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Unemo, M., Clarke, E., Boiko, I., Patel, C. & Patel, R. (2020). Adherence to the 2012 European gonorrhoea guideline in the WHO European Region according to the 2018-19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group gonorrhoea survey. International Journal of STD and AIDS (London), 31(1), 69-76
Open this publication in new window or tab >>Adherence to the 2012 European gonorrhoea guideline in the WHO European Region according to the 2018-19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group gonorrhoea survey
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2020 (English)In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 31, no 1, p. 69-76Article in journal (Refereed) Published
Abstract [en]

Gonorrhoea is a major public health problem globally. Increasing incidence in many particularly developed countries and the emergence of resistance to the extended-spectrum cephalosporin ceftriaxone, the last option for empiric first-line monotherapy, are of serious concern. This paper evaluates the results of the 2018-19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group survey on the diagnosis and treatment of gonorrhoea in Europe. Although high quality clinical care was reported in many European settings, in several countries the testing, diagnostics, antimicrobial treatment, and follow-up of gonorrhoea patients were evidently suboptimal. Increased adherence to evidence-based European and/or nationally-adapted management guidelines is essential in controlling the increasing incidence of gonorrhoea in many European settings and the spread of ceftriaxone-resistant, multidrug-resistant, and extensively drug-resistant gonorrhoea.

Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
Europe, Neisseria gonorrhoeae, antimicrobial resistance, azithromycin, ceftriaxone, culture, nucleic acid amplification test, screening, testing
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-78824 (URN)10.1177/0956462419879278 (DOI)000502917900001 ()31842695 (PubMedID)2-s2.0-8507715949 (Scopus ID)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2020-01-14Bibliographically approved
Pitt, R., Unemo, M., Sonnenberg, P., Alexander, S., Beddows, S., Cole, M. J., . . . Field, N. (2020). Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population. Sexually Transmitted Infections, Article ID sextrans-2019-054129.
Open this publication in new window or tab >>Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population
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2020 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, article id sextrans-2019-054129Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: among the sexually-active British general population.

METHODS: genes to detect known genotypic determinants for resistance to macrolides and fluoroquinolones respectively.

RESULTS: D87N/D87Y) in 3.3% (0.9%-11.2%). Macrolide resistance was more likely in participants reporting STI diagnoses (past 5 years) (44.4% (18.9%-73.3%) vs 10.6% (4.6%-22.6%); p=0.029) or sexual health clinic attendance (past year) (43.8% (23.1%-66.8%) vs 5.0% (1.4%-16.5%); p=0.001). All 11 participants with AMR-conferring mutations had attended sexual health clinics (past 5 years), but none reported recent symptoms.

CONCLUSIONS: reported symptoms. Given anticipated increases in diagnostic testing, new strategies including novel antimicrobials, AMR-guided therapy, and surveillance of AMR and treatment failure are recommended.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
Keywords
Mycoplasma genitalium, antibiotic resistance, molecular epidemiology, mycoplasma, public health
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-78962 (URN)10.1136/sextrans-2019-054129 (DOI)31924741 (PubMedID)
Available from: 2020-01-14 Created: 2020-01-14 Last updated: 2020-01-14Bibliographically approved
Clarke, E., Patel, C., Patel, R. & Unemo, M. (2020). The 2018-19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group report on the diagnosis and treatment of gonorrhoea in Europe. International Journal of STD and AIDS (London), 31(1), 77-81
Open this publication in new window or tab >>The 2018-19 International Union against Sexually Transmitted Infections European Collaborative Clinical Group report on the diagnosis and treatment of gonorrhoea in Europe
2020 (English)In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 31, no 1, p. 77-81Article in journal (Refereed) Published
Abstract [en]

The European Collaborative Clinical Group (ECCG) has been surveying clinical management of sexually transmitted infections (STIs) in Europe since its inauguration in 2011. The ECCG is a network of nearly 130 STI specialists from 34 European countries who conduct questionnaire-based research across the European region. The research of ECCG focuses on providing data regarding clinical practice to inform European STI guideline development and revisions. The present paper describes the results of the 2018–19 ECCG survey regarding diagnosis and treatment of gonorrhoea in Europe.

Place, publisher, year, edition, pages
Royal Society of Medicine Press, 2020
Keywords
Europe, Neisseria gonorrhoeae, antimicrobial resistance, azithromycin, ceftriaxone, culture, nucleic acid amplification test, screening, testing
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-78551 (URN)10.1177/0956462419879270 (DOI)000500657900001 ()31793388 (PubMedID)2-s2.0-85077161346 (Scopus ID)
Available from: 2019-12-13 Created: 2019-12-13 Last updated: 2020-01-13Bibliographically approved
de Vries, H. J., de Barbeyrac, B., de Vrieze, N. H., Viset, J. D., White, J. A., Vall-Mayans, M. & Unemo, M. (2019). 2019 European guideline on the management of lymphogranuloma venereum. Journal of the European Academy of Dermatology and Venereology, 33(10), 1821-1828
Open this publication in new window or tab >>2019 European guideline on the management of lymphogranuloma venereum
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2019 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 33, no 10, p. 1821-1828Article in journal (Refereed) Published
Abstract [en]

New or important issues in this updated version of the 2013 European guideline on the management of lymphogranuloma venereum (LGV):

EPIDEMIOLOGY: Lymphogranuloma venereum continues to be endemic among European men who have sex with men (MSM) since 2003. Lymphogranuloma venereum infections in heterosexuals are extremely rare in Europe, and there is no evidence of transmission of LGV in the European heterosexual population.

AETIOLOGY AND TRANSMISSION: Chlamydia trachomatis serovars/genovars L2b and L2 are the causative strains in the majority of cases in Europe.

CLINICAL FEATURES: Among MSM, about 25% of the anorectal LGV infections are asymptomatic. Genital infections among MSM are rare; the ratio of genital vs. anorectal LGV infections is 1 in 15.

DIAGNOSIS: To diagnose LGV, a sample tested C. trachomatis positive with a commercial nucleic acid amplification test (NAAT) platform should be confirmed with an LGV discriminatory NAAT.

TREATMENT: Doxycycline 100 mg twice a day orally for 21 days is the recommended treatment for LGV. This same treatment is recommended also in asymptomatic patients and contacts of LGV patients. If another regimen is used, a test of cure (TOC) must be performed.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019
National Category
Infectious Medicine Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:oru:diva-75615 (URN)10.1111/jdv.15729 (DOI)000490897700031 ()31243838 (PubMedID)2-s2.0-85073306839 (Scopus ID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-11-15Bibliographically approved
Attram, N., Agbodzi, B., Dela, H., Behene, E., Nyarko, E. O., Kyei, N. N. A., . . . Letizia, A. G. (2019). Antimicrobial resistance (AMR) and molecular characterization of Neisseria gonorrhoeae in Ghana, 2012-2015. PLoS ONE, 14(10), Article ID e0223598.
Open this publication in new window or tab >>Antimicrobial resistance (AMR) and molecular characterization of Neisseria gonorrhoeae in Ghana, 2012-2015
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 10, article id e0223598Article in journal (Refereed) Published
Abstract [en]

Neisseria gonorrhoeae antimicrobial resistance (AMR) surveillance is essential for tracking the emergence and spread of AMR strains in local, national and international populations. This is crucial for developing or refining treatment guidelines. N. gonorrhoeae multiantigen sequence typing (NG-MAST) is beneficial for describing the molecular epidemiology of gonococci at national and international levels. Elucidation of AMR determinants to β-lactam drugs, is a means of monitoring the development of resistance. In Ghana, little is known about the current gonococcal AMR prevalence and no characterization of gonococcal isolates has been previously performed. In this study, gonococcal isolates (n = 44) collected from five health facilities in Ghana from 2012 to 2015, were examined using AMR testing, NG-MAST and sequencing of penA. High rates of resistance were identified to tetracycline (100%), benzylpenicillin (90.9%), and ciprofloxacin (81.8%). One isolate had a high cefixime MIC (0.75 μg/ml). Twenty-eight NG-MAST sequence types (STs) were identified, seventeen of which were novel. The isolate with the high cefixime MIC contained a mosaic penA-34 allele and belonged to NG-MAST ST1407, an internationally spreading multidrug-resistant clone that has accounted for most cefixime resistance in many countries. In conclusion, AMR testing, NG-MAST, and sequencing of the AMR determinant penA, revealed high rates of resistance to tetracycline, benzylpenicillin, and ciprofloxacin; as well as a highly diverse population of N. gonorrhoeae in Ghana. It is imperative to continue with enhanced AMR surveillance and to understand the molecular epidemiology of gonococcal strains circulating in Ghana and other African countries.

Place, publisher, year, edition, pages
PLOS, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-77257 (URN)10.1371/journal.pone.0223598 (DOI)31600300 (PubMedID)
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2019-10-14Bibliographically approved
Boiko, I., Golparian, D., Krynytska, I., Bezkorovaina, H., Frankenberg, A., Onuchyna, M., . . . Unemo, M. (2019). Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and treatment of gonorrhoea patients in Ternopil and Dnipropetrovsk regions of Ukraine, 2013-2018. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 127(7), 503-509
Open this publication in new window or tab >>Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and treatment of gonorrhoea patients in Ternopil and Dnipropetrovsk regions of Ukraine, 2013-2018
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2019 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 127, no 7, p. 503-509Article in journal (Refereed) Published
Abstract [en]

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health concern globally. However, recent gonococcal AMR data from Eastern Europe are extremely limited and no AMR data for strains spreading in Ukraine have ever been internationally published. We investigated the AMR of N. gonorrhoeae isolates in two regions of Ukraine (Ternopil 2013-2018, Dnipropetrovsk 2013-2014), and, where information was available, the treatment administered to the corresponding gonorrhoea patients. Determination of minimum inhibitory concentration (MIC) of eight antimicrobials was performed using Etest and resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied. Overall, 9.3% of the examined 150 isolates were resistant to ciprofloxacin, 6.0% to tetracycline, 2.0% to azithromycin, and 0.7% to benzylpenicillin. No isolates were resistant to ceftriaxone, cefixime, spectinomycin, or gentamicin. However, one (0.7%) isolate showed a MIC value of 0.125 mg/L for both ceftriaxone and cefixime, i.e., bordering resistance. Eighty-eight (67.2%) of 131 patients were administered dual therapy (ceftriaxone 1 g plus doxycycline/clarithromycin/azithromycin/ofloxacin) and 22 (16.8%) ceftriaxone 1 g monotherapy. Worryingly, 21 (16.0%) patients received monotherapy with clarithromycin/doxycycline/azithromycin/ofloxacin/benzylpenicillin. In conclusion, the antimicrobial susceptibility of gonococcal strains spreading in Ternopil and Dnipropetrovsk, Ukraine during 2013-2018 was high. Low levels of resistance to ciprofloxacin, tetracycline, azithromycin, and benzylpenicillin were found, but no resistance to the internationally recommended ceftriaxone, cefixime, or spectinomycin. Ceftriaxone 1 g should remain as empiric first-line treatment, in dual therapy with azithromycin or doxycycline or in monotherapy. Continued and expanded gonococcal AMR surveillance in Ukraine is essential to monitor the susceptibility to particularly extended-spectrum cephalosporins, azithromycin and doxycycline.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Neisseria gonorrhoeae, Gonorrhoea, antimicrobial resistance (AMR), ceftriaxone, azithromycin, Ukraine
National Category
Immunology in the medical area Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-75208 (URN)10.1111/apm.12948 (DOI)000473620900002 ()30903707 (PubMedID)
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Bruni, M. P., Freitas da Silveira, M., Stauffert, D., Bicca, G. L., Caetano Dos Santos, C., da Rosa Farias, N. A., . . . Unemo, M. (2019). Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study. Sexually Transmitted Infections, 95(2), 129-132
Open this publication in new window or tab >>Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study
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2019 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, no 2, p. 129-132Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Trichomonas vaginalis (TV) infection is the most common non-viral STI globally and can result in adverse pregnancy outcomes and exacerbated HIV acquisition/transmission. Nucleic acid amplification tests (NAATs) are the most sensitive diagnostic tests, with high specificity, but TV NAATs are rarely used in Brazil. We investigated the TV prevalence and compared the performance of the US Food and Drug Association-cleared Aptima TV assay with microscopy (wet mount and Gram-stained) and culture for TV detection in women in Pelotas, Brazil in an observational study.

METHODS: From August 2015 to December 2016, 499 consecutive asymptomatic and symptomatic sexually active women attending a Gynaecology and Obstetrics Outpatient Clinic were enrolled. Vaginal fluid and swab specimens were collected and wet mount microscopy, Gram-stained microscopy, culture and the Aptima TV assay performed.

RESULTS: The median age of enrolled women was 36.5 years (range: 15-77). The majority were white, had a steady sexual partner and low levels of education. The TV detection rate was 4.2%, 2.4%, 1.2% and 0% using the Aptima TV assay, culture, wet mount microscopy and Gram-stained microscopy, respectively. The sensitivity of culture and wet mount microscopy was only 57.1% (95% CI 36.5 to 75.5) and 28.6% (95% CI 13.8 to 50.0), respectively.

CONCLUSIONS: was found among women in Pelotas, Brazil and the routine diagnostic test (wet mount microscopy) and culture had low sensitivities. More sensitive diagnostic tests (NAATs) and enhanced testing of symptomatic and asymptomatic at-risk women are crucial to mitigate the transmission of TV infection, TV-associated sequelae and enhanced HIV acquisition and transmission.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Aptima, Brazil, culture, nucleic acid amplification test (NAAT), trichomonas infection, trichomonas vaginalis, wet mount microscopy
National Category
Obstetrics, Gynecology and Reproductive Medicine Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-68678 (URN)10.1136/sextrans-2018-053635 (DOI)000471868700012 ()30154157 (PubMedID)2-s2.0-85052888876 (Scopus ID)
Note

Funding Agencies:

Programa de Apoio a Pos-Graduacao (PROAP)  

Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), Brasilia, DF, Brazil  

Örebro County Council Research Committee  

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden 

Available from: 2018-09-03 Created: 2018-09-03 Last updated: 2019-11-08Bibliographically approved
Bettoni, S., Shaughnessy, J., Maziarz, K., Ermert, D., Jacobsson, S., Riesbeck, K., . . . Ram, S. (2019). C4BP-IGM FUSION PROTEIN AS A NOVEL THERAPEUTIC APPROACH TO TREAT NEISSERIA GONORRHOEAE INFECTIONS. Paper presented at 17th European Meeting on Complement in Human Disease (EMCHD 2019), Madrid, Spain, September 14-17, 2019. Molecular Immunology, 114, 470-470
Open this publication in new window or tab >>C4BP-IGM FUSION PROTEIN AS A NOVEL THERAPEUTIC APPROACH TO TREAT NEISSERIA GONORRHOEAE INFECTIONS
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2019 (English)In: Molecular Immunology, ISSN 0161-5890, E-ISSN 1872-9142, Vol. 114, p. 470-470Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Cell and Molecular Biology Immunology in the medical area
Identifiers
urn:nbn:se:oru:diva-77669 (URN)000490625600222 ()
Conference
17th European Meeting on Complement in Human Disease (EMCHD 2019), Madrid, Spain, September 14-17, 2019
Available from: 2019-10-30 Created: 2019-10-30 Last updated: 2019-10-30Bibliographically approved
Bettoni, S., Shaughnessy, J., Maziarz, K., Ermert, D., Gulati, S., Zheng, B., . . . Blom, A. M. (2019). C4BP-IgM protein as a therapeutic approach to treat Neisseria gonorrhoeae infections. JCI Insight, 4(23), Article ID 131886.
Open this publication in new window or tab >>C4BP-IgM protein as a therapeutic approach to treat Neisseria gonorrhoeae infections
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2019 (English)In: JCI Insight, ISSN 2379-3708, Vol. 4, no 23, article id 131886Article in journal (Refereed) Published
Abstract [en]

Gonorrhea is a sexually transmitted infection with 87 million new cases per year globally. Increasing antibiotic resistance has severely limited treatment options. A mechanism that Neisseria gonorrhoeae uses to evade complement attack is binding of the complement inhibitor C4b-binding protein (C4BP). We screened 107 porin B1a (PorB1a) and 83 PorB1b clinical isolates randomly selected from a Swedish strain collection over the last 10 years and noted that 96/107 (89.7%) PorB1a and 16/83 (19.3%) PorB1b bound C4BP; C4BP binding substantially correlated with the ability to evade complement-dependent killing (r = 0.78). We designed 2 chimeric proteins that fused C4BP domains to the backbone of IgG or IgM (C4BP-IgG; C4BP-IgM) with the aim of enhancing complement activation and killing of gonococci. Both proteins bound gonococci (KD C4BP-IgM = 2.4 nM; KD C4BP-IgG 980.7 nM), but only hexameric C4BP-IgM efficiently outcompeted heptameric C4BP from the bacterial surface, resulting in enhanced complement deposition and bacterial killing. Furthermore, C4BP-IgM substantially attenuated the duration and burden of colonization of 2 C4BP-binding gonococcal isolates but not a non-C4BP-binding strain in a mouse vaginal colonization model using human factor H/C4BP-transgenic mice. Our preclinical data present C4BP-IgM as an adjunct to conventional antimicrobials for the treatment of gonorrhea.

Place, publisher, year, edition, pages
American Society for Clinical Investigation (ASCI), 2019
Keywords
Bacterial infections, Complement, Immunotherapy, Infectious disease, Therapeutics
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-78562 (URN)10.1172/jci.insight.131886 (DOI)000500946900014 ()31661468 (PubMedID)
Funder
Swedish Research Council Formas, 2018-02392
Note

Funding Agencies:

United States Department of Health & Human Services

National Institutes of Health (NIH) - USA AI119327 AI114790 AI132296 AI147930 AI136007

Söderberg Foundation  

Österlund Foundation  

Royal Physiographic Society of Lund  

Sten K. Johnsons Foundation 

Available from: 2019-12-13 Created: 2019-12-13 Last updated: 2019-12-19Bibliographically approved
Rowley, J., Vander Hoorn, S., Korenromp, E., Low, N., Unemo, M., Abu-Raddad, L. J., . . . Taylor, M. M. (2019). Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bulletin of the World Health Organization, 97(8), 548-562P
Open this publication in new window or tab >>Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016
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2019 (English)In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 97, no 8, p. 548-562PArticle in journal (Refereed) Published
Abstract [en]

Objective: To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15-49 years, in 2016.

Methods: For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI.

Findings: For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period.The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 33-4.5); gonorrhoea 0.9% (95% UI: 0.7-1.1); trichomoniasis 53% (95% UI:4.0-7.2); and syphilis 0.5% (95% UI: 0.4-0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9-3.7); gonorrhoea 0.7% (95% UI: 05-1.1); trichomoniasis 0.6% (95% UI: 0.4-0.9); and syphilis 05% (95% UI: 0.4-0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1-165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6-123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4-231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 55-7.1 million) syphilis cases.

Conclusion: Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016-2021.

Place, publisher, year, edition, pages
World Health Organization, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:oru:diva-75706 (URN)10.2471/BLT.18.228486 (DOI)000477948400015 ()31384073 (PubMedID)
Note

Funding Agencies:

U.S. Centers for Disease Control and Prevention  

United Kingdom Department for International Development  

World Health Organization Human Reproduction Programme  

Qatar National Research Fund  NPRP 9-040-3-008 

Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-1710-2081

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