Non-gonococcal Urethritis Research Articles

Epidemiology of Sexually Transmitted and Dermatological Diseases among Patients in 250 Bedded General Hospital, Jamalpur, Bangladesh

Background: Skin diseases are widespread in developing nations. It is commonly acknowledged that the occurrence and characteristics of skin and venereal diseases vary across countries and even within different regions of a single country. These variations are influenced by a complex interplay of social, economic, racial, and environmental factors. Objective: To assess the epidemiology of sexually transmitted infections and skin illnesses among patients visiting the outpatient department of a tertiary care hospital in Bangladesh. Methods: This study was conducted at the outpatient department of skin and venereal diseases at the 250-bedded General Hospital in Jamalpur. The study took place from January 2023 to June 2023 and used a descriptive cross-sectional design. A total of 150 patients, spanning all age groups and presenting with various skin and venereal diseases, were included as the study sample from the 250-bedded General Hospital in Jamalpur during the study period. Data collection was conducted using the purposive sampling method. Results: The study findings revealed that a significant proportion of the patients (28%) fell within the age range of 20-29 years, with 23.3% and 18.7% falling within the age ranges of 10-19 years and <10 years, respectively. A mere 7.3% of individuals were encompassed within the age bracket of 50 years and older. Out of the 150 patients, a majority (54.70%) were male. In the study it was discovered that a noteworthy 14% of the patients were affected by venereal diseases and 86% of the patients were affected by skin diseases. It was particularly noteworthy that the highest prevalence of these venereal diseases was concentrated within the 20-29 years age range, affecting approximately 14.29% of individuals within this group. Specifically, 19.51% of males in the study were found to have venereal diseases, in contrast to a lower prevalence of 7.35% among females. Non-Gonococcal Urethritis (NGU) was a notable condition observed ...

Sexually transmitted infections in the middle east and North Africa: comprehensive systematic review and meta-analysis

BackgroundGlobally, sexually transmitted infections (STIs) collectively cause 2.3 million deaths and 1.2 million cases of cancer annually. However, the epidemiology of STIs in the Middle East and North Africa (MENA) is not well assessed because of various social and cultural factors.MethodsA systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and covering 23 MENA countries, 19 STIs, and data from 20,435,971 participants. PubMed, Embase, regional and international databases, and country-level reports were searched up to May 2024.ResultsThe analysis revealed significant regional variations in the prevalence of STIs within the MENA region. In North Africa, the most common STIs were bacterial vaginosis (31%), human papillomavirus (HPV, 23%), and Candida spp. (15%). In the Gulf Cooperation Council region and Yemen, Ureaplasma (25%), nongonococcal urethritis (NGU, 16%), and Mycoplasma spp. (12%) were the predominant infections. In the Levant region, the top STIs were HPV (20%), hepatitis B virus (HBV, 9%), and Candida spp. (9%). In Iran, Ureaplasma spp. (18%), HPV (17%), and cytomegalovirus (8%) were the most prevalent infections, whereas Ureaplasma spp. (20%), Candida spp. (18%), and HPV (16%) were most frequently detected in Türkiye. Gender-based disparities were observed, with a higher prevalence of Ureaplasma spp., Neisseria gonorrhoeae, and herpes in men and higher rates of Mycoplasma spp., HPV, HBV, and Candida spp. in women. Overall, high rates of nongonococcal urethritis (16.3%), Ureaplasma spp. (13.7%), HPV (12.7%), and Candida spp. (9.4%) were recorded in the MENA region.ConclusionsMost MENA countries lack national STI screening programs, and the reported data are primarily from symptomatic individuals. Establishing robust surveillance systems, addressing stigma and barriers to healthcare access, and expanding STIs screening and vaccination programs are crucial for accurately capturing the true burden of STIs in MENA countries.

Prevalence and macrolide resistance of Mycoplasma genitalium from patients seeking sexual health care in Southern Ghana

BackgroundMycoplasma genitalium (MG), a sexually transmitted infection (STI), has emerged as a common cause of non-gonococcal urethritis and cervicitis worldwide, with documented resistance to commonly used antibiotics including doxycycline and azithromycin. Data in Ghana regarding the prevalence of MG is limited.MethodsThis retrospective study investigated MG presence and macrolide resistance among patients who previously reported to selected clinics for STI symptoms between December 2012 and June 2020. Samples were screened for MG and mutations associated with azithromycin resistance were investigated using Nucleic Acid Amplification Testing (NAAT) including the Resistance Plus MG® kit from SpeeDx and the LightMix® kit for MG, combined with the Modular Mycoplasma Macrolide from TIB Molbiol.ResultsA total of 1,015 samples were screened, out of which MG infection rate by TIB Molbiol and SpeeDx were 3.1% and 3.4%, respectively. The mutation responsible for macrolide resistance was detected in one MG positive sample by both assays. Both diagnostic tests revealed no significant association between MG infection and socio-demographic characteristics, clinical symptoms, gonorrhea, and chlamydia infection status. There was no significant difference in the mycoplasma percentage positivity rate detected using SpeeDx (3.4%) and TIB Molbiol (3.1%).ConclusionsWhile not commonly tested as a cause of STI symptoms, MG is widespread in Ghana, exhibiting symptoms and prevalence comparable to those in other countries and linked to antimicrobial resistance. Future research using various molecular techniques is essential to monitor resistance trends and guide future antibiotic choices.

ETIOPATHOGENETIC REASONING OF URETHRAL MICROBIOTA REHABILITATION IN PATIENTS WITH ACUTE INFECTIOUS URETHRITIS

The microbiota of the male genitourinary tract is a complex dynamic system that has not been sufficiently studied. Unlike the microbiome of the female urethral mucosa, which is constantly changing, the taxonomic composition and population level of the male urethral microbiome is more stable and independent of age. The aim of the study. To improve the results of treatment of patients with inflammatory processes of the urethra by determining the taxonomic composition, population level and microscopic indicators of the "macroorganism-microbiome" ecosystem of the microbiota of the urethra in men with acute urethritis.Material and methods. The taxonomic composition and population level of the first portion of urine of 69 sexually mature men (average age 34.8±7.14 years) with acute infectious (nonspecific) urethritis were investigated. Isolation of conditionally pathogenic bacteria was carried out by the bacteriological method using optimal nutrient media, their pH, temperature and cultivation time for each taxon. The identification of isolated pure cultures was carried out according to morphological, tinctorial, cultural, biochemical properties, as well as signs of pathogenicity and antigenic structure. To determine the mechanisms of colonization of the mucous membrane of the urethra by conditionally pathogenic microorganisms, the microecological method was used.Research results. According to the taxonomic composition and the level of microecological indicators of the "macroorganism-microbiome" ecosystem of the urethra microbiota (Margalef's species richness index, Whittaker's species diversity index, and Simpson's and Berger-Parker's species dominance indices), vulgar (common), hemolytic, and enteropathogenic Escherichia coli, coagulase-positive staphylococcus. The leading role in the formation of urethritis is played by ordinary enterobacteria - E. coli, a slightly smaller etiological role in the formation of urethritis in men belongs to S. aureus (less by 17.83%), E. coli Hly+ (less by 28.35%), enteropathogenic Escherichia coli (by 83.12%). Other microorganisms have a minimal etiological role. Conclusions. Acute urethritis in men is a polyetiological disease. Enterobacteria E. coli, E. coli Hly+, enteropathogenic Escherichia coli, K. pneumoniae, S. aureus, S. epidermidis, S. viridans are involved in the formation of the inflammatory process of the urethra. The leading causative agents of acute urethritis in men are E. coli, S. aureus, E. coli Hly+, enteropathogenic escherichia, which belong to uropathogenic escherichia.

Prevalence of Mycoplasma genitalium and macrolide resistance in rectal and urine samples among men who have sex with men in Sweden

ObjectivesWhile Mycoplasma genitalium is reported as a common rectal infection among men who have sex with men (MSM), published data refer predominantly to urethral infections. Currently, most guidelines recommend M....

Diagnosis and treatment of non-gonococcal urethritis caused by atypical (intracellular) pathogens. What should a urologist know? Review of current clinical guidelines

Diagnosis and treatment of non-gonococcal urethritis caused by atypical (intracellular) pathogens. What should a urologist know? Review of current clinical guidelines

Economic evaluation alongside a clinical trial of near-to-patient testing for sexually transmitted infections

BackgroundCurrent clinical care for common bacterial STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG)) involves empiric antimicrobial therapy when clients are symptomatic, or if asymptomatic, waiting for laboratory testing and recall if indicated. Near-to-patient testing (NPT) can improve pathogen-specific prescribing and reduce unnecessary or inappropriate antibiotic use in treating sexually transmitted infections (STI) by providing same-day delivery of results and treatment. MethodsWe compared the economic cost of NPT to current clinic practice for managing clients with suspected proctitis, non-gonococcal urethritis (NGU), or as an STI contact, from a health provider’s perspective. With a microsimulation of 1000 clients, we calculated the cost per client tested and per STI- and pathogen- detected for each testing strategy. Sensitivity analyses were conducted to assess the robustness of the main outcomes. Costs are reported as Australian dollars (2023). ResultsIn the standard care arm, cost per client tested for proctitis, NGU in men who have sex with men (MSM) and heterosexual men were the highest at $247.96 (95% Prediction Interval (PI): 246.77–249.15), $204.23 (95% PI: 202.70–205.75) and $195.01 (95% PI: 193.81–196.21) respectively. Comparatively, in the NPT arm, it costs $162.36 (95% PI: 161.43–163.28), $158.39 (95% PI: 157.62–159.15) and $149.17 (95% PI: 148.62–149.73), respectively. Using NPT resulted in cost savings of 34.52%, 22.45% and 23.51%, respectively. Among all the testing strategies, substantial difference in cost per client tested between the standard care arm and the NPT arm was observed for contacts of CT or NG, varying from 27.37% to 35.28%. ConclusionWe found that NPT is cost-saving compared with standard clinical care for individuals with STI symptoms and sexual contacts of CT, NG, and MG.

Should We Be Testing for Mycoplasma genitalium on Initial Presentation? Trends in Persistent/Recurrent Urethritis Among Men Presenting for Care in STD Clinics, 2015-2019, STD Surveillance Network.

Mycoplasma genitalium is a major contributor to persistent/recurrent urethritis cases. However, there are limited published studies on recent trends of persistent/recurrent urethritis. A retrospective analysis was conducted of men presenting with symptomatic urethritis in 16 sexually transmitted disease (STD) clinics from 2015 to 2019. Poisson regression was used to assess trends in the annual proportions of urethritis episodes with follow-up (FU) characterized with persistent/recurrent urethritis symptoms. Results were also stratified by results of chlamydia (CT) and gonorrhea (NG) testing and treatment prescribed. There were 99,897 urethritis episodes, from 67,546 unique men. The proportion of episodes with persistent/recurrent symptomatic FU visits increased 50.8% over a 4-year period (annual percentage change [APC], 11.3%; 95% confidence interval [CI], 6.5-16.3). Similar trends were observed in nonchlamydial nongonococcal urethritis episodes (APC, 12.7%; 95% CI, 6.8-18.9) but increases among those positive for NG (APC, 12.1%; 95% CI, -2.3 to -28.5) or for CT (APC, 7.3%; 95% CI, -6.7 to 23.5) were not statistically significant. Among episodes who received azithromycin as first-line treatment, increases in the proportion of persistent/recurrent FU visits were observed (APC, 12.6%; 95% CI, 8.6-16.7). For episodes where first-line treatment was doxycycline, no significant increases were detected (APC, 4.3%; 95% CI, -0.3 to 9.2). We found an increase in the proportion of urethritis episodes with persistent or recurrent symptoms over time. Given these observed trends in episodes negative for NG or CT, an etiology not detectable by routine diagnostics was a likely factor in increased persistence, suggesting patients with urethritis may benefit from diagnostic testing for M. genitalium during an initial symptomatic presentation.

Detection of Macrolide and/or Fluoroquinolone Resistance Genes in Mycoplasma genitalium Strains Isolated from Men in the Northwest Region of Croatia in 2018-2023.

Mycoplasma genitalium (M. genitalium) poses a significant public health challenge due to its association with non-gonococcal urethritis (particularly in men) and antimicrobial resistance. However, despite the prevalence of M. genitalium infections and the rise in resistance rates, routine testing and surveillance remain limited. This is the first study from Croatia that aimed to assess the prevalence and trends of resistance in M. genitalium strains isolated from male individuals by detecting macrolide and fluoroquinolone resistance genes. The study also aimed to explore the factors associated with resistance and changes in resistance patterns over time. Urine samples collected from male individuals in the Zagreb County and northwest region of Croatia between 2018 and 2023 were tested for M. genitalium with the use of molecular methods. Positive samples were subjected to DNA extraction and multiplex tandem polymerase chain reaction (MT-PCR) targeting genetic mutations associated with macrolide (23S rRNA gene) and fluoroquinolone (parC gene) resistance. Of the 8073 urine samples tested from 6480 male individuals (and following the exclusion of repeated specimens), we found that the prevalence of M. genitalium infection was 2.2%. Macrolide resistance was observed in 60.4% of strains, while fluoroquinolone resistance was found in 19.2%. Co-resistance to both antibiotics was present in 18.2% of cases. A statistically significant increase in fluoroquinolone resistance was noted over the study period (p = 0.010), but this was not evident for azithromycin resistance (p = 0.165). There were no statistically significant differences in resistance patterns between age groups, whereas re-testing of patients revealed dynamic changes in resistance profiles over time. The high burden of macrolide resistance and increasing fluoroquinolone resistance underscore the urgent need for comprehensive resistance testing and surveillance programs. The implementation of resistance-guided treatment strategies, along with enhanced access to molecular diagnostics, is pivotal for effectively managing M. genitalium infections.

The Relationship Between Insertive Oral and Anal Sex and Select Measures of the Composition of the Urethral Microbiota Among Men Who Have Sex With Men.

Sexual behavior may influence the composition of the male urethral microbiota, but this hypothesis has not been tested in longitudinal studies of men who have sex with men (MSM). From December 2014 to July 2018, we enrolled MSM with nongonococcal urethritis (NGU) attending a sexual health clinic. Men attended 5 in-clinic visits at 3-week intervals, collected weekly urine specimens at home, and reported daily antibiotics and sexual activity on weekly diaries. We applied broad-range 16S rRNA gene sequencing to urine. We used generalized estimating equations to estimate the association between urethral sexual exposures in the prior 7 days (insertive oral sex [IOS] only, condomless insertive anal intercourse [CIAI] only, IOS with CIAI [IOS + CIAI], or none) and Shannon index, number of species (observed, oral indicator, and rectal indicator), and specific taxa, adjusting for recent antibiotics, age, race/ethnicity, HIV, and preexposure prophylaxis. Ninety-six of 108 MSM with NGU attended ≥1 follow-up visit. They contributed 1140 person-weeks of behavioral data and 1006 urine specimens. Compared with those with no urethral sexual exposures, those with IOS only had higher Shannon index ( P = 0.03 ) but similar number of species and presence of specific taxa considered, adjusting for confounders; the exception was an association with Haemophilus parainfluenzae . CIAI only was not associated with measured aspects of the urethral microbiota. IOS + CIAI was only associated with presence of H. parainfluenzae and Haemophilus . Among MSM after NGU, IOS and CIAI did not seem to have a substantial influence on measured aspects of the composition of the urethral microbiota.

Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study

BackgroundEmpiric treatment of sexually transmitted infections can cause unnecessary antibiotic use. We determined if near-to-patient-testing (NPT) for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium (MG) improved antibiotic-use for a range of clinical presentations. MethodsClients attending with non-gonococcal-urethritis (NGU), proctitis, as STI-contacts, or for an MG-test-of-cure (MG-TOC) between March-December 2021 were recruited. Participants received near-to-patient-testing (NPT-group) for the three STIs using the GeneXpert® System (Cepheid), and concurrent routine-testing by transcription-mediated-amplification (TMA; Aptima, Hologic). Antibiotic-use among NGU or proctitis cases in the NPT-group was compared to clinic-controls undergoing routine-testing only. The proportion in the NPT-group who notified partners <24hrs of their STI-specific result was calculated. FindingsAmong 904 consults by 808 NPT-participants, ≥1 STI was detected in 63/252 (25·0%) with NGU, 18/51 (35·3%) with proctitis, and 167/527 (31·7%) STI-contacts. MG was detected among 35/161 (21·7%) MG-TOC consults. Among NGU and proctitis cases, fewer in the NPT-group received empiric treatment compared to clinic-controls (29·4% [95%CI:24·3-34·9%] vs 83·8% [95%CI:79·2-87·8%], p<0·001), resulting in more NPT-group cases appropriately treated (STI-specific drug/no drug appropriately; 80·9% [95%CI:76·0-85·1%] vs 33·0% [95%CI:27·7-38·6%], p<0·001) and fewer mistreated (incorrect drug/treated but pathogen-negative; 17·8% [13·7-22·6%] vs 54·9% [40·3-68·9%], p<0·001). Of 173/276 in the NPT-group with an STI who responded regarding partner-notification, 95·4% notified all/some partners; 85·9% notified them <24hrs of the STI-specific result. InterpretationNear-to-patient-testing significantly improved antibiotic use and a high proportion of individuals rapidly notified partners of STI-specific results, highlighting the broad benefits of timely diagnostic strategies for STIs in clinical decision making and partner notification. FundingARC ITRP Hub-grant; NHMRC

Normospermic Patients Infected With Ureaplasma parvum: Role of Dysregulated miR-122-5p, miR-34c-5, and miR-141-3p.

Ureaplasma parvum (UP) is a causative agent of non-gonococcal urethritis, involved in the pathogenesis of prostatitis and epididymitis, and it could impair human fertility. Although UP infection is a frequent cause of male infertility the study evidence assessing their prevalence and the association in patients with infertility is still scarce. The molecular processes leading to defects in spermatozoa quality are not completely investigated. MicroRNAs (miRNAs) have been extensively reported as gene regulatory molecules on post-transcriptional levels involved in various biological processes such as gametogenesis, embryogenesis, and the quality of sperm, oocyte, and embryos. Therefore, the study design was to demonstrate that miRNAs in body fluids like sperm could be utilized as non-invasive diagnostic biomarkers for pathological and physiological conditions such as infertility. A post-hoc bioinformatics analysis was carried out to predict the pathways modulated by the miRNAs dysregulated in the differently motile spermatozoa. Here it is shown that normospermic patients infected by UP had spermatozoa with increased quantity of superoxide anions, reduced expression of miR-122-5p, miR-34c-5, and increased miR-141-3p compared with non-infected normospermic patients. This corresponded to a reduction of sperm motility in normospermic infected patients compared with normospermic non-infected ones. A target gene prediction presumed that an essential role of these miRNAs resided in the regulation of lipid kinase activity, accounting for the changes in the constitution of spermatozoa membrane lipids caused by UP. Altogether, the data underline the influence of UP on epigenetic mechanisms regulating spermatozoa motility.

Overview of the Prevalence of Patients with Sexually Transmitted Infections at Dr RM Djoelham Binjai Hospital in the Period of January 2019-July 2023

Sexually Transmitted Infections (STIs) are infections transmitted through vaginal, anal/anal, and oral/oral intercourse. In Indonesia, this disease continues to grow in the community and can cause death. Types of STIs include gonorrhea, non-specific urethritis, syphilis, mole ulcer, inguinal granuloma, lymphogranuloma venereum, bacterial vaginosis, genital herpes, condyloma acuminata, HIV (Human Immunodeficiency Virus), trichomoniasis and candidiasis vulvovaginitis. The retrospective :descriptive method with a cross sectional design and data collection means is secondary data of new patients diagnosed with STIs and recorded in the Medical Record Sciences of Dr RM Djoelham General Hospital for the period January 2019-July 2023. Results : the prevalence of STI patients, from the diagnosis of the most gonorrhea 27 patients (42.9%), age group 17-25 years 27 patients (42.9%), male sex 39 patients (61.9%) and employment is not ASN (State Civil Apparatus) as many as 20 patients (31.7%) and education is high school graduation / equivalent 29 patients (21.4%). Conclusion: counseling and education are routinely provided to all levels of society. so that this STI is controlled so that morbidity and mortality rates decrease.

Pharmacodynamics of zoliflodacin plus doxycycline combination therapy against Neisseria gonorrhoeae in a gonococcal hollow-fiber infection model.

Antimicrobial resistance in the sexually transmitted bacterium Neisseria gonorrhoeae is compromising the management and control of gonorrhea globally. Optimized use and enhanced stewardship of current antimicrobials and development of novel antimicrobials are imperative. The first in class zoliflodacin (spiropyrimidinetrione, DNA Gyrase B inhibitor) is a promising novel antimicrobial in late-stage clinical development for gonorrhea treatment, i.e., the phase III randomized controlled clinical trial (ClinicalTrials.gov Identifier: NCT03959527) was recently finalized, and zoliflodacin showed non-inferiority compared to the recommended ceftriaxone plus azithromycin dual therapy. Doxycycline, the first-line treatment for chlamydia and empiric treatment for non-gonococcal urethritis, will be frequently given together with zoliflodacin because gonorrhea and chlamydia coinfections are common. In a previous static in vitro study, it was indicated that doxycycline/tetracycline inhibited the gonococcal killing of zoliflodacin in 6-h time-kill curve analysis. In this study, our dynamic in vitro hollow-fiber infection model (HFIM) was used to investigate combination therapies with zoliflodacin and doxycycline. Dose-range experiments using the three gonococcal strains WHO F (susceptible to relevant therapeutic antimicrobials), WHO X (extensively drug-resistant, including ceftriaxone-resistant; zoliflodacin-susceptible), and SE600/18 (zoliflodacin-susceptible strain with GyrB S467N substitution) were conducted simulating combination therapy with a single oral dose of zoliflodacin 0.5-4g combined with a doxycycline daily oral dose of 200mg administered as 100mg twice a day, for 7days (standard dose for chlamydia treatment). Comparing combination therapy of zoliflodacin (0.5-4g single dose) plus doxycycline (200mg divided into 100mg twice a day orally, for 7days) to zoliflodacin monotherapy (0.5-4g single dose) showed that combination therapy was slightly more effective than monotherapy in the killing of N. gonorrhoeae and suppressing emergence of zoliflodacin resistance. Accordingly, WHO F was eradicated by only 0.5g single dose of zoliflodacin in combination with doxycycline, and WHO X and SE600/18 were both eradicated by a 2g single dose of zoliflodacin in combination with doxycycline; no zoliflodacin-resistant populations occurred during the 7-day experiment when using this zoliflodacin dose. When using suboptimal (0.5-1g) zoliflodacin doses together with doxycycline, gonococcal mutants with increased zoliflodacin MICs, due to GyrB D429N and the novel GyrB T472P, emerged, but both the mutants had an impaired biofitness. The present study shows the high efficacy of zoliflodacin plus doxycycline combination therapy using a dynamic HFIM that more accurately and comprehensively simulate gonococcal infection and their treatment, i.e., compared to static in vitro models, such as short-time checkerboard experiments or time-kill curve analysis. Based on our dynamic in vitro HFIM work, zoliflodacin plus doxycycline for the treatment of both gonorrhea and chlamydia can be an effective combination.

Urethritis-spectrum of pathogens, diagnostics and treatment

Abroad spectrum of bacteria, fungi, protozoa and viruses can cause urethritis. In particular, N.gonorrhoeae, C.trachomatis, M.genitalium and T.vaginalis are the focus of diagnostic considerations as classic pathogens associated with sexually transmitted infections (STI). Astep-by-step procedure is needed to make adefinitive diagnosis. Microscopy with a staining preparation provides an initial differentiation between gonoccocal and non-gonococcal urethritis in symptomatic men as apoint-of-care (POC) test. Nucleic acid amplification technology (NAAT) is used for specific and sensitive pathogen detection and, as amultiplex diagnostic test, offers the possibility of detecting several organisms from the same sample. In addition, compared to culture, no vital organisms are required, which allows the collection and use of more diverse and less invasive biological samples (e.g. first stream urine in men or vaginal swabs). Susceptibility testing by culture remains essential for N.gonorrhoeae as resistance is emerging. The treatment of urethritis depends on the suspected or proven pathogen according to the current guidelines. Treatment failure can be caused by many factors (coinfection, lack of therapy adherence, reinfection or resistance of the pathogen) and requires arepeated diagnostic and therapeutic procedure and differentiated approach.

A qualitative study exploring experiences of the safetxt digital health intervention to reduce sexually transmitted infections in young people in the UK

ObjectivesPeople aged 16–24 are more likely than other age groups to acquire sexually transmitted infections (STI). Safetxt was a randomised controlled trial of a theory-based digital health intervention to reduce...

Chlamydia trachomatis genotypes in sexually transmitted disease clinic attendees in Colombo, Sri Lanka

Introduction: Chlamydia trachomatis (CT) is the most common cause of non-gonococcal urethritis. Prevalence of CT infections in Sri Lanka was 17.1% in females in 2015. Real-time PCR for diagnostic testing of CT was started in 2015 but screening programmes have not been initiated due to the high cost. The aim of this study was to determine the genotypes of CT in patients from Colombo, since genotypic distribution in Sri Lanka is not known.Methods: Stored first void urine samples (n=208) from a previous study on patients attending two clinics in Colombo were used. Samples that were positive by Artus C. trachomatis Plus RG Real time PCR (Qiagen) were retested with a nested PCR described previously, which generated 15 ompA sequences suitable for standard sequencing.Results: Genovars E (n=6; 40%), F (n=5; 33.3%), G (n=3; 20%) and H (n=1; 6.7%) were identified.Conclusions: As seen in most parts of the world, genovar E and F were the most commonly detected CT genovars among patients in Colombo.

Development of a Rapid and High-Throughput Multiplex Real-Time PCR Assay for Mycoplasma hominis and Ureaplasma Species

Bacterial commensals of the human genitourinary tract, Mycoplasma hominis and Ureaplasma species (parvum and urealyticum) can be sexually transmitted, and may cause nongonococcal urethritis, pelvic inflammatory disease, and infertility. Mycoplasma hominis and Ureaplasma species may also cause severe invasive infections in immunocompromised patients. Current culture-based methods for Mycoplasma/Ureaplasma identification are costly and laborious, with a turnaround time between 1 and 2 weeks. We developed a high-throughput, real-time multiplex PCR assay for the rapid detection of M. hominis and Ureaplasma species in urine, genital swab, body fluid, and tissue. In total, 282 specimens were tested by PCR and compared with historic culture results; a molecular reference method was used to moderate discrepancies. Overall result agreement was 99% for M. hominis (97% positive percentage agreement and 100% negative percentage agreement) and 96% for Ureaplasma species (96% positive percentage agreement and 97% negative percentage agreement). Specimen stability was validated for up to 7 days at room temperature. This multiplex molecular assay was designed for implementation in a high-complexity clinical microbiology laboratory. With this method, >90 samples can be tested in one run, with a turnaround time of 4 to 5 hours from specimen extraction to reporting of results. This PCR test is also more labor effective and cheaper than the conventional culture-based test, thus improving laboratory efficiency and alleviating labor shortages.

Serum and Urethral Antibody Response in Mycoplasma genitalium -Infected Men.

The antibody response to Mycoplasma genitalium in serum and urethral secretions of men with nongonococcal urethritis was examined longitudinally. Serum and urethral antibodies reacted primarily with the MgpB and MgpC adhesins. Serum antibodies persisted throughout follow-up, whereas urethral antibodies waned despite organism persistence. Declining antibodies may facilitate chronic infection.

(034) Secnidazole for Trichomoniasis: Results from a Clinical Trial with Women and a Systematic Literature Review for Men

Abstract Introduction Trichomoniasis is the most prevalent non-viral sexually transmitted infection (STI) in the world, affecting ~4.1% of women and ~1.3% of men aged 40–59 in the United States. Women with T. vaginalis are at 2- to 3-fold increased risk for acquiring human immunodeficiency virus (HIV). Trichomoniasis is also associated with vaginitis, pelvic inflammatory disease, post-hysterectomy cuff cellulitis and other STIs. In addition, it can cause infertility and increase a woman’s risk for adverse pregnancy outcomes including preterm birth, premature rupture of membranes, and delivery of low birthweight infants. In men, trichomoniasis is associated with non-gonococcal urethritis, although men are frequently asymptomatic and may seek treatment only after knowing that their female partners are infected. Current CDC treatment guidelines recommend concurrent treatment of both partners to prevent transmission and reinfection. Objectives To evaluate the efficacy and tolerability of secnidazole in women and men with trichomoniasis. Because logistical and statistical considerations precluded the inclusion of men in the clinical trial, we conducted a systematic literature search (19May2020) to identify other studies of secnidazole in male patients with trichomoniasis. Secnidazole is FDA-approved for the treatment of bacterial vaginosis in women. Methods In a randomized clinical trial (RCT), women with a diagnosis of trichomoniasis received a single, oral dose of secnidazole 2g or placebo at baseline (Visit 1). At Visit 2 (days 6–12), they were evaluated for test of cure (TOC) and switched to the opposite treatment. The primary endpoint was microbiological cure (ie, InPouch™ culture negative for T. vaginalis) at the TOC visit. Adverse events (AEs) were monitored. A trained research associate used ProQuest Dialog™ to search BIOSIS Previews, EMBASE, and MEDLINE using search terms related to secnidazole, clinical trials, men/males, and trichomoniasis. Results For the RCT, 147 women were enrolled; the modified intent-to-treat population included 131 randomized patients. Cure rates were 92.2% and 1.5% for secnidazole and placebo (P&amp;lt;0.001). The most commonly reported AEs were vulvovaginal candidiasis (2.7%) and nausea (2.7%). No serious AEs were reported. For the systematic review, 4 studies were identified, which included 211 men who received secnidazole for treatment of trichomoniasis. In one study that included only men (n=85), the cure rate 5 days after treatment was 100%. In the 3 studies that included men and women, cure rates were 92–97%. For studies reporting AEs, the most common were nausea (4–9%), and dyspepsia (0.5–1.1%). Pharmacokinetics data showed no clinically meaningful differences in secnidazole exposure (Cmax, AUC) between men and women; however, the mean (±SD) half-life (hours) was longer in men versus women (20.2 hours [±3.1] vs. 14.3 hours [±1.3]). Conclusions In a RCT of women with trichomoniasis, cure rates were significantly higher after single-dose secnidazole versus placebo, and tolerability profiles were comparable between treatment groups. In a systematic literature review of secnidazole for trichomoniasis in men, cure rates, tolerability, and pharmacokinetics data were comparable to those in women. Disclosure Yes - Lupin Pharmaceuticals, Inc. Industry initiated, executed and funded study – Yes.