Cases Of Gonorrhea Research Articles

Treatment of female gonorrhea with urotropin. E. A Keropian (Rus. V. Derm., 1926, No. 6)

E. And Keropian (Rus. V. Derm., 1926, No. 6,. Received excellent results from the use in 73 cases of both acute and chronic gonorrhea of the female genitourinary apparatus intravenous and subcutaneous infusion of 30-40% solution of urotropin, one or combined with a gonococcal vaccine.

Enhancing Gonococcal Antimicrobial Resistance Surveillance in Cisgender Women, Strengthening the US Response to Resistant Gonorrhea, 2018 to 2019.

Cisgender women have been underrepresented in antibiotic-resistant gonorrhea (ARGC) surveillance systems. Three of 8 project sites (City of Milwaukee [MIL], Guilford County [GRB], Denver County [DEN]), funded under the Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG), focused efforts to better include cisgender women in ARGC surveillance. MIL, GRB, and DEN partnered with diverse health care settings and developed gonorrhea culture criteria to facilitate urogenital specimen collection in cisgender women and men. Regional laboratories within the Antibiotic Resistance Laboratory Network performed agar dilution antibiotic susceptibility testing (AST) of gonococcal isolates. Data from 2018 and 2019 were analyzed. In SURRG, 90.5% (11,464 of 12,667) of the cisgender women from whom urogenital culture specimens were collected were from MIL, GRB, and DEN. Of women in SURRG whose gonococcal isolates underwent AST, 70% were from these 3 sites. In these 3 sites, a substantial proportion of cisgender women with positive urogenital cultures and AST were from health care settings other than sexually transmitted disease (STD) clinics (non-STD clinics; MIL, 56.0%; GRB, 80.4%; and DEN, 23.5%). Isolates with AST were obtained from 5.1%, 10.2%, and 2.4% of all diagnosed gonorrhea cases among cisgender women in MIL, GRB, and DEN, respectively, and were more often susceptible to all antibiotics than those from cisgender men from each of these sites. With focused efforts and partnerships with non-STD clinics, 3 SURRG sites were able to include robust ARGC surveillance from cisgender women. These findings may guide further efforts to improve gender equity in ARGC surveillance.

Recent advances in understanding and combatting Neisseria gonorrhoeae: a genomic perspective.

The sexually transmitted infection (STI) gonorrhoea remains a major global public health concern. The World Health Organization (WHO) estimates that 87 million new cases in individuals who were 15 to 49 years of age occurred in 2016. The growing number of gonorrhoea cases is concerning given the rise in gonococci developing antimicrobial resistance (AMR). Therefore, a global action plan is needed to facilitate surveillance. Indeed, the WHO has made surveillance leading to the elimination of STIs (including gonorrhoea) a global health priority. The availability of whole genome sequence data offers new opportunities to combat gonorrhoea. This can be through (i) enhanced surveillance of the global prevalence of AMR, (ii) improved understanding of the population biology of the gonococcus, and (iii) opportunities to mine sequence data in the search for vaccine candidates. Here, we review the current status in Neisseria gonorrhoeae genomics. In particular, we explore how genomics continues to advance our understanding of this complex pathogen.

Partner Elicitation After Partner Services Interviews and Reinterviews Among Patients With Antimicrobial-Resistant Gonorrhea.

Partner notification services (PS) are often used to control sexually transmitted infections, but their effectiveness is limited by patients' reluctance to name sex partners. We hypothesized that being notified of having antimicrobial-resistant Neisseria gonorrhoeae (ARGC) would make patients more likely to provide named partner information. We used King County, Washington STD surveillance and Strengthening the US Response to Resistant Gonorrhea data to identify gonorrhea cases. Using log-binomial regression, we computed unadjusted and adjusted prevalence ratios for factors associated with naming any partners during routine PS interview vs. interview after ARGC diagnosis. Among those who completed a standard PS interview and later a reinterview after ARGC diagnosis, we compared mean numbers of reported and contactable partners at initial interview and reinterview using the Wilcoxon rank sum test. From July 2018 to October 2020, 1588 gonorrhea cases were interviewed; 103 (6%) had ARGC. After adjusting for sexual exposure, age, year, disease intervention specialist, reinterview, and diagnosing clinic, being interviewed after ARGC diagnosis remained predictive of naming ≥1 partner relative to routine PS (prevalence ratio, 2.2; 95% confidence interval, 1.6-2.9). Among 40 cases who completed a standard PS interview and later a reinterview after ARGC diagnosis, there was a modest increase in mean partners named at initial versus reinterview (1.4 vs. 1.9 per case, P = 0.09). Cases interviewed after ARGC diagnosis named more contactable partners than did those undergoing routine PS. Reinterviewing patients after ARGC diagnosis provides only a modest increase in contactable partners but may be useful to limit transmission of this potentially challenging infection.

Targeting Culture Criteria to Maximize Culture Positivity of Neisseria gonorrhoeae in 3 Sexual Health Clinic Settings.

Although most gonorrhea (GC) cases in the United States are detected using nucleic acid amplification tests (NAATs), isolation of Neisseria gonorrhoeae (NG) using culture specimens is needed for antibiotic susceptibility testing (AST). We present data on NAATs and cultures collected before and during the Centers for Disease Control and Prevention demonstration project (Strengthening the US Response to Resistant Gonorrhea [SURRG]) to describe a process to define culture criteria for NG isolation for surveillance of NG with reduced susceptibility. For sexually transmitted infection clinics in New York City, NY; San Francisco, CA; and Milwaukee, WI, we calculated NAAT positivity by anatomic site in 2016 (pre-SURRG) across 3 groups: (1) sex partners of persons with GC, (2) patients with symptoms (e.g., urethral or cervical discharge), (3) patients who had tested positive and were returning for GC treatment and compared it with positivity among all other patients. We then examined SURRG-period NAAT positivity among patients from whom a culture was or was not collected, and culture positivity, by specimen site and jurisdiction. Pre-SURRG, NAAT positivity across the 3 select groups was at least twice that of patients who did not meet any criteria. SURRG-period NAAT positivity was higher among patients from whom a culture was also collected. Overall culture positivity was relatively high (New York City, 34.8%; San Francisco, 26.7%; Milwaukee, 24.8%); the proportion of specimens tested varied widely (range, 5.7%-26.5%) by jurisdiction. Evaluation of NAAT data can inform the establishment of criteria for culture collection for AST. Routine evaluation and quality improvement activities related to culture collection/isolation techniques could increase NG isolation for AST.

Increased Detection of Gonorrhea and Chlamydia After Implementation of a Universal Screening Protocol in a Pediatric Primary Care Clinic.

Literature suggests that adolescents may not accurately report sexual activity to their providers, impeding risk-based screening efforts for gonorrhea and chlamydia (GC/CT). We assessed the effect of a clinic-based universal GC/CT screening initiative on GC/CT screening frequency and detection of GC/CT infections among adolescents (boys and girls ≥13 years) and the association between positive GC/CT and documented sexual activity. We conducted a pre-post analysis of a primary care clinic affiliated with an academic institution. The electronic medical record was queried to extract all adolescent well and acute encounters for the 12 months preimplementation and postimplementation of universal GC/CT screening in January 2015. Eight hundred fifty-six encounters from 752 unique adolescents were included. Screening increased postimplementation (23.3% vs 61.4%, P < 0.001) of universal screening. Although there were similar rates of documented sexual activity preimplementation and postimplementation (14.6% vs 16.0%), a larger proportion of unknown sexual activity was documented (10.5% vs 23.7%, P < 0.001). Provider-level factors were the most frequent reasons for not screening. The absolute number of GC/CT cases increased, although the proportion of cases out of all eligible adolescents remained similar as more testing was completed (chlamydia, 5 of 752 vs 12 of 752; P = 0.09; gonorrhea, 0 of 752 vs 1 of 752; P = 0.32). Nearly half of positive chlamydia infections postimplementation appeared in adolescents who reported no sexual activity. Universal screening in a primary care clinic increased screening and detection of cases of gonorrhea and chlamydia, including in adolescents who did not report sexual activity.

Inadequate Engagement in HIV Care Among People With HIV Newly Diagnosed With a Sexually Transmitted Disease: A Multijurisdictional Analysis.

A key challenge of HIV surveillance-based HIV care reengagement is locating people living with HIV (PLWH) who seem to be out of care to reengage them in care. Providing reengagement services to PLWH diagnosed with a sexually transmitted disease (STD)-individuals who are in jurisdiction and connected to the health care system-could be an efficient means of promoting HIV treatment and reducing HIV transmission. Early and late syphilis (ES/LS) and gonorrhea (GC) cases diagnosed in 2016 and 2017 in Louisiana, Michigan, Mississippi, Oregon, Rhode Island, and Texas were matched to each state's HIV surveillance data to determine the proportion of PLWH with these infections who (1) did not have evidence of a CD4 count or viral load in the prior ≥13 months (out of care) or (2) had a viral load ≥1500 copies/mL on their most recent HIV RNA test before STD diagnosis (viremic). Previously diagnosed HIV infection was common among persons diagnosed with ES (n = 6942; 39%), LS (n = 4329; 27%), and GC (n = 9509; 6%). Among these ES, LS, and GC cases, 26% (n = 1543), 33% (n = 1113), and 29% (n = 2391) were out of HIV medical care or viremic at the time of STD diagnosis. A large proportion of STD cases with prior HIV diagnosis are out of care or viremic. Integrating relinkage to care activities into STD partner services and/or the use of matching STD and HIV data systems to prioritize data to care activities could be an efficient means for relinking patients to care and promoting viral suppression.

Mycoplasma genitalium coinfection in men with symptomatic gonococcal urethritis

ObjectivesInternational guidelines recommend Mycoplasma genitalium testing, preferably using an assay to detect macrolide resistance-associated mutations, for men presenting with non-gonococcal urethritis, but there is no specific guidance on such testing...

Trends in Nationally Notifiable Sexually Transmitted Disease Case Reports During the US COVID-19 Pandemic, January to December 2020.

To describe changes in reported sexually transmitted diseases (STDs) during the US coronavirus disease 2019 pandemic, we compared the weekly number of reported nationally notifiable STDs in 2020 to 2019. We reviewed cases of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis reported to the US National Notifiable Disease Surveillance System in 2020. For each STD, we compare the number of 2020 cases reported for a given Morbidity and Mortality Weekly Report (MMWR) week to the number of 2019 cases reported in the same week, expressing 2020 cases as a percentage of 2019 cases. We also calculated the percent difference between 2020 and 2019 cumulative case totals as of MMWR week 50 (week of December 9). During MMWR weeks 1 to 11 (week of December 29, 2019-March 11, 2020), the weekly number of cases of STDs reported in 2020 as a percentage of the cases in the same week in 2019 was similar. However, 2020 numbers were much lower than 2019 numbers in week 15 (week of April 8; chlamydia, 49.8%; gonorrhea, 71.2%; and P&S syphilis, 63.7%). As of week 50, the 2020 cumulative totals compared with 2019 were 14.0% lower for chlamydia, 7.1% higher for gonorrhea, and 0.9% lower for P&S syphilis. During March-April 2020, national case reporting for STDs dramatically decreased compared with 2019. However, resurgence in reported gonorrhea and syphilis cases later in the year suggests STD reporting may have increased in 2020, underscoring the importance of continued STD prevention and care activities.

A case of primary extragenital cutaneous gonorrhea involving the finger

A case of primary extragenital cutaneous gonorrhea affecting the left middle finger of a 16-year-old female patient is presented. The patient denied a history of sexual activity and the only reported symptoms were finger pain and associated lymphangitis. Wound culture was obtained from an incision, and drainage procedure was performed at an emergency room of a community hospital. Laboratory diagnosis was made at a clinical microbiology laboratory using Gram stain, agar culture, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Concurrent blood cultures had no growth at 5 days. The patient was switched from Cephalexin and Trimethoprim-sulfamethoaxole to an appropriate regimen upon sensitivity testing. The patient was lost to follow-up, and it is unknown if the possibility of seeding mucosal infection, such as the pharynx, was investigated.

A Comparative Analysis of Reported Chlamydia and Gonorrhea Cases Among US Army Soldiers, 2015 to 2019.

Chlamydia and gonorrhea have increased nationally and in the US Army. Rates reported in the Army are elevated relative to the general population, partly because of differing population demographics. Age- and sex-specific chlamydia and gonorrhea case rates among Army active component soldiers and the wider 18- to 64-year-old US adult population were computed from reports submitted through national and military surveillance systems in 2015 to 2019. Rates were standardized using the 2015 Army age and sex population distribution. Multivariable generalized linear models were generated to evaluate associated risk factors. Army age- and sex-adjusted chlamydia rates (per 100,000 person-years) were nearly twice those of US adults (2019 rates, 2317 vs. 1241), whereas US age- and sex-adjusted gonorrhea rates surpassed Army rates (2019 rates, 536 vs. 396). Chlamydia and gonorrhea rates were significantly elevated in Army women younger than 25 years relative to US women aged 18 to 24 years (2015-2019 crude rates, 10,404 Army/4243 US for chlamydia and 1014 Army/694 US for gonorrhea). Gonorrhea rates were significantly elevated in US men aged 25 to 44 years (2015-2019 crude rates, 506 US/251 Army and 223 US/86 Army for men aged 25-34 and 35-44 years, respectively). Age, sex, and race-ethnicity were significantly associated with infection among soldiers. Observed increases in chlamydia and gonorrhea and identified risk factors are consistent with those reported nationally. Higher adjusted chlamydia rates among soldiers may reflect greater individual or sexual network risks, screening biases, or increased health care access. The Army's lower adjusted gonorrhea rates may reflect differences in high-risk subgroups (e.g., men who have sex with men), differing sexual networks, or other confounders.

The Presence or Absence of Symptoms Among Cases of Urethral Gonorrhoea Occurring in a Cohort of Men Taking Human Immunodeficiency Virus Pre-exposure Prophylaxis in the PrEPX Study.

We aimed to estimate how often urethral gonorrhoea is symptomatic among men in the Pre-Exposure Prophylaxis Expanded Victoria study. Eighty-seven percent of 213 cases of urethral gonorrhoea were symptomatic. Ensuring men with urethral gonorrhoea both recognize and present early for treatment is critical to reduce transmission.

Impact of the COVID-19 Pandemic on Chlamydia and Gonorrhea Screening in the U.S.

IntroductionThis study evaluates the impact of the COVID-19 pandemic on testing for common sexually transmitted infections. Specifically, changes are measured in chlamydia and gonorrhea testing and case detection among patients aged 14–49 years during the COVID-19 pandemic.MethodsU.S. chlamydia and gonorrhea testing and positivity were analyzed on the basis of >18.6 million tests (13.6 million tests for female patients and 4.7 million tests for male patients) performed by a national reference clinical laboratory from January 2019 through June 2020.ResultsChlamydia and gonorrhea testing reached a nadir in early April 2020, with decreases (relative to the baseline level) of 59% for female patients and 63% for male patients. Declines in testing were strongly associated with increases in weekly positivity rates for chlamydia (R2=0.96) and gonorrhea (R2=0.85). From March 2020 through June 2020, an expected 27,659 (26.4%) chlamydia and 5,577 (16.5%) gonorrhea cases were potentially missed.ConclusionsThe COVID-19 pandemic impacted routine sexually transmitted infection services, suggesting an increase in syndromic sexually transmitted infection testing and missed asymptomatic cases. Follow-up analyses will be needed to assess the long-term implications of missed screening opportunities. These findings should serve as a warning for the potential sexual and reproductive health implications that can be expected from the overall decline in testing and potential missed cases.

Decreases in Reported Sexually Transmitted Infections During the Time of COVID-19 in King County, WA: Decreased Transmission or Screening?

In response to the COVID-19 pandemic, Washington State's Stay Home, Stay Healthy (SHSH) order was implemented on March 24, 2020. We hypothesized that pandemic mitigation measures might reduce sexually transmitted infection (STI) screening and/or transmission. We used King County, WA STI surveillance and sexual health clinic (SHC) data from January 1, 2019, to July 31, 2020. We calculated mean weekly case counts for gonorrhea, primary and secondary (P&S) syphilis, male urethral gonorrhea, and early latent (EL) syphilis for 3 periods in 2020: pre-SHSH (January 1-March 23), SHSH (March 24-June 5), and reopening (June 6-July 31). Primary and secondary syphilis and male urethral gonorrhea were used as proxies for sexual behavior, and EL syphilis was used as a proxy for STI screening. We compared SHC visits (2019 vs. 2020) and SHC gonorrhea treatment practices (across 2020 periods). Compared with January to July 2019, from January to July 2020, reported cases of gonorrhea, male urethral gonorrhea, P&S syphilis, and EL syphilis decreased by 9%, 5%, 16%, and 22%, respectively. Mean weekly case counts of gonorrhea, male urethral gonorrhea, and EL syphilis decreased pre-SHSH to SHSH, but all returned to pre-SHSH levels during reopening. Sexual health clinic visits during SHSH were 55% lower in 2020 than in 2019. In the SHC during SHSH, ceftriaxone treatment of gonorrhea decreased, whereas cefixime/cefpodoxime treatment and gonorrhea treatment with no testing increased. Decreases in reported STIs concurrent with COVID-19 SHSH may reflect a true decline in STI transmission. However, the larger decreases in asymptomatic infections indicate that much of the observed decrease was likely due to decreased screening.

2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19.

2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19.

Oropharyngeal gonorrhoea infections among heterosexual women and heterosexual men with urogenital gonorrhoea attending a sexual health clinic in Melbourne, Australia

ObjectivesThere is limited evidence about the transmission and prevalence of oropharyngeal gonorrhoea in heterosexuals. From August 2017, Melbourne Sexual Health Centre (MSHC) began testing for oropharyngeal gonorrhoea among heterosexuals with untreated urogenital gonorrhoea. This study aims to determine the positivity of oropharyngeal gonorrhoea among heterosexuals diagnosed with urogenital gonorrhoea at MSHC between August 2017 and May 2020. MethodsWe included individuals who had oropharyngeal gonorrhoea testing within 30 days of initial testing. We reported the number and proportion of oropharyngeal gonorrhoea positivity, stratified by gender and contact of gonorrhoea. The χ2 test was performed to compare the oropharyngeal gonorrhoea positivity between groups. ResultsOf 617 individuals with untreated urogenital gonorrhoea, 424 (68.7%) were tested for oropharyngeal gonorrhoea. Oropharyngeal gonorrhoea positivity was 38.9% (95%CI 34.2–43.7%, 165/424), and was higher in women than in men (115/252, 45.6% versus 50/172, 29.1%, p = 0.001). Furthermore, oropharyngeal gonorrhoea positivity was higher among individuals who were contacts of gonorrhoea cases compared to those who were not (29/44, 65.9% versus 136/380, 35.8%, p < 0.001). There was also no significant difference between women who were sex workers and those who were not (30/78, 38.5% versus 85/174, 48.9%, p = 0.126). ConclusionsOur data suggest that oropharyngeal gonorrhoea infection is common among heterosexual women and heterosexual men with untreated urogenital gonorrhoea. Testing heterosexual women and heterosexual men for oropharyngeal gonorrhoea will identify a significant proportion with unrecognized oropharyngeal infections whose recommended treatment is different in some countries.

Development and Evaluation of a Procedure to Identify Possible Gonorrhea Treatment Failure Cases in Illinois.

Cephalosporins are the last effective class of antibiotics to treat gonorrhea infections. In Illinois, gonorrhea cases have increased by 70.9% from 2015 to 2019. Because of the concern of antimicrobial resistance and the increasing number of cases, the Illinois Department of Public Health Sexually Transmitted Diseases Section established a procedure to identify possible gonorrhea treatment failure cases. A procedure was developed that identifies patients who have had 2 gonorrhea cases in the last 60 days, and the first case was treated with the Centers for Disease Control and Prevention-recommended treatment. Interview records were faxed to the local health department (LHD) where the patient resides. Descriptive statistics were used to analyze interview record data. A process evaluation was conducted using telephone interviews with LHDs to obtain qualitative feedback on the procedure. A total of 310 interview records were sent for investigation in 2018 and 2019 with 263 returned. Of those returned, 140 identified reexposure, 104 were unable to be located, 12 refused to be interviewed, 6 had treatment reported incorrectly, and 1 had a possible treatment failure. From telephone interviews with 6 LHDs, 1 question was removed and 2 questions were added to the interview record. Antibiotic-resistant gonorrhea could occur in Illinois at any time. Monitoring for antibiotic-resistant gonorrhea cases is necessary as gonorrhea morbidity continues to increase. This procedure may prove to be a model for other states.

The contemporary world trends in epidemiology of gonococcal infection: The publications review

The gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. N. gonorrhoeae being tropic to columnar epithelium, primarily infects mucosa of urogenital system, rectum, pharynx and conjunctiva. According the WHO, in 2016 about 87 million of new cases of gonorrhea were registered in the age group of 15-49 years old. The number of new gonorrhea cases increases steadily in many countries. The significant contribution into propagation of infection is made by males practicing sex with males, migrants, commercial sex workers, ethnic minorities. The undetected cervical gonococcus infection can result in such severe complications as inflammatory diseases of organs of small pelvis and infertility that directly impacts the reproductive losses of population. The anorectal and and pharyngeal gonorrhea very often takes asymptomatic course that complicates diagnostic and effects the statistical picture of morbidity. The apprehension of world trends in epidemiology of gonococcal infection can become a key point in implementation and development of national and international programs of prevention of propagation of this disease. The review of national and world publications concerning actual clinical epidemiological characteristics of gonococcus infection was implemented through such on-line search systems as PubMed, Google Scholar, BioMed Central (95 publications in total). The conclusions are made about steady increasing of morbidity due to propagation of infection in groups of risky sexual behavior, application of modern diagnostic means and patterns of clinical course of gonorrhea. The role of sexually transmitted infections in development of infertility, inflammatory diseases of organs of small pelvis, miscarriage and reproductive losses of poplation is marked.

A Clinic-Based Quality Improvement Initiative to Increase Screening for Gonorrhea and Chlamydia in Adolescents

BackgroundUniversal screening is a strategy for addressing the limitations of risk-based screening for gonorrhea and chlamydia (GC/CT). This quality improvement (QI) initiative aimed to improve GC/CT screening by implementing universal annual screening for all adolescents ≥ 13 years old. MethodsAt an academic pediatric resident continuity clinic, an interdisciplinary team designed and conducted multiple Plan-Do-Study-Act (PDSA) cycles over one year. The primary aim, and process measure, was to increase the percentage of encounters with screening for GC/CT in the 12 months prior to the encounter to 80%. The secondary outcome measure was rate of detection of GC or CT infection. Further, pulse checks of provider/staff knowledge and adherence were conducted. The balancing measure was denied insurance claims. ResultsThe mean screening rate of 29.2% increased during the project implementation to 65.1% with several bundles of PDSA cycles. There were no cases of gonorrhea detected in the baseline period or implementation period. The case rate of chlamydia was similar during both periods (from 9.7 per 1,000 adolescent encounters to 10.8 per 1,000 adolescent encounters, p = 0.74). There was similarly high provider/staff knowledge about (p = 0.35) and adherence to (p = 0.06) the screening protocol at 6 and 12 months of implementation. There was no increase in percentage of denied insurance claims. ConclusionThis QI initiative doubled rates of GC/CT screening with no statistically significant increase in number of cases.

Resistance of Neisseria gonorrhoeae on oral and mucosa : A Review Article

Gonorrhea is one of the four most common sexually transmitted diseases worldwide. Globally, the highest incidence of gonorrhea cases is in the African and Western Pacific regions (including China, Indonesia and Australia). Gonorrhea is a sexually transmitted disease caused by the bacteria Neisseria gonorrhoeae. These bacteria are gram-negative bacteria in the form of diplococci located intracellularly from PMN cells. Infection from Neisseria gonorrhoeae can be transmitted by sexual intercourse or vertical transmission at the time of delivery. In children, infection can occur as a result of sexual abuse by an individual infected with Gonorrhea or it can also occur from touching items contaminated with N. gonorrhoeae bacteria.