bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S1.42 Russian gonococcal antimicrobial susceptibility programme (RU-GASP) - resistance levels in 2010 and trends during 2005–2010
Authors: Frigo N , Unemo M , Kubanova A , Kubanov A , Solomka V , Polevshikova S , Lesnaya I 
Published: July 2011

BackgroundAntimicrobial resistance (AMR) inNeisseria gonorrhoeaeis a major concern worldwide. AMR surveillance globally is crucial for guiding effective treatment and accordingly for public health purposes. In the former Soviet countries, the knowledge regarding AMR has been limited. However, in 2004 the Russian gonococcal antimicrobial susceptibility programme (RU-GASP), which now acts also under WHO protocols, was initiated. The aims of the present study were to examine and describe the prevalence ofN gonorrhoeaeAMR in 2010 in Russia, and reveal trends during 2005–2010.MethodsIn 2010,N gonorrhoeaeisolates (one isolate per patient; n=407) collected from 46 surveillance sites distributed in all eight Federal Districts of Russia were examined regarding their susceptibility to ceftriaxone, spectinomycin, azithromycin, penicillin G, ciprofloxacin, and tetracycline using agar dilution method, according to CLSI and WHO protocols. β-Lactamase production was identified using nitrocefin discs.ResultsIn 2010, the AMR (intermediate susceptibility) levels were as follows - ceftriaxone 0% (0%), spectinomycin 4.4% (12.3%), azithromycin 4.9% (10.4%), penicillin G 32.5% (39.9%), ciprofloxacin 53.2% (3.0%), and tetracycline 41.9% (26.6%). Three isolates (0.7%) were resistant to all antimicrobials except ceftriaxone. During 2005–2010, the AMR has remained high to penicillin G, tetracycline, and ciprofloxacin. The proportion of resistant isolates to spectinomycin and azithromycin has ranged from 0% (2005) to 7.2% (2008), and 0.4% (2008) to 4.9% (2010), respectively. All isolates in 2005–2010 were susceptible to ceftriaxone. Nevertheless, the minimum inhibitory concentration (MIC) distribution of ceftriaxone has rapidly shifted to higher MICs, and isolates at the breakpoint for intermediate susceptibility/resistance (0.25 mg/l; n=8 [2%] in 2010) have rapidly increased over the years.ConclusionsThe AMR ofN gonorrhoeaein Russia is high and ceftriaxone (3250 mg) should be first-line for empirical treatment. If there are no access to ceftriaxone or in the presence of severe β-lactam antimicrobial allergy, spectinomycin is recommended for use. However, despite exceedingly rare in most countries spectinomycin resistance is annually identified in Russia, and accordingly the level of this resistance is crucial to monitor. Continuous, quality assured and quality controlled gonococcal AMR surveillance in Russia is crucial. RU-GASP now also works under WHO protocols.
P3-S1.20 Aetiology of urethral discharge syndrome and its association with sexual practices among males attending STI clinics in India
Authors: Kumar R , Parimi P , Narayanan P , Das A , Gurung A , Rao G , Risbud A 
Published: July 2011

BackgroundStudies to validate the aetiology of urethral discharge (UD) syndrome are limited in India. The objectives of the study were to determine etiological agents of UD syndrome among males attending STI clinics and associated risk factors.MethodsWe conducted a cross-sectional study among males presenting with complaints of dysuria and/or urethral discharge at eight government and non-governmental organization STI clinics in four Indian states from 2008 to 2009. A behavioural questionnaire was administered, clinical examination performed and urine was collected to test forNeisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) by Gen-Probe-APTIMA Combo II. In cases where a urethral discharge was elicited, urethral swabs were collected and tested forMycoplasma genitalium(MG),Ureaplasma urealyticum(UU) andTrichomonas vaginalis(TV) by using PCR method. Data were analysed using STATA V10.Results246 clients diagnosed with UD syndrome as per the national algorithm were enrolled in the study. 29% of the participants had at least one of the infections. The overall prevalence of GC was 14% and CT was 4%. Among the 86 participants from whom urethral swabs were collected, prevalence of MG and UU was 33% and 34% respectively while TV was not detected. In this sub-group of 86 participants, the prevalence of GC and CT was higher at 24% and 7% respectively while 64% individuals had at least one infection. Factors such as younger age (<25 years), illiteracy, paid sex in last 2 weeks and penetrative anal sex in last 3 months were found to be significantly associated with having any infection (see Abstract P3-S1.20 table 1).Abstract P3-S1.20 Table 1Correlates of infections (gonococcal and/or non-gonococcal)S. No.CharacteristicOR (95% CI)p Value1Age up to 25 years1.7 (0.9 to 3.1)0.062Inability to read or write2.2 (0.9 to 5.1)0.053Paid sex in last 2 weeks2.1 (1.1 to 4.2)0.024Penetrative anal sex in past 3 months2.1 (0.9 to 4.8)0.055Vaginal sex in past 3 months2.8 (0.6 to 26.4)0.166No condom use at last sexual act1.4 (0.7 to 2.7)0.32ConclusionThe current practice of diagnosing UD syndrome based on the history of dysuria and/or discharge is leading to over-diagnosis. A detailed sexual history for determining risk factors and demonstration of urethral discharge on clinical examination will help to improve the diagnosis.
P3-S1.21 Non-culture basedNeisseria gonorrhoeaeantimicrobial resistance surveillance
Authors: Goire N , Freeman K , Tapsall J , Lambert S , Nissen M , Sloots T , Whiley D 
Published: July 2011

BackgroundIncreased reliance on nucleic acid amplification tests for the diagnosis of gonorrhoea, and issues with transporting viableNeisseria gonorrhoeae(NG) isolates, particularly from remote regions, undermines bacterial-culture-based NG antimicrobial resistance (AMR) surveillance. In this study, we explored non-culture based NG AMR surveillance by developing and validating a real-time PCR assay for direct detection of penicillinase-producing NG (PPNG) in clinical samples.MethodsThe PPNG-PCR assay was designed as an indirect marker of penicillinase activity, by targeting a region of sequence conserved across all NG plasmid types harbouring the β-lactamse gene, while not targeting the actual β-lactamase encoding sequence. The assay was evaluated using 118 characterised NG clinical isolates, and then applied to samples collected from the Australia's Northern Territory (years 2008–2009) where penicillin is still used for treatment. These comprised 214 NG-positive clinical samples from whichN gonorrhoeaewere isolated and phenotypic penicillinase results were available and an additional 209 samples that were positive by NG-PCR only.ResultsThe PPNG-PCR2 assay provided 100% sensitivity and 98.5% specificity compared to bacterial culture results for the detection of PPNG in clinical specimens. PPNG-PCR false-positive results, presumably due to cross reaction with unrelated bacterial species, were observed in four clinical samples but were distinguished on the basis of late cycle threshold values. A total of 15/423 (3.6%) samples were positive by PPNG-PCR. These data vary from phenotypic surveillance rates for this region (2.5%–2.9%).ConclusionIn tandem with phenotypic surveillance, the PPNG-PCR assay provides enhanced epidemiological surveillance ofN gonorrhoeaepenicillin resistance and is of particular relevance to regions where penicillin is still used to treat gonorrhoea. We are currently evaluating assays targeting NG chromosomally-mediated resistance mechanism to β-lactam antibiotics.
P3-S1.22 Evaluation of performance of six commercial assays for detection of characterised isolates ofNeisseria gonorrhoeaeand otherNeisseria spp.
Authors: Tabrizi S , Unemo M , Limnios A , Hjelmevoll S O , Garland S , Tapsall J 
Published: July 2011

BackgroundMolecular detection ofNeisseria gonorrhoeaein urogenital samples is now routinely conducted in many diagnostic laboratories with the demand also expanding to testing of extragenital samples. Testing of extragenital samples poses a challenge as it may result in false positive results due to cross-reaction with commensalNeisseria spp.andN meningitidis. Adequate evaluation of molecular assays is essential prior to expanding utilisation of the assays to such specimens.MethodThis study aimed to examine 450 characterised clinical isolates comprising of 216N gonorrhoeaeand 234 otherNeisseria spp.and closely related bacteria from various geographical regions worldwide with six commercial assays including GenProbe APTIMA Combo 2 and APTIMA GC; Roche COBAS Amplicor CT/NG and COBAS 4800 CT/NG; BD ProbeTec GC Qx Amplified DNA Assay and Abbott RealTime CT/NG.ResultsAmong 216N gonorrhoeaeisolates included in the study, all assays except COBAS Amplicor where four (1.9%) gonococcus isolates were not detected, showed a positive result with allN gonorrhoeaeisolates. Among 234Neisseria spp.evaluated, initial results showed all assays evaluated to display cross reaction with non-gonococcal Neisseria isolates. COBAS Amplicor and ProbeTec showed highest number of false positives, detecting 33 (14.1%) and 26 (11%) non-gonococcal Neisseria isolates respectively. Abbott RealTime, APTIMA Combo and APTIMA GC, and Roche COBAS 4800 showed initially low level of cross reaction, that is, detected 2 (1%), 5 (2.1%), 4 (1.7%) and 2 (1%) of the isolates respectively. When retested by the company using a fresh culture, none of these nine isolates showed cross reaction with the respective assays.ConclusionCOBAS Amplicor and ProbeTec displayed highest number of false positives among assays evaluated, with the remaining assays only showing sporadic low level false positivity. Especially when examining extragenital specimens, supplementary testing for all assays and platforms remains recommended.
P3-S1.27 Is antimicrobial resistance inChlamydia trachomatisa reality?
Authors: Pitt R , Alexander S , Horner P , Ison C 
Published: July 2011

IntroductionThe use of single dose therapy and the emergence of a stable tetracycline resistant strain of Chlamydia suis has raised concerns regarding potential development of antimicrobial resistance (AMR) inC trachomatis(CT). Specimens sourced from patients with persistently confirmed CT infections after treatment with first line recommended therapies were examined for the presence of AMR determinants identified in other organisms.MethodsCT DNA positive specimens were examined for viable bacteria by tissue culture. Sequencing for mutations in three genes known to be involved in azithromycin (AZM) AMR; rplV, rplD and 23S rRNA (two alleles) and for the presence of six tetracycline AMR determinants; tet(A), tet(B), tet(C), tet(D), tet(E) and tet(M) was done. Susceptibility testing was performed using isolates grown in duplicate serial dilutions of AZM followed by quantitative RT-PCR. Isolates with a log or more increase in plasmid copy number were deemed resistant and those with a static or decreased copy number were deemed sensitive. Isolates were also screened for contaminating bacteria.ResultsNine isolates were retrieved from twenty CT NAAT positive patients. When examined by AZM MIC assays, all isolates were sensitive. An identical non-silent single nucleotide polymorphism (SNP) was identified in three clinical specimens and one isolate from three patients in the rplD gene. A non-silent SNP was also identified in the rplV gene in one of these patients. The pre and post treatment specimen from a further patient showed a non-silent SNP in the rplD gene and identical point mutations in both alleles of the 23S rRNA gene. The tet(M) resistance determinant was identified in ten specimens and five isolates from eleven different patients. All screens for contaminating bacteria were negative.ConclusionsPreviously unreported mutations in genes responsible for AZM AMR in other organisms have been identified however all isolates were found to be AZM sensitive. Whilst the SNPs identified may not be significant, detection of them demonstrates that CT has undergone mutation in these key genes. A fragment of the tetracycline AMR determinant, tet(M) (responsible for high level tetracycline AMR inNeisseria gonorrhoeae), was identified in several clinical specimens and in five isolates. The function of the tet(M) fragment in CT is currently unknown and the establishment of tetracycline MIC assays are a priority.
P3-S1.29 Effectiveness of gentamicin for gonorrhoea treatment: a systematic review
Authors: Kirkcaldy R , Dowell D 
Published: July 2011

BackgroundThe development of resistance to multiple antimicrobials has limited treatment options for gonorrhoea. Potential emergence of cephalosporin resistance inNeisseria gonorrhoeaeand cephalosporin allergy in some patients make it necessary to evaluate the effectiveness of other available antimicrobials. Gentamicin is widely available in the USA and is used for gonorrhoea treatment in several countries.MethodsWe conducted a systematic review of the medical literature to assess the effectiveness of gentamicin for treatment of uncomplicated urogenital gonococcal infections. Two reviewers assessed relevant articles and independently selected studies that met pre-specified selection criteria (including systematic enrolment and assignment to treatment and culture-confirmed diagnosis and outcome). Summary measures for selected studies were pooled using inverse variance-weighted averages with fixed effects. Heterogeneity was assessed using I-squared, which estimates proportion (from 0% to 100%) of variability attributable to heterogeneity between studies. Pooled percentage with negative follow-up culture was compared with CDC criteria for selection of recommended therapy (>95% efficacy with lower 95% CI >95%).Results18 potentially relevant English-language studies were identified; three met inclusion criteria. Reviewer agreement for initial judgement on meeting selection criteria was substantial (κ 0.68). Two studies used 240 mg, and one study used 280 mg IM gentamicin. Percentages with negative culture after single-dose treatment were 90.7% (n=86), 91.4% (n=220), and 95.0% (n=40). Pooled percentage with negative culture after single-dose treatment was 91.5% (95% CI 88.1% to 94.0%, I-squared = 0%).ConclusionsGentamicin does not meet current CDC criteria for recommended treatment of gonorrhoea. However, if cephalosporin resistance emerges, gentamicin may be a useful alternative agent. Evaluation of additional regimens, including combination therapy, is warranted.
P3-S1.31 Comparison of Copan UriSwab with BD ProbeTec urine preservative transport kit for preservation and detection of CT and NG in the ProbeTec assay
Authors: Castriciano S , Montrucchio G , Moglia R , Concialdi E , Oddone L , Bolla C , Biglino A 
Published: July 2011

BackgroundUrine specimen collection is better accepted by the patients than invasive collection techniques for detection ofChlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG). Self-collection is useful for Sexually Transmitted Infection (STI) screening programs. Dedicated urine collection devices for molecular assay are unsuitable for other molecular assays and for bacteria culture investigation. Urine collection devices that are easy to collect and transport and are leak proof, that can be used for STD screening by culture and molecular assays are essential. Copan has introduced the UriSwab (US), that consists of a leak proof tube with a screw cap containing a plastic stick with sponges attached that absorb and retain the urine sample during transport while preventing bacterial overgrowth. The objective of this study was to compare the Copan UriSwab for collection, transportation and preservation of first catch urine (FCU) specimens to the BD ProbeTec Urine Preservative Transport Kit (UPT) for the detection of CT and NG with the BD ProbeTec assay.MethodFCU specimens were self-collected from 134 male patients attending an STD clinic or who were residents of a detenction center in the Italian city of Asti. Duplicate FCU specimens were collected, one with the US and the other with the UPT. The US specimens were centrifuged and the urine pellets were eluted with ProbeTec lysis buffer. US and UPT urine specimens were processed according to the manufacturer's recommended procedure with the BD ProbeTec ET assay (Becton Dickinson).ResultsOut of 134 males from the detention center and the STD clinic, 115 were negative and 19 positive for either CT or NG in both US and UPT collection devices. Five patients were positive for both CT and GC. The CT prevalence was 8.2 %. The NG prevalence was 10.44%.ConclusionsGood results agreement was found between the Copan UriSwab and the BD urine collection devices for the detection of CT and GC with the BD ProbeTec ET assay. The UriSwab is easy to transport and process in the laboratory for the detection of CT, GC and other STI infectious agents with molecular assays and can also be used for culturing all urogenital bacteria. The UriSwab can facilitate self-collection for STI screening.
P3-S2.01 Non sexually transmitted genital ulcers; patients referred to a STD clinic
Authors: Palit A 
Published: July 2011

IntroductionNon-sexually transmitted genital ulcers are a cause of significant morbidity among sexually active young men and women. Establishing the underlying cause of the genital ulcer and differentiation from sexually transmitted infections may be challenging for the treating physician.Case reportsPatient data were collected from a STD clinic in a tertiary care hospital in south India from 2008 to 2010. All the patients were routinely screened for syphilis and HIV infection. Smears from the ulcers were taken and stained with Gram stain and/or Giemsa stain. Biopsy from the ulcer edge was taken whenever indicated. Following causes for non-sexually transmitted genital ulcers were recorded: Behcet's disease was seen in two male patients. Infectious ulcers; One pregnant woman presented with multiple painful genital ulcers caused byKlebsiellaspp. An HIV infected man on antiretroviral therapy presented with ecthyma gangrenosum of scrotum with unilateral lymphadenopathy caused byPseudomonas sp.Chancroid-like ulcers; a monogamous, HIV-negative office worker and an HIV positive widow, sexually inactive since 5 years, presented with multiple, small shallow genital ulcers with excruciating pain simulating herpes genitalis. The ulcers did not respond to adequate therapy with acyclovir and organism could not be demonstrated on gram stain or bacterial culture. In both the cases, the ulcers healed completely with azithromycin. Factitious ulcer; seen over the shaft of penis in an unmarried man. Genital apthae due to chikungunya fever; during an epidemic of chikungunya fever in the region, 25 patients with acute disease presented with multiple aphthous ulcers involving scrotum, penoscrotal junction and adjacent crural region. Skin biopsy from the ulcers reveals lymphocytic vasculitis.ConclusionCauses of genital ulcers in patients referred to STD clinic may be varied. Atypical cases must be examined with care to identify the cause. Counselling plays an important role in the management of patients with non-sexually transmitted genital ulcer.
P3-S2.03 Clinical evaluation of the BD HSV1 Qx assay for the direct qualitative testing of HSV1 as compared to viral culture and a laboratory-based PCR assay using male and female external anogenital lesions
Authors: Pantone A , Van Der Pol B , Williams J , Corey L , Hook E , Body B , Taylor S , Fine P , Ginde S , Lebed J 
Published: July 2011

BackgroundTo compare the performance characteristics of the BD ProbeTecTM HSV1 Qx Assay* on the BD ViperTM System in Extracted Mode to viral culture and a well-characterised molecular assay for the detection of HSV1. External anogenital lesions were sampled with two different collection devices: a universal viral transport (UVT) kit and a BD Qx swab (QS) kit*.MethodsEleven geographically diverse clinical centers participated in the study, with nine of the sites enrolling participants. The UVT was collected first followed by the QS specimen. A portion of each UVT specimen was transferred to a Qx Diluent tube (diluted UVT) and a cryovial. The remainder of the UVT in the original tube was frozen at −70°C and sent to one of two sites for HSV viral culture using the ELVIS®HSV ID and D3 Typing Test System (Diagnostic Hybrids, Inc). The diluted UVT and QS specimens were shipped to one of three sites for HSV testing on the BD Viper. The UVT aliquot in the cryovial was stored at −70°C and shipped to the University of Washington for PCR testing for HSV.ResultsSubjects (n=508) were enrolled from February to August of 2010 with 312 UVT and 308 QS samples available for comparison to ELVIS culture, and 506 and 502 samples, respectively, for comparison to the PCR assay. Samples positive for HSV2 by viral culture did not have results for HSV1 per the ELVIS package insert and were excluded from further analysis. The sensitivity and specificity of the BD HSV1 Qx Assay as compared to ELVIS culture and the positive (PPA) and negative per cent agreement (NPA) of the assay compared to the HSV PCR assays were determined for both specimen types see Abstract P3-S2.03 table 1.Abstract P3-S2.03 Table 1HSV1Specimen typeHSV1 Qxassay performanceCompared to ELVIS HSV1 cultureCompared to HSV1 PCR assaySensitivitySpecificityPPANPADiluted UVT96.8% (60/62)97.6% (244/250)98.6% (71/72)100% (434/434)QxSwab (QS)96.7% (59/61)95.1% (235/247)100% (71/71)98.8% (426/431)ConclusionsThe BD HSV1 Qx Assay on the BD Viper System had excellent agreement with viral culture and the lab developed PCR assay, which is currently recognised as one of the best available tests for the detection of HSV1. A commercially available molecular-based assay for the detection of HSV would not only improve detection and reduce turn-around time on results, but may also obviate the need for stringent transport conditions required for HSV culture. *Product not for sale, for investigational use only in the US.
P3-S3.01 Anal Pap smear screening among drug users living with HIV in Miami, Florida
Authors: Rosa-Cunha I , Hooton T , Cardenas G , Metsch L 
Published: July 2011

BackgroundHuman papillomavirus (HPV) is associated with anal cancer. Human immunodeficiency virus (HIV) infection and cocaine use are associated with increased risk for HPV infection and associated diseases, but little is known about anal dysplasia among HIV-infected drug users. The objective of our study was to assess the rate of abnormal anal Pap smears among drug users living with HIV in Miami, Florida.MethodsProject HOPE (Hospital is an Opportunity for Prevention and Engagement) is a two-site study conducted in Miami and Atlanta to evaluate the efficacy of a brief prevention intervention for HIV-positive crack cocaine users recruited from two inner-city hospitals during their inpatient stays. At the Miami site, anal Pap smears from women and men (n=46) were collected.ResultsThe study population was 95% Black, the mean age was 47, 63% were female (29/46), 35% heterosexual males (16/46) and 2% men who have sex with men (MSM) (1/46). Approximately half of the participants did not complete high school, 50% were on antiretroviral therapy and 50% had been diagnosed with HIV for more than 14 years. The median CD4 cell count was 198. Overall 69.5% (32/46) of anal Pap smears were abnormal; 69% of women (20/29) and 70.5% of men (12/17) had abnormal Pap smear.ConclusionsThese preliminary data suggest that abnormal anal Pap smears are common in drug users living with HIV in Miami and highlight the need for further studies on prevention and screening of anal dysplasia and cancer in this population.