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imageNo abstract available 12/01/2014 01:00 AM
 

From the ASTDA

imageNo abstract available 12/01/2014 01:00 AM
 

Female Partner Notification Is a Promising Prevention Strategy for Controlling Sexually Transmitted Infections in Shanghai: Demographic and Behavioral Data From a Shanghai Clinic

imageAbstractWe identified predictors of partner presentation and condom use among male gonorrhea patients in Shanghai, China. Stable relationships, intercourse in the preceding week, and longer duration of symptoms were associated with partner presentation. Men were more likely to use condoms with their spouse and if they were 35 years or younger. 12/01/2014 01:00 AM
 

Deriving and Validating A Risk Estimation Tool for Screening Asymptomatic Chlamydia and Gonorrhea

imageBackgroundThere has been considerable interest in the development of innovative service delivery modules for prioritizing resources in sexual health delivery in response to dwindling fiscal resources and rising infection rates. MethodsThis study aims to derive and validate a risk scoring algorithm to accurately identify asymptomatic patients at increased risk for chlamydia and/or gonorrhea infection. We examined the electronic records of patient visits at sexual health clinics in Vancouver, Canada. We derived risk scores from regression coefficients of multivariable logistic regression model using visits between 2000 and 2006. We evaluated the model’s discrimination, calibration, and screening performance. Temporal validation was assessed in visits from 2007 to 2012. ResultsThe prevalence of infection was 1.8% (n = 10,437) and 2.1% (n = 14,956) in the derivation and validation data sets, respectively. The final model included younger age, nonwhite ethnicity, multiple sexual partners, and previous infection and showed reasonable performance in the derivation (area under the receiver operating characteristic curve = 0.74; Hosmer-Lemeshow P = 0.91) and validation (area under the receiver operating characteristic curve = 0.64; Hosmer-Lemeshow P = 0.36) data sets. A risk score cutoff point of at least 6 detected 91% and 83% of cases by screening 68% and 68% of the derivation and validation populations, respectively. ConclusionsThese findings support the use of the algorithm for individualized risk assessment and have important implications for reducing unnecessary screening and saving costs. Specifically, we anticipate that the algorithm has potential uses in alternative settings such as Internet-based testing contexts by facilitating personalized test recommendations, stimulating health care–seeking behavior, and aiding risk communication by increasing sexually transmitted infection risk perception through the creation of tailored risk messages to different groups. 12/01/2014 01:00 AM
 

Etiology and Antimicrobial Susceptibility of Pathogens Responsible for Urethral Discharge Among Men in Harare, Zimbabwe

imageBackgroundPeriodic etiological surveillance of sexually transmitted infection (STI) syndromes is required to validate treatment algorithms used to control STIs. However, such surveys have not been performed in Zimbabwe over the past decade. MethodsA cross-sectional study design was used to determine the prevalence of the key STI etiological agents causing male urethral discharge (MUD). Urethral swab specimens were collected for molecular analysis and Neisseria gonorrhoeae isolation from consenting men 18 years and older who presented with MUD to the 12 clinics in Harare, Zimbabwe, between November 2010 and May 2011. A validated in-house multiplex polymerase chain reaction assay was used to detect the presence of N. gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Gonococci were cultured on selective media, and antimicrobial susceptibilities were determined locally for ciprofloxacin, kanamycin, ceftriaxone, and cefixime using Etest strips, and minimum inhibitory concentrations were reported using defined breakpoints. ResultsAmong 130 participants, N. gonorrhoeae was the most frequent pathogen detected (106; 82.8%), followed by C. trachomatis (15; 11.7%), M. genitalium (6; 4.7%), and T. vaginalis (2; 1.6%). Four (6.1%) of the 66 gonococci isolated were resistant to fluoroquinolones, whereas all viable isolates were susceptible to kanamycin, cefixime, and ceftriaxone. ConclusionsGonorrhea is the most important cause of MUD in men in Harare, and our study highlights the emergence of fluoroquinolone-resistant N. gonorrhoeae. Further STI surveys are required in other regions of Zimbabwe to obtain a nationally representative picture of gonococcal burden and antimicrobial resistance among MUD patients. 12/01/2014 01:00 AM
 

The Antimicrobial Effect of Boric Acid on Trichomonas vaginalis

imageBackgroundThe treatment options for trichomoniasis are largely limited to nitroimidazole compounds (metronidazole and tinidazole). Few alternatives exist in cases of recalcitrant infections or in cases of nitroimidazole hypersensitivity. Recently, the intravaginal administration of boric acid has been advocated as an alternative treatment of trichomoniasis. However, no in vitro studies are available that directly assess the sensitivity of Trichomonas vaginalis to boric acid. MethodsWe examined the sensitivity of common laboratory strains and recent clinical isolates of T. vaginalis to boric acid. The effect of increasing concentrations of boric acid on parasite growth and viability was determined, and a minimal lethal concentration was reported. The effect of pH on boric acid toxicity was assessed and compared with that of lactic and acetic acid. ResultsBoric acid is microbicidal to T. vaginalis, and its antitrichomonal activity is independent of environmental acidification. Unlike acetic acid and lactic acid, boric acid exposure results in growth suppression and lethality over a wide range of pH (5–7) and under conditions that are normally permissible for growth in vitro. ConclusionsThe microbicidal effect of boric acid on T. vaginalis, coupled with its previous clinical use in treating vaginal candidiasis, supports the continued inclusion of boric acid in the therapeutic arsenal for treating trichomoniasis.   12/01/2014 01:00 AM
 

Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae in Europe

imageBackgroundThe European Gonococcal Antimicrobial Surveillance Programme performs antimicrobial resistance surveillance and is coordinated by the European Centre for Disease Prevention and Control. This study used epidemiological and behavioral data combined with the gonococcal susceptibility profiles to determine risk factors associated with harboring resistant gonococci in Europe. MethodsFrom 2009 to 2011, gonococcal isolates from 21 countries were submitted to the European Gonococcal Antimicrobial Surveillance Programme for antimicrobial susceptibility testing. Patient variables associated with resistance to azithromycin, cefixime, and ciprofloxacin were identified using univariate and multivariable logistic regression analyses of odds ratios. Geometric means for ceftriaxone and cefixime minimum inhibitory concentrations (MICs) were compared for patients of different sexual orientation and sex. ResultsA total of 5034 gonococcal isolates were tested from 2009 to 2011. Isolates exhibiting resistance to cefixime (MIC > 0.125 mg/L) and ciprofloxacin (MIC > 0.5 mg/L) were significantly associated with infection in heterosexuals (males only for ciprofloxacin), older patients (>25 years of age), or those without a concurrent chlamydial infection in the multivariable analysis. The geometric mean of cefixime and ceftriaxone MICs decreased from 2009 to 2011, most significantly for men who have sex with men, and isolates from male heterosexuals exhibited the highest MICs in 2011. ConclusionsThe linking of epidemiological and behavioral data to the susceptibility profiles of the gonococcal isolates has allowed those at higher risk for acquiring antimicrobial resistant Neisseria gonorrhoeae to be identified. Improved data numbers and representativeness are required before evidence-based risk groups can be identified, and subsequent focused treatments or public health intervention strategies can be initiated with confidence. 12/01/2014 01:00 AM
 

Identification of Demographic and Behavioral Risk Factors for Antibiotic Resistant Gonorrhea Infections to Combat the Emergence of Potentially Untreatable Infections

No abstract available 12/01/2014 01:00 AM