scholarly journals Non-classical pathogens as causative agents of proctitis in men who have sex with men

2021 ◽  
Author(s):  
Eric P F Chow ◽  
Darren Lee ◽  
Stephanie Bond ◽  
Christopher K Fairley ◽  
Kate Maddaford ◽  
...  
Keyword(s):  
Comparison Group ◽  
Health Centre ◽  
Treponema Pallidum ◽  
Mycoplasma Genitalium ◽  
Risk Difference ◽  
Hiv Status ◽  
Shigella Spp ◽  
Causative Agents ◽  
Sex With Men ◽  
Asymptomatic Men

Abstract Background This study aimed to identify enteric and sexually acquired rectal pathogens, other than chlamydia and gonorrhoea, associated with symptomatic proctitis in MSM. Methods Anorectal swab samples were obtained from MSM presenting with rectal symptoms and a clinical diagnosis of proctitis at the Melbourne Sexual Health Centre between January-2017 and March-2019. Samples that tested positive for Neisseria gonorrhoeae and Chlamydia trachomatis were excluded. As a comparison group, anorectal samples were also obtained from MSM not reporting symptoms of proctitis between November-2018 and February-2019. Samples from both groups were tested for 15 viral, bacterial and protozoal enteric pathogens using PCR. Results Anorectal samples from 499 men with symptomatic proctitis and 506 asymptomatic men were analysed. Age, HIV status and PrEP use did not differ between men with proctitis and asymptomatic men. Treponema pallidum was more common in men with proctitis (risk difference [RD]=3.6%; 95% CI:2.0-5.2%). Most men with anorectal T. pallidum presented with painful anal primary infections. Shigella spp. was more common among men with proctitis compared to asymptomatic men (RD=1.8%; 95%CI:0.1-3.5%). Most men with Shigella did not report diarrhoea. Mycoplasma genitalium was more common in men with proctitis (RD=4.3%; 95%CI:1.1-7.5%). HSV-1 (RD=10.1%; 95%CI:6.8-13.3%) and HSV-2 (RD=7.2%; 95%CI:4.5-10.0%) were more common with proctitis. Conclusions Testing for T. pallidum, Shigella and HSV should be considered in MSM presenting with symptomatic proctitis. These data provide support for M. genitalium as a significant cause of proctitis. A comprehensive diagnostic evaluation is required for MSM with proctitis.

Prevalence of rectal Mycoplasma genitalium and macrolide resistance in men who have sex with men attending Sydney Sexual Health Centre

Sexual Health ◽  
2020 ◽  
Vol 17 (2) ◽  
pp. 114
Author(s):  
Isabella Bradley ◽  
Rick Varma ◽  
Vickie Knight ◽  
Dimitra Iliakis ◽  
Leon McNally ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Sexual Health ◽  
Rectal Swab ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Cross Sectional ◽  
Screening Guidelines ◽  
Sexually Transmissible Infections ◽  
Sex With Men

Background Sexually transmissible infections (STIs) have been increasing in men who have sex with men (MSM) in recent years; however, few studies have investigated the prevalence or antimicrobial resistance in rectal Mycoplasma genitalium in this group. This study aimed to determine the prevalence and predictors of rectal M. genitalium in MSM attending an urban sexual health service in Sydney, Australia, namely the Sydney Sexual Health Centre (SSHC), as well as estimate the rate of macrolide resistance. Methods: A prospective cross-sectional analysis was conducted of rectally asymptomatic MSM having a rectal swab collected as part of their routine care. Participants self-collected a rectal swab to be tested for M. genitalium and completed a 14-item questionnaire that provided information on behavioural risk factors. The prevalence of rectal M. genitalium was determined and multivariate analysis was performed to assess the associations for this infection. Positive specimens then underwent testing for macrolide-resistant mutations (MRMs) using the ResistancePlus MG assay (SpeeDx, Eveleigh, NSW, Australia). Results: In all, 742 patients were consecutively enrolled in the study. The median age was 31 years (interquartile range 27–39 years), with 43.0% born in Australia. Overall, 19.0% of men were bisexual, 22.9% were taking pre-exposure prophylaxis (PrEP) and 4.3% were HIV positive. The prevalence of rectal M. genitalium was 7.0% (95% confidence interval (CI) 5.3–9.1) overall and 11.8% in those taking PrEP. On multivariate analysis, PrEP use was significantly associated with having rectal M. genitalium (odds ratio 2.01; 95% CI 1.09–3.73; P = 0.01). MRMs were detected in 75.0% (36/48; 95% CI 60.4–86.4%) of infections. Conclusion: Rates of rectal M. genitalium infection were high among asymptomatic MSM attending SSHC and MRMs were detected in 75% of infections. PrEP use was found to be significantly associated with rectal M. genitalium infection. These data contribute to the evidence base for screening guidelines in MSM.

scholarly journals Prevalence of Mycoplasma genitalium fluoroquinolone-resistance markers, and dual-class-resistance markers, in asymptomatic men who have sex with men

2021 ◽  
Vol 70 (9) ◽  
Author(s):  
Teck-Phui Chua ◽  
Kaveesha Bodiyabadu ◽  
Dorothy A. Machalek ◽  
Suzanne M. Garland ◽  
Catriona S. Bradshaw ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Type Species ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Fluoroquinolone Resistance ◽  
Content Type ◽  
Link Type ◽  
Resistance Markers ◽  
Sex With Men ◽  
Dual Class

Introduction. Failure of fluoroquinolones, the principal treatment option for macrolide-resistant Mycoplasma genitalium infections, has recently emerged. This is of particular concern for men who have sex with men (MSM), who have high proportions of macrolide-resistant M. genitalium infections. Treatment failure with moxifloxacin is likely the result of single nucleotide polymorphisms (SNPs) in parC, whilst concurrent gyrA mutations may play a role. Gap Statement. The levels of fluoroquinolone resistance and dual-class (i.e. macrolide and fluoroquinolone) resistance in M. genitalium among asymptomatic MSM is unknown. Aim. To (i) determine the proportion of fluoroquinolone resistance and dual-class resistance in M. genitalium infections among asymptomatic MSM, (ii) explore any clinical and behavioural associations with fluoroquinolone resistance, and (iii) determine the distribution of antibiotic resistance among M. genitalium mgpB sequence types (STs). Methodology. M. genitalium positive samples (N=94) were obtained from 1001 asymptomatic MSM enrolled in a study at Melbourne Sexual Health Centre (Carlton, Australia) between August 2016 and September 2017. Sanger sequencing was performed to determine the proportion of M. genitalium infections with SNPs in parC that have previously been associated with failure of moxifloxacin (corresponding to amino changes S83I, D83R, D87Y and D87N) and in gyrA (corresponding to amino acid changes M95I, D99N, D99Y and D99G). Associations between clinical/behavioural factors and parC SNPs were examined. Strain typing was performed by sequencing a portion of the mgpB gene. Results. The proportion of MSM with infections harbouring parC and gyrA SNPs was 13.0 % [95 % confidence interval (CI): 6.8–23.2 %] and 4.7 % (95 % CI: 1.1–13.4 %), respectively; dual-class resistance was 13.0 %. No significant clinical/behavioural associations were found. Antibiotic resistance was not restricted to specific mgpB STs. Conclusion. One in eight (13 %) of asymptomatic MSM with M. genitalium had an infection with dual-class-resistance mutations. Typing by mgpB sequence suggested fluoroquinolone resistance is arising from independent mutation events. This study illustrates that asymptomatic MSM may act as a reservoir for antibiotic-resistant M. genitalium .

scholarly journals Resistance-Guided Antimicrobial Therapy Using Doxycycline–Moxifloxacin and Doxycycline–2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability

2019 ◽  
Vol 71 (6) ◽  
pp. 1461-1468 ◽  
Author(s):  
Duygu Durukan ◽  
Tim R H Read ◽  
Gerald Murray ◽  
Michelle Doyle ◽  
Eric P F Chow ◽  
...  
Keyword(s):  
De Novo ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Evidence Base ◽  
Macrolide Resistance ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
European Guidelines ◽  
Sex With Men ◽  
Guided Therapy

Abstract Background Macrolide resistance in Mycoplasma genitalium (MG) exceeds 50% in many regions, and quinolone resistance is increasing. We recently reported that resistance-guided therapy (RGT) using doxycycline followed by sitafloxacin or 2.5 g azithromycin cured 92% and 95% of macrolide-resistant and macrolide-susceptible infections, respectively. We present data on RGT using doxycycline–moxifloxacin, the regimen recommended in international guidelines, and extend data on the efficacy of doxycycline–2.5 g azithromycin and de novo macrolide resistance. Methods Patients attending Melbourne Sexual Health Centre between 2017 and 2018 with sexually transmitted infection syndromes were treated with doxycycline for 7 days and recalled if MG-positive. Macrolide-susceptible cases received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and resistant cases moxifloxacin (400 mg daily, 7 days). Test of cure was recommended 14–28 days post-antimicrobials. Results There were 383 patients (81 females/106 heterosexual males/196 men who have sex with men) included. Microbial cure following doxycycline–azithromycin was 95.4% (95% confidence interval [CI], 89.7–98.0) and doxycycline–moxifloxacin was 92.0% (95% CI, 88.1–94.6). De novo macrolide resistance was detected in 4.6% of cases. Combining doxycycline–azithromycin data with our prior RGT study (n = 186) yielded a pooled cure of 95.7% (95% CI, 91.6–97.8). ParC mutations were present in 22% of macrolide-resistant cases. Conclusions These findings support the inclusion of moxifloxacin in resistance-guided strategies and extend the evidence for 2.5 g azithromycin and presumptive use of doxycycline. These data provide an evidence base for current UK, Australian, and European guidelines for the treatment of MG.

scholarly journals Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV): design and methods for a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035113
Author(s):  
Cassandra Laurie ◽  
Mariam El-Zein ◽  
Joseph Tota ◽  
Pierre-Paul Tellier ◽  
Francois Coutlée ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Health Centre ◽  
Hpv Infection ◽  
Hiv Status ◽  
Intention To Treat ◽  
Increased Risk ◽  
Mcgill University ◽  
Sex With Men ◽  
Randomised Controlled

IntroductionGay, bisexual and other men who have sex with men (gbMSM) have an increased risk of human papillomavirus (HPV) infection and HPV-associated diseases, such as anal cancer and anogenital warts. A carrageenan-based lubricant could prevent HPV infection, thereby reducing the disease burden in this population. This paper describes the protocol for the Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV) study, an ongoing randomised controlled trial (RCT), evaluating efficacy of a carrageenan-based personal lubricant in reducing type-specific anal HPV incidence and prevalence among sexually active gbMSM, efficacy by HIV status, safety and tolerability of the gel and participant adherence to the intervention.Methods and analysisThe study is a double-blinded, placebo-controlled RCT. Volunteer gbMSM 18 years and older are randomly assigned 1:1 to receive the treatment (a self-applied anal microbicide gel with carrageenan) or placebo (a self-applied placebo gel). At each visit, computerised questionnaires are used to collect data on sociodemographic and clinical variables, lifestyle, sexual behaviour and the gels’ safety and tolerability. At baseline and each follow-up visit (months 1, 2, 3, 6, 9 and 12), nurses collect anal specimens tested for 36 HPV types (linear array assay). HIV status is determined at baseline and 12 months. The primary outcome is incidence of type-specific anal HPV infection(s) undetected at baseline. Secondary outcomes are prevalence of type-specific anal HPV infection, safety, tolerability and adherence. We aim to recruit 380 participants to attain the study’s objectives. Data will be analysed using intention-to-treat and per-protocol approaches with subgroup analyses by HIV status.Ethics and disseminationEthics approval was obtained by the Research Ethics Boards of McGill University, the McGill University Health Centre, Concordia University and Centre Hospitalier de l’Université de Montréal. Trial results will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberNCT02354144.

Primary syphilis lesion characteristics, serological response and management in HIV-positive and HIV-negative men who have sex with men

2020 ◽  
Vol 31 (14) ◽  
pp. 1359-1363
Author(s):  
Daniel Richardson ◽  
Colin Fitzpatrick ◽  
John Devlin ◽  
Zoe Buss ◽  
Luke Parkes ◽  
...  
Keyword(s):  
Treponema Pallidum ◽  
Hiv Positive ◽  
Serological Response ◽  
Health Campaigns ◽  
Hiv Status ◽  
Presumptive Treatment ◽  
Primary Syphilis ◽  
Sex With Men ◽  
Public Health Campaigns ◽  
Living With Hiv

The characteristics and serological responses of primary syphilis are not completely understood. We aimed to describe the characteristics, the serological responses and presumptive treatment of primary syphilis in HIV-positive and -negative men who have sex with men (MSM). We conducted a retrospective review of microbiological and demographic information from MSM presenting with primary syphilis. There were 111 cases of primary syphilis in MSM, the median age was 46 (IQR = 37–53years) and 40 (36%) were living with HIV. Fifty percent of MSM presented with painful lesions and 14% with extra-genital lesions. Extra-genital lesions were significantly more likely to be painful than non-genital lesions (OR 4.72; 95%CI = 1.25–17.83, p = 0.02). Overall, a reactive serological response demonstrated a sensitivity of 80% (57/71) compared with Treponema pallidum PCR. Serology was more sensitive in MSM with no previous syphilis (OR = 3.38, 95%CI = 1.00–11.43, p < 0.05). MSM presenting with painless lesions were more likely to be treated presumptively (OR = 3.39, 95%CI = 1.38–8.33, p < 0.002). There were no differences in the characteristics, serological responses or management according to HIV status. Fifty percent of MSM with primary syphilis presented with painful lesions; extra-genital lesions are more likely to be painful than genital lesions, serology is positive in 80% and there were no differences between HIV-positive and -negative MSM. Understanding the characteristics of primary syphilis will underpin public health campaigns.

scholarly journals Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney

2018 ◽  
Vol 94 (6) ◽  
pp. 406-410 ◽  
Author(s):  
Deborah L Couldwell ◽  
Dean Jalocon ◽  
Melissa Power ◽  
Neisha J Jeoffreys ◽  
Sharon C-A Chen ◽  
...  
Keyword(s):  
New South ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Resistance Mutations ◽  
Sti Testing ◽  
South Wales ◽  
High Prevalence ◽  
Sex With Men ◽  
Exposure Prophylaxis

ObjectivesWe aimed to estimate the prevalence of Mycoplasma genitalium infection and of mutations linked to macrolide resistance using the ResistancePlus MG assay (SpeeDx, Sydney, New South Wales, Australia) in first-void urine (FVU), anorectal and oropharyngeal samples from men who have sex with men (MSM) attending Western Sydney Sexual Health Centre (WSSHC).MethodsConsecutive symptomatic and asymptomatic MSM attending for STI testing were prospectively enrolled. M. genitalium testing using the ResistancePlus MG assay was performed on FVU, anorectal and oropharyngeal samples routinely collected for Chlamydia trachomatis and Neisseria gonorrhoeae assays.ResultsOverall, the prevalence of M. genitalium infection in the study group was 13.4% (68/508). Most (79.4%, 54/68) M. genitalium harboured macrolide resistance mutations (87.5% of urethral and 75.6% of anorectal infections). The anorectum was the most commonly infected site (45/505, 8.9%), followed by the urethra (24/508, 4.7%). No oropharyngeal M. genitalium infections were detected (0/508). Most of the anorectal (93.3%) and urethral (79.2%) infections were asymptomatic.MSM who were taking HIV pre-exposure prophylaxis (PrEP) were twice as likely to be infected with M. genitalium compared with MSM who were not on PrEP (OR 2.1, 95% CI 1.3 to 3.6; P=0.0041). Always using condoms for anal sex in the last 3 months was protective of infection (OR 0.8, 95% CI 0.6 to 1.0; P=0.0186).ConclusionsWe demonstrated a high prevalence of M. genitalium and very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations in M. genitalium infections. This will ensure, in regions or populations with high rates of macrolide resistance among M. genitalium strains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified.

Extragenital Mycoplasma genitalium infections among men who have sex with men

2019 ◽  
Vol 96 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Rosie Louise Latimer ◽  
Lenka Vodstrcil ◽  
Vesna De Petra ◽  
Christopher K Fairley ◽  
Tim RH Read ◽  
...  
Keyword(s):  
Demographic Data ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Limited Data ◽  
Cross Sectional ◽  
Amplification Assay ◽  
Sex With Men ◽  
Exposure Prophylaxis

ObjectivesThere are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice.MethodsThis was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status.ResultsRectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079).ConclusionThese data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.

Timing of primary syphilis treatment and impact on the development of treponemal antibodies: a cross-sectional clinic-based study

2021 ◽  
pp. sextrans-2020-054739
Author(s):  
Janet M Towns ◽  
David E Leslie ◽  
Ian Denham ◽  
Francesca Azzato ◽  
Theo Karapanagiotidis ◽  
...  
Keyword(s):  
Health Centre ◽  
Treponema Pallidum ◽  
Serological Markers ◽  
Positive Serology ◽  
Cross Sectional ◽  
Primary Syphilis ◽  
Syphilis Treatment ◽  
Sex With Men ◽  
Early Primary

BackgroundSerology is negative in a proportion of primary syphilis cases where Treponema pallidum PCR testing is positive. We aimed to identify discordant, T. pallidum PCR-positive, serology-negative primary syphilis cases and any clinical or laboratory factors associated with failure to subsequently seroconvert.MethodsSerodiscordant primary syphilis cases that were T. pallidum PCR-positive and serology-negative (including rapid plasma reagin, T. pallidum particle agglutination, T. pallidum enzyme immunoassay or T. pallidum chemiluminescence assay) were identified from the Melbourne Sexual Health Centre electronic records between April 2011 and December 2019. Clinical and laboratory associations were examined.ResultsThere were 814 primary syphilis cases in the study period and 38 (4.7%) were serodiscordant, 35 in men who have sex with men. Thirty-two had follow-up serology performed a median of 24 days later, of which 16 (50%) seroconverted, mostly (81%) within 6 weeks. Failure to seroconvert was significantly associated with treatment on day 1. Of the 12 cases treated on day 1, 10 (83%) failed to seroconvert compared with 6 of 20 (30%) among those who were treated after day 1.DiscussionEarlier treatment of primary syphilis can prevent the development of serological markers. T. pallidum PCR can identify primary syphilis lesions before the development of serological markers and improve diagnosis of early primary syphilis lesions. Serology alone will miss a proportion of primary syphilis infections and should be repeated if a diagnosis of syphilis is being considered.

Epidemiological Characterization of the Infection by Treponema Pallidum in Pregnant Women in Beira City, Sofala, Mozambique

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Nchowela Guido
Keyword(s):  
Pregnant Women ◽  
Congenital Syphilis ◽  
Health Centre ◽  
Treponema Pallidum ◽  
Timely Manner ◽  
Pregnancy And Childbirth ◽  
Epidemiological Characterization ◽  
Active Syphilis ◽  
Structured Questionnaire

Introduction: Syphilis is one of several diseases that can be transmitted during pregnancy and childbirth, which can lead to complications during pregnancy and in the newborn. This is especially so when the pregnant woman is not diagnosed or treated properly and in a timely manner. Methodology: Data from 262 pregnant women prospectively included, aged 18-41years, attended at the Ponta Gêa Health Centre for antenatal clinics has been analyzed from January to September of 2016. In the prospective study, a rapid treponemal and a non-treponemal test were performed. A structured questionnaire was used to collect socio demographic and clinical variables, which was developed from the literature review. Results: The prevalence of active syphilis was 11.8%; the majority of reactive pregnant women were aged 18-25years (55.4%), (61.3%) of pregnant women were treated with doses below those recommended; only a small number of the partners were treated successfully. The highest seroprevalence of syphilis was found in housewives (77%), in those who attended primary education (71.6%) in those who had a monthly income of 1000- 3000 MZN (70.3%), in those with two or more pregnancies (55.7%) and living with someone has husband and wife (63.5%). The syphilis/HIV co-infection rate was high. Conclusion: According to the results obtained in this study, urgent measures are needed to assess the problems encountered and to improve the screening approach, treatment and monitoring of syphilis during pregnancy in order to prevent the cases of congenital syphilis.

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