bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3-S1.17 Syndromic management of cervicitis and vaginal discharge at a STI clinic in Jamaica: low cure rates for Chlamydial infection and trichomoniasis
Authors: Hobbs M , Anderson C , Hylton-Kong T , Eastman S , Rich K , Gallo M , Legardy-Williams J , Costenbader E , Steiner M , Warner L 
Published: July 2011

BackgroundManagement of cervicitis and abnormal vaginal discharge in Jamaica is based on the syndromic approach recommended by the WHO. To evaluate current algorithms for treatment of gonorrhoea, chlamydial infection and trichomoniasis, we conducted laboratory testing with vaginal specimens from women presenting with cervicitis or vaginitis syndromes at a sexually transmitted infections clinic in Kingston and at follow-up to assess cure rates for these infections.MethodsFrom August, 2010 through January, 2011, vaginal swab specimens were obtained from 258 women >18 years old during a routine clinical examination prior to syndromic treatment according to local guidelines. Treatment for gonorrhoea, chlamydial infection and trichomoniasis was prescribed for women with cervicitis. Treatment for trichomoniasis, bacterial vaginosis and candidiasis was prescribed for women with abnormal vaginal discharge. Women returned the next week for follow-up assessment and specimen collection. Specimens were tested forNeisseria gonorrhoeae(NG) andChlamydia trachomatis(CT) using APTIMA Combo2 and forTrichomonas vaginalis(TV) using APTIMA analyte-specific reagents. All baseline specimens were tested. Follow-up specimens from women with a positive baseline test or who remained symptomatic were also tested. Patients with a positive follow-up test were contacted and instructed to return to the clinic for additional treatment. Cure was defined as a positive baseline test and a negative follow-up test.ResultsBaseline prevalence of infection with NG was 11.7%, CT was 20.7%, TV was 25.6%. At least one of these STIs was detected by laboratory testing in 40.7% of women. Co-infections were common. Women with TV were more likely to have NG or CT than women without TV (OR: 2.6, 95% CI 1.4 to 4.8). STI testing at follow-up indicated cure rates of 77.3% for NG, 43.5% for CT and 47.1% for TV infections. CT incidence at follow-up was 5.9%; no incident NG or TV infections were detected.ConclusionsWith syndromic management, just over half of the STIs in women that were detected by laboratory testing at baseline were cured at follow-up. Reinfection, incorrect or inadequate treatment, failure to comply with treatment instructions or treatment failure could potentially explain prevalent STIs that were detected at follow-up. The low cure rates for chlamydial infection and trichomoniasis are cause for concern.
P3-S1.18 Side effects of doxycycline in adolescents treated for pelvic inflammatory disease
Authors: Risser W , Risser J 
Published: July 2011

BackgroundOur purpose was to assess adverse reactions to doxycline in adolescents under treatment for PID.MethodsAt the Harris County (Houston), Texas, USA Juvenile Detention Center from May 2008 through January 2010, we evaluated adolescents in whom we diagnosed PID. We used the diagnostic criteria and outpatient antibiotic regimen for PID recommended by the CDC. We gave 250 mg ceftriaxone intramuscularly once, and, if they were not pregnant, vomiting, or ill enough to also require metronidazole, we prescribed doxycline, 100 mg twice a day for 14 days. The doxycycline was given before, during, or after breakfast, and approximately 2 h after supper. With the medicine, patients were routinely given a packet of two crackers. We re-assessed these patients at 48–72 h and again at least at 7 and 14 days. At each follow-up, we discussed side effects of doxycycline.ResultsWe evaluated 141 consecutive patients in whom we made the diagnosis of mild to moderate PID: 55% were black, 31% Hispanic, and 15% white. The mean age (SD) was 15.4 (1.2) years. Of the 141 patients, 86 (61%) had no problems when the doxycline was given with two crackers. Forty-five (32%) required more substantial food to avoid nausea and/or vomiting: the medication was given immediately after breakfast or with a sandwich after supper. Those who had side effects in the morning had usually skipped breakfast. Ten (7%) complained of significant gastrointestinal side effects that were not relieved by the simultaneous ingestion of food, and we gave a dose of promethezine 1 h before the doxycycline.Conclusion39% of our patients required more than a small amount of food (two crackers) to avoid gastrointestinal side effects from doxycline. Our results suggest that clinicians should advise adolescents to take this antibiotic after eating a greater amount of food if a small snack does not prevent this problem. Because some patients (7%) did not tolerate doxycline even after they ate a meal or a sandwich, we also recommend early contact with patients who have PID to assess the need to change medications or to add an anti-emetic.
P3-S1.23 Mycoplasma genitaliumin South African men with and without symptoms of urethritis: diagnosis and bacterial load
Authors: Hoosen A , le Roux M C , Adam A 
Published: July 2011

ObjectivesTo diagnose causes of urethritis in symptomatic men and evaluate the role ofMycoplasma genitaliumby calculating bacterial loads in urine specimens from symptomatic and asymptomatic men.MethodsUrine specimens from 94 men with visible urethral discharge, 206 with burning on micturition (BOM) and 75 without any genital symptoms were tested forN gonorrhoeae(NG),C trachomatis (CT), T vaginalis (TV) and M genitalium(MG) using TMA assays. The bacterial load was estimated by quantitative real-time PCR assay in specimens withM genitaliumalone.ResultsAt least one pathogen was detected in 138 (46%); mixed infections in 28 (9.3%). The most common mixed infection was NG + MG (3.7%). There were significant differences for MG (17.3% vs 6.6%), NG (16.7% vs 2.6%), CT (12.3% vs 5.1%), and TV (8.0% vs 1.3%) in symptomatic vs asymptomatic men. There was also a significant difference in presence of MG in the symptomatic men (20.2% in men with discharge vs 4.4% in those with BOM). Patients with urethral discharge (mean 5.3×103 copies/ul) had significantly higherM genitaliumconcentrations than those with BOM (mean 6.7×102 copies/ul) (p<0.001), and the bacterial concentrations in men with symptoms and/or signs of urethritis were significantly higher than that in asymptomatic men (mean 4.6×101 copies/ul) (p=0.02).ConclusionsSignificantly more organisms were detected in patients with urethritis than in those without. There was a strong association betweenM genitaliumbacterial load and men with symptoms of urethritis both BOM and urethral discharge. As the number of organisms increased, the severity of the symptoms increased (greater numbers in urethral discharge), indicating a role forM genitaliumin disease severity. This study also demonstrated the usefulness of quantitative PCR in determining an aetiological role and possibility of monitoring efficacy of treatment for this pathogen.
P3-S1.24 Cost effectiveness of self-taken vaginal swabs using GenProbe AC2 assay vs clinician taken urethral and endocervical swabs for detection of gonorrhoea
Authors: Wilson J , Hulme C , Stewart C , Schoeman S , Wilcox M 
Published: July 2011

BackgroundCulture ofNeisseria gonorrhoeaefrom the urethral and endocervix is currently the recommended method of detecting gonorrhoea (GC) in women in the UK. This necessitates a speculum examination. NAATs are the mainstay of testing forChlamydia trachomatis(CT) infection and assays exist which can also detect GC. NAATs are more sensitive than culture meaning non-invasive samples can be used. No previous study has compared self-taken VVS analysed by AC2 with urethral and endocervical GC culture, which is considered the gold standard test in the UK. We therefore undertook this comparison in a clinical setting with low GC prevalence and performed a cost-effectiveness analysis.MethodsParticipants were recruited within the Centre for Sexual Health at Leeds, UK between March 2009 and January 2010. The women, presenting for a new visit, performed a self-taken VVS and were then examined and urethral and endocervical samples taken for GC culture. Positive AC2 tests were confirmed by the Aptima GC and/or Aptima CT mono-specific platform tests. The cost effectiveness was analysed using incremental cost effectiveness ratios (ICERs). The analysis uses correct detection of GC as the primary endpoint and adopts the perspective of the UK National Health Service. Costs were estimated from a sub-sample of 92 patients in July 2009. The analysis includes costs of clinic time, together with the laboratory costs. Comparisons were made of self-taken VVSs using AC2 vs clinician taken cultures for the whole cohort.Results100 of the 3973 participants (2.5%) were infected with GC. The overall sensitivity of GC culture was 82% and self-taken VVS 95%. 35% of the participants were asymptomatic in whom GC culture sensitivity was 79% and self-taken VVS 91%. The cost effectiveness results are presented in Abstract P3-S1.24 table 1.Abstract P3-S1.24 Table 1Diagnostic testDiagnostic testCostsDifferenceGonorrhoea cases correctly diagnosedDifferenceICERs (£ per correctly diagnosed case)All have GC culture test and CT NAAT irrespective of symptoms250 841.7929 922.498213GC VVS dominatesAll have GC/CT VVS irrespective of symptoms220 919.3095ConclusionsSelf-taken VVS analysed by AC2 are cost effective compared to urethral and endocervical GC culture; being more sensitive and less costly. Whilst those presenting with symptoms continue to require a clinician examination use of VVSs in women with no symptoms removes the need for examination. The cost of the time taken in explanation of self taken swabs for this group represents <20% of the cost of a clinician examination. Cost savings also accrue through use of AC2 alone rather than GC culture and CT NAAT.
P3-S1.25 Evaluation of real time PCR for detection of five sexually transmitted diseases in Abidjan, Ivory Coast
Authors: Kakou-Ngazoa S 
Published: July 2011

ObjectiveTo evaluate a real-time PCR assay for molecular screening of five most common sexually transmitted diseasesTrichomonas vaginalis, Mycoplasma genitalium, Neisseria gonorrhoeae, Chlamydia trachomatisand Herpes simplex virus 2 in Abidjan, Ivory Coast.Methods25 self-collected vaginal swabs were obtained from adult persons with symptoms of vaginal discharge and vulval irritation. The samples were diluted in sterile PBS and the DNA extraction was processed using Nuclisens extraction Kit. 5 μl of genome extract was applied in real-time PCR for each pathogen. The targeted region of real time was the 18 S ribosomal DNA genes forT vaginalisand the 16S rRNA forM genitalium.Results10 of 25 (40%) samples were positive for sexually transmitted dieases. Over 30 % of the samples shown inhibition and were tested positive by serial dilution.Chlamydia trachomatisis the most detected infection in five samples, and one sample was positive respectively byT vaginalisand byN gonorrhoeae. We detect no co-infection in all samples.ConclusionsThe real-time PCR is a suitable specific and sensitive method to investigate and to detect sexually transmitted diseases in developing countries.
P3-S1.28 Is urethritis of unknown aetiology caused by bacteria associated with bacterial vaginosis?
Authors: Frølund M , Datcu R , Ahrens P , Lidbrink P , Björnelius E , Jensen J S 
Published: July 2011

BackgroundThe aetiology of non-gonococcal urethritis (NGU) in men is unknown in 30%–50% of cases. Little is known about the relation of bacterial vaginosis (BV) associated bacteria in men with urethritis of unknown aetiology (UUE). Urethral swabs from men with and without NGU were analysed with PCR for BV associated bacteria to show a possible association with UUE.MethodsUrethral swabs from 9 and 19 men with symptomatic and asymptomatic NGU (>5 PMNL/hpf), respectively, and 30 asymptomatic men without NGU were collected. All samples were negative forNeisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium,Ureaplasma urealyticumandU parvumwith specific PCR assays. Quantitative real-time PCR with TaqMan based assays were performed to detect Atopobium vaginae (Av), Sneathia sanguinegens (Ss), Leptotrichia amnionii (La) and Gardnerella vaginalis (Gv), and with SYBR green assays for BVAB 1, 2 and 3, and Megasphaera phylotype 1 (M1).ResultsGv was detected in 93% of cases with UUE and in 37% of controls (p<0.0001). There was no difference in organism load. In the 28 NGU cases Av, Ss and La were found in 3, 2 and 1 samples, respectively, and in 6, 2 and 1 of the control samples, respectively. The median corresponding organism loads were 14, 95 and 51 for the NGU cases and 16, 10 566 and 353 for the controls. All samples were negative for BVAB 1, 2 and 3 and M1, except one control with 10 genome copies of BVAB 1.ConclusionsGardnerella vaginaliswas associated with male urethritis in this study, especially in men with asymptomatic urethritis, while BVAB 1, 2 and 3, Megasphaera phylotype 1,Atopobium vaginae,Sneathia sanguinegens, andLeptotrichia amnioniiwere not.
P1-S1.43 Antimicrobial susceptibility and molecular epidemiological characteristics ofNeisseria gonorrhoeaein 2009–2010 in Belarus
Authors: Glazkova S , Unemo M , Golparian D , Titov L , Pankratova N , Suhabokava N , Shimanskaya I , Ignatyev G , Domeika M 
Published: July 2011

BackgroundAntimicrobial resistance (AMR) inNeisseria gonorrhoeaeis a global concern, and gonorrhoea may become untreatable. However, AMR data from Eastern Europe are scarce beyond Russia, and in Belarus no AMR data or other characteristics of gonococci have been published in over 20 years. The aim was to describe the AMR and molecular epidemiological characteristics of gonococci circulating in 2009 and 2010 in Belarus.MethodsN gonorrhoeaeisolates cultured in 2009 (n=80) and 2010 (n=78) in the two different cities Minsk (n=45) and Mogilev (n=113) were examined using Etest for nine antimicrobials and nitrocefin solution for β-lactamase production. Where available, breakpoints for susceptibility and resistance according to The European Committee on Antimicrobial Susceptibility Testing (EUCAST;http://www.eucast.org) were used. Moreover, screening for penA mosaic alleles, full-length porB gene sequencing, andN gonorrhoeaemultiantigen sequence typing (NG-MAST) were performed.ResultsThe levels of resistance in 2009–2010 to antimicrobials evidently used in the gonorrhoea treatment in Belarus were—ceftriaxone 0%, spectinomycin 0%, azithromycin 14.4%, tetracycline 30.9%, ciprofloxacin 34.6%, and erythromycin 59.2% (only tested in 2009). The levels of resistance to other antimicrobials of international interest but not used in Belarus were—cefixime 0%, gentamicin 1.3%, and penicillin G 9.9% (only tested in 2009). Extraordinarily, no β-lactamase producing isolates were detected. The circulatingN gonorrhoeaepopulation identified was very heterogeneous and contained many divergent NG-MAST STs, of which more than half have not been previously described worldwide.ConclusionsDue to the high levels of resistance to all antimicrobials previously recommended as first-line treatment, only ceftriaxone and spectinomycin can be recommended for empirical gonorrhoea treatment in Belarus. Continuous and quality assured gonococcal AMR surveillance in Eastern Europe is crucial, in Belarus this surveillance is now initiated using WHO protocols.
P3-S1.30 Successful use of non-invasive self obtained glans/meatal dry FLOQSwabs (COPAN) for CT/NG detection with the BD ProbeTec ET assay in Northern Italy
Authors: Ferrero D V , Biglino A 
Published: July 2011

BackgroundIncreasingChlamydia trachomatis(CT) rates and ever-presentNeisseria gonorrhoeae(NG) infections worldwide in women have led to the consideration of targeted male CT/NG screening programs in order to address the male reservoir. Effortlessly collected, non-invasive, painless, dry, self-obtained male swab specimens that are stable and easy to transport would enhance the success of male screening programs. We undertook a study to compare the results of self obtained glans/meatal swab (SOGS) (COPAN FLOQSwabs) specimens with conventional first catch urine (FCU) specimens. The aim of the study was simply to assess the usefulness of a SOGS specimen when compared to FCU given the SOGS specimen's ease of collection, ease of use and handling in challenged venues (ie, without toilet facilities), and ease of transport.Methods122 male patients attending an STD clinic and males incarcerated near the Italian city of Asti were tested for CT and NG using a SOGS. Patients were verbally instructed and shown a drawing to enhance standardised self-collection. A FCU specimen was also collected. SOGS and FCU specimens were then processed according to the manufacturer's recommended procedure using the BD ProbeTec ET system (Becton Dickinson and Company).ResultsThere were a total of 16 specimens detected positive for either CT or NG. Seven men were infected by both CT and NG. The CT prevalence was 5.7%. The NG prevalence was 13.1%. There was an overall SOGS specimen agreement of 97.5% when compared to FCU specimen results.ConclusionsHigh agreement was obtained with the self obtained glans/meatal COPAN FLOQSwabs when compared to standard FCU specimens. These results indicate that self obtained glans/meatal swab specimens are a viable specimen choice. Dry self obtained glans/meatal swab specimens with FLOQSwabs were easy to collect, transport and test using the BD ProbeTec ET system. The BD ProbeTec ET system showed high agreement when testing both of these specimen types. Simpler methods of collection and transport that produce reliable test results may increase the potential for screening difficult to test male populations, especially those who never test.
P3-S1.32 A validation study of the Gen-Probe APTIMA Combo2 (AC2) assay for detectingChlamydia trachomatisandNeisseria gonorrhoeaein dry swabs
Authors: Cosentino L , Schwebke J R , Hobbs M M , Hillier S L 
Published: July 2011

BackgroundVaginal swabs are an optimal specimen for detection ofChlamydia trachomatis(CT) andNeisseria gonorrhoeae(GC). The Gen-Probe Aptima system (Aptima) requires use of a sample transport media, whereas the Becton Dickinson ProbeTec ET System (Probetec) can utilise dry swabs. The use of dry swabs allows for collection of STD test samples at non-clinical testing venues.MethodsSwabs were collected from 180 sexually active women aged 15–25 years, who had asymptomatic BV and two or more risk factors for STDs. The participants received home vaginal swab self-collection kits for BV and STD testing. Participants mailed the kits directly to the lab. Probetec swabs were tested within 14 days of collection. A dry transport swab was placed into an Aptima vaginal swab collection tube, generally within 14 days of collection and stored at −80°C. Aptima swabs were thawed and tested in batches. Specimens with discordant results in the two nucleic acid amplification test systems were retested with both systems.ResultsThere were 58 women (32%) positive for GC and 62 (34%) positive for CT. The level of agreement between the Aptima and Probetec systems was higher for CT (176/180, 98%) than for GC (171/180, 95%). Of the 13 samples with discordant results, five were resolved with repeat testing. All eight remaining samples had discordant GC results: seven were Probetec positive, Aptima negative and one was Probetec negative, Aptima positive.ConclusionsVaginal swabs tested in the Aptima system were equivalent to Probetec in detecting CT but were less sensitive for the detection of GC. Dry swabs cannot be recommended for detection of GC from vaginal swabs using the Aptima system.
P3-S1.33 Evaluation of the Roche cobas 4800 for the detection ofChlamydia trachomatisandNeisseria gonorrhoeaeusing minimally invasive samples in women
Authors: Hires L , Van Der Pol B , Taylor S , Lillis R , Body B 
Published: July 2011

BackgroundThe Roche cobas 4800 (cobas) is a new diagnostic assay that utilises an automated workstation to isolate nucleic acids from clinical specimens and a real time instrument for the detection ofC trachomatis(CT) andN gonorrhoeae(NG). The objective of this study was to compare the performance characteristics of the cobas to the BD Viper (Viper) and GenProbe Aptima Combo 2 (AC2) assays for the detection of CT and NG using a patient infected standard (PIS).MethodsSpecimens were obtained from women attending STD, family planning, or OB/GYN clinics from 12 geographically distinct locations. Urine and vaginal swabs were obtained from each participant as were endocervical (data not shown) and liquid based cytology samples (data not shown). Women were randomised to either self-obtained (SOV) or clinician-obtained (COV) vaginal swab collection. Four sites performed testing by AC2, cobas, and Viper for urine and by cobas for vaginal swabs. A patient was considered infected if at least two of the assays with different molecular targets gave positive results from cervical or urine samples.ResultsOverall CT sensitivity ranged from 91.9% to 93.9% and specificity ranged from 99.7% to 99.8% for all sample types. Overall GC sensitivity ranged from 97.0% to 100% and specificity from 99.9% to 100% see Abstract P3-S1.33 table 1.Abstract P3-S1.33 Table 1Sample Type VagSample TypenCT Sensitivity [95% CI]CT Specificity [95% CI]nNG Sensitivity [95% CI]NG Specificity [95% CI]Urine427192.3%(251/272) [88.5 to 94.9]99.7%(3989/3999) [99.5 to 99.9]427498.5%(64/65) [91.8 to 99.7]99.9%(4206/4209) [99.8 to 100]SOV208393.9%(123/131) [88.4 to 96.9]99.7%(1946/1952) [99.3 to 99.9]208397.0%(32/33) [84.7 to 99.5]100%(2049/2050) [99.7 to 100]COV216591.9%(125/136) [86.1 to 95.4]99.8%(2024/20 290) [99.4 to 99.9]2164100%(33/33) [89.6 to 100.0]100%(2130/2131) [99.7 to 100.0]ConclusionsThe cobas assay has excellent sensitivity and specificity when compared to PIS. There was no difference in performance between the SOV and COV specimens or between the vaginal and urine specimens. Self-obtained vaginal swabs provide opportunities for increased efficiency within the clinical settings. The assay is easy to perform, automated, and can be completed in <4 h.