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  • 1.
    Bruni, Mirian Pinheiro
    et al.
    Biology Institute, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Freitas da Silveira, Mariangela
    School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Stauffert, Dulce
    School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Bicca, Guilherme Lucas de Oliveira
    School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Caetano Dos Santos, Carolina
    Biology Institute, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    da Rosa Farias, Nara Amélia
    Biology Institute, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine.
    Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr 2, s. 129-132Artikel i tidskrift (Refereegranskat)
    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.

  • 2.
    Clifton, Soazig
    et al.
    University College London, Institute for Global Health, London, UK.
    Field, Nigel
    University College London, Institute for Global Health, London, UK.
    Prior, Gillian
    University College London, Institute for Global Health, London, UK.
    Aldridge, Robert
    University College London, Institute for Health Informatics, London, UK.
    Bonell, Chris
    London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK.
    Copas, Andrew
    University College London, Institute for Global Health, London, UK.
    Gibbs, Jo
    University College London, Institute for Global Health, London, UK.
    Macdowall, Wendy
    London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK.
    Mitchell, Kirstin
    University of Glasgow, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK.
    Tanton, Clare
    London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, UK.
    Thomson, Nicholas
    Wellcome Trust Sanger Institute, Pathogen Genomics, Hinxton, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Sonnenberg, Pam
    University College London, Centre for Population Research in Sexual Health and HIV, Institute for Global Health, London, UK.
    Mercer, Catherine
    University College London, Centre for Population Research in Sexual Health and HIV, Institute for Global Health, London, UK.
    WHAT IS THE OPTIMUM METHOD FOR COLLECTING ROBUST DATA TO UNDERSTAND A NATION'S SEXUAL HEALTH NEEDS?2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr Suppl. 1, s. A181-A181Artikel i tidskrift (Övrigt vetenskapligt)
  • 3.
    Dahlberg, Jenny
    et al.
    Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hadad, Ronza
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Elfving, Karin
    Department of Clinical Microbiology, Falu Lasarett, Falun, Sweden.
    Larsson, Inger
    Department of Clinical Microbiology, Sunderby Hospital, Luleå, Sweden.
    Isaksson, Jenny
    Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Magnuson, Anders
    Fredlund, Hans
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Unemo, Magnus
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Herrmann, Bjőrn
    Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Ten years transmission of the new variant of Chlamydia trachomatis in Sweden: prevalence of infections and associated complications2018Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 94, nr 2, s. 100-104Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: In 2006, a new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden. It has a deletion in the plasmid resulting in failed detection by the single target systems from Abbott and Roche used at that time, whereas the third system used, from Becton Dickinson (BD), detects nvCT. The proportion of nvCT was initially up to 65% in counties using Abbott/Roche systems. This study analysed the proportion of nvCT from 2007 to 2015 in four selected counties and its impact on chlamydia-associated complications.

    METHODS: C. trachomatis-positive specimens collected from 2007 to 2015 were analysed by a specific PCR to identify nvCT cases. Genotyping was performed by multilocus sequence typing (MLST) and ompA sequencing. Ectopic pregnancy and pelvic inflammatory disease records were extracted from the national registers.

    RESULTS: In total, 5101 C. trachomatis-positive samples were analysed. The nvCT proportion significantly decreased in the two counties using Roche systems, from 56% in 2007 to 6.5% in 2015 (p<0.001). In the two counties using BD systems, a decrease was also seen, from 19% in 2007 to 5.2% in 2015 (p<0.001). Fifteen nvCT cases from 2015 and 102 cases from 2006 to 2009 had identical MLST profiles. Counties using Roche/Abbott systems showed higher mean rates of ectopic pregnancy and pelvic inflammatory disease compared with counties using BD systems.

    CONCLUSIONS: The nvCT proportion has decreased in all counties and converged to a low prevalence irrespective of previous rates. Genotyping showed that nvCT is clonal and genetically stable. Failing detection only marginally affected complication rates.

  • 4.
    Day, Michaela
    et al.
    Public Health England, National Infection Service, London, UK.
    Cole, Michelle
    Public Health England, National Infection Service, London, UK.
    Spiteri, Gianfranco
    ECDC, Stockholm, Sweden.
    Jacobsson, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Woodford, Neil
    Public Health England, National Infection Service, London, UK.
    Amato-Gauci, Andrew
    ECDC, Stockholm, Sweden.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    THE EUROPEAN GONOCOCCAL ANTIMICROBIAL SURVEILLANCE PROGRAMME FINDINGS 20172019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr Suppl. 1, s. A43-A43Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) annually investigates antimicrobial susceptibility data for Neisseria gonorrhoeae with patient epidemiological data to monitor current and emerging trends in antimicrobial resistance (AMR) across Europe. Susceptibility to ceftriaxone and azithromycin, currently recommended for combination treatment in the European management guideline, has decreased in the past; regular surveillance of AMR is cru-cial. We present the main Euro-GASP findings from 2017.

    Methods: Agar dilution and minimum inhibitory concentration (MIC) gradient strip tests were used to determine the antimicrobial susceptibility to cefixime, ceftriaxone and azithromycin (using EUCAST breakpoints) of 3248 N. gonorrhoeae isolates collected in 2017 from 27 countries across the European Union/European Economic Area (EU/EEA). Significance of changes in resistance compared to 2016 was analysed using Z-tests.

    Results: There were no isolates with ceftriaxone resistance (MIC>0.125 mg/L) (zero in 2016), 7.5% of isolates were azithromycin resistant (MIC>0.5 mg/L) (7.5% in 2016; p=0.93) and cefixime resistance (MIC>0.125 mg/L) was observed in 1.9% of isolates (2.1% in 2016; p=0.53). Seven isolates from four countries displayed high-level azithromycin resistance (MIC256 mg/L), which is the same number as observed in 2016, although in different countries (five countries in 2016). Ceftriaxone MICs for 28 isolates (0.9%) were 0.125 mg/L (on the resistance breakpoint) which is double the number observed in 2016 (14 isolates, 0.5%) although this increase is not statistically significant (p=0.33). Of the 28 isolates on the ceftriaxone resistance breakpoint, four showed intermediate susceptibility to azithromycin.

    Conclusion: Ceftriaxone, azithromycin and cefixime resistance levels remained stable compared with 2016. However, the current azithromycin resistance rate of 7.5% and the number of isolates on the resistance breakpoint for ceftriaxone threaten the effectiveness of the currently recommended European therapeutic regimen of ceftriaxone 500 mg plus azithromycin 2 g. Continued surveillance is essential together with, ultimately, development of new effective antimicrobials.

  • 5.
    Foerster, Sunniva
    et al.
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro, Sweden.
    Drusano, George
    University of Florida, Orlando, USA.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. WHO Collaborating Centre for Gonorrhoea and Other STIs.
    Neely, Michael
    University of Southern California, Los Angeles, USA.
    Piddock, Laura
    Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland.
    Alirol, Emilie
    Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs.
    IN VITRO COMBINATION TESTING AND SELECTION OF RESISTANCE TO ZOLIFLODACIN COMBINED WITH SIX ANTIMICROBIALS FOR N. GONORRHOEAE2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr Suppl. 1, s. A50-A50Artikel i tidskrift (Övrigt vetenskapligt)
  • 6.
    Guy, Rebecca J.
    et al.
    The Kirby Institute, University of New South Wales, Sydney, Australia.
    Causer, Louise M.
    The Kirby Institute, University of New South Wales, Sydney, Australia.
    Klausner, Jeffrey D.
    Department of Global Health, University of California, San Francisco, USA.
    Unemo, Magnus
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Toskin, Igor
    Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
    Azzini, Anna M.
    Verona University, Verona, Veneto, Italy.
    Peeling, Rosanna W.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Performance and operational characteristics of point-of-care tests for the diagnosis of urogenital gonococcal infections2017Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 93, nr Suppl. 4, s. S16-S21Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: In 2012, there was an estimated 78 million new cases of gonorrhoea globally. Untreated infection may lead to reproductive and neonatal morbidity and facilitate HIV transmission. Diagnosis and treatment are a priority for control and prevention, yet use of point-of-care tests (POCTs) for Neisseria gonorrhoeae (NG) is limited.

    Objectives: To review the performance and operational characteristics of NG POCTs for diagnosis of urogenital gonorrhoea.

    Methods: We compiled and synthesised findings from two separate systematic reviews which included evaluations published until August 2015.

    Results: Six tests were included: five were immunochromatographic tests (ICTs) or optical immunoassay (OIAs) based on antigen detection; with 5-7 steps and results in 25-40 min, and one (GeneXpert CT/NG) was a 'near-patient test' based on nucleic acid amplification technique (NAAT); with three steps, electricity required, and results in 90 min. When compared with laboratory-based NAATs as the reference tests, sensitivities of ICT and OIA-based POCTs ranged from 12.5% to 70% when cervical/vaginal swabs were tested. Specificities ranged from 89% to 99.8%. The near-patient NAAT had sensitivities of >95% and specificities of >99.8% consistently across all specimen types (urine, cervical and vaginal swabs).

    Conclusions: Based on a limited number of evaluations, antigen detection POCTs for NG lacked sufficient sensitivity to be used for screening. A near-patient NAAT has acceptable performance, only involved a few steps, but needs electricity, a temperature-controlled environment and has a 90 min run time. To achieve wider scale up of NG POCTs, we need strong evidence of cost-effectiveness, which should inform guidelines and ultimately increase test development, demand and reduce costs.

  • 7. Hadad, Ronza
    et al.
    Fredlund, Hans
    Örebro universitet, Hälsoakademin.
    Unemo, Magnus
    Örebro universitet, Hälsoakademin.
    Evaluation of the new COBAS TaqMan CT test v2.0 and impact on the proportion of new variant Chlamydia trachomatis by the introduction of diagnostics detecting new variant C trachomatis in Örebro county, Sweden2008Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 85, s. 190-193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The new variant of Chlamydia trachomatis (nvCT), discovered in Sweden in 2006, contains a 377-bp cryptic plasmid deletion, which includes the targets for the COBAS Amplicor/TaqMan C trachomatis/Neisseria gonorrhoea and Abbott m2000rt C trachomatis/N gonorrhoea tests.

    Objectives: To evaluate the new real-time COBAS TaqMan CT test v2.0 (CTM CT v2.0) for C trachomatis diagnostics and to investigate whether the proportion of nvCT was affected by the introduction of genetic diagnostics detecting nvCT (LightMix 480HT) in Örebro county, Sweden.

    Methods: CTM CT v2.0 compared with LightMix 480 HT PCR for the diagnosis of C trachomatis was evaluated. Discrepant samples were analysed using BD ProbeTec ET and Abbott m2000rt RealTime CT II. All previously LightMix and cell culture-positive samples were analysed using an nvCT-specific PCR.

    Results: The sensitivity, specificity, negative predictive value and positive predictive value of CTM CT v2.0 for examined samples (n  =  1058) was 100%, 99.8%, 100% and 98.2%, respectively. Of 11 577 consecutive PCR samples, 9.4% (n  =  1084) were positive and 34.3% (n  =  372) of these were nvCT. Of 2306 consecutive culture samples, 5.0% (n  =  116) were C trachomatis positive and 38.8% (n  =  45) of these were nvCT.

    Conclusions: CTM CT v2.0 is a sensitive and specific method for C trachomatis detection. Studies including larger numbers of symptomatic and asymptomatic patients as well as genital and extragenital samples, and in comparison with other internationally validated and, ideally, US Food and Drug Administration-approved C trachomatis nucleic acid amplification tests are imperative. The proportion of nvCT remains high in Örebro county, Sweden, despite the introduction of genetic diagnostics to detect the mutant. 

  • 8.
    Idahl, Annika
    et al.
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
    Jurstrand, Margaretha
    Faculty of Medicine and Health, Clinical Research Centre, Örebro University, Örebro, Sweden.
    Olofsson, Jan I.
    Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Fredlund, Hans
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Mycoplasma genitalium serum antibodies in infertile couples and fertile women2015Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 91, nr 8, s. 589-591Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The association between Mycoplasma genitalium (M. genitalium) serum antibodies and infertility in women and men, as well as infertility subtypes, was investigated.

    Methods: Stored serum was obtained from two patient cohorts: infertile couples (239 women and 243 men) attending a gynaecological outpatient clinic between October 1997 and February 2001 and 244 age-matched spontaneously pregnant women. An enzyme immunoassay was used to detect serum immunoglobulin G (IgG) antibodies to M. genitalium in these samples. Patient's Chlamydia trachomatis seropositivity had been previously determined. Risks were calculated using multivariate logistic regression.

    Results: M. genitalium serum IgG was more common among women of infertile couples (5.4%) than among fertile controls (1.6%) (OR (95% CI) 3.45 (1.10 to 10.75)), adjusting for C. trachomatis IgG (adjusted OR=3.00 (0.95 to 9.47)). Of the women with tubal factor infertility (TFI) 9.1% had M. genitalium IgG compared with 4.6% of women without TFI (OR=2.07 (0.60 to 7.05)); (AOR=1.20 (0.32 to 74.40)). In patients IgG positive to both microorganisms the OR for having TFI was increased (OR=4.86 (1.22 to 19.36)) compared with those positive to C. trachomatis IgG only (AOR=3.14 (1.58 to 6.20)). No associations were found with other infertility diagnoses. Only two men of the infertile couples were M. genitalium IgG positive (0.8%).

    Conclusions: M. genitalium serum IgG was associated with infertility in women, however insignificant after adjustment for C. trachomatis IgG, but not with infertility subtypes within this study. M. genitalium IgG seroprevalence among men was very low and not associated with male factor infertility.

  • 9.
    Ison, Catherine A.
    et al.
    Microbiol Serv, Sexually Transmitted Bacteria Reference Unit, Publ Hlth England, London, England..
    Deal, Carolyn
    NIAID, Bethesda MD, USA.
    Unemo, Magnus
    Region Örebro län. Dept Lab Med, WHO Collaborating Ctr Gonorrhoea & Other STIs, Orebro Univ Hosp, Orebro, Sweden.
    Current and future treatment options for gonorrhoea2013Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 89, nr 4, s. 52-56Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The delivery of effective antimicrobial therapy is essential for public health control of gonorrhoea, in the absence of a suitable vaccine. The antimicrobial agent chosen should have high efficacy and quality, lack toxicity and give > 95% success when given empirically. Guidelines, which are informed by surveillance data, are used to aid clinicians in their choice of appropriate agent. Historically, gonorrhoea treatment has been delivered as a single, directly observed dose but this has resulted in failure of successive antimicrobial agents which have been replaced by a new antimicrobial to which resistance has been rare or non-existing. Following the drift towards decreased susceptibility and treatment failure to the extended spectrum cephalosporins, and the lack of 'new' alternative antimicrobials, the threat of difficult to treat or untreatable gonorrhoea has emerged. The challenge of maintaining gonorrhoea as a treatable infection has resulted in national, regional and global response or action plans. This review discusses different approaches to the future treatment of gonorrhoea including; use of ceftriaxone, the injectable cephalosporin at increased dosage; dual antimicrobial therapy; use of drugs developed for other infections and use of older agents, directed by rapid point of care tests, to susceptible infections. Finally, it is considered whether the time is right to readdress the possibility of developing an effective gonococcal vaccine, given the major advances in our understanding of natural infection, molecular pathogenesis and the revolution in molecular biology techniques.

  • 10.
    Ison, Catherine A.
    et al.
    Sexually Transmitted Bacteria Reference Unit, Health Protection Agency, London, UK.
    Golparian, Daniel
    WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Saunders, Pamela
    Sexually Transmitted Bacteria Reference Unit, Health Protection Agency, London, UK.
    Chisholm, Stephanie
    Sexually Transmitted Bacteria Reference Unit, Health Protection Agency, London, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Evolution of Neisseria gonorrhoeae is a continuing challenge for molecular detection of gonorrhoea: false negative gonococcal porA mutants are spreading internationally2013Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 89, nr 3, s. 197-201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Identification of genetic targets specific to Neisseria gonorrhoeae for use in molecular detection methods has been a challenge. The porA pseudogene in N gonorrhoeae has been commonly used but recently gonococcal isolates giving a negative result in these PCRs have been reported. Here we describe the characterisation of two such gonococcal isolates received by the reference service at the Health Protection Agency, London, England.

    Methods: Phenotypic characterisation was achieved using conventional biochemical and immunological tests, matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF-MS), antimicrobial susceptibility testing, serovar determination and detection of meningococcal PorA using monoclonal antibody 4BG4-E7. Genetic species confirmation was determined using commercial and in house PCRs and 16S rRNA gene sequencing. Molecular typing using the N gonorrhoeae multi-antigen sequence typing (NG-MAST) and multilocus sequence typing (MLST) was performed. The DNA sequence of the full-length gonococcal porA pseudogene was determined and compared with published sequences.

    Results: Both isolates were confirmed, biochemically and immunologically as N gonorrhoeae, but repeatedly gave negative results with two in house real-time PCR assays for the porA pseudogene. Further characterisation of these isolates identified the presence of a meningococcal porA sequence and showed these isolates belong to serovar Bropyst, and to NG-MAST sequence type (ST) 5967 and MLST ST1901.

    Conclusions: Gonococcal isolates that give false negative results with porA pseudogene PCR assays have now been identified in four countries, three of which are in Europe, and do not appear clonal. This report highlights the genetic diversity of N gonorrhoeae, which remains a challenge for the molecular detection methods.

  • 11.
    Jurstrand, Margaretha
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Fredlund, Hans
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Unemo, Magnus
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    The new variant of Chlamydia trachomatis was present as early as 2003 in Orebro County, Sweden, but remained undetected until 20062013Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 89, nr 7, s. 607-608Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives In 2006, a new variant of Chlamydia trachomatis (nvCT) was reported in Sweden. Because of a cryptic plasmid deletion, the nvCT was undetectable in several of the genetic diagnostic systems used worldwide at the time. This study aimed to evaluate whether the nvCT was present in specimens obtained from patients attending the outpatient sexually transmitted infection (STI) clinic at orebro University Hospital, orebro, Sweden already in 2002-2003. Methods In 2012, archival (-20 degrees C freezer) urogenital specimens (2002 (n=1083) and in 2003 (n=1143)) obtained from men (2002 (n=398) and 2003 (n=486)) and women (2002 (n=301) and 2003 (n=408)) were analysed with Cobas TaqMan CT test V.2.0. All C trachomatis positive specimens were subsequently examined using a duplex PCR assay that simultaneously detects the deletion on the nvCT cryptic plasmid and the ompA gene of C trachomatis genotype E. Results In total, 68 patients (9.7%) in 2002 and 61 (6.8%) in 2003 were C trachomatis positive. The duplex PCR assay identified 26 C trachomatis genotype E positive patients in 2002 (38%) and 25 in 2003 (41%). No nvCT was found in 2002, but one specimen obtained from a 23-year-old man in June 2003 was positive for the nvCT. Conclusions The nvCT was present as early as 2003 in orebro County, Sweden, which concurs with previously reported statistical estimations of its emergence. Accordingly, the nvCT spread undetected for at least 3years, explaining the high proportion (38%) in orebro County when it was first detected in late 2006.

  • 12.
    Kelly, Helen
    et al.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Coltart, Cordelia E. M.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Pai, Nitika Pant
    Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Canada.
    Klausner, Jeffrey D.
    Department of Global Health, University of California, Los Angeles, USA.
    Unemo, Magnus
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Toskin, Igor
    Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
    Peeling, Rosanna W.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Systematic reviews of point-of-care tests for the diagnosis of urogenital Chlamydia trachomatis infections2017Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 93, nr Suppl. 4, s. S22-S30Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: WHO estimates that 131 million new cases of urogenital Chlamydia trachomatis (CT) infections occur globally every year. Most infections are asymptomatic. Untreated infection in women can lead to severe complications. Screening and treatment of at-risk populations is a priority for prevention and control.

    Objectives: To summarise systematic reviews of the performance characteristics of commercially available point-of-care tests (POCT) for screening and diagnosis of urogenital CT infection.

    Methods: Two separate systematic reviews covering the periods 2004-2013 and 2010-2015 were conducted on rapid CT POCTs. Studies were included if tests were evaluated against a valid reference standard.

    Results: In the first review, 635 articles were identified, of which 11 were included. Nine studies evaluated the performance of eight antigen detection rapid POCTs on 10 280 patients and two studies evaluated a near-patient nucleic acid amplification test (NAAT) on 3518 patients. Pooled sensitivity of antigen detection tests was 53%, 37% and 63% for cervical swabs, vaginal swabs and male urine, and specificity was 99%, 97% and 98%, respectively. The pooled sensitivity and specificity of the near-patient NAAT for all specimen types were >98% and 99.4%, respectively. The second review identified two additional studies on four antigen detection POCTs with sensitivities and specificities of 22.7%-37.7% and 99.4%-100%, respectively. A new two-step 15 min rapid POCT using fluorescent nanoparticles showed performance comparable to that of near-patient NAATs.

    Conclusions: The systematic reviews showed that antigen detection POCTs for CT, although easy to use, lacked sufficient sensitivity to be recommended as a screening test. A near-patient NAAT shows acceptable performance as a screening or diagnostic test but requires electricity, takes 90 min and is costly. More affordable POCTs are in development.

  • 13. Kubanova, A.
    et al.
    Frigo, N.
    Kubanov, A.
    Sidorenko, S.
    Priputnevich, T.
    Vachnina, T.
    Al-Khafaji, N.
    Polevshikova, S.
    Solomka, V.
    Domeika, M.
    Unemo, Magnus
    Örebro universitet, Hälsoakademin.
    National surveillance of antimicrobial susceptibility in Neisseria gonorrhoeae in 2005-2006 and recommendations of first-line antimicrobial drugs for gonorrhoea treatment in Russia2008Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 84, nr 4, s. 285-289Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To investigate comprehensively the antimicrobial susceptibility and resistance of Neisseria gonorrhoeae during 2005-2006 in a national survey and to recommend effective antimicrobial drugs for the treatment of gonorrhoea in Russia.

    METHODS: The susceptibility of N gonorrhoeae isolates, cultured mainly from consecutive gonorrhoea patients (n = 1030) during the period January 2005 to December 2006 in Russia, to penicillin G, ceftriaxone, ciprofloxacin, tetracycline and spectinomycin was analysed using the agar dilution method. Nitrocefin discs were used for beta-lactamase detection.

    RESULTS: All isolates were susceptible to ceftriaxone. During 2005 and 2006, however, 5%, 50%, 70% and 77% displayed intermediate susceptibility or resistance to spectinomycin, ciprofloxacin, tetracycline and penicillin G, respectively. Furthermore, 4% of the isolates were beta-lactamase producing during these years. The different federal districts of Russia displayed substantial heterogeneities with regard to the prevalence of gonorrhoea and antimicrobial resistance among N gonorrhoeae isolates.

    CONCLUSIONS: In Russia, penicillins, ciprofloxacin, or tetracycline should definitively not be used in the empirical treatment of gonorrhoea. The recommended first-line antimicrobial drug should be ceftriaxone. If ceftriaxone is not available, spectinomycin ought to be used. Increasing levels of intermediate susceptibility and resistance to spectinomycin have, however, been observed during recent years and, accordingly, great care and monitoring should be undertaken when using this agent. Continuous local, national and international surveillance of N gonorrhoeae antimicrobial susceptibility, in order to reveal the emergence of new resistance, to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis, is crucial.

  • 14. Lan, P. T.
    et al.
    Srålsby Lundborg, C.
    Phuc, H. D.
    Sihavong, A.
    Unemo, Magnus
    Örebro universitet, Hälsoakademin.
    Chuc, N. T. K.
    Khang, T. H.
    Mogren, I.
    Reproductive tract infections including sexually transmitted infections: a population-based study of women of reproductive age in a rural district of Vietnam.2008Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 84, nr 2, s. 126-132Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate the prevalences of reproductive tract infections (RTI)/sexually transmitted infections (STI) among married women in a rural district of Vietnam, and analyse the influence of socioeconomic, sociodemographic, and other determinants possibly related to RTI/STI. Methods: A community-based cross-sectional study. Married women aged 18–49 years (n  =  1012) were interviewed and underwent a gynaecological examination. Specimens were collected for laboratory diagnosis of chlamydia, gonorrhoea, trichomonas, bacterial vaginosis (BV), candidiasis, hepatitis B, HIV, and syphilis. Results: In total, 37% of the women were clinically diagnosed with an RTI/STI. Aetiologically confirmed RTI/STI was identified in 39% of the women (including 6% with STI). Endogenous infections were most prevalent (candidiasis 26%, BV 11%) followed by hepatitis B 8.3%, Chlamydia trachomatis 4.3%, Trichomonas vaginalis 1%, Neisseria gonorrhoeae 0.7%, genital warts 0.2%, and HIV and syphilis 0%. Fifty per cent of the STI cases were asymptomatic. Younger age and intrauterine devices were significantly associated with an increased risk of BV. Determinants of candidiasis were vaginal douching, high education level and low economic status, whereas a determinant of chlamydia was high economic status. Outmigration of the husband was associated with an increased risk of hepatitis B surface antigen seroposivity among women. Conclusions: RTI/STI were prevalent among married women in a rural population of Vietnam. Syndromic algorithms should be consistently supplemented by risk assessment in order to reduce under and overtreatment. Microscopic diagnosis could be applied in primary care settings to achieve more accurate diagnoses. The promotion of health education aimed at reducing RTI/STI prevalences is an important tool in STI/HIV control programmes. Vaccination to prevent hepatitis B for migrants should be considered.

  • 15.
    Latif, Ahmed S.
    et al.
    Public Health Consultant, Brisbane, Australia.
    Gwanzura, Lovemore
    Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
    Machiha, Anna
    STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe.
    Ndowa, Francis
    STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe.
    Tarupiwa, Andrew
    National Microbiology Reference Laboratory, Harare, Zimbabwe.
    Gudza-Mugabe, Muchaneta
    National Microbiology Reference Laboratory, Harare, Zimbabwe.
    Shukusho, Fungai D.
    National Microbiology Reference Laboratory, Harare, Zimbabwe.
    Chakanyuka Musanhu, Christine
    Country Office, World Health Organization, Harare, Zimbabwe.
    Wi, Teodora
    Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
    Unemo, Magnus
    WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Antimicrobial susceptibility in Neisseria gonorrhoeae isolates from five sentinel surveillance sites in Zimbabwe, 2015-20162018Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 94, nr 1, s. 62-66Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns worldwide. Enhanced AMR surveillance for gonococci is essential globally. In Zimbabwe, very limited gonococcal AMR data were reported. Our aims were to (i) implement quality-assured gonococcal AMR surveillance in Zimbabwe and (ii) investigate gonococcal AMR at five health centres in 2015-2016.

    METHODS: Gonococcal isolates from 104 men with urethral discharge were tested for susceptibility to kanamycin, ceftriaxone, cefixime, ciprofloxacin and azithromycin using Etest.

    RESULTS: All isolates (102 possible to test) were susceptible to ceftriaxone and cefixime. The level of resistance (intermediate resistance) to kanamycin and ciprofloxacin was 2.0% (2.0%) and 18.6% (27.5%), respectively. The two kanamycin-resistant isolates (R≥128 mg/L) had a kanamycin minimum inhibitory concentration (MIC) of >256 mg/L. The ciprofloxacin resistance ranged from 9.5% to 30.8% in the five sentinel sites. Only 10 (9.6%) of the isolates were tested for susceptibility to azithromycin and 1 (10.0%) was resistant (MIC=4 mg/L).

    CONCLUSIONS: The emergence of multidrug-resistant gonorrhoea internationally is a major public health concern and gonococcal AMR surveillance is crucial globally. In Zimbabwe, gonococcal AMR surveillance has now been implemented and quality assured according to WHO standards. The results of this first surveillance will be used to directly inform revisions of the national treatment guidelines. It is imperative to further strengthen the surveillance of gonococcal AMR, and ideally also treatment failures, in Zimbabwe and most countries in the WHO African region, which requires continuous national and international support, including technical support, and political and financial commitment.

  • 16.
    Machalek, Dorothy
    et al.
    The Royal Women’s Hospital, Centre for Women’s Infectious Disease Research, Parkville, Australia.
    Tao, Yusha
    Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia.
    Shilling, Hannah
    The Royal Women’s Hospital, Centre for Women’s Infectious Disease Research, Parkville, Australia.
    Jensen, Jorgen
    Statens Serum Institut, Research Unit for Reproductive Microbiology, Copenhagen, Denmark.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs.
    Murray, Gerald
    The Royal Women’s Hospital, Centre for Women’s Infectious Disease Research, Parkville, Australia.
    Chow, Eric
    Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia.
    Low, Nicola
    Institute of Social and Preventive Medicine (ISPM), Bern, Switzerland.
    Garland, Suzanne
    The Royal Women’s Hospital, Centre for Women’s Infectious Disease Research, Parkville, Australia.
    Fairley, Christopher
    Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia.
    Vodstrcil, Lenka
    Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia.
    Hocking, Jane
    University of Melbourne, Melbourne School of Population and Global Health, Parkville, Australia.
    Zhang, Lei
    Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia.
    Bradshaw, Catriona
    Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia.
    MACROLIDE AND FLUOROQUINOLONE RESISTANCE-ASSOCIATED MUTATIONS IN MYCOPLASMA GENITALIUM: A SYSTEMATIC REVIEW AND META-ANALYSIS2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr Suppl. 1, s. A266-A266Artikel i tidskrift (Övrigt vetenskapligt)
  • 17.
    Meo, Paul
    et al.
    Summit Therapeutics, Cambridge, UK.
    Mason, Clive
    Summit Therapeutics, Cambridge, UK.
    Khan, Nawaz
    Summit Therapeutics, Cambridge, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Jacobsson, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    IN-VITRO ACTIVITY OF SMT-571 AND COMPARATORS AGAINST CLINICAL ISOLATES AND REFERENCE STRAINS OF NEISSERIA GONORRHOEAE2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr Suppl. 1, s. A295-A295Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The emergence and spread of multidrug resistance to antibiotics used to treat gonorrhoea has resulted in a dramatic loss of effective regimens for the condition. Currently, the extended spectrum cephalosporin, ceftriaxone, is the only viable monotherapy option available, however, resistance to this last line treatment is now emerging globally. Herein, we assessed the in vitro activity of a novel small molecule antimicrobial with a new mechanism of action, SMT-571, against a large collection of N. gonorrhoeae clinical isolates and reference strains including numerous MDR and XDR gonococcal isolates.

    Methods: MICs (mg/L) of SMT-571 were determined by agar dilution according to current CLSI guidelines. The MICs of ceftriaxone, cefixime, azithromycin, ciprofloxacin, spectinomycin, tetracycline, and ampicillin were determined using the Etest method (AB bioMérieux, Marcy l’Etoile, France).

    Results: SMT-571 showed potent in vitro activity against all the tested N. gonorrhoeae isolates (n=262) with MICs ranging from 0.064 to 0.125 mg/L, and the MIC50, MIC90 and modal MIC were all 0.125 mg/L. The compound was not influenced by pre-existing resistance mechanisms with no cross-resistance or correlation between the MICs of SMT-571 and comparator agents being observed.

    Conclusion: This study is the first broad evaluation of the in vitro activities of a new mechanism, novel small molecule anti-microbial for the treatment of gonorrhoea. SMT-571 demonstrated highin vitroactivity against a large geographically, temporally and genetically diverse collection of clinical N. gonorrhoeae isolates and international reference strains, including various types of high-level resistant, MDR and XDR gonococcal isolates.

  • 18.
    Mercer, Catherine H.
    et al.
    Institute for Global Health, University College London, London, UK .
    Clifton, Soazig
    Institute for Global Health, University College London, London, UK; NatCen Social Research, London, UK.
    Prior, Gillian
    NatCen Social Research, London, UK.
    Aldridge, Robert W.
    Institute of Health Informatics, University College London, London, UK.
    Bonell, Chris
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
    Copas, Andrew J.
    Institute for Global Health, University College London, London, UK.
    Field, Nigel
    Institute for Global Health, University College London, London, UK.
    Gibbs, Jo
    Institute for Global Health, University College London, London, UK.
    Macdowall, Wendy
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
    Mitchell, Kirstin R.
    MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
    Tanton, Clare
    Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
    Thomson, Nick
    Wellcome Trust Sanger Institute, Cambridge, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro, Sweden; National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sonnenberg, Pam
    Institute for Global Health, University College London, London, UK.
    Collecting and exploiting data to understand a nation's sexual health needs: Implications for the British National Surveys of Sexual Attitudes and Lifestyles (Natsal)2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr 3, s. 159-161Artikel i tidskrift (Refereegranskat)
  • 19.
    Pitt, Rachel
    et al.
    National Infection Service, Public Health England, London, United Kingdom.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology.
    Sonnenberg, Pam
    Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom.
    Alexander, Sarah
    National Infection Service, Public Health England, London, United Kingdom.
    Beddows, Simon
    National Infection Service, Public Health England, London, United Kingdom.
    Cole, Michelle Jayne
    National Infection Service, Public Health England, London, United Kingdom.
    Clifton, Soazig
    Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom.
    Mercer, Catherine H.
    Centre for Population Research in Sexual Health and HIV, Institute for Global Health, UCL, London, United Kingdom.
    Johnson, Anne M.
    Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, UCL, London, United Kingdom.
    Ison, Catherine A.
    National Infection Service, Public Health England, London, United Kingdom.
    Field, Nigel
    Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, UCL, London, United Kingdom.
    Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population2020Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, artikel-id sextrans-2019-054129Artikel i tidskrift (Refereegranskat)
    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.

  • 20.
    Rob, Filip
    et al.
    Second Medical Faculty Charles University, Na Bulovce Hospital, Dermatovenerology, Prague, Czech Republic.
    Klubalova, Barbora
    Second Medical Faculty Charles University, Na Bulovce Hospital, Dermatovenerology, Prague, Czech Republic.
    Hercogova, Jana
    Second Medical Faculty Charles University, Na Bulovce Hospital, Dermatovenerology, Prague, Czech Republic.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Faculty of Medicine of Health, Örebro University, Department of Laboratory Medicine, Microbiology, Örebro, Sweden.
    RANDOMIZED CLINICAL TRIAL COMPARING GENTAMICIN plus AZITHROMYCIN VS. CEFTRIAXONE plus AZITHROMYCIN FOR RECTAL AND PHARYNGEAL GONORRHEA2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr Suppl. 1, s. A286-A287Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Dual therapy including ceftriaxone plus azithromycin is currently the recommended first-line gonorrhea treatment internationally. However, for gonorrhea cases where ceftriaxone or other extended-spectrum cephalosporin can not be administered (e.g., cephalosporin resistance, allergy, or unavailability), the therapeutic options are very limited. In a previous randomized controlled clinical trial (RCT) by Kirk-caldy et al. (Clin Infect Dis. 2014), gentamicin 240 mg plus azithromycin 2 g showed 100% microbiological cure for uncomplicated gonorrhoea. However, only 10 pharyngeal infections and one rectal infection were examined. We further evaluated the efficacy and tolerability of gentamicin+azithroomycin for treatment of uncomplicated rectal and pharyngeal gonorrhea.

    Methods: A non-inferiority, open-label, single center RCT was conducted in Prague, Czech Republic. Patients, 18–75 years of age, diagnosed with uncomplicated rectal or pharyngeal gonorrhea by nucleic acid amplification test (NAAT) (GeneProof®) were randomized to treatment with gentamicin 240 mg intramuscularly plus azithromycin 2 g orally or ceftriaxone 500 g intramuscularly plus azithromycin 2 g orally. The primary out-come was negative culture and negative NAAT, i.e., one week and three weeks, respectively, after treatment.

    Results: Both clinical and microbiological cure was achieved by 100% of patients in the gentamicin+azithromycin arm (n=68; 40 rectal, 14 pharyngeal, and 14 infections in both localizations) and ceftriaxone+azithromycin arm (n=66; 36 rectal, 14 pharyngeal, and 16 infections in both localizations). Administration of gentamicin was significantly less painful than ceftriaxone according to the visual analog score (p<0.001). Gastrointestinal adverse events were slightly more common in ceftriaxone arm (50.0%) than in gentamicin arm (41.2%), but in most (64%) cases they were mild.

    Conclusion: Both gentamicin+azithromycin and ceftriaxone+azithromycin were 100% effective for treatment of rectal and pharyngeal gonorrhea. Gentamicin 240 mg plus azithromycin 2 g appears to be an effective alternative for treatment of both urogenital and extragenital gonorrhea in case of ceftriaxone resistance, allergy, or unavailability.

  • 21.
    Sadiq, Syed Tariq
    et al.
    Applied Diagnostic Research and Evaluation Unit, St George's, University of London, London, UK.
    Mazzaferri, Fulvia
    Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy.
    Unemo, Magnus
    World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Rapid accurate point-of-care tests combining diagnostics and antimicrobial resistance prediction for Neisseria gonorrhoeae and Mycoplasma genitalium2017Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 93-S4, s. S65-S68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In addition to inadequate access to early diagnosis and treatment with antimicrobial agents for patients and sexual contacts, management and control of STIs is significantly challenged by emergence and spread of antimicrobial resistance (AMR), particularly for STIs such as Neisseria gonorrhoeae and Mycoplasma genitalium This is further compounded by use of nucleic acid amplification techniques for diagnosis, resulting in reduced phenotypic AMR testing for N. gonorrhoeae and absence or suboptimal AMR surveillance for guiding treatment of both STIs in many settings. Rapid accurate point-of-care (POC) tests for diagnosis of all STIs would be valuable but to significantly impact treatment precision and management of N. gonorrhoeae and M. genitalium infections, combinations of rapid POC diagnostic and AMR testing (POC-AMR) will likely be required. This strategy would combat STI burden and AMR emergence and spread by enabling diagnosis and individualised treatment at the first healthcare visit, potentially reducing selection pressure on recommended antimicrobials, reducing transmission of resistant strains and providing means for AMR surveillance. Microfluidic and nanotechnology platforms under development for rapid detection of STIs provide a basis to also develop molecular rapid POC-AMR prediction. A number of prototypic devices are in the pipeline but none as yet approved for routine use. However, particularly for N. gonorrhoeae, more knowledge is required to assess which antimicrobials lend themselves to a genotypic POC-AMR approach, in relation to genotypic-phenotypic associations and potential impact clinically and epidemiologically. Key for successful deployment will include also understanding cost-effectiveness, cost-consequences and acceptability for key stakeholders.

  • 22.
    Seth-Smith, Helena
    et al.
    University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland.
    Egli-Gany, Dianne
    University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. WHO Collaborating Centrefor Gonorrhoea and other STIs.
    Dona, Valentina
    University of Bern, Institut für Infektionskrankheiten, Bern, Switzerland.
    Endimiani, Andrea
    University of Bern, Institut für Infektionskrankheiten, Bern, Switzerland.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Low, Nicola
    University of Bern, Institute of Social and Preventive Medicine (ISPM), Bern, Switzerland.
    NEISSERIA GONORRHOEAE GENOMIC DIVERSITY IN HIGH RISK GROUPS IN SWITZERLAND2019Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, nr Supl. 1, s. A281-A281Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Neisseria gonorrhoeae cases are increasing in Europe, with decreasing susceptibility to first line antibiotics. Whole genome sequencing (WGS) provides detailed information about gonococcal molecular epidemiology and prediction of antimicrobial resistance (AMR), especially if linked to epidemiological data. The aim of this study was to examine molecular, clinical and social epidemiological aspects of gonorrhoea infections in Switzerland.

    Methods: In 2015–2016, we cultured urethral, cervical, vaginal, rectal, and pharyngeal specimens from patients in three clinics predominantly attended by men who have sex with men (MSM) and female sex workers (FSW). MSM also completed a sexual behaviour questionnaire. Minimal inhibitory concentrations (MIC) were assessed by Etest, interpreted using EUCAST breakpoints except azithromycin (2 mg/L); WGS used an Illumina Miseq.

    Results: We sequenced 140 isolates from 116 participants, MSM (107, 92%, mean age 35.8 years) and FSW (6, 5%, mean age 25.3 years). Amongst MSM, 48/105 respondents (45.7%) reported recent sex abroad. Three patients (two MSM and one FSW) carried different strains at different body sites. The isolates show large genomic diversity, with 69 NG-MAST types and 37 MLST sequence types, largely embedded within characterised European Union clusters. NG-MAST 1407 was identified in n=4 isolates from two patients (FSW, not travel-associated and MSM, sex elsewhere in Europe). Mosaic penAXXXIV was seen in these isolates, and also in an NG-MAST 13488 from an MSM, which was also not travel associated. One isolate (heterosexual male, not travel-associated) with elevated cefixime MIC (0.19mg/ml) carried a mosaic penAX in an NG-MAST 10557 background. Ciprofloxacin resistance was seen in these six isolates, and overall in 59/140 (42%), all containing GyrA mutations S91F and D95A/G/N.

    Conclusion: Switzerland has a high diversity of circulating gonorrhoea, generally related to European clusters. Multidrug resistant isolates were not identified in this study, but NG-MAST 1407 and penA mosaics, associated with elevated cephalosporin MICs, are circulating.

  • 23.
    Spiteri, Gianfranco
    et al.
    European Ctr Dis Prevent & Control, Stockholm, Sweden.
    Cole, Michelle
    Publ Hlth England, London, England.
    Unemo, Magnus
    Region Örebro län. Swedish Reference Lab Pathogen Neisseria, Örebro University Hospital, Örebro, Sweden.
    Hoffmann, Steen
    Dept Bacteriol, Statens Serum Inst, Copenhagen, Denmark.
    Ison, Catherine
    Publ Hlth England, London, England.
    van de Laar, Marita
    European Ctr Dis Prevent & Control, Stockholm, Sweden.
    The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP)-a sentinel approach in the European Union (EU)/European Economic Area (EEA)2013Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 89, nr 4, s. 16-18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Antimicrobial resistance in Neisseria gonorrhoeae is monitored in the European Union/European Economic Area through the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) coordinated by the European Centre for Disease Prevention and Control. Euro-GASP includes a sentinel surveillance programme which aims to detect in a timely manner changes in resistance patterns and inform treatment guidelines. The programme aims to test a representative number of isolates from each European Union/European Economic Area member state per year for a range of therapeutically relevant antimicrobials through a biannual hybrid centralised/decentralised system. Testing is supported by an External Quality Assurance programme and a laboratory training programme. Participation in the programme has increased to 21 countries in 2012. Euro-GASP has been able to detect the rapid spread of isolates with decreased susceptibility to cefixime across Europe in 2010 and 2011. Results from the programme have informed changes in European treatment guidelines for gonorrhoea and led to the development of the 'Response plan to control and manage the threat of multidrug resistant gonorrhoea in Europe'. Future challenges for Euro-GASP include supporting countries to participate in Euro-GASP through decentralised testing, improving timeliness and epidemiological data quality, and increasing participation from Eastern Europe.

  • 24.
    Unemo, Magnus
    et al.
    Region Örebro län. Dept Lab Med, WHO Collaborating Ctr Gonorrhoea & Other STIs, Natl Reference Lab Pathogen Neisseria, Örebro University Hospital, Örebro, Sweden.
    Ison, Catherine A.
    Microbiol Serv, Sexually Transmitted Bacteria Reference Unit, Publ Hlth England, London, England.
    Cole, Michelle
    Microbiol Serv, Sexually Transmitted Bacteria Reference Unit, Publ Hlth England, London, England.
    Spiteri, Gianfranco
    European Ctr Dis Prevent & Control, Stockholm, Sweden.
    van de Laar, Marita
    European Ctr Dis Prevent & Control, Stockholm, Sweden.
    Khotenashvili, Lali
    World Hlth Org Reg Off Europe, Copenhagen, Denmark.
    Gonorrhoea and gonococcal antimicrobial resistance surveillance networks in the WHO European Region, including the independent countries of the former Soviet Union2013Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 89, nr 4, s. 42-46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Antimicrobial resistance (AMR) in Neisseria gonorrhoeae has emerged for essentially all antimicrobials following their introduction into clinical practice. During the latest decade, susceptibility to the last remaining options for antimicrobial monotherapy, the extended-spectrum cephalosporins (ESC), has markedly decreased internationally and treatment failures with these ESCs have been verified. In response to this developing situation, WHO and the European Centre for Disease Prevention and Control (ECDC) have published global and region-specific response plans, respectively. One main component of these action/response plans is to enhance the surveillance of AMR and treatment failures. This paper describes the perspectives from the diverse WHO European Region (53 countries), including the independent countries of the former Soviet Union, regarding gonococcal AMR surveillance networks. The WHO European Region has a high prevalence of resistance to all previously recommended antimicrobials, and most of the first strictly verified treatment failures with cefixime and ceftriaxone were also reported from Europe. In the European Union/European Economic Area (EU/EEA), the European gonococcal antimicrobial surveillance programme (Euro-GASP) funded by the ECDC is running. In 2011, the Euro-GASP included 21/31 (68%) EU/EEA countries, and the programme is further strengthened annually. However, in the non-EU/EEA countries, internationally reported and quality assured gonococcal AMR data are lacking in 87% of the countries and, worryingly, appropriate support for establishment of a GASP is still lacking. Accordingly, national and international support, including political and financial commitment, for gonococcal AMR surveillance in the non-EU/EEA countries of the WHO European Region is essential.

  • 25.
    Unemo, Magnus
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Savicheva, A.
    Budilovskaya, O.
    Sokolovsky, E.
    Larsson, M.
    Domeika, M.
    Laboratory diagnosis of Neisseria gonorrhoeae in St Petersburg, Russia: inventory, performance characteristics and recommended optimisations2006Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 82, nr 1, s. 41-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To perform a comprehensive inventory of the number of samples, performance characteristics, and quality assurance of the laboratory diagnosis of Neisseria gonorrhoeae at five laboratories in St Petersburg and Leningradskaya Oblast, Russia, in 2004, and to recommend optimisations for an increased adherence to international evidence based recommendations of diagnostics. METHODS: Surveillance data were obtained with questionnaire and site visits. For evaluation of the culture media utilised at the laboratories, N gonorrhoeae reference strains (n = 29) were used. RESULTS: During 2004 the total numbers of N gonorrhoeae samples analysed at the five laboratories using microscopy of stained smears and culturing were 330 879 (407 positive) and 38 020 (420 positive), respectively. Four laboratories used a Russian non-selective culture medium-that is, Complegon, and one laboratory utilised Biocult-GC. Both media seemed suboptimal. Only two of the laboratories used any species confirmative assay. Antibiotic susceptibility testing of N gonorrhoeae was performed at only two of the laboratories and each year only occasional isolates were analysed. None of the laboratories comprised a complete laboratory quality assurance system. CONCLUSIONS: According to international recommendations, the diagnosis of N gonorrhoeae in St Petersburg and Leningradskaya Oblast, Russia, is suboptimal. More samples need to be analysed by culturing on a highly nutritious and selective medium and, furthermore, species confirmation and antibiotic susceptibility testing should be more frequently performed. In addition, the utilised methods for culturing and antibiotic susceptibility testing, including medium and interpretative criteria used, ought to be optimised, standardised, and quality assured using systematic internal and external quality controls.

  • 26.
    van Dam, Alje P.
    et al.
    Public Health Laboratory, Cluster of Infectious Diseases, Amsterdam Health Service, Amsterdam, Netherlands; Department of Microbiology, Onze Lieve Vrouwe Gasthuis General Hospital, Amsterdam, Netherlands.
    van Ogtrop, Marc L.
    Department of Microbiology, Onze Lieve Vrouwe Gasthuis General Hospital, Amsterdam, Netherlands.
    Golparian, Daniel
    Department of Laboratory Medicine, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University Hospital, Örebro, Sweden.
    Mehrtens, Jan
    Integral Physician Practice West, Amsterdam, Netherlands.
    de Vries, Henry J. C.
    STI Outpatient Department, Cluster of Infectious Diseases, Amsterdam Health Service, Amsterdam, Netherlands; Centre for Infections and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
    Unemo, Magnus
    Region Örebro län. Department of Laboratory Medicine, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University Hospital, Örebro, Sweden.
    Verified clinical failure with cefotaxime 1g for treatment of gonorrhoea in the Netherlands: a case report2014Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 90, nr 7, s. 513-514Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We describe the first case of treatment failure of gonorrhoea with a third generation cephalosporin, cefotaxime 1g intramuscularly, in the Netherlands. The case was from a high-frequency transmitting population (men having sex with men) and was caused by the internationally spreading multidrug-resistant gonococcal NG-MAST ST1407 clone. The patient was clinically cured after treatment with ceftriaxone 500 mg intramuscularly and this is the only third generation cephalosporin that should be used for first-line empiric treatment of gonorrhoea. Increased awareness of failures with third generation cephalosporins, enhanced monitoring and appropriate verification of treatment failures including more frequent test-of-cures, and strict adherence to regularly updated treatment guidelines are essential globally.

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