PubMed STI Feed

PubMed STI Feed
NCBI: db=pubmed; Term=(sexually transmitted infections OR sexually transmitted diseases) AND (point of care diagnostics OR pregnancy outcomes OR antibiotic resistance) NOT hiv
Updated: 2 hours 59 min ago

C4BP-IgM protein as a novel therapeutic approach to treat Neisseria gonorrhoeae infections.

Wed, 10/30/2019 - 06:06

C4BP-IgM protein as a novel therapeutic approach to treat Neisseria gonorrhoeae infections.

JCI Insight. 2019 Oct 29;:

Authors: Bettoni S, Shaughnessy J, Maziarz K, Ermert D, Gulati S, Zheng B, Mörgelin M, Jacobsson S, Riesbeck K, Unemo M, Ram S, Blom AM

Abstract
Gonorrhea is a sexually transmitted infection with 87 million new cases per year globally. Increasing antibiotic resistance has severely limited treatment options. A mechanism that Neisseria gonorrhoeae uses to evade complement attack is binding of the complement inhibitor C4b-binding protein (C4BP). We screened 107 PorB1a and 83 PorB1b clinical isolates randomly selected from a Swedish strain collection over the last 10 years and noted that 96/107 (89.7%) PorB1a and 16/83 (19.3%) PorB1b bound C4BP; C4BP binding significantly correlated with the ability to evade complement-dependent killing (r = 0.78; p<0.0001). We designed two chimeric proteins that fused C4BP domains to the backbone of immunoglobulins IgG or IgM (C4BP-IgG; C4BP-IgM) with the aim of enhancing complement activation and killing of gonococci. Both proteins bound gonococci (Kd C4BP-IgM = 2.4 nM; Kd C4BP-IgG 981 nM), but only hexameric C4BP-IgM efficiently out-competed heptameric C4BP from bacterial surface resulting in enhanced complement deposition and bacterial killing. Furthermore, C4BP-IgM significantly attenuated the duration and burden of colonization of two C4BP-binding gonococcal isolates, but not a C4BP non-binding strain in the mouse vaginal colonization model using human factor H/C4BP transgenic mice. Our pre-clinical data present C4BP-IgM as an adjunctive to conventional antimicrobials for the treatment of gonorrhea.

PMID: 31661468 [PubMed - as supplied by publisher]

Sexually Transmitted Infections in Pregnancy and Reproductive Health: Proceedings of the STAR Sexually Transmitted Infection Clinical Trial Group Programmatic Meeting.

Tue, 10/29/2019 - 15:05
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Sexually Transmitted Infections in Pregnancy and Reproductive Health: Proceedings of the STAR Sexually Transmitted Infection Clinical Trial Group Programmatic Meeting.

Sex Transm Dis. 2019 Oct 22;:

Authors: Wynn A, Bristow CC, Cristillo AD, Murphy SM, van den Broek N, Muzny C, Kallapur S, Cohen C, Ingalls RR, Wiesenfeld H, Litch JA, Morris SR, Klausner JD

Abstract
The goal of the STAR Sexually Transmitted Infection Clinical Trial Group (STI CTG) Programmatic meeting on STIs in Pregnancy and Reproductive Health in April 2018 was to review the latest research and develop recommendations to improve prevention and management of STIs during pregnancy. Experts from academia, government, non-profit and industry discussed the burden of STIs during pregnancy, the impact of STIs on adverse pregnancy and birth outcomes, interventions that work to reduce STIs in pregnancy, and the evidence, policy, and technology needed to improve STI care during pregnancy. Key points of the meeting are as follows: (i) Alternative treatments and therapies for use during pregnancy are needed; (ii) Further research into the relationship between the vaginal microbiome and STIs during pregnancy should be supported; (iii) More research to determine whether STI tests function equally well in pregnant as non-pregnant women is needed; (iv) Development of new lower cost, rapid point-of-care testing assays could allow for expanded STI screening globally; (v) Policies should be implemented that create standard screening and treatment practices globally; (vi) Federal funding should be increased for STI testing and treatment initiatives supported by the Centers for Disease Control and Prevention (CDC), the Centers of Excellence in STI Treatment, public STD clinics, and the President's Emergency Plan for AIDS Relief (PEPFAR).

PMID: 31658242 [PubMed - as supplied by publisher]

Non-standard treatment for uncomplicated Chlamydia trachomatis urogenital infections: a systematic review.

Tue, 10/29/2019 - 15:05
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Non-standard treatment for uncomplicated Chlamydia trachomatis urogenital infections: a systematic review.

BMJ Open. 2018 12 04;8(12):e023808

Authors: Krahn J, Louette A, Caine V, Ha S, Wong T, Lau TTY, Singh AE

Abstract
OBJECTIVES: To review the literature for non-standard treatment options for uncomplicated Chlamydia trachomatis (CT) infections in adolescents and adults.
DESIGN: Systematic review.
DATA SOURCES: Ovid MEDLINE/PubMed, Ovid EMBASE, Cochrane Trials & Systematic Review Databases, CINAHL Plus with Full Text, Web of Science Core Collection, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and Health Canada Trials Database were searched for studies in English or French from 1 January 2006 to 6 August 2017. Keywords included CT, anti-infective or anti-bacterial agents, therapy/pharmacotherapy/management.
REVIEW METHODS: Included were primary research studies. Outcome measures included clinical or microbiological cure, treatment failure and adverse events. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were assessed for risk of bias using the Revised Cochrane Risk of Bias V.2.0 tool for randomised and the Newcastle-Ottawa Quality Assessment Scale for non-randomised studies.
FUNDING SOURCE: Public Health Agency of Canada.
RESULTS: Of the 6899 records identified through the database search, 11 studies were included. One randomised controlled trial reported that delayed release doxycycline was non-inferior to azithromycin. Two studies examined higher doses of azithromycin but reported no additional benefit. One study looked at a 5-day azithromycin treatment regimen and reported a high cure rate. Two studies reported efficacy of sitafloxacin, and a single study supports the use of levofloxacin. Two phase 2 studies reported efficacy of single-dose rifalazil in both men and women. Only one retrospective study was identified that examined treatment in pregnant women and reported that efficacy with single-dose azithromycin exceeded that of amoxicillin and erythromycin. A single study examining the efficacy of a beta-lactam antibiotic was stopped early due to high treatment failures.
CONCLUSIONS: The paucity of existing data highlights the need for further adequately powered studies to evaluate rifalazil, delayed release doxycycline, levofloxacin and other agents for the treatment of uncomplicated CT infections.
PROSPERO REGISTRATION NUMBER: CRD42017073096.

PMID: 30518587 [PubMed - indexed for MEDLINE]

Direct-qPCR Assay for Coupled Identification and Antimicrobial Susceptibility Testing of Neisseria gonorrhoeae.

Tue, 10/29/2019 - 15:05
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Direct-qPCR Assay for Coupled Identification and Antimicrobial Susceptibility Testing of Neisseria gonorrhoeae.

ACS Infect Dis. 2018 09 14;4(9):1377-1384

Authors: Chen L, Shin DJ, Zheng S, Melendez JH, Gaydos CA, Wang TH

Abstract
Multidrug-resistant gonorrhea has become an urgent issue for global public health. As the causative agent of gonorrhea, Neisseria gonorrhoeae, has been progressively developing resistance to nearly all prescribed antimicrobial drugs, monitoring its antimicrobial resistance on a broader scale has become a crucial agenda for effective antibiotic stewardship. Unfortunately, gold standard antimicrobial susceptibility testing (AST) relies on time and labor-intensive phenotypic assays, which lag behind the current diagnostic workflow for N. gonorrhoeae identification based on nucleic acid amplification tests (NAAT). Newer assay technologies based on NAAT can rapidly identify N. gonorrhoeae from clinical specimen but fundamentally lack the capacity to provide phenotypic AST information. Herein, we propose a direct-quantitative PCR (direct-qPCR) assay that enables pathogen-specific identification and phenotypic AST via quantitative measurement of N. gonorrhoeae growth directly from a liquid medium without any sample preprocessing. The assay has an analytical sensitivity of 102 CFU/mL and is highly specific to N. gonorrhoeae in the presence of urogenital flora and clinical swab eluent. We tested seven N. gonorrhoeae strains against three antibiotic agents, penicillin, tetracycline, and ciprofloxacin, and achieved 95.2% category agreement and 85.7% essential agreement with the FDA-approved E-test. The assay presented in this work has the unique ability to identify N. gonorrhoeae and provide phenotypic AST directly from the liquid medium with cell densities as low as 102 CFU/mL, demonstrating an accelerated, sensitive, and scalable workflow for performing both identification and AST of  N. gonorrhoeae.

PMID: 29999304 [PubMed - indexed for MEDLINE]

Trends in Antimicrobial Resistance Patterns in Neisseria Gonorrhoeae in Australia and New Zealand: A Meta-analysis and Systematic Review.

Mon, 10/28/2019 - 15:03
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Trends in Antimicrobial Resistance Patterns in Neisseria Gonorrhoeae in Australia and New Zealand: A Meta-analysis and Systematic Review.

Antibiotics (Basel). 2019 Oct 23;8(4):

Authors: Fletcher-Lartey S, Dronavalli M, Alexander K, Ghosh S, Boonwaat L, Thomas J, Robinson A, Patel Z, Forssman B, Pal N

Abstract
(1) Background: The widespread development of resistance among Neisseria gonorrhoeae (NG) clinical isolates has been reported by surveillance systems around the world. This meta-analysis estimated the changes in susceptibility patterns among antibiotics under surveillance in Australia and New Zealand. (2) Methods: Articles published in English from 1980-2018, from Australia or New Zealand, that met the selection criteria were included. The meta-analysis was carried out using the R statistical software. (3) Results: In Australia, there has been decreasing susceptibility of gonococcal isolates to selected antimicrobials over time. Azithromycin (Odds Ratio (OR): 0.73; 95% Confidence Interval (CI) 0.64-0.82) and ceftriaxone (OR: 0.69; 95% CI 0.59-0.80) showed decreasing levels of susceptibility each year. Western Australia (OR: 0.76; 95% CI 0.60-0.96) and Victoria (OR: 0.74; 95% CI 0.60-0.90) also had decreasing levels of susceptibility to ceftriaxone over time compared with other states and territories. (4) Conclusions: The results highlight the need for the development of new approaches for managing cases of gonorrhoea. Improved antimicrobial stewardship, enhanced surveillance and contact tracing are needed to identify and respond to changes in antibiotic resistance in a timely manner. Increasing awareness and public health follow-up of cases can help to interrupt the cycle of infection and limit transmission.

PMID: 31652729 [PubMed]

Macrophage-Neisseria gonorrhoeae Interactions: A Better Understanding of Pathogen Mechanisms of Immunomodulation.

Mon, 10/28/2019 - 15:03
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Macrophage-Neisseria gonorrhoeae Interactions: A Better Understanding of Pathogen Mechanisms of Immunomodulation.

Front Immunol. 2018;9:3044

Authors: Escobar A, Rodas PI, Acuña-Castillo C

Abstract
Neisseria gonorrhoeae is a significant health problem worldwide due to multi-drug resistance issues and absence of an effective vaccine. Patients infected with N. gonorrhoeae have not shown a better immune response in successive infections. This might be explained by the fact that N. gonorrhoeae possesses several mechanisms to evade the innate and adaptative immune responses at different levels. Macrophages are a key cellular component in the innate immune response against microorganisms. The current information suggests that gonococcus can hijack the host response by mechanisms that involve the control of macrophages activity. In this mini review, we intend to condense the recent knowledge on the macrophage-N. gonorrhoeae interactions with a focus on strategies developed by gonococcus to evade or to exploit immune response to establish a successful infection. Finally, we discuss the opportunities and challenges of therapeutics for controlling immune manipulation by N. gonorrhoeae.

PMID: 30627130 [PubMed - indexed for MEDLINE]

Antimicrobial resistance prediction and phylogenetic analysis of Neisseria gonorrhoeae isolates using the Oxford Nanopore MinION sequencer.

Mon, 10/28/2019 - 15:03
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Antimicrobial resistance prediction and phylogenetic analysis of Neisseria gonorrhoeae isolates using the Oxford Nanopore MinION sequencer.

Sci Rep. 2018 12 04;8(1):17596

Authors: Golparian D, Donà V, Sánchez-Busó L, Foerster S, Harris S, Endimiani A, Low N, Unemo M

Abstract
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is common, compromising gonorrhoea treatment internationally. Rapid characterisation of AMR strains could ensure appropriate and personalised treatment, and support identification and investigation of gonorrhoea outbreaks in nearly real-time. Whole-genome sequencing is ideal for investigation of emergence and dissemination of AMR determinants, predicting AMR, in the gonococcal population and spread of AMR strains in the human population. The novel, rapid and revolutionary long-read sequencer MinION is a small hand-held device that generates bacterial genomes within one day. However, accuracy of MinION reads has been suboptimal for many objectives and the MinION has not been evaluated for gonococci. In this first MinION study for gonococci, we show that MinION-derived sequences analysed with existing open-access, web-based sequence analysis tools are not sufficiently accurate to identify key gonococcal AMR determinants. Nevertheless, using an in house-developed CLC Genomics Workbench including de novo assembly and optimised BLAST algorithms, we show that 2D ONT-derived sequences can be used for accurate prediction of decreased susceptibility or resistance to recommended antimicrobials in gonococcal isolates. We also show that the 2D ONT-derived sequences are useful for rapid phylogenomic-based molecular epidemiological investigations, and, in hybrid assemblies with Illumina sequences, for producing contiguous assemblies and finished reference genomes.

PMID: 30514867 [PubMed - indexed for MEDLINE]

Australian Gonococcal Surveillance Programme, 1 January to 31 March 2018

Thu, 10/24/2019 - 08:54
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Australian Gonococcal Surveillance Programme, 1 January to 31 March 2018

Commun Dis Intell (2018). 2019 Jun 17;43:

Authors: Lahra MM, Enriquez RP

PMID: 31203584 [PubMed - indexed for MEDLINE]

Australian Gonococcal Surveillance Programme, 1 July to 30 September 2018

Thu, 10/24/2019 - 08:54
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Australian Gonococcal Surveillance Programme, 1 July to 30 September 2018

Commun Dis Intell (2018). 2019 May 15;43:

Authors: Lahra MM, Enriquez RP, George CRR, The National Neisseria Network

PMID: 31091404 [PubMed - indexed for MEDLINE]

Microbiological Analysis from a Phase 2 Randomized Study in Adults Evaluating Single Oral Doses of Gepotidacin in the Treatment of Uncomplicated Urogenital Gonorrhea Caused by Neisseria gonorrhoeae.

Thu, 10/24/2019 - 08:54
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Microbiological Analysis from a Phase 2 Randomized Study in Adults Evaluating Single Oral Doses of Gepotidacin in the Treatment of Uncomplicated Urogenital Gonorrhea Caused by Neisseria gonorrhoeae.

Antimicrob Agents Chemother. 2018 12;62(12):

Authors: Scangarella-Oman NE, Hossain M, Dixon PB, Ingraham K, Min S, Tiffany CA, Perry CR, Raychaudhuri A, Dumont EF, Huang J, Hook EW, Miller LA

Abstract
We evaluated microbiological correlates for the successful treatment of Neisseria gonorrhoeae isolates from a phase 2 study of gepotidacin, a novel triazaacenaphthylene antibacterial, for therapy of uncomplicated urogenital gonorrhea. Culture, susceptibility testing, genotypic characterization, and frequency of resistance (FoR) were performed for selected isolates. Microbiological success was defined as culture-confirmed eradication of N. gonorrhoeae Against 69 baseline urogenital isolates, gepotidacin MICs ranged from ≤0.06 to 1 µg/ml (MIC90 = 0.5 µg/ml). For gepotidacin, the ratio of the area under the free-drug concentration-time curve to the MIC (fAUC/MIC) was associated with therapeutic success. Success was 100% (61/61) at fAUC/MICs of ≥48 and decreased to 63% (5/8) for fAUC/MICs of ≤25. All 3 isolates from microbiological failures were ciprofloxacin resistant, had a baseline gepotidacin MIC of 1 µg/ml, and carried a preexisting ParC D86N mutation, a critical residue for gepotidacin binding. In a test-of-cure analysis, the resistance to gepotidacin emerged in 2 isolates (MICs increased ≥32-fold) with additional GyrA A92T mutations, also implicated in gepotidacin binding. Test-of-cure isolates had the same sequence type as the corresponding baseline isolates. For 5 selected baseline isolates, all carrying a ParC D86N mutation, the in vitro FoR to gepotidacin was low (10-9 to 10-10); the resistant mutants had the same A92T mutation as the 2 isolates in which resistance emerged. Five participants with isolates harboring the ParC D86N mutation were treatment successes. In summary, fAUC/MICs of ≥48 predicted 100% microbiological success, including 3 isolates with the ParC D86N mutation (fAUC/MICs ≥ 97). Pharmacokinetic/pharmacodynamic determinations may help to evaluate new therapies for gonorrhea; further study of gepotidacin is warranted. (This study has been registered at ClinicalTrials.gov under identifier NCT02294682.).

PMID: 30249694 [PubMed - indexed for MEDLINE]

Two cases of multidrug-resistant genitourinary Mycoplasma genitalium infection successfully eradicated with minocycline.

Wed, 10/23/2019 - 08:52
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Two cases of multidrug-resistant genitourinary Mycoplasma genitalium infection successfully eradicated with minocycline.

Int J STD AIDS. 2019 04;30(5):512-514

Authors: Glaser AM, Geisler WM, Ratliff AE, Xiao L, Waites KB, Gaisa M

Abstract
Mycoplasma genitalium (MG) infection is a sexually transmitted infection that causes up to 25% of nongonococcal urethritis (NGU). MG strains carrying genetic markers of antimicrobial resistance that may affect treatment outcomes are increasingly recognized as a public health concern. We present two cases of persistent MG NGU with strains carrying both macrolide and quinolone resistance-associated mutations that were eradicated successfully by an extended course of minocycline.

PMID: 30999836 [PubMed - indexed for MEDLINE]

In vitro activity of the novel triazaacenaphthylene gepotidacin (GSK2140944) against MDR Neisseria gonorrhoeae.

Wed, 10/23/2019 - 08:52
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In vitro activity of the novel triazaacenaphthylene gepotidacin (GSK2140944) against MDR Neisseria gonorrhoeae.

J Antimicrob Chemother. 2018 08 01;73(8):2072-2077

Authors: Jacobsson S, Golparian D, Scangarella-Oman N, Unemo M

Abstract
Objectives: Increased antimicrobial resistance surveillance and new effective antimicrobials are crucial to maintain treatable gonorrhoea. We examined the in vitro activity of gepotidacin, a novel triazaacenaphthylene, and the effect of efflux pump inactivation on clinical Neisseria gonorrhoeae isolates and international reference strains (n = 252) and compared gepotidacin with antimicrobials currently or previously recommended for gonorrhoea treatment.
Methods: MICs (mg/L) were determined by agar dilution (gepotidacin) or by Etest (seven other antimicrobials). The gyrA and parC genes were sequenced and the impact of inactivation of the MtrCDE, MacAB and NorM efflux pumps on gepotidacin MICs was examined.
Results: Gepotidacin showed potent in vitro activity against all gonococcal isolates (n = 252; MIC ≤4 mg/L). The modal MIC, MIC50, MIC90 and MIC range of gepotidacin were 0.5, 0.5, 1 and 0.032-4 mg/L, respectively. Inactivation of the MtrCDE efflux pump, but not MacAB or NorM, decreased the gepotidacin MICs for most strains. No significant cross-resistance between gepotidacin and any other antimicrobials, including the fluoroquinolone ciprofloxacin, was identified. However, the ParC D86N mutation (possibly together with additional antimicrobial resistance mutation), which is associated with fluoroquinolone resistance, was associated with increased gepotidacin MICs.
Conclusions: Gepotidacin demonstrated high in vitro activity against gonococcal strains, indicating that gepotidacin could potentially be an effective option for gonorrhoea treatment, particularly in a dual antimicrobial therapy regimen and for patients with resistance or allergy to extended-spectrum cephalosporins. Nevertheless, elucidating in vitro and in vivo resistance emergence and mechanisms in detail, together with further gonorrhoea clinical studies, ideally also including chlamydia and Mycoplasma genitalium are essential.

PMID: 29796611 [PubMed - indexed for MEDLINE]

Novel Chlamydia species isolated from snakes are temperature-sensitive and exhibit decreased susceptibility to azithromycin.

Wed, 10/23/2019 - 08:52
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Novel Chlamydia species isolated from snakes are temperature-sensitive and exhibit decreased susceptibility to azithromycin.

Sci Rep. 2018 04 04;8(1):5660

Authors: Staub E, Marti H, Biondi R, Levi A, Donati M, Leonard CA, Ley SD, Pillonel T, Greub G, Seth-Smith HMB, Borel N

Abstract
Chlamydia species have recently been recognized as emerging pathogens in snakes. However, isolation of novel snake chlamydiae is critical and their growth characteristics are largely unknown. In this study, two novel chlamydial species are described: Chlamydia serpentis and Chlamydia poikilothermis, isolated after attempts on 23 cloacal and choanal swabs from 18 PCR-positive captive snakes originating from different Swiss snake collections. Isolation success, growth curve and infectivity rates over a 48-hour time period were dependent on temperature (37 °C for C. serpentis, 28 °C for C. poikilothermis). C. serpentis and C. poikilothermis were sensitive to tetracycline and moxifloxacin during evaluation by in vitro antibiotic susceptibility assay but intermediate to resistant (2-4 μg/ml) to azithromycin. Whole genome sequencing of the isolates provided proof of the novel species status, and gives insights into the evolution of these branches of genus Chlamydia.

PMID: 29618824 [PubMed - indexed for MEDLINE]

Immune responses in the human female reproductive tract.

Mon, 10/21/2019 - 08:48
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Immune responses in the human female reproductive tract.

Immunology. 2019 Oct 20;:

Authors: Monin L, Whettlock EM, Male V

Abstract
Mucosal surfaces are key interfaces between the host and its environment but also constitute ports of entry for numerous pathogens. The gut and lung mucosae act as points of nutrient and gas exchange, respectively, but the physiological purpose of the female reproductive tract (FRT) is to allow implantation and development of the foetus. Our understanding of immune responses in the FRT has traditionally lagged behind our grasp of the situation at other mucosal sites but recently reproductive immunologists have begun to make rapid progress in this challenging area. Here, we review current knowledge of immune responses in the human FRT and their heterogeneity within and between compartments. In the commensal-rich vagina, the immune system must allow the growth of beneficial microbes, whereas the key challenge in the uterus is allowing the growth of the semi-allogeneic foetus. In both compartments, these objectives must be balanced with the need to eliminate pathogens. Our developing understanding of immune responses in the FRT will help us develop interventions to prevent the spread of sexually transmitted diseases and to improve outcomes of pregnancy for mothers and babies.

PMID: 31630394 [PubMed - as supplied by publisher]

Prevalence of Mycoplasma genitalium infection and antibiotic resistance in Navarra (North Spain).

Sun, 10/20/2019 - 08:46
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Prevalence of Mycoplasma genitalium infection and antibiotic resistance in Navarra (North Spain).

Sex Transm Infect. 2019 Nov;95(7):549

Authors: Adelantado Lacasa M, Beristain X

PMID: 31628262 [PubMed - in process]

The MOSEXY trial: mobile phone intervention for sexual health in youth-a pragmatic randomised controlled trial to evaluate the effect of a smartphone application on sexual health in youth in Stockholm, Sweden.

Sun, 10/20/2019 - 08:46
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The MOSEXY trial: mobile phone intervention for sexual health in youth-a pragmatic randomised controlled trial to evaluate the effect of a smartphone application on sexual health in youth in Stockholm, Sweden.

Sex Transm Infect. 2019 Oct 18;:

Authors: Nielsen AM, De Costa A, Gemzell-Danielsson K, Marrone G, Boman J, Salazar M, Diwan V

Abstract
An estimated 350 million cases of STIs occur globally each year. In Sweden, Chlamydia is the most common STI with approximately 30 000 cases annually, disproportionally affecting youth. National surveys report low condom use among youth. Smartphone coverage is high among this tech-savvy group. In collaboration with youth, we developed an interactive smartphone application comprising games, peer experiences and information snippets to promote condom use.
OBJECTIVES: To evaluate in a randomised controlled trial, the effectiveness of this smartphone application to improve condom use among youth in Stockholm, Sweden.
METHODS: This two-arm, individually randomised controlled trial was implemented through the Youth Health Clinics (YHC) in Stockholm, Sweden. Youth aged 18-23 years, who owned a smartphone and had ≥2 sexual partners during the past 6 months were eligible. The intervention delivered the interactive elements described above over 180 days. The control group received a 'dummy' application. Both groups received standard of care at the YHC. The primary outcome was proportion of consistent (100%) self-reported condom use at 6 months. Secondary outcomes included self-reported number of partners, occurrence of STIs/pregnancy and STI tests during the study period. An intention-to-treat approach was used.
RESULTS: 214 and 219 youth were randomised to the intervention and control groups, respectively. Consistent condom use was reported for 32/214 (15.0%) in the intervention group and for 35/219 (16.0%) in the control group (OR 0.9, 95% CI 0.5 to 1.6). No significant differences in secondary outcomes were seen.
CONCLUSION: We were unable to detect an effect of the intervention. Future research should focus on targeting different subgroups within the overall risk group, with tailored mHealth interventions. The potential for such interventions in settings where sexual health services are unavailable should be evaluated.
TRIAL REGISTRATION NUMBER: ISRCTN13212899.

PMID: 31628248 [PubMed - as supplied by publisher]

Birthing life and death: women's reproductive health in early twentieth-century Rio de Janeiro.

Sat, 10/19/2019 - 08:44
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Birthing life and death: women's reproductive health in early twentieth-century Rio de Janeiro.

Hist Cienc Saude Manguinhos. 2018 Oct-Dec;25(4):921-941

Authors: Roth C

Abstract
This article explores women's reproductive health in early twentieth-century Rio de Janeiro, showing that elevated and sustained stillbirth and maternal mortality rates marked women's reproductive years. Syphilis and obstetric complications during childbirth were the main causes of stillbirths, while puerperal fever led maternal death rates. Utilizing traditional sources such as medical dissertations and lesser-used sources including criminal investigations, this article argues that despite official efforts to medicalize childbirth and increase access to clinical healthcare, no real improvements were made to women's reproductive health in the first half of the twentieth century. This, of course, did not make pregnancy and childbirth any easier for the women who embodied these statistics in their reproductive lives.

PMID: 30624473 [PubMed - indexed for MEDLINE]

Sex without contraceptives in a multi-center study of adolescent emergency department patients.

Thu, 10/10/2019 - 08:28
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Sex without contraceptives in a multi-center study of adolescent emergency department patients.

Acad Emerg Med. 2019 Oct 09;:

Authors: Chernick LS, Chun T, Richards R, Bromberg JR, Ahmad F, McAninch B, Mull C, Shenoi R, Suffoletto B, Casper C, Linakis J, Spirito A, Pediatric Emergency Care Applied Research Network (PECARN)

Abstract
BACKGROUND: In the United States (US), rates of teenage pregnancy and sexually transmitted infections (STI) remain exceptionally high and racial and ethnic disparities persist. Emergency departments (ED) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multi-center ED data exist. The objective of this study was to (1) determine the prevalence of sex without contraceptives in a large multi-center adolescent ED study and (2) assess patient demographic and risky behaviors associated with sex without contraceptives.
METHODS: Participants aged 14-17 (n=3247) in 16 pediatric EDs across the US completed an electronic survey. Questions focused on validated measures of risky sex, use of alcohol, tobacco, marijuana and other drugs, as well as depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females.
RESULTS: In the prior year, 17.4% (236/1356) of males and 15.8% (299/1891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette smoking males, as well as depressed females.
CONCLUSIONS: Adolescent ED patients across the US are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.

PMID: 31596987 [PubMed - as supplied by publisher]

Multidrug-resistant Neisseria gonorrhoeae isolate, belonging to the internationally spreading Japanese FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, Ireland, August 2018.

Wed, 10/09/2019 - 14:26
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Multidrug-resistant Neisseria gonorrhoeae isolate, belonging to the internationally spreading Japanese FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, Ireland, August 2018.

Euro Surveill. 2018 11;23(47):

Authors: Golparian D, Rose L, Lynam A, Mohamed A, Bercot B, Ohnishi M, Crowley B, Unemo M

Abstract
We describe a multidrug-resistant Neisseria gonorrhoeae urethritis case with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Ireland, August 2018. Whole-genome sequencing showed that the isolate IR72 belongs to the internationally spreading multidrug-resistant ceftriaxone-resistant FC428 clade, initially described in Japan in 2015. IR72 was assigned MSLT ST1903, NG-MAST ST17842 and NG-STAR type 1133, including the ceftriaxone resistance-mediating penA-60.001. Global awareness of spreading ceftriaxone-resistant gonococcal strains that threaten recommended dual therapies is essential.

PMID: 30482267 [PubMed - indexed for MEDLINE]

Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content.

Sun, 10/06/2019 - 08:20
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Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content.

J Sex Med. 2019 Oct 01;:

Authors: Haley SG, Tordoff DM, Kantor AZ, Crouch JM, Ahrens KR

Abstract
BACKGROUND: Transgender and non-binary (TNB) youth face disparities in sexual health risks compared with cisgender peers. Comprehensive sex education programs have the potential to result in delayed sexual debut, increased condom and contraceptive use, and reduced sexual risk-taking; however, little research has explored the specific sex education needs of TNB youth.
AIM: To use insights from TNB youth, parents of TNB youth, and healthcare affiliates to understand deficits in sex education experienced by TNB youth, and to elicit recommended content for a comprehensive and trans-inclusive sex education curriculum.
METHODS: We conducted 21 in-depth interviews with non-minor TNB youth (n = 11) and with parents (n = 5) and healthcare affiliates (n = 5) of TNB youth recruited from Seattle Children's Gender Clinic and local TNB community listerv readerships. Data was analyzed using theoretical thematic analysis.
OUTCOMES: Participants described prior sex education experiences and content needs of TNB youth.
RESULTS: Participants described 5 key sources where TNB youth received sexual health information: school curricula, medical practitioners, peers, romantic partners, and online media. Inapplicability of school curricula and variable interactions with medical practitioners led youth to favor the latter sources. 8 content areas were recommended as important in sex education for TNB youth: puberty-related gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, consent and relationships, sex and desire, sexually transmitted infection prevention, fertility and contraception, and healthcare access.
CLINICAL IMPLICATIONS: Dependence on potentially inaccurate sex education sources leaves TNB youth vulnerable to negative outcomes, including sexually transmitted infections, pregnancy, unsanitary/unsafe sex toy use, and shame about their body or sexual desires.
STRENGTHS & LIMITATIONS: Strengths included capturing perspectives of an underserved population using open-ended interview questions, which allowed topics of greatest importance to participants to arise organically. Limitations included a sample size of 21 participants, and racial and geographic homogeneity of youth and parent participants. Only 1 author identifies as TNB. One-on-one interview methods may have omitted participants who would otherwise have been willing to share their perspective in a more impersonal format.
CONCLUSION: This study demonstrates that TNB youth have unique sex education needs that are not well covered in most sexual health curricula. Recommended content for this population includes standard sex education topics that require trans-inclusive framing (eg, contraception), topics specific to TNB youth (eg, gender-affirming medical interventions), and topics absent from standard curricula that warrant universal teaching (eg, information on consent as it relates to sex acts aside from penile-vaginal sex). Haley SG, Tordoff DM, Kantor AZ, et al. Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content. J Sex Med 2020;XX:XXX-XXX.

PMID: 31585806 [PubMed - as supplied by publisher]

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