Sexually Transmitted Infections Pathogens Research Articles

Mpox (Monkeypox) Virus and Its Co-Infection with HIV, Sexually Transmitted Infections, or Bacterial Superinfections: Double Whammy or a New Prime Culprit?

Epidemiologic studies have established that mpox (formerly known as monkeypox) outbreaks worldwide in 2022–2023, due to Clade IIb mpox virus (MPXV), disproportionately affected gay, bisexual, and other men who have sex with men. More than 35% and 40% of the mpox cases suffer from co-infection with HIV and sexually transmitted infections (STIs) (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus), respectively. Bacterial superinfection can also occur. Co-infection of MPXV and other infectious agents may enhance disease severity, deteriorate outcomes, elongate the recovery process, and potentially contribute to the morbidity and mortality of the ensuing diseases. However, the interplays between MPXV and HIV, bacteria, other STI pathogens and host cells are poorly studied. There are many open questions regarding the impact of co-infections with HIV, STIs, or bacterial superinfections on the diagnosis and treatment of MPXV infections, including clinical and laboratory-confirmed mpox diagnosis, suboptimal treatment effectiveness, and induction of antiviral drug resistance. In this review article, we will discuss the progress and knowledge gaps in MPXV biology, antiviral therapy, pathogenesis of human MPXV and its co-infection with HIV, STIs, or bacterial superinfections, and the impact of the co-infections on the diagnosis and treatment of mpox disease. This review not only sheds light on the MPXV infection and co-infection of other etiologies but also calls for more research on MPXV life cycles and the molecular mechanisms of pathogenesis of co-infection of MPXV and other infectious agents, as well as research and development of a novel multiplex molecular testing panel for the detection of MPXV and other STI co-infections.

Sexually Transmitted Infections in Adolescents and Young Adults: A Cross Section of Public Health.

Sexually transmitted infections (STIs) can be caused by a number of microorganisms that vary greatly in size, life cycle, clinical manifestations, and sensitivity to available treatments. Transmission of STIs can occur during unprotected (or condomless) sexual contact and through the exchange of body fluids during any type of activity. The prevalence of sexually transmitted diseases remains high in the world, despite diagnostic and therapeutic improvements for these infectious diseases that rapidly eliminate the contagiousness of patients. Our study determines the prevalence of STI pathogens in adolescents and young adults in the population of the Province of Macerata (Italy). We will analyze data in correspondence to age and gender, and we will compare our results to international studies. We analyzed STI test results from the entire database of a Provincial Health Authority for the period 2021-2022. The samples came from the following age groups: 0-12, 13-18, 19-25, and 26-35 from 2021 to 2022. The results came from vaginal and cervical swabs (for females); urethral, rectal, and pharyngeal swabs (for males and females); and seminal fluid (for males) for the following infections: HPV, Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasmas, Gardnerella, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum. The results also came from blood tests for HIV, hepatitis C, hepatitis B, and Treponema pallidum (TPHA, VDRL). In addition, we examined results from urine tests for chlamydia, Neisseria gonorrhoeae, trichomonas, and Treponema pallidum. The literature for other countries reports the need for comprehensive, culturally and developmentally sensitive care to address sexuality-related issues in adolescents and young adults, a need that also applies to Italy. These data will be of great importance in adopting evidence-based STI control programs in Marche Region. This study could, indeed, represent a landmark for public health officials and professionals, with the aim of promoting adolescents' access to sexual health services to receive useful information, strengthening preventive measures in younger age groups, and designing sexual education programs.

Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa.

In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to determine the prevalence of STI pathogens at rectal and pharyngeal sites, syphilis seroprevalence, and associated risk factors among a selection of high-risk MSM without symptomatic urethritis attending a men's health clinic in Johannesburg, South Africa. A cross-sectional study was conducted in 2022. Enrolled clients self-reported demographic, sexual behavioral risks, and clinical information. Client or clinician-collected rectal and pharyngeal swabs were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. C. trachomatis-positive rectal samples were reflex tested for lymphogranuloma venereum. Blood specimens were screened for syphilis. Univariate and multivariate regression models were used to determine factors independently associated with the presence of an extragenital STI or syphilis. Among the 97 participants (median age, 29 years), 24.7% had an extragenital STI and 9.4% had high nontreponemal antibody titers (rapid plasma reagin ≥1:16). Rectal STIs were detected in 26.4% participants: N. gonorrhoeae (14.3%), C. trachomatis (9.9%), and M. genitalium (5.5%). Pharyngeal STIs were less prevalent (4.1%). Overall, the prevalence of any STI was 41%. Sex under the influence of drugs (adjusted odds ratio, 4.94; 95% confidence interval, 1.56-15.69) and engaging in condomless receptive anal intercourse with a casual partner (adjusted odds ratio, 8.36; 95% confidence interval, 1.73-40.28) were independent risk factors for having an extragenital STI. The high burden of extragenital STIs and active syphilis in asymptomatic MSM underscores the importance of routine etiological screening in this key population, as the syndromic approach would not enable detection or treatment of these infections.

The impact of sexually transmitted infections on the reproductive health in adolescent girls

Sexually transmitted infections (STIs), remained relevant to this day, are a huge problem for the global health system. The most common bacterial causative agents of STIs are Chlamydia trachomatis and Neisseria gonorrhoeae, which cause numerous urogenital symptoms and can also affect the organs of the female reproductive system, and the course of pregnancy. The group of viral STIs includes a large number of pathogens, among which the hepatitis B virus is of particular interest. The greatest problem in relation to STIs is the antibiotic resistance of pathogens, which greatly complicates the treatment of patients. The ability to solve this problem lies in the creation of fast and accurate methods for diagnosing STI pathogens. An important role in the struggle against STIs can be played by sexual education of adolescents, giving them an idea of the risks and consequences that sexual contact can lead to.
 The search for works for inclusion in this review was carried out using the PubMed, Scopus, Google Scholar databases. The keywords used in the search were “Chlamydia trachomatis”, “Neisseria gonorrhoeae”, “hepatitis B”, “reproductive outcomes” and “sex education”.
 The search input identified four hundred fifty three reports. During the review of abstracts and full texts of papers, 58 reports were selected, among which there were 5 systematic reviews and 18 clinical studies.
 Both chlamydial infection and gonorrhea are associated with the development of infertility, where the tubal factor plays a key role, and pregnancy complications. The use of rapid tests, which provide fast and accurate results in the diagnosis of STIs, shortens the period from the patient’s admission to the appointment of the correct treatment regimen, which speeds up the recovery process for patients. Data on hepatitis B are mixed, but it is associated with numerous complications of pregnancy, while no association with infertility was observed. Sex education can reduce the number of STIs and unwanted pregnancies, which has a positive effect on the physical and emotional state of adolescents.

Antibacterial Activity of Selected Fruit Juices against Multidrug-Resistant Bacterial Pathogens Involved in Urinary Tract and Sexually Transmitted Infections among Tribal Women in Madhya Pradesh, India.

The aim of this study was to evaluate the effect of fruit juices on Multi-Drug Resistant (MDR) bacterial pathogens involved in Urinary Tract Infections (UTIs) and Sexually Transmitted Infections (STIs) among tribal women in the district Anuppur, Madhya Pradesh, India. Fresh juices of lemon (Citrus limon), amla/Indian gooseberry (Phyllanthus emblica), pineapple (Ananas comosus), mosambi/sweet lime (Citrus limetta), orange (Citrus sinensis), kiwi (Actinidia deliciosa), and pomegranate (Punica granatum) fruits were evaluated for in vitro antibacterial activity against bacterial pathogens involved in UITs and STIs among tribal women. Physico-chemical analysis of fresh fruits was also carried out by measuring the pH, moisture, protein, fat, crude fibre, carbohydrate, and ascorbic acid content. Lemon and amla juice showed better antibacterial activity against the pathogens as compared to other juices. MIC results fruit juices against UTIs and STIs pathogens vary depending on the specific pathogen and juice chemical constituents. The physico-chemical analysis showed that the moisture content was highest in mosambi (90%), followed by orange (87%). Ascorbic acid content was found highest in amla (540 mg/100 g), followed by kiwi (90.3 mg/100 g). Pomegranate showed highest concentration of carbohydrate (15.28 g/100 g), fat (1.28 g/100 g), and protein (1.65 g/100 g). Lemon juice had lowest pH of 2.20, followed by amla 2.67. The lemon juice showed highest antibacterial activity against MDR bacterial pathogens involved in UTIs and STIs among tribal women in district Anuppur, Madhya Pradesh, India. The low pH of lemon may be responsible for its high antibacterial activity as compared to other juices.

Modern probiotics in the treatment of sexually transmitted infections. From the problem to its solution

This article is a review of current scientific publications that are devoted to the problem of sexually transmitted infections (STIs) and the importance of probiotics in their treatment. The article also analyzes the data of regulatory documents of the World Health Organization and statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine and the State Statistics Service of Ukraine, which highlight the problem of the prevalence of STIs in the world and in Ukraine.Sexually transmitted infections have a serious negative impact on sexual and reproductive health worldwide. In the absence of treatment, they can have serious outcomes, including neurological and cardiovascular diseases, infertility, ectopic pregnancy, increased risk of infection with the human immunodeficiency virus. One of the serious factors which prevent the reduction of STDs increased rate in the world is the drug resistance for these infections. Infections caused by resistant strains of microorganisms are characterized by a more severe course, more often require hospitalization of the patient, increase the duration of the patient’s stay in the hospital, require the use of combined antibiotic therapy with the administration of reserve drugs.According to the results of scientific studies, Bacillus probiotics are an alternative for solving problems related to STIs and their outcomes. The innovative combination of the components of the drugs that contain the SirionProbioProtection probiotic formula helps to overcome such a problem as the resistance of STI pathogens to etiotropic antibiotic therapy. The use of alternative methods of exposure to STIs and their consequences add to success in providing obstetric and gynecological services.

B-248 Rapid PCR Method for Sexually Transmitted Infection (STI) Multiplex Testing Based on Novel Microfluidic Chip

Abstract Background qPCR is being widely used for STI (Sexually Transmitted Infection) testing as the most sensitive and accurate diagnostic method. Genesystem developed a novel qPCR-based diagnostic platform, called Genoplex chip, which enables the simultaneous detection of multiple sexually transmitted pathogens with a single test. Genoplex chip realized high multiplex detection (up to 14 pathogens by a single pipetting), making it easy and fast to process more targets than conventional qPCR. In this study, Genoplex chip was used for diagnosing sexually transmitted infection(STI) to verify the usefulness in diagnostics. Methods Genoplex chip is a flat-shaped microfluidic chip where target-specific primers and probes are prelabeled free from contamination. This chip has 1 well for negative control and 9 connected wells for target detection. By a single pipetting into the inlet hole, samples are loaded and spread into every well of this microfluidic chip since all the wells are connected to each other. We completed performance validation of this new chip with STI diagnosis. Primers and probes for identifying STI pathogens are prelabeled on the inner surface of the Genoplex chip. We can detect and identify 12 major pathogens of STI, which are Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG), Trichomanas vaginalis (TV), Ureaplasma parvum (UP), Gardnerella vaginalis (GV), Candida albicans (CA), Treponema pallidum (TP), Herpes simplex virus type 1 (HSV1) and Herpes simplex virus type 2 (HSV2) by using these probes. Amplification of the target genes was performed by Genechecker UF-300 PCR System. Results We estimated 50 copies of 12 STI pathogens by qPCR process in 40 min. We also confirmed that there was no contamination and no interference in 12 targets. Conclusion With Genoplex chip, various targets can be quantitatively detected in one sample and more accurate results can be provided in efficient way. This novel system gives an opportunity to overcome the limitations of current molecular diagnostics by innovative multiplex detection technology. Therefore, it is expected that the Genoplex chip system will attract attention in the molecular diagnostics market.

B-250 Simultaneous Detection of Twelve Pathogens of Sexually Transmitted Infections Using an Innovative All-in-One PCR Instrument

Abstract Background Every day, nearly 1 million people are infected with sexually transmitted infections (STI) that are transmitted through sexual contact. Early diagnosis and treatment of STI are critical in reducing their transmission, and PCR is the most sensitive method among diagnostic tests. To address this need, we have developed a new STI Real-Time PCR-based diagnostic kit, which is capable of detecting twelve STI pathogens simultaneously in up to 94 specimens at once. To evaluate the analytical performance, we used the ExistationTM FA System, which automatically performs from decapping primary sample tubes followed by nucleic acid extraction to PCR analysis within 2 h. Twelve (12) pathogens of STI are described below: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV), Mycoplasma hominis (MH), Herpes simplex virus type1 (HSV1), Herpes simplex virus type2 (HSV2), Ureaplasma parvum (UP), Treponema pallidum (TP), Candida albicans (CA), Gardnerella vaginalis (GV), from male urine and female vaginal swabs. Methods The analytical performance evaluation was performed using the new STI diagnostic kit to detect twelve pathogens of STI. The analysis was performed using culture fluids (CT, NG, UU, MG, TV, MH, HSV1, HSV2, UP, CA, GV; ATCC, USA) and TP genomic DNA (Vircell, Spain), which were spiked in urine and vaginal swab media. The limit of detection (LoD) was determined by testing multiple replicates of serial dilutions of the spiked sample around the expected LoD. The LoD was defined as the lowest dilution at which the assay detected ≥95% of 24 replicates. To evaluate precision, each sample was tested 2 times a day in duplicate per run for 5 days. To assess cross-reactivity, twenty-two bacteria and viruses related to STI were used. Results The LoD was determined 60.26 IFU/mL, 35.48 cfu/mL, 467.74 copy/mL, 45.71 cell/mL, 19.5 cells/mL, 316.23 copy/mL, 199.53 TCID50/mL, 13.18 TCID50/mL, 588.84 copy/mL, 993.25 copy/ml, 660.69 copy/mL, 389.05 copy/mL in Urine and 47.86 IFU/mL, 27.54 cfu/mL, 363.08 copy/mL, 38.90 cell/mL, 15.14 cells/mL, 245.47 copy/mL, 181.97 TCID50/mL, 8.71 TCID50/mL, 575.44 copy/mL, 741.31 copy/ml, 524.81 copy/mL, 288.40 copy/mL in vaginal swab media for CT, NG, UU, MG, TV, MH, HSV1, HSV2, UP, CA, GV, and TP, respectively. For repeatability assay, the 12 STI samples showed similar Ct value in each run, with all standard deviation (SD) were less than 2.0. In terms of cross-reactivity, there were no positive results obtained from testing bacteria and viruses using the new STI diagnostic kit. Conclusions The ExistationTM FA system is highly convenient platform for Real-Time PCR-based diagnostics. Particularly, our new STI diagnostic kit provides an accurate and efficient method for simultaneous detection of 12 STI pathogens.

Prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis among patients suspected of sexually transmitted infections in Evercare Hospital Dhaka during 2015 to 2022

Background Sexually Transmitted Infections (STIs) are often diagnosed by clinical symptoms and signs due to lack of sensitive laboratory methods. Most of the time pathogens are not identified and antibiotics are used empirically. The purpose of our study is to find out the STI pathogens detected by sensitive multiplex PCR done routinely in a tertiary care hospital.
 Materials and methods A total of 578 samples were tested from February 2015 to July 2022. Urine, prostatic secretion, urethral swab, high vaginal swab, semen, throat swabs were collected from symptomatic patients for the routine test. DNA was extracted and Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis were screened by using CE-IVD approved multiplex Real Time PCR kit.
 Result Out of 578 cases, 76 (13.15%) were positive for at least one pathogen and 5 were co-infections. Out of 76 positive cases, Chlamydia trachomatis was found 41 (53.9%), Neisseria gonorrhoeae was 13 (17.1%), Mycoplasma genitalium was 12 (15.8%), and Trichomonas vaginalis 5 (6.6%) and co-infections with Neisseria gonorrhoeae and Chlamydia trachomatis was 5 (6.6%). Positivity rate was remarkably higher in male (77.6%) than female (22.4%) and predominant age group was 19-40 years.
 Conclusion The predominant STIs pathogen found in our cohort is Chlamydia trachomatis followed by Neisseria gonorrhoeae. Multiplex PCR is a wide-ranging diagnostic method for the detection of multiple pathogens simultaneously which allows early and accurate diagnosis of STIs.
 Pulse Volume 12-14 2020-2022 p.34-39

A retrospective study on the status of sexually transmitted co-infections in university hospitals in Korea from 2017 to 2021.

The prevalence of sexually transmitted infections (STIs) remains high worldwide. Despite the worldwide increase in the incidence of STIs every year, there are few reports on the frequency of STIs with different pathogens according to age and gender. Accordingly, a study was conducted to determine trends in co-infection with STIs by age and gender in Cheonan, South Korea from 2017 to 2021. To identify trends by age or sex in co-infection of STIs in this region. A retrospective study was conducted on clinical samples examined at Dankook University Hospital from January 2017 to November 2021. A total of 3297 specimens were collected from patients visiting Dankook University Hospital (Cheonan, Korea), and statistical analysis was performed on patients ranging in age from 1 day to 93 years. Multiplex polymerase chain reaction, the most efficient method to diagnose a bacterial infection, was performed using an MJ Research PTC-200 Thermal Cycler (Marshall Scientific, Richmond, VA, USA) and a Seeplex STD Detection Kit (Seegene, Seoul, Republic of Korea). The co-infection rate with STI pathogens was analyzed according to age and sex. Of the 3297 clinical samples, 1017 (30.9%) tested positive for sexually transmitted pathogens, ranging from one to six co-infections. Analysis of the co-infection rate by age revealed that the average age gradually decreased as the total number of co-infection pathogens increased. The co-infection percentage and age distribution of STIs differed according to sex. Co-infection was more prevalent in female patients. Furthermore, co-infection in male patients occurred frequently in the 30-39-year-old group, while those in female patients occurred in the 20-29- and 30-39-year-old groups. Our statistical analysis showed that STI co-infections were more common among younger than older people. Therefore, it helps in recognizing STIs at a young age and provides possible indicator data to prevent STIs at a young age. In addition, further research is needed on co-infection in other regions.

Aetiology of genital ulcer disease and associated factors among Mthatha public clinic attendees.

Genital ulcer disease (GUD) is a sexually transmitted disease characterised by ulcerating lesions. Despite the introduction of sexually transmitted infections (STIs) syndromic management approach into primary healthcare in South Africa (SA) in 1995, the prevalence of STIs in South Africa remains high. The study investigated the aetiology of GUD and factors influencing it among public community health centre (CHC) attendees in the Eastern Cape, South Africa. A total of 105 participants were recruited among individuals presenting with GUD from three CHCs located in the Eastern Cape Province, South Africa. Blood and genital ulcer samples were collected from consented participants. Blood samples with suitable sera were tested for human immunodeficiency virus (HIV) and syphilis. Herpes simplex virus types 1/2 (HSV-1/2), Chlamydia trachomatis, Treponema pallidum, Haemophilus ducreyi and Klebsiella granulomatis were detected in nucleic acid extracted from genital ulcer specimens. Out of the 98 samples with suitable sera, 55.1% and 8.2% were HIV and syphilis seropositive, respectively. Ulcerating STI pathogens were detected in 31.4% of the study participants. Herpes simplex virus type 2 was the most detected pathogen (16.2%) followed by Chlamydia trachomatis (10.5%), HSV-1 (8.6%), Haemophilus ducreyi (8.6%) and Treponema pallidum (6.7%). Multiple pathogens were detected in 13.3% of participants. Detected multiple ulcerating pathogens were common among HIV-positives (p = 0.016). Molecular methods for diagnosing pathogens have the potential to improve the management of GUD. Data generated from this study would contribute to the limited data on GUD in the Eastern Cape Province. Further research with a larger sample size is recommended. Data generated would contribute to the limited data on GUD in the Eastern Cape province, South Africa.

Qualitative and Quantitative Detection of Multiple Sexually Transmitted Infection Pathogens Reveals Distinct Associations with Cervicitis and Vaginitis.

Many diverse pathogens have been discovered from reproductive-tract infections, but the relationship between the presence and abundance of particular pathogen species and disease manifestations is poorly defined. The present work examined the association of multiple common pathogens causing sexually transmitted infections (STIs) with cervicitis and vaginitis. The presence and abundance of 15 STI pathogens and the genotypes of human papillomavirus were determined in a cohort of 944 women that included 159 cervicitis patients, 207 vaginitis patients, and 578 healthy controls. Logistic regression and random forest models were constructed and validated in a separate cohort of 420 women comprising 52 cervicitis patients, 109 vaginitis patients, and 259 healthy controls. The frequency of individual STI pathogen species varied among the symptomatic patients and healthy controls. Abundance determination was necessary for most pathogens that were associated with the studied diseases. STI pathogens were more commonly associated with cervicitis than with vaginitis. Pathogen identification- and quantification-based diagnosis was observed for cervicitis with high sensitivity and specificity, but for vaginitis, the assay results would need to be combined with results of other diagnostic tests to firmly establish the pathogen-disease correlation. Integrated qualitative and quantitative detection of a selected panel of common STI pathogens can reveal their association with cervicitis and vaginitis. STI pathogen identification and quantification can be used to diagnose cervicitis and also help improve correct diagnosis of vaginitis. IMPORTANCE Scarce information exists with regard to whether STI pathogens can be defined as valid microbiological predictive markers for the diagnosis of cervicitis and vaginitis. We therefore conducted this study to assess the presence and abundance of a wide range of STI pathogens among patients having these two diseases and healthy controls as well. High sensitivity and specificity were observed for cervicitis by pathogen identification- and quantification-based diagnosis. In contrast, the assay results obtained for vaginitis would need to be combined with test results obtained by other diagnostic methods to decisively establish the pathogen-disease correlation. Simultaneous qualitative and quantitative detection of a selected panel of common STI pathogens and further coupling with machine learning models is worthwhile for establishing pathogen-based diagnosis of gynecological inflammations, which could be of great value in guiding the rational use of antimicrobials to control the spread of STIs.

Etiological Surveillance of Vaginal Discharge Syndrome in South Africa: 2019 to 2020.

The syndromic management of vaginal discharge syndrome (VDS) is challenging because of the prevalence of mixed infection with sexually transmitted infection (STI) pathogens and non-STI causes, such as bacterial vaginosis and candidiasis (CA). We aimed to determine the relative prevalence of VDS etiologies in women presenting to sentinel primary health care clinics in South Africa. Secondary objectives were to ascertain the predictive value of speculum findings for the presence of STI pathogens and the proportion of women presenting with clinical features of CA who had identifiable yeast on vaginal smear microscopy. Consecutive, consenting women with complaints of abnormal vaginal discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg. A total of 364 women were enrolled at 3 sentinel sites. Bacterial vaginosis was the most common cause of VDS (163 of 361 [45.2%]; 95% confidence interval [CI], 40.1%-50.3%); however, a significant proportion had STI coinfection (71 of 163 [43.6%]; 95% CI, 35.8%-51.5%). The predominant STI etiology was Chlamydia trachomatis (73 [20.2%]; 95% CI, 16.4%-24.7%). An abnormal speculum finding had poor predictive value for STIs, and Gram stain microscopy showed yeast in only 37.2% of vaginal smears from women with CA symptoms. Bacterial vaginosis is the predominant cause of VDS in South Africa; however, STI coinfection is common. Clinical findings are poorly predictive of STI etiologies or candidiasis; therefore, a rapid and accurate STI point-of-care test would be useful in optimizing VDS management.

Comparison of Different Self-Sampling Devices for Molecular Detection of Human Papillomavirus (HPV) and Other Sexually Transmitted Infections (STIs): A Pilot Study

Background: Cervical cancer is the fourth most common cancer in women, and it is well known that high-risk human papillomavirus (hrHPV) infections are the necessary carcinogenic factors for the development of cervical tumors. Moreover, the interaction between HPV and other sexually transmitted infections (STIs) may increase the risk of cancer progression. Self-sampling has been demonstrated to represent a valid and well-accepted alternative, favoring women’s participation in screening programs. This study aimed to investigate the use of FLOQSwabs® (FS) as compared to two other vaginal self-collection devices for the detection of hrHPV and other sexually transmitted infections. Methods: Cervical and vaginal self-samples were collected, using two different combinations of vaginal self-sampling devices, from 40 women referred to colposcopy for a documented abnormal Pap smear. All samples were tested for hrHPV and seven STI pathogens using two commercial molecular assays. Results: Data on hrHPV detection from the first group of women showed an almost perfect agreement (kappa: 0.89) between cervical vs. FS vaginal self-samples, and a substantial agreement (kappa: 0.79) between cervical and HerSwab™ (HS) samples. In the second group of women, an almost perfect agreement (kappa: 0.90) was demonstrated in the detection of hrHPV between cervical samples vs. FS, and a moderate agreement (kappa: 0.60) for cervical vs. Evalyn®Brush (EB) self-collected samples. STI detections showed a very good agreement (kappa: 0.89 and kappa: 1.00) both among FS vs. HS and FS vs. EB, respectively. There was no statistically significant difference between the different devices used. The most frequently detected hrHPV genotypes in the studied population were HPV 16, 31, 35, 51, and 56; whilst the most frequently identified STI pathogens were Ureaplasma parvum and Mycoplasma hominis. Overall, investigated women did not report any discomfort in using the different vaginal self-collection devices. Conclusion: Evaluation of the three different vaginal self-collection devices confirmed their overall good acceptability by the studied population, as well as a similar agreement for hrHPV detection as compared to cervical samples. Our study indicated that the use of self-collected samples offers an alternative strategy to improve women’s participation in cervical cancer screening programs, but also underlined the importance of evaluating the concordance in hrHPV detection of collection devices in combination with the molecular hrHPV assay.

Recency of HIV infection, antiretroviral therapy use and viral loads among symptomatic sexually transmitted infection service attendees in South Africa

Background. Better integration of HIV and sexually transmitted infection (STI) prevention and treatment services is needed to accelerate progress towards the goal of zero new HIV infections. Objectives. To describe HIV positivity, antiretroviral therapy (ART) use, viral suppression and recency of HIV infection among symptomatic STI service attendees at two primary care clinics in South Africa. Methods. In a cross-sectional study, male and female STI service attendees presenting with symptoms consistent with STI syndromes were enrolled following informed consent. An interviewer-administered questionnaire was completed and appropriate genital and blood specimens were collected for STI testing and HIV biomarker measurements including recency of infection and antiretroviral (ARV) drug levels. Descriptive statistics were used to describe enrolled attendees, and to determine the proportion of attendees who were HIV-positive, recently infected, taking ART and virally suppressed. HIV-positive attendees with detectable ARVs were considered to be on ART, while those with viral loads (VLs) ≤200 copies/mL were considered virally suppressed. Results. Of 451 symptomatic attendees whose data were analysed, 93 (20.6%) were HIV-positive, with 15/93 (16.1%) being recently infected. Recent infection was independently associated with genital ulcer disease at presentation, especially ulcers with no detectable STI pathogens. Among the 78 (83.9%) with long-term infection, only 30 (38.5%) were on ART, with 23/30 (76.7%) virally suppressed. Conclusions. In a population at risk of HIV transmission, there was a high burden of recent infection and unsuppressed VLs. Incorporating pre-exposure prophylaxis, ART initiation and adherence support into STI services will be necessary for progress towards eliminating HIV transmission

Association of bacterial vaginosis with the most common sexually transmitted infections

Introduction/Objective. Bacterial vaginosis (BV) is the most common vaginal dysbiosis that increases the possibility of getting sexually transmitted infections (STI). The objectives of this research are to examine association between BV and the nine most common causes of STIs (Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma spp., Trichomonas vaginalis, Neisseria gonorrhoeae, high-risk human papilloma viruses and herpes simplex virus types 1 and 2) and to determine if the presence of BV increases the probability of coinfection with any of the STI microorganisms. Methods. This study involved 235 patients of reproductive age. One sample swab each was collected for vaginal and cervical testing. The vaginal swabs were used for the detection of BV by the reverse transcription polymerase chain reaction (RT-PCR) test. The cervical swabs were used for the detection of the most common STIs, which were tested by four different multiplex RT-PCR tests. Pearson?s ?2 test and Fisher?s probability test were used for statistical analysis of the results. Results. Comparison of the total number of STIs and the condition of the vaginal flora has shown that STIs are the most common in patients with BV (80; 89.9%). Women with BV have a higher frequency of infections with Ureaplasma spp. and M. hominis, 71 (78.9%) and 50 (44.4%), respectively. The presence of detected STI pathogens and relation with the state of vaginal flora indicate that mono infections are present most often in patients with normal flora (51; 42.1%), while coinfections are mostly present in BV patients (50; 55.6%). Conclusion. This study has confirmed the association of M. hominis and Ureaplasma spp. with BV as well as an association of coinfections with this dysbiosis. Better understanding of the association between various STIs and the status of vaginal flora is necessary to enable better diagnosis, prevention of diseases and women?s health protection.

AAUS guidelines 2021 revision sexually transmitted infection (STIs) diagnostic strategy for STI

AAUS guidelines 2021 revision sexually transmitted infection (STIs) diagnostic strategy for STI

Epidemiological and clinical trends of sexually transmitted infections. Literature review

This article presents modern data on epidemiological trends, pathogenesis, and mechanisms of persistence and acquisition of antibiotic resistance of the most common sexually transmitted infections (STIs): chlamydial infection, gonorrhea, trichomoniasis. Data on the frequency of chlamydial infection, gonorrhea, trichomoniasis detection in the DILA medical laboratory in the period from 2018–2020 are also presented.Analysis of epidemiological and microbiological studies indicates a significant increase in the STIs incidence in countries with high economic development and the need for constant revision of diagnostic and treatment approaches, based on new data on the pathogens physiology, mechanisms and levels of antibiotic resistance, possibilities of laboratory diagnostics. Analysis of the DILA data on the chlamydial infection, gonorrhea, trichomoniasis detection is coinciding with the world trends in the increase of their prevalence. At the same time, the analysis of the DILA data demonstrated an interesting clinical phenomenon as a presence of 2 STIs peaks in women: the first at 21–25 years and the second at 51–55 years old.Clinical manifestations of STIs are increasingly losing their typical features today. This indicates the need for a laboratory search for all common STIs in the region. Knowledge of the etiological factor of the inflammatory process allows choosing the correct antibiotic therapy and preventing the further development of antibiotic resistance. This article presents data on the various methods of STIs laboratory tests. Regular visits of women for cervical cancer screening are a good opportunity to screen for STIs. The ability to detect STIs in biomaterial in liquid cytology makes this option more accessible.Thus, since vaccines against common bacterial and protozoa STIs pathogens have not yet been developed, the promotion of hygiene of sexual behavior and timely detection of infected persons during examination or screening with subsequent etiopathogenetic treatment are the basis of the STIs control systems and their consequences prevention.

Establishment and performance evaluation of multiplex PCR-dipstick DNA chromatography assay for simultaneous diagnosis of four sexually transmitted pathogens

IntroductionRapid, sensitive, and specific diagnostic methods are indispensable for sexually transmitted infections (STIs). In this study, a multiplex PCR-dipstick DNA chromatography assay for diagnosis of four STI pathogens, namely Neisseria gonorrhoeae (N. gonorrhoeae), Mycoplasma hominis (M. hominis), Ureaplasma (U. urealyticum and U. parvum), and Chlamydia trachomatis (C. trachomatis), was established and evaluated. MethodsBased on the hybridization of probes and interaction between streptavidin and biotin, PCR products were visualized through hybridization of specific probes and enzymatic color generation. The sensitivity and specificity of all four pathogens were evaluated. Clinical performance of the test was evaluated using 295 specimens, and comparisons among results were determined via culture or colloidal gold assay. ResultsNo cross-reactions were observed, confirming the high specificity of this method. The limit of detection (LOD) of the four STI pathogens was 100 copies/μL. The sensitivity between PCR-dipstick DNA chromatography and culture or colloidal gold assay ranged from 84.6% to 100%. The specificity was between 93.5% and 96.6%, positive predictive value ranged from 53.6% to 86.7%, negative predictive value was over 98.3%, kappa value ranged from 0.676 to 0.864 (Cohen's kappa coefficient test), and the agreement rate was over 93.5%. ConclusionIn conclusion, PCR-dipstick DNA chromatography serves as a rapid, sensitive, and specific method for simultaneous diagnosis of four STI pathogens.

"Sex in the Time of COVID": Clinical Guidelines for Sexually Transmitted Disease Management in an Era of Social Distancing.

"Sex in the Time of COVID": Clinical Guidelines for Sexually Transmitted Disease Management in an Era of Social Distancing.