Pub Date : 2024-10-08DOI: 10.1136/sextrans-2023-056067
Faran Emmanuel, Chukwuebuka Chukwukadibia Ejeckam, Kalada Green, Adediran Adesola Adesina, Gambo Aliyu, Gregory Ashefor, Rose Aguolu, Shajy Isac, James Blanchard
Introduction: Nigeria has the fastest-growing HIV epidemic in West and Central Africa and key populations (KPs) bear a higher burden of HIV. This integrated biological and behavioural surveillance survey was conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) populations to understand the changing dynamics of HIV to improve HIV prevention efforts in Nigeria.
Methods: Using a cross-sectional design, data were collected between October and November 2020 in 12 states, from randomly selected KP members using multistage probability sampling. Behavioural data were collected using a structured questionnaire followed by three rapid HIV tests. The study was approved by ethical review boards in Nigeria and Canada and all ethical considerations including maintaining the privacy and confidentiality of all study subjects were followed.
Results: A total number of 17 975 KP members were interviewed, with a response rate of over 98.0%. A weighted HIV prevalence of 28.8% (95% CI 27.4% to 30.2%), 25.0% (95% CI 23.7% to 26.3%), 15.5% (95% CI 14.3% to 16.4%) and 10.9% (95% CI 9.9% to 11.8%) was found among TGs, MSMs, FSWs and PWIDs respectively. A high number of sex partners and consistent condom use were low for all types of KPs, especially with regular partners. Both MSM and TGs reported high rates of unprotected receptive anal intercourse ranging between 71.2% and 85.0%. Nearly 60.0% of PWID shared their used syringe with another PWID. Overall, 90.2% FSWs, 77.2% MSM, 81.9% TGs and 84.3% PWID were ever tested for HIV.
Conclusion: This study highlights the progressing trends of HIV prevalence among all KPs in Nigeria. A focused prevention approach is needed to control the emerging epidemic among KPs who constitute the epicentre of the HIV epidemic in Nigeria.
导言：尼日利亚是西非和中非艾滋病毒疫情增长最快的国家，重点人群（KPs）的艾滋病毒负担较重。这项综合生物和行为监测调查针对女性性工作者 (FSW)、男男性行为者 (MSM)、注射毒品者 (PWID) 和变性人 (TG) 开展，目的是了解 HIV 不断变化的动态，以改进尼日利亚的 HIV 预防工作：采用横断面设计，于 2020 年 10 月至 11 月期间在 12 个州通过多阶段概率抽样从随机选出的 KP 成员中收集数据。通过结构化问卷收集行为数据，然后进行三次艾滋病毒快速检测。该研究获得了尼日利亚和加拿大伦理审查委员会的批准，并遵循了所有伦理考虑因素，包括维护所有研究对象的隐私和保密性：共访问了 17 975 名 KP 成员，回复率超过 98.0%。在 TGs、MSMs、FSWs 和 PWIDs 中，加权 HIV 感染率分别为 28.8%（95% CI 27.4% 至 30.2%）、25.0%（95% CI 23.7% 至 26.3%）、15.5%（95% CI 14.3% 至 16.4%）和 10.9%（95% CI 9.9% 至 11.8%）。在所有类型的 KPs 中，性伴侣数量多和持续使用安全套的比例都很低，尤其是固定性伴侣。男男性行为者和女性同性恋者报告的无保护受体肛交率都很高，介于 71.2%和 85.0%之间。近 60.0%的吸毒者与另一名吸毒者共用使用过的注射器。总体而言，90.2%的家庭主妇、77.2%的男男性行为者、81.9%的男性同性恋者和 84.3%的艾滋病感染者接受过艾滋病毒检测：这项研究突显了尼日利亚所有 KPs 中艾滋病毒感染率不断上升的趋势。需要采取有针对性的预防方法来控制正在构成尼日利亚艾滋病毒流行中心的 KPs 中出现的流行病。
{"title":"HIV epidemic among key populations in Nigeria: results of the integrated biological and behavioural surveillance survey (IBBSS), 2020-2021.","authors":"Faran Emmanuel, Chukwuebuka Chukwukadibia Ejeckam, Kalada Green, Adediran Adesola Adesina, Gambo Aliyu, Gregory Ashefor, Rose Aguolu, Shajy Isac, James Blanchard","doi":"10.1136/sextrans-2023-056067","DOIUrl":"https://doi.org/10.1136/sextrans-2023-056067","url":null,"abstract":"<p><strong>Introduction: </strong>Nigeria has the fastest-growing HIV epidemic in West and Central Africa and key populations (KPs) bear a higher burden of HIV. This integrated biological and behavioural surveillance survey was conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) populations to understand the changing dynamics of HIV to improve HIV prevention efforts in Nigeria.</p><p><strong>Methods: </strong>Using a cross-sectional design, data were collected between October and November 2020 in 12 states, from randomly selected KP members using multistage probability sampling. Behavioural data were collected using a structured questionnaire followed by three rapid HIV tests. The study was approved by ethical review boards in Nigeria and Canada and all ethical considerations including maintaining the privacy and confidentiality of all study subjects were followed.</p><p><strong>Results: </strong>A total number of 17 975 KP members were interviewed, with a response rate of over 98.0%. A weighted HIV prevalence of 28.8% (95% CI 27.4% to 30.2%), 25.0% (95% CI 23.7% to 26.3%), 15.5% (95% CI 14.3% to 16.4%) and 10.9% (95% CI 9.9% to 11.8%) was found among TGs, MSMs, FSWs and PWIDs respectively. A high number of sex partners and consistent condom use were low for all types of KPs, especially with regular partners. Both MSM and TGs reported high rates of unprotected receptive anal intercourse ranging between 71.2% and 85.0%. Nearly 60.0% of PWID shared their used syringe with another PWID. Overall, 90.2% FSWs, 77.2% MSM, 81.9% TGs and 84.3% PWID were ever tested for HIV.</p><p><strong>Conclusion: </strong>This study highlights the progressing trends of HIV prevalence among all KPs in Nigeria. A focused prevention approach is needed to control the emerging epidemic among KPs who constitute the epicentre of the HIV epidemic in Nigeria.</p>","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-08DOI: 10.1136/sextrans-2024-056186
Jennifer C Ratner, Janet Wilson, Kevin Roberts, Catherine Armitage, Richard Christopher Barton
Objectives: Azoles have been the mainstay of recurrent vulvovaginal candidiasis (RVVC) for many years. Because of a recent anecdotal increase in non-Candida albicans yeasts (NCAY) and azole-resistant C. albicans cases, their prevalence was calculated from cultures for yeasts in women with complicated/RVVC over 3 years.
Methods: Retrospective data search of vaginal cultures from adult women in Leeds, UK between April 2018 and March 2021 was conducted. Samples with clinical details of complicated/RVVC had full yeast identification and antifungal susceptibility performed. Differences in prevalence between 12-month periods were determined using χ2 tests.
Results: Over the 3 years, cultures were performed on 5461 vaginal samples from women with clinical information indicating they had complicated/RVVC, RVVC, with 1828 (33.5%) growing yeasts.Over 85% of yeasts each year were C. albicans, however the proportion declined yearly with an increase in NCAY species. Nakaseomyces glabrata was the most frequent NCAY species isolated, increasing from 2.8% in 2018-19 to 6.8% in 2020-21. Total NCAY species increased from 6.0% in 2018-19 to 12.6% in 2020-21. Fluconazole-sensitive dose-dependant (SDD) and resistant isolates increased from 3.5% in 2018-19 to 7.7% in 2019-20 and 9.6% in 2020-21. Most resistance was in C. albicans and the majority of cases were seen in primary care. Most fluconazole non-sensitive isolates were either SDD or resistant to itraconazole (77% and 23%, respectively) and were intermediate or resistant to voriconazole (36.4% and 60%, respectively).
Conclusion: There was a significant increase in the prevalence of NCAY and fluconazole-resistant C. albicans in complicated/RVVC cultures over these 3 years. Successful treatment of such cases can be very challenging. The exact reasons for this increase remain unclear but it follows a policy change that encouraged a clinical diagnosis and empirical treatment of vulvovaginal candidiasis, rather than fungal culture, in primary care.
{"title":"Increasing rate of non-<i>Candida albicans</i> yeasts and fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, United Kingdom.","authors":"Jennifer C Ratner, Janet Wilson, Kevin Roberts, Catherine Armitage, Richard Christopher Barton","doi":"10.1136/sextrans-2024-056186","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056186","url":null,"abstract":"<p><strong>Objectives: </strong>Azoles have been the mainstay of recurrent vulvovaginal candidiasis (RVVC) for many years. Because of a recent anecdotal increase in non-<i>Candida albicans</i> yeasts (NCAY) and azole-resistant <i>C. albicans</i> cases, their prevalence was calculated from cultures for yeasts in women with complicated/RVVC over 3 years.</p><p><strong>Methods: </strong>Retrospective data search of vaginal cultures from adult women in Leeds, UK between April 2018 and March 2021 was conducted. Samples with clinical details of complicated/RVVC had full yeast identification and antifungal susceptibility performed. Differences in prevalence between 12-month periods were determined using χ<sup>2</sup> tests.</p><p><strong>Results: </strong>Over the 3 years, cultures were performed on 5461 vaginal samples from women with clinical information indicating they had complicated/RVVC, RVVC, with 1828 (33.5%) growing yeasts.Over 85% of yeasts each year were <i>C. albicans</i>, however the proportion declined yearly with an increase in NCAY species. <i>Nakaseomyces glabrata</i> was the most frequent NCAY species isolated, increasing from 2.8% in 2018-19 to 6.8% in 2020-21. Total NCAY species increased from 6.0% in 2018-19 to 12.6% in 2020-21. Fluconazole-sensitive dose-dependant (SDD) and resistant isolates increased from 3.5% in 2018-19 to 7.7% in 2019-20 and 9.6% in 2020-21. Most resistance was in <i>C. albicans</i> and the majority of cases were seen in primary care. Most fluconazole non-sensitive isolates were either SDD or resistant to itraconazole (77% and 23%, respectively) and were intermediate or resistant to voriconazole (36.4% and 60%, respectively).</p><p><strong>Conclusion: </strong>There was a significant increase in the prevalence of NCAY and fluconazole-resistant <i>C. albicans</i> in complicated/RVVC cultures over these 3 years. Successful treatment of such cases can be very challenging. The exact reasons for this increase remain unclear but it follows a policy change that encouraged a clinical diagnosis and empirical treatment of vulvovaginal candidiasis, rather than fungal culture, in primary care.</p>","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1136/sextrans-2023-055965
Aamirah Mussa, Adriane Wynn, Rebecca Ryan, Chibuzor M Babalola, Emily Hansman, Selebaleng Simon, Bame Bame, Neo Moshashane, Maitumelo Masole, Melissa L Wilson, Jeffrey D Klausner, Chelsea Morroni
Objectives: Chlamydia trachomatis and Neisseria gonorrhoeae are common sexually transmitted infections (STIs). Untreated infection in pregnancy can result in adverse neonatal outcomes, including vertical transmission. Screening for these infections is not routine in low- and middle-income countries (LMICs).
Methods: The Maduo Study was a non-randomised cluster crossover trial in Botswana to provide preliminary data on the effect of antenatal C. trachomatis and N. gonorrhoeae screening and treatment on postdelivery prevalence and vertical transmission to infants. Pregnant women asymptomatic for STIs were enrolled at four clinics (seven clusters). The intervention arm received C. trachomatis and N. gonorrhoeae screening at first antenatal care, third trimester and postdelivery. The standard-of-care arm received postdelivery screening only. Infants of women with a positive test postdelivery in both arms were screened. A cluster-level analysis was performed to compare the risk of postdelivery infection between intervention and standard-of-care arms.
Results: The study enrolled 500 women; 206 (82.1%) and 187 (75.1%) were retained in the intervention and standard-of-care arms, respectively and screened ≤12 weeks postdelivery. C. trachomatis prevalence in the intervention arm reduced from 22.7% at first antenatal care to 1.0% postdelivery. N. gonorrhoeae prevalence reduced from 1.2% at first antenatal care to 0% postdelivery. The risk of C. trachomatis and/or N. gonorrhoeae was lower in the intervention arm postdelivery (0.6%) compared with the standard-of-care arm (15.7%); adjusted risk difference: -14.7% (95% CI -23.0%, -6.4%). Among 26 infants born to women with either infection postdelivery, 10 (38.5%) tested positive (C. trachomatis: 9; N. gonorrhoeae: 1).
Conclusions: Postdelivery prevalence of C. trachomatis was significantly lower among pregnant women in Botswana who received diagnostic antenatal screening. Among women with C. trachomatis and/or N. gonorrhoeae postdelivery, more than one-third transmitted the infection to their infants. This exploratory study suggests antenatal STI screening has the potential to reduce infection in newborns in similar LMIC settings.
{"title":"Effect of antenatal <i>Chlamydia trachomatis</i> and <i>Neisseria gonorrhoeae</i> screening on postdelivery prevalence and vertical transmission in Gaborone, Botswana: findings from an exploratory study.","authors":"Aamirah Mussa, Adriane Wynn, Rebecca Ryan, Chibuzor M Babalola, Emily Hansman, Selebaleng Simon, Bame Bame, Neo Moshashane, Maitumelo Masole, Melissa L Wilson, Jeffrey D Klausner, Chelsea Morroni","doi":"10.1136/sextrans-2023-055965","DOIUrl":"10.1136/sextrans-2023-055965","url":null,"abstract":"<p><strong>Objectives: </strong><i>Chlamydia trachomatis</i> and <i>Neisseria gonorrhoeae</i> are common sexually transmitted infections (STIs). Untreated infection in pregnancy can result in adverse neonatal outcomes, including vertical transmission. Screening for these infections is not routine in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>The Maduo Study was a non-randomised cluster crossover trial in Botswana to provide preliminary data on the effect of antenatal <i>C. trachomatis</i> and <i>N. gonorrhoeae</i> screening and treatment on postdelivery prevalence and vertical transmission to infants. Pregnant women asymptomatic for STIs were enrolled at four clinics (seven clusters). The intervention arm received <i>C. trachomatis</i> and <i>N. gonorrhoeae</i> screening at first antenatal care, third trimester and postdelivery. The standard-of-care arm received postdelivery screening only. Infants of women with a positive test postdelivery in both arms were screened. A cluster-level analysis was performed to compare the risk of postdelivery infection between intervention and standard-of-care arms.</p><p><strong>Results: </strong>The study enrolled 500 women; 206 (82.1%) and 187 (75.1%) were retained in the intervention and standard-of-care arms, respectively and screened ≤12 weeks postdelivery. <i>C. trachomatis</i> prevalence in the intervention arm reduced from 22.7% at first antenatal care to 1.0% postdelivery. <i>N. gonorrhoeae</i> prevalence reduced from 1.2% at first antenatal care to 0% postdelivery. The risk of <i>C. trachomatis</i> and/or <i>N. gonorrhoeae</i> was lower in the intervention arm postdelivery (0.6%) compared with the standard-of-care arm (15.7%); adjusted risk difference: -14.7% (95% CI -23.0%, -6.4%). Among 26 infants born to women with either infection postdelivery, 10 (38.5%) tested positive (<i>C. trachomatis</i>: 9; <i>N. gonorrhoeae</i>: 1).</p><p><strong>Conclusions: </strong>Postdelivery prevalence of <i>C. trachomatis</i> was significantly lower among pregnant women in Botswana who received diagnostic antenatal screening. Among women with <i>C. trachomatis</i> and/or <i>N. gonorrhoeae</i> postdelivery, more than one-third transmitted the infection to their infants. This exploratory study suggests antenatal STI screening has the potential to reduce infection in newborns in similar LMIC settings.</p><p><strong>Trial registration number: </strong>NCT04955717.</p>","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1136/sextrans-2024-056232
Victoria Tittle, Sara Louise Day, Anna Tostevin, Adrian M Kelly, Jonathan Spate, Fiona Burns, Jo Gibbs, Alison Howarth, Ann Sullivan
Objectives: Since 2018, Sexual Health London (SHL) has provided remote sexually transmitted infection (STI) testing services to London residents over 16 years of age. SHL was an asymptomatic screening service. In 2020, SHL widened access to non-urgent symptomatic testing. We undertook a 4-year evaluation on the uptake of SHL's online testing pathway and outcomes, including the association of positive chlamydia and gonorrhoea nucleic acid amplification test (NAAT) outcomes with user demographics and user utility.
Methods: This is a retrospective data analysis of routine SHL clinical data from 8 January 2018 to 31 March 2022 of all STI test kit orders, focusing on HIV, chlamydia and gonorrhoea outcomes. Descriptive analysis on uptake of each stage of SHL's clinical care pathway is provided, including HIV testing outcomes. Binary logistic regression was used to examine the association between SHL user-completed online consultation information, SHL uptake and chlamydia and gonorrhoea NAAT results (negative or positive).
Results: During the evaluation period, there were 1 476 187 orders made by 670 293 unique users. The return rate for chlamydia and gonorrhoea NAATs was 79.5% and 67.6% for HIV blood samples. The positivity rate from sufficient samples was 4.5% for chlamydia, 1.6% for gonorrhoea and 0.3% reactivity for HIV. There were increased odds of a positive chlamydia and gonorrhoea NAAT result in non-cisgender women, those with a high number of STI orders, non-UK born and those who collected an STI test kit from a clinic-based service.
Conclusions: To date, this is the largest number of orders in an evaluation of online postal sexual health infection testing in the UK, and highest return rate of samples, suggesting acceptability of SHL for STI testing. Positivity rates for chlamydia and gonorrhoea NAAT tests are lower than national figures, which may reflect asymptomatic screening prior to 2020 and testing of non-urgent symptoms since 2020.
{"title":"An evaluation of an online STI service across London: reviewing uptake, utility and outcomes over a 4-year period.","authors":"Victoria Tittle, Sara Louise Day, Anna Tostevin, Adrian M Kelly, Jonathan Spate, Fiona Burns, Jo Gibbs, Alison Howarth, Ann Sullivan","doi":"10.1136/sextrans-2024-056232","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056232","url":null,"abstract":"<p><strong>Objectives: </strong>Since 2018, Sexual Health London (SHL) has provided remote sexually transmitted infection (STI) testing services to London residents over 16 years of age. SHL was an asymptomatic screening service. In 2020, SHL widened access to non-urgent symptomatic testing. We undertook a 4-year evaluation on the uptake of SHL's online testing pathway and outcomes, including the association of positive chlamydia and gonorrhoea nucleic acid amplification test (NAAT) outcomes with user demographics and user utility.</p><p><strong>Methods: </strong>This is a retrospective data analysis of routine SHL clinical data from 8 January 2018 to 31 March 2022 of all STI test kit orders, focusing on HIV, chlamydia and gonorrhoea outcomes. Descriptive analysis on uptake of each stage of SHL's clinical care pathway is provided, including HIV testing outcomes. Binary logistic regression was used to examine the association between SHL user-completed online consultation information, SHL uptake and chlamydia and gonorrhoea NAAT results (negative or positive).</p><p><strong>Results: </strong>During the evaluation period, there were 1 476 187 orders made by 670 293 unique users. The return rate for chlamydia and gonorrhoea NAATs was 79.5% and 67.6% for HIV blood samples. The positivity rate from sufficient samples was 4.5% for chlamydia, 1.6% for gonorrhoea and 0.3% reactivity for HIV. There were increased odds of a positive chlamydia and gonorrhoea NAAT result in non-cisgender women, those with a high number of STI orders, non-UK born and those who collected an STI test kit from a clinic-based service.</p><p><strong>Conclusions: </strong>To date, this is the largest number of orders in an evaluation of online postal sexual health infection testing in the UK, and highest return rate of samples, suggesting acceptability of SHL for STI testing. Positivity rates for chlamydia and gonorrhoea NAAT tests are lower than national figures, which may reflect asymptomatic screening prior to 2020 and testing of non-urgent symptoms since 2020.</p>","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1136/sextrans-2024-056198
Drieda Zaçe, Lorenzo Vittorio Rindi, Mirko Compagno, Luna Colagrossi, Maria Mercedes Santoro, Massimo Andreoni, Carlo Federico Perno, Loredana Sarmati
Objective HIV-1 management has advanced significantly with antiretroviral therapy (ART), yet challenges persist, including low-level HIV-1 viraemia (LLV). LLV presents a complex scenario, with varied definitions in the literature, reflecting uncertainties in its clinical interpretation. Questions arise regarding the underlying mechanisms of LLV, whether it signifies ongoing viral replication or stems from other factors. This study aimed to systematically review strategies for LLV management, providing insights into optimal clinical approaches. Methods MEDLINE, EMBASE, Cochrane Library, Web of Science and Canadian Agency for Drugs and Technologies in Health were searched for relevant literature on LLV management. We included studies published between 2004 and 2024, assessing interventions such as ART modification, genotypic resistance testing, adherence assessment, performing therapeutic drug monitoring, testing for chronic coinfections and assessing the viral reservoir via HIV DNA quantification. Meta-analyses were conducted where feasible. Results The systematic review identified 48 eligible records. Findings indicated limited evidence supporting the effectiveness of ART regimen modification in achieving virological suppression among individuals with LLV. However, studies assessing genotypic resistance testing revealed a significant association between resistance-associated mutations and virological suppression during LLV. Adherence to ART emerged as a critical determinant of treatment efficacy, with interventions showing promise in achieving viral suppression. The clinical utility of therapeutic drug monitoring in managing LLV remained inconclusive. Gaps in the literature were identified regarding follow-up scheduling, managing concurrent chronic infections and assessing inflammatory markers in LLV management. Conclusions While ART modification may not consistently achieve virological suppression, genotypic resistance testing may offer insights into treatment outcomes. Adherence to ART emerged as a crucial factor, necessitating tailored interventions. However, further research is needed to elucidate the clinical utility of therapeutic drug monitoring and other management strategies. The study highlights the importance of ongoing research to refine therapeutic approaches and improve patient outcomes in LLV management. PROSPERO registration number CRD42024511492. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Managing low-level HIV viraemia in antiretroviral therapy: a systematic review and meta-analysis","authors":"Drieda Zaçe, Lorenzo Vittorio Rindi, Mirko Compagno, Luna Colagrossi, Maria Mercedes Santoro, Massimo Andreoni, Carlo Federico Perno, Loredana Sarmati","doi":"10.1136/sextrans-2024-056198","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056198","url":null,"abstract":"Objective HIV-1 management has advanced significantly with antiretroviral therapy (ART), yet challenges persist, including low-level HIV-1 viraemia (LLV). LLV presents a complex scenario, with varied definitions in the literature, reflecting uncertainties in its clinical interpretation. Questions arise regarding the underlying mechanisms of LLV, whether it signifies ongoing viral replication or stems from other factors. This study aimed to systematically review strategies for LLV management, providing insights into optimal clinical approaches. Methods MEDLINE, EMBASE, Cochrane Library, Web of Science and Canadian Agency for Drugs and Technologies in Health were searched for relevant literature on LLV management. We included studies published between 2004 and 2024, assessing interventions such as ART modification, genotypic resistance testing, adherence assessment, performing therapeutic drug monitoring, testing for chronic coinfections and assessing the viral reservoir via HIV DNA quantification. Meta-analyses were conducted where feasible. Results The systematic review identified 48 eligible records. Findings indicated limited evidence supporting the effectiveness of ART regimen modification in achieving virological suppression among individuals with LLV. However, studies assessing genotypic resistance testing revealed a significant association between resistance-associated mutations and virological suppression during LLV. Adherence to ART emerged as a critical determinant of treatment efficacy, with interventions showing promise in achieving viral suppression. The clinical utility of therapeutic drug monitoring in managing LLV remained inconclusive. Gaps in the literature were identified regarding follow-up scheduling, managing concurrent chronic infections and assessing inflammatory markers in LLV management. Conclusions While ART modification may not consistently achieve virological suppression, genotypic resistance testing may offer insights into treatment outcomes. Adherence to ART emerged as a crucial factor, necessitating tailored interventions. However, further research is needed to elucidate the clinical utility of therapeutic drug monitoring and other management strategies. The study highlights the importance of ongoing research to refine therapeutic approaches and improve patient outcomes in LLV management. PROSPERO registration number CRD42024511492. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1136/sextrans-2024-056199
Lorenzo Vittorio Rindi, Drieda Zaçe, Mirko Compagno, Luna Colagrossi, Maria Mercedes Santoro, Massimo Andreoni, Carlo Federico Perno, Loredana Sarmati
Objective While antiretroviral therapy (ART) is highly effective, detection of low levels of HIV-1 RNA in plasma is common in treated individuals. Given the uncertainties on the topic, we convened a panel of experts to consider different clinical scenarios, producing a Delphi consensus to help guide clinical practice. Methods A panel of 17 experts in infectious diseases, virology and immunology rated 32 statements related to four distinct scenarios: (1) low-level viremia during stable (≥6 months) first-line ART (≥2 consecutive HIV-1 RNA measurements 50–500 copies/mL); (2) a viral blip during otherwise suppressive ART (a HIV-1 RNA measurement 50–1000 copies/mL with adjacent measurements <50 copies/mL); (3) low-level viral rebound during previously suppressive ART (≥2 consecutive HIV-1 RNA measurements 50–500 copies/mL); (4) residual viremia during suppressive ART (persistent HIV-1 RNA quantification below 50 copies/mL). A systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement, informed the 32 statements. The Delphi procedure was modified to include two voting rounds separated by a moderated group discussion. Grading of Recommendations, Assessment, Development, and Evaluations-based recommendations were developed. Results Overall, 18/32 statements (56.2%) achieved a strong consensus, 3/32 (9.4%) achieved a moderate consensus and 11/32 (34.4%) did not achieve a consensus. Across the four scenarios, the panel unanimously emphasised the importance of implementing specific interventions prior to considering therapy changes, including assessing adherence, testing for genotypic drug resistance and scheduling more frequent follow-up visits. Strategies indicated in selected circumstances included therapeutic drug monitoring, quantifying total HIV-1 DNA and evaluating concomitant chronic infections. Conclusions While acknowledging the many uncertainties about source, significance and optimal management of low-level viremia during ART, the findings provide insights to help harmonise clinical practice. There is a need for well-designed randomised studies assessing different interventions to manage low-level viremia and future research regarding its definition. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Management of low-level HIV viremia during antiretroviral therapy: Delphi consensus statement and appraisal of the evidence","authors":"Lorenzo Vittorio Rindi, Drieda Zaçe, Mirko Compagno, Luna Colagrossi, Maria Mercedes Santoro, Massimo Andreoni, Carlo Federico Perno, Loredana Sarmati","doi":"10.1136/sextrans-2024-056199","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056199","url":null,"abstract":"Objective While antiretroviral therapy (ART) is highly effective, detection of low levels of HIV-1 RNA in plasma is common in treated individuals. Given the uncertainties on the topic, we convened a panel of experts to consider different clinical scenarios, producing a Delphi consensus to help guide clinical practice. Methods A panel of 17 experts in infectious diseases, virology and immunology rated 32 statements related to four distinct scenarios: (1) low-level viremia during stable (≥6 months) first-line ART (≥2 consecutive HIV-1 RNA measurements 50–500 copies/mL); (2) a viral blip during otherwise suppressive ART (a HIV-1 RNA measurement 50–1000 copies/mL with adjacent measurements <50 copies/mL); (3) low-level viral rebound during previously suppressive ART (≥2 consecutive HIV-1 RNA measurements 50–500 copies/mL); (4) residual viremia during suppressive ART (persistent HIV-1 RNA quantification below 50 copies/mL). A systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement, informed the 32 statements. The Delphi procedure was modified to include two voting rounds separated by a moderated group discussion. Grading of Recommendations, Assessment, Development, and Evaluations-based recommendations were developed. Results Overall, 18/32 statements (56.2%) achieved a strong consensus, 3/32 (9.4%) achieved a moderate consensus and 11/32 (34.4%) did not achieve a consensus. Across the four scenarios, the panel unanimously emphasised the importance of implementing specific interventions prior to considering therapy changes, including assessing adherence, testing for genotypic drug resistance and scheduling more frequent follow-up visits. Strategies indicated in selected circumstances included therapeutic drug monitoring, quantifying total HIV-1 DNA and evaluating concomitant chronic infections. Conclusions While acknowledging the many uncertainties about source, significance and optimal management of low-level viremia during ART, the findings provide insights to help harmonise clinical practice. There is a need for well-designed randomised studies assessing different interventions to manage low-level viremia and future research regarding its definition. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1136/sextrans-2024-056236
Yoshiko Sakuma, Warittha Tieosapjaroen, Dan Wu, Hayley Conyers, Thomas Shakespeare, John Guigayoma, Fern Terris-Prestholt, Stephen W Pan, Joseph D Tucker, Jason Ong, Eneyi Kpokiri
Objectives Sexual health is an integral part of well-being. However, the sexual health needs and desires of middle-aged and older adults have been largely disregarded. Therefore, this study aimed to understand the sexual health service preferences of adults aged 45 and older to improve the accessibility of sexual health services in the UK. Methods The formative stage of the discrete choice experiment (DCE) followed three steps: concept elicitation, refining and implementation. The attributes and levels were determined through 22 semistructured interviews during the concept elicitation, followed by pilot testing for refining the survey. Qualtrics XM, with conjoint project features, was implemented as the DCE survey platform. We used a random parameter logit model to estimate the relative importance (RI) of each attribute and preference for each attribute level. We also used a latent class model to explore groups of participants with similar preferences. Results In total, 200 responses were included for analysis. The demographic breakdown included 62.5% females, 35.5% people with disabilities and 26.0% identifying as a sexual minority. The median age was 53. Preferences for using sexual health services were mainly influenced by the mode of delivery (RI 32%), location (RI 18%) and cost (RI 16%). Participants showed a preference for face-to-face interactions at sexual health clinics and displayed a willingness to pay for private services. Extra support and the consultation style played minor roles in their decision-making process. No differences in preferences were identified among disabled people. However, sexual minorities expressed their preferences for conventional messaging. Conclusions Our study revealed that middle-aged and older individuals prioritise sexual health services offering face-to-face consultations, emphasising a preference to attend sexual health clinics over cost. Aligning service delivery with these preferences has the potential to significantly improve the accessibility and uptake of sexual health services for adults aged 45 and older in the UK. No data are available. Data for this paper are not publicly available.
{"title":"Preferences for sexual health services among middle-aged and older adults in the UK: a discrete choice experiment","authors":"Yoshiko Sakuma, Warittha Tieosapjaroen, Dan Wu, Hayley Conyers, Thomas Shakespeare, John Guigayoma, Fern Terris-Prestholt, Stephen W Pan, Joseph D Tucker, Jason Ong, Eneyi Kpokiri","doi":"10.1136/sextrans-2024-056236","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056236","url":null,"abstract":"Objectives Sexual health is an integral part of well-being. However, the sexual health needs and desires of middle-aged and older adults have been largely disregarded. Therefore, this study aimed to understand the sexual health service preferences of adults aged 45 and older to improve the accessibility of sexual health services in the UK. Methods The formative stage of the discrete choice experiment (DCE) followed three steps: concept elicitation, refining and implementation. The attributes and levels were determined through 22 semistructured interviews during the concept elicitation, followed by pilot testing for refining the survey. Qualtrics XM, with conjoint project features, was implemented as the DCE survey platform. We used a random parameter logit model to estimate the relative importance (RI) of each attribute and preference for each attribute level. We also used a latent class model to explore groups of participants with similar preferences. Results In total, 200 responses were included for analysis. The demographic breakdown included 62.5% females, 35.5% people with disabilities and 26.0% identifying as a sexual minority. The median age was 53. Preferences for using sexual health services were mainly influenced by the mode of delivery (RI 32%), location (RI 18%) and cost (RI 16%). Participants showed a preference for face-to-face interactions at sexual health clinics and displayed a willingness to pay for private services. Extra support and the consultation style played minor roles in their decision-making process. No differences in preferences were identified among disabled people. However, sexual minorities expressed their preferences for conventional messaging. Conclusions Our study revealed that middle-aged and older individuals prioritise sexual health services offering face-to-face consultations, emphasising a preference to attend sexual health clinics over cost. Aligning service delivery with these preferences has the potential to significantly improve the accessibility and uptake of sexual health services for adults aged 45 and older in the UK. No data are available. Data for this paper are not publicly available.","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142216350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1136/sextrans-2024-056269
Lucy Rabuszko, Sarah Stuart-George, Callum Chessell, Colin Fitzpatrick, Deborah Williams, Daniel Richardson
Introduction Outbreaks of invasive Neisseria meningitidis subtype C in networks of gay, bisexual and other men who have sex with men (MSM) have been reported. We aimed to explore any factors seen in MSM with invasive N.meningitidis subtype C. Method We searched three bibliographical databases for manuscripts written in English exploring at least one factor seen in MSM with invasive N. meningitidis subtype C published up to May 2024. Following an initial search, removal of duplicates and abstract review, two authors independently reviewed full-text manuscripts and performed a risk of bias assessment using the Joanna Briggs Institute toolkit. Narrative data were synthesised to generate themes. Results 16 manuscripts were included in this review from the USA (n=10), Germany (n=2), France (n=2), Canada (n=1) and Italy (n=1) and consisted of nine case series, four cross-sectional studies, two case reports and one case–control study published between 2003 and 2024 involving 236 MSM with invasive N. meningitidis subtype C, of which at least 64 died. We have highlighted some demographic (African-American or Hispanic identity in the USA, living with HIV), behavioural (kissing, sharing drinks, visiting sex-on-premises venues, visiting gay-oriented venues, using websites/mobile phone apps to meet sexual partners, recreational drug use, multiple and non-regular sexual partners) and infection (previous Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae , Mpox) factors in MSM with invasive N. meningitidis subtype C. Conclusion These data serve as an important resource to inform and target future public health strategies and outbreak control measures for the prevention of invasive N. meningitidis subtype C in MSM. PROSPERO registration number CRD42024543551. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Invasive Neisseria meningitidis subtype C in gay, bisexual and other men who have sex with men: a systematic review","authors":"Lucy Rabuszko, Sarah Stuart-George, Callum Chessell, Colin Fitzpatrick, Deborah Williams, Daniel Richardson","doi":"10.1136/sextrans-2024-056269","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056269","url":null,"abstract":"Introduction Outbreaks of invasive Neisseria meningitidis subtype C in networks of gay, bisexual and other men who have sex with men (MSM) have been reported. We aimed to explore any factors seen in MSM with invasive N.meningitidis subtype C. Method We searched three bibliographical databases for manuscripts written in English exploring at least one factor seen in MSM with invasive N. meningitidis subtype C published up to May 2024. Following an initial search, removal of duplicates and abstract review, two authors independently reviewed full-text manuscripts and performed a risk of bias assessment using the Joanna Briggs Institute toolkit. Narrative data were synthesised to generate themes. Results 16 manuscripts were included in this review from the USA (n=10), Germany (n=2), France (n=2), Canada (n=1) and Italy (n=1) and consisted of nine case series, four cross-sectional studies, two case reports and one case–control study published between 2003 and 2024 involving 236 MSM with invasive N. meningitidis subtype C, of which at least 64 died. We have highlighted some demographic (African-American or Hispanic identity in the USA, living with HIV), behavioural (kissing, sharing drinks, visiting sex-on-premises venues, visiting gay-oriented venues, using websites/mobile phone apps to meet sexual partners, recreational drug use, multiple and non-regular sexual partners) and infection (previous Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae , Mpox) factors in MSM with invasive N. meningitidis subtype C. Conclusion These data serve as an important resource to inform and target future public health strategies and outbreak control measures for the prevention of invasive N. meningitidis subtype C in MSM. PROSPERO registration number CRD42024543551. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142216348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1136/sextrans-2024-056166
Zohra Lodhia, Dora Cordeiro, Cristina Correia, Inês João, Teresa Carreira, Luís Vieira, Alexandra Nunes, Rita Ferreira, Sandra Schäfer, Elzara Aliyeva, Clara Portugal, Isabel Monge, Maria Ana Pessanha, Cristina Toscano, Rita Côrte-Real, Marília Antunes, Joao Paulo Gomes, Vítor Borges, Maria José Borrego
Objectives Chlamydia trachomatis is classified into 15 major genotypes, A to L3, based on the diversity of ompA gene. Here, we evaluated and characterised the distribution and diversity of ompA -genotypes over 32 years (1990–2021) in Portugal. Methods The collection of the Portuguese National Reference Laboratory for Sexually Transmitted Infections includes 5824 C . trachomatis -positive samples that were successfully ompA -genotyped between 1990 and 2021. An in-depth analysis of ompA -genotypes distribution across the years, as well as by biological sex, age and anatomical site of infection was performed. Results ompA -genotype E was consistently the most frequently detected across the years, with a median frequency of 34.6%, followed by D/Da (17.6%), F (14.3%) and G (10.7%). The prevalence of lymphogranuloma venereum (LGV) genotypes (mostly L2, 62.0%, followed by L2b, 32.1%) increased since 2016, reaching the highest value in 2019 (20.9%). LGV, G and Da genotypes were associated with biological sex, specifically with being male, and were the most frequent among anorectal specimens (37.7%, 19.4% and 17.7%, respectively). Notably, LGV ompA -genotypes represented 38.9% of the male anorectal specimens since 2016, and were also detected among oropharynx and urogenital samples. ompA -genotype E was the most frequently detected at the oropharynx (28.6%) and urogenital (33.9%) sites during the study period, followed by D/Da (17.4%) and F (16.0%) in the urogenital specimens, and by G (26.1%) and D/Da (25.7%) in oropharynx specimens. Our data also highlight the emergence of the recombinant L2b/D-Da strain since 2017 (representing between 2.0% and 15.5% of LGV cases per year) and the non-negligible detection of ompA -genotype B in urogenital and anorectal specimens. Conclusions This study provides a comprehensive landscape of C. trachomatis molecular surveillance in Portugal, highlighting the continued relevance of ompA -genotyping as a complement to rapid LGV-specific detection tests. It also contributes to a deeper understanding of C. trachomatis epidemiology, diversity and pathogenicity. Data are available in a public, open access repository. .
{"title":"Distribution of Chlamydia trachomatis ompA-genotypes over three decades in Portugal","authors":"Zohra Lodhia, Dora Cordeiro, Cristina Correia, Inês João, Teresa Carreira, Luís Vieira, Alexandra Nunes, Rita Ferreira, Sandra Schäfer, Elzara Aliyeva, Clara Portugal, Isabel Monge, Maria Ana Pessanha, Cristina Toscano, Rita Côrte-Real, Marília Antunes, Joao Paulo Gomes, Vítor Borges, Maria José Borrego","doi":"10.1136/sextrans-2024-056166","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056166","url":null,"abstract":"Objectives Chlamydia trachomatis is classified into 15 major genotypes, A to L3, based on the diversity of ompA gene. Here, we evaluated and characterised the distribution and diversity of ompA -genotypes over 32 years (1990–2021) in Portugal. Methods The collection of the Portuguese National Reference Laboratory for Sexually Transmitted Infections includes 5824 C . trachomatis -positive samples that were successfully ompA -genotyped between 1990 and 2021. An in-depth analysis of ompA -genotypes distribution across the years, as well as by biological sex, age and anatomical site of infection was performed. Results ompA -genotype E was consistently the most frequently detected across the years, with a median frequency of 34.6%, followed by D/Da (17.6%), F (14.3%) and G (10.7%). The prevalence of lymphogranuloma venereum (LGV) genotypes (mostly L2, 62.0%, followed by L2b, 32.1%) increased since 2016, reaching the highest value in 2019 (20.9%). LGV, G and Da genotypes were associated with biological sex, specifically with being male, and were the most frequent among anorectal specimens (37.7%, 19.4% and 17.7%, respectively). Notably, LGV ompA -genotypes represented 38.9% of the male anorectal specimens since 2016, and were also detected among oropharynx and urogenital samples. ompA -genotype E was the most frequently detected at the oropharynx (28.6%) and urogenital (33.9%) sites during the study period, followed by D/Da (17.4%) and F (16.0%) in the urogenital specimens, and by G (26.1%) and D/Da (25.7%) in oropharynx specimens. Our data also highlight the emergence of the recombinant L2b/D-Da strain since 2017 (representing between 2.0% and 15.5% of LGV cases per year) and the non-negligible detection of ompA -genotype B in urogenital and anorectal specimens. Conclusions This study provides a comprehensive landscape of C. trachomatis molecular surveillance in Portugal, highlighting the continued relevance of ompA -genotyping as a complement to rapid LGV-specific detection tests. It also contributes to a deeper understanding of C. trachomatis epidemiology, diversity and pathogenicity. Data are available in a public, open access repository. <https://zenodo.org/doi/10.5281/zenodo.11518772>.","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142216351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1136/sextrans-2024-056302
Angelo Roberto Raccagni, Virginia Batignani, Alma Zinola, Francesca Saluzzo, Federico Di Marco, Antonella Castagna, Daniela Maria Cirillo, Silvia Nozza
Outbreaks of Shigella sonnei and Shigella flexneri have been reported recently among gay, bisexual and other men who have sex with men (GBMSM), with transmission linked to sexual contact, particularly practices that involve oral-anal contact or faecal-oral exposure.1–8 The emergence of extensively drug-resistant (XDR) S. sonnei harbouring plasmid-encoded blaCTX-M-27 has raised concerns about the potential spread of this extended-spectrum beta-lactamase (ESBL)-producing gene.4–7 Two ESBL+ Shigella strains have been reported in Italy, one in a 10-year-old girl returning from Albania (2018) and one in a hospitalised patient (2021, no epidemiological or clinical data available).9 10 We present the case of a 35-year-old gay man diagnosed with XDR S. sonnei at our centre in Milan in February 2024. The individual was receiving HIV pre-exposure prophylaxis (PrEP) and doxycycline post-exposure prophylaxis (DoxyPEP). Past medical history included three episodes of gonorrhoeal proctitis, one chlamydial proctitis, a syphilis diagnosis and the detection of rectal HPV DNA. He travelled frequently within and outside of Italy. He presented following the acute onset of afebrile profuse mucous and fatty diarrhoea with tenesmus. He described condomless anal-receptive and oral-anal sexual intercourse with >50 partners in the previous month, including 20 days prior to the onset of symptoms with a man visiting Milan from the UK. The man later disclosed an untreated Shigella infection. On the initial presentation, he was treated empirically with a single dose of tinidazole 2 …
{"title":"Infection with extensively drug-resistant Shigella sonnei harbouring blaCTX-M-27 in a gay man in Italy","authors":"Angelo Roberto Raccagni, Virginia Batignani, Alma Zinola, Francesca Saluzzo, Federico Di Marco, Antonella Castagna, Daniela Maria Cirillo, Silvia Nozza","doi":"10.1136/sextrans-2024-056302","DOIUrl":"https://doi.org/10.1136/sextrans-2024-056302","url":null,"abstract":"Outbreaks of Shigella sonnei and Shigella flexneri have been reported recently among gay, bisexual and other men who have sex with men (GBMSM), with transmission linked to sexual contact, particularly practices that involve oral-anal contact or faecal-oral exposure.1–8 The emergence of extensively drug-resistant (XDR) S. sonnei harbouring plasmid-encoded blaCTX-M-27 has raised concerns about the potential spread of this extended-spectrum beta-lactamase (ESBL)-producing gene.4–7 Two ESBL+ Shigella strains have been reported in Italy, one in a 10-year-old girl returning from Albania (2018) and one in a hospitalised patient (2021, no epidemiological or clinical data available).9 10 We present the case of a 35-year-old gay man diagnosed with XDR S. sonnei at our centre in Milan in February 2024. The individual was receiving HIV pre-exposure prophylaxis (PrEP) and doxycycline post-exposure prophylaxis (DoxyPEP). Past medical history included three episodes of gonorrhoeal proctitis, one chlamydial proctitis, a syphilis diagnosis and the detection of rectal HPV DNA. He travelled frequently within and outside of Italy. He presented following the acute onset of afebrile profuse mucous and fatty diarrhoea with tenesmus. He described condomless anal-receptive and oral-anal sexual intercourse with >50 partners in the previous month, including 20 days prior to the onset of symptoms with a man visiting Milan from the UK. The man later disclosed an untreated Shigella infection. On the initial presentation, he was treated empirically with a single dose of tinidazole 2 …","PeriodicalId":21624,"journal":{"name":"Sexually Transmitted Infections","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142216353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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