Chlamydia Trachomatis In Men Research Articles

Viability assessment of Chlamydia trachomatis in men who have sex with men using molecular and culture methods.

Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection (STI) worldwide. Diagnosis relies on nucleic acid amplification techniques, such as PCR, which does not distinguish between viable pathogens and residual bacterial DNA, leading to potential overdiagnosis and overtreatment. PCR with confirmation of pathogen viability has not been widely explored in the STI field. Our aim was to establish a C. trachomatis viability PCR (V-PCR) and to apply it to anorectal swabs from men who have sex with men (MSM). We performed validation of a published V-PCR protocol by preparing artificial samples with known ratios of viable and non-viable C. trachomatis. Mock samples were treated with propidium monoazide (PMAxxTM) before DNA extraction and quantitative PCR (qPCR) to detect C. trachomatis. The V-PCR was then applied to C. trachomatis PCR-positive anorectal swabs from MSM. Viability was expressed as the difference in C. trachomatis (CT) copies between PMAxxTM untreated and treated samples (ΔLog10 CT/mL). The anorectal samples were inoculated in cell culture for isolation. Genotyping was performed by examining the ompA gene sequence. Of 236 anorectal swabs, 69 (29.2%) were C. trachomatis PCR-positive, and we obtained V-PCR data from 54. There were 7/54 (12.9%), samples with <1% viable CT (>2.52 ΔLog10 CT/mL) 4/54 (7.4%) samples with 1%-10% viable CT (1.59-2.52), 16/54 (29.6%) with 10.01-50% viable CT (0.86-1.59) and 27/54 (50.0%) with 50.01%-100% viable CT (<0.35-0.86). C. trachomatis was isolated successfully from 39/69 (56.5%) samples in cell culture. Genotypes based on ompA were obtained for 62/69 (89.9%) samples: G (n=15/62), D/Da (n=15/62), J (n=15/62), E (n=11/62), L1 (n=4/62) and L2 (n=2). We successfully implemented a viability test based on PCR, which can distinguish, detect and quantify viable C. trachomatis in anorectal swabs from MSM. Rapid, reliable assessment of C. trachomatis viability could help to improve antimicrobial stewardship.

Prevalence of Chlamydia Trachomatis in men who have sex with other men at Ishtar MSM Health &amp; Wellness Center in Nairobi county between June 2021- December 2021

Prevalence of Chlamydia Trachomatis in men who have sex with other men at Ishtar MSM Health &amp; Wellness Center in Nairobi county between June 2021- December 2021

Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services.

IntroductionThe longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms.MethodsRadio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men.ResultsAmong 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts.ConclusionsSyndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.

Doxycycline Versus Azithromycin for the Treatment of Rectal Chlamydia in Men Who Have Sex With Men: A Randomized Controlled Trial.

Azithromycin and doxycycline are both recommended treatments for rectal Chlamydia trachomatis (CT) infection, but observational studies suggest that doxycycline may be more effective. This randomized, double-blind, placebo-controlled trial compared azithromycin (single 1-g dose) versus doxycycline (100 mg twice daily for 7 days) for the treatment of rectal CT in men who have sex with men (MSM) in Seattle and Boston. Participants were enrolled after a diagnosis of rectal CT in clinical care and underwent repeated collection of rectal swabs for nucleic acid amplification testing (NAAT) at study enrollment and 2 weeks and 4 weeks postenrollment. The primary outcome was microbiologic cure (CT-negative NAAT) at 4 weeks. The complete case (CC) population included participants with a CT-positive NAAT at enrollment and a follow-up NAAT result; the intention-to-treat (ITT) population included all randomized participants. Among 177 participants enrolled, 135 (76%) met CC population criteria for the 4-week follow-up visit. Thirty-three participants (19%) were excluded because the CT NAAT repeated at enrollment was negative. Microbiologic cure was higher with doxycycline than azithromycin in both the CC population (100% [70 of 70] vs 74% [48 of 65]; absolute difference, 26%; 95% confidence interval [CI], 16-36%; P < .001) and the ITT population (91% [80 of 88] vs 71% [63 of 89]; absolute difference, 20%; 95% CI, 9-31%; P < .001). A 1-week course of doxycycline was significantly more effective than a single dose of azithromycin for the treatment of rectal CT in MSM. NCT03608774.

Pilot study of pharyngeal Chlamydia trachomatis in HIV-positive and HIV-negative men who have sex with men.

Unlike pharyngeal Neisseria gonorrhoeae, less is known about pharyngeal Chlamydia trachomatis in men who have sex with men (MSM). We reviewed cases of pharyngeal chlamydia in MSM from January to December 2019. The overall prevalence of pharyngeal chlamydia was 75/6613 (1.13%; 95% confidence interval (CI) = 0.9-1.14). The median number of sexual partners was three, four (5%) reported throat symptoms and 20 (26%) were HIV positive. Multi-site and concomitant infection was common: rectal chlamydia [39 (52%)], urethral chlamydia [12 (16%)], early syphilis [2 (3%)] and gonorrhoea [14 (19%)]. HIV-positive MSM with pharyngeal chlamydia were older (P = 0.02) and more likely to have had previous syphilis (odds ratio = 4.9; 95% CI = 1.6-14.7; P = 0.005). Further research is needed to explore the characteristics of pharyngeal chlamydia and benefits of increased screening for asymptomatic pharyngeal chlamydia in MSM.

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis in men having sex with men in Port-au-Prince, Haiti: a cross-sectional study

ObjectivesOver the last 15 years, the prevalence of HIV in Haiti has stabilised to around 2.0%. However, key populations remain at higher risk of contracting HIV and other sexually transmitted...

Is self-swabbing for gonorrhea and Chlamydia an acceptable method for screening in men who have sex with men?

Evidence-Based Answer The Aptima Combo 2 assay® (AC2), a nucleic acid amplification test (NAAT), demonstrates substantial agreement between self-collected specimens (SCS) and provider-collected specimens (PCS) testing for rectal and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men (MSM). Selfcollection using strand displacement assays (SDA) has poor sensitivity (SOR: B, multiple diagnostic studies). The Cobas Amplicor PCR (PCR) has not been adequately proven for this indication (SOR: C, low-quality diagnostic study).

Patterns of Extragenital Chlamydia and Gonorrhea in Women and Men Who Have Sex With Men Reporting a History of Receptive Anal Intercourse.

Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men is risk based. Despite high frequencies of oral and receptive anal intercourse (RAI) among women, extragenital screening is not recommended. Women (n = 175) and men who have sex with men (n = 224) primarily recruited from a sexually transmitted infection clinic reporting a lifetime history of RAI completed a structured questionnaire and clinician-collected swab samples from the rectum, pharynx, vagina (women), and urine (men). CT and GC were detected using 2 commercial nucleic acid amplification tests (Aptima Combo 2; Hologic, Inc, Bedford, MA; Xpert CT/NG, Cepheid Innovation, Sunnyvale, CA). The median age of the population was 26 years, 62% were white, and 88% were enrolled from a sexually transmitted disease clinic. Men were more likely than women to have GC (22.8% vs. 3.4%) and CT (21.9% vs. 12.6%). In men versus women, GC was detected in 16.5% versus 2.3% of pharyngeal swabs, 11.6% versus 2.3% of rectal swabs, and 5.4% versus 2.9% of urine samples or vaginal swabs. C. trachomatis was detected in 2.2% versus 1.7% of pharyngeal swabs, 17.4% versus 11.4% of rectal swabs, and 4.5% versus 10.3% for urogenital sites in men versus women. Overall 79.6% of CT and 76.5% of GC in men and 18.2% of CT and 16.7% of GC in women were detected only in the pharynx or rectum. Reliance on urogenital screening alone misses most of GC and CT in men and more than 15% of infections in women reporting RAI.

Neisseria gonorrhoeae and Chlamydia trachomatis among women reporting extragenital exposures.

The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. We define the prevalence of extragenital GC and CT in women attending 2 urban sexually transmitted disease clinics in Baltimore City and compare it with the prevalence of extragenital infections in MSM and men who have sex with women. All patients who reported extragenital exposures in the preceding 3 months, who presented for care between June 1, 2011, and May 31, 2013, and who were tested for GC and CT using nucleic acid amplification tests at all sites of exposure were included in the analyses. We used logistic regression models to identify risk factors for extragenital infections. A total of 10,389 patients were included in this analysis (88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC infections and 13.8% of CT infections would have been missed with urogenital-only testing. Unlike MSM, age ≤ 18 years was the strongest predictor of extragenital infections in women. Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing. Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women.

Should we screen heterosexuals for extra-genital chlamydial and gonococcal infections?

Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are two of the most prevalent bacterial sexually transmitted infections in the UK. Although the high burden of extra-genital infections with GC and CT in men who have sex with men has been well established, a significant number of extra-genital site infections with CT and GC could similarly be present in heterosexual women. For this reason we started to routinely offer extra-genital site testing for GC and CT in all patients attending our sexual health clinic who reported having had receptive anal sex and/or giving oral sex. This followed a review of current evidence by the clinical team and a change in local testing policy. This study not only confirmed a large reservoir of extra-genital infection amongst men who have sex with men, but also demonstrates that a comparable reservoir of extra-genital infection is present amongst heterosexual women. Our study adds to the mounting evidence that extra-genital site testing in heterosexual women should occur when oral or anal sexual activity is reported.

How men with non-chlamydial, non-gonococcal urethritis are managed in Australasia

The aim of this study was to ascertain how sexual health physicians in Australia and New Zealand manage men with chlamydia-negative non-gonococcal urethritis (NGU), particularly in relation to the notification of their female sexual partners. In July 2006, a cross-section survey was sent out to all the members of the Australasian Chapter of Sexual Health Medicine. Seventy-three percent of sexual health physicians believed that female partners of men who present with chlamydia-negative NGU were at risk of adverse reproductive health outcomes. At least 62% usually initiated some form of partner notification of female partners of men with chlamydia-negative NGU. However, only 19% (21/111) of sexual health physicians routinely tested for, and only 65% sometimes tested for, pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in men presenting with NGU. These included Mycoplasma genitalium, herpes simplex virus, ureaplasma species, Trichomonas vaginalis and adenoviruses.

Factors prompting men subsequently diagnosed with chlamydia to use a sexual health service

The development of strategies to increase screening for Chlamydia trachomatis in men requires an understanding of factors that prompt them to use medical services for sexual health purposes. We reviewed the records of all men diagnosed with chlamydia at the Canberra Sexual Health Centre (CSHC) between 1 July 2003 and 30 June 2005 to determine what motivated them to attend. Of the 2599 men visiting the CSHC for any reason during the review period, 137 (5.3%) tested positive for chlamydia. The majority (54.7%) was in the 15–24 year old age group and 70.1% were heterosexual. Only four men (2.9%) identified as Aboriginal or Torres Strait Islanders and four (2.9%) reported intravenous drug use (IDU) in the 12 months preceding their chlamydia test. Of the men, 10.9% were diagnosed with an additional sexually transmissible infection (STI) (i.e. either gonorrhoea, genital herpes or warts), 17.5% had previously tested positive for an STI including chlamydia or a blood-borne virus (i.e. either non-specific urethritis, syphilis, anal or penile warts, gonorrhea, hepatitisB, herpes simplex virus,HIV, or pubic lice) and 37.2% had already been screened for chlamydia at least once. The primary reasons for attendance were (1) symptoms in 54.0%, (2) a recent history of unprotected sex in 16.1% and (3) a partner with an STI in 26.3% (Table 1). The most

Lymphogranuloma Venereum in North America: Case Reports and an Update for Gastroenterologists

In 2003, a sharp increase in cases of lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis in men who have sex with men was reported in Europe and, recently, cases of LGV have been reported in North America. We reviewed 3 cases of LGV proctitis recently diagnosed in Canada. All 3 cases occurred in men who had sex with men; 2 of the patients had human immunodeficiency virus infection and 1 subsequently seroconverted. A delay in diagnosis occurred in all 3 patients: 2 patients were misdiagnosed initially with inflammatory bowel disease and 1 patient was treated as a case of non-LGV C trachomatis. Given the recent outbreak, gastroenterologists in Europe and North America need to be familiar with the diagnosis and treatment of LGV because it mimics inflammatory bowel disease endoscopically and histologically.

Should a low prevalence of asymptomatic &lt;I&gt;Chlamydia trachomatis&lt;/I&gt; infection in gay men attending HIV clinics discourage from opportunistic screening?

Genitourinary (GU) medicine notifications for homosexually acquired Chlamydia trachomatis (CT) infections show a 414% increase from 1996 to 2002. However, little is known about the prevalence of CT in men who have sex with men (MSM) outside GU medicine settings. Behavioural studies show that MSM with diagnosed HIV infection continue to engage in high-risk sexual behaviour with the risk for sexually transmitted infections (STI) acquisition and HIV transmission. This study analysed the results of urine-based CT screening in MSM attending a London HIV clinic in order to inform local policy on the benefit and patients' acceptability of opportunistic screening. Among men screened, 1.9% (2/107) had asymptomatic CT infection. Screening was well accepted and practical to be implemented in the clinic routine. It is unclear whether isolated routine urine screening is cost effective in the context of HIV prevention. HIV clinics should incorporate a public health perspective and actively contribute to HIV prevention by addressing sexual health and scope opportunities for STI screening.

Retrospective review of the correlation of symptoms, signs and microscopy with the diagnosis of Chlamydia trachomatis in men.

We have investigated the correlation of symptoms, signs and microscopy on the detection of Chlamydia trachomatis infection in men attending our clinic. One hundred and eleven men diagnosed with chlamydia over an 11-month period in our clinic were reviewed. Of these, 70 (63%) were symptomatic and 41 (37%) were asymptomatic. 84% (59/70) of symptomatic and 51% (21/41) of asymptomatic patients met the UK clinical criteria for diagnosis of non-gonococcal urethritis (NGU) and received treatment appropriate for chlamydia and NGU at their initial clinic visit. Our findings show that 19% (21/111) of men with Chlamydia trachomatis infection would leave the clinic untreated if a urethral smear preparation was not performed on those who were clinically asymptomatic at presentation. We feel that this is a sufficient argument to warrant continuing the current practice of testing asymptomatic men attending GUM clinics for NGU.

The Frequency of Co-Infection With Neisseria Gonorrhoeae And Chlamydia Trachomatis In Men And Women In Eastern Sydney

The frequency of simultaneous infection with Neisseria gonorrhoeae and Chlamydia trachomatis in men and women in Eastern Sydney was examined prospectively over a 21 month period in patients from whom appropriate specimens were obtained. In men gonococcal disease (113 cases) and chlamydial infections (124 cases) occurred in approximately equal frequencies, but there were only 4 instances (3.5%) where C. trachomatis was detected at the same time as N. gonorrhoeae. Demographic data and phenotypic profiles of the gonococci isolated suggested that much of the gonorrhea occurred in homosexual men who are generally considered to have a low incidence of chlamydial disease. Gonococcal disease (34 cases) was far less common than chlamydial infection (112 cases) in women, but co-infection with chlamydia was noted in 6 (17.6%) of the cases of gonorrhea (p < 0.01). The current recommendation for the routine addition of tetracyclines to gonococcal treatment regimens for men requires revision.

Factors affecting urine EIA sensitivity in the detection of Chlamydia trachomatis in men.

This study examined the effects of four variables on the detection of Chlamydia trachomatis in urine from men by enzyme immunoassay (EIA). These variables were: symptoms and signs of urethritis, urine polymorphonuclear leucocytes (PMN), inclusion counts from urethral chlamydia cell cultures and the time between testing and last voiding. Included were patients with and without symptoms and/or signs of urethritis attending the Edmonton Sexually Transmitted Disease Clinic. Men were asked to submit a 20 ml volume urine sample. Urethral swabs were collected for gram stain, chlamydia and gonorrhea culture. A total of 318 men were evaluated of whom 47 had chlamydia. Excluding six men who were coinfected with gonorrhoea, sensitivities and specificities of the Microtrak, Chlamydiazyme and IDEIA systems were 78.1% and 99.6%, 75.6% and 100%, and 80.5% and 97.8% respectively. Last void time did not affect the sensitivity. However, sensitivity was best when applied to men with severe evidence of urethritis. There is evidence that urine EIA could be used to detect chlamydia in men with acute urethritis but not in those without signs of urethritis.

Efficacy of ofloxacin in the treatment of non-gonococcal urethritis in men and genital infections caused by Chlamydia trachomatis in men and women.

The efficacy of ofloxacin was evaluated in 30 men with non-gonococcal urethritis (NGU) and 17 women with Chlamydia trachomatis infection of the cervix. All were treated with ofloxacin 200 mg twice daily for seven days. Before treatment, Ch. trachomatis was isolated from 11 (37%) of the 30 men with NGU. Of these 30 men, the symptoms and signs of urethritis were eliminated in 20 (67%) two weeks after completion of ofloxacin therapy. Ch. trachomatis was not re-isolated from any of the 11 men with positive isolation before treatment. All of the group of 17 women with Ch. trachomatis infection of the cervix had complete cure two weeks after completion of ofloxacin treatment. Ofloxacin appears to be an effective treatment for lower genital tract infections with Ch. trachomatis in men and women and its efficacy in NGU appears to be comparable to standard tetracycline therapy.

Isolation of Chlamydia trachomatis in men from the urethra in gonococcal urethritis.

In the present study 143 males, aged 14-70 years and being treated for gonococcal urethritis, were examined for concomitant chlamydial infection. C. trachomatis was isolated from cell cultures of the excretion of 24 (16.8%) of these patients. Chlamydia-positive men were treated with oxytetracycline 250 mg 4 times daily for two weeks and following treatment all cultures for C. trachomatis were negative.

Diagnostic facilities for Chlamydia trachomatis in men

Diagnostic facilities for Chlamydia trachomatis in men