zithromax and Sexually-Transmitted-Diseases

Mycoplasma genitalium was first isolated from the urethral swabs of two symptomatic men with urethritis in 1980. It is a sexually transmitted bacterium associated with a number of urogenital conditions in women like cervicitis, endometritis, pelvic inflammatory disease, infertility, and susceptibility to human immunodeficiency virus (HIV). However, M. genitalium may also act like a stealth pathogen at female reproductive tract, giving no symptoms. Its prevalence varies between different groups, with the average being 0.5-10% in the general population and 20-40% in women with sexually transmitted infections. The recommended treatment of this infection is azithromycin as a single 1-g dose. However, in recent years, macrolide resistance has increased which is significantly lowering the cure rate, being less than 50% in some studies. New treatment regimens need to be investigated due to increasing drug resistance. The discussion and suggestion of an algorithm for management of this infection is the highlight of this paper.

Topics: Anti-Bacterial Agents; Asymptomatic Infections; Azithromycin; Drug Resistance, Bacterial; Female; Humans; Macrolides; Mycoplasma genitalium; Mycoplasma Infections; Pelvic Inflammatory Disease; Prevalence; Reproductive Tract Infections; Sexually Transmitted Diseases; Urethritis

Urethritis prevalence in Europe changed in the last years due to both the increase of migratory streams from North Africa and the more frequent exposition of males to relevant risk factors. Owing to these reasons, urethritis treatment should be optimized by accurate microbiological investigations to avoid the risk of persistence, recurrence, or reinfection.. The aim of this systematic review is to optimize the treatments for urethritis and investigate the applicability of nucleic acid amplification test (NAAT) as the primary microbiological investigation.. A literature search in Medline, Cochrane, and Google Scholar databases was conducted up to June 2018. Subject headings were selected as follows: Urethritis OR gonococcal urethritis OR non-gonococcal urethritis AND Antibiotics OR Recurrence. A total of 528 abstracts were identified and selected. Finally, 12 full-text articles were selected for a qualitative synthesis. The Preferred Reported Items for Systematic Reviews and Meta-Analyses statement was used to perform an accurate research checklist and report.. Empirical treatments are no more recommended, although a broad spectrum of antibiotic therapy may be initiated while awaiting the results from pathogens' microbiological characterization. First-line treatment for gonococcal urethritis consists of a single dose of ceftriaxone/azithromycin combined therapy. Specific therapies should be initiated for nongonococcal urethritis according to each single pathogen involved in the infection process. Owing to this reason, NAAT is mandatory in the clinical approach to the disease, although the Gram stain of urethral discharge or smear remains applicable for some less frequent nongonococcal urethritis. Moreover, the urethritis "modern view" also includes noninfectious etiologies that occurred after traumas or injection of irritating compounds. Sexual abstinence of at least 7 d should be observed from the start of treatment to avoid reinfection, while sexual partners should evenly be treated.. The treatment of urethritis implies accurate determination of pathogens involved in the infection process by NAAT with subsequent appropriate antibiotic therapy, thus avoiding the risk of antibiotic resistance and overuse of antibiotics indicated for empirical treatments. The population exposed to relevant risk factors should be adequately informed about the increased risk of developing infections and motivated toward the intensive use of condoms during sexual intercourses.. Urethritis is a sexually transmitted disease generally characterized by urethral discharge or other symptoms such as itching, tingling, and apparent difficulties in having a regular urinary flow. Microbiological investigations are mandatory to obtain satisfactory results from the treatment. Multiple antibiotic treatments are often necessary due to the high risk of multiple pathogens responsible for the disease. Similarly, sexual partners should be investigated and treated in the same way. Several risk factors such as immunodeficiency, multiple sexual partners, homo- and bisexuality, and alcohol abuse may be related to the disease. In these cases, the use of condom is strongly recommended.

Topics: Africa, Northern; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Condoms; Drug Therapy, Combination; Europe; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Prevalence; Risk Factors; Sexually Transmitted Diseases; Urethritis

The WHO recommends the administration of sulfadoxine-pyrimethamine (SP) to all pregnant women living in areas of moderate (stable) to high malaria transmission during scheduled antenatal visits, beginning in the second trimester and continuing to delivery. Malaria parasites have lost sensitivity to SP in many endemic areas, prompting the investigation of alternatives that include azithromycin-based combination (ABC) therapies. Use of ABC therapies may also confer protection against curable sexually transmitted infections and reproductive tract infections (STIs/RTIs). The magnitude of protection at the population level would depend on the efficacy of the azithromycin-based regimen used and the underlying prevalence of curable STIs/RTIs among pregnant women who receive preventive treatment. This systematic review summarizes the efficacy data of azithromycin against curable STIs/RTIs.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Clinical Trials as Topic; Drug Combinations; Drug Resistance, Bacterial; Female; Humans; Malaria, Falciparum; Male; Pregnancy; Pregnancy Outcome; Pyrimethamine; Reproductive Tract Infections; Sexually Transmitted Diseases; Sulfadoxine; Treatment Outcome; Vaginosis, Bacterial

The intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) has been a key component of the focused antenatal care package for nearly a decade, reducing the burden of low birthweight attributable to malaria in sub-Saharan Africa. However, SP has lost parasite sensitivity in many sub-Saharan locations during the same period, rendering its beneficial effect in IPTp debatable. Malaria transmission has also declined in some epidemiological settings. There is no evidence to suggest, however, that the risk of malaria in pregnancy without preventive measures has declined in the same locations. Thus, the urgency to identify efficacious drugs and/or new strategies to prevent malaria in pregnancy remains as great as ever. We summarise the results of recently published SP-IPTp studies from areas of high drug resistance and/or low malaria transmission. We also present the evidence for mefloquine and azithromycin-based combinations (ABCs), two leading drug options to replace SP in IPTp. We discuss optimal dosing for ABCs and their likely protection against several sexually transmitted and reproductive tract infections. We also summarise data from a diagnosis-based alternative to IPTp known as the intermittent screening and treatment (IST) for malaria. Clinical and operational research is urgently needed to compare birth outcomes achieved by IPTp with ABCs vs. IST using an efficacious antimalarial therapy.

Topics: Adult; Africa South of the Sahara; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antimalarials; Azithromycin; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Drug Resistance; Drug Therapy, Combination; Female; Humans; Malaria; Mefloquine; Pregnancy; Pregnancy Complications, Parasitic; Prenatal Care; Public Health; Pyrimethamine; Sexually Transmitted Diseases; Sulfadoxine; Treatment Outcome

The first-line therapy for the intermittent preventive treatment of malaria in pregnancy (IPTp) is sulphadoxine-pyrimethamine (SP). There is an urgent need to identify safe, well-tolerated and efficacious alternatives to SP due to widespread Plasmodium falciparum resistance. Combination therapy using azithromycin and chloroquine is one possibility that has demonstrated adequate parasitological response > 95% in clinical trials of non-pregnant adults in sub-Saharan Africa and where IPTp is a government policy in 33 countries.. Key safety, tolerability and efficacy data are presented for azithromycin and chloroquine, alone and/or in combination, when used to prevent and/or treat P. falciparum, P. vivax, and several curable sexually transmitted and reproductive tract infections (STI/RTI). Pharmacokinetic evidence from pregnant women is also summarized for both compounds.. The azithromycin-chloroquine regimen that has demonstrated consistent efficacy in non-pregnant adults has been a 3-day course containing daily doses of 1 g of azithromycin and 600 mg base of chloroquine. The pharmacokinetic evidence of these compounds individually suggests that dose adjustments may not be necessary when used in combination for treatment efficacy against P. falciparum, P. vivax, as well as several curable STI/RTI among pregnant women, although clinical confirmation will be necessary. Mass trachoma-treatment campaigns have shown that azithromycin selects for macrolide resistance in the pneumococcus, which reverses following the completion of therapy. Most importantly, no evidence to date suggests that azithromycin induces pneumococcal resistance to penicillin.

Topics: Adult; Anti-Bacterial Agents; Antimalarials; Azithromycin; Chloroquine; Drug Therapy, Combination; Female; Humans; Malaria, Falciparum; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases

Pelvic inflammatory disease (PID), the infection and inflammation of the female upper genital tract, is a common cause of infertility, chronic pain and ectopic pregnancy. Diagnosis and management are challenging, largely resulting from varying signs and symptoms and a polymicrobial etiology that is not fully delineated. Owing to the potential for serious sequelae, a low threshold for diagnosis and treatment is recommended. As PID has a multimicrobial etiology, including Neisseria gonorrhoeae, Chlamydial trachomatis and anaerobic and mycoplasmal bacteria, treatment of PID should consist of a broad spectrum antibiotic regimen. Recent treatment trials have focused on shorter duration regimens, such as azithromycin, and monotherapies including ofloxacin, but data are sparse. Research comparing sequelae development by differing antimicrobial regimens is extremely limited, but will ultimately shape future treatment guidelines.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Female; Humans; Infertility, Female; Neisseria gonorrhoeae; Ofloxacin; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Risk Factors; Sexually Transmitted Diseases; Ureaplasma; Women's Health

Non-gonococcal urethritis/cervicitis (NGU) is now the most common sexually transmitted infection that is possible to treat. Mycoplasma genitalium is a microorganism about to be established as an aetiological agent of NGU and upper genital infection.. The article is based on literature identified through a Pubmed search.. There seems to be sufficient evidence to conclude that Mycoplasma genitalium causes sexually transmitted infection. The microbe is associated with non-gonococcal urethritis in both men and women and cervicitis in women. It may also be the cause of upper genital infection in women. M. genitalium seems to cause more severe urethritis and more often lead to symptomatic urethritis/cervicitis than non-chlamydia-non-gonococcal urethritis/cervicitis that is not associated with M. genitalium. For testing, a cervical/vaginal swab should be used for women and first void urine should be collected for both sexes. Nucleic acid amplification tests are used. Azithromycin is more effective against M. genitalium than doxycycline and erythromycin. Moxifloxacin is effective in cases of azithromycin resistance.

Topics: Anti-Bacterial Agents; Azithromycin; Female; Humans; Male; Mycoplasma genitalium; Mycoplasma Infections; Sexually Transmitted Diseases; Urethritis; Uterine Cervicitis

Topics: Anti-Bacterial Agents; Azithromycin; Chancroid; Female; Gonorrhea; Humans; Pelvic Inflammatory Disease; Sexually Transmitted Diseases; Syphilis; Urethritis

Azithromycin is an acid stable orally administered macrolide antimicrobial drug, structurally related to erythromycin, with a similar spectrum of antimicrobial activity. Azithromycin is marginally less active than erythromycin in vitro against Gram-positive organisms, although this is of doubtful clinical significance as susceptibility concentrations fall within the range of achievable tissue azithromycin concentrations. In contrast, azithromycin appears to be more active than erythromycin against many Gram-negative pathogens and several other pathogens, notably Haemophilus influenzae, H. parainfluenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, Urea-plasma urealyticum and Borrelia burgdorferi. Like erythromycin and other macrolides, the activity of azithromycin is unaffected by the production of beta-lactamase. However, erythromycin-resistant organisms are also resistant to azithromycin. Following oral administration, serum concentrations of azithromycin are lower than those of erythromycin, but this reflects the rapid and extensive movement of the drug from the circulation into intracellular compartments resulting in tissue concentrations exceeding those commonly seen with erythromycin. Azithromycin is subsequently slowly released, reflecting its long terminal phase elimination half-life relative to that of erythromycin. These factors allow for a single dose or single daily dose regimen in most infections, with the potential for increased compliance among outpatients where a more frequent antimicrobial regimen might traditionally be indicated. The potential disadvantage of low azithromycin serum concentrations, however, is that breakthrough bacteraemia may occur in patients who are severely ill; nevertheless, animal studies suggest that tissue concentrations of azithromycin are more important than those in serum when treating respiratory and other infections. The clinical efficacy of azithromycin has been confirmed in the treatment of infections of the lower and upper respiratory tracts (the latter including paediatric patients), skin and soft tissues (again including paediatric patients), in uncomplicated urethritis/cervicitis associated with N. gonorrhoeae, Chlamydia trachomatis or U. urealyticum and in the treatment of early Lyme disease. Azithromycin was as effective as erythromycin and other commonly used drugs including clarithromycin, beta-lactams (penicillins and cephalosporins), and quinolone and tetracycline antibiotics in some of the abov

Topics: Animals; Azithromycin; Bacterial Infections; Biological Availability; Erythromycin; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Intestinal Absorption; Microbial Sensitivity Tests; Respiratory Tract Infections; Sexually Transmitted Diseases; Tissue Distribution

Azithromycin is an azalide antimicrobial agent. Structurally related to the macrolide antibiotic erythromycin, its mechanism of activity (similar to erythromycin) is interference with bacterial protein synthesis by binding to the 50S component of the 70S ribosomal subunit. Although slightly less potent than erythromycin against gram-positive organisms, azithromycin demonstrates superior activity in vitro against a wide variety of gram-negative bacilli, including Haemophilus influenzae. Absorption is approximately 37% after a 500-mg oral dose. The large volume of distribution (23 L/kg) and low peak serum level (0.4 micrograms/ml) are consistent with data demonstrating extensive tissue distribution and intracellular accumulation. Metabolism is predominantly hepatic (to inactive metabolites), with biliary excretion a major pathway of elimination. Drug elimination is biphasic, with a terminal half-life of up to 5 days. Published trials have examined the efficacy and safety of azithromycin in the treatment of adults with upper and lower respiratory tract infections, skin and skin structure infections, streptococcal pharyngitis, and sexually transmitted diseases. Many used a 5-day course of 250 mg once daily, supplemented with a 250-mg dose on the first day of therapy. Selected trials in sexually transmitted diseases examined single 1-g doses. Promising results also were obtained with oral daily doses of 500 mg in patients with human immunoviral infection who also had Mycobacterium avium complex infection and in animals with toxoplasmosis. Adverse reactions are primarily gastrointestinal (nausea, diarrhea, abdominal pain), with minimal laboratory abnormalities reported. Gastrointestinal tolerance is better than that of erythromycin. Drug interactions have not been observed to date, although coadministration of azithromycin with a large meal may reduce absorption by up to 50%.

Topics: Azithromycin; Drug Interactions; Erythromycin; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Respiratory Tract Infections; Sexually Transmitted Diseases; Skin Diseases, Infectious

Azithromycin (Zithromax) and clarithromycin (Biaxin Filmtabs) are new macrolide antibiotics with several advantages over erythromycin. Azithromycin has an expanded spectrum against gram-negative bacilli. Clarithromycin is more active than erythromycin against gram-positive cocci; combination with its 14-hydroxy metabolite enhances its antimicrobial activity. These new agents penetrate well into tissues and concentrate in macrophages and polymorphonuclear leukocytes. They offer improved bioavailability and an extended half-life. The high tissue-to-serum level and extended elimination half-life of azithromycin allow for once-daily dosing and short-course therapy. Clarithromycin and 14-hydroxyclarithromycin maintain high serum levels and tissue-to-serum concentrations. Both of these new agents have been effective in streptococcal pharyngitis, acute sinusitis, acute lower respiratory tract infections, skin and soft-tissue infections, and sexually transmitted diseases. A single dose of azithromycin is effective for genital chlamydial infections. Adverse reactions to these agents have usually been mild and have not included serious organ toxicity. In clinical trials, the rate of premature discontinuation of therapy has been less than observed with erythromycin. Azithromycin and clarithromycin should be used according to the current guidelines of the Food and Drug Administration; their future role will be determined by ongoing laboratory and clinical evaluations.

Topics: Anti-Bacterial Agents; Azithromycin; Clarithromycin; Clinical Protocols; Clinical Trials as Topic; Drug Resistance, Microbial; Erythromycin; Humans; Respiratory Tract Infections; Sexually Transmitted Diseases; Skin Diseases, Infectious; Therapeutic Equivalency

Azithromycin and clarithromycin are erythromycin analogues that have recently been approved by the FDA. These drugs inhibit protein synthesis in susceptible organisms by binding to the 50S ribosomal subunit. Alteration in this binding site confers simultaneous resistance to all macrolide antibiotics. Clarithromycin is several-fold more active in vitro than erythromycin against gram-positive organisms, while azithromycin is 2- to 4-fold less potent. Azithromycin has excellent in vitro activity against H influenzae (MIC90 0.5 microgram/ml), whereas clarithromycin, although less active against H influenzae (MIC90 4.0 micrograms/ml) by standard in vitro testing, is metabolized into an active compound with twice the in vitro activity of the parent drug. Both azithromycin and clarithromycin are equivalent to standard oral therapies against respiratory tract and soft tissue infections caused by susceptible organisms, including S aureus, S pneumoniae, S pyogenes, H influenzae, and M catarrhalis. Clarithromycin is more active in vitro against the atypical respiratory pathogens (e.g., Legionella), although insufficient in vivo data are available to demonstrate a clinical difference between azithromycin and clarithromycin. Superior pharmacodynamic properties separate the new macrolides from the prototype, erythromycin. Azithromycin has a large volume of distribution, and, although serum concentrations remain low, it concentrates readily within tissues, demonstrating a tissue half-life of approximately three days. These properties allow novel dosing schemes for azithromycin, because a five-day course will provide therapeutic tissue concentrations for at least ten days. Clarithromycin has a longer serum half-life and better tissue penetration than erythromycin, allowing twice-a-day dosing for most common infections. Azithromycin pharmacokinetics permit a five-day, single daily dose regimen for respiratory tract and soft tissue infections, and a single 1 g dose of azithromycin effectively treats C trachomatis genital infections; these more convenient dosing schedules improve patient compliance. Azithromycin and clarithromycin also are active against some unexpected pathogens (e.g., B burgdorferi, T gondii, M avium complex, and M leprae). Clarithromycin, thus far, appears the most active against atypical mycobacteria, giving new hope to what has become a difficult group of infections to treat. Gastrointestinal distress, a well known and major obstacle to patient complia

Topics: Azithromycin; Bacterial Infections; Clarithromycin; Erythromycin; Gram-Negative Bacterial Infections; Humans; In Vitro Techniques; Mycobacterium Infections, Nontuberculous; Respiratory Tract Infections; Sexually Transmitted Diseases; Skin Diseases, Infectious

Hotel-based sex workers in Bangladesh have high rates of sexually transmissible infections (STIs), high client turnover and low condom use. Two monthly clinic-based strategies were compared: periodic presumptive treatment (PPT) and enhanced syndromic management (ESM) - one round of presumptive treatment followed by treatment based on assessment and laboratory tests.. A randomised controlled trial compared PPT and ESM by prevalence and incidence, behaviour, retention, cost and STI incidence and prevalence. Demographic, behavioural and clinical data were collected from women at two clinics in Dhaka. All women received presumptive treatment and were randomised to receive PPT or ESM at nine monthly visits.. In total, 549 women (median age: <20 years) were enrolled. At baseline, the prevalence of chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) was 41% (ESM: 41%; PPT: 42%). After 9 months, chlamydia and gonorrhoea decreased to 7% overall, (ESM: 7.4%; PPT: 6.8%). At each visit, 98% of women receiving ESM met the therapy criteria and were treated. Retention was low (50%). Total costs were 50% lower per visit for each woman for PPT (ESM: $11.62 v. PPT: $5.80). The number of sex work sessions was reduced from 3.3 to 2.5 (P<0.001), but income did not change. Coercion was reduced but condom use at last sex did not change significantly.. Monthly PPT and ESM were effective approaches for STI control. PPT offered a feasible, low-cost alternative to ESM. Educational aspects led to a reduction in coercion and fewer sessions. Implementation studies are needed to improve condom use and retention.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bangladesh; Candidiasis, Vulvovaginal; Cefixime; Chlamydia Infections; Chlamydia trachomatis; Combined Modality Therapy; Condoms; Cross-Sectional Studies; Developing Countries; Drug Therapy, Combination; Female; Gonorrhea; Health Education; Humans; Incidence; Mass Screening; Metronidazole; Occupational Diseases; Sex Workers; Sexually Transmitted Diseases; Trichomonas Vaginitis; Uterine Cervicitis; Utilization Review; Vaginitis; Vaginosis, Bacterial; Workplace; Young Adult

A national opportunistic chlamydia screening programme, mainly targeting young sexually active women, is gradually being introduced across the UK and in future will predominantly occur in primary care sites. The relative efficacy of recommended antibiotic treatments for chlamydia has been poorly studied and especially that of single dose azithromycin. In Portsmouth, 1536 patients treated for chlamydia, with four different antibiotic regimens, during the Department of Health pilot study, were asked to return for test of cure. No difference in treatment outcome was found using doxycycline, oxytetracycline, erythromycin or azithromycin. Directly observed therapy with azithromycin may be especially helpful in treating young chlamydia-positive patients.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Erythromycin; Female; Humans; Pilot Projects; Sexually Transmitted Diseases; Treatment Outcome

The purpose of this study was to assess presumptive sexually transmitted disease treatment on pregnancy outcome and HIV transmission.. In a randomized trial in Rakai District, Uganda, 2070 pregnant women received presumptive sexually transmitted disease treatment 1 time during pregnancy at varying gestations, and 1963 control mothers received iron/folate and referral for syphilis. Maternal-infant sexually transmitted disease/HIV and infant outcomes were assessed. Intent-to-treat analyses estimated adjusted rate ratios and 95% confidence intervals.. Sexually transmitted diseases were reduced: Trichomonas vaginalis (rate ratio, 0.28; 95% CI, 0.18%-0.49%), bacterial vaginosis (rate ratio, 0.78; 95% CI, 0.69-0.87), Neisseria gonorrhoeae /Chlamydia trachomatis (rate ratio, 0.43; 95% CI, 0.27-0.68), and infant ophthalmia (rate ratio, 0.37; 95% CI, 0.20-0.70). There were reduced rates of neonatal death (rate ratio, 0.83; 95% CI, 0.71-0.97), low birth weight (rate ratio, 0.68; 95% CI, 0.53-0.86), and preterm delivery (rate ratio, 0.77; 95% CI, 0.56-1.05); but there were no effects on maternal HIV acquisition or perinatal HIV transmission.. Reductions of maternal sexually transmitted disease improved pregnancy outcome but not maternal HIV acquisition or perinatal HIV transmission.

Topics: Azithromycin; Birth Weight; Cefixime; Drug Therapy, Combination; Endophthalmitis; Female; Folic Acid; HIV Infections; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Iron; Metronidazole; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases; Uganda

Our objectives were to describe the baseline findings of a trial of antibiotic prophylaxis to prevent sexually transmitted infections (STIs) and HIV-1 in a cohort of Nairobi female sex workers (FSWs). A questionnaire was administered and a medical examination was performed. HIV-negative women were randomly assigned to either one gram azithromycin or placebo monthly. Mean age of the 318 women was 32 years, mean duration of sex work 7 years and mean number of clients was 4 per day. High-risk behaviour was frequent: 14% practised anal intercourse, 23% sex during menses, and 3% used intravenous drugs. While 20% reported condom use with all clients, 37% never use condoms. However, STI prevalence was relatively low: HIV-1 27%, bacterial vaginosis 46%, Trichomonas vaginalis 13%, Neisseria gonorrhoeae 8%, Chlamydia trachomatis 7%, syphilis 6% and cervical intraepithelial neoplasia (CIN) 3%. It appears feasible to access a population of high-risk FSWs in Nairobi with prevention programmes, including a proposed trial of HIV prevention through STI chemoprophylaxis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Cohort Studies; Drug Administration Schedule; Female; HIV Infections; HIV-1; Humans; Incidence; Kenya; Middle Aged; Prevalence; Risk-Taking; Sex Work; Sexual Behavior; Sexually Transmitted Diseases; Vaginosis, Bacterial

The aim of this study was to compare the clinical and microbiological efficacy of a single 1 gram dose of azithromycin against 1 week of doxycycline at 100 mg twice a day in the treatment of: (1) uncomplicated non-gonococcal urethritis (NGU) in male patients, and (2) culture proven Chlamydia trachomatis cervicitis in female sex workers.. The subjects were 53 male patients who attended the clinic and were diagnosed to have non gonococcal urethritis based on clinical symptoms and a urethral smear, and 63 female sex workers, who had both a positive enzyme immunoassay (EIA) test and Chlamydia trachomatis cultures. Follow-up visits were made at one and two weeks post-treatment to assess efficacy, subsequent relapse and presence of side effects. The male patients were also assessed at four weeks post treatment to determine default and reinfection rates.. Both azithromycin (clinical cure rates 62.5% at one week, 86.4% at two weeks in male patients; 96.6% at two weeks in female sex workers) and doxycycline (clinical cure rates 65.4% at one week, 90.9% at two weeks in male patients; 100% at two weeks in female sex workers) were effective in treating non-gonococcal urethritis and chlamydial cervicitis. Both drugs were very effective in eradicating proven Chlamydia trachomatis infections, with success in 100% of cases of Chlamydia trachomatis NGU in males, and 96.6% and 100% cure rates, for azithromycin and doxycycline respectively, in female sex workers with cervicitis. There were no statistically significant differences between the two drugs in terms of clinical efficacy, influence on default rates or subsequent risk of reinfection.. We conclude that a single dose of azithromycin is as effective as a one week course of doxycycline in treating non-gonococcal urethritis in males and in the elimination of Chlamydia trachomatis in females with cervicitis, with the added advantage of a convenient single dose that can be supervised.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Female; Gonorrhea; Humans; Male; Middle Aged; Sex Work; Sexually Transmitted Diseases; Singapore; Treatment Outcome; Urethritis; Uterine Cervicitis

To describe the design and first-round survey results of a trial of intensive sexually transmitted disease (STD) control to reduce HIV-1 incidence.. Randomized, controlled, community-based trial in Rakai District, Uganda.. In this ongoing study, 56 communities were grouped into 10 clusters designed to encompass social/sexual networks; clusters within blocks were randomly assigned to the intervention or control arm. Every 10 months, all consenting resident adults aged 15-59 years are visited in the home for interview and sample collection (serological sample, urine, and, in the case of women, self-administered vaginal swabs). Sera are tested for HIV-1, syphilis, gonorrhea, chlamydia, trichomonas and bacterial vaginosis. Following interview, all consenting adults are offered directly observed, single oral dose treatment (STD treatment in the intervention arm, anthelminthic and iron-folate in the control arm). Treatment is administered irrespective of symptoms or laboratory testing (mass treatment strategy). Both arms receive identical health education, condom and serological counseling services.. In the first home visit round, the study enrolled 5834 intervention and 5784 control arm subjects. Compliance with interview, sample collection and treatment was high in both arms (over 90%). Study arm populations were comparable with respect to sociodemographic and behavioral characteristics, and baseline HIV and STD rates. The latter were high: 16.9% of all subjects were HIV-positive, 10.0% had syphilis, and 23.8% of women had trichomonas and 50.9% had bacterial vaginosis.. Testing the effects of STD control on AIDS prevention is feasible in this Ugandan setting.. An ongoing (1994-98) randomized, community-based trial in Uganda's Rakai District is assessing the assumption that intensive sexually transmitted disease (STD) control efforts result in marked declines in HIV/AIDS prevalence. Described, in this article, are the project design and findings of the first-round baseline survey. 56 communities were grouped into 10 clusters designed to encompass social/sexual networks and clusters within blocks were randomly assigned to the intervention or control arm. All consenting permanent residents of the district are visited in their homes at 10-month intervals where they are administered extensive questionnaires, provide urine and vaginal swab samples, and are offered mass treatment regardless of symptoms or laboratory testing (single oral dose STD treatment in the intervention arm and anthelmintics and iron folate in the control arm). Both groups receive identical health education, condom promotion, and serologic counseling services. In the first round of home visits, 5834 intervention and 5784 control arm subjects were enrolled, representing about 90% of eligible adults. The groups were comparable in terms of sociodemographic and behavioral characteristics and baseline rates of HIV and STDs. 16.9% of subjects were HIV-positive, 10.0% had syphilis, 23.8% of women had trichomonas, and 50.9% had bacterial vaginosis. Detailed STD assessment is expected not only to document the relationship between STD control and HIV, but also to identify which STDs confer the greatest population attributable risk for HIV transmission, facilitating targeted control efforts in the future.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adolescent; Adult; Anti-Infective Agents; Azithromycin; Cefixime; Cefotaxime; Ciprofloxacin; Female; HIV-1; Humans; Incidence; Injections, Intramuscular; Male; Metronidazole; Middle Aged; Penicillin G Benzathine; Prevalence; Sexual Behavior; Sexually Transmitted Diseases; Single-Blind Method; Uganda

To evaluate the use of single-dose azithromycin for empirical treatment of nongonococcal urethritis.. Randomized, double-blind, multicenter trial comparing azithromycin vs doxycycline therapy, with a 2:1 randomization ratio. Patients were evaluated clinically and microbiologically for Chlamydia trachomatis and Ureaplasma urealyticum infection before therapy and at 2 and 5 weeks after study entry.. Eleven sexually transmitted disease clinics throughout the United States.. A total of 452 men aged 18 years or older with symptomatic nongonococcal urethritis of less than 14 days' duration.. Patients were treated with either 1.0 g of azithromycin as a single oral dose or 100 mg of doxycycline taken orally twice daily for 7 days.. Clinical resolution of symptoms and signs of nongonococcal urethritis, microbiological cure of C trachomatis and U urealyticum, and occurrence of adverse experiences.. Of the 452 patients enrolled, 248 in the azithromycin-treated group and 123 in the doxycycline-treated group were evaluable for clinical response. The two treatment groups were comparable in terms of age, weight, ethnic distribution, sexual preference, sexual activity, and history of prior nongonococcal urethritis or gonorrhea. Sixteen percent of the azithromycin group and 24% of the doxycycline group were culture positive for C trachomatis before therapy, while 38% and 28%, respectively, were culture positive for U urealyticum. The cumulative clinical cure rate was 81% (95% confidence interval [CI], 75% to 85%) in the azithromycin-treated group and 77% (95% CI, 69% to 84%) in the doxycycline-treated group. Clinical cure rates in the two groups were also comparable when patients were stratified by presence or absence of infection with C trachomatis or U urealyticum prior to therapy. Among those infected with C trachomatis, overall microbiological cure rates were 83% (95% CI, 65% to 94%) for azithromycin-treated patients (n = 30) and 90% (95% CI, 68% to 98%) for doxycycline-treated patients (n = 21). Among those infected with U urealyticum, overall microbiological cure rates were 45% (95% CI, 34% to 57%) for azithromycin-treated patients (n = 75) and 47% (95% CI, 30% to 65%) for doxycycline-treated patients (n = 32). Adverse reactions were generally mild to moderate and occurred in 23% of the azithromycin-treated group and 29% of the doxycycline-treated group.. For empirical treatment of the acute nongonococcal urethritis syndrome in men, a single oral dose of azithromycin was as effective as a standard 7-day course of doxycycline in achieving clinical cure. Further, clinical cure rates were comparable with either regimen, regardless of the presence or absence of Chlamydia or Ureaplasma infection.

Topics: Adult; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Double-Blind Method; Doxycycline; Humans; Male; Sexually Transmitted Diseases; Syndrome; Ureaplasma Infections; Ureaplasma urealyticum; Urethritis

One hundred and eighty-two patients were enrolled in a randomized third-party blinded study to assess the efficacy and safety of azithromycin in the treatment of sexually transmitted diseases. Three regimens of azithromycin, including a single oral dose, were compared with a standard treatment with doxycycline. The patients were followed for four weeks. Efficacy was evaluated in 168 patients (113 azithromycin, 55 doxycycline). Fourteen patients had negative cultures or did not come for all follow-up visits. Of the 168, 138 were infected with Chlamydia trachomatis, 43 with Neisseria gonorrhoeae, and 45 with Ureaplasma urealyticum. Ninety-six per cent of patients with chlamydial infections and 92% of those with gonorrhoea were cured with azithromycin. Two patients infected with N. gonorrhoeae, four with C. trachomatis and six with U. urealyticum had positive cultures on follow-up visits after receiving azithromycin. Of these 11 patients with positive cultures on follow-up visits, seven (five with U. urealyticum and two with C. trachomatis) violated the protocol by having intercourse with infected individuals during the study. Azithromycin was very well tolerated; one patient complained of mild abdominal pain shortly after receiving the drug, seven patients complained of mild nausea and two patients had mild diarrhoea.

Topics: Adolescent; Adult; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Therapy, Combination; Erythromycin; Female; Gonorrhea; Humans; Male; Middle Aged; Mycoplasmatales Infections; Neisseria gonorrhoeae; Randomized Controlled Trials as Topic; Sexually Transmitted Diseases; Ureaplasma

These days sexually transmitted infections (STIs) are important public health problems not only due to their high prevalence, but also because they require early diagnosis and treatment to avoid complications. In recent years, there has been an exponential increase in cases of infections caused by Chlamydia trachomatis and gonococcus in the population under 25years of age. In addition, an increase in the incidence of syphilis and hepatitisC (HCV) has also been detected, especially in men who have sex with other men (MSM). Genital herpes continues to be the second most frequent STI in the world, behind condyloma acuminata, and the first cause of genital ulcer among Spain in the sexually active population. A decrease in reported HIV cases was observed during 2020, but almost half of these new cases had a late diagnosis (<350CD4cell/μL). Current guidelines recommend offering STI annual screening to populations at risk or more often depending on the risk. STIs can appear in the form of syndromes, such as secretory syndrome (urethritis, proctitis, and cervicitis) or ulcerated syndrome (ulcers). The STIs that can cause secretory syndrome are mainly caused by Neisseria gonorrhoeae and C.trachomatis, which co-infect up to 40% of cases, and also cause urethritis, cervicitis or proctitis depending on where they are located. Gonococcus has an incubation period of 2-7days and Chlamydia 2-6weeks, and they are diagnosed using PCR and/or culture (the last one only valid for gonococcus) of samples collected according to sexual activities. Empirical treatment to cover both germs will be accomplished with ceftriaxone, 1g single intramuscular dose plus doxycycline 100mg every 12h orally for 7days, or azithromycin 1g single dose orally (we will use azithromycin only if we suspect a poor compliance with treatment, difficulty in going to the control or in pregnancy). Likewise, whenever we diagnose an STI firstly, we must offer advice and health education in order to promote the adoption of safe sexual behaviours and the correct use of barrier methods. Secondly, we must also screen for other STIs (HIV, syphilis, hepatitisB, and hepatitisA andC depending on the risk), offer HBV and HAV vaccination if it is appropriate, and finally study and treat all sexual partners from the previous 3months.

Topics: Azithromycin; Female; HIV Infections; Homosexuality, Male; Humans; Male; Neisseria gonorrhoeae; Pregnancy; Primary Health Care; Sexual and Gender Minorities; Sexually Transmitted Diseases; Syphilis; Urethritis; Uterine Cervicitis

From 2017 to 2021, genital (urine) and extragenital (pharyngeal and anorectal swabs) biological specimens were provided by men-who-have-sex-with-men (MSM) attending the STI clinic of the Infectious Disease Unit at the Verona University Hospital, Verona, Italy. A total of 1040 MSM were evaluated and 107 samples from 96 subjects resulted positive for MG. Among the MG-positive samples, all those available for further analysis (n=47) were considered for detection of mutations known to be associated with macrolide and quinolone resistance. 23S rRNA,. Our observations confirm that mutations in 23S rRNA gene are associated with azithromycin treatment failure and that mutations in

Topics: Anti-Bacterial Agents; Azithromycin; Drug Resistance, Bacterial; Fluoroquinolones; Genitalia; Homosexuality, Male; Humans; Macrolides; Male; Moxifloxacin; Mutation; Mycoplasma genitalium; Prevalence; RNA, Ribosomal, 23S; Sexual and Gender Minorities; Sexually Transmitted Diseases

The aim of this paper is to describe the prevalence of

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Coinfection; Drug Resistance, Bacterial; Female; Humans; Macrolides; Male; Mycoplasma genitalium; Mycoplasma Infections; Neisseria gonorrhoeae; Netherlands; Prevalence; Primary Health Care; Sexually Transmitted Diseases; Trichomonas vaginalis; Trichomonas Vaginitis

To prepare for the development of the 2021 Centers for Disease Control and Prevention (CDC) sexually transmitted infections treatment guidelines, the CDC convened a committee of expert consultants in June 2019 to discuss recent abstracts and published literature on the epidemiology, diagnosis, and management of sexually transmitted infections.This paper summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infections in adolescents and adults that were reviewed and discussed for consideration in developing the guidelines. The evidence reviewed mostly focused on efficacy of doxycycline and azithromycin for urogenital, rectal, and oropharyngeal CT infection, CT risk factors in women, performance of CT nucleic acid amplification tests on self-collected meatal specimens in men, and performance of newer CT point-of-care tests.

Topics: Adolescent; Adult; Azithromycin; Centers for Disease Control and Prevention, U.S.; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Male; Sexually Transmitted Diseases; United States

In South Africa, male urethritis syndrome (MUS) is the most common sexually transmitted infection (STI) syndrome in men. We determined the distribution of STI etiologies and the susceptibility profiles of Neisseria gonorrhoeae isolates from men presenting with MUS to 3 sentinel surveillance health care facilities. Secondary objectives were to determine the seroprevalence of coinfections (HIV, syphilis, herpes simplex virus 2).. Consecutive, consenting men with symptomatic urethral 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, South Africa.. Among 769 men enrolled, N. gonorrhoeae was the commonest cause of MUS (674 [87.8%]; 95% confidence interval [CI], 85.2%-89.9%), followed by Chlamydia trachomatis (161 [21.0%]; 95% CI, 18.2%-24.0%). Of 542 cultivable N. gonorrhoeae isolates, all were susceptible to ceftriaxone (modal minimum inhibitory concentration, 0.004 mg/L) and azithromycin (modal minimum inhibitory concentration, 0.128 mg/L). Seroprevalence rates of HIV, syphilis, and HSV-2 were 21.4% (95% CI, 18.5%-24.5%), 2.3%, and 50.1%, respectively. Condom use at last sexual encounter was reported by only 7%, less than 50% had been medically circumcised, and only 66.7% (58 of 87) who self-reported an HIV-positive status were adherent on antiretroviral drugs.. Neisseria gonorrhoeae and C. trachomatis were the predominant causes of MUS. Currently recommended dual ceftriaxone and azithromycin therapy are appropriate for MUS syndromic management; however, surveillance must be maintained to timeously detect emerging and increasing gonococcal resistance. Clinic-based interventions must be intensified in men seeing sexual health care to reduce the community transmission and burden of STI and HIV.

Topics: Azithromycin; Ceftriaxone; Chlamydia trachomatis; Gonorrhea; Herpesvirus 2, Human; HIV Infections; Humans; Male; Neisseria gonorrhoeae; Seroepidemiologic Studies; Sexually Transmitted Diseases; South Africa; Syphilis; Urethritis

The prevalence of sexually transmitted infections (STIs) is high in New Caledonia (NC), but there are no data on. We recruited 217 men referred to the Noumea public medical centre (CMP) with signs of urethritis and meeting the inclusion criteria from May 2016 to March 2018. Each was tested for. The prevalence of MG was 10.1% (22/217). Azithromycin resistance of MG (mutation in the 23S rRNA gene) could only be assessed for 10 of the 22 strains. Only one (1/10; 10%) was resistant. The prevalence of other STIs tested was high, as CT, NG and/or TV were associated in 77.3% (17/22) of MG-positive cases.. Although co-infections further justify syndromic management, the presence of MG in NC urethritis cases could call treatment guidelines into question.

Topics: Azithromycin; Chlamydia trachomatis; Humans; Male; Mycoplasma genitalium; Mycoplasma Infections; Neisseria gonorrhoeae; New Caledonia; Prevalence; Sexual Health; Sexually Transmitted Diseases; Trichomonas vaginalis; Urethritis

We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up.. Prospective observational cohort study.. Sexual assault centre in Oslo, Norway.. 645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019.. Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up.. At primary examination, the prevalence of genital chlamydia was 8.4%,. Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up.. ClinicalTrials.gov Registry (NCT03132389).

Topics: Azithromycin; Child; Cohort Studies; Female; Gonorrhea; Humans; Male; Norway; Prospective Studies; Sex Offenses; Sexually Transmitted Diseases

A higher dose of ceftriaxone is now recommended for gonorrhea. Doxycycline, not azithromycin, is first-line therapy for chlamydia.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Centers for Disease Control and Prevention, U.S.; Chlamydia Infections; Gonorrhea; Humans; Sexually Transmitted Diseases; United States

In high-income countries, shigellosis is mainly found in travellers to high-risk regions or in men who have sex with men (MSM). This study investigated the genomic characteristics and the features of antimicrobial resistance of MSM-associated Shigella flexneri and Shigella sonnei circulating in Barcelona, Spain, elucidating their connectivity with contemporaneous Shigella spp. from other countries.. Antimicrobial susceptibility, whole-genome sequencing, genomic characterization and phylogenetic analysis were performed in MSM-associated Shigella spp. recovered from 2015 to 2019. Reference genomes of MSM-associated Shigella spp. were included for contextualization and to determine their connection with international outbreaks.. In total, 44 S. flexneri and 26 S. sonnei were identified among MSM. Overall, 80% showed resistance to azithromycin, 65.7% showed resistance to trimethoprim-sulphamethoxazole and 32.8% showed resistance to ciprofloxacin; 27.1% were resistant to all three antimicrobials. mphA and/or ermB, and qnrS and mutations in the quinolone resistance determining regions were found in the azithromycin- and ciprofloxacin-resistant isolates, respectively. Additionally, two isolates carried bla. This study investigated the circulation of lineages of S. flexneri and S. sonnei among MSM in Spain that were mainly resistant to first-/second-line oral treatments, and closely related to dominant MSM-associated lineages described previously in the UK and Australia. These data reinforce the urgent need for the implementation of public health measures focusing on the early detection and prevention of transmission of this emerging pathogen, which is contributing to the antimicrobial resistance crisis in sexually transmitted infections.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Disease Susceptibility; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Genetic Variation; Genome; Geography; Homosexuality, Male; Humans; Male; Microbial Sensitivity Tests; Sexually Transmitted Diseases; Shigella; Spain; Whole Genome Sequencing

Neisseria gonorrhoeae (NG) continues to develop antimicrobial resistance (AR), and treatment options are limited. ARNG surveillance aids in identifying threats and guiding treatment recommendations but has traditionally been limited to sexually transmitted infection (STI) clinics. Large portions of STI care is delivered outside of STI clinics, such as emergency departments (EDs). These facilities might provide additional venues to expand surveillance and outbreak preparedness.. Through the Strengthening the US Response to Resistant Gonorrhea program, Greensboro, NC, and Indianapolis, IN, identified 4 EDs in high-morbidity areas to expand culture collection. Patient demographics, culture recovery rates, and antimicrobial susceptibility results between EDs and local STI clinics were compared along with lessons learned from reviewing programmatic policies and discussions with key personnel.. During the period 2018-2019, non-Hispanic Black patients were the most represented group at all 6 sites (73.6%). Age was also similar across sites (median range, 23-27 years). Greensboro isolated 1039 cultures (STI clinic [women, 141; men, 612; transwomen, 3]; EDs, 283 [women, 164; men, 119]). Indianapolis isolated 1278 cultures (STI clinic, 1265 [women, 125; men, 1139; transwomen, 1]; ED, 13 all male). Reduced azithromycin susceptibility was found at the Indianapolis (n = 86) and Greensboro (n = 25) STI clinics, and one Greensboro ED (n = 8).Implementation successes included identifying an on-site "champion," integrating with electronic medical records, and creating an online training hub. Barriers included cumbersome data collection tools, time constraints, and hesitancy from clinical staff.. Partnering with EDs for ARNG surveillance poses both challenges and opportunities. Program success can be improved by engaging a local champion to help lead efforts.

Topics: Adult; Azithromycin; Emergency Service, Hospital; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Sexual Partners; Sexually Transmitted Diseases; Young Adult

Shigellosis outbreaks caused by Shigella with decreased susceptibility to azithromycin (DSA-Shigella) among men who have sex with men (MSM) have been reported worldwide. We describe sexual health indicators and antimicrobial drug resistance for shigellosis cases in Minnesota, USA. We analyzed a sample of isolates received during 2012-2015 and cross-referenced cases with the Minnesota Department of Health Sexually Transmitted Disease Database to ascertain patients' HIV status and recent chlamydia, gonorrhea, and syphilis infections. Of 691 Shigella isolates, 46 (7%) were DSA-Shigella; 91% of DSA-Shigella patients were men, of whom 60% were living with HIV. Among men, those with DSA-Shigella infection had greater odds of living with HIV, identifying as MSM, or having a recent diagnosis of a sexually transmitted disease. DSA-Shigella was associated with MSM, HIV infection, and recent sexually transmitted disease. To decrease spread of DSA-Shigella, interventions targeted at communities at high risk are needed.

Topics: Anti-Bacterial Agents; Azithromycin; Drug Resistance, Bacterial; Dysentery, Bacillary; Female; Gonorrhea; HIV Infections; Homosexuality, Male; Humans; Male; Minnesota; Sexual and Gender Minorities; Sexually Transmitted Diseases; Shigella

Neisseria meningitidis sequence type 11 is an emerging cause of urethritis. We demonstrate by using whole-genome sequencing orogenital transmission of a N. meningitidis sequence type 11 isolate causing urethritis in a monogamous couple of men who have sex with men. These results suggest dissemination of this clonal complex among low-risk patients.

Topics: Acute Disease; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Communicable Diseases, Emerging; Humans; Injections, Intramuscular; Male; Meningococcal Infections; Neisseria meningitidis; Sexual and Gender Minorities; Sexually Transmitted Diseases; Treatment Outcome; Urethritis; Whole Genome Sequencing; Young Adult

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

Rectal Chlamydia trachomatis (CT) is common among clinic-attending women, but little is known about clearance and health implications of rectal CT.. At the municipal sexually transmitted disease clinic in Seattle, Washington, in 2017-2018, we enrolled women at high risk for urogenital CT into an 8-week prospective study. Women received standard CT treatment at enrollment. Women self-collected daily rectal and vaginal specimens for nucleic acid amplification tests (NAATs) and completed weekly sexual exposure diaries. We performed CT culture on the enrollment rectal specimen.. We enrolled 50 women; 13 (26%) tested positive for vaginal (n = 11) and/or rectal (n = 11) CT. Sixty percent of women with rectal CT per NAAT were also culture positive. Median time to CT clearance after azithromycin treatment was 8.0 days for vaginal CT and 7.0 days for rectal CT. Eight women with rectal CT at enrollment had at least 1 rectal CT-positive NAAT after clearance of the initial infection; none reported anal sex.. Most NAAT-positive rectal infections were culture positive, suggesting active infection. Time to NAAT clearance of rectal and genital tract CT was similar, and intermittent rectal CT positivity was common in the absence of anal sexual exposure. The cause of recurrent/intermittent rectal CT and the clinical implications of these infections require further study.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Nucleic Acid Amplification Techniques; Prospective Studies; Rectum; Recurrence; Sexual Behavior; Sexually Transmitted Diseases; Vagina; Washington; Young Adult

Topics: Azithromycin; Ceftriaxone; Gonorrhea; Humans; Neisseria gonorrhoeae; Sexually Transmitted Diseases; United Kingdom

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Sexual Partners; Sexually Transmitted Diseases; Young Adult

Expedited partner therapy (EPT) for Chlamydia trachomatis (Ct) is the practice of providing Ct-infected patients with medication, or prescription (prescription-EPT) to deliver to their sex partners without first examining those partners. New York City (NYC) providers commonly use prescription-EPT, yet NYC pharmacists report only occasional receipt of EPT prescriptions. This project assessed the frequency of EPT prescriptions filled in 2 NYC neighborhoods.. The 2 NYC facilities reporting the most frequent use of prescription-EPT were identified from Ct provider case reports and contacted to ascertain their EPT practices. Providers at the first facility (facility 1) prescribed two 1-g doses of azithromycin, including sex partner treatment on the index patient's electronic prescription. Providers at the second facility (facility 2) gave patients paper prescriptions for sex partners. We reviewed prescriptions filled in 2015 for azithromycin, 1 or 2 g at pharmacies near these facilities; prescriptions indicating partner therapy were classified "EPT prescriptions".. Facility 1 providers submitted 112 Ct case reports indicating prescription-EPT, compared with 114 submitted by facility 2 providers. Twelve of 26 identified pharmacies agreed to participate. At 7 pharmacies near facility 1, we found 61 EPT prescriptions from facility 1 and 37 from other facilities. At 5 pharmacies near facility 2, we found only 1 EPT prescription from facility 2 and 3 from other facilities.. Expedited partner therapy prescriptions were received in NYC pharmacies near to EPT-prescribing facilities, but with great variability and at a lower frequency than suggested by provider case reports. Provider EPT prescribing practices may impact the likelihood that partners receive medication and should be further evaluated.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Female; Humans; Male; Pharmacies; Prescriptions; Public Health; Sentinel Surveillance; Sexual Partners; Sexually Transmitted Diseases; Young Adult

An HIV-negative man with pharyngeal gonorrhea had a positive test-of-cure (nucleic acid amplification test) result 7 days after treatment with ceftriaxone/azithromycin. Neisseria gonorrhoeae Multi-Antigen Sequencing Type 1407 and mosaic pen A (XXXIV) gene were identified in the test-of-cure specimen, and culture was negative. Retreatment with ceftriaxone 500 mg intramuscularly plus azithromycin 2 g orally yielded a negative test-of-cure result.

Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Azithromycin; Ceftriaxone; Gonorrhea; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pharynx; Sexually Transmitted Diseases; Treatment Outcome; Young Adult

Topics: Administration, Intravenous; Azithromycin; Ceftriaxone; Drug Resistance, Bacterial; Europe; Gonorrhea; Humans; Practice Guidelines as Topic; Sexually Transmitted Diseases; United States

We report an outbreak of azithromycin-nonsusceptible Shigella flexneri 3a infection in Taiwan associated with men who have sex with men. The bacterial strains belonged to the sublineage A of a recently reported outbreak lineage associated with men who have sex with men, characterized by reduced azithromycin susceptibility and circulation in shigellosis low-risk regions.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Disease Outbreaks; Drug Resistance, Bacterial; Dysentery, Bacillary; Homosexuality, Male; Humans; Male; Sexually Transmitted Diseases; Shigella flexneri; Taiwan; Young Adult

To describe antibiotic use for treatment of Mycoplasma genitalium (MG) at an urban sexual health centre in Australia. To describe MG positivity rates in those returning for 1 month test of cure (TOC) following first-line antibiotic treatment for MG.. Retrospective cross-sectional case-note review for all patients diagnosed with MG at Sydney Sexual Health Centre from 2009 to 2013.. Two hundred and eighteen MG cases were identified; 66% were male and 90% were symptomatic at presentation. Four people did not return for treatment. Azithromycin containing regimens were prescribed as first-line treatment in 88% of cases; azithromycin 1 g stat in 75% of cases and a course of extended azithromycin 1 g stat plus 500 mg daily for 4 days in 14% of cases. TOC was performed in 53% (95% CI 46% to 60%) of cases and 28% (95% CI 20% to 38%) of these cases were MG-positive at TOC. Of those having a MG-positive result at TOC, 26% received azithromycin 1 g stat and 33% received extended azithromycin. Accounting for cases lost to follow-up in azithromycin containing regimens, the positive MG TOC rate was estimated to be between 15% and 61%.. High rates of MG positivity were found in those attending TOC following first-line treatment of MG with azithromycin containing regimens.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Australia; Azithromycin; Cohort Studies; Cross-Sectional Studies; Female; Female Urogenital Diseases; Humans; Male; Male Urogenital Diseases; Middle Aged; Mycoplasma genitalium; Mycoplasma Infections; Retrospective Studies; Sexually Transmitted Diseases; Treatment Outcome; Young Adult

Topics: Azithromycin; Drug Resistance, Bacterial; Dysentery, Bacillary; Female; Humans; Male; Sexually Transmitted Diseases

Shigellosis is an acute, severe bacterial colitis that, in high-income countries, is typically associated with travel to high-risk regions (Africa, Asia, and Latin America). Since the 1970s, shigellosis has also been reported as a sexually transmitted infection in men who have sex with men (MSM), in whom transmission is an important component of shigellosis epidemiology in high-income nations. We aimed to use sophisticated subtyping and international sampling to determine factors driving shigellosis emergence in MSM linked to an outbreak in the UK.. We did a large-scale, cross-sectional genomic epidemiological study of shigellosis cases collected from 29 countries between December, 1995, and June 8, 2014. Focusing on an ongoing epidemic in the UK, we collected and whole-genome sequenced clinical isolates of Shigella flexneri serotype 3a from high-risk and low-risk regions, including cases associated with travel and sex between men. We examined relationships between geographical, demographic, and clinical patient data with the isolate antimicrobial susceptibility, genetic data, and inferred evolutionary relationships.. We obtained 331 clinical isolates of S flexneri serotype 3a, including 275 from low-risk regions (44 from individuals who travelled to high-risk regions), 52 from high-risk regions, and four outgroup samples (ie, closely related, but genetically distinct isolates used to determine the root of the phylogenetic tree). We identified a recently emerged lineage of S flexneri 3a that has spread intercontinentally in less than 20 years throughout regions traditionally at low risk for shigellosis via sexual transmission in MSM. The lineage had acquired multiple antimicrobial resistance determinants, and prevailing sublineages were strongly associated with resistance to the macrolide azithromycin. Eight (4%) of 206 isolates from the MSM-associated lineage were obtained from patients who had previously provided an isolate; these serial isolations indicated atypical infection patterns (eg, reinfection).. We identified transmission-facilitating behaviours and atypical course(s) of infection as precipitating factors in shigellosis-affected MSM. The intercontinental spread of antimicrobial-resistant shigella through established transmission routes emphasises the need for new approaches to tackle the public health challenge of sexually transmitted infections in MSM.. Wellcome Trust (grant number 098051).

Topics: Adolescent; Adult; Aged; Azithromycin; Child; Child, Preschool; Cross-Sectional Studies; Disease Outbreaks; Drug Resistance, Bacterial; Dysentery, Bacillary; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Phylogeny; Risk; Sexually Transmitted Diseases; Shigella flexneri; Travel; United Kingdom; Young Adult

During 2012-2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected. Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Coinfection; Drug Resistance, Bacterial; Dysentery, Bacillary; Female; Genes, Bacterial; Homosexuality, Male; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Phosphotransferases (Alcohol Group Acceptor); Public Health Surveillance; Quebec; Sexually Transmitted Diseases; Shigella

Greenland reports the highest rates of chlamydial infection and gonorrhea in the Arctic. Our objective was to determine the presence, and describe the basic epidemiology, of Mycoplasma genitalium for Greenland.. Cross-sectional study.. 314 residents from Nuuk and Sisimiut, between the ages of 15 and 65 years, participated in "Inuulluataarneq" (the Greenland Sexual Health Project) between July 2008 and November 2009. Participants provided self-collected samples for sexually transmitted infection (STI) testing and completed a sexual health survey. Descriptive statistics and logistic regression were used to summarize the basic characteristics of STI cases overall and M. genitalium and Chlamydia trachomatis specifically. Clinically relevant characteristics in each full model were gender (male or female), age (in years), age at sexual debut (in years), number of sexual partners in the past 3 months (continuous) and history of forced sex and community.. The overall prevalence of STIs was 19.0%, specifically: 9.8% for M. genitalium and 9.4% for C. trachomatis; 100% of M. genitalium-positive cases carried macrolide resistance determinants. Being female [OR = 3.2; 95% confidence interval (CI): 1.1-9.8] and younger age (OR = 0.9; 95% CI: 0.9-1.0) were associated with M. genitalium positivity. Age was also associated with C. trachomatis (OR = 0.9; 95% CI: 0.8-0.9) and STI positivity overall (OR = 0.9; 95% CI: 0.9-0.9).. We observed a high prevalence of M. genitalium and macrolide resistance in this study. A better understanding of M. genitalium sequelae is needed to inform policy around testing, treatment, control and antibiotic use.

Topics: Adolescent; Adult; Aged; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Cross-Sectional Studies; Drug Resistance, Bacterial; Drug Resistance, Microbial; Female; Greenland; Health Surveys; Humans; Male; Middle Aged; Mycoplasma genitalium; Mycoplasma Infections; Prevalence; Sexually Transmitted Diseases; Young Adult

Chlamydia trachomatis is a gram-negative bacterium that infects the columnar epithelium of the cervix, urethra, and rectum, as well as nongenital sites such as the lungs and eyes. The bacterium is the cause of the most frequently reported sexually transmitted disease in the United States, which is responsible for more than 1 million infections annually. Most persons with this infection are asymptomatic. Untreated infection can result in serious complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy in women, and epididymitis and orchitis in men. Men and women can experience chlamydia-induced reactive arthritis. Treatment of uncomplicated cases should include azithromycin or doxycycline. Screening is recommended in all women younger than 25 years, in all pregnant women, and in women who are at increased risk of infection. Screening is not currently recommended in men. In neonates and infants, the bacterium can cause conjunctivitis and pneumonia. Adults may also experience conjunctivitis caused by chlamydia. Trachoma is a recurrent ocular infection caused by chlamydia and is endemic in the developing world.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chlamydial Pneumonia; Doxycycline; Epididymitis; Female; Humans; Incidence; Infertility, Female; Lymphogranuloma Venereum; Male; Mass Screening; Orchitis; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Pregnancy; Pregnancy, Ectopic; Prevalence; Risk Factors; Sexually Transmitted Diseases; Trachoma; Treatment Outcome; United States

The British Association for Sexual Health and HIV (BASHH) UK gonorrhoea guideline has been updated in 2011. It offers advice on diagnosis, treatment and health promotion for anogenital and pharyngeal gonorrhoea. Nucleic acid amplification tests (NAATs) are now being used more for diagnosis and are increasing detection rates in the pharynx and rectum. First line treatment using ceftriaxone with azithromycin is now advised, along with routine test of cure (TOC). The aim is to slow the spread of resistant gonorrhoea now that fewer antibiotics remain effective. A patient information leaflet has been developed.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Disease Management; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Sexually Transmitted Diseases

The case notes of cases of genital chlamydial infection were audited against the UK National Guideline. This was the first web-based and the largest national audit to date, with 193 clinics in all UK Regions contributing data. About half of all cases had no symptoms, with about one-third attending for routine or asymptomatic screens; suggesting significant provision of screening by clinics that might be managed differently to reduce workload. Nucleic acid amplification tests (NAATs) are now well established for chlamydial detection in UK clinics, with 93% of cases having genital NAATs. Azithromycin is now more commonly used than doxycycline (54% vs. 37%). Of 26 pregnant women, 20 were treated with azithromycin, suggesting that most prescribers treating pregnant women consider that erythromycin is not an adequate alternative to azithromycin. Most women had NAATs obtained from sites recommended by the Guideline, with 93% of women who had genital NAATs having these from the cervix or vulvovaginal area.

Topics: Adolescent; Adult; Aged; Ambulatory Care Facilities; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Female; Female Urogenital Diseases; Humans; Male; Male Urogenital Diseases; Medical Audit; Middle Aged; Nucleic Acid Amplification Techniques; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases; Treatment Outcome; United Kingdom

The objectives of this study were to determine whether periodic presumptive treatment (PPT) for sexually transmitted infections (STIs) in service women could be implemented in 3 border provinces of Laos and whether its implementation was associated with a reduction in the prevalence of cervical infections.. Four hundred forty-two service women were interviewed using a standardized questionnaire in 3 border provinces at baseline (day 1) and 419 3 months (day 90) later. Azithromycin at a dosage of 1 g was administered at monthly intervals over 3 months in Khammouane province, on days 1, 30, and 90 in Oudomxai and days 1, 60, and 90 in Savannakhet. Urine samples were collected at baseline and day 90 for gonorrhea and chlamydia testing.. Baseline samples showed very high levels of both gonorrhea and/or chlamydia of 42.7% in Oudomxai, 39.9% in Khammouane, and 22.7% in Savannakhet. At day 90, after 2 or 3 rounds of PPT, these were, respectively, 12.3%, 21.9%, and 17.0%. Overall, the prevalence of any cervical infection decreased by 45% from 32.4% (95% confidence interval [CI] = 28.1-36.9) at day 1 to 18.0% (95% CI = 14.5-22.1) at day 90 (P < 0.001).. Lower prevalences of cervical infections were observed after 2 to 3 rounds of PPT. The optimal time between rounds of PPT is uncertain, but while these high STI rates prevail, a 1- to 2-month gap is recommended. After the introduction of this PPT project, costs of STI drugs reduced 5-fold making PPT a sustainable intervention in Laos for service women until user-friendly services are developed.

Topics: Adolescent; Adult; Azithromycin; Chlamydia; Chlamydia Infections; Condoms; Female; Gonorrhea; HIV; Humans; Laos; Sex Work; Sexually Transmitted Diseases

To evaluate care delivery patterns in patients treated for pelvic inflammatory disease in pediatric outpatient settings and to determine the effect of practice type on care delivery.. Retrospective review of medical records for patients treated as outpatients in an urban academic pediatric facility. Care patterns were evaluated according to the Centers for Disease Control sexually transmitted disease guidelines.. Fifty-six adolescent patients who were diagnosed with pelvic inflammatory disease in pediatric ambulatory settings between January 1, 2002, and December 31, 2002.. Demographic information, documented patient history and examination, laboratory data, and discharge instructions.. Forty percent of patients were prescribed inadequate courses of medications. Patients who were seen in the pediatric emergency department were less likely to receive a standard medication regimen than those seen in the ambulatory setting. Most patients did not receive adequate instruction for self-care on review of written discharge instructions, and there were no differences based on location of care.. Many adolescents treated as outpatients for pelvic inflammatory disease may not receive adequate medications and instructions for self-care at discharge in pediatric ambulatory settings. This study suggests a need for aggressive quality improvement measures to enhance the care of adolescents with pelvic inflammatory disease in pediatric outpatient settings.

Topics: Academic Medical Centers; Adolescent; Ambulatory Care; Anti-Bacterial Agents; Azithromycin; Cefixime; Doxycycline; Drug Utilization Review; Emergency Service, Hospital; Female; Humans; Insurance, Health; Maryland; Outcome and Process Assessment, Health Care; Outpatient Clinics, Hospital; Patient Discharge; Patient Education as Topic; Pediatrics; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Retrospective Studies; Sexually Transmitted Diseases

Our objective was to assess whether antibiotic prophylaxis should be offered to women post sexual assault by considering acceptability of prophylaxis, follow up attendance rates and the prevalence of sexually transmitted infections (STIs) in these women. Retrospective case notes review of female survivors of rape or sexual assault attending the Rose Clinic, Ambrose King Centre, Royal London Hospital between 1 January 1997 and 31 May 1999 was carried out. The following selection criteria were applied: age greater than 16 years; attending within two weeks of assault; having experienced vaginal and/or anal penetration. All women were screened for STI using standard investigation methods detailed below. Antibiotic prophylaxis was offered within two weeks of the assault, the antibiotic regimens used as recommended. The women were invited to attend for results at two weeks and offered a further screen at three months post assault. Bacterial vaginosis was present in 32% of the women screened, Chlamydia trachomatis was identified in 8%, none tested positive for Neisseria gonorrhoeae. Of the 25 women who were offered antibiotic prophylaxis, 88% accepted. Follow up attendances were 57% at two weeks and 30% at three months. Antibiotic prophylaxis was acceptable to women. Among recent rape victims, follow-up rates are low confirmed by our study. These factors support the use of antibiotic prophylaxis post sexual assault. There was an apparently high prevalence of STIs amongst women in this study. More research is required with respect to this aspect of the work and to consider the cost-benefit analysis of antibiotic prophylaxis.

Topics: Adolescent; Adult; Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Chlamydia trachomatis; Ciprofloxacin; Female; Genital Diseases, Female; Humans; Metronidazole; Patient Acceptance of Health Care; Rape; Sexually Transmitted Diseases; Trichomonas vaginalis; Vaginosis, Bacterial

Topics: Adult; Azithromycin; Chemoprevention; Female; HIV Infections; HIV Seropositivity; Humans; Mycobacterium avium-intracellulare Infection; Sexual Behavior; Sexually Transmitted Diseases

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antitrichomonal Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Condylomata Acuminata; Doxycycline; Epididymitis; Female; Humans; Infectious Disease Transmission, Vertical; Male; Metronidazole; Papillomaviridae; Papillomavirus Infections; Pelvic Inflammatory Disease; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Complications, Parasitic; Scabies; Sexually Transmitted Diseases; Sexually Transmitted Diseases, Bacterial; Sexually Transmitted Diseases, Viral; Syphilis; Tumor Virus Infections; Urethritis

Research on the relationship between sexually transmitted diseases (STDs) and HIV was presented at the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Researchers have found significant associatioons between STDs and HIV, including a common mode of transmission. Data from several African studies on HIV are described. Topics include the impact of STD treatment, Herpes Simplex Virus 2 (HSV-2), HIV in the female genital track, and cervicovaginal secretion.

Topics: Anti-Bacterial Agents; Azithromycin; Cefixime; Drug Administration Schedule; Drug Therapy, Combination; Female; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Metronidazole; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Sexually Transmitted Diseases; Viral Load

Topics: Anti-Bacterial Agents; Azithromycin; History, 20th Century; Humans; Sexually Transmitted Diseases

Topics: Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Ciprofloxacin; Clinical Trials as Topic; Costs and Cost Analysis; Female; Humans; Male; Sexually Transmitted Diseases; Uganda

Topics: Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Humans; Male; Sexually Transmitted Diseases; Syndrome; Ureaplasma Infections; Ureaplasma urealyticum; Urethritis