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  • 1.
    Beale, M.
    et al.
    Wellcome Sanger Institute, Cambridge, UK.
    Marks, M.
    London School of Hygiene and Tropical Medicine, London, UK.
    Cole, M.
    National Infection Service, Public Health England, London, UK.
    Lee, M.
    British Columbia Centre for Disease Control, Vancouver, Canada.
    Pitt, R.
    National Infection Service, Public Health England, London, UK.
    Ruis, C.
    University of Cambridge Department of Medicine, Cambridge, UK.
    Naidu, P.
    Alberta Precision Laboratories, Edmonton, Canada.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for STI.
    Krajden, M.
    British Columbia Centre for Disease Control, Vancouver, Canada.
    Lukehart, S.
    University of Washington, Seattle, USA.
    Morshed, M.
    British Columbia Centre for Disease Control, Vancouver, Canada.
    Fifer, H.
    National Infection Service, Public Health England, London, UK.
    Thomson, N.
    Wellcome Sanger Institute, Cambridge, UK; London School of Hygiene and Tropical Medicine, London, UK.
    CONTEMPORARY SYPHILIS IS CHARACTERISED BY RAPID GLOBAL SPREAD OF PANDEMIC TREPONEMA PALLIDUM LINEAGES2021Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 97, nr Suppl. 1, s. A17-A17, artikel-id O01.8Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Syphilis is an important sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. The last two decades have seen syphilis incidence rise in many high-income countries, yet the evolutionary and epidemiological relationships that underpin this are poorly understood, as is the global T. pallidum population structure.

    Methods: We assembled a geographically and temporally diverse collection of clinical and laboratory samples, performing direct sequencing on the majority, and combining these with 133 publicly available sequences to compile a dataset comprising 726 T. pallidum genomes. We analysed the resulting genomes using detailed phylogenetic analysis and clustering.

    Results: We show that syphilis globally can be described by only two deeply branching lineages, Nichols and SS14. We show that both of these lineages can be found circulatingcon currently in 12 of the 23 countries sampled. To provide further phylodynamic resolution we subdivided Treponema pallidum subspecies pallidum into 17 distinct sublineages. Importantly, like SS14, we provide evidence that two Nichols sublineages have expanded clonally across 9 countries contemporaneously with SS14. Moreover, pairwise genome analysis showed that recent isolates circulating in 14 different countries were genetically identical in their core genome to those from other countries, suggesting frequent exchange through international transmission pathways. This contrasts with the majority of samples collected prior to 1983, which are phylogenetically distinct from these more recently isolated sublineages. Bayesian temporal analysis provided evidence of a population bottleneck and decline occurring during the late 1990s, followed by a rapid population expansion a decade later. This was driven by the dominant T. pallidum sublineages circulating today, many of which are resistant to macrolides.

    Conclusion: Combined we show that the population of contemporary syphilis in high-income countries has undergone a recent and rapid global expansion. This dataset will provide a framework for future characterisation and epidemiological investigation of syphilis populations.

  • 2.
    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.

  • 3.
    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)
  • 4.
    Cole, Michelle Jayne
    et al.
    National Infection Service, Public Health England, London, UK.
    Davis, Grahame S.
    National Infection Service, Public Health England, London, UK.
    Fifer, Helen
    National Infection Service, Public Health England, London, UK.
    Saunders, John Michael
    National Infection Service, Public Health England, London, UK; Research Department of Infection and Population Health, University College London, London, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology.
    Hadad, Ronza
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Roberts, David J.
    National Infection Service, Public Health England, London, UK.
    Fazal, Mohammed
    National Infection Service, Public Health England, London, UK.
    Day, Michaela Joanne
    National Infection Service, Public Health England, London, UK.
    Minshull, Jack
    National Infection Service, Public Health England, London, UK.
    Muir, Peter
    Bristol Public Health Laboratory, Public Health England, Bristol, UK.
    Horner, Paddy J.
    School of Social and Community Medicine, University of Bristol, Bristol, UK; Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
    Gill, Noel O.
    National Infection Service, Public Health England, London, UK.
    Folkard, Kate
    National Infection Service, Public Health England, London, UK.
    No widespread dissemination of Chlamydia trachomatis diagnostic: escape variants and the impact of Neisseria gonorrhoeae positivity on the Aptima Combo 2 assay2022Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 98, nr 5, s. 366-370Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: (NG) with the Hologic Aptima CT (ACT) assay was recommended to identify any CT variants.

    METHODS: From June to October 2019, specimens with discrepant AC2/ACT CT results were submitted to Public Health England and screened for detectable CT DNA using an inhouse real-time (RT)-PCR. When enough DNA was present, partial CT 23S rRNA gene sequencing was performed. Analysis of available relative light units and interpretative data was performed.

    RESULTS: A total of 317 discordant AC2/ACT specimens were collected from 315 patients. Three hundred were tested on the RT-PCR; 53.3% (n=160) were negative and 46.7% (n=140) were positive. Due to low DNA load in most specimens, sequencing was successful for only 36 specimens. The CT 23S rRNA wild-type sequence was present in 32 specimens, and two variants with C1514T or G1523A mutation were detected in four specimens from three patients. Of the discordant specimens with NG interpretation, 36.6% of NG-negative/CT-negative AC2 specimens had detectable CT DNA on the inhouse RT-PCR vs 53.3% of NG-positive/CT-negative specimens.

    CONCLUSIONS: No widespread dissemination of AC2 diagnostic-escape CT variants has occurred in England. We however identified the impact of NG positivity on the discordant AC2/ACT specimens; a proportion appeared due to NG positivity and the associated NG signal, rather than any diagnostic-escape variants or low DNA load. Several patients with gonorrhoea may therefore receive false-negative AC2 CT results. Single diagnostic targets and multiplex diagnostic assays have their limitations such as providing selection pressure for escape mutants and potentially reduced sensitivity, respectively. These limitations must be considered when establishing diagnostic pathways.

  • 5.
    Dahlberg, Jenny
    et al.
    Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hadad, Ronza
    Örebro universitet, Institutionen för naturvetenskap och teknik. 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.

  • 6.
    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.

  • 7.
    Dema, Emily
    et al.
    University College London, London, UK.
    Sonnenberg, Pam
    University College London, London, UK.
    Gibbs, Jo
    University College London, London, UK.
    Conolly, Anne
    NatCen Social Research, London, UK.
    Willis, Malachi
    University of Glasgow, Glasgow, UK.
    Riddell, Julie
    University of Glasgow, Glasgow, UK.
    Pérez, Raquel Bosó
    University of Glasgow, Glasgow, UK.
    Copas, Andrew J.
    University College London, London, UK.
    Tanton, Clare
    London School of Hygiene and Tropical Medicine, London, UK.
    Bonell, Chris
    London School of Hygiene and Tropical Medicine, London, UK.
    Clifton, Soazig
    NatCen Social Research, London, UK.
    Oeser, Clarissa
    University College London, London, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Mercer, Catherine H.
    University College London, London, UK.
    Mitchell, Kirstin R.
    University of Glasgow, Glasgow, UK.
    Field, Nigel
    University College London, London, UK.
    How did the COVID-19 pandemic affect unmet need for condoms at a population level? (Natsal-COVID)2022Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 98, nr Suppl. 1, s. A42-A42, artikel-id P39Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Use of condoms to prevent STIs/HIV and unplanned pregnancy remains important during the COVID-19 pandemic. However, it is unknown whether the pandemic affected condom access and which population groups were most impacted.

    Methods: 6658 participants (18-59y) completed a cross-sectional web survey one-year after the initial British lockdown from 23 March 2020. Quota-based sampling and weighting resulted in a sample that was quasi-representative of the British population. We report the prevalence of unmet need for condoms because of the pandemic among sexually-experienced participants aged 18-44 years (n=2869). Adjusted odds ratios (AOR) quantify associations with demographic and behavioural factors.

    Results: Overall, 6.9% of women and 16.2% of men reported unmet need for condoms in the past year because of the pandemic. This was more likely to be reported by participants who: were aged 18-24 years vs. 35-44 (AOR: men 2.25 [95%CI:1.26-4.01], women 2.95[1.42-6.16]); were Black or Black British vs. White (men 2.86 [1.45-5.66], women 1.93 [1.03-8.30]); reported same-sex sex vs. not (past five years; men 2.85 [1.68-4.86], women 5.00 [2.48-10.08]); or ≥1 new relationships vs. not (past year, men 5.85 [3.55-9.66], women 6.38 [3.24-12.59]). Men, but not women, reporting STI-related service use (past year) were more likely to report unmet need for condoms compared to men that did not report service use (3.83 [2.18-6.71]).

    Discussion: Unmet need for condoms because of the pandemic was more likely to be reported by populations at higher risk of adverse sexual health outcomes, including STI/HIV transmission. Improved access to free/low-cost condoms is crucial for all.

  • 8.
    Dema, Emily
    et al.
    Institute for Global Health, University College London, London, UK.
    Sonnenberg, Pam
    Institute for Global Health, University College London, London, UK.
    Gibbs, Jo
    Institute for Global Health, University College London, London, UK.
    Conolly, Anne
    Institute for Global Health, University College London, London, UK; Health and Biomedical Surveys, NatCen Social Research, London, UK.
    Willis, Malachi
    Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK.
    Riddell, Julie
    Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK.
    Pérez, Raquel Bosó
    Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK.
    Copas, Andrew J.
    Institute for Global Health, University College London, London, UK.
    Tanton, Clare
    Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
    Bonell, Chris
    Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
    Oeser, Clarissa
    Institute for Global Health, University College London, London, UK.
    Clifton, Soazig
    Institute for Global Health, University College London, London, UK; Health and Biomedical Surveys, NatCen Social Research, London, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine.
    Mercer, Catherine H.
    Institute for Global Health, University College London, London, UK.
    Mitchell, Kirstin R.
    Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK.
    Field, Nigel
    Institute for Global Health, University College London, London, UK.
    How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID)2023Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 99, nr 4, s. 261-267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate how differential access to key interventions to reduce STIs, HIV and their sequelae changed during the COVID-19 pandemic.

    Methods: British participants (18-59 years) completed a cross-sectional web survey 1 year (March-April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16-74 years) conducted in 2010-2012. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually experienced participants (18-44 years) (n=3869, Natsal-COVID; n=8551, Natsal-3). ORs adjusted for age and other potential confounders describe associations with demographic and behavioural factors.

    Results: In 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18-24 years, of black or black British ethnicity, and reporting same-sex sex (past 5 years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners and with cervical screening among smokers.

    Conclusions: Our study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, there was not strong evidence that differential access has changed during the pandemic when compared with 2010-2012. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.

  • 9.
    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)
  • 10.
    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.

  • 11. 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, Sweden2009Ingår 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. 

  • 12.
    Hadad, Ronza
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections; National Reference Laboratory for STIs, Department of Laboratory Medicine.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections; National Reference Laboratory for STIs, Department of Laboratory Medicine.
    Velicko, I.
    Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Lindroth, Y.
    Department of Laboratory Medicine, Medical Microbiology, Lund University, Skåne Laboratory Medicine, Lund, Sweden.
    Ohlsson, A.
    Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Fredlund, H.
    WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Örebro, Sweden; National Reference Laboratory for STIs, Department of Laboratory Medicine, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections; National Reference Laboratory for STIs, Department of Laboratory Medicine.
    GENOMIC EPIDEMIOLOGY OF NEISSERIA GONORRHOEAE ISOLATES IN SWEDEN-2016 NATIONAL STUDY2021Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 97, nr Suppl. 1, s. A135-A135Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The number of reported cases of gonorrhoea in Sweden continuously increased from an incidence of 7.8 per 100 000 inhabitants in 2009 to 31.4 in 2019. The largest increase in incidence was observed during 2016–2017. No national molecular epidemiological study investigating the population of N. gonorrhoeae circulating in Sweden has been performed in the last two decades. Our aim was to examine the antimicrobial resistance (AMR) and genome-based epidemiology, in conjunction to patient epidemiological data, of all gonococcal isolates (n=1279; one isolate per case) from gonorrhoea cases in Sweden during 2016.

    Methods: AMR testing was performed using Etest, and MICs were interpreted using current clinical resistance breakpoints from EUCAST. All isolates were whole genome sequenced using Illumina HiSeq X platform. Patient epidemiological data was obtained from the Public Health Agency of Sweden.

    Results: The gonorrhoea patients consisted of 252 (19.7%) women and 1027 men (80.3%). The medium age of the women was 27.4 years and of the men 32.1 years. Regarding sexual orientation, 619 (48.4%) reported homosexual, 605 (47.3%) heterosexual, 31 (2.4%) bisexual, and 24 (1.9%) did not report. Most prevalent countries of infection were Sweden (n=875, 68.4%), followed by Thailand (n=70, 5.5%) and Germany (n=32, 2.5%).

    Overall, the phenotypic AMR was as follows: ceftriaxone and spectinomycin (0%), cefixime (1.7%), azithromycin (1.3%) and ciprofloxacin (51.1%). A high concordance between phenotypic AMR and molecular AMR determinants was found. Results from the genome-based epidemiology are currently in final analysis.

    Conclusions: AMR in N. gonorrhoeae in Sweden remains low, in particular to ceftriaxone and azithromycin that is recommended internationally for dual therapy. The incidence increases in Sweden appear to be driven by increased spread among men-who-have-sex-with-men but also younger heterosexuals of both genders. This is the first national genome-based epidemiological study for N. gonorrhoeae in Sweden and final genomic results are pending.

  • 13.
    Hernando Rovirola, Cristina
    et al.
    Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain.
    Spiteri, Gianfranco
    European Centre for Disease Prevention and Control, Stockholm, Sweden.
    Sabidó, Meritxell
    TransLab, Medical Science Department, Universitat de Girona, Girona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
    Montoliu, Alexandra
    Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain; Health Sciences Research Institute of the Germans Trias i Pujol Foundation (IGTP), Badalona, Spain.
    Gonzalez, Victoria
    Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain; Laboratory of Microbiology, Germans Trias i Pujol Hospital (HGTiP), Badalona, Spain.
    Casabona, Jordi
    Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Health Sciences Research Institute of the Germans Trias i Pujol Foundation (IGTP), Badalona, Spain; Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain.
    Cole, Michelle Jayne
    National Infection Service, Public Health England, London, UK.
    Noori, Teymur
    European Centre for Disease Prevention and Control, Stockholm, Sweden.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and other STIs.
    Antimicrobial resistance in Neisseria gonorrhoeae isolates from foreign-born population in the European Gonococcal Antimicrobial Surveillance Programme2020Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 96, nr 3, s. 204-210Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: infections worldwide. We compared the prevalence of AMR gonococcal isolates among native persons to foreign-born (reporting country different from country of birth) persons, and describe the epidemiological and clinical characteristics of foreign-born patients and their associations to AMR.

    METHODS: We analysed isolates and patient data reported to the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) 2010-2014 (n=9529).

    RESULTS: Forty-three per cent of isolates had known country of birth and 17.2% of these were from persons born abroad. Almost 50% of foreign-born were from the WHO European Region (13.1% from non-European Union [EU] and the European Economic Area [EEA] countries). Compared with isolates from natives, isolates from foreign-born had a similar level (p>0.05) of azithromycin resistance (7.5% vs 7.2%), ciprofloxacin resistance (50.0% vs 46.3%) and of decreased susceptibility to ceftriaxone (1.9% vs 2.8%); a lower rate of cefixime resistance (5.7% vs 3.6%, p=0.02), and a higher proportion of isolates producing penicillinase (8.4% vs 11.7%, p=0.02). Among isolates from persons born outside EU/EEA, the level of decreased susceptibility to ceftriaxone was higher (1.8% vs 3.5%, p=0.02), particularly in those from the WHO Eastern Mediterranean Region and non-EU/EEA WHO European countries (1.9% vs 9.6% and 8.7%, respectively, p<0.01). In multivariable analysis, foreign-born patients with AMR isolates were more likely to be from non-EU/EEA WHO European countries (adjusted OR [aOR]: 3.2, 95% CI 1.8 to 5.8), WHO Eastern Mediterranean countries (aOR: 1.8, 95% CI 1.1 to 3.3) and heterosexual males (aOR: 1.8, 95% CI 1.2 to 2.7).

    CONCLUSIONS: Importation of AMR strains remains an important threat in the EU/EEA. Research to improve understanding of sexual networks within foreign born and sexual tourism populations could help to inform effective tailor-made interventions. The Euro-GASP demonstrates the public health value of quality-assured surveillance of gonococcal AMR and the need for strengthened AMR surveillance, particularly in the non-EU/EEA WHO European Region.

  • 14.
    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.

  • 15.
    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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    Kakooza, Francis
    et al.
    Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.
    Musinguzi, Patrick
    Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda.
    Workneh, Meklit
    Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
    Walwema, Richard
    Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
    Kyambadde, Peter
    Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda.
    Mande, Emmanuel
    Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
    Lubega, Christopher
    Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
    Nakasi, Jhamira M.
    Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
    Kiggundu, Reuben
    Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
    Hamill, Matthew M.
    Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
    Bagaya, Bernard S.
    Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.
    Lamorde, Mohammed
    Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine Clinic of Microbiology.
    Manabe, Yukari C.
    Division of Infectious Diseases, Johns Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; Hopkins University, School of Medicine, Baltimore, Maryland, USA.
    Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda2021Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 97, nr 4, s. 312-316Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The emergence of multidrug-resistant Neisseria gonorrhoeae (NG) is a major global health threat necessitating response and control measures. NG antimicrobial resistance (AMR) surveillance data from sub-Saharan countries is exceedingly limited. This paper aims to describe the establishment, design and implementation of a standardised and quality-assured gonococcal surveillance programme and to describe the susceptibility patterns of the cultured gonococcal isolates in Kampala, Uganda.

    Methods: From March 2018 to September 2019, using the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) protocol, consecutive males with urethral discharge syndrome were recruited from 10 surveillance sites in Kampala City, Uganda, in collaboration with the Ministry of Health. Males completed a questionnaire and provided a urethral swab specimen. Culture, identification and antimicrobial susceptibility testing (Etest) were performed.

    Results: Of the 1013 males recruited, 73.1% (740/1013) had a positive Gram stain and 51.1% (n=518) were culture-positive for NG. Using Etest (458 isolates), the resistance to ciprofloxacin was 99.6%. Most isolates were susceptible to azithromycin, cefoxitin and gentamicin, that is, 99.8%, 98.5% and 92.4%, respectively, and all isolates were susceptible to ceftriaxone and cefixime.

    Conclusions: We established a standardised, quality-assured WHO EGASP. Using Etest, 458 isolates were characterised, with associated epidemiological surveillance data, in 1.5 years, which by far exceed the minimum 100 isolates per year and country requested in the WHO Global GASP, to detect AMR levels with confidence. These isolates with the epidemiological data can be used to develop population level interventions.

  • 19.
    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.

  • 20. 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.

  • 21. 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.

  • 22.
    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
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. 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.

  • 23.
    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)
  • 24.
    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.

  • 25.
    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)
  • 26.
    Ong, Jason J.
    et al.
    Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; London School of Hygiene and Tropical Medicine, London, UK; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
    Lim, Aaron
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Bradshaw, Catriona
    Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
    Taylor-Robinson, David
    Faculty of Medicine, Imperial College London, London, UK.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Orebro, Sweden; Institute for Global Health, University College London, London, UK.
    Horner, Paddy J.
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Vickerman, Peter
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Zhang, Lei
    Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China.
    Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia2023Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, artikel-id sextrans-2022-055611Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Mycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of different testing strategies for MG in MSM, taking a healthcare provider perspective.

    METHODS: We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective.

    RESULTS: Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective.

    CONCLUSION: Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.

  • 27.
    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, Vol. 96, nr 6, s. 464-468Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Mycoplasma genitaliumis a common sexually transmitted infection. Treatment guidelines focus on those with symptoms and sexual contacts, generally with regimens including doxycycline and/or azithromycin as first-line and moxifloxacin as second-line treatment. We investigated the prevalence of antimicrobial resistance (AMR)-conferring mutations inM. genitaliumamong the sexually-active British general population.

    Methods: The third national survey of sexual attitudes and lifestyles (Natsal-3) is a probability sample survey of 15 162 men and women aged 16-74 years in Britain conducted during 2010-12. Urine test results forM. genitaliumwere available for 4507 participants aged 16-44 years reporting>1 lifetime sexual partner. In this study, we sequenced regions of the 23S rRNA andparCgenes to detect known genotypic determinants for resistance to macrolides and fluoroquinolones respectively.

    Results: 94% (66/70) of specimens were re-confirmed asM. genitaliumpositive, with successful sequencing in 85% (56/66) for 23S rRNA and 92% (61/66) forparCgenes. Mutations in 23S rRNA gene (position A2058/A2059) were detected in 16.1% (95%CI: 8.6% to 27.8%) and inparC(encodingParCD87N/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: This study highlights challenges inM. genitaliummanagement and control. Macrolide resistance was present in one in six specimens from the general population in 2010-2012, but no participants with AMRM. genitaliumreported symptoms. Given anticipated increases in diagnostic testing, new strategies including novel antimicrobials, AMR-guided therapy, and surveillance of AMR and treatment failure are recommended.

  • 28.
    Ratna, Natasha
    et al.
    UK Health Security Agency, London, UK; Institute for Global Health, University College London, London, UK.
    Dema, Emily
    Institute for Global Health, University College London, London, UK.
    Conolly, Anne
    NatCen Social Research, London, UK.
    Riddell, Miss Julie
    MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.
    Willis, Malachi
    MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.
    Pérez, Raquel Bosó
    MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.
    Copas, Andrew
    Institute for Global Health, University College London, London, UK.
    Gibbs, Jo
    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.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted.
    Migchelsen, Stephanie J.
    UK Health Security Agency, London, UK.
    Sonubi, Tamilore
    UK Health Security Agency, London, UK.
    Harb, Ana
    UK Health Security Agency, London, UK.
    Sonnenberg, Pam
    Institute for Global Health, University College London, London, UK.
    Mitchell, Kirstin
    MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK.
    Mercer, Cath
    Institute for Global Health, University College London, London, UK.
    Mohammed, Hamish
    UK Health Security Agency, London, UK.
    Field, Nigel
    Institute for Global Health, University College London, London, UK.
    Ethnic variations in sexual risk behaviour, sexual health service use and unmet need during the first year of the COVID-19 pandemic: an analysis of population-based survey and surveillance data2022Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 98, nr Suppl. 1, s. A8-A9, artikel-id O16Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Prior to the COVID-19 pandemic, STIs disproportionately affected some Black communities. We examined ethnic inequalities in sexual health during the pandemic.

    Methods: Analyses were restricted to England residents aged 18–59. We included 5,240 sexually-experienced participants from Natsal-COVID survey Wave 2 (quasi-representative web panel survey) reporting one-year outcomes from March 2020-April 2021. We estimated weighted proportions and adjusted odds ratios (AORs) between ethnicity and sexual risk behaviour (condomless sex with new partner on first occasion), sexual health service (SHS) use, and unmet need (trying but failing to access SHS). Using GUMCAD national surveillance data from before (March 2019-March 2020) and during (March 2020-March 2021) the pandemic, we compared proportional differences in rates of STI tests and diagnoses by ethnicity.

    Results: Compared to Natsal-COVID participants of White ethnicity, sexual risk behaviour (8%) was higher among participants of Mixed/Other (22%, AOR:2.26 [95% CI 1.08-4.73]) and Asian (15%, 1.58 [1.07-2.35]); SHS use (5%) was higher in Black (20%, 3.04 [1.75-5.28]) and Mixed/Other (20%, 2.64 [1.35-5.14]); and unmet need (2%) was higher in Black (11%, 5.01 [2.26-11.09]) and Asian (5%, 2.33 [1.11-4.90]) ethnicity. In GUMCAD, among people attending SHS, we observed similar reductions of around 50% in testing and diagnoses during the pandemic across different ethnic groups, although the greatest reduction was in people of Asian ethnicity (56% and 52% respectively).

    Discussion: Two independent national data sources showed sexual health inequalities persisted during the first year of the pandemic with evidence of more unmet need among minority ethnicities, but further work is needed to assess whether these worsened.

  • 29.
    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.

  • 30.
    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.

  • 31.
    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.

  • 32.
    Shipitsyna, Elena
    et al.
    Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russian Federation.
    Khusnutdinova, Tatiana
    Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russian Federation; Department of Clinical Laboratory Diagnostics, St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation.
    Budilovskaya, Olga
    Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russian Federation; Department of Clinical Laboratory Diagnostics, St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation.
    Shedko, Elizaveta
    Laboratory of Molecular Diagnostics and Epidemiology of Reproductive Tract Infections, Central Research Institute of Epidemiology, Moscow, Russian Federation.
    Goloveshkina, Elena
    Laboratory of Molecular Diagnostics and Epidemiology of Reproductive Tract Infections, Central Research Institute of Epidemiology, Moscow, Russian Federation.
    Khayrullina, Guzel
    Group of Development and Implementation of New Technologies and Products, Central Research Institute of Epidemiology, Moscow, Russian Federation.
    Krysanova, Anna
    Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russian Federation; Department of Clinical Laboratory Diagnostics, St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation.
    Shalepo, Kira
    Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russian Federation; Department of Clinical Laboratory Diagnostics, St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation.
    Savicheva, Alevtina
    Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russian Federation; Department of Clinical Laboratory Diagnostics, St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Örebro universitet, Örebro, Sweden; Institute for Global Health, University College London, London, UK.
    Performance of the first commercial dual resistance assay, AmpliSens Mycoplasma genitalium-ML/FQ-Resist-FL, for detection of potential macrolide and quinolone resistance-associated mutations and prevalence of M. genitalium resistance mutations in St. Petersburg, Russia2023Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 99, nr 3, s. 191-194Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Antimicrobial resistance in Mycoplasma genitalium (MG) is a poorly surveyed and controlled global health concern. We evaluated the first commercial dual resistance assay, AmpliSens M. genitalium-ML/FQ-Resist-FL assay, for detection of potential macrolide and quinolone resistance-associated mutations (MRAMs and QRAMs, respectively) and estimated the prevalence of these mutations in MG in St. Petersburg, Russia.

    METHODS: Urogenital samples positive (n=145 from 2007 to 2020) and negative (n=56 from 2021) for MG in routine diagnostics were retrospectively analysed using the AmpliSens M. genitalium-ML/FQ-Resist-FL assay (Central Research Institute of Epidemiology, Moscow, Russia) and Sanger sequencing for validation.

    RESULTS: The AmpliSens M. genitalium-ML/FQ-Resist-FL assay detected potential MRAMs and QRAMs with sensitivities of 100% (CI95% 83.9 to 100) and 92.3% (CI95% 66.7 to 99.6) and specificities of 99.2% (CI95% 95.6 to 100) and 100% (CI95% 97.2 to 100), respectively, in clinical specimens with ≥1000 MG geq/mL. In total, MRAMs were detected in 13.8% (CI95% 9.1 to 20.3) of samples, with 23S rRNA A2058G being the most prevalent mutation (45.0% (CI95% 25.8 to 65.8)). QRAMs were found in 9.0% (CI95% 5.3 to 14.7) of samples, with S83I the most frequent mutation (53.8% (CI95% 29.1 to 76.8)). Dual resistance was observed in 5.5% (CI95% 2.8 to 10.5) of samples. Potential MRAM and dual resistance rates significantly increased over time: from 0% in 2007-2008 to 25% (p trend =0.0009) and 10% (p trend =0.0447), respectively, in 2018-2020. QRAM rate appeared to increase (from 0% to 13%), but significance was not reached (p trend =0.0605).

    CONCLUSIONS: The rapid increase in MG antimicrobial resistance in St. Petersburg, especially prominent for MRAMs, necessitates implementation of macrolide resistance-guided therapy in Russia. The first commercial dual resistance assay, AmpliSens M. genitalium-ML/FQ-Resist-FL assay, was sensitive and specific for detection of potential MRAMs and QRAMs and could be valuable in macrolide resistance-guided therapies and possibly for surveillance of QRAMs. International surveillance of antimicrobial resistance-associated mutations in MG, further research into clinical relevance of several parC mutations and novel treatments are essential.

  • 33.
    Smid, Joost H.
    et al.
    Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
    Althaus, Christian L.
    Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
    Low, Nicola
    Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine, Clinical Microbiology.
    Herrmann, Bjőrn
    Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Rise and fall of the new variant of Chlamydia trachomatis in Sweden: mathematical modelling study2020Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 96, nr 5, s. 375-379Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: A new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden in 2006. The nvCT has a plasmid deletion, which escaped detection by two nucleic acid amplification tests (Abbott-Roche, AR), which were used in 14 of 21 Swedish counties. The objectives of this study were to assess when and where nvCT emerged in Sweden, the proportion of nvCT in each county and the role of a potential fitness difference between nvCT and co-circulating wild-type strains (wtCT).

    METHODS: We used a compartmental mathematical model describing the spatial and temporal spread of nvCT and wtCT. We parameterised the model using sexual behaviour data and Swedish spatial and demographic data. We used Bayesian inference to fit the model to surveillance data about reported diagnoses of chlamydia infection in each county and data from four counties that assessed the proportion of nvCT in multiple years.

    RESULTS: Model results indicated that nvCT emerged in central Sweden (Dalarna, Gävleborg, Västernorrland), reaching a proportion of 1% of prevalent CT infections in late 2002 or early 2003. The diagnostic selective advantage enabled rapid spread of nvCT in the presence of high treatment rates. After detection, the proportion of nvCT decreased from 30%-70% in AR counties and 5%-20% in counties that Becton Dickinson tests, to around 5% in 2015 in all counties. The decrease in nvCT was consistent with an estimated fitness cost of around 5% in transmissibility or 17% reduction in infectious duration.

    CONCLUSIONS: We reconstructed the course of a natural experiment in which a mutant strain of C. trachomatis spread across Sweden. Our modelling study provides support, for the first time, of a reduced transmissibility or infectious duration of nvCT. This mathematical model improved our understanding of the first nvCT epidemic in Sweden and can be adapted to investigate the impact of future diagnostic escape mutants.

  • 34.
    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.

  • 35.
    Toskin, Igor
    et al.
    Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
    Govender, Veloshnee
    Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
    Blondeel, Karel
    Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Murtagh, Maurine
    The Murtagh Group, LCC, Woodside, California, USA.
    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.
    Zemouri, Charifa
    College of Dental Medicine, Qatar University, Doha, Qatar.
    Peeling, Rosanna W.
    International Diagnostics Centre, London School of Hygiene and Tropical Medicine, London, UK.
    Kiarie, James
    Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
    Call to action for health systems integration of point-of-care testing to mitigate the transmission and burden of sexually transmitted infections2020Ingår i: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 96, nr 5, s. 342-347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration.

    METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers.

    RESULTS: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care.

    CONCLUSION: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.

  • 36.
    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.

  • 37.
    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.

  • 38.
    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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