Coinfection With Chlamydial and Gonorrheal Infection Among US Adults With Early Syphilis

Dionne-Odom, Jodie; Workowski, Kimberly A.; Perlowski, Charlotte; Taylor, Stephanie N.; Mayer, Kenneth H.; McNeil, Candice J; Hamill, Matthew M; Dombrowski, Julia C.; Batteiger, Teresa A.; Seña, Arlene C.; Wiesenfeld, Harold C.; Newman, Lori M.; Hook, Edward W.

doi:10.1097/olq.0000000000001605

Cited by 3 publications

(2 citation statements)

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“…Microbiology services and laboratories respond in many cases to requests for STI studies in which they do not know the clinical symptoms, so multiplex platforms that cover numerous possibilities are used, without being able in many cases to optimize the available resources. However, this strategy has brought as a benefit the diagnosis of coinfections, in clear increase in recent years [ 67 , 68 ].…”

Section: What Are the Problems Of Etiological Diagnosis Of Sti?mentioning

confidence: 99%

Sexually transmitted infections in Spain: Current status

Del Romero,

Moreno Guillén,

Rodríguez-Artalejo

et al. 2023

Rev Esp Quimioter

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Sexually Transmitted Infections (STI) are a major public health problem. The problems inherent to their diagnosis, treatment and prevention have to do not only with their nature, but also with organizational issues and overlapping competencies of the different health authorities in Spain. The real situation of STI in Spain, at present, is poorly known. For this reason, the Scientific Committee on COVID and Emerging Pathogens of the Illustrious Official College of Physicians of Madrid (ICOMEM) has formulated a series of questions on this subject which were distributed, not only among the members of the Committee, but also among experts outside it. The central health authorities provide very high and increasing figures for gonococcal infection, syphilis, Chlamydia trachomatis infection and lymphogranuloma venereum (LGV). Both HIV infection and Monkeypox are two important STI caused by viruses in our environment, to which it should be added, mainly, Herpes simplex virus (HSV) and Human papillomavirus (HPV) infections. Emerging microorganisms such as Mycoplasma genitalium pose not only pathogenic challenges but also therapeutic problems, as in the case of N. gonohrroeae. The pathways that patients with suspected STI follow until they are adequately diagnosed and treated are not well known in Spain. Experts understand that this problem is fundamentally managed in public health institutions, and that Primary Care and Hospital Emergency Services, together with some institutions that deal monographically with this problem, are the recipients of most of these patients. One of the most serious difficulties of STI lies in the availability of the microbiological tests necessary for their diagnosis, particularly in this era of outsourcing of microbiology services. Added to this is the increased cost of implementing the latest generation of molecular techniques and the difficulties of transporting samples. It is clear that STI are not diseases to which the entire population is equally exposed and it is necessary to have a better knowledge of the risk groups where to focus the necessary interventions adapted to their characteristics. It should not be forgotten that STI are also a problem in the pediatric age group and that their presence can be a marker of sexual abuse with all that this implies in terms of health care and medicolegal activity. Finally, STI are infections that are associated with a high cost of care for which we have very little information. The possibility of expanding the automatic performance of laboratory tests for STI surveillance through laboratory routines is encountering ethical and legal problems that are not always easy to solve. Spain has created a ministerial area of specific attention to STI and there are plans to improve the diagnosis, treatment and prevention of these problems, but we still lack the necessary evidence on their impact. We cannot forget that these are diseases that transcend the individual and constitute a Public Health problem.

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Section: What Are the Problems Of Etiological Diagnosis Of Sti?mentioning

confidence: 99%

Sexually transmitted infections in Spain: Current status

Del Romero,

Moreno Guillén,

Rodríguez-Artalejo

et al. 2023

Rev Esp Quimioter

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“…Among sexually active, HIV-positive MSM, we previously have found high rates of C. trachomatis and/or N. gonorrhoeae coinfections in those with recent hepatitis C virus (HCV) infection (50%) and incident syphilis (36%) (4). A sub-study nested in a randomized controlled trial evaluating the treatment response of early syphilis also demonstrated a high rate of sexually transmitted coinfections (27%) in patients with early syphilis, including chlamydial infection, gonorrhea, and non-gonococcal urethritis (9). With the advances in polymerase-chain-reaction (PCR) technology, multiplex PCR assay can amplify several different DNA sequences simultaneously and enable rapid detection of sexually transmitted coinfections.…”

Section: Introductionmentioning

confidence: 97%

Sexually transmitted coinfections among at-risk HIV-positive MSM: implications for optimal preemptive treatment

Wu,

Lin,

et al. 2024

Front. Med.

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BackgroundConcurrent sexually transmitted infections (STIs) are common in sexually active populations. We aimed to estimate the prevalence and coinfection rates of bacterial STIs among sexually active, HIV-positive men who have sex with men (MSM), and to assess the potential benefits of different combination treatment regimens in managing concurrent bacterial STIs.MethodsFrom September 2021 to September 2023, HIV-positive MSM underwent STI testing when they had symptoms suggestive of STIs or recently acquired hepatitis C virus (HCV) infection or early syphilis. The oral rinse, rectal swab, and urethral swab specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma spp., Ureaplasma spp., and Trichomonas vaginalis with the use of multiplex real-time polymerase-chain-reaction assays. The estimated coinfection rates were used to evaluate the benefits of different combination treatment regimens for managing coinfections.ResultsDuring the study period, 535 participants (median age, 37 years; and CD4 count, 615 cells/mm3) were enrolled. On their first visits, at least one bacterial pathogen was detected in 57.9% and concomitant bacterial infections were found in 32.9% of the participants. The most commonly identified pathogen was U. urealyticum (36.3%), followed by C. trachomatis (22.8%), and N. gonorrhoeae (19.8%). The factors associated with any bacterial STIs included older age (per 1-year increase, adjusted odds ratio [AOR], 0.97; 95% confidence interval [CI], 0.95–1.00), early syphilis (AOR, 1.87; 95% CI, 1.22–2.84), and having more than 5 sex partners in the preceding 3 months (AOR, 2.08, 95% CI, 1.07–4.06). A combination therapy of benzathine penicillin G with a 7-day course of doxycycline could simultaneously treat 27.1% of C. trachomatis coinfections in participants with early syphilis, while a combination therapy of ceftriaxone with doxycycline could simultaneously treat 40.6% of chlamydial coinfections in participants with gonorrhea.ConclusionBacterial STIs were prevalent and concomitant infections were not uncommon among sexually active, HIV-positive MSM, supporting regular screening for bacterial STIs. The effectiveness of preemptive use of doxycycline as combination therapy for concurrent STIs warrants more investigations.

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HIV and Syphilis Co-Screening Rates Among Patients Tested for Gonorrhea and Chlamydia at a Large, Urban Hospital

Almirol,

Meyer,

Mason

et al. 2024

Sexual Trans Dis

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Background Current guidelines recommend concurrent screening for HIV and syphilis with gonorrhea and chlamydia testing. Despite this, many patients are still not screened. This study describes trends in demographics and encounter locations associated with missed opportunities for HIV and syphilis screening among patients tested for gonorrhea or chlamydia. Methods This is a retrospective review of all encounters with gonorrhea or chlamydia testing in a large, urban hospital from November 1, 2018, to July 31, 2021. Demographic information and encounter location were extracted from the medical record. Encounters were categorized as including both HIV and syphilis (complete) screening, HIV screening only, or neither. Logistic regression was used to examine associations between demographics and encounter location and likelihood of complete screening. Results There were 42,791 patient encounters, of which 40.2% had complete screening, 6.2% had concurrent HIV screening only, and 53.6% had no concurrent screening. Increasing age, female sex (aOR 0.58, 95% CI 0.55-0.61, p < 0.01), non-Hispanic Black race (aOR 0.52, 95% CI 0.49-0.55, p < 0.01), and public insurance (aOR 0.72, 95% CI 0.69-0.75, p < 0.01) were associated with lower odds of complete screening. Emergency department (ED) encounters were most likely to include complete screening (aOR 3.11, 95% CI 2.96-3.26, p < 0.01). Conclusions This study found a large proportion of patients tested for gonorrhea and chlamydia had missed opportunities for HIV and syphilis screening. Significant demographic disparities were found. The ED was most likely to screen for both HIV and syphilis. Decreasing disparities in screening could have profound effects on the HIV and syphilis epidemics.

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Coinfection With Chlamydial and Gonorrheal Infection Among US Adults With Early Syphilis

Abstract: Among 865 US adults with early syphilis, more than 1 in 4 had bacterial STI coinfection. This study supports routine mucosal screening for chlamydia and gonorrhea in people with syphilis.

Cited by 3 publications

References 20 publications

Sexually transmitted infections in Spain: Current status

Sexually transmitted infections in Spain: Current status

Sexually transmitted coinfections among at-risk HIV-positive MSM: implications for optimal preemptive treatment

HIV and Syphilis Co-Screening Rates Among Patients Tested for Gonorrhea and Chlamydia at a Large, Urban Hospital

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