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Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis

imageAbstract: Multidrug-resistant Neisseria gonorrhoeae infections have been declared 1 of the top 3 urgent threats to public health. Approaches to combat resistance include targeted therapy with antibiotics previously thought to be ineffective, made possible by rapid molecular assays to predict susceptibility. Previous studies have associated the gyrase A (gyrA) gene of N. gonorrhoeae with in vitro resistance to ciprofloxacin. We conducted a systematic review of studies comparing N. gonorrhoeae gyrA genotype results with conventional antimicrobial susceptibility testing results. We identified 31 studies meeting inclusion criteria, among which 7 different loci for mutations in the gyrA gene were identified, from 16 countries between the years of 1996 and 2016. We then performed a meta-analysis among those studies stratifying by use of real-time polymerase chain reaction (PCR) or non–real-time PCR technique, and compared the summary receiver operating characteristic curves between the 2 PCR methods. Among studies using real-time PCR, the pooled estimate of sensitivity and specificity of gyrA genotype results for the prediction of N. gonorrhoeae susceptibility to ciprofloxacin were 98.2% (95% confidence interval [CI], 96.5–99.1%) and 98.6% (95% CI, 97.0–99.3%), respectively. The summary operating characteristic curves for studies using real-time PCR techniques were well separated from those using non–real-time PCR techniques, with only slight overlap in the CIs, suggesting that real-time PCR techniques were a more accurate approach. GyrA genotype testing is a novel approach to combating the emergence of multidrug-resistant N. gonorrhoeae and is a sensitive and specific method to predict in vitro ciprofloxacin susceptibility. 05/01/2017 01:00 AM
 

Adverse Birth Outcomes and Maternal Neisseria gonorrhoeae Infection: A Population-Based Cohort Study in Washington State

imageBackground: Neisseria gonorrhoeae (gonorrhea) remains an important cause of reproductive and obstetric complications. There has been limited population-based research to evaluate the association between maternal gonorrhea and adverse birth outcomes. Methods: A population-based retrospective cohort study was conducted of women with singleton pregnancies in Washington State from 2003 to 2014 using linked birth certificate and birth hospitalization discharge data. The exposed cohort consisted of women with gonorrhea diagnosed during pregnancy. The unexposed group, defined as pregnant women without gonorrhea, was selected by frequency-matching by birth year in a 4:1 ratio. Logistic regression was used to determine crude and adjusted odds ratios (OR) for the association of maternal gonorrhea and adverse birth outcomes. Results: Women with gonorrhea during pregnancy (N = 819) were more likely to be younger, black, single, less educated, multiparous, and smokers compared with women without gonorrhea (N = 3276). Maternal gonorrhea was significantly associated with a 40% increased odds (adjusted OR, 1.4; 95% confidence interval [CI], 1.0–1.8) of low birth weight infants compared with women without gonorrhea when adjusted for marital and smoking status. Maternal gonorrhea was associated with a 60% increased odds (OR, 1.6; 95% CI, 1.3–2.0) of small for gestational age infants compared with women without gonorrhea. Conclusions: This analysis showed that pregnant women with gonorrhea were more likely to have low birth weight infants, consistent with prior literature, and provided new evidence that maternal gonorrhea is associated with small for gestational age infants. These findings support increased public health efforts to prevent, identify, and treat gonorrhea infection during pregnancy. 05/01/2017 01:00 AM
 

Keep Screening! Maternal Gonococcal Infection and Adverse Birth Outcomes

No abstract available 05/01/2017 01:00 AM
 

The Case for Extragenital Screening of Chlamydia trachomatis and Neisseria gonorrhoeae in the College Health Setting

imageBackground: Although the Centers for Disease Control and Prevention does not recommend routine oropharyngeal and anorectal screening for Chlamydia trachomatis and Neisseria gonorrhoeae in the general population, they do recommend it for men who have sex with men. However, risk-based extragenital screening of men may not have been adopted at all college health centers, and existing research has not focused on the college population. Methods: We examined health records of men at a college health center in a large urban university over 6 years to evaluate effectiveness of C. trachomatis and N. gonorrhoeae screening. We also evaluated the proportion of C. trachomatis and N. gonorrhoeae infections that would have been missed if risk-based extragenital screening were not performed. Decisions to screen at extragenital sites were based on patient-reported risk behavior. Results: For 4093 male college students screened, 7.6% of the screening visits used extragenital screening in response to self-reported risk behaviors. The case positivity rate for C. trachomatis was 3.1% with urogenital-only screening and 3.7% with risk-prompted extragenital screening. The case positivity rate for N. gonorrhoeae was 0.7% with urogenital-only screening and 3.3% with risk-prompted extragenital screening. If the college health center had relied solely on urogenital screening rather than risk-based extragenital screening, 26.4% of C. trachomatis infections and 63.2% of N. gonorrhoeae infections would have been missed. Conclusions: One out of four C. trachomatis infections and 2 of 3 N. gonorrhoeae infections would have been missed without extragenital screening in this analysis of college men. This study reinforces Centers for Disease Control and Prevention recommendations for risk-based extragenital screening and is the first report to focus on college men. Because guidelines exist only for men, future studies should focus on extragenital screening in college women to build evidence for another group of patients that may benefit from this practice, given the high risk in young adults. 05/01/2017 01:00 AM
 

The Use of Mathematical Models of Chlamydia Transmission to Address Public Health Policy Questions: A Systematic Review

imageBackground: Mathematical models of chlamydia transmission can help inform disease control policy decisions when direct empirical evaluation of alternatives is impractical. We reviewed published chlamydia models to understand the range of approaches used for policy analyses and how the studies have responded to developments in the field. Methods: We performed a literature review by searching Medline and Google Scholar (up to October 2015) to identify publications describing dynamic chlamydia transmission models used to address public health policy questions. We extracted information on modeling methodology, interventions, and key findings. Results: We identified 47 publications (including two model comparison studies), which reported collectively on 29 distinct mathematical models. Nine models were individual-based, and 20 were deterministic compartmental models. The earliest studies evaluated the benefits of national-level screening programs and predicted potentially large benefits from increased screening. Subsequent trials and further modeling analyses suggested the impact might have been overestimated. Partner notification has been increasingly evaluated in mathematical modeling, whereas behavioral interventions have received relatively limited attention. Conclusions: Our review provides an overview of chlamydia transmission models and gives a perspective on how mathematical modeling has responded to increasing empirical evidence and addressed policy questions related to prevention of chlamydia infection and sequelae. 05/01/2017 01:00 AM
 

Mobile Phone and Internet Use Mostly for Sex-Seeking and Associations With Sexually Transmitted Infections and Sample Characteristics Among Black/African American and Hispanic/Latino Men Who Have Sex With Men in 3 US Cities

imageBackground: Men who have sex with men (MSM) have a relatively high prevalence of sexually transmitted infections (STIs). This study examines the association of self-reported STIs and use of mobile phones and/or computer-based Internet to meet sexual partners among black and Hispanic/Latino MSM in the United States. Methods: Black and Hispanic/Latino MSM (N = 853) were recruited from 3 US cities (Chicago, IL; Kansas City, MO; and Fort Lauderdale, FL) via online and community outreach. Men completed a computer-assisted, self-interview assessment on demographics, use of mobile phones and computer-based Internet for sex-seeking, sexual risk behavior, and self-reported bacterial STIs in the past year. Multivariable logistic regression was used to model independent associations of STIs and use of these technologies to meet sexual partners. Results: Twenty-three percent of the sample reported having an STI in the past year; 29% reported using a mobile phone and 28% a computer-based Internet mostly for sex-seeking; and 22% reported using both. Number of male sexual partners (past year) was associated with any STI (adjusted odds ratio, 1.03; 95% confidence interval, 1.01–1.06). Adjusting for human immunodeficiency virus status, number of male sexual partners (past year), and demographic variables, men who reported use of both mobile phones and computer-based Internet for sex-seeking had increased odds of reporting an STI (adjusted odds ratio, 2.59; 95% confidence interval, 1.75–3.83), as well as with separate reports of chlamydia, gonorrhea, and syphilis (P’s < 0.05). Conclusions: Enhanced community education regarding STI prevention, testing, and treatment options are necessary among this subpopulation of MSM who may benefit from messaging via Internet and mobile phone application sites. 05/01/2017 01:00 AM
 

Designing Human Immunodeficiency Virus Counselling and Testing Services to Maximize Uptake Among High School Learners in South Africa: What Matters?

imageBackground: Increasing human immunodeficiency virus (HIV) testing in South Africa is vital for the HIV response. Targeting young people is important as they become sexually active and because HIV risk rapidly increases as youth enter their 20s. This study aims to increase the understanding of high school learners' preferences regarding the characteristics of HIV testing service delivery models and to inform policy makers and implementers regarding potential barriers to and facilitators of HIV testing. Methods: An attitudinal survey was used to examine HIV testing preferences among 248 high school learners in KwaZulu-Natal. Statistical tests were used to identify the most favored characteristics of testing service delivery models and examine key differences in preferences based on demographic characteristics and testing history. Results: Most learners were found to prefer testing offered at a clinic on a Saturday (43%), using a finger prick test (59%), conducted by a doctor (61%) who also provides individual counselling (60%). Shorter testing times were preferred, as well as a monetary incentive to cover any associated expenses. Time, location, the type of test, and who conducts the test were most important. However, stratified analysis suggests that preferences diverge, particularly around gender, grade, but also sexual history and previous testing experience. Conclusions: Human immunodeficiency virus testing services can be improved in line with preferences, but there is no single optimal design that caters to the preferences of all learners. It is unlikely that a “one-size-fits-all” approach will be effective to reach HIV testing targets. A range of options may be required to maximize coverage. 05/01/2017 01:00 AM
 

Assessing the Performance of 3 Human Immunodeficiency Virus Incidence Risk Scores in a Cohort of Black and White Men Who Have Sex With Men in the South

imageBackground: Risk scores have been developed to identify men at high risk of human immunodeficiency virus (HIV) seroconversion. These scores can be used to more efficiently allocate public health prevention resources, such as pre-exposure prophylaxis. However, the published scores were developed with data sets that comprise predominantly white men who have sex with men (MSM) collected several years prior and recruited from a limited geographic area. Thus, it is unclear how well these scores perform in men of different races or ethnicities or men in different geographic regions. Methods: We assessed the predictive ability of 3 published scores to predict HIV seroconversion in a cohort of black and white MSM in Atlanta, GA. Questionnaire data from the baseline study visit were used to derive individual scores for each participant. We assessed the discriminatory ability of each risk score to predict HIV seroconversion over 2 years of follow-up. Results: The predictive ability of each score was low among all MSM and lower among black men compared to white men. Each score had lower sensitivity to predict seroconversion among black MSM compared to white MSM and low area under the curve values for the receiver operating characteristic curve indicating poor discriminatory ability. Conclusions: Reliance on the currently available risk scores will result in misclassification of high proportions of MSM, especially black MSM, in terms of HIV risk, leading to missed opportunities for HIV prevention services. 05/01/2017 01:00 AM