Urinary Tract and Genital Infections including Sexually Transmitted Infections (STIs)

2019 ◽  
Author(s):  
Jayshree Dave ◽  
C. Y. William Tong
Keyword(s):  
Public Health ◽  
Single Dose ◽  
Herpes Simplex ◽  
Neisseria Gonorrhoeae ◽  
Contact Tracing ◽  
Sexually Transmitted ◽  
Significant Public Health ◽  
Sex With Men ◽  
Painful Ulcer ◽  
High Level

Urethritis, characterized by inflammation of the urethra in men, is caused by Neisseria gonorrhoeae (gonococcus), Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Other causes of non-gonococcal urethritis include ureaplasmas, adenoviruses, and herpes simplex viruses. The presence of urethritis is confirmed by the presence of five or more polymorphs in urethral smear by high-power microscopy. Symptoms can be minor to profound and vary from clear to mucopurulent discharge. Gonococcus is commoner in men who have sex with men (MSM) compared to heterosexuals, and high-risk activities such as chemsex parties increase spread with significant public health consequences. Antibiotic resistance in gonococcus has clinical and public health implications as three cases of extensively drug-resistant Neisseria gonorrhoeae with resistance to ceftriaxone (MIC = 0.5 mg/L) and high-level resistance to azithromycin (MIC > 256 mg/L) have been described compromising current treatment recommended by British Association for Sexual Health and HIV Guidelines (BASHH). In England an outbreak of high level azithromycin-resistant gonococcus has also been described by Public Health England (PHE), who alerted clinicians about the need for follow up and test of cure, contact tracing, and treatment failure. C. trachomatis infection can be treated with azithromycin 1g orally as a single dose or with seven days of oral doxycycline. Risk factors for chlamydia include age younger than twenty-five years, multiple sexual partners, and avoidance of barrier methods for contraception. Metronidazole 2g single dose or 400– 500mg twice daily for seven days is recommended for treatment of trichomonas, which can cause a moderate discharge in up to 60% of males. Resistance to azithromycin and doxycycline is common in M. genitalium strains and management of these patients with urethritis requires GUM referral for comprehensive investigation, contact tracing, and public health notification. Molecular methods are used for the diagnosis of these organisms and gonococcal culture is undertaken to obtain antimicrobial susceptibility data from patients with a previous diagnosis by molecular method, in GUM attendees, and their contacts. Herpes simplex infection results in a painful ulcer preceded by a vesicle. The diagnosis can be confirmed using polymerase chain reaction (PCR) tests of a swab taken from the vesicle or ulcer.

scholarly journals Men treated for syphilis in Białystok, Poland, 2014-2018

2019 ◽  
pp. 329-335
Author(s):  
Agnieszka Beata Serwin ◽  
Adriana Grochowska ◽  
Iwona Flisiak
Keyword(s):  
Urban Areas ◽  
Partner Notification ◽  
Secondary Syphilis ◽  
Contact Tracing ◽  
Professional Activity ◽  
Symptomatic Infection ◽  
Sexually Transmitted ◽  
Sexual Contacts ◽  
Sex With Men

INTRODUCTION. Incidence of syphilis is increasing in Europe in recent years, mainly due to high incidence in men, especially men who have sex with men (MSM). AIM. To analyse sociodemographic, epidemiological and clinical characteristics of men treated for syphilis in Bialystok in 2014 – 2018, to compare these of MSM and men who have sex with women (MSW). MATERIAL AND METHODS. Analysis of age, residency, professional activity, type of sexual contacts (steady vs. casual), marital status, stage of syphilis diagnosed, concomitant sexually transmitted infections (STIs), treatment, partner notification and follow-up attendance. RESULTS. Of 49 male patients with syphilis 26 (53.06%) were MSM and 23 (46.94%) – MSW. The average age was 33.67 and 35.87 years in MSM and MSW patients, respectively. Majority of patients in both groups were residents of urban areas. Tradesmen and those unemployed constituted the highest proportion in MSM and MSW group, respectively. MSM were in majority single and had only casual contacts while MSW, mostly married or engaged in steady relationship, had also casual contacts. Secondary syphilis was most frequently diagnosed in MSM and late latent syphilis - in MSW. Eight patients (16.32%) had concomitant HIV infection, in all diagnosed before syphilis. Contact tracing was successful in 26.92% of MSM and 39.13% of MSW. Follow-up was not done or not completed in half of MSM and more than half of MSW. CONCLUSIONS. Results confirm that MSM play a crucial role in the current epidemics of syphilis. They have mainly casual sexual contacts and have symptomatic infection. In both MSM and MSW contact tracing and follow-up attendance is suboptimal.

The GHESKIO Centers for Research in Haiti: An Education and Research Model in Action

2018 ◽  
pp. 321-337
Author(s):  
Vanessa Rouzier ◽  
Virginia Young ◽  
Jean William Pape
Keyword(s):  
Public Health ◽  
Diarrheal Diseases ◽  
Sexually Transmitted ◽  
Cornell University ◽  
The Family ◽  
Making A Difference ◽  
Significant Public Health ◽  
Health Model ◽  
Sarcome De Kaposi ◽  
Hiv Aids

GHESKIO (Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes/The Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections) Centers, founded in 1982, is one of the oldest institutions dedicated to the fight against HIV/AIDS. GHESKIO has 3 main objectives: patient care, training of medical personnel and community leaders, and operational research. GHESKIO efforts are focused on 4 of the most important diseases in Haiti: diarrheal diseases, HIV/AIDS, other sexually transmitted infections (STIs), and tuberculosis (TB). The emphasis is on the family because the diseases that the GHESKIO Centers are concerned with are likely to be spread in the family setting. From its inception, GHESKIO Centers have been affiliated with Cornell University Weill Cornell Medical College and the Haitian Ministry of Public Health and Population (MOPHP). GHESKIO is an official nongovernmental organization recognized by the Haitian government and working in close collaboration with the Haitian MOPHP, which has provided GHESKIO with facilities at the university hospital and at the National Institute Research Laboratory. GHESKIO is the country’s referral center and the Caribbean-leading institution for treatment and research in HIV/AIDS, STIs, TB, and diarrheal diseases. In the 36 years since its inception, the GHESKIO Centers have continued to evolve and grow despite the challenging sociopolitical and economic conditions of the country. Haiti is the poorest nation in the western hemisphere, with 80% of the population living under the poverty line and 54% in abject poverty.1–3 Haiti has the most significant HIV and TB epidemics outside of Africa. In addition, in the past 6 years, Haiti has weathered 3 of the most devastating natural catastrophes in recent times, including a magnitude 7.0 earthquake in 2010, the largest and deadliest cholera epidemic that same year, and a devastating category-5 hurricane, Matthew, in 2016. The GHESKIO model offers integrated preventive and curative services for HIV, TB, STIs, and diarrheal diseases in 2 campuses located in the north and south of Port-au-Prince. This approach has been expanded to include other notable diseases and services. All services are offered at each site to facilitate access to comprehensive care in a “one-stop shop” approach because the poor often cannot afford to travel to different health facilities for all their families’ needs. In addition to health services for HIV/AIDS, including the provision of antiretroviral therapy, treatment for STIs, TB treatment, psychological care, and reproductive health, support is provided with microcredit opportunities, primary and vocational school scholarships, and community outreach interventions that complete the global health model of GHESKIO. The story of GHESKIO is a model of success despite adversity, addressing significant public health problems and making a difference locally and internationally.

A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand

Sexual Health ◽  
2015 ◽  
Vol 12 (2) ◽  
pp. 170 ◽  
Author(s):  
Edward Coughlan ◽  
Heather Young ◽  
Catherine Parkes ◽  
Maureen Coshall ◽  
Nigel Dickson ◽  
...  
Keyword(s):  
Public Health ◽  
Social Media ◽  
Contact Tracing ◽  
Outbreak Response ◽  
Public Health Communication ◽  
Sexually Transmissible Infections ◽  
Sexual Contacts ◽  
Sex With Men ◽  
Use Of Social Media ◽  
Clinical Records

During 2012, Christchurch experienced a dramatic increase in cases of infectious syphilis among men who have sex with men. This was accompanied by some novel trends; notably, the acquisition of infection in a younger age group, with local sexual contacts, commonly via the use of social media. This study is a report on an approach to case identification and public health communication as a component of a multifaceted outbreak response. Enhanced syphilis surveillance data on public health responses to outbreaks of sexually transmissible infections was collated and reviewed, alongside clinical records and literature. Reported outbreak response methods were adapted for the Christchurch cohort. A Facebook page was created to raise awareness of infectious syphilis, the importance of screening and where to get tested. Twenty-six males were diagnosed with infectious syphilis in 2012, an increase from previous years, of which 22 reported only male sexual contact. High use of social media used to find potential sexual contacts was reported. Enhanced syphilis surveillance characterised in detail an infectious syphilis outbreak in Christchurch. Index cases were identified, contact tracing mapping was used to identify transmission networks and social media was also used to educate the risk group. There was a decrease in infectious syphilis presentations, with no cases in the last 3 months of 2012.

scholarly journals Online prescribing for sexually transmitted infections – what’s on offer? An evaluation of internet pharmacies based in the United Kingdom

2021 ◽  
Author(s):  
Elizabeth Okecha ◽  
Emily Boardman ◽  
Saleha Patel ◽  
Emile Morgan
Keyword(s):  
Herpes Simplex ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Sexual Health ◽  
Sexually Transmitted Infections ◽  
Trichomonas Vaginalis ◽  
National Guidelines ◽  
Sexually Transmitted ◽  
Internet Pharmacies ◽  
Online Pharmacies

AbstractBackgroundOnline pharmacies offer an alternative approach for patients to manage their sexual health. Our aim was to determine the type of antimicrobials sold as treatment for sexually transmitted infections (STIs) by UK internet pharmacies and if providers were adhering to national guidelines.MethodsA search engine results page (SERP) generated a list of registered UK online pharmacies offering treatment for the following infections: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex and Trichomonas vaginalis. An initial audit in 2017 benchmarked each provider against the British Association of Sexual Health & HIV (BASHH guidelines. Results were fed back to each provider before re-audit in 2020. Websites selling antibiotics for non-gonococcal urethritis (NGU) and Mycoplasma genitalium were included at re-audit.ResultsThere were 30 pharmacies identified in 2017 of which, five were excluded. Treatment could be obtained for Neisseria gonorrhoeae from five pharmacies without providing a culture result; three (60%) pharmacies sold BASHH approved antibiotics for Neisseria gonorrhoeae. All 25 pharmacies sold Chlamydia trachomatis treatment; 22 (88%) offered first line treatment options but no website assessed for proctitis. Herpes simplex treatment was sold on 22 websites of which, 13 (59%) offered treatment recommended by BASHH. Trichomonas vaginalis treatment was sold by four websites in line with BASHH. Results at re-audit showed an improvement in standards, although advice before, during and after treatment remained variable.DiscussionOur work has allowed us to engage with providers to improve prescribing within the UK online pharmacy industry. However, tougher regulation is needed in order to embed sustainable change for patients who choose to access treatment online.

scholarly journals Trends in antimicrobial susceptibility for azithromycin and ceftriaxone in Neisseria gonorrhoeae isolates in Amsterdam, the Netherlands, between 2012 and 2015

2017 ◽  
Vol 22 (1) ◽  
Author(s):  
Carolien M Wind ◽  
Maarten F Schim van der Loeff ◽  
Alje P van Dam ◽  
Henry JC de Vries ◽  
Jannie J van der Helm
Keyword(s):  
The Netherlands ◽  
Neisseria Gonorrhoeae ◽  
Treatment Strategies ◽  
Sex Partners ◽  
Hiv Status ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
New Treatment ◽  
Sex With Men ◽  
Infection Clinic

Resistance of Neisseria gonorrhoeae to azithromycin and ceftriaxone has been increasing in the past years. This is of concern since the combination of these antimicrobials is recommended as the first-line treatment option in most guidelines. To analyse trends in antimicrobial resistance, we retrospectively selected all consultations with a positive N. gonorrhoeae culture at the sexually transmitted infection clinic, Amsterdam, the Netherlands, from January 2012 through September 2015. Minimum inhibitory concentrations (MICs) for azithromycin and ceftriaxone were analysed per year, and determinants associated with decreased susceptibility to azithromycin (MIC > 0.25 mg/L) or ceftriaxone (MIC > 0.032 mg/L) were assessed. Between 2012 and 2015 azithromycin resistance (MIC > 0.5 mg/L) was around 1.2%, the percentage of isolates with intermediate MICs (> 0.25 and ≤ 0.5 mg/L) increased from 3.7% in 2012, to 8.6% in 2015. Determinants associated with decreased azithromycin susceptibility were, for men who have sex with men (MSM), infections diagnosed in the year 2014, two infected sites, and HIV status (HIV; associated with less decreased susceptibility); for heterosexuals this was having ≥ 10 sex partners (in previous six months). Although no ceftriaxone resistance (MIC > 0.125 mg/L) was observed during the study period, the proportion of isolates with decreased ceftriaxone susceptibility increased from 3.6% in 2012, to 8.4% in 2015. Determinants associated with decreased ceftriaxone susceptibility were, for MSM, infections diagnosed in 2014, and pharyngeal infections; and for heterosexuals, infections diagnosed in 2014 or 2015, being of female sex, and having ≥ 10 sex partners. Continued decrease of azithromycin and ceftriaxone susceptibility will threaten future treatment of gonorrhoea. Therefore, new treatment strategies are warranted.

scholarly journals Persistent transmission of shigellosis in England is associated with a recently emerged multi-drug resistant strain ofShigella sonnei

2019 ◽  
Author(s):  
Megan Bardsley ◽  
Claire Jenkins ◽  
Holly D Mitchell ◽  
Amy FW Mikhail ◽  
Kate S Baker ◽  
...  
Keyword(s):  
Public Health ◽  
Phylogenetic Analysis ◽  
Sexual Transmission ◽  
Health Concern ◽  
Drug Resistant ◽  
Adult Males ◽  
Significant Public Health ◽  
Sex With Men ◽  
The Uk ◽  
Travel Abroad

AbstractBackgroundWhole genome sequencing has enhanced surveillance and facilitated detailed monitoring of transmission ofShigellaspecies in England.MethodsWe undertook an epidemiological and phylogenetic analysis of isolates from all cases of shigellosis referred to Public Health England between 2015 to 2018 to explore recent strain characteristics and transmission dynamics ofShigellaspecies.ResultsOf the 4950 confirmed cases of shigellosis identified during this period, the highest proportion of isolates wereS. sonnei(54.4%), followed byS. flexneri(39.2%),S. boydii(4.1%) andS. dysenteriae(2.2%). Most cases were adults (82.9%) and male (59.5%), and 34.9% cases reported recent travel outside the UK. Throughout the study period diagnoses ofS. flexneriandS. sonneiwere most common in men with no history of recent travel abroad. Species prevalence was not static with cases ofS. flexneriin men decreasing from 2015-2016, and the number of cases ofS. sonneiincreasing from 2017. Phylogenetic analysis showed this recent increase inS. sonneiwas attributed to a novel clade exhibiting resistance to ciprofloxacin and azithromycin, which had emerged from a Central Asia sub-lineage.ConclusionsDespite changes in species prevalence,Shigelladiagnoses in England are persistently the most common in adult males without reported travel history, consistent with sexual transmission amongst men who have sex with men. The trend in increasing ciprofloxacin resistance, in addition to plasmid-mediated azithromycin resistance, inS. sonneiis of significant public health concern with respect to transmission of multi-drug resistant gastrointestinal pathogens and the risk of treatment failures.SummaryShigelladiagnoses in England are most prevalent amongst men who have sex with men.S. sonneiexhibiting resistance to both azithromycin and ciprofloxacin has replaced azithromycin-resistantS. flexnerias the most commonly isolated species in this setting.

scholarly journals Extragenital Gonorrhoea in Men Who Have Sex with Men: A Retrospective Study in a STI Clinic in Lisbon, Portugal

2018 ◽  
Vol 31 (5) ◽  
pp. 247 ◽  
Author(s):  
Margarida Moura Valejo Coelho ◽  
Eugénia Matos-Pires ◽  
Vasco Serrão ◽  
Ana Rodrigues ◽  
Cândida Fernandes
Keyword(s):  
Human Immunodeficiency Virus ◽  
Retrospective Study ◽  
Neisseria Gonorrhoeae ◽  
Sexually Transmitted Infection ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Sexually Transmitted Infection Clinic ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Infection Clinic

Introduction: Recent studies worldwide reveal a significant prevalence of extragenital infections by Neisseria gonorrhoeae among men who have sex with men. We aimed to analyse the frequency and characteristics of extragenital gonococcal infections diagnosed in men who have sex with men in a walk-in Sexually Transmitted Infection clinic in Lisbon, Portugal.Material and Methods: We conducted a cross-sectional, retrospective study of the anorectal and/or oropharyngeal Neisseria gonorrhoeae infections in men who have sex with men, diagnosed in our Sexually Transmitted Infection clinic between January 2014 and December 2016.Results: We found extragenital infection in 87 cases of gonorrhoea identified in men who have sex with men in this period, including: 49 cases of anorectal disease, 9 of oropharyngeal disease, 13 cases of infection at both extragenital sites, and 16 of simultaneous extragenital and urogenital gonorrhoea. Patients’ ages ranged from 17 to 64 years (median: 28 years). Forty-seven (54%) of the patients did not present with any extragenital symptoms. Thirty (35%) were human immunodeficiency virus-1-positive.Discussion: Since most extragenital Neisseria gonorrhoeae infections are asymptomatic, they may be missed and go untreated unless actively investigated. Current international guidelines recommend the screening of gonorrhoea at extragenital sites in men who have sex with men because anorectal and oropharyngeal infections constitute a potential disease reservoir, and may facilitate transmission and/or acquisition of human immunodeficiency virus infection.Conclusion: Our results highlight the relevance of testing men who have sex with men for Neisseria gonorrhoeae at extragenital sites, regardless of the existence of local complaints. The implementation of adequate screening programmes in Portugal should be considered. We also reinforce the need to raise awareness in the population regarding the adoption of prophylactic measures against transmission of sexually transmitted infections during anal and/or oral sexual exposure.

A cluster of acute hepatitis C virus infection among men who have sex with men – results from contact tracing and public health implications

AIDS ◽  
2005 ◽  
Vol 19 (9) ◽  
pp. 969-974 ◽  
Author(s):  
Hannelore M Götz ◽  
Gerard van Doornum ◽  
Hubert GM Niesters ◽  
Jan G den Hollander ◽  
H Bing Thio ◽  
...  
Keyword(s):  
Public Health ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Virus Infection ◽  
Acute Hepatitis ◽  
Contact Tracing ◽  
Acute Hepatitis C ◽  
Hepatitis C Virus Infection ◽  
Health Implications ◽  
Sex With Men

scholarly journals The “3 in 1” Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men

2015 ◽  
Vol 54 (3) ◽  
pp. 650-656 ◽  
Author(s):  
B. Sultan ◽  
J. A. White ◽  
R. Fish ◽  
G. Carrick ◽  
N. Brima ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Standard Of Care ◽  
Nucleic Acid Amplification ◽  
Site Testing ◽  
Predictive Values ◽  
Content Type ◽  
Sexually Transmitted ◽  
Soc Testing ◽  
Sex With Men

Triple-site testing (using pharyngeal, rectal, and urethral/first-void urine samples) forNeisseria gonorrhoeaeandChlamydia trachomatisusing nucleic acid amplification tests detects greater numbers of infections among men who have sex with men (MSM). However, triple-site testing represents a cost pressure for services. MSM over 18 years of age were eligible if they requested testing for sexually transmitted infections (STIs), reported recent sexual contact with eitherC. trachomatisorN. gonorrhoeae, or had symptoms of an STI. Each patient underwent standard-of-care (SOC) triple-site testing, and swabs were taken to form a pooled sample (PS) (pharyngeal, rectal, and urine specimens). The PS was created using two methods during different periods at one clinic, but we analyzed the data in combination because the sensitivity of the two methods did not differ significantly forC. trachomatis(P= 0.774) orN. gonorrhoeae(P= 0.163). The sensitivity of PS testing (92%) was slightly lower than that of SOC testing (96%) for detectingC. trachomatis(P= 0.167). ForN. gonorrhoeae, the sensitivity of PS testing (90%) was significantly lower than that of SOC testing (99%) (P< 0.001). When pharynx-only infections were excluded, the sensitivity of PS testing to detectN. gonorrhoeaeinfections increased to 94%. Our findings show that pooling of self-taken samples could be an effective and cost-saving method, with high negative predictive values. (Interim results of this study were presented at the BASHH 2013 summer meeting.)

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