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In vitro activity of the ketolide cethromycin in multidrug-resistant clinical Neisseria gonorrhoeae isolates and international reference strains.

Tue, 05/21/2019 - 07:45
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In vitro activity of the ketolide cethromycin in multidrug-resistant clinical Neisseria gonorrhoeae isolates and international reference strains.

J Chemother. 2019 May 20;:1-6

Authors: Jacobsson S, Alirol E, Unemo M

Abstract
Antimicrobial resistance in Neisseria gonorrhoeae is a major public health problem, which compromises the treatment of gonorrhoea globally. We evaluated the in vitro activity of the ketolide cethromycin against a large panel of clinical gonococcal isolates and international reference strains (n = 254), including numerous multidrug-resistant and extensively drug-resistant isolates. Cethromycin showed potent in vitro activity against most of the gonococcal isolates with the following modal MIC, MIC50 and MIC90: 0.064 mg/L, 0.125 mg/L and 0.5 mg/L, respectively. However, cross-resistance between azithromycin and cethromycin was identified (Spearman's rank correlation coefficient 0.917) and isolates displaying high-level resistance to azithromycin (MIC >256 mg/L; n = 9) also showed high MICs of cethromycin (32-256 mg/L). In conclusion, the cross-resistance with azithromycin indicates that cethromycin may not be considered for empirical first-line monotherapy of gonorrhoea. However, cethromycin might be valuable in combination antimicrobial therapy and for second-line therapy e.g. for cases with ceftriaxone resistance or allergy.

PMID: 31106713 [PubMed - as supplied by publisher]

Gentamicin as an alternative to ceftriaxone in the treatment of gonorrhoea: the G-TOG non-inferiority RCT.

Sat, 05/18/2019 - 07:01

Gentamicin as an alternative to ceftriaxone in the treatment of gonorrhoea: the G-TOG non-inferiority RCT.

Health Technol Assess. 2019 May;23(20):1-104

Authors: Ross JD, Harding J, Duley L, Montgomery AA, Hepburn T, Tan W, Brittain C, Meakin G, Sprange K, Thandi S, Jackson L, Roberts T, Wilson J, White J, Dewsnap C, Cole M, Lawrence T

Abstract
BACKGROUND: Gonorrhoea is a common sexually transmitted infection that can cause pain and discomfort, affect fertility in women and lead to epididymo-orchitis in men. Current treatment is with ceftriaxone, but there is increasing evidence of antimicrobial resistance reducing its effectiveness. Gentamicin is a potential alternative treatment requiring further evaluation.
OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of gentamicin as an alternative treatment to ceftriaxone in the treatment of gonorrhoea.
DESIGN: A multicentre, parallel-group, blinded, non-inferiority randomised controlled trial.
SETTING: Fourteen sexual health clinics in England.
PARTICIPANTS: Adults aged 16-70 years with a diagnosis of uncomplicated, untreated genital, pharyngeal or rectal gonorrhoea based on a positive Gram-stained smear on microscopy or a positive nucleic acid amplification test (NAAT).
RANDOMISATION AND BLINDING: Participants were randomised using a secure web-based system, stratified by clinic. Participants, investigators and research staff assessing participants were blinded to treatment allocation.
INTERVENTIONS: Allocation was to either 240 mg of gentamicin (intervention) or 500 mg of ceftriaxone (standard treatment), both administered as a single intramuscular injection. All participants also received 1 g of oral azithromycin.
MAIN OUTCOME MEASURE: The primary outcome measure was clearance of Neisseria gonorrhoeae at all infected sites, confirmed by a negative Aptima Combo 2® (Hologic Inc., Marlborough, MA, USA) NAAT, at 2 weeks post treatment.
RESULTS: We randomised 720 participants, of whom 81% were men. There were 358 participants in the gentamicin group and 362 in the ceftriaxone group; 292 (82%) and 306 (85%) participants, respectively, were included in the primary analysis. Non-inferiority of gentamicin to ceftriaxone could not be demonstrated [adjusted risk difference for microbiological clearance -6.4%, 95% confidence interval (CI) -10.4% to -2.4%]. Clearance of genital infection was similar in the two groups, at 94% in the gentamicin group and 98% in the ceftriaxone group, but clearance of pharyngeal infection and rectal infection was lower in the gentamicin group (80% vs. 96% and 90% vs. 98%, respectively). Reported pain at the injection site was higher for gentamicin than for ceftriaxone. The side-effect profiles were comparable between the groups. Only one serious adverse event was reported and this was deemed not to be related to the trial medication. The economic analysis found that treatment with gentamicin is not cost neutral compared with standard care, with average patient treatment costs higher for those allocated to gentamicin (£13.90, 95% CI £2.47 to £37.34) than to ceftriaxone (£6.72, 95% CI £1.36 to £17.84).
LIMITATIONS: Loss to follow-up was 17% but was similar in both treatment arms. Twelve per cent of participants had a negative NAAT for gonorrhoea at their baseline visit but this was balanced between treatment groups and unlikely to have biased the trial results.
CONCLUSIONS: The trial was unable to demonstrate non-inferiority of gentamicin compared with ceftriaxone in the clearance of gonorrhoea at all infected sites. Clearance at pharyngeal and rectal sites was lower for participants allocated to gentamicin than for those allocated to ceftriaxone, but was similar for genital sites in both groups. Gentamicin was associated with more severe injection site pain. However, both gentamicin and ceftriaxone appeared to be well tolerated.
FUTURE WORK: Exploration of the genetic determinants of antibiotic resistance in N. gonorrhoeae will help to identify accurate markers of decreased susceptibility. Greater understanding of the immune response to infection can assist gonococcal vaccine development.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN51783227.
FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 20. See the NIHR Journals Library website for further project information.

PMID: 31099330 [PubMed - in process]

Launch of the BASHH guideline for the management of M. genitalium in adults.

Sat, 05/18/2019 - 07:01
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Launch of the BASHH guideline for the management of M. genitalium in adults.

Sex Transm Infect. 2019 Jun;95(4):237

Authors: Soni S, Horner PJ

PMID: 31097546 [PubMed - in process]

Implementation of a protocol and staff educational sessions improves the care of survivors of sexual assault.

Sat, 05/18/2019 - 07:01
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Implementation of a protocol and staff educational sessions improves the care of survivors of sexual assault.

Maturitas. 2019 Jun;124:39-42

Authors: Gilles C, Manigart Y, Rousseau C, Libois A, Gennotte AF, Rozenberg S

Abstract
OBJECTIVE: We previously conducted an audit of the care provided for survivors of sexual violence seen at our emergency department and observed that 90% of them did not receive optimal care. This study analysed whether the implementation of a new protocol and educational sessions for staff increased the proportion of such patients who received optimal medical care.
METHODS: A computerized chart detailing a new care protocol was developed specifically for rape survivors. Educational sessions focusing on the use of the new protocol were organized for healthcare providers. We then conducted another audit that reviewed retrospectively the charts of all survivors of sexual violence who were cared for at a public university hospital.
MAIN OUTCOME MEASURE: Optimal medical care was defined as including systematic investigations for sexually transmitted diseases, and the provision of prophylactic antibiotics, a pregnancy test, emergency contraception, and psychological and medical follow-up.
RESULTS: We analysed the charts of 362 survivors of sexual violence and observed that all of the required procedures were completed for 337 patients (93%) and the required preventive measures were provided to 325 patients (90%).
CONCLUSION: After the implementation of the new protocol and educational sessions, the proportion of survivors who received optimal medical care increased from 10% to 90%. Nevertheless, optimal management also implies social, psychological and legal support. We hope that the establishment of specialist sexual assault centres will further improve management.

PMID: 31097177 [PubMed - in process]

Equine trypanosomosis: enigmas and diagnostic challenges.

Fri, 05/17/2019 - 06:50
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Equine trypanosomosis: enigmas and diagnostic challenges.

Parasit Vectors. 2019 May 15;12(1):234

Authors: Büscher P, Gonzatti MI, Hébert L, Inoue N, Pascucci I, Schnaufer A, Suganuma K, Touratier L, Van Reet N

Abstract
Equine trypanosomosis is a complex of infectious diseases called dourine, nagana and surra. It is caused by several species of the genus Trypanosoma that are transmitted cyclically by tsetse flies, mechanically by other haematophagous flies, or sexually. Trypanosoma congolense (subgenus Nannomonas) and T. vivax (subgenus Dutonella) are genetically and morphologically distinct from T. brucei, T. equiperdum and T. evansi (subgenus Trypanozoon). It remains controversial whether the three latter taxa should be considered distinct species. Recent outbreaks of surra and dourine in Europe illustrate the risk and consequences of importation of equine trypanosomosis with infected animals into non-endemic countries. Knowledge on the epidemiological situation is fragmentary since many endemic countries do not report the diseases to the World Organisation for Animal Health, OIE. Other major obstacles to the control of equine trypanosomosis are the lack of vaccines, the inability of drugs to cure the neurological stage of the disease, the inconsistent case definition and the limitations of current diagnostics. Especially in view of the ever-increasing movement of horses around the globe, there is not only the obvious need for reliable curative and prophylactic drugs but also for accurate diagnostic tests and algorithms. Unfortunately, clinical signs are not pathognomonic, parasitological tests are not sufficiently sensitive, serological tests miss sensitivity or specificity, and molecular tests cannot distinguish the taxa within the Trypanozoon subgenus. To address the limitations of the current diagnostics for equine trypanosomosis, we recommend studies into improved molecular and serological tests with the highest possible sensitivity and specificity. We realise that this is an ambitious goal, but it is dictated by needs at the point of care. However, depending on available treatment options, it may not always be necessary to identify which trypanosome taxon is responsible for a given infection.

PMID: 31092285 [PubMed - in process]

Neisseria cinerea with High Ceftriaxone MIC Is a Source of Ceftriaxone and Cefixime Resistance-Mediating penA Sequences in Neisseria gonorrhoeae.

Wed, 05/15/2019 - 06:32
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Neisseria cinerea with High Ceftriaxone MIC Is a Source of Ceftriaxone and Cefixime Resistance-Mediating penA Sequences in Neisseria gonorrhoeae.

Antimicrob Agents Chemother. 2018 03;62(3):

Authors: Igawa G, Yamagishi Y, Lee KI, Dorin M, Shimuta K, Suematsu H, Nakayama SI, Mikamo H, Unemo M, Ohnishi M

Abstract
Mosaic penA alleles have caused most of the cephalosporin resistance in Neisseria gonorrhoeae, but their evolution is mostly unknown. The penA gene from Neisseria cinerea strain AM1601 (ceftriaxone MIC, 1.0 μg/ml) caused ceftriaxone resistance (MIC, 1 μg/ml) in a ceftriaxone-susceptible gonococcal strain. The 3'-terminal half of AM1601 penA was almost identical to that of the ceftriaxone-resistant gonococcal GU140106 and FC428 strains. N. cinerea can serve as a reservoir of ceftriaxone resistance-mediating penA sequences that can be transferred to gonococci.

PMID: 29311079 [PubMed - indexed for MEDLINE]

Prevalence of bacterial vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon.

Sun, 05/12/2019 - 08:36
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Prevalence of bacterial vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon.

BMC Pregnancy Childbirth. 2019 May 10;19(1):166

Authors: Kamga YM, Ngunde JP, Akoachere JKT

Abstract
BACKGROUND: Bacterial vaginosis (BV) is a common reproductive tract disorder in women of child bearing age, accounting for one third of vaginal infections. It is characterized by an increase in vaginal pH, decreased Lactobacilli, and overgrowth of facultative and anaerobic bacteria. Studies have consistently shown BV to be a risk factor for adverse obstetric and gynecological outcomes. BV is believed to play a critical role in the transmission of sexually transmitted infections. Its aetiology and risk factors are poorly understood. This study determined the prevalence and risk factors for BV among pregnant women in Kumba Health District (KHD) Cameroon to generate findings that could guide the design of interventions for prevention of infection and associated poor pregnancy outcomes.
METHODS: A structured questionnaire was administered to 309 women seeking antenatal care (ANC) in three health facilities in KHD between May to July 2016, to capture data on demographic, gynecological and obstetric characteristics, and hygiene behavior. High vaginal swabs (HVS) collected from these women were gram stained, examined under a microscope and BV evaluated by Nugent scoring. Chi square (χ2) test was used to determine the relationship between BV and factors investigated. Statistical significance was set at p < 0.05.
RESULTS: The prevalence of BV was 26.2%. Nine point 1 % of participants had a mixed infection with Candida. BV was higher (29.5%) in participants from the rural area (χ2 = 8.609. P = 0.014), those who did not use antibiotics (31.9%) prior to the study (χ2 = 12.893, P = 0.002) and women with no history of a genital tract infection (χ2 = 18.154, P = 0.001). There was a significant difference in prevalence with respect to gestation age (χ2 = 13.959, P = 0.007) with the highest occurring in women in the second trimester (31.7%). Women who practiced douching (χ2 = 23.935, P = 0.000) and those who did not wash pants with disinfectant (χ2 = 7.253, P = 0.027) had a high prevalence.
CONCLUSION: BV could be a health concern among pregnant women in study area. BV prevalence was affected by some hygiene behaviors, socio-demographic and clinical factors. Screening and treatment of positive cases during antenatal visits to prevent adverse outcomes, as well as education of women on vaginal hygiene is highly recommended.

PMID: 31077161 [PubMed - in process]

Successful treatment of gonococcal osteomyelitis with one week of intravenous antibiotic therapy.

Sat, 05/11/2019 - 08:11
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Successful treatment of gonococcal osteomyelitis with one week of intravenous antibiotic therapy.

Int J STD AIDS. 2019 May;30(6):610-612

Authors: Gharamti AA, Pinto NC, Henao-SanMartin V, Franco-Paredes C, Henao-Martínez AF

Abstract
Gonorrhea is one of the most common sexually transmitted infections (STIs). In a minority of cases, a disseminated infection can occur including gonococcal osteoarticular disease. With the steep and sustained increase in STIs in the US, we could see invasive gonococcal disease more often. Most cases of gonococcal osteomyelitis receive prolonged courses of antibiotic therapy. We report here the successful treatment of gonococcal osteomyelitis with one week of antibiotic therapy. Given the emergence of bacterial resistance worldwide and associated side effects, it is crucial to limit antibiotic exposures to the smallest effective dose possible.

PMID: 31074358 [PubMed - in process]

Is Reclassification of the Oral Contraceptive Pill from Prescription to Pharmacist-Only Cost Effective? Application of an Economic Evaluation Approach to Regulatory Decisions.

Fri, 05/10/2019 - 08:01
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Is Reclassification of the Oral Contraceptive Pill from Prescription to Pharmacist-Only Cost Effective? Application of an Economic Evaluation Approach to Regulatory Decisions.

Pharmacoeconomics. 2019 May 09;:

Authors: Gumbie M, Parkinson B, Cutler H, Gauld N, Mumford V

Abstract
BACKGROUND AND OBJECTIVE: Unplanned pregnancies can lead to poorer maternal and child health outcomes. The Australian Therapeutic Goods Administration committee rejected reclassifying a range of oral contraceptive pills (OCPs) from prescription to pharmacist-only medicines in 2015, mainly based on safety concerns. Improving access to OCPs may encourage some women to use contraceptives or switch from other contraceptive methods. However, some adverse events may increase and some women may stop using condoms, increasing their risk of sexually transmitted infections. This study aimed to estimate the cost effectiveness of reclassifying OCPs from prescription to pharmacist-only.
PERSPECTIVE: Healthcare system.
SETTING: Australian primary care.
METHODS: A Markov model was used to synthesise data from a variety of sources. The model included all Australian women aged 15-49 years (N = 5,644,701). The time horizon was 35 years. Contraceptive use before reclassification was estimated using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, while survey data informed use after reclassification. Health outcomes included pregnancies, pregnancy outcomes (live birth, miscarriage, stillbirth, ectopic pregnancy and abortion), sexually transmitted infections, adverse events (venous thromboembolism, depression, myocardial infarction and stroke), ovarian cancer cases and quality-adjusted life-years. Costs included those related to general practitioner and specialist consultations, contraceptives and other medicines, pharmacist time, hospitalisations and adverse events. All costs were reported in 2016 Australian Dollars. A 5% discount rate was applied to health outcomes and costs.
RESULTS: Reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining prescription-only. Thus, reclassifying OCPs was more effective and cost saving. However, a sensitivity analysis found that more research on the probability of pregnancy in women not using contraception and not trying to conceive is needed.
CONCLUSION: Reclassifying OCPs is likely to be considered cost effective by Australian decision makers.

PMID: 31069781 [PubMed - as supplied by publisher]

Syphilis-attributable adverse pregnancy outcomes in China: a retrospective cohort analysis of 1187 pregnant women with different syphilis treatment.

Tue, 05/07/2019 - 07:22
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Syphilis-attributable adverse pregnancy outcomes in China: a retrospective cohort analysis of 1187 pregnant women with different syphilis treatment.

BMC Infect Dis. 2019 Mar 29;19(1):292

Authors: Liu H, Chen N, Yu J, Tang W, He J, Xiao H, Lin S, Hu F, Feng Q, Tucker JD, Xia H, Qiu X

Abstract
BACKGROUND: Syphilis is responsible for a substantial burden of preventable adverse outcomes in pregnancy. The purpose of this study was to compare the frequency of adverse pregnancy outcomes among syphilis-seropositive women who received different treatment regimens at different times in Guangzhou, China.
METHODS: Pregnant women with syphilis infection who received prenatal and delivery services in Guangzhou between January 2014 and December 2016 were included. Association between treatment status and the composite adverse outcomes (preterm birth, infant smaller than gestational age, stillbirth, and spontaneous abortion) was estimated.
RESULTS: Of 1187 syphilis-seropositive pregnant women included in the analysis, 900 (75.8%) syphilis-seropositive pregnant women received treatment, and 287(24.2%) did not receive treatment. Adverse pregnancy outcomes were observed among 16.3% (147/900) of women with treatment and 33.8% (97/287) of women without treatment. Syphilis-seropositive pregnant women treated with one or two courses of penicillin had a similar risk of adverse pregnancy outcomes (adjusted RR = 1.36, 95% CI: 0.94-1.96). Adverse outcomes were more common among women whose non-treponemal serum test titer was >1:8 and received treatment after 28 weeks compared to before 28 weeks (adjusted RR = 2.34, 95% CI: 1.22-4.48).
CONCLUSIONS: Women who received one course of penicillin and women who received two courses of penicillin had a similar risk of adverse pregnancy outcomes. Syphilis treatment before 28 weeks of pregnancy is critical. Strategies to promote high-quality prenatal services are needed.

PMID: 30925908 [PubMed - indexed for MEDLINE]

Considering the Potential Application of Whole Genome Sequencing to Gonorrhea Prevention and Control.

Fri, 05/03/2019 - 15:40
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Considering the Potential Application of Whole Genome Sequencing to Gonorrhea Prevention and Control.

Sex Transm Dis. 2018 06;45(6):e29-e32

Authors: Kirkcaldy RD, Town K, Gernert KM, Bowen VB, Torrone EA, Kersh EN, Bernstein KT

PMID: 29465637 [PubMed - indexed for MEDLINE]

Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin.

Thu, 05/02/2019 - 06:27
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Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin.

Eur J Clin Microbiol Infect Dis. 2018 Sep;37(9):1661-1672

Authors: Ryan L, Golparian D, Fennelly N, Rose L, Walsh P, Lawlor B, Mac Aogáin M, Unemo M, Crowley B

Abstract
High-level resistance and treatment failures with ceftriaxone and azithromycin, the first-line agents for gonorrhoea treatment are reported and antimicrobial-resistant Neisseria gonorrhoeae is an urgent public health threat. Our aims were to determine antimicrobial resistance rates, resistance determinants and phylogeny of N. gonorrhoeae in Ireland, 2014-2016. Overall, 609 isolates from four University Hospitals were tested for susceptibility to extended-spectrum cephalosporins (ESCs) and azithromycin by the MIC Test Strips. Forty-three isolates were whole-genome sequenced based on elevated MICs. The resistance rate to ceftriaxone, cefixime, cefotaxime and azithromycin was 0, 1, 2.1 and 19%, respectively. Seven high-level azithromycin-resistant (HLAzi-R) isolates were identified, all susceptible to ceftriaxone. Mosaic penA alleles XXXIV, X and non-mosaic XIII, and G120K plus A121N/D/G (PorB1b), H105Y (MtrR) and A deletion (mtrR promoter) mutations, were associated with elevated ESC MICs. A2059G and C2611T mutations in 23S rRNA were associated with HLAzi-R and azithromycin MICs of 4-32 mg/L, respectively. The 43 whole-genome sequenced isolates belonged to 31 NG-MAST STs. All HLAzi-R isolates belonged to MLST ST1580 and some clonal clustering was observed; however, the isolates differed significantly from the published HLAzi-R isolates from the ongoing UK outbreak. There is good correlation between previously described genetic antimicrobial resistance determinants and phenotypic susceptibility categories for ESCs and azithromycin in N. gonorrhoeae. This work highlights the advantages and potential of whole-genome sequencing to be applied at scale in the surveillance of antibiotic resistant strains of N. gonorrhoeae, both locally and internationally.

PMID: 29882175 [PubMed - indexed for MEDLINE]

Continued Evolution of Gonococcal Antimicrobial Resistance.

Thu, 05/02/2019 - 06:27
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Continued Evolution of Gonococcal Antimicrobial Resistance.

Clin Infect Dis. 2017 09 15;65(6):924-926

Authors: Hook EW

PMID: 28549116 [PubMed - indexed for MEDLINE]

Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data.

Wed, 05/01/2019 - 06:16
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Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data.

BMC Infect Dis. 2019 Mar 25;19(1):281

Authors: Cole MJ, Quaye N, Jacobsson S, Day M, Fagan E, Ison C, Pitt R, Seaton S, Woodford N, Stary A, Pleininger S, Crucitti T, Hunjak B, Maikanti P, Hoffmann S, Viktorova J, Buder S, Kohl P, Tzelepi E, Siatravani E, Balla E, Hauksdóttir GS, Rose L, Stefanelli P, Carannante A, Pakarna G, Mifsud F, Cassar RZ, Linde I, Bergheim T, Steinbakk M, Mlynarczyk-Bonikowska B, Borrego MJ, Shepherd J, Pavlik P, Jeverica S, Vazquez J, Abad R, Weiss S, Spiteri G, Unemo M

Abstract
BACKGROUND: Confidence in any diagnostic and antimicrobial susceptibility testing data is provided by appropriate and regular quality assurance (QA) procedures. In Europe, the European Gonococcal Antimicrobial Susceptibility Programme (Euro-GASP) has been monitoring the antimicrobial susceptibility in Neisseria gonorrhoeae since 2004. Euro-GASP includes an external quality assessment (EQA) scheme as an essential component for a quality-assured laboratory-based surveillance programme. Participation in the EQA scheme enables any problems with the performed antimicrobial susceptibility testing to be identified and addressed, feeds into the curricula of laboratory training organised by the Euro-GASP network, and assesses the capacity of individual laboratories to detect emerging new, rare and increasing antimicrobial resistance phenotypes. Participant performance in the Euro-GASP EQA scheme over a 10 year period (2007 to 2016, no EQA in 2013) was evaluated.
METHODS: Antimicrobial susceptibility category and MIC results from the first 5 years (2007-2011) of the Euro-GASP EQA were compared with the latter 5 years (2012-2016). These time periods were selected to assess the impact of the 2012 European Union case definitions for the reporting of antimicrobial susceptibility.
RESULTS: Antimicrobial susceptibility category agreement in each year was ≥91%. Discrepancies in susceptibility categories were generally because the MICs for EQA panel isolates were on or very close to the susceptibility or resistance breakpoints. A high proportion of isolates tested over the 10 years were within one (≥90%) or two (≥97%) MIC log2 dilutions of the modal MIC, respectively. The most common method used was Etest on GC agar base. There was a shift to using breakpoints published by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in the latter 5 years, however overall impact on the validity of results was limited, as the percentage categorical agreement and MIC concordance changed very little between the two five-year periods.
CONCLUSIONS: The high level of comparability of results in this EQA scheme indicates that high quality data are produced by the Euro-GASP participants and gives confidence in susceptibility and resistance data generated by laboratories performing decentralised testing.

PMID: 30909883 [PubMed - indexed for MEDLINE]

Etest to detect drug-resistant Neisseria gonorrhoeae to contemporary treatment; methodological issues concerning accuracy and reproducibility.

Wed, 05/01/2019 - 06:16
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Etest to detect drug-resistant Neisseria gonorrhoeae to contemporary treatment; methodological issues concerning accuracy and reproducibility.

J Med Microbiol. 2018 Apr;67(4):465

Authors: Sabour S

PMID: 29458552 [PubMed - indexed for MEDLINE]

Molecular Characterization of Markers Associated With Antimicrobial Resistance in Neisseria gonorrhoeae Identified From Residual Clinical Samples.

Tue, 04/30/2019 - 06:15
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Molecular Characterization of Markers Associated With Antimicrobial Resistance in Neisseria gonorrhoeae Identified From Residual Clinical Samples.

Sex Transm Dis. 2018 05;45(5):312-315

Authors: Melendez JH, Hardick J, Barnes M, Barnes P, Geddes CD, Gaydos CA

Abstract
BACKGROUND: The emergence and spread of antimicrobial-resistant (AMR) Neisseria gonorrhoeae (NG) is a major public health concern. In the era of nucleic acid amplifications tests, rapid and accurate molecular approaches are needed to help increase surveillance, guide antimicrobial stewardship, and prevent outbreaks.
METHODS: Residual urethral swabs, collected prospectively in the Baltimore City Health Department during a 6-month period, were analyzed by real-time polymerase chain reaction assays for NG DNA and AMR determinants to fluoroquinolones, penicillin, and extended-spectrum cephalosporins.
RESULTS: N. gonorrhoeae DNA was detected in 34.8% (73/210) of samples, including 67.3% (68/101) of the swabs that had been previously identified as NG positive by culture. Markers associated with decreased susceptibility to fluoroquinolones were detected in 22.4% of the polymerase chain reaction NG-positive samples. The rate of penicillinase-producing NG was very low (1.6%), and no markers associated with decreased susceptibility to extended-spectrum cephalosporins were detected in this cohort of men using the AMR assays herein described.
CONCLUSIONS: Detection of molecular markers associated with AMR in NG can be performed directly from residual clinical samples, although the recovery rate of adequate DNA for molecular testing from these samples can be suboptimal. A high number of samples with mutations associated with decreased susceptibility to fluoroquinolones were identified.

PMID: 29465687 [PubMed - indexed for MEDLINE]

A Population-Based Study to Compare Treatment Outcomes Among Women With Urogenital Chlamydial Infection in Washington State, 1992 to 2015.

Tue, 04/30/2019 - 06:15
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A Population-Based Study to Compare Treatment Outcomes Among Women With Urogenital Chlamydial Infection in Washington State, 1992 to 2015.

Sex Transm Dis. 2018 05;45(5):319-324

Authors: Khosropour CM, Bell TR, Hughes JP, Manhart LE, Golden MR

Abstract
BACKGROUND: United States guidelines recommend azithromycin or doxycycline for chlamydia (Chlamydia trachomatis [CT]) treatment. These therapies are similarly efficacious for urogenital infections when outcomes are measured 7 to 42 days after treatment, although doxycycline may be superior for rectal infections. Some investigators have suggested that persistent rectal infections may lead to autoinfection of the urogenital tract, potentially resulting in higher rates of recurrent infection in azithromycin-treated women.
METHODS: We used Washington State surveillance data to identify women 14 years or older with urogenital CT (1992-2015) treated with azithromycin or doxycycline. We defined persistent/recurrent CT as a repeat positive CT test result 14 to 180 days after treatment of the initial infection. We used log binomial regression to estimate the adjusted relative risk (aRR) of persistent/recurrent infection associated with treatment with azithromycin versus doxycycline.
RESULTS: From 1992 to 2015, there were 268,596 reported cases of urogenital CT, including 168,301 (63%) who received azithromycin and 66,432 (25%) who received doxycycline. The risk of persistent/recurrent urogenital CT was 6.7% and 4.7% in azithromycin- and doxycycline-treated cases, respectively (P < 0.001). Adjusting for age, race/ethnicity, year, pregnancy status, jurisdiction reporting, reason for examination, and gonorrhea coinfection, azithromycin-treated women were significantly more likely to have persistent/recurrent urogenital CT than doxycycline-treated women (aRR, 1.24; 95% confidence interval [CI], 1.19-1.30). Adjusting the retesting window to 21 to 180 days (aRR, 1.24; 95% CI, 1.19-1.30) and 28 to 180 days (aRR, 1.25; 95% CI, 1.19-1.30) did not alter our primary findings.
CONCLUSIONS: Persistent/recurrent urogenital CT may be more common among women treated with azithromycin than with doxycycline. The reason for this difference is uncertain and is an important area of future investigation.

PMID: 29465681 [PubMed - indexed for MEDLINE]

Sexual behaviors, risks, and sexual health outcomes for adolescent females following bariatric surgery.

Sat, 04/27/2019 - 08:38
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Sexual behaviors, risks, and sexual health outcomes for adolescent females following bariatric surgery.

Surg Obes Relat Dis. 2019 Mar 20;:

Authors: Zeller MH, Brown JL, Reiter-Purtill J, Sarwer DB, Black L, Jenkins TM, McCracken KA, Courcoulas AP, Inge TH, Noll JG, TeenView Study Group, Teen-LABS Consortium

Abstract
BACKGROUND: Adolescents females with severe obesity are less likely to be sexually active, but those who are sexually active engage in risky sexual behaviors.
OBJECTIVES: To examine patterns and predictors of sexual risk behaviors, contraception practices, and sexual health outcomes in female adolescents with severe obesity who did or did not undergo bariatric surgery across 4 years.
SETTING: Five academic medical centers.
METHODS: Using a prospective observational controlled design, female adolescents undergoing bariatric surgery (n = 111; Mage = 16.95 ± 1.44 yr; body mass index: MBMI = 50.99 ± 8.42; 63.1% white) and nonsurgical comparators (n = 68; Mage = 16.18 ± 1.36 yr; MBMI = 46.47 ± 5.83; 55.9% white) completed the Sexual Activities and Attitudes Questionnaire at presurgery/baseline and 24- and 48-month follow-up, with 83 surgical females (MBMI = 39.27 ± 10.08) and 49 nonsurgical females (MBMI = 48.56 ± 9.84) participating at 48 months.
RESULTS: Most experienced sexual debut during the 4-year study period, with a greater increase in behaviors conferring risk for sexually transmitted infections (STIs) for surgical females (P = .03). Half (50% surgical, 44.2% nonsurgical, P = .48) reported partner condom use at last sexual intercourse. The proportion of participants who had ever contracted an STI was similar (18.7% surgical, 14.3% nonsurgical). Surgical patients were more likely to report a pregnancy (25.3% surgical, 8.2% nonsurgical, P = .02) and live birth (16 births in 15 surgical, 1 nonsurgical), with 50% of offspring in the surgical cohort born to teen mothers (age ≤19 yr).
CONCLUSIONS: Bariatric care guidelines and practices for adolescent females must emphasize the risks and consequences of teen or unintended pregnancies, sexual decision-making, dual protection, and STI prevention strategies to optimize health and well-being for the long term.

PMID: 31023575 [PubMed - as supplied by publisher]

In vitro assessment of gentamicin and azithromycin-based combination therapy against Neisseria gonorrhoeae isolates in India.

Fri, 04/26/2019 - 08:22
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In vitro assessment of gentamicin and azithromycin-based combination therapy against Neisseria gonorrhoeae isolates in India.

J Med Microbiol. 2019 Apr;68(4):555-559

Authors: Sood S, Agarwal SK, Singh R, Gupta S, Sharma VK

Abstract
PURPOSE: The public health burden of infections caused by Neisseria gonorrhoeae is magnified due to high rates of resistance to traditional antimicrobials. The aim of this study was to evaluate the in vitro efficacy of an alternative dual therapy comprising gentamicin and azithromycin.
METHODOLOGY: The E-test method was used to determine the minimum inhibitory concentrations (MICs) of gentamicin and azithromycin individually prior to testing in combination using the cross or 90o angle formation method. A total of 70 clinical isolates of N.gonorrhoeae displaying varying ceftriaxone MICs along with 2 reference strains (WHO K and P) and 1 ceftriaxone-resistant QA isolate were examined. The fractional inhibitory concentration index (FICI) was calculated and the results were interpreted using the following criteria: synergy, FICI ≤0.5; indifference or additive, FICI >0.5 to ≤4.0; and antagonism, FICI >4.0.
RESULTS: A total of 54 (77.1 %) isolates displayed indifference, while 16 (22.9 %) demonstrated synergy. When azithromycin was tested alone, the MICs ranged from 0.016 to 2 µg ml-1 . However, in combination with gentamicin, the mean MIC value of all isolates decreased from 0.275 µg ml-1 to 0.090 µg ml-1 (P=0.05).When gentamicin was tested alone, the MICs ranged from 0.25 to 8 µg ml-1, with a mean MIC of 4.342 µg ml-1, whereas in combination with azithromycin it decreased significantly to 2.042 µg ml-1 (P=0.04).
CONCLUSION: No antagonism was observed in this combination, suggesting that it could be a future treatment option as we prepare for a post-cephalosporin era. However, comprehensive in vivo evaluations are warranted and recommendations should be made based on clinical trials.

PMID: 30869583 [PubMed - indexed for MEDLINE]

[Sexually transmitted Mycoplasma genitalium infection is difficult to treat].

Fri, 04/26/2019 - 08:22
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[Sexually transmitted Mycoplasma genitalium infection is difficult to treat].

Ugeskr Laeger. 2018 May 14;180(20):

Authors: Jensen JS, Salado-Rasmussen K

Abstract
Mycoplasma genitalium infection is sexually transmitted, and it is almost as common as chlamydia in most European settings. Symptoms are indistinguishable from those of chlamydia, and late sequelae are believed to be similar. Treatment of M. genitalium infection is complicated due to widespread antimicrobial resistance not only to first-line azithromycin but now also increasingly to second-line moxifloxacin, leaving no other antibiotics registered in Denmark available for effective treatment. In the absence of available antimicrobials, screening of asymptomatic individuals should be avoided.

PMID: 29798753 [PubMed - indexed for MEDLINE]

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