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Antimicrobial resistance and molecular characterisation of Neisseria gonorrhoeae isolates in Fukuoka, Japan, 1996-2016.

Wed, 05/20/2020 - 10:40
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Antimicrobial resistance and molecular characterisation of Neisseria gonorrhoeae isolates in Fukuoka, Japan, 1996-2016.

J Glob Antimicrob Resist. 2019 06;17:3-7

Authors: Tanaka M, Furuya R, Kobayashi I, Kanesaka I, Ohno A, Katsuse AK

Abstract
OBJECTIVES: Antimicrobial resistance and molecular characteristics of Neisseria gonorrhoeae isolates obtained from 1996-2005 (n=200) and 2008-2016 (n=200) in Fukuoka, Japan, were examined.
METHODS: MICs were determined by agar dilution. Sequence types (STs) were examined using N. gonorrhoeae multiantigen sequence typing (NG-MAST). Sequencing of major extended-spectrum cephalosporin (ESC) resistance determinants (penA, mtrR and ponA) was performed.
RESULTS: Increases in the proportion of gonococci with decreased susceptibility or resistance to cefixime (from 18.0% in 1996-2005 to 46.0% in 2008-2016) and ceftriaxone (from 2.5% to 4.0%) were observed. Gonococcal isolates also showed increased resistance to ciprofloxacin and azithromycin. The four most prevalent NG-MAST STs with a multidrug-resistant phenotype were ST2958 (n=18), ST1407 (n=14), ST6798 (n=12) and ST4015 (n=10). The number of isolates belonging to these four STs rose between the first and second period. Among the 54 isolates belonging to the four major STs, 42 (77.8%) contained a penA mosaic allele and 12 (22.2%) contained a penA non-mosaic allele. The sequence pattern types in the 42 isolates with a penA mosaic allele included type X (64.3%), type XXXIV (33.3%) and a novel pattern type (2.4%). In contrast, all 12 isolates with the penA non-mosaic allele included the sequence pattern type V.
CONCLUSION: Neisseria gonorrhoeae isolates with decreased susceptibility or resistance to ESC have increased over the years. Four major STs with a multidrug-resistant phenotype were identified. These isolates contained a penA mosaic allele or a non-mosaic allele.

PMID: 30448519 [PubMed - indexed for MEDLINE]

Sexually Transmitted and Blood-Borne Infections in Pregnant Women and Adverse Pregnancy Outcomes.

Tue, 05/19/2020 - 07:38
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Sexually Transmitted and Blood-Borne Infections in Pregnant Women and Adverse Pregnancy Outcomes.

J Obstet Gynaecol Can. 2020 May 14;:

Authors: D'Aiuto C, Valderrama A, Byrns M, Boucoiran I

Abstract
OBJECTIVES: To analyze risk factors for the presence of sexually transmitted and blood-borne infections (STBBIs) in pregnancy and to determine whether pregnant women with STBBIs are more likely to experience adverse pregnancy outcomes.
METHODS: This retrospective cohort study involved analyzing the electronic records of 3460 pregnant women followed at Sainte-Justine Hospital in Montréal, Québec, between March 2017 and January 2019. An outcome is defined as a pregnancy where the woman has at least one positive laboratory result for chlamydia, gonorrhea, syphilis, hepatitis B, or hepatitis C (i.e., has one or multiple STBBIs). We performed a logistic regression analysis to determine adjusted odds ratios (aORs) for the risk factors of STBBIs in pregnant women.
RESULTS: We identified 84 positive STBBI cases, an overall prevalence of 2.4% (95% CI 1.9-2.9). A logistic regression analysis showed the following factors to be significantly associated with the presence of STBBIs in pregnancy: age <20 years (OR 4.75; 95% CI 1.89-11.96), age 20-29 years (OR 2.38; 95% CI 1.37-4.14), Afro-Caribbean origin (OR 4.12; 95% CI 1.83-9.27), other non-Caucasian origin (OR 2.38; 95% CI 1.20-4.70), and history of STBBIs (OR 2.33; 95% CI 1.02-5.36). STBBIs were not significantly associated with social and material deprivation indices nor were they associated with low birth weight or preterm birth.
CONCLUSION: This study shows age <20 years, age 20-29 years, Afro-Caribbean or other non-Caucasian origin and history of STBBIs to be risk factors for the presence of STBBIs in pregnancy. These results will allow us to propose interventions to reduce STBBIs in women with common risk factors as part of a comprehensive approach to perinatal care.

PMID: 32418858 [PubMed - as supplied by publisher]

Recognition of the β-lactam carboxylate triggers acylation of Neisseria gonorrhoeae penicillin-binding protein 2.

Tue, 05/19/2020 - 07:38
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Recognition of the β-lactam carboxylate triggers acylation of Neisseria gonorrhoeae penicillin-binding protein 2.

J Biol Chem. 2019 09 20;294(38):14020-14032

Authors: Singh A, Tomberg J, Nicholas RA, Davies C

Abstract
Resistance of Neisseria gonorrhoeae to extended-spectrum cephalosporins (ESCs) has become a major threat to human health. The primary mechanism by which N. gonorrhoeae becomes resistant to ESCs is by acquiring a mosaic penA allele, encoding penicillin-binding protein 2 (PBP2) variants containing up to 62 mutations compared with WT, of which a subset contribute to resistance. To interpret molecular mechanisms underpinning cephalosporin resistance, it is necessary to know how PBP2 is acylated by ESCs. Here, we report the crystal structures of the transpeptidase domain of WT PBP2 in complex with cefixime and ceftriaxone, along with structures of PBP2 in the apo form and with a phosphate ion bound in the active site at resolutions of 1-7-1.9 Å. These structures reveal that acylation of PBP2 by ESCs is accompanied by rotation of the Thr-498 side chain in the KTG motif to contact the cephalosporin carboxylate, twisting of the β3 strand to form the oxyanion hole, and rolling of the β3-β4 loop toward the active site. Recognition of the cephalosporin carboxylate appears to be the key trigger for formation of an acylation-competent state of PBP2. The structures also begin to explain the impact of mutations implicated in ESC resistance. In particular, a G545S mutation may hinder twisting of β3 because its side chain hydroxyl forms a hydrogen bond with Thr-498. Overall, our data suggest that acylation is initiated by conformational changes elicited or trapped by binding of ESCs and that these movements are restricted by mutations associated with resistance against ESCs.

PMID: 31362987 [PubMed - indexed for MEDLINE]

Pelvic inflammatory disease: management requires a patient, prudent, prejudice-free provider.

Tue, 05/12/2020 - 10:25
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Pelvic inflammatory disease: management requires a patient, prudent, prejudice-free provider.

Int J Adolesc Med Health. 2018 11 13;32(1):

Authors: Greydanus DE, Merrick J, Cabral MD

PMID: 30422800 [PubMed - indexed for MEDLINE]

Prevalence, Macrolide Resistance, and Fluoroquinolone Resistance in Mycoplasma genitalium in Men Who Have Sex With Men Attending an Sexually Transmitted Disease Clinic in Dublin, Ireland in 2017-2018.

Sat, 05/09/2020 - 16:19
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Prevalence, Macrolide Resistance, and Fluoroquinolone Resistance in Mycoplasma genitalium in Men Who Have Sex With Men Attending an Sexually Transmitted Disease Clinic in Dublin, Ireland in 2017-2018.

Sex Transm Dis. 2019 04;46(4):e35-e37

Authors: Mulligan V, Lynagh Y, Clarke S, Unemo M, Crowley B

Abstract
This is the first prevalence study of Mycoplasma genitalium and antimicrobial resistance study in Ireland. In urine samples from men who have sex with men (n = 400) attending a sexually transmitted disease clinic in Dublin, the prevalence of M. genitalium was 3% (12 of 400 specimens; 95% confidence interval, 1.3-4.7%), and the prevalences of macrolide resistance (75%), fluoroquinolone resistance (33.3%), and multidrug resistance (33.3%) were very high.

PMID: 30676483 [PubMed - indexed for MEDLINE]

Resistance Profile of Neisseria gonorrhoeae in KwaZulu-Natal, South Africa Questioning the Effect of the Currently Advocated Dual Therapy.

Sat, 05/09/2020 - 16:19
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Resistance Profile of Neisseria gonorrhoeae in KwaZulu-Natal, South Africa Questioning the Effect of the Currently Advocated Dual Therapy.

Sex Transm Dis. 2019 04;46(4):266-270

Authors: Rambaran S, Naidoo K, Dookie N, Moodley P, Sturm AW

Abstract
BACKGROUND: We report on the antimicrobial resistance profile of Neisseria gonorrhoeae isolates and the distribution of tetM genes in isolates with high-level tetracycline resistance in KwaZulu-Natal, South Africa.
METHODS: Male and female patients presenting with urethral and/or vaginal discharge were recruited into the study. Urethral and cervical secretions were cultured on New York City agar. Confirmatory tests for N. gonorrhoeae included Gram stain, catalase, oxidase, and carbohydrate utilization tests. Beta-lactamase was tested by means of the chromogenic cephalosporin test. Minimum inhibitory concentrations were determined using agar dilution with multipoint inoculation. Polymerase chain reaction with gel electrophoresis was used to detect the presence and type of the tetM gene.
RESULTS: N. gonorrhoeae was isolated from the specimens of 319 (26%) of the 1220 recruited patients. Of these 319 isolates, 71% were resistant to 3 or more drugs. Resistance to azithromycin was found in 68% of the isolates. All isolates showed high-level tetracycline resistance with minimum inhibitory concentration values of 16 and 32 mg/mL. The tetM gene was present in 293 (92%). The American type was found in 264 (90%) and the Dutch type in 29 (10%). Twenty-six (8%) did not carry a tetM gene.
CONCLUSIONS: The current syndromic management with dual ceftriaxone and azithromycin is due to the high level of azithromycin resistance factually single-drug therapy. High-level tetracycline resistance based on a resistance mechanism other than ribosome protection by the tetM gene product is present in N. gonorrhoeae infecting South African patients.

PMID: 30657464 [PubMed - indexed for MEDLINE]

Recent Developments in Biomedical Issues in Sexually Transmitted Infections: Implications for Behavioral Parameters of Interest.

Thu, 05/07/2020 - 07:15
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Recent Developments in Biomedical Issues in Sexually Transmitted Infections: Implications for Behavioral Parameters of Interest.

Sex Transm Dis. 2019 06;46(6):e65-e67

Authors: Aral SO, Bachmann LH, Marrazzo JM

PMID: 30601376 [PubMed - indexed for MEDLINE]

Could Dampening Expression of the Neisseria gonorrhoeae mtrCDE-Encoded Efflux Pump Be a Strategy To Preserve Currently or Resurrect Formerly Used Antibiotics To Treat Gonorrhea?

Wed, 05/06/2020 - 07:13
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Could Dampening Expression of the Neisseria gonorrhoeae mtrCDE-Encoded Efflux Pump Be a Strategy To Preserve Currently or Resurrect Formerly Used Antibiotics To Treat Gonorrhea?

mBio. 2019 08 13;10(4):

Authors: Chen S, Connolly KL, Rouquette-Loughlin C, D'Andrea A, Jerse AE, Shafer WM

Abstract
Neisseria gonorrhoeae has developed resistance to every antibiotic introduced for treatment of gonorrhea since 1938, and concern now exists that gonorrheal infections may become refractory to all available antibiotics approved for therapy. The current recommended dual antibiotic treatment regimen of ceftriaxone (CRO) and azithromycin (AZM) is threatened with the emergence of gonococcal strains displaying resistance to one or both of these antibiotics. Non-beta-lactamase resistance to penicillin and third-generation cephalosporins, as well as low-level AZM resistance expressed by gonococci, requires overexpression of the mtrCDE-encoded efflux pump, which in wild-type (WT) strains is subject to transcriptional repression by MtrR. Since earlier studies showed that loss of MtrCDE renders gonococci hypersusceptible to beta-lactams and macrolides, we hypothesized that transcriptional dampening of mtrCDE would render an otherwise resistant strain susceptible to these antibiotics as assessed by antibiotic susceptibility testing and during experimental infection. In order to test this hypothesis, we ectopically expressed a WT copy of the mtrR gene, which encodes the repressor of the mtrCDE efflux pump operon, in N. gonorrhoeae strain H041, the first reported gonococcal strain to cause a third-generation-cephalosporin-resistant infection. We now report that MtrR production can repress the expression of mtrCDE, increase antimicrobial susceptibility in vitro, and enhance beta-lactam efficacy in eliminating gonococci as assessed in a female mouse model of lower genital tract infection. We propose that strategies that target the MtrCDE efflux pump should be considered to counteract the increasing problem of antibiotic-resistant gonococci.IMPORTANCE The emergence of gonococcal strains resistant to past or currently used antibiotics is a global public health concern, given the estimated 78 million infections that occur annually. The dearth of new antibiotics to treat gonorrhea demands that alternative curative strategies be considered to counteract antibiotic resistance expressed by gonococci. Herein, we show that decreased expression of a drug efflux pump that participates in gonococcal resistance to antibiotics can increase gonococcal susceptibility to beta-lactams and macrolides under laboratory conditions, as well as improve antibiotic-mediated clearance of gonococci from the genital tract of experimentally infected female mice.

PMID: 31409679 [PubMed - indexed for MEDLINE]

Multidrug Resistance in Neisseria gonorrhoeae: Identification of Functionally Important Residues in the MtrD Efflux Protein.

Sat, 05/02/2020 - 07:05
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Multidrug Resistance in Neisseria gonorrhoeae: Identification of Functionally Important Residues in the MtrD Efflux Protein.

mBio. 2019 11 19;10(6):

Authors: Chitsaz M, Booth L, Blyth MT, O'Mara ML, Brown MH

Abstract
A key mechanism that Neisseria gonorrhoeae uses to achieve multidrug resistance is the expulsion of structurally different antimicrobials by the MtrD multidrug efflux protein. MtrD resembles the homologous Escherichia coli AcrB efflux protein with several common structural features, including an open cleft containing putative access and deep binding pockets proposed to interact with substrates. A highly discriminating N. gonorrhoeae strain, with the MtrD and NorM multidrug efflux pumps inactivated, was constructed and used to confirm and extend the substrate profile of MtrD to include 14 new compounds. The structural basis of substrate interactions with MtrD was interrogated by a combination of long-timescale molecular dynamics simulations and docking studies together with site-directed mutagenesis of selected residues. Of the MtrD mutants generated, only one (S611A) retained a wild-type (WT) resistance profile, while others (F136A, F176A, I605A, F610A, F612C, and F623C) showed reduced resistance to different antimicrobial compounds. Docking studies of eight MtrD substrates confirmed that many of the mutated residues play important nonspecific roles in binding to these substrates. Long-timescale molecular dynamics simulations of MtrD with its substrate progesterone showed the spontaneous binding of the substrate to the access pocket of the binding cleft and its subsequent penetration into the deep binding pocket, allowing the permeation pathway for a substrate through this important resistance mechanism to be identified. These findings provide a detailed picture of the interaction of MtrD with substrates that can be used as a basis for rational antibiotic and inhibitor design.IMPORTANCE With over 78 million new infections globally each year, gonorrhea remains a frustratingly common infection. Continuous development and spread of antimicrobial-resistant strains of Neisseria gonorrhoeae, the causative agent of gonorrhea, have posed a serious threat to public health. One of the mechanisms in N. gonorrhoeae involved in resistance to multiple drugs is performed by the MtrD multidrug resistance efflux pump. This study demonstrated that the MtrD pump has a broader substrate specificity than previously proposed and identified a cluster of residues important for drug binding and translocation. Additionally, a permeation pathway for the MtrD substrate progesterone actively moving through the protein was determined, revealing key interactions within the putative MtrD drug binding pockets. Identification of functionally important residues and substrate-protein interactions of the MtrD protein is crucial to develop future strategies for the treatment of multidrug-resistant gonorrhea.

PMID: 31744915 [PubMed - indexed for MEDLINE]

Successful pregnancy and delivery following selective use of photodynamic therapy in treatment of cervix and vulvar diseases.

Sat, 05/02/2020 - 07:05
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Successful pregnancy and delivery following selective use of photodynamic therapy in treatment of cervix and vulvar diseases.

Photodiagnosis Photodyn Ther. 2019 Dec;28:65-68

Authors: Maździarz A

Abstract
BACKGROUND: Photodynamic therapy has been gaining popularity, particularly among young women. Therefore it is crucial to evaluate PDT for safety and its impact on fertility and delivery of healthy newborns.
OBJECTIVE: The study analyzed the PDT treatment of 10 young women, who suffered from diseases of the vulva and cervix. The aim of the analysis was evaluating what impact PDT treatment had on their pregnancies and delivery.
METHODS: 10 patients (22-32 years of age, 25.5 years of age on average) were treated with PDT in 2007-2014. 2 patients suffered from squamous cell hyperplasia, 2 patients from vulvar lichen sclerosus, 1 - genital warts, 1 - VIN I (current terminology: LSIL/Flat condyloma), 2 - CIN III (HSIL), 2 - CIN I (LSIL). The patients underwent photodynamic therapy (PDT). In the course of PDT the 5% 5- aminolevulinic acid was used in gel form three hours before irradiation. The affected areas were irradiated with a halogen lamp PhotoDyn 501 (590-760 nm) during a 10-min radiation treatment. The treatment was repeated weekly for 10 weeks.
RESULTS: The median observation time period between the end of therapy and delivery was 3.92 years (2-7 years). None of the patients suffered from infertility. All patients gave birth to healthy, full-term infants. In case of one pregnancy cervical cerclage was needed. Two patients were treated for hypothyroidism caused by the Hashimoto disease. One patient had gestational diabetes. Two patients had already given birth to 2 children. Five patients gave birth by caesarean section.
CONCLUSION: Topical PDT selectively used for treating the diseases of the female reproductive organs was applied in our group of patients and proved to be a safe method. It had no apparent negative impact on female fertility and allowed these women to give birth to healthy children.

PMID: 31299392 [PubMed - indexed for MEDLINE]

Syphilis in Pregnancy.

Fri, 05/01/2020 - 07:03
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Syphilis in Pregnancy.

Obstet Gynecol Surv. 2019 Sep;74(9):557-564

Authors: Tsai S, Sun MY, Kuller JA, Rhee EHJ, Dotters-Katz S

Abstract
Importance: Since 2013, the United States has seen a rise in cases of congenital syphilis, culminating in a relative increase of 153% from 2013 to 2017 and 918 reported cases in 2017. In all, 50% to 80% of pregnant women with syphilis experience an adverse pregnancy outcome including stillbirth or spontaneous abortion.
Objective: This article aims to review the current evidence and recommendations for management of syphilis in pregnancy.
Evidence Acquisition: Original research articles, review articles, and guidelines on syphilis were reviewed.
Results: In pregnancy, routine screening for syphilis is recommended on initiation of prenatal care. In high-risk populations, repeat testing is recommended in the early third trimester and at delivery. Penicillin remains the recommended treatment in pregnancy. After treatment, nontreponemal titers should be repeated at minimum during the early third trimester and at delivery to assess for serologic response. In high-risk populations, titers should be repeated monthly.
Conclusion and Relevance: Routine screening in pregnancy is essential for identification of syphilis infection and prevention of congenital syphilis. Subsequent adequate treatment with penicillin therapy more than 30 days before delivery and at the correct dosages depending on the stage of infection should be incorporated into clinical practice.

PMID: 31830301 [PubMed - indexed for MEDLINE]

Incidence and Imminence of Pregnancy in At-Risk Teens After Emergency Department Visits.

Fri, 05/01/2020 - 07:03
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Incidence and Imminence of Pregnancy in At-Risk Teens After Emergency Department Visits.

Pediatr Emerg Care. 2019 Dec;35(12):837-839

Authors: Smith AL, Chen L

Abstract
BACKGROUND: Interventions aimed at reducing teen pregnancy rates in the United States have focused on clinics and schools. Teens disproportionately seek care in emergency departments (EDs), making these an important and understudied arena for interventions to prevent subsequent unwanted pregnancies. Establishing the risk of subsequent pregnancy (SP) in this population is a necessary prelude to effective interventions. Therefore, we set out to measure the incidence and imminence of pregnancy in sexually active teens after an ED visit.
METHODS: A medical record review was conducted in an urban medical center with a general ED and a pediatric ED. Subjects were included if they were female individuals aged 13 to 19 years, were tested for gonorrhea and chlamydia in the EDs from 2004 to 2006, and were patients in the primary care clinics at the affiliated institution. Subsequent pregnancies were determined from the primary clinic charts. The duration of follow-up was 4 years.
RESULTS: Three hundred ninety-eight subjects were included in the study. The mean age at ED visit was 17.3 years. A majority (70.1%) had a documented SP. For patients with an SP, the mean interval from ED visit to conception was 15.8 months. Patients who had an SP were significantly more likely to be an ethnic minority, to have tested positive for gonorrhea, and to have visited the adult ED.
CONCLUSIONS: In this population of sexually active teens, 70.1% became pregnant within 4 years of being tested for gonorrhea and chlamydia in the ED. The encounter in the ED represents a potential opportunity for pregnancy-prevention interventions.

PMID: 31790072 [PubMed - indexed for MEDLINE]

Mycoplasma genitalium in Singapore is associated with Chlamydia trachomatis infection and displays high macrolide and Fluoroquinolone resistance rates.

Thu, 04/30/2020 - 07:01
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Mycoplasma genitalium in Singapore is associated with Chlamydia trachomatis infection and displays high macrolide and Fluoroquinolone resistance rates.

BMC Infect Dis. 2020 Apr 28;20(1):314

Authors: Hart T, Tang WY, Mansoor SAB, Chio MTW, Barkham T

Abstract
BACKGROUND: Mycoplasma genitalium is an emerging sexually transmitted infection, with increasing rates of resistance to fluroquinolones and macrolides, the recommended treatments. Despite this, M. genitalium is not part of routine screening for Sexually Transmitted Infections (STIs) in many countries and the prevalence of infection and patterns of disease remain to be determined in many populations. Such data is of particular importance in light of the reported rise in antibiotic resistance in M. genitalium isolates.
METHODS: Urine and urethral swab samples were collected from the primary public sexual health clinic in Singapore and tested for C. trachomatis (CT) or N. gonorrhoeae (NG) infection and for the presence of M. genitalium. Antibiotic resistance in M. genitalium strains detected was determined by screening for genomic mutations associated with macrolide and fluroquinolone resistance.
RESULTS: We report the results of a study into M. genitalium prevalence at the national sexual health clinic in Singapore. M. genitalium was heavily associated with CT infection (8.1% of cases), but present in only of 2.4% in CT negative cases and not independently linked to NG infection. Furthermore, we found high rates of resistance mutations to both macrolides (25%) and fluoroquinolones (37.5%) with a majority of resistant strains being dual-resistant. Resistance mutations were only found in strains from patients with CT co-infection.
CONCLUSIONS: Our results support targeted screening of CT positive patients for M. genitalium as a cost-effective strategy to reduce the incidence of M. genitalium in the absence of comprehensive routine screening. The high rate of dual resistance also highlights the need to ensure the availability of alternative antibiotics for the treatment of multi-drug resistant M. genitalium isolates.

PMID: 32345231 [PubMed - in process]

Disseminated melioidosis in early pregnancy - an unproven cause of foetal loss.

Tue, 04/28/2020 - 06:57
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Disseminated melioidosis in early pregnancy - an unproven cause of foetal loss.

BMC Infect Dis. 2020 Mar 06;20(1):201

Authors: Chang CY, Lau NLJ, Currie BJ, Podin Y

Abstract
BACKGROUND: Melioidosis is a potentially life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Melioidosis is difficult to diagnose due to its diverse clinical manifestations, which often delays administration of appropriate antibiotic therapy.
CASE PRESENTATION: Melioidosis is uncommon in pregnancy but both spontaneous abortion and neonatal melioidosis have been reported. We report a case of bacteraemic melioidosis in a young woman with a subsequent spontaneous abortion, with B. pseudomallei cultured from a high vaginal swab as well as blood.
CONCLUSION: It remains unclear in this and previously reported cases as to whether the maternal melioidosis was sexually transmitted.

PMID: 32143598 [PubMed - indexed for MEDLINE]

Differences in maternal characteristics and pregnancy outcomes between syphilitic women with and without partner coinfection.

Sat, 04/25/2020 - 09:52
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Differences in maternal characteristics and pregnancy outcomes between syphilitic women with and without partner coinfection.

BMC Pregnancy Childbirth. 2019 Nov 27;19(1):439

Authors: Zhang XH, Chen YM, Sun Y, Qiu LQ, Chen DQ

Abstract
BACKGROUND: Partner infection is a significant factor in preventing mother-to-child syphilis transmission. We compared pregnancy outcomes between syphilis discordant and syphilis concordant couples.
METHODS: We conducted a retrospective study among 3076 syphilis-positive women who received syphilis screening together with their partners during pregnancy. Multivariate analysis was used to explore risks for abnormal outcomes in objects correcting for the major covariate factors. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated to compare pregnancy outcomes between syphilis concordant and syphilis discordant couples.
RESULTS: Overall, 657 of the 3076 women were diagnosed with gestational syphilis and had a syphilis-positive partner, giving a partner concordance prevalence of 21.36%. Women in concordant couples were more likely to have higher parity, more children, late antenatal care and syphilis screening, a lower proportion of latent syphilis, and elevated serologic titers than women in discordant couples (P < 0.01 for all). Totally, 10.08% of women had adverse pregnancy outcomes. Multivariate analysis showed partners' syphilis infection (ORadj = 1.44, 95% CI: 1.10-1.89), untreated pregnancy syphilis (ORadj = 1.67, 95% CI: 1.15-2.43), and higher maternal serum titers (> 1:8) (ORadj = 1.53, 95% CI: 1.17-2.00) increased the risks of adverse pregnancy outcomes. Concordance was associated with increased risk for stillbirth (ORadj = 2.86, 95%CI:1.36-6.00), preterm birth (PTB) (ORadj = 1.38,95%CI:1.02-1.87) and low birth weight (LBW) (ORadj = 1.55, 95%CI:1.13-2.11) compared with discordance. Even among treated women, concordance was associated with increased risk for stillbirth (ORadj = 3.26, 95%CI:1.45-7.31) and LBW (ORadj = 1.52, 95%CI:1.08-2.14). Among women with one treatment course, the risks for PTB(ORadj = 1.81, 95%CI:1.14-2.88) and LBW(ORadj = 2.08, 95%CI:1.28-3.38)were also higher among concordant couples than discordant couples. Nevertheless, there were no significant differences between concordant and discordant couples in risks of stillbirth (ORadj = 2.64, 95% CI: 0.98-7.05),PTB (ORadj = 1.15, 95% CI: 0.76-1.74), and LBW(ORadj = 1.21, 95% CI: 0.78-2.02) among women with two treatment courses.
CONCLUSION: Male partner coinfection increased the risks for stillbirth, PTB and LBW, particularly when gestational syphilis treatment was suboptimal. However, this risk could be reduced by adequate treatment.

PMID: 31771540 [PubMed - indexed for MEDLINE]

Chlamydia-infected macrophages are resistant to azithromycin treatment and are associated with chronic oviduct inflammation and hydrosalpinx development.

Fri, 04/24/2020 - 06:50
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Chlamydia-infected macrophages are resistant to azithromycin treatment and are associated with chronic oviduct inflammation and hydrosalpinx development.

Immunol Cell Biol. 2019 11;97(10):865-876

Authors: Harvie MC, Carey AJ, Armitage CW, O'Meara CP, Peet J, Phillips ZN, Timms P, Beagley KW

Abstract
Chlamydia infection remains the leading sexually-transmitted bacterial infection worldwide, causing damaging sequelae such as tubal scarring, infertility and ectopic pregnancy. As infection is often asymptomatic, prevention via vaccination is the optimal strategy for disease control. Vaccination strategies aimed at preventing bacterial infection have shown some promise, although these strategies often fail to prevent damaging inflammatory pathology when Chlamydia is encountered. Using a murine model of Chlamydia muridarum genital infection, we employed two established independent models to compare immune responses underpinning pathologic development of genital Chlamydia infection. Model one uses antibiotic treatment during infection, with only early treatment preventing pathology. Model two uses a plasmid-cured variant strain of C. muridarum that does not cause pathologic outcomes like the plasmid-containing wild-type counterpart. Using these infection models, contrasted by the development of pathology, we identified an unexpected role for macrophages. We observed that mice showing signs of pathology had greater numbers of activated macrophages present in the oviducts. This may have been due to early differences in macrophage activation and proinflammatory signaling leading to persistent or enhanced infection. These results provide valuable insight into the cellular mechanisms driving pathology in Chlamydia infection and contribute to the design and development of more effective vaccine strategies for protection against the deleterious sequelae of Chlamydia infection of the female reproductive tract.

PMID: 31348541 [PubMed - indexed for MEDLINE]

Prevalence and determinants of gender-based violence among high school female students in Wolaita Sodo, Ethiopia: an institutionally based cross-sectional study.

Thu, 04/23/2020 - 06:48

Prevalence and determinants of gender-based violence among high school female students in Wolaita Sodo, Ethiopia: an institutionally based cross-sectional study.

BMC Public Health. 2020 Apr 21;20(1):540

Authors: Tantu T, Wolka S, Gunta M, Teshome M, Mohammed H, Duko B

Abstract
BACKGROUND: Gender-based violence (GBV) often occurs in resource-limited settings such as Ethiopia. It could result in psychological and physical adverse outcomes such as stress, anxiety, depression, unsafe abortion, unwanted pregnancy, and sexually transmitted infections. This study aimed to assess the prevalence and factors associated with gender-based violence among female high school students in Wolaita Sodo, Ethiopia.
METHODS: An institutionally based-cross-sectional study was conducted in Wolaita Sodo, Ethiopia. A total of 604 female high school students were recruited through multi-stage stratified sampling techniques. The gender-based-violence assessment tool, validated by the World Health Organization, was used to assess gender-based-violence and other determinants. The strength of statistical association was measured by adjusted odds ratios and 95% confidence intervals. Statistical significance was declared at p-value < 0.05.
RESULTS: The lifetime prevalence of GBV, sexual violence, and physical violence were found to be 63.2, 37.2, and 56.3%, respectively. The prevalence of sexual violence before and after joining the current school as well as in the current academic year were 30.5, 37.2, and 22% respectively. Having regular boy-friends (AOR = 2.02; 95% CI:1.07-3.79), being sexually active (AOR = 6.10; 95% CI: 2.49-14.92), having female or male friends who drink alcohol (AOR = 2.18; 95% CI:1.26-3.77), students witnessed their mothers being beaten by their partners or husband (AOR = 1.92; 95% CI:1.19-3.11) and joining public school (AOR = 1.74; 95% CI:1.11-2.76) were significantly associated with gender-based violence.
CONCLUSION: The prevalence of gender-based-violence was high. This needs a due concern from governmental, non-governmental and civic organizations as well as other responsible bodies to tackle factors associated with GBV in this study. Further large scale studies incorporating male students are warranted to elucidate the factors associated with GBV in Ethiopia.

PMID: 32316941 [PubMed - in process]

Why Too Soon? Early Initiation of Sexual Intercourse Among Adolescent Females in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey.

Tue, 04/21/2020 - 06:45

Why Too Soon? Early Initiation of Sexual Intercourse Among Adolescent Females in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey.

Int J Womens Health. 2020;12:269-275

Authors: Turi E, Merga BT, Fekadu G, Abajobir AA

Abstract
Background: Early sexual initiation - sexual activity that begun earlier than 18 years of age - is among risky sexual behaviors which may be associated with increased risks of adverse outcomes such as sexually transmitted infections (STIs), unwanted pregnancy and unsafe abortions. However, there is no nationally representative evidence on early initiation of sexual intercourse and its determinant factors among adolescent females in Ethiopia.
Methods: Data were extracted from the 2016 Ethiopian Demographic and Health Survey (EDHS) to assess early initiation of sexual intercourse and factors contributing to it in adolescent females. The analysis included a weighted sample of 3881 adolescent females aged 15-19 years. A multivariable logistic regression analysis was conducted and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), declaring statistical significance at a p-value <0.05 in all analyses.
Results: About 1 in 5 (21.9%, 95% CI: 20.5%, 23.33%) adolescent females experienced early sexual debut. Administrative regions (Amhara, AOR = 2.3, 95% CI: 1.30, 4.09 and Gambella, AOR = 4.89, CI 95%: 1.08, 22.07), religion (Muslim, AOR = 1.76, 95% CI: 1.24, 2.49), substance use (e.g., ever chewed khat, AOR = 2.02, 95% CI: 1.47, 2.77, ever drunk alcohol, AOR = 1.83, 95% CI: 1.35, 2.48) and having no knowledge on family planning (AOR = 4.47, 95% CI: 2.22, 8.99) were found to have statistically significant association with early sexual debut in adolescent females. Whereas any levels of formal education decreased the odds of early sexual debut (primary, AOR = 0.44, 95% CI: 0.35, 0.56; secondary, AOR = 0.19, 95% CI: 0.13, 0.28, and higher, AOR= 0.31, 95% CI: 0.15, 0.63). Similarly, all categories of wealth indices as compared to the poorest were protective of early sexual initiation in adolescent females (AOR = 0.40-0.57) as was for education as compared to no education (AOR = 0.19-0.44).
Conclusion: A significant proportion of adolescent females initiate early sexual intercourse in Ethiopia and multifaceted factors appear to determine their early sexual experiences. Contextualized interventions including strengthening information, education and communication on adverse consequences of early sexual initiation in regions and improving contraceptive knowledge of teenagers will play a paramount role.

PMID: 32308501 [PubMed]

Antimicrobial Resistance Screening in Chlamydia trachomatis by Optimized McCoy Cell Culture System and Direct qPCR-Based Monitoring of Chlamydial Growth.

Tue, 04/21/2020 - 06:45
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Antimicrobial Resistance Screening in Chlamydia trachomatis by Optimized McCoy Cell Culture System and Direct qPCR-Based Monitoring of Chlamydial Growth.

Methods Mol Biol. 2019;2042:33-43

Authors: Meštrović T, Virok DP, Ljubin-Sternak S, Raffai T, Burián K, Vraneš J

Abstract
Obligate intracellular localization of Chlamydia trachomatis (C. trachomatis) complicates antimicrobial sensitivity testing efforts that we are so accustomed to in routine bacteriology. Cell culture systems with immunofluorescence staining, to identify cellular inclusions in the presence of various concentrations of antimicrobial drugs, are still the most pervasive techniques, but more specific and sensitive nucleic acid concentration measuring methods are increasingly being used. Here we describe how to approach antimicrobial susceptibility/resistance screening in C. trachomatis by using a McCoy cell culture system, optimized by a research group from Croatia, and direct qPCR-based monitoring of chlamydial growth, optimized by a research group from Hungary.

PMID: 31385269 [PubMed - indexed for MEDLINE]

Changing antimicrobial susceptibility and molecular characterisation of Neisseria gonorrhoeae isolates in Guangdong, China: in a background of rapidly rising epidemic.

Fri, 04/17/2020 - 06:37
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Changing antimicrobial susceptibility and molecular characterisation of Neisseria gonorrhoeae isolates in Guangdong, China: in a background of rapidly rising epidemic.

Int J Antimicrob Agents. 2019 Dec;54(6):757-765

Authors: Qin X, Zhao Y, Chen W, Wu X, Tang S, Li G, Yuqi Y, Cao W, Liu X, Huang J, Yang J, Chen W, Tang W, Zheng H

Abstract
The prevalence of Neisseria gonorrhoeae infections has increased rapidly since 2015 in China. Antimicrobial resistance and molecular mobilisation in N. gonorrhoeae are two important factors driving this increasing prevalence. This study explored changes in antimicrobial susceptibility and molecular characteristics of N. gonorrhoeae collected in Guangdong, China (2013-2017). A total of 704 isolates were collected in two cities in Guangdong. MICs of major antimicrobials were determined. Penicillinase-producing N. gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were characterised, and N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed. High resistance to penicillin (68.2%), tetracycline (85.7%) and ciprofloxacin (98.2%) was observed. Spectinomycin, ceftriaxone and azithromycin appeared effective, with susceptibilities of 100%, 96.4% and 90.7%, respectively. Resistance to penicillin decreased significantly from 78.4% to 73.6% and to azithromycin from 11.9% to 3.7%. Total prevalence of PPNG, TRNG and PPNG/TRNG was 25.4%, 33.1% and 13.4%, respectively. Rates of PPNG decreased significantly from 37.3% to 23.9%, TRNG from 50.0% to 31.3%, and PPNG/TRNG from 23.5% to 11.7%. However, the ratio of African-type PPNG increased significantly (18.4% to 64.1%) compared with decreasing Asian-type PPNG (81.6% to 33.3%), and the ratio of American-type TRNG increased significantly (0% to 13.7%) compared with decreasing Dutch-type TRNG (100% to 86.3%). A total of 271 sequence types (STs) were identified by NG-MAST from 380 isolates collected in 2013, 2014 and 2017, with 145 novel STs. African-type PPNG is increasing and replacing Asian-type, and novel STs have emerged. Gonococcal isolates with new genotypes might contribute to the rising gonorrhoea epidemic in this area.

PMID: 31425792 [PubMed - indexed for MEDLINE]

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