trimethoprim--sulfamethoxazole-drug-combination and Sexually-Transmitted-Diseases

Topics: AIDS-Related Opportunistic Infections; Diagnosis, Differential; Granuloma Inguinale; Humans; Male; Sexually Transmitted Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Bacteria; Bacterial Infections; Child; Drug Combinations; Drug Resistance; Female; Humans; Kinetics; Male; Plasmids; Protozoan Infections; Sexually Transmitted Diseases; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In urban Australia, the burden of shigellosis is either in returning travelers from shigellosis-endemic regions or in men who have sex with men (MSM). Here, we combine genomic data with comprehensive epidemiological data on sexual exposure and travel to describe the spread of multidrug-resistant Shigella lineages.. A population-level study of all cultured Shigella isolates in the state of Victoria, Australia, was undertaken from 1 January 2016 through 31 March 2018. Antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatic analyses of 545 Shigella isolates were performed at the Microbiological Diagnostic Unit Public Health Laboratory. Risk factor data on travel and sexual exposure were collected through enhanced surveillance forms or by interviews.. Rates of antimicrobial resistance were high, with 17.6% (95/541) and 50.6% (274/541) resistance to ciprofloxacin and azithromycin, respectively. There were strong associations between antimicrobial resistance, phylogeny, and epidemiology. Specifically, 2 major MSM-associated lineages were identified: a Shigellasonnei lineage (n = 159) and a Shigella flexneri 2a lineage (n = 105). Of concern, 147/159 (92.4%) of isolates within the S. sonnei MSM-associated lineage harbored mutations associated with reduced susceptibility to recommended oral antimicrobials: namely, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Long-read sequencing demonstrated global dissemination of multidrug-resistant plasmids across Shigella species and lineages, but predominantly associated with MSM isolates.. Our contemporary data highlight the ongoing public health threat posed by resistant Shigella, both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Child; Ciprofloxacin; Computational Biology; Drug Resistance, Bacterial; Female; Homosexuality, Male; Humans; Male; Microbial Sensitivity Tests; Mutation; Plasmids; Risk Factors; Sexually Transmitted Diseases; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination; Victoria; Whole Genome Sequencing; Young Adult

The 12th World AIDS Conference in Geneva provided evidence that STD prophylaxis/treatment does not reduce HIV transmission. New guidelines for antiretroviral therapy in terms of when to treat and when to change are also presented. Research findings and practical applications are also provided for the following areas: HIV therapeutic monitoring, immune reconstitution, prevention, TMP-SMX prophylaxis, lipodystrophy, serum lipid changes, and diabetes.

Topics: AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Diabetes Complications; Drug Therapy, Combination; HIV Infections; Humans; Lipids; Lipodystrophy; Managed Care Programs; Practice Guidelines as Topic; Sexually Transmitted Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda; Viral Load

Topics: Adult; Drug Combinations; Enterobacteriaceae Infections; Homosexuality; Humans; Male; Penile Diseases; Sexually Transmitted Diseases; Shigella flexneri; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination