Chlamydia Trachomatis Co-infection Research Articles

Doxycycline adherence for the management of Chlamydia trachomatis infections

BackgroundThe updated 2021 CDC treatment guidelines recommend a single dose of 500 mg intramuscular ceftriaxone for Neisseria gonorrhea and doxycycline 100 mg by mouth twice daily for 7 days for Chlamydia trachomatis coinfection. However, there is a significant public health concern regarding patient non-adherence to the 7-day course of doxycycline. To date, there are no studies assessing this concern. Therefore, the objective of this study was to evaluate a patient's adherence to doxycycline for chlamydial infections after discharge from the Emergency Department (ED). MethodsThis was an IRB-approved, single-center, retrospective cohort study evaluating the adherence to doxycycline for Chlamydia trachomatis infections. Patients who received treatment and were discharged from the ED with a doxycycline e-prescription between May 2021 and September 2022 were included. Patients were excluded if <18 years of age, pregnant, a sexual assault victim, or admitted inpatient. The primary endpoint was the incidence of doxycycline prescription pick-up after discharge from the ED. The secondary endpoint was the incidence of repeat ED visits for the same chief complaint within 28 days. Descriptive statistics were computed for all study variables and Fisher's Exact tests were used to assess the outcomes. ResultsA review of 144 patients who tested positive for chlamydia and were discharged from the ED with an e-prescription for doxycycline revealed that 18% of patients did not pick up their prescription (N = 26). Non-adherent patients were more likely to return to the ED with the same chief complaint within 28 days (23.1% vs 7.6%, OR 3.6 [1.2–11.3], p = 0.026). No differences were detected in baseline demographics, housing status, insurance type, sexual orientation, or Sexually Transmitted Infection history. ConclusionFor patients with a positive chlamydia infection who were discharged from the ED on doxycycline, an 18% non-adherence rate was found and a 3.6-fold higher likelihood of returning to the ED with the same chief complaint if the prescription was not picked up.

Acceptability, feasibility and cost of point of care testing for sexually transmitted infections among South African adolescents where syndromic management is standard of care

BackgroundYoung people (YP) in southern Africa are at substantial risk of HIV and sexually transmitted infections (STIs). Despite the epidemiological and biological link between STIs and HIV transmission and acquisition, infections such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) remain widely undiagnosed. Syndromic STI management is the standard of care in low- and middle-income countries (LMICs) despite a high prevalence of asymptomatic infections. We conducted an observational study to explore the acceptability, feasibility, and cost of a STI test-and-treat service for YP in Cape Town.MethodsYP attending a mobile clinic (MC) and a youth centre clinic (YC) were offered STI screening. Urine testing for CT and NG using a 90-min molecular point-of-care (POC) test on the GeneXpert platform was conducted and treatment provided. Data were collated on demographics, sexual behaviour, presence of symptoms, uptake of same-day treatment, prevalence of CT/NG, and service acceptability.ResultsThree hundred sixty six participants were enrolled (median age 20, 83% female).57% (209/366) of participants tested positive for either CT (126/366, 34%) or NG (57/366, 16%) or co-infection (26/366, 7%).Clinical symptoms were a poor predictor of GeneXpert diagnosed CT or NG, with a sensitivity of 46.8% and 54.0% for CT and NG respectively. Although half of participants initially chose to receive same day results and treatment, only a third waited for results on the day. The majority of participants (91%) rated the service highly via a post-visit acceptability questionnaire.ConclusionCurable STIs are highly prevalent in this population. STI screening using POC testing was feasible and acceptability was high. The study provides further impetus for moving policy beyond syndromic management of STIs in South Africa.

Expression of HPV-16 E6 and E7 oncoproteins alters Chlamydia trachomatis developmental cycle and induces increased levels of immune regulatory molecules.

Infection with Human Papillomavirus (HPV) is a recognized risk factor for Chlamydia trachomatis (CT) infection and vice versa. Coinfection of HPV and CT in women is a very common and usually asymptomatic finding that has been linked to increased risk of cervical cancer. It has been demonstrated that CT facilitates the entry of multiple high risk HPV genotypes, leading to damage of the mucosal barrier and interfering with immune responses and viral clearance, which ultimately favours viral persistence and malignant transformation. Although the facilitating effects elicited by CT infection on viral persistence have been reported, little is known about the consequences of HPV infection on CT development. Herein, we took advantage of a genetically modified human cervical cell line co-expressing HPV-16 major oncogenic proteins E6 and E7, as an experimental model allowing to investigate the possible effects that HPV infection would have on CT development. Our results show that CT infection of HPV-16 E6E7 expressing cells induced an upregulation of the expression of E6E7 oncoproteins and host cell inhibitory molecules PD-L1, HVEM and CD160. Additionally, smaller chlamydial inclusions and reduced infectious progeny generation was observed in E6E7 cells. Ultrastructural analysis showed that expression of E6 and E7 did not alter total bacterial counts within inclusions but resulted in increased numbers of reticulate bodies (RB) and decreased production of infectious elementary bodies (EB). Our results indicate that during CT and HPV coinfection, E6 and E7 oncoproteins impair RB to EB transition and infectious progeny generation. On the other hand, higher expression of immune inhibitory molecules and HPV-16 E6E7 are cooperatively enhanced in CT-infected cells, which would favour both oncogenesis and immunosuppression. Our findings pose important implications for clinical management of patients with HPV and CT coinfection, suggesting that screening for the mutual infection could represent an opportunity to intervene and prevent severe reproductive health outcomes, such as cervical cancer and infertility.

Rectal shedding of monkeypox virus in a patient coinfected with Chlamydia trachomatis and Neisseria gonorrhoeae: a case report

BackgroundInfection by the monkeypox virus classically causes a cutaneous rash that is preceded by fever and lymph node swelling, as well as other nonspecific systemic symptoms. A recent outbreak occurred and spread in Europe and other regions, especially among patients who declare themselves as men who have sex with men. Current reports have shown that cutaneous lesions may be limited to the anogenital area. We report on a case of proctitis caused by monkeypox virus, without visible typical lesions of this virus.Case presentationA 29-year-old Caucasian male presented with a monkeypox virus proctitis that recurred after treatment for a documented Neisseria gonorrhoeae and Chlamydia trachomatis coinfection, likely acquired at the same time. The proctitis was preceded by fever and a swollen inguinal lymph node, and was associated with a hemorrhoid. The monkeypox virus polymerase chain reaction of a rectal swab documented high viral loads, although no typical lesion was visible. After resolution of the rectitis, the patient developed a single dermatome herpes zoster, despite the absence of usual risk factors. The patient evolved well without further specific treatment.ConclusionThis case shows that monkeypox virus can be responsible for proctitis, without any typical lesion, along with the important rectal shedding of the virus. It raises the concern of contagion during anal intercourse through body fluids and gives further credit that monkeypox virus can be a sexually transmitted infection. This should prompt routine rectal screening in patients with proctitis accompanied by fever and swollen lymph nodes, and in patients who have a history of unprotected receptive anal sex, even in presence of other sexually transmitted infections, and especially during a monkeypox virus outbreak. The potential link between monkeypox virus infection and shingles warrants further investigations.

Chlamydia trachomatis Coinfection Does Not Influence Mycoplasma genitalium Bacterial Load in Urogenital Samples.

Mycoplasma genitalium (MG) is associated with urethritis in men and weakly associated with pelvic inflammatory disease in women. Mycoplasma genitalium coinfections with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are commonly reported; however, little is known about their interaction. One study suggested that MG/NG coinfections might increase the bacterial load of NG, which has been shown to have a higher transmission potential. As even less is known about the impact of a simultaneous MG/CT infection, we assessed whether patients with urogenital MG/CT coinfections have a higher bacterial load than patients with a single infection. There were 1673 urogenital samples from patients from a population-based chlamydia study, and our sexually transmitted infection clinic tested for both CT and MG. When positive, the load was quantified. Nonparametric tests compared the CT and MG load, and linear regression analyses tested the association of the CT and MG load within a patient. In 60 MG-positive patients, MG load ranged from 1.7 to 6.0 log10 copies/ml, similar to the CT load distribution. Only 6 patients were MG-positive and CT-negative, but the MG load distribution was similar to that of CT-positive patients (n.s.). The MG and CT load was unrelated in coinfected persons (n.s.). We found no correlation between the CT and MG load in urogenital samples, and the MG load distribution was similar in CT-positive and CT-negative patients. These results could have implications for the transmission risk of these infections.

Association of Human Papillomavirus and Chlamydia trachomatis Coinfection with Cervical Intraepithelial Lesions and Cervical Cancer

Association of Human Papillomavirus and Chlamydia trachomatis Coinfection with Cervical Intraepithelial Lesions and Cervical Cancer

Higher Prevalence of Multi-Drug Resistant Gonococcal Infections Among Patients with Prior Gonococcal and Chlamydia Infections

Abstract Introduction/Objective Neisseria gonorrhoeae (NG) is the 2nd most common cause of sexually transmitted infection worldwide. WHO data from 2009-14 showed widespread resistance to ciprofloxacin (97%), azithromycin (81%), and oral cefixime and injectable ceftriaxone (66%). We have investigated local epidemiology of antimicrobial resistance in PCR-confirmed NG by chromosomal multi-locus sequence typing and analysis. Methods/Case Report Clinical specimens of 85 patients who tested positive for NG using automated PCR (COBAS 4800; Roche Diagnostics) were used in this study. The samples were amplified by PCR using 10 primers (Integrated DNA Technologies, USA) targeting seven antibiotic resistance-associated loci in the bacterial chromosome (penA, mtrR, ponA, porB, gyr, parC and 23s rRNA) and sequenced on a 48-channel ABI 3730 Sanger sequencer (Thermo Fisher). The resulting sequences were analyzed using the NG Sequence Typing for Antibiotic Resistance (NG-STAR) database for matching alleles, correlating to clinical resistance. Results were analyzed by Chi-square or Fisher’s exact tests. Results (if a Case Study enter NA) Most patients positive for NG were non-Hispanic Black males (60%), with mean age of 25 years (range: 14-53 years). 23.5% had Chlamydia trachomatis (CT) co-infection, and 29.4% had other sexually transmitted infections, such as syphilis, HIV and HPV. 15.0% had previous NG infection, and 12% had previous CT infection. Sixty-five samples (76.5%) yielded at least one gene locus with a DNA sequence with &amp;gt;95% similarity in the NG-STAR database. About half (50.6%) of these sample had confirmed resistance mutations, 5 of which indicated resistance to multiple antibiotics. All specimens with porB and gyr mutations were resistant to penicillins, ceftriaxone, cefixime, erythromycin, tetracycline and ciprofloxacin. Most of those with mtrR mutations were resistant to ciprofloxacin. Most of those with mutations (with or without resistance) had previous NG infection. Significant correlation was observed between those with at least 1 mutated gene locus and CT co-infection (p=0.0001). Conclusion A significant proportion of our patients tested positive for resistance mutations, a majority of whom had previous NG infection. There was significant correlation between the presence of mutations and CT co-infection. These findings warrant utilization of culture and sensitivity testing in patients with previous NG and CT co-infection.

Clinical, epidemiological and therapeutic characteristics of Mycoplasma genitalium infection in a French STI center

ObjectivesWe report the characteristics of Mycoplasmagenitalium (MG) infection in patients from a STI center in Paris. We evaluated outcomes after treatment. MethodsWe included all patients tested for MG, Chlamydiatrachomatis (CT) and Neisseria gonorrhoeae (NG) infection in our center from January 2017 to December 2018, using multiplex PCR on urine specimen, vaginal or rectal swabs. We collected data regarding sex, age, HIV status, PrEP use, sexual behavior, NG and CT co-infection, symptoms and treatment. ResultsMG infection prevalence was 7% (397/5586) (95% CI 6.4–7.8). It ranged from 4.6% in patients consulting for routine STI testing (3.9% in women, 5% in men), to 16% in HIV-positive patients and 25% in PrEP users. Among the 397 MG infected patients, 351 (88%) were asymptomatic and 87 (22%) were co-infected with NG or CT. Among the 270 (68%) treated patients, 249 (92%) received azithromycin. Failure rate was 74% in the 103 patients tested post-treatment. Treatment failure tended to be higher with azithromycin single dose than with 5-day azithromycin (88% vs. 70%; P=0.07). Azithromycin and moxifloxacin were used as second-line treatment in 24 and 23 patients, respectively. Post-treatment PCR remained positive in 55% of the 44 tested patients with a better eradication rate with moxifloxacin than with azithromycin (70% vs. 33%; P=0.04). ConclusionMG infection is highly prevalent in PrEP users and HIV-positive patients and is mostly asymptomatic. Management of MG infection should be tailored and adapted to the risk of antibiotic resistance and reinfection.

Proinflammatory and Oxidative Stress States Induced by Human Papillomavirus and Chlamydia trachomatis Coinfection Affect Sperm Quality in Asymptomatic Infertile Men.

Background and Objectives: To investigate the effect of infection with human papillomavirus (HPV) or Chlamydia trachomatis (CT) and HPV + CT coinfection on sperm quality, inflammation, and the state of oxidative stress (OS) in asymptomatic infertile men. Materials and Methods: Semen samples from 84 asymptomatic military infertile men were studied. The polymerase chain reaction (PCR) was used for the molecular detection of HPV and CT. Semen parameters were analyzed according to the World Health Organization guidelines. Inflammation was evaluated by an IL-1β, IL-6, and IFN-γ enzyme-linked immunosorbent assay (ELISA) and OS by the quantification of lipid peroxidation (LPO), 8-hydroxydeoxyguanosine (8-OHdG), and total antioxidant capacity (TAC). Results: A total of 81 of the 84 (96.4%) samples were positives for the pathogens, with 55/81 (68%) being positive for HPV, 11/81 (13.5%) for CT, and 15/81 (18.5%) for HPV + CT coinfection. Seminal parameters were affected in the infected groups, including pH increases above the normal range in all groups. An abnormal sperm morphology was observed in the HPV and HPV + CT groups. Higher cytokine levels were detected in the HPV group and the highest IL-1β level was found in the HPV + CT group. No cytokines were detected in the CT group. High LPO and 8-OHdG levels were found in all groups with a lower TAC. Comparisons between groups showed the highest OS state was observed in the HPV group. Conclusions: High HPV infection or coinfection (HVP + CT) in these infertile men suggest compromising male fertility by inducing a proinflammatory state and OS. Infection with CT suggests an alteration of the state of OS by promoting an alkaline pH.

Analysis of a fractional order model for HPV and CT co-infection

In this work, a fractional order model for human papillomavirus (HPV) and Chlamydia trachomatis (CT) co-infection is considered and analyzed. The existence and uniqueness of the model solutions are established through Banach and Schaefer’s fixed point theorem. The positivity and boundedness of the solutions are also proven using Mittag-Leffler function. Furthermore, we also show that the fractional model is Ulam–Hyers–Rassias stable. In conclusion, simulation results are presented for different control strategies and various fractional parameter values (ψ). Simulations of the model reveal that the population of individuals co-infected with HPV and CT decreases with increasing HPV screening rates (Λ1 and Λ2), at ψ=0.85. The CT only treatment strategy has positive population level impact on the number of infected individuals with HPV only. This strategy also has more positive population level impact on the HPV only new cases, as compared to the impact of the HPV screening strategy on CT only new cases. The population of individuals co-infected with HPV and CT decreases with increasing fractional order values ψ, when both HPV screening and CT treatment strategies are implemented.

Culture-Independent Genotyping Revealed 3 Strain Clusters in a Potential Neisseria gonorrhoeae Outbreak in Young Heterosexuals (

Investigation was undertaken to determine the genetic relatedness of Neisseria gonorrhoeae (NG) isolates of young (<25 years) heterosexuals of a potential outbreak from October 2017 to March 2019 in South-Limburg, the Netherlands. Data and residual sample material of routine diagnostics were retrieved for outbreak cases (78/81), young heterosexuals at baseline (January 2016 to September 2017, n = 30), and men who have sex with men (2018, n = 47). Total DNA was isolated, and NG was genotyped using culture-free NG multiantigen sequence typing. Sanger sequence data were used to construct a phylogenetic tree. Cases of outbreak clusters were geographically mapped, and descriptive analyses were performed on patient characteristics, comparing these clusters. Outbreak investigation showed 81 cases of young heterosexuals between October 2017 and March 2019 (4.5 per month) compared with 30 between January 2016 and September 2017 (1.4 per month), which was considered as baseline. Culture-independent genotyping of NG was performed to assess the genetic relatedness, as only 21 outbreak cases were culture confirmed. This revealed 3 independent outbreak clusters G2 (n = 18), G13113 (n = 11), and GNewST (n = 24). None of the clusters were geographically linked or introduced by bridging with men who have sex with men networks. Number of sex partners reported by men and Chlamydia trachomatis coinfection were associated with clusters G2 and GNewST, respectively. Culture-independent typing proved to be essential to identify the 3 outbreak clusters. However, targeted interventions were difficult because information on sex partners was limited. Therefore, prospective culture-independent typing could be used for early outbreak detection and aid in transmission prevention.

Optimal Control and Cost-Effectiveness Analysis of an HPV-Chlamydia trachomatis Co-infection Model.

In this work, a co-infection model for human papillomavirus (HPV) and Chlamydia trachomatis with cost-effectiveness optimal control analysis is developed and analyzed. The disease-free equilibrium of the co-infection model is shown not to be globally asymptotically stable, when the associated reproduction number is less unity. It is proven that the model undergoes the phenomenon of backward bifurcation when the associated reproduction number is less than unity. It is also shown that HPV re-infection ([Formula: see text]) induced the phenomenon of backward bifurcation. Numerical simulations of the optimal control model showed that: (i) focusing on HPV intervention strategy alone (HPV prevention and screening), in the absence of C. trachomatis control, leads to a positive population level impact on the total number of individuals singly infected with C. trachomatis, (ii) Concentrating on C. trachomatis intervention controls alone (C. trachomatis prevention and treatment), in the absence of HPV intervention strategies, a positive population level impact is observed on the total number of individuals singly infected with HPV. Moreover, the strategy that combines and implements HPV and C. trachomatis prevention controls is the most cost-effective of all the control strategies in combating the co-infections of HPV and C. trachomatis.

Prevalence and risk factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium among women in Pelotas, Southern Brazil.

The frequently asymptomatic sexually transmitted infections (STIs) caused by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) are poorly diagnosed in Brazil and can lead to severe complications/sequelae without timely detection and treatment. We investigated prevalence of CT, NG, and MG infections and associated demographic, behavioral, and clinical factors in consecutive women attending a gynecology and obstetrics outpatient clinic in Pelotas, Southern Brazil. Vaginal swab samples were prospectively obtained from asymptomatic and symptomatic women (n = 498) from August 2015 to December 2016 and tested with Aptima Combo2 and Aptima M. genitalium assays (Hologic). The prevalence of CT, NG, and MG was 6.8% (34/498), 1.0% (5/498), and 4.2% (21/498), respectively. Three (0.6%) cases of CT and NG co-infection and one (0.2%) case of CT and MG co-infection were identified. The risk factors associated with these bacterial STIs were youth (&lt;30 years), no steady sexual partner, infection with additional STI, and lack of income. Bacterial STIs, particularly CT and MG, were prevalent among women, including pregnant women (60% of positive cases), in Pelotas, Brazil. Sensitive and specific diagnostic testing and early treatment are essential to control STIs, limit transmission chains, avoid future complications/sequelae, and reduce health and cost burdens on the population.

Human Papilloma Virus and Chlamydia trachomatis: Casual Acquaintances or Partners in Crime?

Interactions between microorganisms can alter subsequent disease outcomes. Human papilloma virus (HPV) and Chlamydia trachomatis (CT) establish human genital co-infections, and CT infection is a co-factor for HPV-induced cervical cancer. This review focuses upon (i) data indicating that clinically significant interactions occur and (ii) proposed mechanisms underlying these outcomes. Epidemiological surveys indicate that (i) simultaneous HPV/CT genital co-infections are common; (ii) CT co-infection accelerates HPV-induced cytopathology; and (iii) HPV infection facilitates CT infection. Single-infection studies suggest specific molecular mechanisms by which co-infection alters clinical outcomes, including (i) HPV E6/E7 protein modification of host cell pathways enhances CT replication or immune evasion and (ii) CT-mediated host cell or neutrophil dysfunctions promote HPV-mediated neoplasia. There are multiple avenues for future dissection of HPV/CT interactions. Moreover, the known and potential health consequences of co-infection highlight the need for improving current HPV vaccines and developing an effective CT vaccine.

Association of abnormal cervical cytology with coinfection of human papillomavirus and Chlamydia trachomatis

Introduction:Chlamydia trachomatis (CT) and human papillomavirus (HPV) are considered to be major sexually transmitted infections (STIs) and likely health hazard among women. In addition, HPV and CT are considered as potential cofactors in the development of cervical intraepithelial neoplasia (CIN).Objectives: The main objective of this study was to investigate the association of HPV and CT infection with the presence of abnormal cervical cytology.Materials and Methods: A cross-sectional study was carried out on 90 women with complaints of vaginal discharge attending STI clinic in a tertiary care hospital in New Delhi. Papanicolaou staining and polymerase chain reaction were done for the detection of HPV and CT. Statistical analyses were performed for comparison.Results:Abnormal cervical cytology was observed in 42.2% of the study participants (41.1% low-grade squamous intraepithelial neoplasia and 1.1% high-grade intraepithelial neoplasia). HPV and CT were positive in 21.1% and 31.5% of participants with abnormal cervical cytology, respectively. Coinfection with HPV and CT was observed in 84.2% of participants with cervical atypia. Further, genital herpes was diagnosed in 18.9% of the studied population and a significant association was observed between genital herpetic ulcers and abnormal cervical cytology (P = 0.016).Conclusion:CT was found to be a significant risk factor for cervical cytological abnormalities in our study. HPV and CT coinfection were also associated with a higher prevalence of cervical atypia. As chlamydial infection is easily treatable, we recommend screening and treatment of all women of the reproductive age group for Chlamydia to decrease the risk of cervical dysplasia.Limitation: This is a single-center STI clinic-based study. Multicenter and community-based studies with a larger cohort will confirm the association.

HPV genotypes distribution in Chlamydia trachomatis co-infection in a large cohort of women from north-east Italy.

Human papillomavirus (HPV) and Chlamydia trachomatis are pathogens with oncogenic potential associated with persistent infections. Epidemiological data on C. trachomatis infection status, C. trachomatis/HPV co-infection and the relationship between HPV genotypes in Italian women are only preliminary. The aim of the present study was to characterize the relationship between HPV genotypes and C. trachomatis in an extending cohort of asymptomatic immunocompetent women from an area of north-east Italy. A retrospective study was conducted using Luminex technology on cervical swabs from asymptomatic immunocompetent women, comprising 921 attending the prevention centre for the Cervical Cancer Program and 6214 who had been referred to the Sexually Transmitted Infections Center, with clinical indications of HPV and C. trachomatis infections. A quantitative real-time PCR was performed to assess chronic C. trachomatis infection by heat-shock protein 60 (Hsp60) gene expression. The overall prevalence of the investigated pathogens was 39 % (359/921) for HPV and 4 % (251/6214) for C. trachomatis. The Hsp60 gene was detected in 57 % of the women infected with C. trachomatis. HPV co-infection was present in 58 % of C. trachomatis-infected women. A high prevalence of co-infection was found in women with chronic C. trachomatis infection (68 %, P = 0.0002), especially in women ≤ 25 years (72 %) where HPV multiple infections were found in 78 % (P = 0.022). HPV genotype distribution showed that uncommon low-risk genotypes were associated with C. trachomatis. These results indicate a high frequency of co-detection of multiple HPV genotypes in chronically infected young women and suggest that the expression of the C. trachomatis Hsp60 gene may favour HPV infection.

003.6 Timing of test of cure for anogenitalneisseria gonorrhoeaeinfections - a prospective cohort study using nucleic acid amplification tests

Introduction The use of nucleic acid amplification tests (NAATs) to diagnose Neisseria gonorrhoeae (Ng) infections has rapidly replaced culture. This complicates performance of test of cure (TOC) to monitor treatment failure. As evidence for the timing of TOC using modern Ng NAATs is highly limited, we assessed the time to Ng-clearance when using modern NAATs. Methods We included patients attending the STI Clinic Amsterdam from March–October 2014 with anogenital Ng. We collected swabs or urine for RNA-based NAAT (Aptima Combo 2 assay [AC2], Hologic) and DNA-based NAAT (Cobas 4800 NG/CT assay [C4800], Roche). Treatment for Ng was ceftriaxone 500 mg. Upon treatment, patients self-collected daily samples for both NAATs for 28 days, and recorded sexual contact in a diary. After 28 days, patients returned to the clinic with their samples, and we collected final samples for culture and NAAT. Clearance was defined as two consecutive negative results. Reinfection was defined as >2 positive results after clearance, with at least one result positive in both DNA and RNA-based NAAT. A blip was defined as a positive RNA or DNA result after clearance without reinfection. Results We included 77 patients of whom 62 completed the study. The median number of self-collected samples was 27. Anatomical locations were distributed evenly (urethra: 20, vagina: 21, rectum: 21). 23 (37%) patients had a Chlamydia trachomatis co-infection. All patients cleared Ng during the study and median time to clearance was 2 days (range: 1–9) for both NAATs. 95% of patients cleared before day 6 (AC2) and day 7 (C4800). Reinfection was observed in one patient. Blips occured in 6 (AC2) and 15 (C4800) patients, respectively. Conclusion With modern RNA- or DNA-based NAATs, a TOC of anogenital gonorrhoea can be performed after 7–9 days. However, intermittent positive test results after clearance occurred in 10–25% of patients. Disclosure of interest statement This study was funded by the Public Health Service Amsterdam. Aptima products and test kits were provided by Hologic. Roche PCR products and Cobas 4800 test kits were provided by Roche.

Prevalence and Correlates of Chlamydia trachomatis and Neisseria gonorrhoeae by Anatomic Site Among Urban Thai Men Who Have Sex With Men.

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection are prevalent among men who have sex with men (MSM) and may infect multiple anatomic sites. We measured site-specific prevalence and correlates of CT and NG infection among Bangkok MSM Cohort Study participants. In April 2006 to November 2010, 1744 men enrolled in the Bangkok MSM Cohort Study. Participants provided historical information and underwent physical examination. Rectal, urethral, and pharyngeal CT and NG screening were performed by nucleic acid amplification and/or culture. Logistic regression was used to identify correlates of site-specific CT, NG, and coinfection. Among 1743 participants, 19.2% were infected with CT and/or NG. CT, NG, and CT-NG coinfection were detected in 11.6%, 4.6%, and 2.9%, of participants, respectively. Rectal, urethral, and pharyngeal CT infections were detected in 9.5%, 4.5%, and 3.6% of cases. N. gonorrhoeae was present at these sites in 6.1%, 1.8%, and 0.5% of cases. Most infections were asymptomatic (CT: 95.3%, NG: 83.2%). Rectal CT and NG infections were mutually associated (CT: adjusted odds ratio [AOR], 5.4; 95% confidence interval [CI], 3.4-8.7; NG: AOR, 2.4; 95% CI, 1.1-5.2) and independently associated with HIV infection (CT: AOR, 1.6, 95% CI, 1.0-2.4; NG: AOR, 2.0, 95% CI, 1.3-3.1). Numerous behavioral correlates of infection were observed. CT and NG infections are highly prevalent among MSM in Bangkok, most frequently affect the rectum, and are most often asymptomatic. Routine screening of asymptomatic MSM for CT and NG infection should include rectal sampling and focus on men with HIV and a history of other sexually transmitted infections.

Incidence and persistence of carcinogenic genital human papillomavirus infections in young women with or without Chlamydia trachomatis co-infection.

We assessed whether infection with chlamydia increases the incidence of carcinogenic human papillomavirus (HPV) infections and if HPV persistence is affected by chlamydia co-infection. For 1982 women (16–29 years-old) participating in two consecutive rounds of a chlamydia screening implementation trial, swabs were polymerase chain reaction tested to detect chlamydia and 14 carcinogenic HPV genotypes. HPV type-specific incidence and persistence rates were stratified for chlamydia positivity at follow-up. Associations were assessed by multilevel logistic regression analyses with correction for sexual risk factors. HPV type-specific incidence ranged from 1.4% to 8.9% and persistence from 22.7% to 59.4% after a median follow-up of 11 months (interquartile range: 11–12). Differences in 1-year HPV persistence rates between chlamydia -infected and noninfected women were less distinct than differences in HPV incidence rates (pooled adjusted odds ratios of 1.17 [95% CI: 0.69–1.96] and 1.84 [95% CI: 1.36–2.47], respectively). The effect of chlamydia co-infection on HPV-infection risk did not significantly differ by HPV genotype. In conclusion, infection with chlamydia increases the risk of infection by carcinogenic HPV types and may enhance persistence of some HPV types. Although these findings could reflect residual confounding through unobserved risk factors, our results do give reason to explore more fully the association between chlamydia and HPV type-specific acquisition and persistence.

Chlamydia trachomatis Co-infection in HPV Positive Women brings no Additional Risk of High-grade Cervical Intraepithelial Neoplasia

Background: Co-infection by Chlamydia trachomatis (CT) in women with Human Papillomavirus (HPV) infection has been shown to increase the risk of developing cervical intraepithelial neoplasia (CIN). The present study was designed to analyze the association between HPV e CT co-infection and the severity of cervical neoplasia. Methods: Two hundred fifty-one women with PCR-confirmed HPV infection were tested for CT co-infection by PCR, prior to cervical conizations due to CIN. Prevalence rates of CT and HPV types were reported for the histological diagnosis categories. Results: The prevalence of Chlamydia trachomatis was 15.1% (38/251). CT negative women showed a significant association between age ≥ 30 years and CIN 2 or worse diagnosis; this association was not found in CT positive women. In women < 29 years of age, negative for CT, the infection by HPV 16 /18 were detected in 50% of the women with CIN 2 or worse diagnosis and in 19.5% of women with CIN 1 or negative (OR=5.83; 95%CI: 2.19-15.57). Conclusion: No association with CIN 2 or worse diagnosis was observed for Chlamydia trachomatis positive women for all age groups. These data can suggest that HPV type and no CT infection may correlate with risk for severity of histological diagnoses in younger women.