Posts filed under ‘Infecciones de transmision sexual’

A Liquid Biopsy Compatible Approach for Human Papillomavirus–Associated Oropharyngeal Cancer Detection

The Journal of Molecular Diagnostics January 2020 V.22 N.1 P.50-59    

Previous efforts to evaluate the detection of human papilloma viral (HPV) DNA in whole saliva as a diagnostic measure for HPV-associated oropharyngeal cancer (HPV-OPC) have not shown sufficient clinical performance.

We hypothesize that salivary exosomes are packaged with HPV-associated biomarkers, and efficient enrichment of salivary exosomes through isolation can enhance diagnostic and prognostic performance for HPV-OPC.

In this study, an acoustofluidic (the fusion of acoustics and microfluidics) platform was developed to perform size-based isolation of salivary exosomes.

These data showed that this platform is capable of consistently isolating exosomes from saliva samples, regardless of viscosity variation and collection method.

Compared with the current gold standard, differential centrifugation, droplet digital RT-PCR analysis showed that the average yield of salivary exosomal small RNA from the acoustofluidic platform is 15 times higher.

With this high-yield exosome isolation platform, we show that HPV16 DNA could be detected in isolated exosomes from the saliva of HPV-associated OPC patients at 80% concordance with tissues/biopsies positive for HPV16.

Overall, these data demonstrated that the acoustofluidic platform can achieve high-purity and high-yield salivary exosome isolation for downstream salivary exosome–based liquid biopsy applications.

Additionally, HPV16 DNA sequences in HPV-OPC patients are packaged in salivary exosomes and their isolation will enhance the detection of HPV16 DNA. . . . .

FULL TEXT

https://jmd.amjpathol.org/article/S1525-1578(19)30395-2/fulltext

PDF

https://jmd.amjpathol.org/article/S1525-1578(19)30395-2/pdf

January 3, 2020 at 3:50 pm

Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020 

Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports January 3, 2020 V.68 N.5 P.1–20

                                          

This report (hereafter referred to as STD QCS) provides CDC recommendations to U.S. health care providers regarding quality clinical services for sexually transmitted diseases (STDs) for primary care and STD specialty care settings. These recommendations complement CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2015 (hereafter referred to as the STD Guidelines), a comprehensive, evidence-based reference for prevention, diagnosis, and treatment of STDs. STD QCS differs from the STD Guidelines by specifying operational determinants of quality services in different types of clinical settings, describing on-site treatment and partner services, and indicating when STD-related conditions should be managed through consultation with or referral to a specialist. These recommendations might also help in the development of clinic-level policies (e.g., standing orders, express visits, specimen panels, and reflex testing) that can facilitate implementation of the STD Guidelines. CDC organized the recommendations for STD QCS into eight sections: 1) sexual history and physical examination, 2) prevention, 3) screening, 4) partner services, 5) evaluation of STD-related conditions, 6) laboratory, 7) treatment, and 8) referral to a specialist for complex STD or STD-related conditions.

CDC developed the recommendations by synthesizing relevant, evidence-based guidelines and recommendations issued by other experts; reviewing current practice in the United States; soliciting Delphi ratings by subject matter experts on STD care in primary care and STD specialty care settings; discussing the scientific evidence supporting the proposed recommendations at a consultation meeting of experts and institutional stakeholders held November 20, 2015, in Atlanta, Georgia; conducting peer reviews of draft recommendations and supporting evidence; and discussing draft recommendations and supporting evidence during meetings of the CDC/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment STD Work Group. These recommendations are intended to help health care providers in primary care or STD specialty care settings offer STD services at their clinical settings and to help the persons seeking care live safer, healthier lives by preventing and treating STDs and related complications.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/68/rr/rr6805a1.htm?s_cid=rr6805a1_w&deliveryName=USCDC_921-DM16420

PDF

https://www.cdc.gov/mmwr/volumes/68/rr/pdfs/rr6805a1-H.pdf

 

January 2, 2020 at 3:33 pm

American trypanosomiasis and Chagas disease – Sexual transmission

International Journal of Infectious Diseases April 2019 V.81 N.4 P.81-84

Clever Gomes, Adriana B. Almeida, Ana C. Rosa, Perla F. Araujo, Antonio R.L. Teixeira

Highlights

  • Trypanosoma cruzi infection can be transmitted sexually from males and females to naïve mates.
  • T. cruzi parasites were detected in semen ejaculates from individuals with Chagas disease by nucleic acid techniques.
  • Semen aliquots from humans with Chagas disease instilled into the vagina of naïve female mice resulted in T. cruzi infections.
  • Breeding T. cruzi-infected male and female mice vertically transmitted the infection to progeny mice.

Objective

To contribute to the discussion on the research findings indicating the sexual transmission of American trypanosomiasis and Chagas disease in humans.

Methods

A review of the literature was performed to investigate the routes of transmission of Trypanosoma cruzi parasites and to evaluate the distribution of Chagas disease, which is now found across five continents.

Results

The epidemiological profile of American trypanosomiasis, which is still considered a neglected disease of the poor people of Latin America, has changed over time. A family-based study demonstrated that the blood protozoan T. cruzi can be transmitted sexually from infected males and females to naïve mates.

Conclusions

Evidence that Chagas disease can be transmitted sexually, coupled with the migration of individuals with Chagas disease to previously non-endemic countries and increased travel to endemic countries, has implications for public health. Improved screening of blood supplies and prenatal care are required to prevent congenital spread.

FULL TEXT

https://www.ijidonline.com/article/S1201-9712(19)30032-3/fulltext

PDF

https://www.ijidonline.com/article/S1201-9712(19)30032-3/pdf

June 30, 2019 at 12:18 pm

Gentamicin as an alternative treatment for gonorrhoea

LANCET June 22, 2019 V.393 N.10190 P.2474-2475

COMMENT

A high gonorrhoea disease burden, increasing rates, and growing antimicrobial resistance portend a developing global public health crisis.1 Gonorrhoea can cause reproductive complications such as pelvic inflammatory disease and infertility, blindness in infants born to infected mothers, and can facilitate HIV acquisition and transmission. Effective treatment prevents sequelae and transmission. Yet Neisseria gonorrhoeae has developed resistance to each antimicrobial used for treatment.2 Development of new antimicrobials has not kept pace…..

FULL TEXT

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30244-2/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2930244-2

 

LANCET June 22, 2019 V.393 N.10190 P.2511-2520

Gentamicin compared with ceftriaxone for the treatment of gonorrhoea (G-ToG): a randomised non-inferiority trial

Background

Gonorrhoea is a common sexually transmitted infection for which ceftriaxone is the current first-line treatment, but antimicrobial resistance is emerging. The objective of this study was to assess the effectiveness of gentamicin as an alternative to ceftriaxone (both combined with azithromycin) for treatment of gonorrhoea.

Methods

G-ToG was a multicentre, parallel-group, pragmatic, randomised, non-inferiority trial comparing treatment with gentamicin to treatment with ceftriaxone for patients with gonorrhoea. The patients, treating physician, and assessing physician were masked to treatment but the treating nurse was not. The trial took place at 14 sexual health clinics in England. Adults aged 16–70 years were eligible for participation if they had a diagnosis of uncomplicated genital, pharyngeal, or rectal gonorrhoea. Participants were randomly assigned to receive a single intramuscular dose of either gentamicin 240 mg (gentamicin group) or ceftriaxone 500 mg (ceftriaxone group). All participants also received a single 1 g dose of oral azithromycin. Randomisation (1:1) was stratified by clinic and performed using a secure web-based system. The primary outcome was clearance of Neisseria gonorrhoeae at all initially infected sites, defined as a negative nucleic acid amplification test 2 weeks post treatment. Primary outcome analyses included only participants who had follow-up data, irrespective of the baseline visit N gonorrhoeae test result. The margin used to establish non-inferiority was a lower confidence limit of 5% for the risk difference. This trial is registered with ISRCTN, number ISRCTN51783227.

Findings

Of 1762 patients assessed, we enrolled 720 participants between Oct 7, 2014, and Nov 14, 2016, and randomly assigned 358 to gentamicin and 362 to ceftriaxone. Primary outcome data were available for 306 (85%) of 362 participants allocated to ceftriaxone and 292 (82%) of 358 participants allocated to gentamicin. At 2 weeks after treatment, infection had cleared for 299 (98%) of 306 participants in the ceftriaxone group compared with 267 (91%) of 292 participants in the gentamicin group (adjusted risk difference −6·4%, 95% CI −10·4% to −2·4%). Of the 328 participants who had a genital infection, 151 (98%) of 154 in the ceftriaxone group and 163 (94%) of 174 in the gentamicin group had clearance at follow-up (adjusted risk difference −4·4%, −8·7 to 0). For participants with a pharyngeal infection, a greater proportion receiving ceftriaxone had clearance at follow-up (108 [96%] in the ceftriaxone group compared with 82 [80%] in the gentamicin group; adjusted risk difference −15·3%, −24·0 to −6·5). Similarly, a greater proportion of participants with rectal infection in the ceftriaxone group had clearance (134 [98%] in the ceftriaxone group compared with 107 [90%] in the gentamicin group; adjusted risk difference −7·8%, −13·6 to −2·0). Thus, we did not find that a single dose of gentamicin 240 mg was non-inferior to a single dose of ceftriaxone 500 mg for the treatment of gonorrhoea, when both drugs were combined with a 1 g dose of oral azithromycin. The side-effect profiles were similar between groups, although severity of pain at the injection site was higher for gentamicin (mean visual analogue pain score 36 of 100 in the gentamicin group vs 21 of 100 in the ceftriaxone group).

Interpretation

Gentamicin is not appropriate as first-line treatment for gonorrhoea but remains potentially useful for patients with isolated genital infection, or for patients who are allergic or intolerant to ceftriaxone, or harbour a ceftriaxone-resistant isolate. Further research is required to identify and test new alternatives to ceftriaxone for the treatment of gonorrhoea.

Funding

UK National Institute for Health Research.

FULL TEXT

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32817-4/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2932817-4

 

 

June 22, 2019 at 7:59 pm

2018 European guideline on the organization of a consultation for sexually transmitted infections

Journal of The European Academy of Dermatology and Venereology

New in the 2018 guidelines

This is an update of the 2012 IUSTI guideline. In this new version, we have expanded the sections on sexual history taking to include PEP and PrEP use, intimate partner and gender‐based violence, chemsex, swinging and psychosexual problems. We highlight the potential for the use of technology in the context of sexual health to facilitate sexual history taking and partner notification. We have explained the principle of safeguarding young and other vulnerable people who may present to services.

This guideline is primarily aimed at services provided in mainstream clinic/office environments, but increasingly many countries are seeing an era of rapid transition of sexual health services in which satellite clinics and online service provision are centre stage. Services are moving away from the main hospitals/clinics into smaller peripheral sites and various non‐traditional or outreach type settings such as saunas, brothels, bars, clubs, educational facilities, prisons and gay pride events. The advantage of such services is that it might allow hard‐to‐reach groups to be engaged with clinical services.1 We need a cohesive, multiagency approach to addressing the challenges associated with this style of service provision, if we are to harness the potential for decentralization of sexual health services while safeguarding the most vulnerable and remaining true to the founding principles of sexual health care….

FULL TEXT

https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.15577

PDF

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.15577

June 17, 2019 at 10:39 am

Performance of Treponemal Tests for the Diagnosis of Syphilis

Clinical Infectious Diseases March 15, 2019 V.68 N.6 P.913–918

Performance of Treponemal Tests for the Diagnosis of Syphilis

We compared performance of 5 treponemal immunoassays, the Treponema pallidum particle agglutination assay (TPPA), and the fluorescent treponemal antibody absorption test (FTA-ABS). FTA-ABS was less sensitive for primary syphilis (78%) than the immunoassays or TPPA (94%–96% sensitivity). TPPA was 100% specific.

Background

Treponemal immunoassays are increasingly used for syphilis screening with the reverse sequence algorithm. There are few data describing performance of treponemal immunoassays compared to traditional treponemal tests in patients with and without syphilis.

Methods

We calculated sensitivity and specificity of 7 treponemal assays: (1) ADVIA Centaur (chemiluminescence immunoassay [CIA]); (2) Bioplex 2200 (microbead immunoassay); (3) fluorescent treponemal antibody absorption test (FTA-ABS); (4) INNO-LIA (line immunoassay); (5) LIAISON CIA; (6) Treponema pallidum particle agglutination assay (TPPA); and (7) Trep-Sure (enzyme immunoassay [EIA]), using a reference standard combining clinical diagnosis and serology results. Sera were collected between May 2012–January 2013. Cases were characterized as: (1) current clinical diagnosis of syphilis: primary, secondary, early latent, late latent; (2) prior treated syphilis only; (3) no evidence of current syphilis, no prior history of syphilis, and at least 4 of 7 treponemal tests negative.

Results

Among 959 participants, 262 had current syphilis, 294 had prior syphilis, and 403 did not have syphilis. FTA-ABS was less sensitive for primary syphilis (78.2%) than the immunoassays or TPPA (94.5%–96.4%) (all P ≤ .01). All immunoassays were 100% sensitive for secondary syphilis, 95.2%–100% sensitive for early latent disease, and 86.8%–98.5% sensitive in late latent disease. TPPA had 100% specificity.

Conclusions

Treponemal immunoassays demonstrated excellent sensitivity for secondary, early latent, and seropositive primary syphilis. Sensitivity of FTA-ABS in primary syphilis was poor. Given its high specificity and superior sensitivity, TPPA is preferred to adjudicate discordant results with the reverse sequence algorithm over the FTA-ABS.

FULL TEXT

https://academic.oup.com/cid/article/68/6/913/5050740

PDF (CLIC en PDF)

 

Clinical Infectious Diseases March 15, 2019 V.68 N.6 P.934–939

Syphilis Testing Among Sexually Active Men Who Have Sex With Men and Who Are Receiving Medical Care for Human Immunodeficiency Virus in the United States: Medical Monitoring Project, 2013–2014

Among sexually active HIV-positive men who have sex with men in the United States receiving medical care for HIV, nearly one-third were not tested for syphilis at least annually and many at increased risk were not tested at recommended frequencies.

Background

Guidelines recommend that sexually active men who have sex with men (MSM) including human immunodeficiency virus (HIV)-positive MSM be tested at least annually for syphilis, with testing every 3–6 months for MSM at elevated risk. We examined the proportion of HIV-positive MSM tested for syphilis in the past 3, 6, and 12 months by their HIV care provider during 2013–2014.

Methods

Using data from the Medical Monitoring Project, a population-based HIV surveillance system, we evaluated the proportion of MSM who had documentation of being tested for syphilis by their HIV care provider in the past 3, 6, and 12 months.

Results

During 2013–2014, 71% (95% confidence interval [CI]: 69%–73%) of sexually active HIV-positive MSM were tested for syphilis in the past year. This proportion was higher among MSM reporting condomless sex: (75%; 95% CI: 72%–78%), and among MSM reporting ≥ 2 sex partners (77%; 95% CI: 74%–79%), in the past 12 months. Among MSM reporting condomless sex, 49% (95% CI: 45%–53%) were tested in the past 6 months, and 26% (95% CI: 22%–30%) in the past 3 months. Among MSM reporting ≥ 2 sex partners, 49% (95% CI: 44%–54%) were tested in the past 6 months and 26% (95% CI: 22%–29%) in the past 3 months.

Conclusions

Nearly one-third of sexually active HIV-positive MSM were not tested annually, and many at increased risk were not tested at recommended frequencies. Efforts to improve compliance with screening guidelines for high-risk HIV-positive MSM are warranted.

FULL TEXT

https://academic.oup.com/cid/article/68/6/934/5050272

PDF (CLIC en PDF)

May 4, 2019 at 12:08 pm

Disseminated Gonococcal Infection

N Engl J of Medic April 18, 2019 V.380 P.1565

IMAGES IN CLINICAL MEDICINE

Florez-Pollack and M.M. Mauskar

A 20-year-old woman presented to the emergency department with a rash involving the arms, legs, trunk, and scalp, which had erupted that morning. She also reported generalized muscle aches, fever, and pain in both ankles. Two weeks earlier …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMicm1811120?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMicm1811120?articleTools

April 21, 2019 at 11:37 am

Neisseria gonorrhoeae — Rising Infection Rates, Dwindling Treatment Options

N Engl J Med November 8, 2018 V.379 P.1795

Blank and D.C. Daskalakis

Gnorrhea infection is the second most commonly reported notifiable condition in the United States, and case rates have been increasing since 2009. In 2017, a total of 555,608 cases of gonorrhea were reported nationally, the largest number since 1991 and an 18.6% increase over 2016 (see graph).1

In 2015, the Obama administration deemed Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and Neisseria gonorrhoeae the most urgent infectious public health threats to national security, given the accelerating emergence of antibiotic resistance in these organisms.2 Though gonorrhea ranked third on this list, the number of cases of gonorrhea dwarfs those of the other two infections. Worldwide, gonorrhea cases have persistently affected young adults. Without a concerted global effort to mitigate antibiotic resistance, infected persons (primarily, sexually active young adults, who tend to be otherwise healthy) may require extended hospital stays and additional follow-up visits for an infection that can currently be managed on an outpatient basis. Such a shift could impose a serious burden on health care systems and societal productivity internationally. In the United States, this concern is compounded by the fact that for decades, gonorrhea infections have disproportionately affected black Americans, American Indians and Alaska Natives, Native Hawaiians and other Pacific Islanders, and Hispanic Americans….

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1812269?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1812269

December 4, 2018 at 7:00 pm

Gepotidacin for the Treatment of Uncomplicated Urogenital Gonorrhea: A Phase 2, Randomized, Dose-Ranging, Single-Oral Dose Evaluation

Clinical Infectious Diseases August 15, 2018 V.67 N.4 P.505-512

Stephanie N Taylor; David H Morris; Ann K Avery; Kimberly A Workowski; Byron E Batteiger

In this phase 2 study, single oral doses of gepotidacin were ≥95% effective for bacterial eradication in culture-proven uncomplicated urogenital gonorrhea. New antibiotics for drug-resistant Neisseria gonorrhoeae are urgently needed. With additional evaluation, gepotidacin may provide an alternative therapeutic option.

FULL TEXT

https://academic.oup.com/cid/article/67/4/504/4958398

PDF (CLIC en PDF)

November 4, 2018 at 8:25 am

The projected timeframe until cervical cancer elimination in Australia: a modelling study

The Lancet Public Health October 20, 2018

Michaela T Hall, MMath Kate T Simms, PhDJie-Bin Lew, PhDMegan A Smith, PhDJulia ML Brotherton, PhDMarion Saville, MBChB et al.

Background

In 2007, Australia was one of the first countries to introduce a national human papillomavirus (HPV) vaccination programme, and it has since achieved high vaccination coverage across both sexes. In December, 2017, organised cervical screening in Australia transitioned from cytology-based screening every 2 years for women aged from 18–20 years to 69 years, to primary HPV testing every 5 years for women aged 25–69 years and exit testing for women aged 70–74 years. We aimed to identify the earliest years in which the annual age-standardised incidence of cervical cancer in Australia (which is currently seven cases per 100 000 women) could decrease below two annual thresholds that could be considered to be potential elimination thresholds: a rare cancer threshold (six new cases per 100 000 women) or a lower threshold (four new cases per 100 000 women), since Australia is likely to be one of the first countries to reach these benchmarks.

Methods

In this modelling study, we used Policy1-Cervix—an extensively validated dynamic model of HPV vaccination, natural history, and cervical screening—to estimate the age-standardised incidence of cervical cancer in Australia from 2015 to 2100. We incorporated age-specific coverage of the Australian National HPV Vaccination Program in girls, including the catch-up programme, and the inclusion of boys into the vaccine programme from 2013, and a change from the quadrivalent to the nonavalent vaccine from 2018. We also modelled the effects of the transition to primary HPV screening. We considered two scenarios for future screening recommendations regarding the cohorts who will be and who have been offered the nonavalent vaccine: either that HPV screening every 5 years continues, or that no screening would be offered to these women.

Findings

We estimate that, in Australia, the age-standardised annual incidence of cervical cancer will decrease to fewer than six new cases per 100 000 women by 2020 (range 2018–22), and to fewer than four new cases per 100 000 women by 2028 (2021–35). The precise year of attaining these rates is dependent on the population used for age-standardisation, HPV screening behaviour and test characteristics, the incremental effects of vaccination of men on herd immunity in women, and assumptions about the future frequency of benign hysterectomies. By 2066 (2054–77), the annual incidence of cervical cancer will decrease and remain at fewer than one case per 100 000 women if screening for HPV every 5 years continues for cohorts who have been offered the nonavalent vaccine, or fewer than three cases per 100 000 women if these cohorts are not screened. Cervical cancer mortality is estimated to decrease to less than an age-standardised annual rate of one death per 100 000 women by 2034 (2025–47), even if future screening is only offered to older cohorts that were not offered the nonavalent vaccine.

Interpretation

If high-coverage vaccination and screening is maintained, at an elimination threshold of four new cases per 100 000 women annually, cervical cancer could be considered to be eliminated as a public health problem in Australia within the next 20 years. However, screening and vaccination initiatives would need to be maintained thereafter to maintain very low cervical cancer incidence and mortality rates.

Funding: National Health and Medical Research Council (Australia).

FULL TEXT

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30183-X/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S2468-2667%2818%2930183-X

October 4, 2018 at 7:24 am

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