Incidence and Treatment Outcomes of Pharyngeal<i>Neisseria gonorrhoeae</i>and<i>Chlamydia trachomatis</i>Infections in Men Who Have Sex with Men: A 13‐Year Retrospective Cohort Study

Ota, Kaede V.; Fisman, David N.; Tamari, Itamar; Śmieja, Marek; Ng, Lai-King; Jones, Kenneth M.; DiPrima, Alessandro; Richardson, Susan E.

doi:10.1086/597586

Cited by 49 publications

(44 citation statements)

References 20 publications

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“…We found 55% of MSM with rectal Gonorrhoea to have normal anoscopy (Table 1b). Most oro-pharyngeal and anorectal Gonorrhoea and chlamydia would go undiagnosed and untreated without testing in these sites [2,26,27], for example we found that 67% and 82%, respectively, of the patients with positive ano-rectal samples were positive only in this site (Tabled 1b and 2b). Routine testing for oropharyngeal and asymptomatic ano-rectal STI:s in MSM in different settings has revealed a Gonorrhoea prevalence of 1,7-9,2% and 5,0-6,9%, respectively, and a chlamydia prevalence of 1,2-1,7% and 4,7-8,0%, respectively [1, 7, 18-20, 28, 29].…”

Section: Localized Asymptomatic Stismentioning

confidence: 75%

“…Oro-pharyngeal Gonorrhoea is more difficult to eradicate than ano-genital with approximately 9-10% treatment failures on single dose cefixime or ceftriaxone -a further contributing factor to a reservoir for continuing transmission [27,34]. Treatment with single dose cefixime in combination with 1 g azithromycin has improved efficacy and been reported, in some studies with small numbers of patients, to result in 100% negative control cultures [34].…”

Section: Oro-pharyngealmentioning

confidence: 99%

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Sexually Transmitted Infections (STI) in Men Who Have Sex with Men (MSM)

Bratt¹,

Edlund²,

Cullberg³

et al. 2009

TOIDJ

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Abstract:The impact of increasingly efficient antiretroviral therapy (ART) on survival and general well-being has contributed to a "business as usual" attitude to sex among men who have sex with men (MSM). There has been a recent marked increase of sexually transmitted infections (STI) including syphilis, LGV and Hepatits C among MSM. STIs located in the oral cavity or rectum are asymptomatic in over 80% and 50%, respectively and these sites must be seen as important reservoirs. On the other hand severe proctitis may be mistreated as inflammatory bowel disease without adequate medical history and testing. Due to the reappearance of syphilis, all genital ulcers, non-itching exanthema and severe disease symptoms (e.g. fever, fatigue, lymphadenopathy, hepato-splenomegaly, increased liver enzymes, neurological and ophthalmologic symptoms without other explanations) should lead to testing for syphilis. There is a marked association between STIs and HIV. Syphilis, LGV and Hepatits C are strongly overrepresented in HIV positive MSM, while gonorrhoea, LGV and syphilis increase the HIV susceptibility. Syphilis leads to increased viral load in HIV positive. The major risk factors for Hepatitis B are number of sex partners and receptive anal intercourse. High grade Human Papilloma Virus (HPV) anal lesions can progress to cancer. There is a 30 fold increase risk for anal cancer among MSM, a risk that is doubled in HIV infection, making anal cancer one of the most common non-AIDS tumours. All MSM should be offered Hepatitis A and B vaccination and the inclusion of boys in HPV vaccination programs must be considered. The aim of this article is to describe asymptomatic and symptomatic bacterial and viral STIs of the oral cavity, penis/urethra and rectum and the sexually transmittable viral Hepatitis and HIV in MSM and to inspire the medical establishment to adhere to testing guidelines in this group. This article is built on a review of published findings, the presentation of own data on Gonorrhoea and chlamydia and our own experience in treating all STIs including HIV in MSM since 1982 at a Gay Men's Health Clinic (Venhälsan) at Stockholm South General Hospital, Sweden.

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Section: Localized Asymptomatic Stismentioning

confidence: 75%

Section: Oro-pharyngealmentioning

confidence: 99%

Sexually Transmitted Infections (STI) in Men Who Have Sex with Men (MSM)

Bratt¹,

Edlund²,

Cullberg³

et al. 2009

TOIDJ

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show abstract

“…Three studies were identified that evaluated OP CT infection treatment outcomes with a doxycycline or azithromycin regimen [20,22,30]. Wikström et al reported that all 8 women and 1 heterosexual man treated with a doxycycline regimen (200 mg day 1, then 100 mg daily for 8 days) for OP CT infection had a negative repeat OP CT strand displacement amplification (SDA); the timing of repeat testing was not provided [20].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

Geisler

2015

Clin Infect Dis.

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In preparation for the 2015 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases (STD) Treatment Guidelines, the CDC convened an advisory group in 2013 to examine recent abstracts and published literature addressing the epidemiology, diagnosis, and management of STDs. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infection in adolescents and adults that were considered in development of the 2015 CDC STD Treatment Guidelines. The evidence reviewed primarily focused on CT infection risk factors in women, clinical significance of oropharyngeal CT detection, acceptability and performance of CT testing on self-collected specimens in men, performance of CT point-of-care tests, efficacy of recommended and investigational CT infection treatments, and timing of test of cure following CT infection treatment in pregnant women.Keywords. chlamydia; diagnosis; management; CDC; guidelines.Chlamydia trachomatis (CT) infection is the most frequently reported bacterial sexually transmitted infection in the United States and remains highly prevalent, with >1.4 million cases reported to the Centers for Disease Control and Prevention (CDC) annually [1]. Young age is a strong predictor of CT infection, with the highest CT infection prevalence in persons <25 years of age [1]. Because the majority of CT infections are asymptomatic, detection of infection often relies on screening. The 2010 CDC Sexually Transmitted Diseases (STD) Treatment Guidelines recommends annual CT screening in all sexually active women 25 years of age or younger and also older women with risk factors (eg, those who have a new sex partner or multiple sex partners) [2]. Benefits of CT screening in women have been demonstrated in areas where screening programs have reduced rates of pelvic inflammatory disease (PID) [3,4], a precursor of infertility, and recent literature suggests a continued decline in PID rates in the United States [5].The approach to the diagnosis and management of uncomplicated CT infection in adolescents and adults includes (1) CT testing using nucleic acid amplification tests (NAATs); (2) treatment with CDC-recommended therapy to reduce complications and prevent transmission to others; (3) treatment of sexual partners to prevent reinfection of patients and complications in patients and partners; (4) risk-reduction counseling; (5) repeat CT testing a few months following treatment to identify repeat infection; and (6) in pregnant women at a minimum of 3 weeks following treatment to identify persisting or repeat infection so that repeat treatment can be provided promptly to reduce risk for maternal and neonatal morbidity.Following release of the 2010 CDC STD Treatment Guidelines [2], unanswered questions and topics requiring further study on the epidemiology, diagnosis, and management of uncomplicated CT infection remained. In preparation for the 2015 CDC STD Treatment Guidelines, the CDC convened an advisory group in...

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“…[56][57][58][59][60]71,72 This correlates with the pharmacokinetic properties of the individual antimicrobials. Treatment with spectinomycin has poor efficacy at eradicating pharyngeal gonorrhoea.…”

Section: Therapy For Uncomplicated Gonococcal Infection Of the Pharynxmentioning

confidence: 99%

“…16 Test of cure is particularly important to perform to ensure effective eradication of pharyngeal infection, which is substantially harder to treat than genital and anorectal infections. [56][57][58][59][60]71,72 When symptoms persist after treatment, culture is recommended to identify persisting infection and for antimicrobial sensitivity testing and may be performed 3-7 days after completion of therapy, possibly supplemented a week later with a NAAT for increased sensitivity if culture is negative. Tests of cure in asymptomatic patients can be performed with a NAAT 2 weeks after completion of treatment and ideally, all positives should be cultured and antibiotic susceptibility testing performed before further treatment is given [IV; C].…”

Section: Follow Up and Test Of Curementioning

confidence: 99%