Anogenital Infection Research Articles

Could APTIMA mRNA Assay Contribute to Predicting Cervical Bacterial Sexually Transmitted Co-Infections? A Colposcopy Population Study.

In addition to chronic hrHPV anogenital infection, continuing inflammatory cervical changes are intrinsic in the development of precancerous lesions. In younger women, much of this inflammatory background parallels the progressive maturation of squamous metaplasia, often rendering treatment interventions redundant; however, patients with persistent cervical precancer, as well as those harboring invasive bacterial pathogens, might benefit from controlling the active inflammatory process by shortening the HPV natural cycle and avoiding subsequent cervical surgery. In a colposcopy population of 336 predominantly young asymptomatic individuals, we explored the impact of molecularly detected bacterial STIs on HPV DNA and APTIMA positivity rates using validated assays. In the multivariable analysis, several largely anticipated epidemiological factors were related to STI positivity. In this cohort, the HPV DNA test illustrated better performance for the prediction of STI positivity than the corresponding APTIMA test (sensitivity 52.94% vs. 33.82%), while inversely, the APTIMA test was more indicative of bacterial STI negativity than the HPV DNA test (specificity 77% vs. 60%). In addition, no significant differences between these two molecular assays were documented in terms of PPV, NPV, and overall accuracy. Despite the high Ureaplasma urealyticum and low Chlamydia trachomatis prevalence recorded in this study's population, which is among the first assessing the co-variation of bacterial STI expression with established HPV biomarkers, the APTIMA assay did not predict concurrent bacterial STIs superiorly compared with an established HPV DNA assay.

Dermatovenereology in the Russian Federation: results of 2023

The article presents information on dynamics of dermatovenerological service resources, indicators of the population of the Russian Federation provision with dermatovenerologists and dermatovenerological beds, main performance rates and results of dermatovenereological medical care providing in outpatient, inpatient and day hospital conditions for the period 2019–2023. The dynamics of sexually transmitted infections (syphilis, gonococcal infection, trichomoniasis, chlamydial infection, anogenital herpetic viral infection and anogenital venereal warts) incidence in the Russian Federation, as well as contribution of foreign citizens to the syphilis incidence rates are analyzed. The dynamics of prevalence and incidence rates of diseases of the skin and subcutaneous tissue in the Russian Federation in 2019–2023, as well as dynamics of prevalence and incidence of atopic dermatitis, psoriasis, contact dermatitis, localized scleroderma, discoid lupus erythematosus among children aged 0–17 years and adults 18 years and older are presented.

Analysis of the epidemiological situation and dynamics of the incidence of sexually transmitted infections in the Russian Federation over a ten-year period (2012–2022)

Sexually transmitted infections (STIs) are socially significant diseases and require close attention due to the multifactorial causes that influence their spread. In 2012–2022, the Russian Federation maintained a downward trend in the incidence of STIs (from 267.6 to 91.3 cases per 100 thousand population), established since 1998 in all age groups. In 2022, compared to 2012, the incidence rates decreased: syphilis — by 42.7%; gonococcal infection — by 77.7%; trichomoniasis — by 75.8%; chlamydial infections — by 72.1%; anogenital herpetic infection — by 51.2%; anogenital (venereal) warts — by 36.5%. But at the same time, in 2021 and 2022, there was an increase in the incidence of syphilis and gonococcal infection: compared to 2019, the increase in the incidence of syphilis was 25.9%, and that of gonococcal infection — 5.2%. The increase in the incidence of syphilis was largely due to an increase in this indicator in the Central (from 18.1 to 37.3 cases per 100 thousand population) and Northwestern (from 14.5 to 16.2 cases per 100 thousand population) federal districts ( FO). An increase in the incidence of gonococcal infection in 2022 compared to 2019 was observed in the Central (+26.3%), Northwestern (+31.2%) and Ural (+27.6%) Federal Districts.

Anogenital herpesvirus infection: focus on HIV-positive patients

The annual growth in the number of people living with HIV infection inevitably leads to an increase in the number of cases of any type of comorbidity. The article analyzes modern epidemiological, clinical, therapeutic aspects of anogenital herpes simplex virus infection (AHVI) in HIV-positive patients. Human immunodeficiency virus (HIV) and herpes simplex virus 2 (HSV-2) combine epidemiological and biological synergy. Concomitant anogenital herpes increases the risk of HIV infection by 2.74.7 times, and also contributes to its transmission through unprotected sexual intercourse. In HIV-infected patients with AHVI, the genital excretion of HSV-2 is increased. Among HIV-positive individuals, the seroprevalence of HSV-2 exceeds the population figures by 1.93.8 times. The incidence of AHVI in a cohort of Russians with a positive HIV status is 57.8 times higher than in the general population. The review demonstrates that both infections can have a negative mutual influence on the clinical course of each other. Particular emphasis is placed on the timely diagnosis of cases of coinfection. Based on the current regulatory documents, the authors developed and presented an algorithm for testing for HIV in patients with a newly diagnosed anogenital herpes.

Reasons for hospitalisation in youth with type 1 diabetes, 2010-2019.

To determine the incidence of hospitalisation for all diagnoses among Australian youth with type 1 diabetes. We linked Australians aged under 20 years with type 1 diabetes on the National Diabetes Services Scheme (n = 45,685) to hospital admission data from 2010 to 2019. We determined relative risks (RR) of hospitalisation among those with type 1 diabetes in the states of Victoria and Queensland (n = 21,898) compared to the general population for 2010-2017 using Poisson regression. Australian youth with type 1 diabetes had increased risk for almost all reasons for hospitalisation compared to the general population, especially infections such as anogenital herpesviral infections (RR 54.83, 95% CI 33.21-90.53), and mental health disorders including personality disorders (RR 9.70, 95% CI 8.02-11.72). Among those with type 1 diabetes, over 60% of hospitalisations were directly related to diabetes, almost half of which were for ketoacidosis. Approximately 15% of ketoacidosis admissions occurred within 3 months of diabetes diagnosis. One quarter of those with admissions for ketoacidosis were readmitted for ketoacidosis within 12 months. Residence in areas of high socio-economic disadvantage was an independent risk factor for admission and readmission for ketoacidosis. Youth with type 1 diabetes are susceptible to a wide range of complications. Clinicians should consider screening and prevention for conditions such as infections and mental health disorders. Targeted support and education around glycaemic management should be considered in those at high risk for ketoacidosis admission including those living in areas of high socio-economic disadvantage.

Genotypic characterization of HPV serotypes in cervical samples from Indian women: a multi centric study.

Human papilloma virus (HPV infection) plays a important role in causing cervical cancer. Out of 184 different HPV genotypes, 40 diverse types only can cause anogenital infection. HPV present in >99% of cervical cancers with high risk types (16, 18) associated with cancer and Low risk types (6, 11) are associated with genital warts. Aim of the study is to determine the epidemiology of HPV infection in Indian women's population. Three hundred and thirty four liquid based cytology (LBC) samples were collected across India from the different age groups of Indian women. Pap smear, PCR and gene sequencing tests were performed for the collected LBC samples. Low risk serotype 6 (16.7%) were detected compared to other high risk serotypes. Majority of positive cases were observed in the age group between 19 and 39 groups. Northern part of India contributes high (7.1%) in HPV infection compared to other regions of India. Reports from these studies covered few regions of India showing a wide range in the prevalence of HPV infection and serotype distribution due to diversified socio economic and geo climatic conditions. This study aims to identify the epidemiology of HPV in the Indian population and concludes that early and periodic screening of women for HPV can avoid the risk of cervical cancer at the early stage of infection.

Molecular study of the presence and transcriptional activity of HPV in semen

PurposeHuman Papillomavirus (HPV) in semen represents a controversial topic. Recent evidence suggests a correlation with poor semen quality, but its detection is still unstandardized in this biological fluid. Thus, the aims of this study were to verify the ability of nested PCR to reveal HPV-DNA in semen; to evaluate association of seminal HPV with sperm parameters and risk factors for infection; to investigate the rate of HPV-DNA positivity in patients with and without risk factors; to assess HPV transcriptional activity.MethodsWe enrolled sexually active men and collected clinical and anamnestic data during andrological and sexually transmitted infections (STIs) evaluation. For each patient, we performed semen analysis and nested PCR to detect HPV-DNA in semen. In positive semen samples, we proceeded with genotyping and RNA quantification to detect HPV transcriptional activity.ResultsWe enrolled 185 men (36.0 ± 8.3 years), of which 85 with (Group A) and 100 without HPV risk factors (Group B). Nested PCR was able to reveal HPV-DNA in semen, discovering a prevalence of 8.6% (11.8% in Group A and 6% in Group B, respectively). We observed no correlation between sperm quality and seminal HPV. Genital warts and previous anogenital infection were significantly associated with the risk of HPV positivity in semen. Moreover, no viral transcriptional activity was detected in positive semen samples.ConclusionsOur study suggests that searching for seminal HPV could be important in patients both with and without risk factors, especially in assisted reproduction where the risk of injecting sperm carrying HPV-DNA is possible.

(043) Genital Tucking Practices in Trans Individuals and Anogenital Implications

Abstract Introduction Genital tucking is a practice performed by some transgender women and gender nonconforming individuals to reduce or conceal the contour of the penis and testicles. A variety of genital tucking techniques exist that are used to achieve an individual’s desired appearance. The penis and scrotum may be moved into the perineal area or between the buttocks. Some individuals may additionally reposition the testicles upward into the inguinal canals. Typically, these techniques are reinforced through the use of compression underwear, a specialized supportive undergarment termed a gaff, or adhesive tape. Despite the important role genital tucking plays in gender expression and affirmation, little, if any, research currently exists on the prevalence of tucking practices, the techniques employed, and its effects on anogenital health. Dermatological injury due to genital tucking encompasses a broad range of complications and may be largely avoidable if correct anogenital care and tucking methods are implemented. Objectives The purpose of this study is to present key findings generated from a review of available literature on anogenital dermatological conditions and their association with genital tucking. Data are presented on genital tucking techniques, associated health risks with emphasis on dermatological considerations, as well as suggested physician preventative counseling. Methods PubMed was searched for publications corresponding to the areas of interest (moisture-associated skin damage, medical adhesive-related skin injury, anogenital care techniques). Research from primary publications, consensus statements, and literature reviews were included. Findings were synthesized and applied to the context of genital tucking practices. Results As certain tucking practices expose the anogenital skin to excessive moisture, friction, and adhesive products, dermatological complications are a significant concern. Individuals who tuck may experience medical adhesive-related skin injury which includes mechanical injury (e.g., skin tears, blistering), dermatitis (e.g., hypersensitivity reactions), and other injuries such as maceration and folliculitis. Moreover, genital tucking may predispose individuals to intertriginous dermatitis, an inflammatory skin condition that occurs due to friction and trapped moisture within skin folds. Predisposing risk factors to skin injury that may disproportionately affect transgender individuals who tuck include dehydration, exposure to estrogen hormone therapy, and immunodeficiency. Prevention of adverse outcomes related to tucking should include counseling and regular surveillance of the anogenital area. Patients should be counseled on the selection and use of absorbent, natural fabrics as well as the safest and most effective adhesive tapes. Applying barrier and drying agents before tucking and employing proper adhesive removal techniques should be recommended to further reduce risk of anogenital skin injury and infection. Conclusions This review was the first of our knowledge to discuss the practice of genital tucking, the associated dermatological risk factors, and the critical role physicians play in caring for and counseling patients on tucking practices. Genital tucking preventative counseling and routine examination of the affected area may improve anogenital health of individuals who engage in this practice. Disclosure No.

A Herpes Simplex Virus 1 DNA Polymerase Multidrug Resistance Mutation Identified in a Patient With Immunodeficiency and Confirmed by Gene Editing.

Herpes simplex virus 1 can cause severe infections in individuals who are immunocompromised. In these patients, emergence of drug resistance mutations causes difficulties in infection management. Seventeen herpes simplex virus 1 isolates were obtained from orofacial/anogenital lesions in a patient with leaky severe combined immunodeficiency over 7 years, before and after stem cell transplantation. Spatial/temporal evolution of drug resistance was characterized genotypically-with Sanger and next-generation sequencing of viral thymidine kinase (TK) and DNA polymerase (DP)-and phenotypically. CRISPR/Cas9 was used to introduce the novel DP Q727R mutation, and dual infection-competition assays were performed to assess viral fitness. Isolates had identical genetic backgrounds, suggesting that orofacial/anogenital infections derived from the same virus lineage. Eleven isolates proved heterogeneous TK virus populations by next-generation sequencing, undetectable by Sanger sequencing. Thirteen isolates were acyclovir resistant due to TK mutations, and the Q727R isolate additionally exhibited foscarnet/adefovir resistance. Recombinant Q727R mutant virus showed multidrug resistance and increased fitness under antiviral pressure. Long-term follow-up of a patient with severe combined immunodeficiency revealed virus evolution and frequent reactivation of wild-type and TK mutant strains, mostly as heterogeneous populations. The DP Q727R resistance phenotype was confirmed with CRISPR/Cas9, a useful tool to validate novel drug resistance mutations.

The role of infected epithelial cells in Chlamydia-associated fibrosis.

Ocular, genital, and anogenital infection by the obligate intracellular pathogen Chlamydia trachomatis have been consistently associated with scar-forming sequelae. In cases of chronic or repeated infection of the female genital tract, infection-associated fibrosis of the fallopian tubes can result in ectopic pregnancy or infertility. In light of this urgent concern to public health, the underlying mechanism of C. trachomatis-associated scarring is a topic of ongoing study. Fibrosis is understood to be an outcome of persistent injury and/or dysregulated wound healing, in which an aberrantly activated myofibroblast population mediates hypertrophic remodeling of the basement membrane via deposition of collagens and other components of the extracellular matrix, as well as induction of epithelial cell proliferation via growth factor signaling. Initial study of infection-associated immune cell recruitment and pro-inflammatory signaling have suggested the cellular paradigm of chlamydial pathogenesis, wherein inflammation-associated tissue damage and fibrosis are the indirect result of an immune response to the pathogen initiated by host epithelial cells. However, recent work has revealed more direct routes by which C. trachomatis may induce scarring, such as infection-associated induction of growth factor signaling and pro-fibrotic remodeling of the extracellular matrix. Additionally, C. trachomatis infection has been shown to induce an epithelial-to-mesenchymal transition in host epithelial cells, prompting transdifferentiation into a myofibroblast-like phenotype. In this review, we summarize the field's current understanding of Chlamydia-associated fibrosis, reviewing key new findings and identifying opportunities for further research.

Anogenital HSV in Children: Should Providers Be Concerned for Sexual Abuse?

Anogenital herpes simplex virus (HSV) is most commonly acquired via sexual transmission, although other nonsexual modes of transmission have been proposed. When a child presents with a first-time outbreak of anogenital HSV, providers must consider sexual abuse. There are currently no evidence-based consensus guidelines to inform management of these patients. The purpose of this study was to describe how child abuse pediatricians (CAPs) evaluate children with anogenital HSV infection and determine whether any consistent practice patterns are followed. The patients included in this study were children between the ages of 0 and 12 years with a first-time outbreak of anogenital HSV who were medically evaluated by a CAP. Patient charts were retroactively reviewed for the period of January 1 2004 to May 1 2020. Twenty-two cases were referred for evaluation by a CAP in the chosen time frame. Fifteen were seen in person. Ten of these patients were interviewed, 15 had an anogenital exam with colposcopy, and 14 were tested for at least one other sexually transmitted infection. A diagnosis of sexual abuse was made for 1 patient. This study demonstrates that although nonsexual transmission of anogenital HSV may be possible, providers must still consider sexual abuse. Children with a first-time outbreak of anogenital HSV should have a comprehensive evaluation for sexual abuse, including interview, physical exam, and testing for sexually transmitted infections. Evidence-based concerns for sexual abuse should be reported to child protective services.

Immunological Disorders in Men Patients with Anogenital Warts

Anogenital warts (AV) or human papillomavirus infection (PVI), along with genital herpes, HIV infection, molluscum contagiosum, hepatitis B, and cytomegalovirus infection, are common sexually transmitted viral infections (STIs). In the pathogenesis of PVI, the leading role is given to disorders of the immune system, primarily its cellular department. The aim of the study was to study immunological changes in men with papillomavirus infection (genital warts). Material and research methods. Under observation were 47 men with OK, whose age ranged from 18 to 42 years. Results. Thus, studies have shown that among men in the Republic of Tajikistan, the most common STIs of viral origin (AB - OK) have a certain distribution, they occur, in most cases, in the form of mixed infection with other, more often bacterial STIs. In the pathogenesis of AD, immunity disorders are important, which must be taken into account in the treatment of patients.

Depo Medroxyprogesterone (DMPA) Promotes Papillomavirus Infections but Does Not Accelerate Disease Progression in the Anogenital Tract of a Mouse Model.

Contraceptives such as Depo-medroxyprogesterone (DMPA) are used by an estimated 34 million women worldwide. DMPA has been associated with increased risk of several viral infections including Herpes simplex virus-2 (HSV-2) and Human immunodeficiency virus (HIV). In the current study, we used the mouse papillomavirus (MmuPV1) anogenital infection model to test two hypotheses: (1) contraceptives such as DMPA increase the susceptibility of the anogenital tract to viral infection and (2) long-term contraceptive administration induces more advanced disease at the anogenital tract. DMPA treatments of both athymic nude mice and heterozygous NU/J (Foxn1nu/+) but ovariectomized mice led to a significantly increased viral load at the anogenital tract, suggesting that endogenous sex hormones were involved in increased viral susceptibility by DMPA treatment. Consistent with previous reports, DMPA treatment suppressed host anti-viral activities at the lower genital tract. To test the impact of long-term contraceptive treatment on the MmuPV1-infected lower genital tract, we included two other treatments in addition to DMPA: 17β-estradiol and a non-hormone based contraceptive Cilostazol (CLZ, Pletal). Viral infections were monitored monthly up to nine months post infection by qPCR. The infected vaginal and anal tissues were harvested and further examined by histological, virological, and immunological analyses. Surprisingly, we did not detect a significantly higher grade of histology in animals in the long-term DMPA and 17β-estradiol treated groups when compared to the control groups in the athymic mice we tested. Therefore, although DMPA promotes initial papillomavirus infections in the lower genital tract, the chronic administration of DMPA does not promote cancer development in the infected tissues in our mouse model.

Prevalence of anogenital infection by Human Papillomavirus (HPV) in users of immunobiological therapy

Objective: To compare the prevalence of anogenital infection by human papillomavirus (HPV) in immunobiological users being treated for immune-mediated chronic inflammatory diseases with that in non-users. Methodology: The total sample studied consisted of 228 participants divided into 2 groups: 114 users and 114 non-users of immunobiological, cytotoxic or corticosteroid therapy, with non-psoriasis dermatoses and non-HPV predisposing conditions. Both groups were evaluated clinically and by polymerase chain reaction (PCR). Results: The prevalence of low-risk HPV in the immunobiological user and non-user groups was 8/49 (16,3%) and 3/29 (10,3%), respectively (p=0.524). The low-risk types found were HPV 6, 11, 40, 42 and 44. The prevalence of high-risk HPV was 23/114 (20,2%) in the users versus 21/114 (18,4%) in the non-users (p=0.737), distributed according to the following types: HPV 16 (3/228 – 1,3%), 18 (5/228 – 2,2%), and non-16/18 (36/228 – 15,8%). After pairing by sex and age, the prevalence of high-risk HPV was 13/62 (21,0%) and 8/62 (12,9%) for immunobiological users and non-users, respectively (p=0.231). Conclusion: The prevalence of anogenital HPV infection in patients with immune-mediated chronic inflammatory diseases treated with immunobiologicals is similar to that in non-users.

Translated article] What Proportion of the Spanish Dermatology Caseload Corresponds to Primarily Sexually Transmitted Infections and Other Anogenital Dermatoses? Results From the DIADERM National Random Survey

Background and objectivePredominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methodsObservational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. ResultsOnly 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. ConclusionsSTIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Lymphogranuloma venereum.

The L1, L2, and L3 strains are more invasive than those causing most anogenital infections.[1][1]–[4][2] Before 2004, LGV was rare in Canada, but has since become endemic. Between 2013 and 2020, 2052 C. trachomatis isolates forwarded to the National Microbiology Laboratory tested positive for LGV-

¿Cuánta carga asistencial suponen las infecciones de transmisión predominantemente sexual y otras dermatosis anogenitales en las consultas de Dermatología en España? Resultados del muestreo aleatorio nacional DIADERM

Background and objectivePredominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methodsObservational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. ResultsOnly 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. ConclusionsSTIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Viral Venereal Diseases of the Skin.

Viral venereal diseases remain difficult to treat. Human papilloma virus (HPV) and herpes simplex virus (HSV) are two common viral venereal diseases. HPV infections are characterized by anogenital warts and less commonly by premalignant or malignant lesions. HSV infections classically present as grouped vesicles on an erythematous base with associated burning or pain; however, immunosuppressed patients may have atypical presentations with nodular or ulcerative lesions. This review discusses the epidemiology, diagnosis, and management of anogenital HPV and HSV infections with an emphasis on treatment modalities for the practicing dermatologist. Diagnosis of these diseases typically relies on clinical assessment, although multiple diagnostic techniques can be utilized and are recommended when diagnosis is uncertain or evaluating an individual with increased risk of malignancy. Management of HPV and HSV infections involves appropriate counseling, screening, and multiple treatment techniques. Particularly for HPV infections, a practitioner may need to use a combination of techniques to achieve the desired outcome.

German evidence and consensus-based (S3) guideline: Vaccination recommendations for the prevention of HPV-associated lesions.

Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.

Oropharyngeal Neisseria gonorrhoeae infections: should women be routinely tested?

Oropharyngeal infection with Neisseria gonorrhoeae is important: it is harder to treat than anogenital infection and the oropharynx provides a niche for the development of antimicrobial resistance.1 Additionally, since oropharyngeal N gonorrhoeae infections are usually asymptomatic, they can easily remain undetected, providing a reservoir of infection that facilitates onward transmission. Emerging evidence suggests that in addition to oral sex, oropharyngeal infection might be transmitted through kissing.