Evaluation of self-collected rectal swabs for the detection of bacteria responsible for sexually transmitted infections in a cohort of HIV-1-infected patients
Authors: Christelle Tomei
Amélie Ménard
Isabelle Ravaux
Philippe Colson
Andreas Stein
Catherine Tamalet
Sophie Edouard
Didier Raoult
Hervé Tissot-Dupont
Catherine Dhiver
Journal: Journal of Medical Microbiology (2017)
Discipline: MICROBIOLOGY
Keywords: Chlamydia trachomatis; HIV; Mycoplasma genitalium; Neisseria gonorrhoeae; STI
Affiliations: Aix Marseille Univ, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée-Infection, Marseille, France

Abstract:  Purpose. The standard approach to screening sexually transmitted infections (STIs) has often been restricted to urogenital specimens. Most current guidelines, however, also recommend testing extra-genital sites, including rectal locations, because asymptomatic rectal carriage of pathogens has often been reported. The aim of our study was to evaluate self-collected rectal swabs to screen bacterial STIs in HIV-infected patients in Marseille, France.Methodology. Between January 2014 and December 2015, 118 HIV-infected patients (93 males and 25 females) agreed to self-sample anal swabs for detection of bacterial STI. Detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, Mycoplasma genitalium and Haemophilus ducreyi was performed using in-house qPCR assay.Results/Key findings. Bacterial STIs were found in 8 % (9/118) of the patients. C. trachomatis was the most commonly detected bacterium (4.2 %) followed by N. gonorrhoeae (2.5 %), M. genitalium (1.7 %) and T. pallidum (0.8 %). All the positive patients were males. The rectal carriage of pathogenic bacteria was fortuitously discovered for seven men (78 %) who did not present rectal signs of STIs and was suspected for two men who presented proctitis (22 %).Conclusion. In conclusion, testing extra-genital sites is crucial for the diagnosis of STIs in men and women presenting or not concomitant urogenital infections in order to detect asymptomatic carriage with the aim of controlling and preventing transmission to their sexual partners. 

Retracted: No

PubPeer comments:
 The authors mentioned that between January 2014 and December 2015, 118 HIV-infected patients (93 males and 25 females) agreed to self-sample anal swabs for detection of bacterial STI. This recruitment is prospective. The study collects rectal swab. This is an additional interventional done on volunteer. The study is an interventional prospective study. The authors mentioned that the study was approved by the IHU ethics committee with the no. 2016-015. The first part of this approval number is the year of approval. This number means the Ethic committee approved the study in 2016. After the recruitment of participants between 2014 and 2015. It seems to be a retrospective ethics committee approval for a prospective interventional study which seriously deviate from Helsinki Declaration. In accordance with Editors guidances and Helsinki Declaration, if a study has not been granted ethics committee approval prior to commencing, retrospective ethics approval cannot be obtained and it may not be possible to consider the manuscript for peer review. Accepting retrospective ethics approval for interventional prospective study would promote these practices and this risk should be considered very seriously by Editors. It would be in the public interest if the editor can clarify this point. Otherwise, in France, interventional prospective study MUST get an approval from certified IRB (Comitu00e9 de Protection des Personnes) before to start. The local IHU Ethics Committee is not on the list of the certified IRB and has not the ability to validate a prospective interventional study. It would be in the public interest if the authors can explain why the study did not mention any approval from a Comitu00e9 de Protection des Personnes before to start the recruitment in January 2014. ,