Predominance of High-Level Tetracycline-Resistant Neisseria gonorrhoeae in Kenya: Implications for Global Implementation of Doxycycline Postexposure Prophylaxis for Prevention of Sexually Transmitted Infections

Soge, Olusegun O.; Issema, Rodal; Bukusi, Elizabeth A.; Baeten, Jared M.; Mujugira, Andrew; Celum, Connie; McClelland, R. Scott; Stewart, Jenell

doi:10.1097/olq.0000000000001769

Cited by 12 publications

(6 citation statements)

References 22 publications

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“…The prevalence of the tetM gene in certain populations is significant, as observed by a study involving 50 endocervical swab specimen's positive for N. gonorrhoeae from women in Kenya. In this study, the American-type plasmid-mediated tetM gene was identified in 96% of the samples, suggesting that DoxyPEP for STI prevention might have limited efficacy against gonorrhea in sub-Saharan Africa 42 .…”

Section: Antimicrobial Resistance and Microbiome Disruptionmentioning

confidence: 76%

Doxycycline prophylaxis for bacterial sexually transmitted infections: evaluating effectiveness, risks, and challenges

Monteiro,

Borges-da-Costa

2024

PJDV

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The increase in sexually transmitted infections (STIs) in Europe and the USA, especially among men who have sex with men (MSM) and transgender women (TW), has raised concerns and prompted the exploration of doxycycline prophylaxis as a potential intervention. Doxycycline prophylaxis can be administered either as a daily 100 mg dose (DoxyPrEP) or a single 200 mg dose post-sexual activity (DoxyPEP). Recent clinical trials, primarily focusing on higher-risk groups, have shown reductions of approximately 70% in syphilis and chlamydia infections and conflicting results regarding gonorrhea infection (up to 50%). Despite these advancements, the effectiveness of doxycycline prophylaxis among women has not been established and this strategy raises concerns about community acceptability, adverse events, safety, antimicrobial resistance, microbiome disruption, and cost-effectiveness. Ongoing clinical trials and agent-based models aim to address these uncertainties to predict the impact on a population level and on specific groups. This review aims to assess the existing data of doxycycline STI prophylaxis, identify knowledge gaps, and synthesize existing literature and guidelines about the current recommendations.

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Section: Antimicrobial Resistance and Microbiome Disruptionmentioning

confidence: 76%

Doxycycline prophylaxis for bacterial sexually transmitted infections: evaluating effectiveness, risks, and challenges

Monteiro,

Borges-da-Costa

2024

PJDV

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“…We emphasize that the long-term impacts of doxyPEP on the N. gonorrhoeae population in the United States are unknown, as lineages may acquire new resistance alleles and introduction of lineages from other geographic regions is possible. 11,12 For example, a recent study found that strains encoding tetM are highly prevalent among women in Kenya, 13 and phylogenetic analysis of our global dataset identified several lineages with high-level tetracycline resistance not represented among GISP isolates (Supplementary Figure 2).…”

mentioning

confidence: 89%

A genomic perspective on the near-term impact of doxycycline post-exposure prophylaxis onNeisseria gonorrhoeaeantimicrobial resistance

Mortimer

Grad

2023

Preprint

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Post-exposure prophylaxis with doxycycline (doxyPEP) is being introduced to prevent bacterial sexually transmitted infections. Pre-existing tetracycline resistance inNeisseria gonorrhoeaelimits doxyPEP effectiveness against gonorrhea, and selection for tetracycline resistant lineages may influence prevalence of resistance to other antimicrobials via selection for multi-drug resistant strains. Using genomic and antimicrobial susceptibility data from 5,644 clinical isolates ofN. gonorrhoeae, we assessed the near-term impact of doxyPEP onN. gonorrhoeaeantimicrobial resistance. We found that the impact on antimicrobial resistance is likely to be influenced by the strength of selection for plasmid-encoded and chromosomally-encoded tetracycline resistance, as isolates with high-level, plasmid-encoded resistance had lower minimum inhibitory concentrations to other antimicrobials compared to isolates with low-level tetracycline resistance. The impact of doxyPEP may differ across demographic groups and geographic regions within the United States due to variation in pre-existing tetracycline resistance.

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“…Its efficacy can be attributed to its broad-spectrum activity and its proficient tissue penetration. 136,137 Macrolides: Azithromycin, a macrolide antibiotic, is commonly administered as a single-dose regimen for the treatment of Chlamydia trachomatis and Mycoplasma genitalium infections. Owing to its extended half-life and pronounced anti-inflammatory characteristics, it stands as a preferred choice for managing these infections.…”

Section: Antibiotics In the Treatment Of Reproductive Tract Infectionsmentioning

confidence: 99%

Fertility treatment-induced oxidative stress and reproductive disorders

Liew,

Dutta,

Sengupta

2024

JIST

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Rising global infertility rates have amplified the dependence on assisted reproductive technologies (ARTs) for conception. This necessitates a thorough examination of fertility drug effects on reproductive health. This review explores the impact of fertility drugs, such as antioxidants, antibiotics, and antiinflammatory agents, on oxidative stress (OS), reproductive irregularities, and treatment outcomes. While antioxidants can potentially improve reproductive outcomes by modulating OS, excessive consumption can lead to the 'antioxidant paradox' -a delicate balance between external antioxidant intake, OS reduction, and its effects on fertility. Moreover, some antibiotics and anti-inflammatory drugs can intensify OS, possibly exacerbating reproductive issues. The article emphasizes the complex relationship between fertility drugs and ovarian stimulation, highlighting the need for personalized treatments and careful weighing of the advantages and drawbacks of fertility interventions. This review emphasizes the intricate relationship among fertility drugs, ovarian stimulation, and semen quality, advocating for personalized treatment plans and a thorough assessment of the benefits and drawbacks of fertility interventions. The comprehensive insights obtained from this extensive review aims to aid clinical protocols and support informed decisions in reproductive medicine.

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Predominance of High-Level Tetracycline-Resistant Neisseria gonorrhoeae in Kenya: Implications for Global Implementation of Doxycycline Postexposure Prophylaxis for Prevention of Sexually Transmitted Infections

Abstract: Most archived Neisseria gonorrhoeae samples collected from 2008 to 2012 from Kenyan women had tet(M)-encoding high-level tetracycline resistance; this could reduce the efficacy of doxycycline postexposure prophylaxis against N. gonorrhoeae.

Cited by 12 publications

References 22 publications

Doxycycline prophylaxis for bacterial sexually transmitted infections: evaluating effectiveness, risks, and challenges

Doxycycline prophylaxis for bacterial sexually transmitted infections: evaluating effectiveness, risks, and challenges

A genomic perspective on the near-term impact of doxycycline post-exposure prophylaxis onNeisseria gonorrhoeaeantimicrobial resistance

Fertility treatment-induced oxidative stress and reproductive disorders

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