Posts filed under ‘Infecciones de transmision sexual’

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

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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

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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

Rectal Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Women Reporting Anal Intercourse

Obstetrics & Gynecology September 2018  V.132 N.3  P.692–697

Llata, Eloisa, MD, MPH; Braxton, Jim; Asbel, Lenore, MD; Chow, Joan, PhD; Jenkins, Lindsay; Murphy, Ryan, PhD; Pathela, Preeti, DrPh; Schumacher, Christina, PhD; Torrone, Elizabeth, PhD

OBJECTIVE:

To examine the prevalence and treatment of rectal Chlamydia trachomatis and Neisseria gonorrhoeae infections among women reporting receptive anal intercourse in a network of sexually transmitted disease or sexual health clinics and estimate the proportion of missed infections if women were tested at the genital site only.

METHODS:

We conducted a cross-sectional analysis of C trachomatis and N gonorrhoeae test results from female patients reporting receptive anal intercourse in the preceding 3 months during visits to 24 sexually transmitted disease clinics from 2015 to 2016. Primary outcomes of interest were 1) anatomic site-specific C trachomatis and N gonorrhoeae testing and positivity among women attending selected U.S. sexually transmitted disease clinics who reported receptive anal intercourse and 2) the proportion of rectal infections that would have remained undetected if only genital sites were tested.

RESULTS:

Overall, 7.4% (3,743/50,785) of women reported receptive anal intercourse during the 2 years. Of the 2,818 women tested at both the genital and rectal sites for C trachomatis, 292 women were positive (61 genital only, 60 rectal only, and 171 at both sites). Of the 2,829 women tested at both the genital and rectal sites for N gonorrhoeae, 128 women were positive (31 genital only, 23 rectal only, and 74 at both sites). Among women tested at both anatomic sites, the proportion of missed C trachomatis infections would have been 20.5% and for N gonorrhoeae infections, 18.0%.

CONCLUSION:

Genital testing alone misses approximately one fifth of C trachomatis and N gonorrhoeae infections in women reporting receptive anal intercourse in our study population. Missed rectal infections may result in ongoing transmission to other sexual partners and reinfection.

FULL TEXT

https://journals.lww.com/greenjournal/Fulltext/2018/09000/Rectal_Chlamydia_trachomatis_and_Neisseria.22.aspx

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August 31, 2018 at 3:52 pm

Risk of HPV-16/18 Infections and Associated Cervical Abnormalities in Women Seropositive for Naturally Acquired Antibodies: Pooled Analysis Based on Control Arms of Two Large Clinical Trials

The Journal of Infectious Diseases July 1, 2018 V.218 N.1 P.84-94

Mahboobeh Safaeian; Xavier Castellsagué; Allan Hildesheim; Sholom Wacholder; Mark H Schiffman

Using data from PATRICIA and Costa Rica Vaccine trials, the risk of detecting a new HPV-18 infection and associated lesions was compared between women HPV seropositive and seronegative at enrollment. High HPV-18 naturally acquired antibodies were associated with partial protection.

FULL TEXT

https://academic.oup.com/jid/article/218/1/84/4990620

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August 13, 2018 at 6:19 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)

August 12, 2018 at 8:16 pm

Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018

MMWR August 8, 2018 V.67  Early Release

Marion E. Rice, MPH; Romeo R. Galang, MD; Nicole M. Roth, MPH; et al.

Introduction

Zika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning.

Methods

Pregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection.

Results

Among 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both.

Conclusion

One in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6731e1-H.pdf

 

 

MMWR August 8, 2018 V.67  Early Release

Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure — United States, August 2018

Kara D. Polen, MPH; Suzanne M. Gilboa, PhD; Susan Hills, MBBS; et al.

Zika virus infection can occur as a result of mosquitoborne or sexual transmission of the virus. Infection during pregnancy is a cause of fetal brain abnormalities and other serious birth defects (1,2). CDC has updated the interim guidance for men with possible Zika virus exposure who 1) are planning to conceive with their partner, or 2) want to prevent sexual transmission of Zika virus at any time (3). CDC now recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) before engaging in unprotected sex. CDC now also recommends that for couples who are not trying to conceive, men can consider using condoms or abstaining from sex for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) to minimize their risk for sexual transmission of Zika virus. All other guidance for Zika virus remains unchanged. The definition of possible Zika virus exposure remains unchanged and …

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6731e2-H.pdf

August 8, 2018 at 8:26 am

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