Anogenital infection by Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected men and women in Salvador, Brazil

Travassos, Ana Gabriela; Xavier-Souza, Eveline; Netto, Eduardo Martins; Dantas, Eda Vinhaes; Timbó, Maiara; Nóbrega, Isabella; Haguihara, Tatiana; Neumayer, Júlia; Lisboa, Nathalia; Soidan, Maria Angela; Ferreira, Fábio de Oliveira; Brites, Carlos

doi:10.1016/j.bjid.2016.09.004

Cited by 12 publications

(10 citation statements)

References 29 publications

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“…Anogenital CT was the most common STI detected, with an overall prevalence of 20.5% for HIV-uninfected women and 19.5% for HIV-infected women. The prevalence of anogenital CT infection was higher than that found in multicenter and isolated studies conducted with HIV-uninfected and HIV-infected women in other low- and middle-income countries [26], but variable findings exist in previous studies from Brazil [5,27,28]. In the Brazilian Amazon, the prevalence of genital infection by CT ranges from ~4.8% to ~11.0% in nonindigenous women [29–31].…”

Section: Discussionmentioning

confidence: 86%

“…STI surveillance strategies in the Tapajós region should be targeted to the general population of women, independent of HIV-infected status, with a focus on young women and adolescents with a history of STI or HPV infection who are single and use alcohol, especially during their reproductive life. The risk factors found are well established in the literature [27,28,40,41]. Cross-sectional population-based studies indicate that not only geographic but also political isolation are responsible for unequal access to health services and maternal and child care in more urbanized areas of the Amazon [44,45].…”

Section: Discussionmentioning

confidence: 95%

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Sexually transmitted infections among HIV-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil: Self-collected vs. clinician-collected samples

et al. 2019

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The anogenital prevalence of sexually transmitted infections (STIs) and the use of cervico-vaginal self-collected vs. clinician-collected samples were evaluated for the diagnosis of human immunodeficiency virus (HIV)-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil. We recruited 153 women for a cross-sectional study (112 HIV-uninfected and 41 HIV-infected) who sought health services. Anal and cervical scrapings and cervico-vaginal self-collection samples were collected. Real-time polymerase chain reaction methods were used for Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis and Mycoplasma genitalium . A syphilis test was also performed. Risk factors for STIs were identified by multivariate analysis. The overall prevalence of STIs was 30.4% (34/112) in HIV-uninfected women and 24.4% (10/41) in HIV-infected women. Anogenital Chlamydia trachomatis infection was the most prevalent in both groups of women (20.5% vs 19.5%). There was significant agreement for each STI between self-collected and clinician-collected samples: 91.7%, kappa 0.67, 95% confidence interval (CI) 0.49–0.85 for Chlamydia trachomatis ; 99.2%, kappa 0.85, 95% CI 0.57–1.00 for Neisseria gonorrhoeae ; 97.7%, kappa 0.39, 95% CI -0.16–0.94 for Trichomonas vaginalis ; and 94.7%, kappa 0.51, 95% CI 0.20–0.82 for Mycoplasma genitalium . Women with human papillomavirus had coinfection or multiple infections with other STIs. Risk factors for STIs were being ≤ 25 years old, being employed or a student, reporting a history of STI and having a positive HPV test. A high prevalence of STIs in women in the Tapajós region was found. Cervico-vaginal self-collection is a useful tool for STI screening and can be used in prevention control programs in low-resource settings, such as in northern Brazil.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 95%

Sexually transmitted infections among HIV-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil: Self-collected vs. clinician-collected samples

et al. 2019

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“…Overall, 25 reporting on both CT and NG anorectal positivity were eligible (Figure 1). Twelve (48%) studies were from North America [18][19][20][21][22][23][24][25][26][27][28][29], seven (28%) from the Netherlands [14,15,[30][31][32][33][34], three (12%) from the United Kingdom [35][36][37], two (8%) from South America [38,39], and one (4%) from Africa [40]. Table 1 shows that 23 studies were cross-sectional [14, 15, 18-24, 26-38, 40], one was a prospective cohort study [25] and one was a case-control [39].…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Overall, 14 (56%) studies specified consecutive recruitment of patients attending clinics or inclusion of all data reducing selection bias [14, 18, 19, 22, 23, 26-31, 33, 35, 36]. Inclusion/exclusion criteria were specified for 22 (88%) studies [15,[19][20][21][22][23][24][25][26][27][28][29][30][32][33][34][35][36][37][38][39][40]. Measurement bias was considered low in 21 (84%) studies because the type of NAAT used was described.…”

Section: Assessment Of Within-study Biasmentioning

confidence: 99%

Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis

et al. 2019

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ObjectivesThere has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (NG). Given that urogenital NG is more strongly associated with pelvic inflammatory disease, this is an evidence gap. This systematic review and meta-analysis investigates the associations between anorectal CT in women and CT positivity at other sites (urogenital/oropharyngeal) and with anal intercourse, and compares these with anorectal NG within the same study populations.MethodsElectronic databases were searched for English-language studies published to October 2018 using the following terms: (“Chlamydia” OR “Chlamydia trachomatis”) AND ((“anal” OR “rect*” OR “anorect*”) OR (“extra?genital” OR “multi?site”)). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression.Results25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5%, with a summary estimate of 8.0% (95% CI 7.0 to 9.1; I2=88.5%). Anorectal NG positivity ranged from 0% to 17.0%, with a summary estimate of 2.1% (95% CI 1.6 to 2.8; I2=92.7%). The association between urogenital and anorectal positivity was stronger for NG than CT (summary prevalence ratio (PR)=89.3 (95% CI 53.1 to 150.3; I2=80.1%), PR=32.2 (95% CI 25.6 to 40.7; I2=70.3%), respectively), and between oropharyngeal and anorectal positivity it was stronger for NG than CT (PR=34.8 (95% CI 10.2 to 118.2; I2=89.9%), PR=8.8 (95% CI 6.8 to 11.5; I2=58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I2=0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I2=0.0%).ConclusionsAnorectal CT is more common than anorectal NG, but anorectal NG is more strongly associated with anal intercourse, urogenital and oropharyngeal NG, suggesting that ongoing discussion about anorectal CT should also include NG. Longitudinal data are required to further understanding of the aetiology of anorectal STIs and assess whether anorectal screening is needed in women.Trial registration numberCRD42df017080188.

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“…Treatment for asymptomatic infections may also differ based on the pathogen and location. For these reasons, extragenital screening of heterosexual women is increasingly advocated, particularly as infections are often detected even without self-reported oral/anal intercourse [15, 16].…”

Section: Introductionmentioning

confidence: 99%

Extragenital chlamydia infection among active-duty women in the United States Navy

et al. 2019

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BackgroundPharyngeal and anorectal reservoirs of gonorrhea (GC) and chlamydia (CT) are increasingly recognized among heterosexual women. While a number of studies performed at sexually transmitted disease (STD) clinics have found a high prevalence of extragenital GC/CT infection, such screening is typically not offered during routine primary care visits for women. We sought to define the prevalence of and factors associated with extragenital GC/CT among women in the U.S. Navy.MethodsWe recruited servicewomen stationed in San Diego, California, between the ages of 18 and 25 who presented for an annual physical exam between January and September, 2017. Nucleic acid amplification testing was performed on swabs collected at endocervical, oropharyngeal and anorectal sites to assess the presence of GC/CT. An anonymous behavioral questionnaire was also administered to characterize sexual risk. Descriptive statistics were used to compare women with and without a prior history of any sexually transmitted infection (STI) (self-report) along with a current GC/CT diagnosis. This study was approved by the Institutional Review Board of the Uniformed Services University of Health Sciences.ResultsOf the 75 patients who were approached, 60 subjects were enrolled in the study, including white 20 (33.3%), black/African American 18 (31.0%), Hispanic/Latina 13 (21.7%) and Asian/Pacific Islander 9 (15.5%) women. Among all the women, six (10.0%) were diagnosed with CT infection, all via endocervical exam. Of these, five (8.3%) had concurrent anorectal infection, including two cases (3.3%) accompanied by pharyngeal infection. Of the subjects, 15 (25.0%) reported anal intercourse in their most recent sexual encounter, most of which was condomless (13/15, 86.7%). A high number of women who reported sex with a casual male partner (19/45, 42.2%) reported rarely or never using condoms; last, 41.7% consuming at least 3 drinks on a typical drinking day, and one-third of the reported drinking more than once per week.ConclusionsWe found a high prevalence of anorectal CT infection, although no infections were detected without concurrent endocervical involvement. Nonetheless, the high prevalence of condomless anal intercourse reported by participants argues for further study and ongoing consideration of extragenital screening among high-risk patients. Behavioral interventions are also warranted given the high prevalence of sexual and related risk factors.

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Anogenital infection by Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected men and women in Salvador, Brazil

Abstract: Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.

Cited by 12 publications

References 29 publications

Sexually transmitted infections among HIV-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil: Self-collected vs. clinician-collected samples

Sexually transmitted infections among HIV-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil: Self-collected vs. clinician-collected samples

Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis

Extragenital chlamydia infection among active-duty women in the United States Navy

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