Abstract
<h3>Objectives</h3> It has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in <i>Neisseria gonorrhoeae</i> (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal <i>Chlamydia trachomatis</i> (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin. <h3>Methods</h3> Azithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013–2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013–2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012–2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin. <h3>Results</h3> Modal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients. <h3>Conclusions</h3> We found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions.
Highlights
Oropharyngeal human papillomavirus 16 (HPV) infection, with the same viral type associated with cervical cancer, HPV 16, has been shown to be strongly associated with head and neck squamous cell carcinoma (HNSCC), especially the tonsil and base of tongue (BOT) subsites.[6]
Squamous cell carcinoma (SCC) of the oropharynx to date has almost always been associated with tobacco and alcohol exposure, occurred in late middle-aged and elderly patients, and was more common in men
The nodes associated with HPV-related SCC are usually in level IIa, ipsilateral to the primary tumor, and are either necrotic or truly cystic.[9]
Summary
Oropharyngeal HPV infection, with the same viral type associated with cervical cancer, HPV 16, has been shown to be strongly associated with HNSCC, especially the tonsil and base of tongue (BOT) subsites.[6] Squamous cell carcinoma (SCC) of the oropharynx to date has almost always been associated with tobacco and alcohol exposure, occurred in late middle-aged and elderly patients, and was more common in men. Patients with HPV-associated oropharyngeal SCC have different demographics. Compared with tobaccoand alcohol-related oropharyngeal SCC, patients with HPVassociated tumors tend to be younger, do not currently or have not ever smoked, and have a better prognosis after chemoradiation therapy.[7] Whether populations at risk, including adolescent boys, should be vaccinated against HPV, just as young sexually active girls are will be determined by public health officials in the several years.[8]
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