Gonorrhea Research Articles

Multicenter Clinical Performance Evaluation of the NeuMoDx™ CT/NG Assay 2.0.

Given the continued increases in rates of both Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection, additional diagnostic assays may be useful in increasing access to testing for these sexually transmitted infections. We evaluated the performance of the NeuMoDx™ CT/NG Assay 2.0 on the NeuMoDx-96 and NeuMoDx-288 Molecular Systems. The clinical sensitivity and specificity of the assay was assessed when used with: 1) endocervical swabs; 2) self-, and clinician-collected vaginal swabs; and 3) first-catch urine specimens (female and male). Results were compared to a patient infection status based on US Food and Drug Administration (FDA)-cleared assays. The NeuMoDx CT/NG Assay 2.0 demonstrated high sensitivity and specificity in both symptomatic and asymptomatic participants. All specimen types other than endocervical swabs had >95% sensitivity and > 99% specificity for both pathogens. For endocervical samples, sensitivity was 93.2% and 93.3% for CT and NG, respectively. There was no difference in performance based on platform. The frequency of invalid results was low (<1%). The NeuMoDx CT/NG Assay 2.0 demonstrated performance similar to currently FDA-cleared assays, with the added choice of a moderate- (96-sample) or a high-throughput (288-sample) platform. The system therefore offers solutions to laboratories running lower volumes of testing that may obviate the need for outsourcing to larger reference laboratories.

Impact of varying pre-exposure prophylaxis programs on HIV and Neisseria gonorrhoeae transmission among MSM in the Netherlands: a modelling study.

In 2019, a five-year pre-exposure prophylaxis (PrEP) program started in the Netherlands, in which up to 8,500 men who have sex with men (MSM) can obtain PrEP and 3-monthly consultations with HIV/STI testing. We assessed the impact of the PrEP program on transmission of HIV and Neisseria gonorrhea (NG) among MSM in the Netherlands and examined prospective variations of the program after 2024. We used an agent-based model to estimate the effect of the PrEP program. For prospective PrEP programs from 2024, we varied the capacity (8,500; 12,000; 16,000 participants) and consultation frequency (3-monthly; 6-monthly; 70% 3-monthly and 30% 6-monthly) for t. At a capacity of 8,500 participants and 3-monthly consultations, the PrEP program could lead to 3,140 (95%CrI 1,780 - 4,780) and 27,930 (95%CrI 14,560 - 46,280) averted HIV and NG infections; requiring 316,050 (95%CrI 314,120 - 317,580) consultations. At a capacity of 16,000 participants the programs with 3-monthly consultations and 6-monthly consultations could lead to comparable numbers of averted HIV (3,940 (95%CrI 2,420 - 5,460), and 3,900 (2,320 - 5,630) respectively) and NG infections (29,970 (95%CrI 15,490 - 50,350), and 29,960 (95%CrI 13,610 - 50,620) respectively), while requiring substantially different numbers of consultations: 589,330 (95%CrI 586,240 - 591,160) and 272,590 (95%CrI 271,770 - 273,290) respectively. Continuation of a PrEP program could lead to a substantial reduction in HIV and NG transmission. More infections could be averted if the number of participants is increased. In turn, the consultations frequency could be reduced without reducing the number of averted infections if capacity is increased.

Performance and acceptability of self-collected specimens for diagnosis of rectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae infections among men who have sex with men in China: a randomized controlled trial

BackgroundExtragenital Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are prevalent among men who have sex with men (MSM). Self-sampling could potentially eliminate barriers to extragenital CT/NG testing for MSM that are hard to reach, who refuse to go for clinician-based testing, or who decline an examination. However, the required evidence to determine whether self-collected specimens are as accurate as clinician-taken specimens in terms of CT/NG diagnostic accuracy was limited in low and middle income countries. We therefore compared self-collected rectal and pharyngeal specimens with clinician-taken specimens for diagnostic accuracy among MSM in China.MethodsThis was a prospective convenience sample from 6 sexually transmitted infection (STI) clinics in China. We randomized the order of self-collected and clinician-taken specimens from the pharynx and rectum, plus first-void urine, for CT/NG detection. Self-sampling performance was compared with clinician-sampling as to agreement, sensitivity, and specificity. The acceptability of self-sampling was evaluated by questionnaire.ResultsAmong the 325 participants, prevalences of rectal CT and NG infections were 13.6% and 5.2% and pharyngeal CT and NG prevalences were 1.5% and 2.8%, respectively. The agreements between the CT tests with the self-collected and clinician-taken specimens were 98.8% (κ = 0.95, 95% CI 0.89-1.00) for rectal site and 99.4% (κ = 0.83, 95% CI 0.60-1.00) for pharyngeal site; and the agreements between NG tests were 99.4% (κ = 0.94, 95% CI 0.86-1.00) for rectal site and 98.2% (κ = 0.72, 95% CI 0.50–0.93) for pharyngeal site. The sensitivity and specificity of self-collected swabs was as follows: rectal CT: 93.0% and 99.6%; pharyngeal CT: 100.0% and 99.4%; rectal NG: 100.0% and 99.4%; pharyngeal NG: 88.9% and 98.4%. Self-collection was highly acceptable, showing that 62.0% MSM preferred self-sampling over clinician-sampling; 90.2% would use self-sampling for detection of CT and NG again.ConclusionsExtragenital screening for CT and NG should be recommended as part of STI services to MSM population. Self-collection of rectal and pharyngeal specimens had good performance for CT and NG tests and acceptability to the target population.Trial registrationThis trial was registered with the Chinese Clinical Trial Registry, ChiCTR2300073473. Registered 12/07/2023.

Mpox outbreak among men who have sex with men in Kraków, Poland; June-November 2022.

Mpox is a zoonotic disease caused by mpox virus. Sporadic cases reported before 2022 were almost universally linked to a direct contact with animals or travel to endemic regions of Africa. However, in 2022, a significant shift occurred in human‑to‑human transmission, leading to a global outbreak in 117 countries. In Poland, 217 cases of mpox were reported. The aim of this study was to evaluate the epidemiology, clinical presentation, laboratory findings, and coinfections with sexually transmitted pathogens among patients with mpox. We retrospectively analyzed all mpox cases diagnosed at the University Hospital in Kraków between June 2022 and November 2022. Forty‑five patients at a median (interquartile range) age of 34 (19-48) years were diagnosed with mpox. Most of them (n = 44; 98%) were men, 42 (93%) identified themselves as men who have sex with men (MSM). Twenty‑two of the patients (49%) had previously been diagnosed with HIV. Together with mpox diagnosis, new cases of sexually transmitted infections (STIs) were identified. Specifically, 4 patients (9%) were newly diagnosed with HIV, 5 with syphilis, 4 with Chlamydia trachomatis infection, 3 with Neisseria gonorrhoeae infection, and 2 with Ureaplasma urealyticum infection; in this group, 4 patients (33%) had more than 1 sexually transmitted coinfection. The 2022 mpox outbreak in Kraków primarily affected MSM and was transmitted through sexual contact. Health care professionals should be aware of emerging STIs. Educational initiatives should emphasize the importance of vaccinations, safe sexual practices, and regular testing.

Computational modeling of cyclotides as antimicrobial agents against Neisseria gonorrhoeae PorB porin protein: integration of docking, immune, and molecular dynamics simulations

BackgroundNeisseria gonorrhoeae is the bacterium responsible for gonorrhoea, one of the most common sexually transmitted infections (STIs) globally. In 2020, the World Health Organization (WHO) estimated 82.4 million new cases of Neisseria gonorrhoeae infections. Current treatments rely on antibiotics, but the emergence of multi drug resistance (MDR) strains poses a significant threat to public health. This research aims to use computational modeling of cyclotides as antimicrobial agents targeting the Neisseria gonorrhoeae PorB Porin protein to inhibit its pathogenicity.MethodologyThe PorB Porin protein was retrieved from the Protein Data Bank (PDB ID: 4AUI), cleaned, and visualized using Discovery Visual Studio. Physicochemical properties were predicted using ProtParam. Cyclotides were obtained from the CyBase database, with 3D models generated and refined via the Swiss Model for docking studies. HDOCK was used for molecular docking. Toxicity and allergenicity predictions were performed with ToxinPred and AlgPred. A heatmap of the peptide was created using Protein-Sol. Molecular dynamics (MD) simulations were conducted for 100,000 picoseconds using Desmond from Schrödinger LLC, while binding energy was analyzed using MMGBSA. Immune response simulations were done with C-ImmSim 10.1, and peptide simulation in water was performed via WebGro.ResultsThe protein’s GRAVY value is −0.539, indicating moderate hydrophilicity, and its isoelectric point is 9.14, suggesting a fundamental nature. Globa D had the highest docking score (−270.04 kcal/mol) and was deemed non-toxic and non-allergenic. MD simulations showed stable protein-ligand interactions, and MMGBSA revealed a low binding energy of −36.737 kcal/mol. Immune simulations indicated an effective immune response and peptide simulations demonstrated Globa D’s stability in water, making it a potential candidate for pharmaceutical applications.ConclusionGloba D proved the best drug candidate against Neisseria gonorrhoeae by inhibiting PorB Porin protein chain A. Further in vitro and in vivo studies are recommended to validate these findings and explore clinical applications.

The occurrence of single-site pharyngeal Neisseria gonorrhoeae among female sex workers in the Netherlands.

Female sex workers (FSW) have a higher burden of sexually transmitted infections (STI), including Neisseria gonorrhoeae (NG), than the non-sex worker population, mainly due to social vulnerability and work-related factors. This large study evaluated the anatomical site distribution of NG, and specifically the occurrence of single-site pharyngeal NG, among FSW visiting Dutch STI clinics in the Netherlands. Coded STI clinic consultations from FSW attending any Dutch STI clinic between 2016 and 2021, in which tests were performed on all three anatomical sites, according to the Dutch testing policy for FSW, were included in analyses (n = 22,304). To compare the anatomical site distribution of NG among FSW with women in general, 15,494 consultations from women who were tested on three anatomical sites in clinics that performed standard testing at three anatomical sites were used. Descriptive statistics were used to compare the anatomical site distribution of NG and occurrence of single-site pharyngeal NG among FSW and universally tested women. NG was diagnosed among 3.5% (782/22,034) among FSW and 1.7% (271/15,494) among universally tested women (p < 0.001). Pharyngeal NG was diagnosed among 2.3% among FSW, versus 0.8% among universally tested women (p < 0.001). Single-site pharyngeal NG was diagnosed in 19.9% (156/782) of all NG infections, compared to 14.8% (40/271) of NG infections among universally tested women. The substantial proportion pharyngeal NG and single-site pharyngeal NG among FSW, confirms the relevance of pharyngeal testing among this key population for optimal patient management, also in the context of the potential role of pharyngeal NG in antimicrobial resistance.

Prevalence of gonococcal and chlamydial infections among men who have sex with men in sub-Saharan Africa: a systematic review and meta-analysis

BackgroundMen who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STI) including Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct). The lack of robust data on STIs among African MSM has limited the development of evidence-based screening strategies. This study aimed at documenting the pooled prevalence of Ng/Ct among MSM in sub-Saharan Africa (SSA).MethodsThis systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) 2020 guidelines. Relevant articles from the following databases were searched: PubMed, Scopus, ISI Web of Science, and the Directory of Open Access Journals (DOAJ). Eligible studies reported on the prevalence of Ng/Ct among the MSM population in SSA. Publication bias was assessed using the Hoy tool, Doi plot, and LFK ratio. Due to heterogeneity among studies, subgroup analyses were performed using the MetaXL add-on tool for Microsoft Excel.ResultsOf 525 articles screened, 20 were selected for inclusion. Six were cross-sectional, four had a prospective cohort study design, and one was an epidemiological study. The pooled prevalence of Ng/Ct in MSM was 27% (95% CI, 19–39%), with an I2 of 98% signifying heterogeneity among the studies. Subgroup analysis by country revealed South Africa had the highest prevalence (38%).DiscussionInterpretationThe high prevalence of Ng/Ct infection among MSM in SSA is of concern.LimitationsDue to limited data available on Ng/Ct prevalence, the true prevalence of SSA and its associated risk factors is uncertain.ConclusionAs the first study to systematically review the available literature on STI prevalence among the MSM population in SSA, it showed the burden of Ng/Ct is higher than in other regions, warranting the strengthening of health systems to improve education, testing, and treatment in MSM population.Systematic review registrationPROSPERO CRD42022327095.

Tackling immunosuppression by Neisseria gonorrhoeae to facilitate vaccine design.

Gonorrhoea, caused by Neisseria gonorrhoeae, is a common sexually transmitted infection. Increasing multi-drug resistance and the impact of asymptomatic infections on sexual and reproductive health underline the need for an effective gonococcal vaccine. Outer membrane vesicles (OMVs) from Neisseria meningitidis induce modest cross-protection against gonococcal infection. However, the presence of proteins in OMVs derived from N. gonorrhoeae that manipulate immune responses could hamper their success as a vaccine. Here we modified two key immunomodulatory proteins of the gonococcus; RmpM, which can elicit 'blocking antibodies', and PorB, an outer membrane porin which contributes to immunosuppression. As meningococcal PorB has adjuvant properties, we replaced gonococcal PorB with a meningococcal PorB. Immunisation with OMVs from N. gonorrhoeae lacking rmpM and expressing meningococcal porB elicited higher antibody titres against model antigens in mice compared to OMVs with native PorB. Further, a gonococcal protein microarray revealed stronger IgG antibody responses to a more diverse range of antigens in the Nm PorB OMV immunised group. Finally, meningococcal PorB OMVs resulted in a Th1-skewed response, exemplified by increased serum IgG2a antibody responses and increased IFNɣ production by splenocytes from immunised mice. In summary, we demonstrate that the replacement of PorB in gonococcal OMVs enhances immune responses and offers a strategy for gonococcal vaccine development.

Aptima Combo2-avoiding variants detected in cervical and endometrial specimens from a cohort of sexually active cisgender women during 16S microbiome profiling.

Performance of a 16S rRNA analysis of the cervicovaginal microbiome of 220 participants recruited into the T Cell Response against Chlamydia (TRAC) cohort between February 2011 and August 2014 in Allegheny County, Pennsylvania USA surprisingly detected DNA encoding chlamydial 16S rRNA in samples from seven participants who had tested negatively for Chlamydia trachomatis (CT) and DNA encoding gonococcal 16S rRNA from five participants who had tested negatively for Neisseria gonorrhoeae (NG) infection with the Aptima Combo2 assay (Hologic). We used targeted PCR amplification followed by sequencing to characterize the chlamydial 23S rRNA locus and qPCR to detect gonococcal DNA in residual diagnostic swab eluates or DNA used to generate 16S rRNA libraries. Discrepant specimens that contained chlamydial DNA carried a diagnostic-avoidant, G1526A variant in the 23S rRNA locus identical to variants previously detected in Finland, Denmark, and the UK. PCR validation of gonococcal DNA was confirmed for all participants who had tested negatively, with stochastic effects consistent with infection levels close to the limit of detection by the diagnostic assay. These data indicate that this probe-avoidant CT mutant, and possibly others, were circulating in the northeastern US prior to their detection and characterization in 2019 and subsequently. Although infrequent, documentation of false negative results for CT indicates a need for clinicians to consider performance of a second test that uses alternate PCR probes if patients have persistent symptoms or have known contact to an infected sex partner and their initial NAAT is negative.

Doxycycline Postexposure Prophylaxis (DoxyPEP) for Bacterial STI Prevention

This Viewpoint describes what dermatologists should know about doxycycline postexposure prophylaxis (doxyPEP) for bacterial sexually transmitted infection (STI) prevention, specifically syphilis, chlamydia, and gonorrhea.

Positivity and Follow-up Testing of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Universally Screened Female Basic Military Trainees.

Follow-up testing is recommended three months after patients initially test positive with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Follow-up testing adherence in the United States has been reported below one third of women, even in universally insured populations. We assessed both the positivity of CT and GC infections in female basic military trainees and the rates of follow-up testing for those who tested positive. Between January 1, 2006-December 31, 2021, female Air Force Basic Military Trainees were universally screened with urinary nucleic acid amplification testing for CT and GC. Those who tested positive were evaluated to determine demographic information as well as follow-up testing rates. Patients who were evaluated with a repeat CT/GC NAAT test within 12 months after a positive CT/GC test result were considered to have received appropriate follow-up. 5,022 (5.2%) of 97,168 trainees tested positive for only-CT (4,749 (4.8%)), only GC (138 (0.1%)) or both CT/GC (135 (0.1%) during the study period. Those at increased risk of infection were those <24 years of age, Hispanic and Black individuals, high school education level, and single women. Of the 4,687 still in the military at three months after diagnosis, 3,268 (69.7%) had repeat testing within 12 months. There was no significant difference in follow-up testing by age, race, educational level, marital status, or organism causing original infection. Follow-up testing among female USAF basic military trainees is higher than in other universally insured populations. This study demonstrates remaining barriers to adherence to recommended guidelines.

"Another tool for the sexual health toolkit": U.S. health care provider knowledge and attitudes about doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections among men who have sex with men.

Doxycycline post-exposure prophylaxis (doxy-PEP) reduces chlamydia, gonorrhea, and syphilis infections among men who have sex with men (MSM) and transwomen (TW). Perspectives of health care providers (HCPs) regarding doxy-PEP can inform implementation efforts. From August 2022 to January 2023, HCPs were recruited from 13 cities with high sexually transmitted infection (STI) rates for semi-structured, in-depth interviews about their awareness of and attitudes towards doxy-PEP for STI prevention. HCPs were purposively sampled to include people with experience prescribing PrEP and provision of care to MSM. Interviews were conducted virtually via Zoom. Transcripts and debrief reports were analyzed using a directed content analysis approach to explore knowledge, attitudes, and beliefs about doxy-PEP. Among 30 HCPs, almost half (47%) were between 31-40 years of age, 53% identified as male, and 47% reported their sexual orientation as gay or queer. Half (53%) of participants practiced in the South, 43% had >100 MSM in their clinic panel, and 17% had previously prescribed doxy-PEP. We identified four overarching themes: 1) HCPs expressed positive attitudes towards doxy-PEP; 2) antimicrobial resistance concerns limit enthusiasm for some HCPs; 3) additional data about the long-term safety of doxy-PEP would improve their confidence; and 4) development of guidelines would facilitate the prescription of doxy-PEP, including eligibility, dosing instructions, and treatment management. HCPs were motivated to prescribe doxy-PEP with almost 20% already having prescribed it. Guidelines and data about long-term safety, especially antimicrobial resistance, would facilitate introduction of doxy-PEP into clinical practice.

A Pair of Hearts: Two Cases of Mitral Valve Gonococcal Endocarditis.

Gonorrhea is a sexually transmitted infection. Manifestations include asymptomatic infection and disseminated, life-threatening disease. We present two cases of mitral valve gonococcal endocarditis and discuss epidemiologic trends in disseminated gonococcal infection, acknowledging antimicrobial resistance, genetic variability in gonococcal strains, and contextual factors related to the COVID-19 pandemic and STI control.

Breakthrough Rectal Neisseria gonorrhoeae Infections After Meningococcal B Vaccination: Microbiological and Clinical Features.

4CMenB appears to be effective in reducing Neisseria gonorrhoeae (Ng) infections. Aims are to assess factors associated with breakthrough rectal Ng after 4CMenB and evaluate clinical and microbiological characteristics of breakthrough infections compared with before vaccination. This was a retrospective study of gay, bisexual, and other men who have sex with men (GBMSM) vaccinated with 4CMenB (2 doses) between 2017 and 2023 at the San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS San Raffaele Scientific Institute), Milan, Italy, and tested for rectal Ng. Rectal Ng infection is considered breakthrough if it occurs >1 month after the second 4CMenB dose and with positive nucleic acid amplification test (NAAT) result. Follow-up was from July 2017 (first 4CMenB vaccination) to November 2023 (data freeze). Rectal Ng was screened with both NAAT and gonococcal-specific cultures. Characteristics of individuals with or without breakthrough Ng and of Ng infections before or after 4CMenB were compared using Mann-Whitney and χ2/Fisher tests. Overall, 473 GBMSM vaccinated with 4CMenB were included, with a median age (interquartile range) of 43 (37-51) years; 451 of 473 were living with human immunodeficiency virus. The percentage of NAAT-positive rectal Ng swab samples was 76 of 957 (7.7%) after 4CMenB and 51 of 456 (11.1%) before. Breakthrough rectal Ng after baseline were 76 in 57 of 473 people. People with rectal Ng after 4CMenB were younger, more likely to have a previous sexually transmitted infection, and had more sexual partners than those without (all P < .001). Breakthrough rectal Ng infections were less frequently symptomatic (34.2% vs 66.7%; P = .001) and more likely with negative gonococcal-specific culture (55.3% vs 19.6%; P < .001) compared with before vaccination. Breakthrough rectal Ng infections after 4CMenB were 76 in 57/473 people, preferentially identified in GBMSM with higher-risk sexual behaviors, were less often symptomatic, and more often with negative gonococcal-specific cultures, suggesting lower infection virulence.

Doxycycline Post-Exposure Prophylaxis for Bacterial Sexually Transmitted Infections: The Current Landscape and Future Directions.

The incidence of bacterial sexually transmitted infections (STI) continues to rise particularly among men who have sex with men (MSM). Doxycycline post-exposure prophylaxis (doxy-PEP) has emerged as a promising biomedical prevention strategy. This review aims to summarize the results of recent studies, highlight the current normative guidance on the use of doxy-PEP, and discuss remaining questions. In the past decade, there have been four randomized controlled trials and three real-world analyses of doxy-PEP, which consistently demonstrated a reduction in Chlamydia trachomatis and Treponema pallidum infections among MSM. Questions remain regarding the efficacy of doxy-PEP for Neisseria gonorrhoeae infection and among cisgender women. Possible detrimental impacts include an increase in antimicrobial resistance as well as alterations to the gut microbiome Doxy-PEP is an effective strategy for preventing Chlamydia trachomatis and Treponema pallidum among MSM. Further work is needed to investigate the benefits among other populations, as well as to monitor for adverse effects.

Gonococcal infections and risk factors for reinfection: a descriptive and case-case analysis of notifications in the Australian Capital Territory, 2017-2022.

In Australia, gonococcal infection notification rates are increasing with reinfections representing a substantial proportion of infections. Understanding the local epidemiology of gonococcal infections and reinfections and the risk factors for reinfection can assist with the design of targeted interventions. This study aimed to describe the epidemiology of gonococcal infections and reinfections between 2017 and 2022 in the Australian Capital Territory (ACT), and to examine the risk factors for reinfection. Data for gonococcal infections notified in the ACT between 2017 and 2022 were described. The epidemiological characteristics of individuals with a single infection and reinfection were compared using a case-case study design. There were 1,886 gonococcal infection notifications during the study period. Of these, 20.4% were reinfections (n = 385). Of 1,501 individuals, 1,254 (83.5%) had a single infection and 247 (16.5%) had a reinfection. Between 2017 and 2022, the annual gonococcal infection notification rate per 100,000 population increased from 59.98 to 80.14 and the proportion of reinfections from 4.0% to 26.8%. Compared with those with a single infection, individuals with a reinfection had significantly greater odds of being male, of having a same-sex sexual exposure, of using HIV pre-exposure prophylaxis at diagnosis, and of having been diagnosed at a sexual health/family planning clinic. Individuals with a reinfection had significantly greater odds of being in the 25-34, 35-44 and 45-54 years age groups than in the 14-24 years age group. The odds of anatomical site of first infection being only the rectum, only the throat, or at more than one site, compared with urogenital only, were significantly greater for those with a reinfection. Gonococcal reinfections contribute substantially to gonococcal infection notifications in the ACT. Targeted interventions are needed to prevent gonococcal reinfections among at-risk groups, particularly among men who have sex with men, people who use HIV pre-exposure prophylaxis, and individuals accessing sexual health/family planning services.

Exploring the prevalence of chlamydial and gonorrheal infections in pregnant women: a multicenter study in Egypt

BackgroundChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widespread, treatable sexually transmitted infections (STIs) of global significance, affecting millions annually. Left untreated, they pose significant risks, including pelvic inflammatory disease (PID), infertility, and complications during pregnancy. The U.S. Centers for Disease Control recommends annual chlamydial screening for sexually active women to address these risks. Responding to this global challenge, the World Health Organization (WHO) has formulated a global health sector strategy on sexually transmitted infections, outlining priority actions to strengthen STI responses in countries. However, STI epidemiological studies encounter challenges in developing nations like Egypt due to socio-cultural factors, poverty, and limited diagnostic facilities. In Egypt, STI diagnosis primarily relies on clinical presentations, lacking structured screening programs for CT and NG. This study’s main objective is to estimate the prevalence of Chlamydial and gonorrheal infections, advocating for supportive STI strategies in Egypt. Additionally, the study aims to provide a foundation for national prevalence estimates of CT and NG infections.MethodsA cross-sectional study encompassed five antenatal clinics in different regions of Egypt. A total of 1040 pregnant women attending these clinics were consecutively sampled. Data collection involved structured questionnaires, and urine samples were subjected to the GeneXpert CT/NG qualitative real-time PCR test.ResultsThe prevalence of CT infections was 0.29% (95% CI, 0.10–0.86%), with no detected NG infections. The three CT-positive cases were distributed across different recruitment centers, with no statistically significant differences observed between infected and non-infected participants. Notably, 40.3% of recruited women reported gynecological symptoms, primarily discharge. Additionally, 9.6% had undergone previous testing for sexually transmitted infections, with 8.2% receiving positive results.ConclusionsThis study provides valuable data on the prevalence of CT and NG infections among pregnant women attending ANC clinics in Egypt. The findings underscore the importance of ongoing surveillance, routine screening, and targeted interventions to ensure the reproductive health and well-being of pregnant women and their infants. Further research is warranted to explore the broader implications of STIs in different populations and to inform evidence-based guidelines for screening and management in diverse settings. Trial registration: IRB no.: 17,400,017; WHO ERC Protocol Id. A66005.

Antimicrobial Resistance of Neisseria gonorrhoeae Isolates among Men Who Have Sex with Men in Lower Silesia, Poland.

Neisseria gonorrhoeae (NG) has developed resistance to nearly all antibiotics used for its treatment. However, very limited data are available regarding the antimicrobial resistance of NG isolates among MSM in Poland. The aim of this study was to evaluate the susceptibility of Neisseria gonorrhoeae isolates in this key population. We investigated the antimicrobial susceptibility of NG isolates to six antimicrobials (ceftriaxone, cefixime, azithromycin, ciprofloxacin, tetracycline, and benzylpenicillin). Minimum inhibitory concentrations (MICs; mg/L) were determined using Etests on gonococcal isolates. One hundred high-risk MSM were included in the study (25 HIV-positive and 75 HIV-negative using pre-exposure prophylaxis for HIV). The rate of NG infection was 28%. All NG isolates were susceptible to cefixime and ceftriaxone. Susceptibility to azithromycin was found in 69.2% (18/26) of the NG isolates and resistance in 30.8% (8/26) of NG isolates. Susceptibility to tetracycline was found in 50% (13/26) of the isolates and resistance in 50% (13/26) of the isolates. We observed gonorrhea to be more prevalent in patients with a higher number of oral sexual contacts. Increasing azithromycin resistance is especially concerning for future treatment options, especially if ceftriaxone/cefixime resistance starts to develop and for people with beta-lactam antibiotics allergies. Doxy-PEP might lose its partial efficacy for NG soon.

Zap the clap with DNA: a novel microbicide for preventing Neisseria gonorrhoeae infection.

Each year, Neisseria gonorrhoeae (Ngo) causes over 1.5 million new infections in the United States, and >87 million worldwide. The absence of a vaccine for preventing gonorrhea, the rapid emergence of multidrug-resistant and extremely drug-resistant Ngo strains, and the limited number of antibiotics available for treating gonorrhea underscore the importance of developing new modalities for addressing Ngo infection. Here, we describe DNA-based microbicides that kill Ngo but not commensals. Previously, we showed that Ngo is killed when it takes up differentially methylated DNA with homology to its genome. We exploited this Achilles heel to develop a new class of microbicides for preventing Ngo infection. These microbicides consist of DNA molecules with specific sequences and a methylation pattern different from Ngo DNA. These DNAs kill low-passage and antibiotic-resistant clinical isolates with high efficiency but leave commensals unharmed. Equally important, the DNAs are equally effective against Ngo whether they are in buffered media or personal lubricants. These findings illustrate the potential of this new class of practical, low-cost, self-administered DNA-based microbicides for preventing Ngo transmission during sexual intercourse.

Effects of doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections on gonorrhoea prevalence and antimicrobial resistance among men who have sex with men in the USA: a modelling study

Doxycycline post-exposure prophylaxis (PEP) has been shown to be efficacious for the prevention of bacterial sexually transmitted infections, but resistance implications for Neisseria gonorrhoeae remain unknown. We aimed to use a mathematical model to investigate the anticipated impact of doxycycline PEP on the burden of gonorrhoea and antimicrobial resistance dynamics in men who have sex with men (MSM) in the USA. Using a deterministic compartmental model, characterising gonorrhoea transmission in a US MSM population comprising three sexual activity groups defined by annual partner turnover rates, we introduced doxycycline PEP at various uptake levels (10-90%) among those with high sexual activity. Infections were stratified by symptom status and resistance profile (ie, susceptible, ceftriaxone-resistant, tetracycline-resistant, or dual-resistant), with ceftriaxone the treatment for active infection. As resistance to tetracycline, not doxycycline, is monitored and reported nationally, we used this as a proxy for doxycycline PEP resistance. We compared the 20-year prevalence, incidence rates, and cumulative incidence of gonococcal infection, resistance dynamics (time to 5% prevalence of ceftriaxone resistance, 5% prevalence of dual resistance, and 84% prevalence of tetracycline resistance), and antibiotic consumption with baseline (ie, no doxycycline PEP). Uptake of doxycycline PEP resulted in substantial reductions in the prevalence and incidence of gonorrhoea, but accelerated the spread of tetracycline resistance. The maximum reduction in prevalence over 20years compared with no uptake ranged from 40·3% (IQR 15·3-83·4) with 10% doxycycline PEP uptake to 77·4% (68·4-84·9) with 90%uptake. Similarly, the maximum reduction in the incidence rate ranged from 38·6% (14·1-83·6) with 10% uptake to 77·6% (68·1-84·7) with 90% uptake. Cumulative gonococcal infections were reduced by a median of 14·5% (IQR8·4-21·6) with 10% uptake and up to 46·2% (26·5-59·9) with 90% uptake after 5years, and by 6·5% (3·4-13·0) with 10% uptake and 8·7% (4·3-36·2) with 90% uptake by 20years. In almost all scenarios explored, doxycycline PEP lost clinical effectiveness (defined as 84% prevalence of tetracycline resistance) within the 20-year period, but itslifespan ranged from a median of 12·1years (IQR 9·9-15·7) with 10% uptake to 1·6years (1·3-1·9) with 90%uptake. Doxycycline PEP implementation had minimal impact on extending the clinical lifespan of ceftriaxone monotherapy (5·0years [IQR 4·0-6·2]), with the median time to 5% prevalence of resistance ranging from 4·8years (3·9-6·0) for 90% uptake to 5·0years (4·1-6·2) for 10% uptake. Similarly, the median time to 5%prevalence of dual resistance to ceftriaxone and tetracycline ranged from 4·8years (3·9-6·0) for 90% uptake to 5·8years (4·8-7·4) for 10% uptake. Median decrease in ceftriaxone consumption for high doxycycline PEP uptake levels compared with baseline ranged from 41·7% (27·0-54·3) for 50% uptake to 50·2% (29·3-62·7) for 90% uptake at 5years, but dropped to 11·8% (6·9-32·0) for 50% uptake and 12·1% (7·0-41·6) for 90% uptake after 20years. Notwithstanding the clear benefits of doxycycline PEP for other sexually transmitted infections, for Ngonorrhoeae, model findings suggest that doxycycline PEP is an effective but impermanent solution for reducing infection burden, given eventual selection for resistant strains. This finding presents a challenge for policy makers considering strategies for doxycycline PEP implementation and oversight: the need to balance the clear, short-term clinical benefits with the risk of harm via antimicrobial resistance. US Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases.