Posts filed under ‘Infecciones de transmision sexual’

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

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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

Neisseria gonorrhoeae molecular typing for understanding sexual networks and antimicrobial resistance transmission: A systematic review

Journal of Infection June 2018 V.76 N.6 P.507–514

Katy Town, Hikaru Bolt, Sara Croxford, Michelle Cole, Simon Harris, Nigel Field, Gwenda Hughes

Highlights

  • Combined molecular and epidemiological data can describe the spread of gonorrhoea.
  • Sexual networks can be inferred from molecular clusters of infection.
  • Gender and sexual orientation are commonly used to characterise these networks.
  • Application of these data within gonorrhoea control interventions is limited.
  • Future studies should focus on evaluating molecular typing data in practice.

Objectives

Neisseria gonorrhoeae (NG) is a significant global public health concern due to rising diagnoses rates and antimicrobial resistance. Molecular combined with epidemiological data have been used to understand the distribution and spread of NG, as well as relationships between cases in sexual networks, but the public health value gained from these studies is unclear. We conducted a systematic review to examine how molecular epidemiological studies have informed understanding of sexual networks and NG transmission, and subsequent public health interventions.

Methods

Five research databases were systematically searched up to 31st March 2017 for studies that used sequence-based DNA typing methods, including whole genome sequencing, and linked molecular data to patient-level epidemiological data. Data were extracted and summarised to identify common themes.

Results

Of the 49 studies included, 82% used NG Multi-antigen Sequence Typing. Gender and sexual orientation were commonly used to characterise sexual networks that were inferred using molecular clusters; clusters predominantly of one patient group often contained a small number of isolates from other patient groups. Suggested public health applications included using these data to target interventions at specific populations, confirm outbreaks, and inform partner management, but these were mainly untested.

Conclusions

Combining molecular and epidemiological data has provided insight into sexual mixing patterns, and dissemination of NG, but few studies have applied these findings to design or evaluate public health interventions. Future studies should focus on the application of molecular epidemiology in public health practice to provide evidence for how to prevent and control NG.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30085-9/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30085-9/pdf

July 28, 2018 at 7:29 pm

Sexually transmitted infections in older populations

Current Opinion in Infectious Diseases. 26(1):80-85, February 2013.

Poynten, I. Mary; Grulich, Andrew E.; Templeton, David J.

Purpose of review

People are living longer and healthier lives. In recent years, there has been a focus on recognition of ongoing sexual activity among older adults and leading from this, the potential for an increase in diagnoses of sexually transmitted infections (STIs). Data on STI rates, sexual behaviour and factors affecting susceptibility to STIs are discussed.

Recent findings

There is limited published literature in this field and few recent longitudinal studies of STI acquisition in people older than 50 years. Although there is evidence of an increase in incidence, STIs remain rare in older compared with younger populations. Compared with their heterosexual counterparts, older men who have sex with men are at higher risk of incident HIV and some other STIs. The HIV epidemic is ageing as a result of increasing life span and acquisition of HIV at older ages. Improved longevity, evolving societal norms and physiological changes may place older people at risk of HIV and other STIs.

Summary

Routine STI screening is not warranted in all older people. Education and prevention strategies for all people at greater risk of HIV, regardless of age are required. Age-appropriate interventions designed to impart knowledge and provide the requisite skills needed to reduce STI risk in older age would be beneficial.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2013/02000/Sexually_transmitted_infections_in_older.12.aspx?WT.mc_id=HPxADx20100319xMP

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June 30, 2018 at 10:49 am

The Brief Case: Disseminated Neisseria gonorrhoeae in an 18-Year-Old Female

Journal of Clinical Microbiology April 2018 V.56  N.4

Julianne E. Burns and Erin H. Graf

CASE

An 18-year-old previously healthy female presented to a Philadelphia, PA, pediatric emergency department in February for further evaluation of polyarticular arthritis. Two weeks prior, she had presented to an outside hospital with body aches and onset of acute pain in the left arm and leg. The etiology was thought to be cervical radiculopathy, and she was discharged on naproxen and prednisone. She returned to the outside hospital 5 days later without improvement and now with pain and swelling in her left knee, right thumb, right wrist, and bilateral ankles. She had a markedly elevated erythrocyte sedimentation rate (ESR) of 80 mm/h (reference range, 0 to 20 mm/h) and C-reactive protein (CRP) of 76.6 mg/dl (reference range, 0 to 0.9 mg/dl). A workup for autoimmune disease included negative results for antinuclear antibody, rheumatoid factor, and anticyclic citrullinated peptide. Serologic testing for Lyme disease was also negative……

PDF

http://jcm.asm.org/content/56/4/e00932-17.full.pdf+html

 

 

Closing the Brief Case: Disseminated Neisseria gonorrhoeae in an 18-Year-Old Female

SELF ASSESSMENT QUESTIONS

Which of the following specimens is recommended and FDA cleared for nucleic acid amplification testing (NAAT) in suspected cases of disseminated Neisseria gonorrhoeae?

a-Whole blood

b-Urine

c-Synovial fluid

d.Serum

PDF

http://jcm.asm.org/content/56/4/e00933-17.full.pdf+html

March 27, 2018 at 8:21 am

Impact of Rapid Susceptibility Testing and Antibiotic Selection Strategy on the Emergence and Spread of Antibiotic Resistance in Gonorrhea

The Journal of Infectious Diseases November 27, 2017 V.216 N.9  P.1141–1149  

Ashleigh R Tuite; Thomas L Gift; Harrell W Chesson; Katherine Hsu; Joshua A Salomon …

Background

Increasing antibiotic resistance limits treatment options for gonorrhea. We examined the impact of a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles on slowing resistance spread.

Methods

A mathematical model describing gonorrhea transmission incorporated resistance emergence probabilities and fitness costs associated with resistance based on characteristics of ciprofloxacin (A), azithromycin (B), and ceftriaxone (C). We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with the following: (1) empiric treatment (B and C), and treatment guided by POC tests determining susceptibility to (2) A only and (3) all 3 antibiotics.

Results

Continued empiric treatment without POC testing was projected to result in >5% of isolates being resistant to both B and C within 15 years. Use of either POC test in 10% of identified cases delayed this by 5 years. The 3 antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, whereas the A-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake.

Conclusions

Rapid diagnostics reporting antibiotic susceptibility may extend the usefulness of existing antibiotics for gonorrhea treatment, but ongoing monitoring of resistance patterns will be critical.

abstract

https://academic.oup.com/jid/article/216/9/1141/4100269

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January 31, 2018 at 11:18 pm

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