transmitted infections (STIs). In a randomized trial of periodic presumptive treatment (PPT) to reduce vaginal infections, we observed a significant reduction in BV. We further assessed the intervention effect on incident Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium infection. METHODS Nonpregnant, human immunodeficiency virus-uninfected women from the United States and Kenya received intravaginal metronidazole (750 mg) plus miconazole (200 mg) or placebo for 5 consecutive nights each month for 12 months. Genital fluid specimens were collected every other month. Poisson regression models were used to assess the intervention effect on STI acquisition. RESULTS Of 234 women enrolled, 221 had specimens available for analysis. Incidence of any bacterial STI (C. trachomatis, N. gonorrhoeae, or M. genitalium infection) was lower in the intervention arm, compared with the placebo arm (incidence rate ratio [IRR], 0.54; 95% confidence interval [CI], .32-.91). When assessed individually, reductions in STI incidences were similar but not statistically significant (IRRs, 0.50 [95% confidence interval {CI}, .20-1.23] for C. trachomatis infection, 0.56 [95% CI, .19-1.67] for N. gonorrhoeae infection, and 0.66 [95% CI, .38-1.15] for M. genitalium infection). CONCLUSIONS In addition to reducing BV, this PPT intervention may also reduce the risk of bacterial STI among women. Because BV is highly prevalent, often persists, and frequently recurs after treatment, interventions that reduce BV over extended periods could play a role in decreasing STI incidence globally.
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Affiliation(s)
- Jennifer E Balkus
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center Department of Global Health
| | | | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock
| | | | - Joshua Kimani
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Jane Schwebke
- Department of Medicine, University of Alabama at Birmingham
| | - Juma Shafi
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Charles Rivers
- Department of Medicine, University of Alabama at Birmingham
| | - Emanuel Kabare
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - R Scott McClelland
- Department of Global Health Department of Medicine, University of Washington, Seattle University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya
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Rao D, Kumar S, Mohanraj R, Frey S, Manhart LE, L Kaysen D. The impact of domestic violence and depressive symptoms on preterm birth in South India. Soc Psychiatry Psychiatr Epidemiol 2016; 51:225-32. [PMID: 26747253 DOI: 10.1007/s00127-015-1167-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE India has the highest absolute number of maternal deaths, preterm birth cases, and under-5 mortality in the world, as well as high domestic violence (DV) rates. We sought to examine the impact of DV and its psychosocial correlates on pregnancy and birth outcomes. METHODS Women seeking antenatal care in Tamil Nadu, South India (N = 150) were assessed during pregnancy, and birth outcomes were abstracted from medical records after the babies were born. RESULTS We found that psychological abuse (OR 3.9; 95% CI 1.19-12.82) and mild or greater depressive symptoms (OR 3.3; 95% CI 0.99-11.17) were significantly associated with increased risk of preterm birth. Physical abuse was also associated with increased risk of preterm birth, but this was not statistically significant (OR 1.9; 95% CI 0.59-6.19). In each of the above adjusted models, low maternal education was associated with increased risk of preterm birth, in the analysis with depressive symptoms OR 0.18, CI 0.04-0.86 and in the analyses with psychological abuse OR 0.19, CI 0.04-0.91. CONCLUSIONS These findings suggest that future research should focus on understanding the psychosocial antecedents to preterm birth, to better target interventions and improve maternal child health in limited resource settings.
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Affiliation(s)
- Deepa Rao
- Departments of Global Health, Psychiatry and Behavioral Sciences, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA.
| | | | | | - Sarah Frey
- Departments of Global Health, Psychiatry and Behavioral Sciences, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
| | - Lisa E Manhart
- Departments of Epidemiology, Global Health, University of Washington, Seattle, WA, USA
| | - Debra L Kaysen
- Departments of Global Health, Psychiatry and Behavioral Sciences, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
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45
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Colombara DV, Manhart LE, Carter JJ, Hawes SE, Weiss NS, Hughes JP, Barnett MJ, Goodman GE, Smith JS, Qiao YL, Galloway DA. Prior human polyomavirus and papillomavirus infection and incident lung cancer: a nested case-control study. Cancer Causes Control 2015; 26:1835-44. [PMID: 26415892 DOI: 10.1007/s10552-015-0676-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/22/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To test whether infection with select human polyomaviruses (HPyV) and human papillomaviruses (HPV) is associated with incident lung cancer. METHODS We performed a nested case-control study, testing serum from the carotene and retinol efficacy trial, conducted 1985-2005, for antibodies to Merkel cell (MCV), KI (KIV), and WU (WUV) HPyVs as well as to six high-risk and two low-risk HPV types. Incident lung cancer cases (n = 200) were frequency-matched with controls (n = 200) on age, enrollment and blood draw dates, intervention arm assignment, and the number of serum freeze/thaw cycles. Sera were tested using multiplex liquid bead microarray antibody assays. We used logistic regression to assess the association between HPyV and HPV antibodies and lung cancer. RESULTS There was no evidence of a positive association between levels of MCV, KIV, or WUV antibodies and incident lung cancer (p corrected >0.10 for all trend tests; odds ratio (OR) range 0.72-1.09, p corrected >0.10 for all). There was also no evidence for a positive association between HPV 16 or 18 infection and incident lung cancer (p corrected ≥0.10 for all trend tests; OR range 0.25-2.54, p > 0.05 for all OR > 1), but the number of persons with serologic evidence of these infections was small. CONCLUSIONS Prior infection with any of several types of HPyV or HPV was not associated with subsequent diagnosis of lung cancer. Infection with these viruses likely does not influence a person's risk of lung cancer in Western smoking populations.
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Affiliation(s)
- Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. .,Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA. .,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA.
| | - Lisa E Manhart
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA
| | - Joseph J Carter
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA
| | - Noel S Weiss
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, F-600, Health Sciences Building, Box 357232, Seattle, WA, 98195-7232, USA
| | - Matt J Barnett
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Gary E Goodman
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, 17 South Pan Jia Yuan Lane, Chaoyang Dist., P. O. Box 2258, Beijing, 100021, People's Republic of China
| | - Denise A Galloway
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
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46
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Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect 2015; 92:155-60. [PMID: 26297719 DOI: 10.1136/sextrans-2015-052214] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 06/15/2015] [Accepted: 08/04/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. METHODS We conducted a case-control study of MSM attending Public Health-Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel-Haenszel OR estimates. RESULTS Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal urethritis, 31.4% of chlamydial urethritis and 35.9% non-gonococcal, non-chlamydial urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal urethritis, chlamydial urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. CONCLUSIONS The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.
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Affiliation(s)
- Lindley A Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program
| | | | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA Public Health, Seattle & King County HIV/STD Program Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Colombara DV, Hughes JP, Burnett-Hartman AN, Hawes SE, Galloway DA, Schwartz SM, Bostick RM, Potter JD, Manhart LE. Analysis of liquid bead microarray antibody assay data for epidemiologic studies of pathogen-cancer associations. J Immunol Methods 2015; 425:45-50. [PMID: 26071614 DOI: 10.1016/j.jim.2015.06.007] [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: 10/04/2014] [Revised: 02/03/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Liquid bead microarray antibody (LBMA) assays are used to assess pathogen-cancer associations. However, studies analyze LBMA data differently, limiting comparability. METHODS We generated 10,000 Monte Carlo-type simulations of log-normal antibody distributions (exposure) with 200 cases and 200 controls (outcome). We estimated type I error rates, statistical power, and bias associated with t-tests, logistic regression with a linear exposure and with the exposure dichotomized at 200 units, 400 units, the mean among controls plus two standard deviations, and the value corresponding to the optimal sensitivity and specificity. We also applied these models, and data visualizations (kernel density plots, receiver operating characteristic (ROC) curves, predicted probability plots, and Q-Q plots), to two empirical datasets to assess the consistency of the exposure-outcome relationship. RESULTS All strategies had acceptable type I error rates (0.03 ≤ P ≤ 0.048), except for the dichotomization according to optimal sensitivity and specificity, which had a type I error rate of 0.27. Among the remaining methods, logistic regression with a linear predictor (Power=1.00) and t-tests (Power=1.00) had the highest power to detect a mean difference of 1.0 MFI (median fluorescence intensity) on the log scale and were unbiased. Dichotomization methods upwardly biased the risk estimates. CONCLUSION These results indicate that logistic regression with linear predictors and unpaired t-tests are superior to logistic regression with dichotomized predictors for assessing disease associations with LBMA data. Logistic regression with continuous linear predictors and t-tests are preferable to commonly used LBMA dichotomization methods.
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Affiliation(s)
- Danny V Colombara
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA.
| | - James P Hughes
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Biostatistics, School of Public Health, University of Washington, F-600 Health Sciences Building, Box 357232, Seattle, WA 98195-7232, USA
| | - Andrea N Burnett-Hartman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA
| | - Denise A Galloway
- Human Biology Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Microbiology, School of Medicine, University of Washington, Box 357735, Seattle, WA 98195-7735, USA
| | - Stephen M Schwartz
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA; Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA 30322, USA
| | - John D Potter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA; Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Lisa E Manhart
- Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA; University of Washington Center for AIDS and STD, 325 9th Ave, Campus Box 359931, Seattle, WA 98104, USA
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Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis 2015; 61:418-26. [PMID: 25900174 DOI: 10.1093/cid/civ312] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/08/2015] [Indexed: 11/14/2022] Open
Abstract
To determine the association between Mycoplasma genitalium infection and female reproductive tract syndromes through meta-analysis, English-language, peer-reviewed studies were identified via PubMed, Embase, Biosis, Cochrane Library, and reference review. Two reviewers independently extracted data. Random-effects models were employed to calculate summary estimates, between-study heterogeneity was evaluated using I(2) statistics, publication bias was assessed via funnel plots and the Begg and Egger tests, and methodologic quality was rated. Mycoplasma genitalium infection was significantly associated with increased risk of cervicitis (pooled odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.35-2.04]), pelvic inflammatory disease (pooled OR, 2.14 [95% CI, 1.31-3.49]), preterm birth (pooled OR, 1.89 [95% CI, 1.25-2.85]), and spontaneous abortion (pooled OR, 1.82 [95% CI, 1.10-3.03]). Risk of infertility was similarly elevated (pooled OR, 2.43 [95% CI, .93-6.34]). In subanalyses accounting for coinfections, all associations were stronger and statistically significant. Testing of high-risk symptomatic women for M. genitalium may be warranted.
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Affiliation(s)
- Rebecca Lis
- Departments of Epidemiology and Global Health, Center for AIDS and STD, University of Washington School of Public Health, Seattle
| | - Ali Rowhani-Rahbar
- Departments of Epidemiology and Global Health, Center for AIDS and STD, University of Washington School of Public Health, Seattle
| | - Lisa E Manhart
- Departments of Epidemiology and Global Health, Center for AIDS and STD, University of Washington School of Public Health, Seattle
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Abstract
Whether perceived or enacted, HIV-related stigma is widespread in India, and has had a crippling effect on People Living with HIV/AIDS (PLHA). Research has shown that a positive attitude towards the illness sets a proactive framework for the individual to cope with his or her infection; therefore, healthy coping mechanisms are essential to combat HIV-related stigma. This qualitative study involving in-depth interviews and focus group discussions with PLHA affiliated with HIV support groups in South India explored positive coping strategies employed by PLHA to deal with HIV-related stigma. Interviews and focus group discussions were translated, transcribed, and analyzed for consistent themes. Taboos surrounding modes of transmission, perceiving sex workers as responsible for the spread of HIV, and avoiding associating with PLHA provided the context of HIV-related stigma. Despite these challenges, PLHA used several positive strategies, classified as Clear Knowledge and Understanding of HIV, Social Support and Family Well-Being, Selective Disclosure, Employment Building Confidence, and Participation in Positive Networks. Poor understanding of HIV and fears of being labeled immoral undermined healthy coping behavior, while improved understanding, affiliation with support groups, family support, presence of children, and financial independence enhanced PLHA confidence. Such positive coping behaviours could inform culturally relevant interventions.
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Affiliation(s)
- Shuba Kumar
- Samarth, Mylapore, Chennai, Tamil Nadu, India
| | | | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, Washington, United States
| | - Katherine R. Murray
- Department of Global Health, University of Washington, Seattle, Washington, United States
| | - Lisa E. Manhart
- Department of Global Health, University of Washington, Seattle, Washington, United States
- Department of Epidemiology, University of Washington, Seattle, Washington, United States
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50
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Mohanraj R, Jeyaseelan V, Kumar S, Mani T, Rao D, Murray KR, Manhart LE. Cultural adaptation of the Brief COPE for persons living with HIV/AIDS in southern India. AIDS Behav 2015; 19:341-51. [PMID: 25096895 PMCID: PMC4320041 DOI: 10.1007/s10461-014-0872-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Physical and psychological stressors of HIV infection demand adequate coping responses from persons living with HIV/AIDS (PLHA) and coping strategies may vary by cultural context. The Brief COPE is a well validated scale that has been used extensively to assess coping with cancer, depression, and HIV infection in other settings, but never in India. In this study we translated and validated the 28 item Brief COPE among 299 PLHA in South India, assessing reliability, validity, and cultural appropriateness. Although the original scale demonstrated acceptable internal consistency (alpha = 0.70) and good convergent validity with depression, the test-retest reliability was marginal (test-retest = 0.6) and the original factor structure demonstrated poor fit in a confirmatory factor analysis (CFA). An exploratory factor analysis yielded a 16 item scale with five factors (active planning, social support, avoidant emotions, substance use, religion). A second CFA demonstrated good model fit and acceptable reliability (alpha = 0.61) of the adapted scale.
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Affiliation(s)
| | | | | | | | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA USA
| | | | - Lisa E. Manhart
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
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