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NCBI: db=pubmed; Term=(sexually transmitted infections OR sexually transmitted diseases) AND (point of care diagnostics OR pregnancy outcomes OR antibiotic resistance) NOT hiv
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Mycoplasma genitalium: the next sexually transmitted superbug?

Fri, 03/22/2019 - 08:38
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Mycoplasma genitalium: the next sexually transmitted superbug?

BMJ. 2018 10 29;363:k4376

Authors: Hughes G, Saunders J

PMID: 30373885 [PubMed - indexed for MEDLINE]

Stromal Fibroblasts Drive Host Inflammatory Responses That Are Dependent on Chlamydia trachomatis Strain Type and Likely Influence Disease Outcomes.

Thu, 03/21/2019 - 08:23
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Stromal Fibroblasts Drive Host Inflammatory Responses That Are Dependent on Chlamydia trachomatis Strain Type and Likely Influence Disease Outcomes.

MBio. 2019 Mar 19;10(2):

Authors: Jolly AL, Rau S, Chadha AK, Abdulraheem EA, Dean D

Abstract
Chlamydia trachomatis ocular strains cause a blinding disease known as trachoma. These strains rarely cause urogenital infections and are not found in the upper genital tract or rectum. Urogenital strains are responsible for a self-limited conjunctivitis and the sequelae of infertility, ectopic pregnancy, and hemorrhagic proctitis. However, the differential cellular responses that drive these clinically observed disease outcomes are not completely understood. Primary conjunctival, endocervical, and endometrial epithelial and stromal fibroblast cells, HeLa229 cells, and immortalized conjunctival epithelial (HCjE) cells were infected with the ocular A/Har-13 (A) and Ba/Apache-2 (Ba) strains and urogenital D/UW-3 (D) and E/Bour (E) strains. Infection rates, progeny production, and cytokine/chemokine secretion levels were evaluated in comparison with those in uninfected cells. All strain types infected all cell types with similar levels of efficacy and development. However, progeny production levels differed among primary cells: Ba produced significantly more progeny than E in endocervical and endometrial fibroblasts, while A progeny were less abundant than E progeny. C. trachomatis infection of primary epithelial cells elicited an increase in pro- and anti-inflammatory mediators compared to levels in uninfected cells, but there were no significant differences by strain type. In contrast, for primary fibroblasts, ocular strains elicited significant increases in the pro- and anti-inflammatory mediators macrophage inflammatory protein (MIP)-1β, thymus- and activation-regulated chemokine (TARC), interleukin (IL)-2, IL-12p70, and interferon gamma-induced protein 10 (IP-10) compared to levels in urogenital strains, while urogenital strains elicited a distinct and significant increase in the proinflammatory mediators IL-1α, IL-1β, IL-8, gamma interferon (IFN-γ), and granulocyte-macrophage colony-stimulating factor (GM-CSF). Our data indicate that primary fibroblasts, not epithelial cells, drive host inflammatory responses that are dependent on strain type and likely influence disease outcomes, establishing their importance as a novel model for studies of C. trachomatis disease pathogenesis.IMPORTANCE Chlamydia trachomatis is a human pathogen and the leading cause of preventable blindness and sexually transmitted diseases in the world. Certain C. trachomatis strains cause ocular disease, while others cause upper genital tract pathology. However, little is known about the cellular or immunologic basis for these differences. Here, we compared the abilities of the strain types to infect, replicate, and initiate an immune response in primary human ocular and urogenital epithelial cells, as well as in fibroblasts from the underlying stroma. While there were no significant differences in infection rates or intracellular growth for any strain in any cell type, proinflammatory responses were driven not by the epithelial cells but by fibroblasts and were distinct between ocular and urogenital strains. Our findings suggest that primary fibroblasts are a novel and more appropriate model for studies of immune responses that will expand our understanding of the differential pathological disease outcomes caused by various C. trachomatis strain types.

PMID: 30890604 [PubMed - in process]

Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark.

Thu, 03/21/2019 - 08:23
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Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark.

Lancet Infect Dis. 2016 09;16(9):1057-1064

Authors: Davies B, Turner KME, Frølund M, Ward H, May MT, Rasmussen S, Benfield T, Westh H, Danish Chlamydia Study Group

Abstract
BACKGROUND: Uncertainty in the risk of reproductive complications (pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility) following chlamydia infection and repeat infection hampers the design of evidence-based chlamydia control programmes. We estimate the association between diagnosed chlamydia and episodes of hospital health care (inpatient, outpatient, and emergency department) for a reproductive complication.
METHODS: We constructed and analysed a retrospective population-based cohort of women aged 15-44 years from administrative records in Denmark (1995-2012). We used a subset of the national Danish Chlamydia Study. The master dataset contains all residents of Denmark (including Greenland) who had a positive chlamydia test recorded by a public health microbiology laboratory from Jan 1, 1992, to Nov 2, 2011. Individuals were randomly matched (by age and sex) to four individuals drawn from the population register (Danish Civil Registration System) who did not have a positive chlamydia test during this interval. The outcomes in the study were hospital episodes of health-care (inpatient, outpatient, and emergency department) with a diagnosis of pelvic inflammatory disease, ectopic pregnancy, or tubal factor infertility.
FINDINGS: The 516 720 women (103 344 positive, 182 879 negative, 230 497 never-tested) had a mean follow-up of 7·96 years. Compared with women with only negative tests, the risk of each complication was 30% higher in women with one or more positive tests (pelvic inflammatory disease, adjusted hazard ratio [AHR] 1·50 [95% CI 1·43-1·57]; ectopic pregnancy, AHR 1·31 [1·25-1·38]; tubal factor infertility, AHR 1·37 [1·24-1·52]) and 60% lower in women who were never-tested (pelvic inflammatory disease, AHR 0·33 [0·31-0·35]; ectopic pregnancy, AHR 0·42 [0·39-0·44]; tubal factor infertility AHR 0·29 [0·25-0·33]). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (pelvic inflammatory disease, 0·6%; ectopic pregnancy, 0·2%; tubal factor infertility, 0·1%). Repeat infections increased the risk of pelvic inflammatory disease by a further 20% (AHR 1·20, 95% CI 1·11-1·31).
INTERPRETATION: A single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of pelvic inflammatory disease. Therefore, control programmes must prevent first and repeat infections to improve women's reproductive health.
FUNDING: Unrestricted partial funding from Frederiksberg Kommune, Frederiksberg, Denmark. BD held an Medical Research Council Population Health Scientist Fellowship (G0902120). KT held an National Institute for Health Research Post-Doctoral Fellowship 2009-02-055.

PMID: 27289389 [PubMed - indexed for MEDLINE]

Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men.

Tue, 03/19/2019 - 08:02
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Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men.

Emerg Infect Dis. 2019 Apr;25(4):719-727

Authors: Read TRH, Murray GL, Danielewski JA, Fairley CK, Doyle M, Worthington K, Su J, Mokany E, Tan LT, Lee D, Vodstrcil LA, Chow EPF, Garland SM, Chen MY, Bradshaw CS

Abstract
During 2016-2017, we tested asymptomatic men who have sex with men (MSM) in Melbourne, Australia, for Mycoplasma genitalium and macrolide resistance mutations in urine and anorectal swab specimens by using PCR. We compared M. genitalium detection rates for those asymptomatic men to those for MSM with proctitis and nongonococcal urethritis (NGU) over the same period. Of 1,001 asymptomatic MSM, 95 had M. genitalium; 84.2% were macrolide resistant, and 17% were co-infected with Neisseria gonorrhoeae or Chlamydia trachomatis. Rectal positivity for M. genitalium was 7.0% and urine positivity was 2.7%. M. genitalium was not more commonly detected in the rectums of MSM (n = 355, 5.6%) with symptoms of proctitis over the same period but was more commonly detected in MSM (n = 1,019, 8.1%) with NGU. M. genitalium is common and predominantly macrolide-resistant in asymptomatic MSM. M. genitalium is not associated with proctitis in this population.

PMID: 30882306 [PubMed - in process]

Risk Factors for Congenital Syphilis Transmitted from Mother to Infant - Suzhou, China, 2011-2014.

Sat, 03/16/2019 - 07:15
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Risk Factors for Congenital Syphilis Transmitted from Mother to Infant - Suzhou, China, 2011-2014.

MMWR Morb Mortal Wkly Rep. 2019 Mar 15;68(10):247-250

Authors: Wang Y, Wu M, Gong X, Zhao L, Zhao J, Zhu C, Gong C

Abstract
Mother-to-child transmission of syphilis remains a major global public health issue, and elimination of congenital syphilis is one of the millennium development goals of the World Health Organization (1). In 2012, an estimated 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes, including 143,000 early fetal deaths and stillbirths, 62,000 neonatal deaths, 44,000 preterm or low-weight births, and 102,000 infected infants worldwide (2). In China, the number of congenital syphilis cases reported annually increased from 468 in 2000 to 10,032 in 2013; the corresponding national congenital syphilis incidence rate increased nearly 26-fold, from 2.6 cases per 100,000 live births in 2000 to 69.9 in 2013 (3,4). To examine risk factors for mother-to-child transmission of syphilis, a cohort of pregnant women with a new syphilis diagnosis and their live-born infants was recruited during July 2011-July 2014 in Suzhou, in eastern China. Multivariable logistic regression results demonstrated that gestational age >36 weeks at the time of maternal syphilis diagnosis, higher maternal titers of rapid plasma reagin (RPR) and higher Treponema pallidum particle agglutination assay (TPPA) titers are risk factors for congenital syphilis. Among women with syphilis diagnosed at >36 weeks' gestational age, three quarters were migrant women. Recommendations for strengthening community and provider education about mother-to-child transmission of syphilis, early diagnosis and timely treatment of syphilis in pregnancy, and improving and providing access to prenatal care and screening migrant pregnant women with temporary residence status might reduce the incidence of congenital syphilis in China.

PMID: 30870407 [PubMed - indexed for MEDLINE]

Preliminary study of tetracycline resistance genes in Treponema pallidum.

Fri, 03/15/2019 - 09:55
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Preliminary study of tetracycline resistance genes in Treponema pallidum.

J Glob Antimicrob Resist. 2017 06;9:1-2

Authors: Xiao H, Li Z, Li F, Wen J, Liu D, Du W, Hou J, Li Z, Zheng R, Liu D, Chu T, Du D, Tian H

PMID: 28274848 [PubMed - indexed for MEDLINE]

Vulvovaginal candidiasis: species distribution of Candida and their antifungal susceptibility pattern.

Thu, 03/14/2019 - 06:46
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Vulvovaginal candidiasis: species distribution of Candida and their antifungal susceptibility pattern.

BMC Womens Health. 2018 06 15;18(1):94

Authors: Bitew A, Abebaw Y

Abstract
BACKGROUND: Vulvovaginal candidiasis is a global issue of concern due to its association with economic costs, sexually transmitted infections, and ascending genital tract infection. The aim of this study was to determine species distribution and antifungal susceptibility pattern of Candida species causing vulvovaginal candidiasis.
METHODS: A cross sectional study was conducted from November 2015 to December 2016 at the Family Guidance Association of Ethiopia. Vaginal swabs collected from study subjects that were clinically diagnosed with vulvovaginal candidiasis were cultured. Yeast identification and antifungal susceptibility testing were determined by the automated VITEK 2 compact system. The association of vulvovaginal candidiasis with possible risk factors was assessed and analyzed using SPSS version 20.
RESULTS: The overall prevalence of vulvovaginal candidiasis was 41.4%. The association of vulvovaginal candidiasis was statistically significant with previous genital tract infection (p = 0.004), number of life-time male sex partners (p = .037), and number of male sex partners in 12 month (p = 0.001). Of 87 Candida isolates recovered, 58.6% were C. albicans while 41.4% were non-albicans Candida species. The highest overall drug resistance rate of Candida species was observed against fluconazole (17.2%), followed by flycytosine (5.7%). All Candida isolates were 100% susceptible to voriconazole, caspofungin, and micafungin. C. albicans, was 100% susceptible to all drugs tested except fluconazole and flycytosine with a resistance rate of 2% each drug. C. krusei, was 100 and 33.3% resistant to fluconazole and flycytosine, respectively.
CONCLUSIONS: High prevalence rate of vulvovaginal candidiasis and observation of high prevalence rate of non-albicans Candida species in the present study substantiate, the importance of conducting continuous epidemiological surveys to measure changes in species distribution from C. albicans to non-albicans Candida species in Ethiopia. Although, fluconazole still appeared to be active against all isolates of C. albicans and non-albicans Candida species high resistance rate of C. krusei against the drug may demonstrate a search for alternative antifungal drugs when treating vulvovaginal candidiasis caused by C. krusei.

PMID: 29902998 [PubMed - indexed for MEDLINE]

Adverse pregnancy outcomes due to Chlamydia trachomatis.

Sat, 03/09/2019 - 08:24
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Adverse pregnancy outcomes due to Chlamydia trachomatis.

Lancet Infect Dis. 2018 05;18(5):499

Authors: Chen XS

PMID: 29695363 [PubMed - indexed for MEDLINE]

Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000-2016: Estimates using the Spectrum STI tool.

Thu, 03/07/2019 - 08:09
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Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000-2016: Estimates using the Spectrum STI tool.

Infect Dis Model. 2018;3:13-22

Authors: Enkhbat E, Korenromp EL, Badrakh J, Zayasaikhan S, Baya P, Orgiokhuu E, Jadambaa N, Munkhbaatar S, Khishigjargal D, Khad N, Mahiané G, Ishikawa N, Jagdagsuren D, Taylor MM

Abstract
Introduction: Mongolia's health ministry prioritizes control of Sexually Transmitted Infections, including syphilis screening and treatment in antenatal care (ANC).
Methods: Adult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool, using data from ANC surveys and routine screening over 1997-2016. Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis (CS) and CS-attributable adverse birth outcomes (ABO), which we compared with CS case reports.
Results: Syphilis prevalence in pregnant women was estimated at 1.7% in 2000 and 3.0% in 2016. We estimated 652 CS cases, of which 410 ABO, in 2016. Far larger, annually increasing numbers of CS cases and ABO were estimated to have been prevented: 1654 cases, of which 789 ABO in 2016 - thanks to increasing coverages of ANC (99% in 2016), ANC-based screening (97% in 2016) and treatment of women diagnosed (81% in 2016). The 42 CS cases reported nationally over 2016 (liveborn infants only) represented 27% of liveborn infants with clinical CS, but only 7% of estimated CS cases among women found syphilis-infected in ANC, and 6% of all estimated CS cases including those born to women with undiagnosed syphilis.
Discussion/Conclusion: Mongolia's ANC-based syphilis screening program is reducing CS, but maternal prevalence remains high. To eliminate CS (target: <50 cases per 100,000 live births), Mongolia should strengthen ANC services, limiting losses during referral for treatment, and under-diagnosis of CS including still-births and neonatal deaths, and expand syphilis screening and prevention programs.

PMID: 30839908 [PubMed]

Azithromycin Resistance through Interspecific Acquisition of an Epistasis-Dependent Efflux Pump Component and Transcriptional Regulator in Neisseria gonorrhoeae.

Wed, 03/06/2019 - 08:04
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Azithromycin Resistance through Interspecific Acquisition of an Epistasis-Dependent Efflux Pump Component and Transcriptional Regulator in Neisseria gonorrhoeae.

MBio. 2018 08 07;9(4):

Authors: Wadsworth CB, Arnold BJ, Sater MRA, Grad YH

Abstract
Mosaic interspecifically acquired alleles of the multiple transferable resistance (mtr) efflux pump operon correlate with increased resistance to azithromycin in Neisseria gonorrhoeae in epidemiological studies. However, whether and how these alleles cause resistance is unclear. Here, we use population genomics, transformations, and transcriptional analyses to dissect the relationship between variant mtr alleles and azithromycin resistance. We find that the locus encompassing the mtrR transcriptional repressor and the mtrCDE pump is a hot spot of interspecific recombination introducing alleles from Neisseria meningitidis and Neisseria lactamica into N. gonorrhoeae, with multiple rare haplotypes in linkage disequilibrium at mtrD and the mtr promoter region. Transformations demonstrate that resistance to azithromycin, as well as to other antimicrobial compounds such as polymyxin B and crystal violet, is mediated through epistasis between these two loci and that the full-length mosaic mtrD allele is required. Gene expression profiling reveals the mechanism of resistance in mosaics couples novel mtrD alleles with promoter mutations that increase expression of the pump. Overall, our results demonstrate that epistatic interactions at mtr gained from multiple neisserial species has contributed to increased gonococcal resistance to diverse antimicrobial agents.IMPORTANCENeisseria gonorrhoeae is the sexually transmitted bacterial pathogen responsible for more than 100 million cases of gonorrhea worldwide each year. The incidence of resistance to the macrolide azithromycin has increased in the past decade; however, a large proportion of the genetic basis of resistance remains unexplained. This study is the first to conclusively demonstrate the acquisition of macrolide resistance through mtr alleles from other Neisseria species, demonstrating that commensal Neisseria bacteria are a reservoir for antibiotic resistance to macrolides, extending the role of interspecies mosaicism in resistance beyond what has been previously described for cephalosporins. Ultimately, our results emphasize that future fine-mapping of genome-wide interspecies mosaicism may be valuable in understanding the pathways to antimicrobial resistance. Our results also have implications for diagnostics and public health surveillance and control, as they can be used to inform the development of sequence-based tools to monitor and control the spread of antibiotic-resistant gonorrhea.

PMID: 30087172 [PubMed - indexed for MEDLINE]

A Novel Sialylation Site on Neisseria gonorrhoeae Lipooligosaccharide Links Heptose II Lactose Expression with Pathogenicity.

Tue, 03/05/2019 - 08:02
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A Novel Sialylation Site on Neisseria gonorrhoeae Lipooligosaccharide Links Heptose II Lactose Expression with Pathogenicity.

Infect Immun. 2018 08;86(8):

Authors: Ram S, Gulati S, Lewis LA, Chakraborti S, Zheng B, DeOliveira RB, Reed GW, Cox AD, Li J, St Michael F, Stupak J, Su XH, Saha S, Landig CS, Varki A, Rice PA

Abstract
Sialylation of lacto-N-neotetraose (LNnT) extending from heptose I (HepI) of gonococcal lipooligosaccharide (LOS) contributes to pathogenesis. Previously, gonococcal LOS sialyltransterase (Lst) was shown to sialylate LOS in Triton X-100 extracts of strain 15253, which expresses lactose from both HepI and HepII, the minimal structure required for monoclonal antibody (MAb) 2C7 binding. Ongoing work has shown that growth of 15253 in cytidine monophospho-N-acetylneuraminic acid (CMP-Neu5Ac)-containing medium enables binding to CD33/Siglec-3, a cell surface receptor that binds sialic acid, suggesting that lactose termini on LOSs of intact gonococci can be sialylated. Neu5Ac was detected on LOSs of strains 15253 and an MS11 mutant with lactose only from HepI and HepII by mass spectrometry; deleting HepII lactose rendered Neu5Ac undetectable. Resistance of HepII lactose Neu5Ac to desialylation by α2-3-specific neuraminidase suggested an α2-6 linkage. Although not associated with increased factor H binding, HepII lactose sialylation inhibited complement C3 deposition on gonococci. Strain 15253 mutants that lacked Lst or HepII lactose were significantly attenuated in mice, confirming the importance of HepII Neu5Ac in virulence. All 75 minimally passaged clinical isolates from Nanjing, China, expressed HepII lactose, evidenced by reactivity with MAb 2C7; MAb 2C7 was bactericidal against the first 62 (of 75) isolates that had been collected sequentially and were sialylated before testing. MAb 2C7 effectively attenuated 15253 vaginal colonization in mice. In conclusion, this novel sialylation site could explain the ubiquity of gonococcal HepII lactose in vivo Our findings reinforce the candidacy of the 2C7 epitope as a vaccine antigen and MAb 2C7 as an immunotherapeutic antibody.

PMID: 29844237 [PubMed - indexed for MEDLINE]

Preseptal cellulitis caused by Neisseria gonorrhoeae: A rare disease need to be vigilant.

Tue, 03/05/2019 - 08:02
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Preseptal cellulitis caused by Neisseria gonorrhoeae: A rare disease need to be vigilant.

J Microbiol Immunol Infect. 2017 Jun;50(3):397-398

Authors: Yao HY, Wang CH

PMID: 26210760 [PubMed - indexed for MEDLINE]

Immunochip for Syphilis Serodiagnostics with the Use of Extended Array of Treponema pallidum Recombinant Antigens.

Tue, 02/26/2019 - 13:20
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Immunochip for Syphilis Serodiagnostics with the Use of Extended Array of Treponema pallidum Recombinant Antigens.

Bull Exp Biol Med. 2018 Oct;165(6):767-771

Authors: Runina AV, Katunin GL, Filippova MA, Zatevalov AM, Kubanov AA, Deryabin DG

Abstract
An immunochip for multiple parallel detection of specific serum IgG in serological screening for syphilis is based on the use of an extended array of Treponema pallidum recombinant proteins and includes traditionally used immunodominant antigens (Tp15, Tp17, Tp47, and TmpA) and new synthetic proteins (Tp0277, Tp0319, Tp0453, Tp0684, Tp0965, and Tp1038). The use of individual antigens has demonstrated high analytical value of Tp0277 (periplasmatic C-terminal protease), Tp0319 (cytoplasmic membrane-associated lipoprotein TmpC), and external membrane-associated protein Tp0453 with transporting function, all of them improving significantly the efficiency of screening for syphilis in comparison with the traditional array of antigens. Multiparametric analysis of the results obtained on the immunochip with the use of linear discriminant analysis confirmed the efficiency of extended array of T. pallidum diagnostic antigens. Due to proposed modification, the "positive" and "negative" sera are clearly differentiated: the serological study showed 94.1% sensitivity and 100% specificity.

PMID: 30353336 [PubMed - indexed for MEDLINE]

Genomic epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in New Zealand.

Tue, 02/26/2019 - 13:20
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Genomic epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in New Zealand.

J Antimicrob Chemother. 2018 02 01;73(2):353-364

Authors: Lee RS, Seemann T, Heffernan H, Kwong JC, Gonçalves da Silva A, Carter GP, Woodhouse R, Dyet KH, Bulach DM, Stinear TP, Howden BP, Williamson DA

Abstract
Background: Antimicrobial-resistant Neisseria gonorrhoeae is a major threat to public health. No studies to date have examined the genomic epidemiology of gonorrhoea in the Western Pacific Region, where the incidence of gonorrhoea is particularly high.
Methods: A population-level study of N. gonorrhoeae in New Zealand (October 2014 to May 2015). Comprehensive susceptibility testing and WGS data were obtained for 398 isolates. Relatedness was inferred using phylogenetic trees, and pairwise core SNPs. Mutations and genes known to be associated with resistance were identified, and correlated with phenotype.
Results: Eleven clusters were identified. In six of these clusters, >25% of isolates were from females, while in eight of them, >15% of isolates were from females. Drug resistance was common; 98%, 32% and 68% of isolates were non-susceptible to penicillin, ciprofloxacin and tetracycline, respectively. Elevated MICs to extended-spectrum cephalosporins (ESCs) were observed in 3.5% of isolates (cefixime MICs ≥ 0.12 mg/L, ceftriaxone MICs ≥ 0.06 mg/L). Only nine isolates had penA XXXIV genotypes, three of which had decreased susceptibility to ESCs (MIC = 0.12 mg/L). Azithromycin non-susceptibility was identified in 43 isolates (10.8%); two of these isolates had 23S mutations (C2611T, 4/4 alleles), while all had mutations in mtrR or its promoter.
Conclusions: The high proportion of females in clusters suggests transmission is not exclusively among MSM in New Zealand; re-assessment of risk factors for transmission may be warranted in this context. As elevated MICs of ESCs and/or azithromycin were found in closely related strains, targeted public health interventions to halt transmission are urgently needed.

PMID: 29182725 [PubMed - indexed for MEDLINE]

Fitness cost and benefit of antimicrobial resistance in Neisseria gonorrhoeae: Multidisciplinary approaches are needed.

Tue, 02/26/2019 - 13:20
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Fitness cost and benefit of antimicrobial resistance in Neisseria gonorrhoeae: Multidisciplinary approaches are needed.

PLoS Med. 2017 10;14(10):e1002423

Authors: Unemo M, Althaus CL

Abstract
In a Perspective on the research article by Didelot and colleagues, Magnus Unemo and Christian Althaus discuss the value of modelling studies to inform antimicrobial resistance management and the limitations of the current evidence base informing such models.

PMID: 29088232 [PubMed - indexed for MEDLINE]

Is sexual autonomy a protective factor for neonatal, child, and infant mortality? A multi-country analysis.

Sat, 02/23/2019 - 07:10

Is sexual autonomy a protective factor for neonatal, child, and infant mortality? A multi-country analysis.

PLoS One. 2019;14(2):e0212413

Authors: Memiah P, Opanga Y, Bond T, Cook C, Mwangi M, Fried J, Joseph MA, Owuor K, Mochache V, Machira YW

Abstract
BACKGROUND: Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman's ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality.
METHODOLOGY: This was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15-49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under-five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of "respondent can refuse sex," "respondent can ask partner to use condom," and "if spouse is justified in asking husband to use condom." Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi-square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables.
RESULTS: The sampled women were predominantly urban (75%; n = 5758) and poor (48.7%; n = 3702). A majority of those that experienced mortality (neonatal mortality 53.5%, infant mortality 54.3%, under-five mortality 55.7%) were young (under 20) at the time of their first child's birth while their male partners were older. The multivariate analysis supports the beneficial effects of women's sexual autonomy in East Africa. Women who exercised sexual autonomy experienced significantly lower rates of child mortality at all three stages: neonatal (NHR = 0.80, 95% CI: 0.68-0.94, p = 0.006), infant (IHR = 0.82, 95% CI: 0.72-0.93, p = 0.003), and under-five (UHR = 0.84, 95% CI: 0.75-0.94, p = 0.002), net of all other factors. Receiving antenatal care and using contraceptives also contributed significantly to lower child mortality rates.
CONCLUSION: Our findings suggest that sexual autonomy among East African women is an urgent priority that is crucial to the survival of neonates, infants, and children in East Africa. Women should be informed, empowered, and autonomous concerning their reproductive and sexual health.

PMID: 30794592 [PubMed - in process]

Evaluating the progress to eliminate mother-to-child transmission (MTCT) of syphilis in Hunan Province, China: A study based on a health service delivery model.

Sat, 02/23/2019 - 07:10
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Evaluating the progress to eliminate mother-to-child transmission (MTCT) of syphilis in Hunan Province, China: A study based on a health service delivery model.

PLoS One. 2018;13(9):e0203565

Authors: Liu Z, Wang T, Liu Y, Wang A, Xie D, Kong F, Xiong L, Chen L, Wang H

Abstract
To prevent mother-to-child transmission (MTCT) of syphilis, Hunan Province launched a free syphilis screening and treatment programme in 2011. Thus far, the programme has been implemented for 6 years. This study aimed to assess progress toward the elimination of MTCT of syphilis in Hunan Province from 2011-2016. Estimates of syphilis-related adverse pregnancy outcomes (APOs) were based on the health service delivery model developed by the WHO, which were then translated into disability-adjusted life years (DALYs). Default values in the model were replaced by a Chinese version. The progress of this programme was assessed through the reduction of estimated DALYs with and without screening and treatment services. The results showed that the estimated number of syphilis-related APOs in Hunan Province from 2011 to 2016 was 3,840, more than 70% of which occurred among women who had at least one antenatal care visit but were not screened or treated for syphilis during pregnancy. The public health burden resulting from maternal syphilis-related APOs was 192,528 DALYs over six years, and with the current screening and treatment coverage, approximately 163,794 expected DALYs (46%) were averted. Our estimates indicate that in Hunan Province, syphilis in pregnancy continues to be an important cause of APOs, which can lead to substantial perinatal morbidity and mortality. Approximately half of the expected public health burden resulting from syphilis-related APOs was averted by the current screening and treatment services, which suggests progress toward the elimination of MTCT of syphilis in Hunan Province.

PMID: 30192825 [PubMed - indexed for MEDLINE]

Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil.

Sat, 02/23/2019 - 07:10
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Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil.

Rev Lat Am Enfermagem. 2018 Aug 09;26:e3019

Authors: Padovani C, Oliveira RR, Pelloso SM

Abstract
OBJECTIVE: To analyze the prevalence of syphilis in during pregnancy and its association with socioeconomic characteristics, reproductive history, prenatal and labor care, and newborn characteristics.
METHOD: A retrospective, cross-sectional study based on gestational and congenital syphilis reports. A (records) linkage was performed in the Brazilian databases: "Information System for Notifiable Diseases" (Sistema de Informação de Agravos de Notificação - SINAN); "Live Births Information System" (Sistema de Informação sobre Nascidos Vivos - SINASC); and "Mortality Information System" (Sistema de Informação sobre Mortalidade - SIM).
RESULTS: The prevalence of gestational syphilis was 0.57%. The following associations of syphilis in pregnancy were found: non-white skin color/ethnicity (PR=4.6, CI=3.62-5.76); low educational level (PR=15.4; CI=12.60-18.86); and absence of prenatal care (PR=7.4, CI=3.68-14.9). The perinatal outcomes associated with gestational syphilis were prematurity (PR=1.6 CI=1.17-2.21) and low birth weight (PR=1.6; CI=1.14-2.28). Two deaths from congenital syphilis, one death from another cause and five stillbirths were reported.
CONCLUSION: The results signify a long way until reaching the World Health Organization's goal of eradicating congenital syphilis.

PMID: 30110097 [PubMed - indexed for MEDLINE]

Treating chlamydial infections in pregnancy and preventing adverse birth outcomes.

Sat, 02/23/2019 - 07:10
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Treating chlamydial infections in pregnancy and preventing adverse birth outcomes.

Lancet Infect Dis. 2018 04;18(4):368-369

Authors: Adamson PC, Klausner JD

PMID: 29371068 [PubMed - indexed for MEDLINE]

Messages about Contraception and Condoms in Mother-Adolescent Dyadic Conversations: Knowledge, Risks and Effectiveness.

Wed, 02/20/2019 - 10:00
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Messages about Contraception and Condoms in Mother-Adolescent Dyadic Conversations: Knowledge, Risks and Effectiveness.

J Pediatr Adolesc Gynecol. 2019 Feb 16;:

Authors: McCallister CJ, Akers AY, Worlds AD, Morrison PK

Abstract
STUDY OBJECTIVE: Little is known about the content of parental discussions with young adolescents about reproductive health topics. We sought to characterize the messages mothers share about contraception and condoms.
DESIGN: Recruitment occurred between January 2012 and May 2013. Mothers and their 12- to 14-year-old adolescent son or daughter were invited to participate in a semi-structured conversation about everyday issues and health topics, including reproductive health topics. Discussions were audio-recorded, transcribed and a grounded theory approach to content analysis performed. Content analysis was performed to characterize maternal messages regarding contraception and condoms.
SETTING: Urban city in western Pennsylvania.
PARTICIPANTS: Twenty-five dyads; 14 mother-daughter dyads and 11 mother-son dyads.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES(S): Maternal reproductive health messages during conversations with early adolescent children.
RESULTS: Four key themes emerged. Theme 1 focused on general facts about condoms and contraceptive methods, how each works, and how to obtain them. Theme 2 emphasized the consequences of sexual behaviors and the advantages of safe sex. Theme 3 conveyed the effectiveness of condoms and contraceptive methods for preventing pregnancy and sexually transmitted infections. Theme 4 described where adolescents could get more information about condoms and contraception.
CONCLUSIONS: Mothers convey a broad range of information about contraceptives and condoms to young adolescents.

PMID: 30779964 [PubMed - as supplied by publisher]

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