Sexually transmitted diseases最新文献

Background: Doxycycline use in sexually transmitted infection (STI) care is changing. Concerns about antimicrobial resistance (AR) have accompanied recent recommendations for doxycycline as bacterial STI post-exposure prophylaxis (doxy PEP). We describe trends in tetracycline resistance (TetR) among Neisseria gonorrhoeae (GC) isolates collected through United States (US) national surveillance in anticipation of expanded use of doxy PEP.

Methods: GC isolates were collected from men with symptomatic urethritis attending Gonococcal Isolate Surveillance Project (GISP) clinics during 1987-2022 or from patients diagnosed with gonorrhea attending GISP, enhanced GISP and/or Strengthening the US Response to Resistant Gonorrhea clinics during 2018-2022. Antimicrobial susceptibility testing was performed using agar dilution. We describe TetR (tetracycline minimum inhibitory concentration (MIC) ≥2 μg/mL) and high-level tetracycline resistance (TetHLR) (MIC ≥16 μg/mL) patterns among collected GC isolates, including by sex and sex of sex partner(s).

Results: A total of 183,668 urethral GC isolates were collected from men with symptomatic urethritis during 1987-2022. The proportion of isolates demonstrating TetR was stable during 1987 (19.7%) to 2022 (19.7%) though isolates demonstrating TetHLR increased from 2.8% to 14.6%. A total of 38,383 GC isolates were collected from patients with gonorrhea during 2018-2022; TetHLR increased across all sex/sex of sex partner(s) groups and was highest among men reporting male sex partner(s).

Conclusions: An increasing proportion of GC isolates collected through US national surveillance are demonstrating TetHLR. As doxycycline use expands in STI care, enhanced surveillance will be needed to monitor downstream impacts of its use on antimicrobial-resistant GC.

Abstract: A nine-year retrospective study from a North Indian STI reference centre observed 10% (5/50) azithromycin-resistant gonococcal isolates, including one HLR-AZM (MIC 256 μg/mL) strain. WGS of resistant isolates revealed 23S rRNA mutations (A2059G, C2611T, and C2597T), multiple resistance determinants, and MLST ST-7363/NG-STAR ST-6332 lineages, underscoring the need for continued molecular surveillance.

Background: Early entry into prenatal care and timely syphilis diagnosis and treatment of pregnant women can prevent congenital syphilis (CS). We assessed syphilis testing and treatment for pregnant women and their infants using electronic health records (EHRs).

Methods: We extracted syphilis testing results from pregnancy episodes documented in EHRs for women seeking care at the Medical University of South Carolina health system during 2021-2022. Chart reviews confirmed syphilis diagnosis, stage, and treatment. We calculated percentages of pregnant women who were 1) screened for syphilis, 2) received abnormal (i.e. reactive) test results, 3) newly diagnosed with syphilis, and 4) adequately treated for syphilis before delivery. We assessed testing and treatment outcomes of infants exposed to maternal syphilis.

Results: Among 12,959 pregnant women, 75% (n = 9,708) had ≥1 syphilis test during pregnancy; 106 (1.1%) had ≥1 abnormal test. From chart reviews, 54 women (51%) with abnormal tests were newly diagnosed with syphilis. The remaining abnormal tests were false positives (n = 15) or previous diagnoses (n = 37). Forty-four (81%) new diagnoses were treated during pregnancy; 30 (56%) were treated >30 days before delivery. Fifty-six infants born to women with an abnormal syphilis test were evaluated for CS of whom 24 (43%) had abnormal test results and 18 (75%) were treated for CS.

Conclusions: Although EHRs could reliably assess syphilis testing during pregnancy, chart review and consultation with public health authorities were necessary to confirm adequate treatment and CS follow-up. Triangulating EHRs with other data sources could enhance understanding of syphilis during pregnancy and inform CS prevention efforts.

Abstract: Bacterial vaginosis (BV) is a common gynecological condition among women of reproductive age that occurs due to a dysbiosis in the vaginal microbiota. It is associated with several serious obstetric and gynecological complications, such as pelvic inflammatory disease, infertility, postpartum infections, and increased risk of other genital tract infections. This community-based cross-sectional study aimed to determine the BV proportion and associated risk factors among 1,133 asymptomatic nonpregnant women in the Philippines. Nugent scoring of the Gram stain of vaginal smears was used to diagnose BV at a score range of 7 to 10. Sociodemographic and behavioral data were collected using a pre-tested and semi-structured questionnaire in Filipino. In this study, the overall proportion of women with BV was 24.18% (95% CI: 21.78 - 26.76). Multivariable regression analyses showed that older age (aOR: 1.03; 95% CI: 1.01 - 1.05), having a part-time work status (aOR: 1.99; 95% CI: 1.04 - 3.83), and younger age at first vaginal intercourse sex (aOR: 0.93; 95% CI: 0.88 - 0.97) were associated with higher odds of having BV. On the other hand, being a former alcohol drinker (aOR: 0.42; 95% CI: 0.30 - 0.59), living in a rural area (aOR: 0.58; 95% CI: 0.35 - 0.93), and progestin-only contraceptive use (aOR 0.67; 95% CI 0.47-0.95) were factors associated with lower odds of BV among nonpregnant women. In conclusion, this study provided updated epidemiologic data on BV among asymptomatic nonpregnant women of reproductive age in the Philippines, with significant associations observed with age, sexual and work history, alcohol use, and place of residence.

Abstract: Utilizing aggregated, United States electronic medical record data at the state level, we found that increased mpox incidence was associated with increased bacterial STI rates in men for the same month as well as higher STI rates after the second mpox vaccination. Those seeking vaccination or testing for mpox should be screened for other STIs.

Background: Kenyan guidelines recommend syndromic management for sexually transmitted infections (STIs), which may miss many infections. We used nucleic acid amplification testing (NAAT) to screen for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at three anatomic sites among adolescents and adults with behavioral risk factors in Western Kenya.

Methods: From December 2021 through April 2023, we enrolled participants without HIV who were aged 14-55 years and reported a recent history of an STI, transactional sex, condomless sex with multiple partners, injection drug use, and/or anal sex with male partners. Urine, oropharyngeal swabs, and anorectal swabs were tested using Xpert® CT/NG (Cepheid). Multivariable robust Poisson regression models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with the prevalence of both STIs combined.

Results: Among 405 participants tested for CT/NG at enrollment, 324 (80.0%) were females and 324 (80.0%) were aged 14-24 years. CT and/or NG was diagnosed in 143 (35.3%) participants, including CT in 111 (27.4%) and NG in 76 (18.8%). Infections were most prevalent at the urogenital site, with 124 (30.6%) participants diagnosed with CT and/or NG. Anorectal CT/NG was observed in 117 (28.9%) and oropharyngeal CT/NG in 14 (3.5%). Females had higher prevalences than males of both urogenital (33.6% vs. 18.5%, p = 0.012) and anorectal CT/NG (31.8% vs. 17.3%, p = 0.015). A theoretical screening approach that only tested for urogenital infections would have missed 18.0% of CT cases and 18.4% of NG cases. In multivariable analyses, there were no statistically significant associations between sociodemographic variables and CT/NG prevalence.

Conclusions: Urogenital and anorectal CT/NG were common in two communities in Western Kenya with behavioral vulnerability. Self-reported sexual behaviors were not predictive of extragenital CT/NG. NAAT-based urogenital and anorectal screening of sexually active adolescents and young adults could reduce CT/NG burden in this population.

Background: Rapid dual treponemal/non-treponemal (lipoidal antigen) tests could improve syphilis detection strategies among people living with HIV (PLHIV). The World Health Organization (WHO) recommends minimum performance targets for syphilis point-of-care tests: sensitivity >80% for the treponemal component, >95% for the non-treponemal component, and specificity >90% for both. We evaluated the diagnostic accuracy of a dual treponemal/non-treponemal test in PLHIV.

Methods: Cross-sectional study using stored serum samples donated by PLHIV who had been previously enrolled in a study conducted in Cali, Colombia. The index test was the Dual Path Platform® Syphilis Screen & Confirm Assay (DPP-SSCA, Chembio Diagnostic Systems, Inc.). A combination of Treponema pallidum haemagglutination assay (TPHA) and treponemal enzyme-linked immunosorbent assay (ELISA) served as the reference standard for the treponemal component, and the rapid plasma reagin (RPR) test for the non-treponemal component. We estimated the sensitivity and specificity of both components.

Results: We performed 280 DPP-SSCA on serum from 220 PLHIV (60 samples tested in duplicate). Median age: 35.2 years; 75.9% male; 53.0% with undetectable viral load; and 35.9% with previously treated syphilis. The treponemal component had 74.5% sensitivity (95%CI: 58.4-85.9) and 97.2% specificity (95%CI: 92.8-98.9). The non-treponemal component had 90.4% sensitivity (95%CI: 74.9-96.7) and 46.5% specificity (95%CI: 38.0-55.3).

Conclusions: In PLHIV, the serum-based DPP-SSCA did not meet WHO performance targets. Given the low specificity of the non-treponemal component, the development of improved diagnostic tools and rigorous validation are needed to ensure reliable and rapid diagnosis of active syphilis infection in this population.

Background: Health departments prioritize reproductive-aged women for syphilis partner services (PS) to prevent congenital syphilis (CS). We assessed trends in PS effectiveness among women.

Methods: We classified reported syphilis cases (all stages) between 2015-2022 from eight US jurisdictions as non-pregnant women (NPW) >45 years ("non-reproductive-aged NPW", a group sometimes not assigned for PS), NPW between 15-45 years ("reproductive-aged NPW"), pregnant women without a CS outcome ("pregnant no CS"), and pregnant women with a CS outcome ("pregnant and CS"). We compared trends in the yearly proportion within each group who reported partners and whose partners were treated (preventatively or if infected, before or due to PS).

Results: During 2015-2022, annual counts of syphilis increased (non-reproductive-aged NPW +151.5%; reproductive-aged NPW +208.0%; pregnant no CS +160.4%; pregnant and CS +559.3%). Overall, 88% of women were assigned for PS, >90% of assigned cases were interviewed and > 94% of interviewed cases were treated. Across groups, the proportion interviewed naming ≥1 locatable partner was higher in 2015 compared to 2022 (non-reproductive-aged NPW 53.3% to 36.3%; reproductive-aged NPW 68.6% to 42.8%; pregnant no CS 80.8% to 65.0%; pregnant and CS 73.6% to 47.0%), and the proportion with ≥1 partner treated was higher(non-reproductive-aged NPW 31.3% to 21.7%; reproductive-aged NPW 43.7% to 24.9%; pregnant no CS 53.0% to 38.0%; pregnant and CS 41.5% to 23.4%).

Conclusion: As syphilis increased, health departments reached most women with syphilis and assured treatment. A decreasing proportion of women reported locatable partners. Integration of PS with other strategies is needed to prevent re-infection and syphilis transmission in women.

Background: In November 2019, New York City (NYC) mandated universal syphilis screening during pregnancy at 28-32 weeks gestation (early third trimester syphilis screening, ETTSS) for congenital syphilis prevention. Medicaid is a significant payer for pregnancy-related and sexually transmitted infection care in NYC. We examined adherence to, and disparities in, ETTSS among pregnancies of NYC Medicaid recipients from 2020-2022.

Methods: We used Medicaid claims data to identify pregnancies using International Classification of Diseases, 10 th Revision codes related to delivery outcome and gestational age. We included people ages > 12 years with birth events at > 33 weeks gestation, and enrollment in Medicaid for the entire pregnancy. We identified syphilis screening using Current Procedural Terminology codes and enumerated screening timelines. Using log-binomial regression, we calculated adjusted prevalence ratios (aPR) for ETTSS by race/ethnicity, birth outcome, county of residence, and neighborhood poverty level.

Results: Of 105,092 pregnancies, 29.7% (31,193/105,092) received ETTSS. The proportion of pregnancies that received ETTSS increased from 29.4% (8,925/30,396) in 2020 to 30.0% (11,656/38,859) in 2022 (p = 0.03). Compared with Hispanic persons, ETTSS was lower in Non-Hispanic (NH) Asian/Pacific Islander (aPR = 0.89, confidence interval (CI) = 0.86-0.92), NH-Black (aPR = 0.90, CI = 0.88-0.93), NH-white (aPR = 0.76, CI = 0.74-0.79), and NH-Other race (aPR = 0.80, CI = 0.77-0.83) groups. ETTSS was higher among pregnant people living in high/very high poverty-neighborhoods compared to those in low/medium poverty neighborhoods (aPR = 1.15, CI = 1.13-1.17).

Conclusions: ETTSS was performed in less than one-third of pregnancies, with differential screening levels by key socio-demographics. Monitoring ETTSS adherence over time is important to inform congenital syphilis prevention interventions.

Abstract: We analyzed 162,397 de-identified HSV Western Blot results performed at the University of Washington Virology Laboratory from 1999 to 2020. HSV-1 seroprevalence declined by 0.53% per year, while indeterminate HSV-1 results increased by 0.08% annually. Similarly, HSV-2 seroprevalence decreased by 0.72% and indeterminate results increased by 0.16% each year.