ORCID Profile
0000-0002-5534-8392
Current Organisation
Western Sydney Local Health District
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Medical Biotechnology | Sociology not elsewhere classified | Medical Biotechnology Diagnostics (incl. Biosensors) | Pharmacology and Pharmaceutical Sciences not elsewhere classified |
ANZSRC Socio-Economic Objective (SEO)
Human Diagnostics | Human Pharmaceutical Treatments (e.g. Antibiotics) | Expanding Knowledge in Technology
Related Links
Publications
Treatment efficacy of azithromycin 1 g single dose versus doxycycline 100 mg twice daily for 7 days for the treatment of rectal chlamydia among men who have sex with men - a double-blind randomised controlled trial protocol
Publisher: Springer Science and Business Media LLC
Date: 06-01-2017
Will targeting oropharyngeal gonorrhoea delay the further emergence of drug-resistant Neisseria gonorrhoeae strains?
Publisher: BMJ
Date: 24-04-2015
DOI: 10.1136/SEXTRANS-2014-051731
Abstract: Gonorrhoea is an important sexually transmitted infection associated with serious complications and enhanced HIV transmission. Oropharyngeal infections are often asymptomatic and will only be detected by screening. Gonococcal culture has low sensitivity (<50%) for detecting oropharyngeal gonorrhoea, and, although not yet approved commercially, nucleic acid lification tests (NAAT) are the assay of choice. Screening for oropharyngeal gonorrhoea should be performed in high-risk populations, such as men-who-have-sex-with-men(MSM). NAATs have a poor positive predictive value when used in low-prevalence populations. Gonococci have repeatedly thwarted gonorrhoea control efforts since the first antimicrobial agents were introduced. The oropharyngeal niche provides an enabling environment for horizontal transfer of genetic material from commensal Neisseria and other bacterial species to Neisseria gonorrhoeae. This has been the mechanism responsible for the generation of mosaic penA genes, which are responsible for most of the observed cases of resistance to extended-spectrum cephalosporins (ESC). As antimicrobial-resistant gonorrhoea is now an urgent public health threat, requiring improved antibiotic stewardship, laboratory-guided recycling of older antibiotics may help reduce ESC use. Future trials of antimicrobial agents for gonorrhoea should be powered to test their efficacy at the oropharynx as this is the anatomical site where treatment failure is most likely to occur. It remains to be determined whether a combination of frequent screening of high-risk in iduals and/or laboratory-directed fluoroquinolone therapy of oropharyngeal gonorrhoea will delay the further emergence of drug-resistant N. gonorrhoeae strains.
The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
Integration of preventing mother-to-child transmission of HIV and syphilis testing and treatment in antenatal care services in the Northern Cape and Gauteng provinces, South Africa.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Determination of Neisseria gonorrhoeae susceptibility to ciprofloxacin in clinical specimens from men using a real-time PCR assay.
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.IJANTIMICAG.2013.02.026
Abstract: A real-time PCR (RT-PCR) assay was modified to simultaneously detect Neisseria gonorrhoeae and to determine gonococcal susceptibility to ciprofloxacin using clinical s les. The modified RT-PCR assay was validated using DNA extracted from 40 linked isolates and urethral swabs, 24 of which had linked first-pass urine s les, obtained from men presenting with urethral gonorrhoea. The RT-PCR assay enabled lification of N. gonorrhoeae dcmH, gyrA and parC genes. The quinolone resistance-determining regions (QRDRs) of the isolates' gyrA and parC genes were sequenced. Following successful validation, 33 first-pass urine-derived DNA extracts, obtained from men with gonorrhoea, were tested with the assay and results were compared with blinded ciprofloxacin susceptibility data. Gonococcal susceptibility to ciprofloxacin correlated perfectly with gyrA licon generation. No gyrA licons were detected for gonococcal infections due to ciprofloxacin-intermediate/resistant organisms. Amplification of parC correlated less well with ciprofloxacin susceptibility phenotypes. Simultaneous non-generation of gyrA and parC licons consistently predicted the presence of ciprofloxacin-resistant gonococci. Characteristic point mutations in the gyrA arC QRDRs were found in DNA lified from those extracts that failed to produce gyrA arC licons. The RT-PCR assay performed well with DNA extracted from first-pass urine specimens and results correlated perfectly with ciprofloxacin susceptibility phenotypes. In conclusion, the modified RT-PCR assay can detect N. gonorrhoeae in DNA extracted from first-pass urine specimens of men with urethral gonorrhoea and accurately predicts gonococcal susceptibility to ciprofloxacin. This molecular assay provides a useful tool for surveillance and patient management in settings where fluoroquinolones can still be used for treatment of gonorrhoea.
Escalation in the relative prevalence of ciprofloxacin-resistant gonorrhoea among men with urethral discharge in two South African cities: association with HIV seropositivity
Publisher: BMJ
Date: 10-2008
Abstract: The objectives of this study were to assess the prevalence of ciprofloxacin-resistant gonorrhoea in two South African cities and to investigate the association between the isolation of ciprofloxacin-resistant Neisseria gonorrhoeae and the HIV serostatus of patients. Gonococci were cultured from endourethral swabs taken from consecutive men with urethritis attending clinics in Johannesburg and Cape Town. Minimum inhibitory concentrations (MIC) for ciprofloxacin and ceftriaxone were determined with E-tests. Isolates with a ciprofloxacin MIC of 1 mg/l or greater were defined as resistant and isolates with a ceftriaxone MIC of 0.25 mg/l or less were defined as susceptible. Rapid tests were used to screen and confirm the presence of HIV antibodies. Survey data from 2004 were used as a baseline to assess trends in gonococcal resistance to ciprofloxacin. In 2004, the prevalence of ciprofloxacin resistance was 7% in Cape Town and 11% in Johannesburg. In 2007, 37/139 (27%) Cape Town isolates and 47/149 (32%) Johannesburg isolates were resistant to ciprofloxacin in comparison with 2004 data, this represents 2.9-fold and 1.9-fold increases, respectively. All isolates were fully susceptible to ceftriaxone. There was a significant association between HIV seropositivity and the presence of ciprofloxacin-resistant gonorrhoea among patients (p = 0.034). Johannesburg and Cape Town have witnessed significant rises in the prevalence of ciprofloxacin-resistant gonorrhoea among men with urethritis. The resistant phenotype is linked to HIV seropositivity. There is now an urgent need to change national first-line therapy for presumptive gonococcal infections within South Africa.
Penile myiasis: a case report
Publisher: BMJ
Date: 06-2004
Abstract: We report a case of penile myiasis in a Brazilian man caused by the larva of Dermatobia hominis. Myiasis is a parasitic disease of humans and other vertebrates caused by larvae of several fly species. Although urinary myiasis is well recognised, infestation of the genital tissue is a rare occurrence. Once the diagnosis has been made, the treatment is usually straightforward and uncomplicated.
A Model for the Roll-Out of Comprehensive Adult Male Circumcision Services in African Low-Income Settings of High HIV Incidence: The ANRS 12126 Bophelo Pele Project
Publisher: Public Library of Science (PLoS)
Date: 20-07-2010
Characterization of a novel {beta}-lactamase-producing plasmid in Neisseria gonorrhoeae: sequence analysis and molecular typing of host gonococci
Publisher: Oxford University Press (OUP)
Date: 26-04-2011
DOI: 10.1093/JAC/DKR162
Abstract: To determine the complete nucleotide sequence of the novel Johannesburg β-lactamase-encoding gonococcal plasmid (pEM1) and to determine the strain relatedness of Johannesburg plasmid-containing penicillinase-producing Neisseria gonorrhoeae (PPNG) by molecular typing. Eleven PPNG isolates containing the Johannesburg β-lactamase-encoding plasmid were previously identified among gonococci isolated from men with urethral discharge attending a clinic in Alexandra (Johannesburg) using a PCR assay. DNA sequence-based characterization of one such plasmid was performed to determine its relatedness to the prototype Asia plasmid. The 11 PPNG isolates containing the Johannesburg plasmid and 105 other clinical gonococci isolates were typed using N. gonorrhoeae multi-antigen sequence typing (NG-MAST). Plasmid pEM1 was determined to comprise 4865 bp and to be a deletion derivative of the prototype Asia plasmid with a unique 2560 bp deletion in the non-TnA region. NG-MAST genotyping demonstrated a significant association between sequence type (ST) 502, or other closely related STs, and the Johannesburg plasmid-containing PPNG (P < 0.0001). Sequencing of a novel β-lactamase-encoding plasmid (pEM1) found in PPNG isolates in Johannesburg shows it to be a deletion derivative of the prototype Asia plasmid, the deletion most likely arising as a result of DNA rearrangements. The majority of Johannesburg plasmid-containing PPNG isolates were, or were very closely related to, ST502.
Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors among Female Sex Workers in Australia: A Retrospective Cohort Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Evaluation of a Cervicography-Based Program to Ensure Quality of Visual Inspection of the Cervix in HIV-Infected Women in Johannesburg, South Africa
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Efficacy and Safety of Gepotidacin as Treatment of Uncomplicated Urogenital Gonorrhea (EAGLE-1): Design of a Randomized, Comparator-Controlled, Phase 3 Study
Publisher: Springer Science and Business Media LLC
Date: 09-2023
Killer‐cell immunoglobulin‐like receptor genotyping and HLA killer‐cell immunoglobulin‐like receptor‐ligand identification by real‐time polymerase chain reaction
Publisher: Wiley
Date: 02-08-2011
A History of the African AIDS epidemic.
Publisher: BMJ
Date: 06-2006
The cost effectiveness of hospital-based 25% podophyllin vs home-based 0.5% podophyllotoxin in the treatment of anogenital warts.
Publisher: SAGE Publications
Date: 05-1995
DOI: 10.1177/095646249500600320
Abstract: Physical abuse is a leading cause of pediatric morbidity and mortality. Physicians do not consistently screen for abuse, even in high-risk situations. Alerts in the electronic medical record may help improve screening rates, resulting in early identification and improved outcomes. Triggers to identify children < 2 years old at risk for physical abuse were coded into the electronic medical record at a freestanding pediatric hospital with a level 1 trauma center. The system was run in "silent mode" physicians were unaware of the system, but study personnel received data on children who triggered the alert system. Sensitivity, specificity, and negative and positive predictive values of the child abuse alert system for identifying physical abuse were calculated. Thirty age-specific triggers were embedded into the electronic medical record. From October 21, 2014, through April 6, 2015, the system was in silent mode. All 226 children who triggered the alert system were considered subjects. Mean (SD) age was 9.1 (6.5) months. All triggers were activated at least once. Sensitivity was 96.8% (95% CI, 92.4-100.0%), specificity was 98.5% (95% CI, 98.3.5-98.7), and positive and negative predictive values were 26.5% (95% CI, 21.2-32.8%) and 99.9% (95% CI, 99.9-100.0%), respectively, for identifying children < 2 years old with possible, probable, or definite physical abuse. Triggers embedded into the electronic medical record can identify young children with who need to be evaluated for physical abuse with high sensitivity and specificity.
Human papillomavirus (HPV) infection in heterosexual South African men attending sexual health services: associations between HPV and HIV serostatus
Publisher: BMJ
Date: 11-2010
Abstract: To investigate the distribution of human papillomavirus (HPV) genotypes and determine the associations between HPV infection and HIV coinfection in sexually active heterosexual men with anogenital warts (GW), male urethral discharge or asymptomatic men. Valid specimens for HPV genotyping were obtained from three patient groups consisting of 108 men with GW, 56 men with urethral discharge syndrome and 50 asymptomatic men attending for HIV voluntary counselling and testing. The Linear Array HPV Genotyping Test was used to determine the HPV genotype distribution among study participants. Sera were tested for HIV antibodies using two commercial rapid tests. The prevalence of anogenital HPV among study participants was 78% (166). HPV DNA was detected in 100% (108) of GW, 48% (27) of men with urethral discharge syndrome and 62% (31) of voluntary counselling and testing participants. HPV types 6, 11, 16 and 18 were prevalent as either single or combined infections in 81% (134) of all HPV-positive study participants. HPV types 6 and/or 11 were significantly higher among GW patients (p<0.001). After adjusting for patient groups, HIV seropositivity was significantly associated with multiple HPV infections (OR=3.98, 95% CI 1.58 to 10.03) but not with the presence of a foreskin (OR=0.67, 95% CI 0.32 to 1.40). Infections with HPV were prevalent among sexually active heterosexual men attending the men's sexual health clinic. Associations were observed between HIV coinfection and multiple HPV infections. Further population-based studies on the prevalence of HPV genotypes are required to determine if men should be included in any future national HPV vaccination programme in South Africa.
Improving men's sexual health: a challenge for today
Publisher: BMJ
Date: 12-2004
Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney
Publisher: BMJ
Date: 22-03-2018
DOI: 10.1136/SEXTRANS-2017-053480
Abstract: We aimed to estimate the prevalence of Mycoplasma genitalium infection and of mutations linked to macrolide resistance using the ResistancePlus MG assay (SpeeDx, Sydney, New South Wales, Australia) in first-void urine (FVU), anorectal and oropharyngeal s les from men who have sex with men (MSM) attending Western Sydney Sexual Health Centre (WSSHC). Consecutive symptomatic and asymptomatic MSM attending for STI testing were prospectively enrolled. M. genitalium testing using the ResistancePlus MG assay was performed on FVU, anorectal and oropharyngeal s les routinely collected for Chlamydia trachomatis and Neisseria gonorrhoeae assays. Overall, the prevalence of M. genitalium infection in the study group was 13.4% (68/508). Most (79.4%, 54/68) M. genitalium harboured macrolide resistance mutations (87.5% of urethral and 75.6% of anorectal infections). The anorectum was the most commonly infected site (45/505, 8.9%), followed by the urethra (24/508, 4.7%). No oropharyngeal M. genitalium infections were detected (0/508). Most of the anorectal (93.3%) and urethral (79.2%) infections were asymptomatic. MSM who were taking HIV pre-exposure prophylaxis (PrEP) were twice as likely to be infected with M. genitalium compared with MSM who were not on PrEP (OR 2.1, 95% CI 1.3 to 3.6 P=0.0041). Always using condoms for anal sex in the last 3 months was protective of infection (OR 0.8, 95% CI 0.6 to 1.0 P=0.0186). We demonstrated a high prevalence of M. genitalium and very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations in M. genitalium infections. This will ensure, in regions or populations with high rates of macrolide resistance among M. genitalium strains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified.
A Cross Sectional Analysis of Gonococcal and Chlamydial Infections among Men-Who-Have-Sex-with-Men in Cape Town, South Africa
Publisher: Public Library of Science (PLoS)
Date: 29-09-2015
From zero to zero in 100 years: gonococcal antimicrobial resistance
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/MA16058
Abstract: The threat of antimicrobial resistance (AMR) in bacteria has been escalated to a rightful seat on the global health agenda. In September 2016, for only the fourth time in United Nations (UN) history, the UN General Assembly in New York will meet to focus on a health threat – antimicrobial resistance. Other diseases afforded this level of consultation at the UN were human immunodeficiency virus (HIV), non-communicable diseases and Ebola virus. There are grim predictions for the future in terms of AMR and health security that span income settings. These predictions challenge the premise that minor bacterial infections of childhood are innocuous, and threaten to halt the medical advancements dependant on antibiotic therapy. Those with compromised immune systems, whether endogenous or induced, will be at highest risk. The development and spread of AMR has been, and will continue to be, fanned by the relentless selection pressure of exposure to antibiotics whether used appropriately, unnecessarily or suboptimally, in human health, animal health and agriculture. The distribution of antibiotic resistant bacteria is facilitated by travel and transport. Antimicrobial resistance will affect those in the community and the hospital.
Team huddles in sexual health clinics improve communication, clinic capacity and flow, and team relationships and well-being
Publisher: BMJ
Date: 04-12-2020
Microbial Composition Predicts Genital Tract Inflammation and Persistent Bacterial Vaginosis in South African Adolescent Females
Publisher: American Society for Microbiology
Date: 2018
DOI: 10.1128/IAI.00410-17
Abstract: Young African females are at an increased risk of HIV acquisition, and genital inflammation or the vaginal microbiome may contribute to this risk. We studied these factors in 168 HIV-negative South African adolescent females aged 16 to 22 years. Unsupervised clustering of 16S rRNA gene sequences revealed three clusters (subtypes), one of which was strongly associated with genital inflammation. In a multivariate model, the microbiome compositional subtype and hormonal contraception were significantly associated with genital inflammation. We identified 40 taxa significantly associated with inflammation, including those reported previously ( Prevotella , Sneathia , Aerococcus , Fusobacterium , and Gemella ) as well as several novel taxa (including increased frequencies of bacterial vaginosis-associated bacterium 1 [BVAB1], BVAB2, BVAB3, Prevotella amnii , Prevotella pallens , Parvimonas micra , Megasphaera , Gardnerella vaginalis , and Atopobium vaginae and decreased frequencies of Lactobacillus reuteri , Lactobacillus crispatus , Lactobacillus jensenii , and Lactobacillus iners ). Women with inflammation-associated microbiomes had significantly higher body mass indices and lower levels of endogenous estradiol and luteinizing hormone. Community functional profiling revealed three distinct vaginal microbiome subtypes, one of which was characterized by extreme genital inflammation and persistent bacterial vaginosis (BV) this subtype could be predicted with high specificity and sensitivity based on the Nugent score (≥9) or BVAB1 abundance. We propose that women with this BVAB1-dominated subtype may have chronic genital inflammation due to persistent BV, which may place them at a particularly high risk for HIV infection.
Inflammatory Cytokine Profiles of Semen Influence Cytokine Responses of Cervicovaginal Epithelial Cells
Publisher: Frontiers Media SA
Date: 04-12-2018
HIV-1 subtype variability and transmitted drug resistance in a culturally diverse population in Western Sydney, New South Wales, Australia
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH20013
Abstract: Abstract Background Transmitted human immunodeficiency virus type 1 (HIV-1) drug resistance (TDR) is an important contributor to antiretroviral treatment failure, and is associated with HIV-1 transmission among men who have sex with men (MSM), non-MSM clusters and in iduals diagnosed with concurrent sexually transmissible infections (STI). Western Sydney has a culturally erse population, with a high proportion of non-Australian-born in iduals. This study describes the prevalence of TDR and non-B HIV-1 subtypes in a clinic-based population. Methods: A clinic database was examined for all newly diagnosed treatment-naïve HIV-1 patients and information on their HIV-1 resistance and subtype, demographics including country of birth and diagnosis of a bacterial sexually transmissible infection was collected. Results: Data were available from 74/79 in iduals (62 cis-male, 16 cis-female and 1 transgender woman). Of the 74 genotypes, the prevalence of non-B subtypes and TDR was 43/74 (58% 95%CI = 46.9–69.3) and 14/74 (19% 95%CI = 10.0 to 27.8). It was also found that 30/79 (38%) had a concurrent bacterial STI. TDR was associated with subtype B infection (OR 3.53 95%CI = 1.41–8.82 P = 0.007) and being born in Australia (OR 12.0 95%CI = 2.45–58.86 P = 0.002). Conclusion: The relative prevalence of non-B HIV-1 subtypes and TDR is higher in Western Sydney than in the rest of Australia. TDR is associated with subtype B HIV-1 and being Australian born, suggesting ongoing local transmission. This highlights the ersity of the HIV epidemic locally and the need for interventions to prevent ongoing HIV transmission.
The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2018
Distinct Cytokine Patterns in Semen Influence Local HIV Shedding and HIV Target Cell Activation
Publisher: Oxford University Press (OUP)
Date: 23-11-2013
Cross-Sectional Study of Genital, Rectal, and Pharyngeal Chlamydia and Gonorrhea in Women in Rural South Africa
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
Haemophilus ducreyi: from sexually transmitted infection to skin ulcer pathogen.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2016
Etiology and Antimicrobial Susceptibility of Pathogens Responsible for Urethral Discharge Among Men in Harare, Zimbabwe
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Behçet's syndrome: a review for the genitourinary medicine physician.
Publisher: SAGE Publications
Date: 05-1996
Abstract: Behcet's syndrome is a multisystem disorder due to vasculitis of unknown aetiology. It may present to genitourinary m edicine physicians with genital ulceration. Careful history-taking and clinical examination should allow a correct diagnosis which may be confirmed by reference to the new diagnostic criteria including perform ing a pathergy test. Of particular im portance is a prompt referral to an ophthalmologist for an ocular slit-lam p assessm ent as eye involvement can be severe and therapy needs to be started early in the course of the illness. The managem ent of Behc et's syndrome may also involve rheumatologists, gastroenterologists, neurologists and immunologists. Close liaison between these clinicians may be necessary to provide optim um care for the patient with Behcet's syndrome.
WHO global strategy for the prevention and control of sexually transmitted infections: time for action
Publisher: BMJ
Date: 12-2007
Treatment of chancroid in resource-poor countries
Publisher: Informa UK Limited
Date: 04-2005
Abstract: Chancroid, formerly a major cause of the genital ulcer disease syndrome, remains an important cofactor in both the transmission and acquisition of HIV-1 infection. Those countries with the greatest burden of HIV also have some of the highest prevalence rates of chancroid worldwide. The diagnosis of chancroid, caused by the fastidious bacterium Haemophilus ducreyi, is both expensive and difficult in many resource-poor areas. These areas of the world use syndromic management to treat genital ulcers and such an approach has proven effective in reducing rates of bacterial genital ulcer diseases. There are currently inexpensive and effective single-dose therapies available to treat chancroid. Single-dose regimens, given at first presentation, improve compliance and reduce the risk of sexually transmitted infections. Bacterial resistance to several antimicrobial agents has increased over the years and remains a continued threat to effective antimicrobial therapy. Follow-up of cases, and partner notification and treatment is carried out to limit reinfection and onward transmission of chancroid. Patients with coexistent HIV may be particularly at risk of failing single-dose therapy and should therefore be reviewed wherever possible.
Health care seeking among men with genital ulcer disease in South Africa: correlates and relationship to human immunodeficiency virus-1 and herpes simplex virus type 2 detection and shedding.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: implications for HIV prevention efforts
Publisher: Springer Science and Business Media LLC
Date: 03-10-2018
Antimicrobial Resistance Surveillance for Neisseria gonorrhoeae-What Do We Really Need to Know to Guide Public Health Interventions?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
Expression of the cytolethal distending toxin in a geographically diverse collection of Haemophilus ducreyi clinical isolates
Publisher: BMJ
Date: 08-2003
DOI: 10.1136/STI.79.4.294
Abstract: To screen a collection of isolates of Haemophilus ducreyi for expression of the cytolethal distending toxin (CDT). 45 clinical isolates of H ducreyi were screened for cytotoxic activity by examining the effect of culture supernatants on Hela cells. Expression was confirmed using immunoblotting with CDT specific monoclonal antibodies and the presence of the cdt genes determined by lification of the cdt genes in a multiplex polymerase chain assay. Of the 45 clinical isolates, six isolates from differing geographical origins did not demonstrate cytotoxic activity. Expression of CDT was also not detected in these six isolates using immunoblotting and the genes cdtA, cdtB, and cdtC were not lified using PCR. The remaining isolates demonstrated cytotoxic activity, expressed the CDT proteins, and the presence of the cdt genes was confirmed. CDT is considered a virulence factor of H ducreyi but was found to be absent in 13% of isolates from different geographical origins.
Endocervical and vaginal microbiota in South African adolescents with asymptomatic Chlamydia trachomatis infection
Publisher: Springer Science and Business Media LLC
Date: 23-07-2018
DOI: 10.1038/S41598-018-29320-X
Abstract: Adolescent girls and young women represent a key risk group for sexually transmitted infections (STIs). The vaginal microbiota is thought to play an important role in susceptibility to STIs such as Chlamydia trachomatis . We compared the microbiota of the lateral vaginal wall and endocervix, and assessed associations with C . trachomatis infection in South African adolescents. The endocervical and vaginal lateral wall microbiota were characterized by lifying and sequencing the V4 region of the 16S rRNA gene and C . trachomatis diagnosed using molecular methods. Of the 72 girls included, 30 had asymptomatic C . trachomatis infections. Three major vaginal community types were identified one Lactobacillus crispatus , one L . iners and one erse, Gardnerella vaginalis dominant. The microbiota of the endocervix was significantly different from that of the lateral wall in terms of ersity. There were many differentially abundant taxa between the endocervix and lateral vaginal wall, including Achromobacter spanius and Enterococcus faecium . Women with C . trachomatis had higher relative abundance of G . vaginalis and other anaerobes. In this African adolescent cohort, significant differences between the lateral vaginal wall and endocervical microbiota ersity and composition were evident, although neither were strongly associated with C . trachomatis infection.
Comparison of lavage and swabs for the collection of genital ulcer specimens to measure HIV RNA shedding
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.JCV.2009.06.025
Abstract: The optimum collection procedure for the evaluation of HIV-1 burden in ulcer secretions has not been well defined. The objective of this study was to compare ulcer swabs and ulcer lavages for the detection and quantitation of HIV-1 RNA in genital ulcers. A convenience s le of the first 84 HIV-positive participants in a randomized double blind placebo controlled trial of acyclovir episodic treatment among men with genital ulcer disease were included in this evaluation. At baseline, participants were screened for HIV, syphilis and HSV-2 by serology and for ulcer etiology by PCR. Ulcer specimens were collected by using (1) a non-traumatic washing procedure with 10ml of PBS, and (2) sterile dry swabs. Ulcer s les were tested with HIV-1 Amplicor 1.5 Ultra Sensitive Assay with a lower threshold of 50 copies/ml. Of ulcer s les 35 (41.7%) had HIV detected by ulcer lavage and 32 (38.1%) by swabs (p=0.68). Overall, 45 (53.6%) were positive by one or both methods. The overall proportion of agreement was 73% (61/84). The chance-corrected proportion of agreement was 0.46 (95% CI: 0.26, 0.65) as estimated by the Kappa statistic. The log mean viral load from lavages (1.49log(10) copies/ml, 95% CI: 1.17-1.81) did not differ significantly from that of swabs (1.41log(10) copies/ml, 95% CI: 1.16-1.71) (p=0.29) with a mean difference of 0.08log copies/ml (SD 0.96). Ulcer lavage and ulcer swab performed in moderate agreement in the detection and quantitation of HIV RNA from ulcer specimens.
Ciprofloxacin treatment of recurrent Salmonella typhimurium septicaemia in a splenectomized and immunosuppressed patient
Publisher: Oxford University Press (OUP)
Date: 1988
DOI: 10.1093/JAC/21.6.809
Abstract: This study aimed to find the strength of the correlation between ORange(®) (intraoperative wavefront aberrometer) objective refraction during pseudophakic cataract surgery (Gen 1) and 1-week objective autorefraction postcataract surgery in order to establish the clinical degree of confidence in the ORange. Gen 1 was used because Gen 2 was not available at the time of the study. However, Gen 1 can still be a good reference. Thirty-two consecutive eyes were included in this prospective nonrandomized study. ORange was used after phacoemulsification and intraocular lens implantation. There were no complications and no withdrawals from the study. The refraction data from the ORange were recorded in spherical equivalents and put into Excel. One week postoperatively, autorefraction was done and the data were again recorded in spherical equivalents and put into Excel. Both sets of data were then transferred to SPSS for a correlation study. Because ORange is an objective refractor, it is necessary to use another objective refractor, such as the Zeiss Autorefractor, for comparison. Measurement at 1 week postoperatively is for cornea clearance for autorefraction and is the closest time to intraoperative assessment for comparison. The Pearson correlation was r = +0.56, P < 0.01, which qualifies for a moderate or good correlation (0.5-0.75). Intraoperative refraction using the ORange Gen 1 after cataract surgery and intraocular lens implantation is moderate to good when correlated with objective autorefraction 1 week after cataract surgery.
Determinants of HIV Type 1 Shedding from Genital Ulcers among Men in South Africa
Publisher: Oxford University Press (OUP)
Date: 04-2010
DOI: 10.1086/651115
Abstract: Our study evaluated correlates of human immunodeficiency virus (HIV)-1 lesional shedding among men with genital ulcer disease (GUD). Participants were recruited at primary health care clinics as part of a randomized trial of episodic acyclovir among men with GUD. This analysis was done among HIV-positive men identified at baseline. Participants were serologically screened for HIV infection, syphilis, and herpes simplex virus type 2 infection and for urethritis and ulcer etiology by polymerase chain reaction. Plasma and genital ulcer HIV-1 loads and CD4 cell counts were quantified. We evaluated variables associated with the presence and quantity of HIV-1 in ulcers. Among 387 HIV-positive men, the median plasma HIV-1 load and CD4 cell count were 87,200 copies/mL and 282 cells/mm(3). Overall, 173 (45.6%) had detectable HIV-1 RNA in ulcers. Men with Trichomonas vaginalis infection had higher ulcer viral loads on average than did those who were not infected (mean difference, 0.62 95% confidence interval [CI], 0.07-1.2 P=.027). After multivariable analysis, higher plasma HIV-1 load (odds ratio [OR], 2.5 95% CI, 1.7-3.5 P< .001), larger lesions (OR, 2.5 95% CI, 1.5-4.1 P < .001), purulent ulcers (OR, 2.2 95% CI, 1.1-4.2 P 5 OR, 3.6 95% CI, 1.6-8.4 P=.002), and herpes seropositivity (OR, 3.4 95% CI, 1.7-7.0 P < .001) remained associated with increased odds of HIV-1 lesional shedding. Ulcers associated with herpes simplex virus type 2 infection were less likely to shed (OR, 0.6 95% CI, 0.3-1.0 P =.05), compared with ulcers with unknown etiology. HIV-positive men should be screened and treated for GUD to minimize HIV shedding and transmission to uninfected sexual partners.
Validation of Cervical Cancer Screening Methods in HIV Positive Women from Johannesburg South Africa
Publisher: Public Library of Science (PLoS)
Date: 11-01-2013
The detection of urethritis pathogens among patients with the male urethritis syndrome, genital ulcer syndrome and HIV VCT clients: should South Africa's syndromic management approach be revised?
Publisher: BMJ
Date: 08-2008
Abstract: To determine the prevalence of urethritis pathogens amongst male symptomatic urethritis (MUS) patients, genital ulcer (GUS) patients without urethritis symptoms and men requesting HIV testing at a voluntary counselling and testing (VCT) clinic. A prospective study was conducted in Johannesburg, South Africa. Men from the three groups were screened for urethritis pathogens using molecular tests. Culture for Neisseria gonorrhoeae and, initially, trichomoniasis was performed. Antimicrobial susceptibility testing was undertaken for ciprofloxacin on all gonococcal isolates ciprofloxacin resistant isolates were screened for ceftriaxone resistance. 664 participants were recruited (438 MUS, 76 GUS and 158 VCT) over 2 years. Gonorrhoea was detected in 62.3% MUS, 15.8% GUS and 3.2% VCT participants. Chlamydial infection was detected in 19.3% MUS, 13.2% GUS and 8.2% VCT participants. Trichomoniasis was detected in 4.9% MUS, 19.7% GUS and 3.8% VCT participants. Mycoplasma genitalium infection was detected in 14.4% MUS, 13.2% GUS and 7.0% VCT participants. Ciprofloxacin resistance increased from 13.0% in the first year to 26.3% in the second year all resistant isolates were susceptible to ceftriaxone. Urethritis pathogens, including Trichomonas vaginalis, should be covered in syndromic management treatment of genital ulcers in the absence of clinical urethritis. Consideration should be given to adding metronidazole to existing MUS treatment. Ciprofloxacin can no longer be relied upon to treat presumptive gonococcal infections in South Africa.
Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
Publisher: Public Library of Science (PLoS)
Date: 04-11-2021
DOI: 10.1371/JOURNAL.PCBI.1009385
Abstract: The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this population could result in an epidemic that would be difficult and costly to control. An in idual-based, anatomical site-specific mathematical model of NG transmission among Australian MSM was developed and used to evaluate the potential for elimination of an imported NG strain under a range of case-based and population-based test-and-treat strategies. When initiated upon detection of the imported strain, these strategies enhance the probability of elimination and reduce the outbreak size compared with current practice (current testing levels and no contact tracing). The most effective strategies combine testing targeted at regular and casual partners with increased rates of population testing. However, even with the most effective strategies, outbreaks can persist for up to 2 years post-detection. Our simulations suggest that local elimination of imported NG strains can be achieved with high probability using combined case-based and population-based test-and-treat strategies. These strategies may be an effective means of preserving current treatments in the event of wider XDR NG emergence.
Quality of Sexually Transmitted Infection Case Management Services in Gauteng Province, South Africa: An Evaluation of Health Providers' Knowledge, Attitudes, and Practices.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Neisseria gonorrhoeae Transmission Among Men Who Have Sex With Men: An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
Mind your binomials: a guide to microbial nomenclature and spelling in Sexually Transmitted Infections.
Publisher: BMJ Publishing Group
Date: 2015
DOI: 10.7892/BORIS.62257
The burden of asymptomatic sexually transmitted infections among men in Carletonville, South Africa: implications for syndromic management
Publisher: BMJ
Date: 10-2008
Abstract: To determine the prevalence of sexually transmitted infections (STI) and HIV among men attending an outreach STI/HIV screening service in informal settlements in South Africa over a 3-month period. A mobile clinic van was utilised to offer men: (1) urine screening for gonorrhoea, trichomoniasis, chlamydial and Mycoplasma genitalium infections (2) serological screening for syphilis and herpes simplex virus type 2 (HSV-2) (3) on-site HIV voluntary counselling and testing. Urethritis pathogens were detected by molecular methods. HIV serostatus was determined using rapid tests. Demographic, sexual behaviour and clinical data were recorded on a nurse-administered questionnaire. Statistical analysis utilised the chi(2) test. 309 men attended the service 304 (98%) requested serological screening for syphilis and HSV-2, 301 (97%) underwent urine-based screening for urethritis pathogens and 269 (87%) had an HIV test. Over 90% of men were asymptomatic for STI. Gonorrhoea was more prevalent in the symptomatic group (p<0.001) there were no significant differences in the prevalence of other urethritis pathogens between the groups. The total number of infections with each urethritis pathogen was highest in the asymptomatic group with twice as much gonorrhoea, 25 times as much chlamydial infection, six times as much trichomoniasis and nine times as much M genitalium infection compared with the symptomatic group. The overall HIV prevalence among clinic attendees was 29.7%. The uptake of both STI and HIV testing was high among men attending the service. The relatively high burden of both STI and HIV among the male clinic attendees has implications for the transmission of HIV.
Successful treatment of Behçet's syndrome in an African female patient with thalidomide.
Publisher: SAGE Publications
Date: 11-1996
Relationship between female genital tract infections, mucosal interleukin‐17 production and local T helper type 17 cells
Publisher: Wiley
Date: 23-10-2015
DOI: 10.1111/IMM.12527
Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study
Publisher: Elsevier BV
Date: 11-2018
Urethritis/cervicitis pathogen prevalence and associated risk factors among asymptomatic HIV-infected patients in South Africa.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women.
Publisher: Elsevier BV
Date: 04-1998
DOI: 10.1016/S0924-8579(98)00021-1
Abstract: This study is a comparison of the microbiological and clinical efficacy of single-dose fosfomycin trometamol therapy and a 5 day course of trimethoprim in the treatment of uncomplicated urinary tract infection in female patients. Urine dip-slide s les were obtained from 547 female patients aged 18-65 by 22 General Practitioners (GPs) participating in the study from 21 centres in the UK. All patients were diagnosed as having a urinary tract infection by their GP on the basis of history and clinical examination. Patients were randomised to receive either single dose fosfomycin trometamol or a 5 day course of trimethoprim in a 2:1 ratio. Patients who had significant bacteriuria (> or = 10(5) c.f.u/ml) at the first visit (300) were included in the microbiological analysis. The two commonest urinary pathogens isolated were Escherichia coli and Staphylococcus saprophyticus. Trimethoprim resistance was more frequent amongst E. coli isolates whereas fosfomycin trometamol resistance was more common amongst S. saprophyticus isolates. Microbiological cure was demonstrated in 83.3% of the trimethoprim treated group and 83% of the fosfomycin trometamol treated group. Persistence of the infecting bacteria was seen in 17% of each treatment arm.
HIV/sexually transmitted infection epidemiology, management and control in the IUSTI Africa region: focus on sub-Saharan Africa
Publisher: BMJ
Date: 22-11-2011
Women’s knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys
Publisher: Public Library of Science (PLoS)
Date: 24-03-2017
The prevalence of human papillomavirus infections and associated risk factors in men-who-have-sex-with-men in Cape Town, South Africa
Publisher: Springer Science and Business Media LLC
Date: 22-08-2016
Development of a rotor-gene real-time PCR assay for the detection and quantification of Mycoplasma genitalium
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.MIMET.2011.12.017
Abstract: We developed and validated a real-time quantitative polymerase chain reaction (qPCR) assay to determine Mycoplasma genitalium bacterial load in endocervical swabs, based on lification of the pdhD gene which encodes dihydrolipoamide dehydrogenase, using the Rotor-Gene platform. We first determined the qPCR assay sensitivity, limit of detection, reproducibility and specificity, and then determined the ability of the qPCR assay to quantify M. genitalium in stored endocervical specimens collected from Zimbabwean women participating in clinical research undertaken between 1999 and 2007. The qPCR assay had a detection limit of 300 genome copies/mL and demonstrated low intra- and inter-assay variability. The assay was specific for M. genitalium DNA and did not lify the DNA from other mycoplasma and ureaplasma species. We quantified M. genitalium in 119 of 1600 endocervical swabs that tested positive for M. genitalium using the commercial Sacace M. genitalium real-time PCR, as well as 156 randomly selected swabs that were negative for M. genitalium by the same assay. The M. genitalium loads ranged between <300 and 3,240,000 copies/mL. Overall, the qPCR assay demonstrated good range of detection, reproducibility and specificity and can be used for both qualitative and quantitative analyses of M. genitalium in endocervical specimens and potentially other genital specimens.
Prevalence and associations of genital ulcer and urethral pathogens in men presenting with genital ulcer syndrome to primary health care clinics in South Africa.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2012
Trends and associations of Trichomonas vaginalis infection in men and women with genital discharge syndromes in Johannesburg, South Africa
Publisher: BMJ
Date: 20-04-2013
DOI: 10.1136/SEXTRANS-2013-051049
Abstract: To better understand the epidemiology of Trichomonas vaginalis infection, we investigated the association between T vaginalis and demographic, clinical, microbiological and behavioural characteristics of patients presenting with genital discharges to a primary healthcare clinic in Johannesburg, South Africa. During six annual surveys (2007-2012), 1218 cases of male urethral discharge syndrome and 1232 cases of vaginal discharge syndrome were consecutively recruited. Diagnostic methods included nucleic acid lification (Neisseria gonorrhoeae, Chlamydia trachomatis, T vaginalis and Mycoplasma genitalium), microscopy (bacterial vaginosis and Candida) and serology (Treponema pallidum, herpes simplex virus type 2 (HSV-2) and HIV). Logistic regression analyses and χ2 tests were used to identify predictors of T vaginalis infection. The prevalence of T vaginalis decreased from 2007 to 2012 (men from 13.4% to 4.8% women from 33.8 to 23.1%). Overall, 74 (6.1%) men and 291 (23.6%) women were T vaginalis positive, with the highest prevalence in those aged ≥40 years (men 13.6% women 30.9%). T vaginalis infection occurred more often in pregnant women (adjusted OR (aOR) 2.67 95% CI 1.29 to 5.54) and in women with serological evidence of T pallidum (aOR 1.63 95% CI 1.08 to 2.45) or HSV-2 infections (aOR 1.75 95% CI 1.16 to 2.64). T vaginalis infection occurred less often in men with coexistent gonorrhoea (aOR 0.35 95% CI 0.21 to 0.57) and in women with either bacterial vaginosis (aOR 0.60 95% CI 0.44 to 0.82) or Candida morphotypes (OR 0.61 95% CI 0.43 to 0.86). Although the prevalence of T vaginalis infection has decreased over time, it remains an important cause of genital discharge in South Africa, particularly in older patients and pregnant women.
Mycoplasma genitalium is associated with increased genital HIV-1 RNA in Zimbabwean women.
Publisher: Oxford University Press (OUP)
Date: 17-11-2014
Abstract: Mycoplasma genitalium is a common sexually transmitted infection associated with human immunodeficiency virus (HIV) infection. Some studies suggest that M. genitalium may increase the risk of HIV acquisition. However, results have been inconsistent, and this association has never been examined longitudinally. Stored endocervical s les from a longitudinal cohort study of 131 Zimbabwean women in whom HIV-1 seroconversion recently occurred were tested for detection and quantity of M. genitalium using polymerase chain reaction analysis. The associations between M. genitalium and the detection and quantity of genital HIV type 1 (HIV-1) RNA, the detection and quantity of plasma HIV-1 RNA, and the CD4(+) T-cell count was analyzed using mixed-effects regression analysis. M. genitalium was detected in 10.5% of stored specimens (44 of 420), and infection persisted for up to 300 days. M. genitalium was independently associated with detection of genital HIV-1 RNA (adjusted odds ratio, 2.67 95% confidence interval, .99-7.20), after adjustment for plasma viral load, viral set point, CD4(+) T-cell count, herpes simplex virus type 2 detection, and gonorrhea. There was no evidence of an association between M. genitalium detection or quantity and either plasma HIV-1 RNA load or CD4(+) T-cell count. The growing evidence for an association between M. genitalium and HIV genital shedding and the high prevalence and persistence of M. genitalium in this population suggest that further research into this association is important. Consideration of the cost-effectiveness of M. genitalium screening interventions may be warranted.
Understanding the Targeting and Uptake of HIV Testing Among Gay and Bisexual Men Attending Sexual Health Clinics
Publisher: Springer Science and Business Media LLC
Date: 19-12-2018
DOI: 10.1007/S10461-017-2012-2
Abstract: We assessed trends in HIV testing outcomes during a period of clinic-based initiatives introduced to increase HIV testing among gay and bisexual men (GBM) attending sexual health clinics (SHCs) in New South Wales (NSW). A cohort of 25,487 HIV-negative GBM attending 32 SHCs in NSW (2009-2015) was classified into six sub-groups each year based on client-type (new/existing), risk-status (low/high-risk), and any recent HIV testing. Poisson regression methods were used to assess HIV testing outcomes in sub-groups of GBM. HIV testing outcomes and the sub-groups with greatest statistically significant annual increases were: in iduals attending (26% in high-risk existing clients with recent testing) testing uptake (4% in low-risk existing clients with no recent testing) testing frequency (6% in low-risk existing clients with no recent testing and 5% in high-risk existing clients with recent testing) and total tests (31% in high-risk existing clients with recent testing). High-risk existing clients with recent testing had a 13% annual increase in the proportional contribution to total tests. Our findings show improved targeting of testing to high-risk GBM at NSW SHCs. The clinic-based initiatives should be considered for translation to other similar settings.
Modern management of genital ulcer disease-frappez fort et frappez vite.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Clinical characteristics of overseas-born men who have sex with men (MSM) in the AHOD cohort and implications for clinical practice
Publisher: BMJ
Date: 06-01-2020
Multiple tropical pathology in an HIV-positive man.
Publisher: SAGE Publications
Date: 03-1995
Macrolide resistance testing and molecular subtyping of Treponema pallidum strains from southern Africa
Publisher: BMJ
Date: 18-05-2012
DOI: 10.1136/SEXTRANS-2011-050322
Abstract: To determine whether the 23S ribosomal RNA (rRNA) A2058G and A2059G mutations that confer macrolide resistance are present among southern African strains of Treponema pallidum and to determine their subtype distribution. 117 genital ulcer specimens, collected between March 2005 and April 2010 in South Africa and Lesotho and previously determined to be positive for T pallidum DNA by molecular testing, were retested using a commercial real-time PCR assay. Those specimens that were still positive for T pallidum DNA were screened for the macrolide resistance-encoding point mutations in the 23S rRNA gene using rapid PCR-based restriction digest assays. Molecular characterisation of two variable treponemal genes, arp and tpr, was used to subtype the T pallidum strains. 1 of 100 T pallidum-positive specimens, collected in Lesotho, contained the A2058G macrolide resistance-encoding 23S rRNA gene mutation, whereas the A2059G mutation was absent. It was possible to fully type 97/100 of all T pallidum DNA-positive s les. A total of nine arp repeat sizes, nine tpr patterns and a combined total of 20 subtypes were identified. Overall, the most common subtypes were 14d (32%), followed by 17d (12%), 14a (10%), 14b (8%), 22b (6%) and 14i (5%). Subtypes 14d and 14a were the predominant subtypes in s les from South Africa (43%) and Lesotho (22%), respectively. Macrolide resistance among T pallidum strains appears to be uncommon in southern Africa. Although a high degree of genetic heterogeneity was observed among the strains tested, T pallidum subtype 14d appears to be the predominant circulating strain.
Summary of Proceedings of the IUSTI Global Challenges Symposium (ISSTDR 2007/10th IUSTI World Congress)
Publisher: SAGE Publications
Date: 02-2009
Meeting the public health challenge of multidrug- and extensively drug-resistantNeisseria gonorrhoeae
Publisher: Informa UK Limited
Date: 09-2009
DOI: 10.1586/ERI.09.63
Abstract: Globally, antimicrobial resistance (AMR) in Neisseria gonorrhoeae is increasing in prevalence, both within and across antibiotic classes, including extended-spectrum cephalosporins, raising concerns that gonorrhea may become untreatable in certain circumstances. The AMR surveillance that is essential to optimize standard treatments is often lacking or of poor quality in countries with high disease rates. Recent initiatives by the WHO to enhance global AMR surveillance that focus on multidrug- and extensively drug-resistant N. gonorrhoeae through revision of surveillance standards and use of a new panel of N. gonorrhoeae control strains are described. Keys to meeting these new challenges posed by gonococcal AMR remain the reduction in global burden of gonorrhea combined with implementation of wider strategies for general AMR control, and better understanding of mechanisms of emergence and spread of AMR.
Prevalence of antibiotic resistance in pneumococci. Prevalence of resistance to penicillin is higher in east London ...
Publisher: BMJ
Date: 28-09-1996
DOI: 10.1136/BMJ.313.7060.819B
Abstract: Nine- and twelve-membered triaza-macrocycles were appended to one end of homospermidine to make polyamine lassos. These compounds were shown to be potent polyamine transport inhibitors (PTIs) using pancreatic ductal adenocarcinoma L3.6pl cells, which have high polyamine transport activity. The smaller triazacyclononane-based lasso significantly reduced the uptake of a fluorescent polyamine probe and inhibited spermidine uptake and reduced intracellular polyamine levels in difluoromethylornithine (DFMO)-treated L3.6pl cells. Both designs were shown to be effective inhibitors of
The Gonococcus fights back: is this time a knock out?
Publisher: BMJ
Date: 23-07-2010
Abstract: Since the introduction of antibiotics in the 1930s, Neisseria gonorrhoeae has exhibited a remarkable ability to acquire novel genetic resistance determinants. Initially, sulphonamides were replaced by penicillin, while tetracyclines were prescribed for penicillin-allergic patients. With the advent of penicillinase-producing gonococci, spectinomycin was only briefly useful as alternative treatment and plasmid-mediated tetracycline resistance spread rapidly from the mid-1980s onwards. The fluoroquinolones followed but chromosomally mediated resistance appeared after only a decade of use. Seventy years on, we now face a global public health challenge of immense significance--the emergence of resistance to cephalosporins. With lack of investment in the search for new anti-gonococcal antimicrobial agents or vaccine research, the global spread of multiresistant gonococci can be seen. The impact of untreatable gonorrhoea on HIV transmission could be enormous in high-prevalence countries. This threat comes at a time when many national STI control programmes are weak. To delay the emergence of extensively drug-resistant gonorrhoea, public health systems require strengthening and novel strategies need implementing to enhance the therapeutic lifespan of the few antimicrobial agents that we have left.
Correlates of Bacterial Ulcers and Acute HSV-2 Infection among Men with Genital Ulcer Disease in South Africa: Age, Recent Sexual Behaviors, and HIV.
Publisher: AOSIS
Date: 25-01-2016
Inconsistent HIV pre‐exposure prophylaxis use and HIV transmission in men who have sex with men (MSM)
Publisher: Wiley
Date: 08-2020
DOI: 10.1002/JIA2.25579
Association of the ANRS-12126 Male Circumcision Project with HIV Levels among Men in a South African Township: Evaluation of Effectiveness using Cross-sectional Surveys
Publisher: Public Library of Science (PLoS)
Date: 03-09-2013
Identification of predominant culturable vaginal Lactobacillus species and associated bacteriophages from women with and without vaginal discharge syndrome in South Africa
Publisher: Microbiology Society
Date: 02-2011
Abstract: Lactobacillus jensenii , Lactobacillus crispatus , Lactobacillus iners , Lactobacillus gasseri and Lactobacillus vaginalis were identified by 16S rRNA gene sequencing as the predominant culturable vaginal Lactobacillus species in a group of South African women, comprising 24, 22, 10, 10 and 9 %, respectively. A significant effect of vaginal discharge syndrome (VDS) and bacterial vaginosis (BV) on the distribution of predominant Lactobacillus species was observed. Whilst L. crispatus isolates were almost equally distributed between in iduals with and without VDS and were not significantly reduced in women with BV versus normal microflora, L. jensenii isolates were significantly reduced in women with VDS ( P =0.022) and reduced in women with BV versus normal microflora ( P =0.053). Unlike L. crispatus , L. jensenii isolates were also significantly reduced in women with BV-associated VDS versus women without VDS and with normal microflora ( P =0.051). In addition, lysogeny was commonly observed for L. crispatus , with 77 % of isolates yielding phage particles with contractile and non-contractile tails. Only 29 % of L. jensenii isolates yielded phage particles, and these were visible as tailless or podo-like particles.
Whole-genome sequences of Chlamydia trachomatis directly from clinical samples without culture
Publisher: Cold Spring Harbor Laboratory
Date: 22-03-2013
Abstract: The use of whole-genome sequencing as a tool for the study of infectious bacteria is of growing clinical interest. Chlamydia trachomatis is responsible for sexually transmitted infections and the blinding disease trachoma, which affect hundreds of millions of people worldwide. Recombination is widespread within the genome of C. trachomatis , thus whole-genome sequencing is necessary to understand the evolution, ersity, and epidemiology of this pathogen. Culture of C. trachomatis has, until now, been a prerequisite to obtain DNA for whole-genome sequencing however, as C. trachomatis is an obligate intracellular pathogen, this procedure is technically demanding and time consuming. Discarded clinical s les represent a large resource for sequencing the genomes of pathogens, yet clinical swabs frequently contain very low levels of C. trachomatis DNA and large amounts of contaminating microbial and human DNA. To determine whether it is possible to obtain whole-genome sequences from bacteria without the need for culture, we have devised an approach that combines immunomagnetic separation (IMS) for targeted bacterial enrichment with multiple displacement lification (MDA) for whole-genome lification. Using IMS-MDA in conjunction with high-throughput multiplexed Illumina sequencing, we have produced the first whole bacterial genome sequences direct from clinical s les. We also show that this method can be used to generate genome data from nonviable archived s les. This method will prove a useful tool in answering questions relating to the biology of many difficult-to-culture or fastidious bacteria of clinical concern.
Acute HIV Infections among Men with Genital Ulcer Disease in South Africa
Publisher: Oxford University Press (OUP)
Date: 15-06-2010
DOI: 10.1086/652785
Abstract: We investigated acute human immunodeficiency virus (HIV) infection among men enrolled in a genital ulcer treatment trial in South Africa. HIV-negative participants were tested at baseline by HIV RNA polymerase chain reaction and followed up after 1 month to measure HIV seroconversion. There were 228 HIV-negative men at baseline 10 were positive for HIV RNA, and 8 seroconverted to HIV at day 28. The prevalence of acute HIV among HIV-negative men at baseline was 18 (7.9%) of 228 men (95% confidence interval [CI], 4.4-11.4) and 18 (2.9%) of 615 men (95% CI, 1.6-4.3) in the overall study population. These data highlight the importance of genital ulcer patients in HIV transmission. Trial Registration. ClinicalTrials.gov identifier: NCT00164424 .
Ongoing evolution of Chlamydia trachomatis lymphogranuloma venereum: exploring the genomic diversity of circulating strains
Publisher: Microbiology Society
Date: 29-06-2021
Abstract: Lymphogranuloma venereum (LGV), the invasive infection of the sexually transmissible infection (STI) Chlamydia trachomatis , is caused by strains from the LGV biovar, most commonly represented by ompA -genotypes L2b and L2. We investigated the ersity in LGV s les across an international collection over seven years using typing and genome sequencing. LGV-positive s les ( n =321) from eight countries collected between 2011 and 2017 (Spain n =97, Netherlands n =67, Switzerland n =64, Australia n =53, Sweden n =37, Hungary n =31, Czechia n =30, Slovenia n =10) were genotyped for pmpH and ompA variants. All were found to contain the 9 bp insertion in the pmpH gene, previously associated with ompA -genotype L2b. However, analysis of the ompA gene shows ompA -genotype L2b ( n =83), ompA -genotype L2 ( n =180) and several variants of these ( n =52 12 variant types), as well as other/mixed ompA -genotypes ( n =6). To elucidate the genomic ersity, whole genome sequencing (WGS) was performed from selected s les using SureSelect target enrichment, resulting in 42 genomes, covering a ersity of ompA -genotypes and representing most of the countries s led. A phylogeny of these data clearly shows that these ompA -genotypes derive from an ompA -genotype L2b ancestor, carrying up to eight SNPs per isolate. SNPs within ompA are overrepresented among genomic changes in these s les, each of which results in an amino acid change in the variable domains of OmpA (major outer membrane protein, MOMP). A reversion to ompA -genotype L2 with the L2b genomic backbone is commonly seen. The wide ersity of ompA -genotypes found in these recent LGV s les indicates that this gene is under immunological selection. Our results suggest that the ompA -genotype L2b genomic backbone is the dominant strain circulating and evolving particularly in men who have sex with men (MSM) populations.
A multicentre double-blind randomised controlled trial evaluating the efficacy of daily use of antibacterial mouthwash against oropharyngeal gonorrhoea among men who have sex with men: the OMEGA (Oral
Publisher: Springer Science and Business Media LLC
Date: 28-06-2017
Human papillomavirus types in HIV seropositive men with penile warts in Johannesburg, South Africa
Publisher: SAGE Publications
Date: 02-2011
Abstract: Few data exist regarding the human papillomavirus (HPV) types in penile warts (PW) of HIV-infected men in Africa. Nurses collected penile swabs for HPV typing from 74 HIV-positive men with PW. HPV genotyping was performed using the Roche Linear Array Test. Analysis was performed on data relating to 74 s les. The mean age of the men was 36.0 years and 78.5% (51/65) were uncircumcised. Of the 73/74 validated results, all tested positive for HPV 42.5% (31/73) and 32.9% (24/73) had HPV types 6 and 11, respectively. 84.9% of men tested positive for any oncogenic type: 20/73 (27.4%) were positive for type 16, 11/73 (15.1%) were positive for type 18 and 8/73 (11.0%) men had both types. Our study shows a high prevalence (68.5%) of HPV type 6 and/or 11 in this male population with PW. Given the poor availability of treatment, a quadrivalent vaccine for men may have significant benefit.
Varicella-zoster vaccination for health care workers
Publisher: Elsevier BV
Date: 05-1994
Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa
Publisher: Springer Science and Business Media LLC
Date: 12-2009
The 374 clinic: an outreach sexual health clinic for young men
Publisher: BMJ
Date: 12-2004
Tetracycline-resistant Neisseria gonorrhoeae. Characteristics of patients and isolates at a London Genitourinary Medicine Clinic.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 1996
DOI: 10.1097/00007435-199609000-00006
Abstract: To compare auxotypes, serovars, and antibiograms of tetracycline-resistant Neisseria gonorrhoeae (TRNG) and non-TRNG isolated from patients attending an East London Genitourinary Medicine (GUM) Clinic. To obtain plasmid profiles for penicillinase-producing gonococci (PPNG) as well as presumptive TRNG. To identify differences in patient characteristics for the TRNG and non-TRNG patient groups. Gonococcal isolates were collected from 400 patients attending the GUM clinic at the Royal London Hospital GUM Clinic over a 1-year period. Isolates (378) were tested for susceptibility to various antibiotics, auxotyped, and serotyped. Plasmid profiles were obtained for PPNG and isolates exhibiting high-level tetracycline resistance (TRNG). The presence of the tet M determinant was confirmed using the polymerase chain reaction (PCR). The PCR product was digested with the restriction endonuclease (RE) Hpa II and electrophoresed on a 2.5% agarose gel to determine an "RE pattern." Patient data were collected by retrospective case-note review. TRNG (n = 42) accounted for 11% of the 378 isolates tested, and the remaining 336 (89%) isolates were non-TRNG. Non-requiring auxotrophy and P1B-2 serovar expression occurred more frequently among TRNG. PPNG accounted for 31% of TRNG and 5% of non-TRNG. Chromosomal resistance to penicillin (CMRNG) was absent among TRNG but accounted for 11% of non-TRNG. One TRNG isolate showed decreased susceptibility to ciprofloxacin (MIC 0.25 mg/l). All isolates were sensitive to cefotaxime, cefixime, spectinomycin, and azithromycin. All TRNG possessed the 25.2 MDa plasmid and produced a PCR product of appropriate size after tet M gene sequence lification. RE digests of the PCR product gave a single pattern. None of the TRNG in contrast to 18% of the non-TRNG were acquired homosexually. Ethnic distribution differed between the patients with TRNG and patients without non-TRNG (Afro-Caribbean 81% versus 58% white 19% versus 36%). Most TRNG were acquired in the United Kingdom. TRNG differ from the non-TRNG in their auxotype and serovar distribution. PPNG are more common among the TRNG isolates, whereas CMRNG appear absent. TRNG are isolated more commonly from Afro-Caribbean patients and were not represented among homosexually acquired isolates.
Inflammatory cytokine biomarkers to identify women with asymptomatic sexually transmitted infections and bacterial vaginosis who are at high risk of HIV infection
Publisher: BMJ
Date: 28-10-2015
The use of experimental animal and human models in the study of chancroid pathogenesis.
Publisher: SAGE Publications
Date: 02-1999
The role of core groups in the emergence and dissemination of antimicrobial-resistant N gonorrhoeae.
Publisher: BMJ
Date: 15-11-2013
DOI: 10.1136/SEXTRANS-2013-051020
Abstract: Core groups contain in iduals who are regularly infected with Neisseria gonorrhoeae and are able to transmit their infection to a large number of sexual partners. Classical core groups, such as sex workers and their male partners, or men who have sex with men (MSM), have contributed to the emergence and spread of antimicrobial-resistant N gonorrhoeae over many years. Sex workers and their clients were the most important core group driving the dissemination of penicillinase-producing N gonorrhoeae in the 1970s. Such in iduals have continued to contribute to penicillinase-producing N gonorrhoeae outbreaks as well as to the subsequent emergence of gonococcal resistance to fluoroquinolones, macrolides, spectinomycin and cephalosporins in various settings. MSM have been a very important core group since the 1980s, first with the spread of TetM-expressing N gonorrhoeae and, second, with the dissemination of fluoroquinolone-resistant N gonorrhoeae. MSM-associated sexual networks have most recently been critical to the spread of gonococci resistant to third generation extended spectrum cephalosporins, including cefixime and ceftriaxone. In iduals within other core groups have also been linked to the transmission of antimicrobial-resistant gonorrhoea, such as military personnel, travellers, drug users, young adults, older men and members of street gangs. Understanding core behaviours and their geospatial clustering is essential for an optimal public health response to the rising prevalence of antimicrobial-resistant gonorrhoea. Furthermore, rapid and effective treatment of N gonorrhoeae infections in core in iduals and their sexual partners should be a priority for gonorrhoea control programmes.
A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics
Publisher: BMJ
Date: 02-09-2016
DOI: 10.1136/SEXTRANS-2016-052578
Abstract: Although sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell sex in Australia. This study reports the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among men who have sex with men attending Australian publicly funded sexual health clinics and compares prevalence between sex workers and non-sex workers. From 2011 to 2014, de-identified patient data were extracted from 40 sexual health clinics in four Australian jurisdictions. The χ In total, 27 469 gay, bisexual and other men who have sex with men attended participating clinics 443 (1.6%) reported sex work. At first consultation, 18% of sex workers and 17% of non-sex workers were diagnosed with HIV or an STI (p=0.4): 13% of sex workers were newly diagnosed with chlamydia, 15% with gonorrhoea, 0.5% with infectious syphilis and 0.6% with HIV. After controlling for demographic and behavioural factors, sex work was not independently associated with an HIV or STI diagnosis. These findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men.
Field evaluation of Standard Diagnostics' Bioline HIV/Syphilis Duo test among female sex workers in Johannesburg, South Africa
Publisher: BMJ
Date: 06-05-2016
DOI: 10.1136/SEXTRANS-2015-052474
Abstract: Point-of-care tests provide immediate results with the opportunity for same-day interventions with improved public health outcomes. A dual HIV/syphilis test enables early treatment of both diseases. We conducted a field evaluation of the Standard Diagnostics' SD Bioline HIV/Syphilis Duo test (SD Bioline) among female sex workers. SD Bioline was conducted on finger-prick blood according to manufacturer's instructions and compared with (i) Genscreen HIV1/2 (third generation) and Vironostika Ag/Ab (fourth generation) assays for HIV, and (ii) Of 263 women recruited, 14 (5.3%) declined an HIV test. Among the remaining 249 women, 187 (75.1%) were HIV positive, 51 (20.5%) had syphilis antibodies with seven (2.8%) active infections. For HIV, the sensitivity and specificity were 98.9% (95% CI 95.8% to 99.8%) and 100% (95% CI 92.7% to 100%). For syphilis, the sensitivity and specificity were 66.7% (95% CI 52.0% to 78.9%) and 98.0% (95% CI 94.5% to 99.3%). Sera with high TPPA titres were more likely to test positive. In field conditions, while the SD Bioline test has high sensitivity and specificity for HIV and high specificity for syphilis, the test has lower sensitivity for syphilis than reported from laboratory evaluations. As the dual test detects only two thirds of syphilis cases, it should only be used in areas with weak screening programmes.
Global resistance of Neisseria gonorrhoeae: when theory becomes reality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
Distribution and risk factors of Trichomonas vaginalis infection in England: an epidemiological study using electronic health records from sexually transmitted infection clinics, 2009-2011.
Publisher: Cambridge University Press (CUP)
Date: 29-11-2013
DOI: 10.1017/S0950268813002902
Abstract: We used data from the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) over a 3-year period (2009–2011) to investigate the distribution and risk factors of Trichomonas vaginalis infection in England. Socio-demographic and clinical risk factors associated with a diagnosis of T. vaginalis were explored using multivariable logistic regression. Rates of T. vaginalis infection were highest in London and the West Midlands. For men and women, T. vaginalis infection was significantly associated with: older age compared to those aged 20–24 years, non-white ethnicity (in particular black Caribbean and black ‘other’ ethnic groups), and birth in the Caribbean vs . birth in the UK. Current gonorrhoea or chlamydia infection was associated with a diagnosis of T. vaginalis in women. Further research is required to assess the public health impact and cost-effectiveness of introducing targeted screening for women at high risk of infection in areas of higher prevalence.
Plasmid-mediated penicillin and tetracycline resistance among Neisseria gonorrhoeae isolates in South Africa: prevalence, detection and typing using a novel molecular assay.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Level of viral suppression and the cascade of HIV care in a South African semi-urban setting in 2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-08-2016
Primary syphilis in men causes painful anogenital lesions and serology is not always helpful
Publisher: BMJ
Date: 31-03-2020
Sexually transmissible infections: current approaches to management
Publisher: Medpharm Publications
Date: 06-2022
Episodic Therapy for Genital Herpes in Sub-Saharan Africa: A Pooled Analysis from Three Randomized Controlled Trials
Publisher: Public Library of Science (PLoS)
Date: 25-07-2011
Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa
Publisher: South African Medical Association NPC
Date: 15-03-2013
DOI: 10.7196/SAMJ.6722
Abstract: Patients with community-acquired urinary tract infections (UTIs) frequently present to healthcare facilities in South Africa (SA). To provide information on UTI aetiology and antimicrobial susceptibility of pathogens. We recruited women with UTI-related symptoms, who tested positive for ≥2 urine dipstick criteria (proteinuria, blood, leucocytes or nitrites) at 1 public and 5 private primary healthcare facilities in 2011. Demographic and clinical data were recorded and mid-stream urine (MSU) specimens were cultured. UTI pathogens were Gram-stained and identified to species level. Etest-based antimicrobial susceptibility testing was performed for amoxicillin/clavulanic acid, cefixime, cefuroxime, ciprofloxacin, fosfomycin, levofloxacin, nitrofurantoin, norfloxacin and trimethoprim/sulphamethoxazole. Of the 460 women recruited, 425 MSU s les were processed and 204 UTI pathogens were identified in 201 s les. Most pathogens were Gram-negative bacilli (GNB) (182 89.2%) and 22 (10.8%) were Gram-positive cocci (GPC). Escherichia coli was the most frequent GNB (160 79.6%), while Enterococcus faecalis was the predominant GPC (8 4.0%). The UTI pathogens had similar susceptibility profiles for fosfomycin (95.5% 95% confidence interval (CI) 92.6 - 98.4), the 3 fluoroquinolones (94.1% 95% CI 90.8 - 97.4), nitrofurantoin (91.7% 95% CI 87.8 - 95.6), cefuroxime (90.1% 95% CI 86.0 - 94.3) and cefixime (88.2% 95% CI 83.7 - 92.6). UTI pathogens were less susceptible to amoxicillin/clavulanic acid (82.8% 95% CI 77.5 - 88.0) when compared with fluoroquinolones and fosfomycin. Trimethoprim/ sulphamethoxazole was the least efficacious antimicrobial agent (44.3% susceptible 95% CI 37.4 - 51.2). This study provides relevant data for the empirical treatment of community-acquired UTIs in SA.
Mixed gonococcal infections in a high-risk population, Sydney, Australia 2015: implications for antimicrobial resistance surveillance?
Publisher: Oxford University Press (OUP)
Date: 05-10-2016
DOI: 10.1093/JAC/DKW406
Abstract: Previous studies have shown that mixed-strain gonococcal infections can occur. However, it remains unclear whether such infections impact upon the reliability of Neisseria gonorrhoeae antimicrobial resistance (AMR) surveillance. In this study, we aimed to resolve this question by intensively s ling isolates from gonorrhoea-positive specimens in a high-risk population in Sydney, Australia. A total of 615 N. gonorrhoeae isolates, originating from 63 clinical s les (31 rectal swabs and 32 throat swabs), were characterized. All isolates were subject to N. gonorrhoeae identification, antimicrobial susceptibility testing and genotyping by SNP-based MLST. Only 2 of the 63 (3.2%) s les provided evidence of mixed-strain infections. These comprised two rectal swabs that harboured isolates of different SNP-based MLST genotypes however, the AMR susceptibility profiles of the different genotypes from these s les were indistinguishable. Within-s le differences in the AMR susceptibility profiles were observed for a further seven s les however, the differences were not considered significant MIC values were typically within a 2-fold difference or were close to test breakpoints. Results of this study provide further evidence that mixed-strain gonococcal infections do occur, although at low prevalence. Our data indicate that at a population level such infections are unlikely to impact significantly upon N. gonorrhoeae AMR surveillance.
Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis
Publisher: Oxford University Press (OUP)
Date: 13-04-2017
DOI: 10.1093/CID/CIX326
Abstract: Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91% Ptrend < .0001) and HIV-positive MSM (42% to 77% Ptrend < .0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend < .0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend < .0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend < .0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend = .030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend < .0001), while secondary infections decreased from 45% to 26% (Ptrend = .0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87 P = .005) or frequency (r = -0.93 P = .001). Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.
Comparison of care HPV and Hybrid Capture 2 Assays for Detection of High-Risk Human Papillomavirus DNA in Cervical Samples from HIV-1-Infected African Women
Publisher: American Society for Microbiology
Date: 12-2013
DOI: 10.1128/JCM.02144-13
Abstract: The care HPV and HC2 assays were compared for high-risk human papillomavirus (HR-HPV) DNA detection in cervical s les from 149 HIV-1-infected African women. The HR-HPV DNA detection rates were 37.6% and 34.9% for care HPV and HC2, respectively. Agreement between the two tests was 94.6% (95% confidence interval [CI], 89.7% to 97.7%) with a kappa value of 0.88 (95% CI, 0.81 to 0.96), indicating an excellent agreement. care HPV may be considered as suitable as HC2 for cervical cancer screening among HIV-infected African women.
High Prevalence of Ciprofloxacin-Resistant Gonorrhea Among Female Sex Workers in Kampala, Uganda (2008–2009)
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2014
Associations Between Psychosocial Factors and Incidence of Sexually Transmitted Disease Among South African Adolescents
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
Chancroid: from clinical practice to basic science.
Publisher: Mary Ann Liebert Inc
Date: 2000
Abstract: Chancroid is a sexually transmitted disease caused by the bacterium Haemophilus ducreyi. It usually presents as a genital ulcer and may be associated with regional lymphadenopathy and bubo formation. H. ducreyi infection is predominantly seen in tropical resource-poor regions of the world where it is frequently the most common etiological cause of genital ulceration. Genital ulcer disease has been shown to be an extremely important co-factor in HIV transmission. With the advent of the AIDS epidemic, there has been increased research effort to elucidate those factors involved in the pathogenesis of chancroid. Several putative virulence factors have now been identified and isogenic H. ducreyi mutants constructed by mutagenesis of their encoding genes. This approach has facilitated investigations into the role each of these putative virulence factors may play in H. ducreyi pathogenesis through the use of in vitro and in vivo model systems. One major goal of current chancroid research is to identify antigens which are immunogenic and could form the basis of a vaccine against H. ducreyi infection. Such a vaccine, if shown to be effective in decreasing the prevalence of chancroid, could have the added benefit of slowing down the HIV incidence rates in those populations where chancroid is a major co-factor for HIV transmission.
Antimicrobial resistance in Neisseria gonorrhoeae and Treponema pallidum: evolution, therapeutic challenges and the need to strengthen global surveillance
Publisher: BMJ
Date: 22-11-2011
Trends in the relative prevalence of genital ulcer disease pathogens and association with HIV infection in Johannesburg, South Africa, 2007–2015
Publisher: Public Library of Science (PLoS)
Date: 04-04-2018
A one-year survey of gonococcal infection seen in the genitourinary medicine department of a London district general hospital
Publisher: SAGE Publications
Date: 09-1999
Abstract: The results of a one-year clinical, epidemiological and microbiological survey of gonococcal infection presenting to the Patrick Clements Clinic (PCC), a London district general hospital (DGH) genitourinary medicine (GUM) clinic, are presented. Clinical and epidemiological patient data were collected by a combination of questionnaire and retrospective case-note review. Microscopy performance within the PCC, outcome of treatment, return for tests of cure and efficacy of contact tracing were assessed. Isolates were tested for susceptibility to penicillin, tetracycline and ciprofloxacin. The study showed the PCC continues to diagnose and treat over 200 cases of gonorrhoea per year. High level resistance to penicillin, tetracycline and ciprofloxacin was documented among the year's isolates and antibiotic resistance was linked to acquisition of gonorrhoea overseas. Despite interviewing 183 patients concerning health advice and contact tracing issues, only 55% of new episodes re-attended for a first test of cure. In addition, only 29% of reported sexual contacts attended GUM clinics for investigation and treatment.
Comprehensive global genome dynamics of Chlamydia trachomatis show ancient diversification followed by contemporary mixing and recent lineage expansion
Publisher: Cold Spring Harbor Laboratory
Date: 06-06-2017
Abstract: Chlamydia trachomatis is the world's most prevalent bacterial sexually transmitted infection and leading infectious cause of blindness, yet it is one of the least understood human pathogens, in part due to the difficulties of in vitro culturing and the lack of available tools for genetic manipulation. Genome sequencing has reinvigorated this field, shedding light on the contemporary history of this pathogen. Here, we analyze 563 full genomes, 455 of which are novel, to show that the history of the species comprises two phases, and conclude that the currently circulating lineages are the result of evolution in different genomic ecotypes. Temporal analysis indicates these lineages have recently expanded in the space of thousands of years, rather than the millions of years as previously thought, a finding that dramatically changes our understanding of this pathogen's history. Finally, at a time when almost every pathogen is becoming increasingly resistant to antimicrobials, we show that there is no evidence of circulating genomic resistance in C. trachomatis .
High human papillomavirus (HPV) prevalence in South African adolescents and young women encourages expanded HPV vaccination campaigns
Publisher: Public Library of Science (PLoS)
Date: 02-01-2018
Etiology and STI/HIV coinfections among patients with urethral and vaginal discharge syndromes in South Africa.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
'Clinics aren't meant for men': sexual health care access and seeking behaviours among men in Gauteng province, South Africa.
Publisher: Informa UK Limited
Date: 06-2011
DOI: 10.1080/17290376.2011.9724989
Abstract: Men may be key players in the transmission of sexually transmitted infections (STI), and it is important that STI/HIV health services reach men. The objective of this study was to explore sexual health care access and seeking behaviours in men. This study used focus groups to examine sexual health care access and seeking behaviours in men 5 years after implementation of free antiretroviral therapy (ART) in the South African public sector. Six focus groups (N=58) were conducted with men ≫18 years in an urban area of Gauteng province. Men were recruited from various locations throughout the community. Men reported several barriers and facilitators to the use of public and private clinics for sexual health services including HIV testing, and many men reported seeking care from traditional healers. Men often viewed public clinics as a place for women and reported experiences with some female nurses who were rude or judgmental of the men. Additionally, some men reported that they sought sexual health care services at public clinics however, they were not given physical examinations by health care providers to diagnose their STI syndrome. Most men lacked knowledge about ART and avoided HIV testing because of fear of death or being abandoned by their families or friends. Study findings suggest that men still require better access to high-quality, non-judgmental sexual health care services. Future research is needed to determine the most effective method to increase men's access to sexual health care services.
HIV infection in patients with sexually transmitted infections in Zimbabwe – Results from the Zimbabwe STI etiology study
Publisher: Public Library of Science (PLoS)
Date: 11-06-2018
Chancroid: clinical manifestations, diagnosis, and management
Publisher: BMJ
Date: 02-2003
DOI: 10.1136/STI.79.1.68
Abstract: Chancroid is a sexually transmitted disease (STD) caused by the Gram negative bacterium Haemophilus ducreyi and is characterised by necrotising genital ulceration which may be accompanied by inguinal lymphadenitis or bubo formation. H ducreyi is a fastidious organism which is difficult to culture from genital ulcer material. DNA lification techniques have shown improved diagnostic sensitivity but are only performed in a few laboratories. The management of chancroid in the tropics tends to be undertaken in the context of syndromic management of genital ulcer disease and treatment is usually with erythromycin. A number of single dose regimens are also available to treat H ducreyi infection. Genital ulceration as a syndrome has been associated with increased transmission of human immunodeficiency virus (HIV) infection in several cross sectional and longitudinal studies. Effective and early treatment of genital ulceration is therefore an important part of any strategy to control the spread of HIV infection in tropical countries.
Concern regarding the alleged spread of hypervirulent lymphogranuloma venereum Chlamydia trachomatis strain in Europe
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 13-04-2017
Early Detection of Human Immunodeficiency Virus Type 1-Specific B-Lymphocyte-Derived Antibodies in a High-Risk Population▿
Publisher: American Society for Microbiology
Date: 07-2009
DOI: 10.1128/CVI.00280-08
Abstract: Diagnosis of acute human immunodeficiency virus (HIV) infection, a key driver of the HIV epidemic, remains a public health challenge. The PlasmAcute technology offers an opportunity to detect early anti-HIV antibody responses. B lymphocytes (B cells) were isolated from the blood of seronegative miners in South Africa by using the PlasmAcute method. B-cell lysates and paired sera were tested for anti-HIV-1 antibodies by two different enzyme-linked immunosorbent assays immunoreactivity was confirmed by Western blotting. All volunteers were tested for HIV type 1 (HIV-1) viral load, p24 antigen, and CD4 count. Sera from HIV-seronegative men who had positive viral loads and were positive for p24 antigen were retested for anti-HIV antibodies after immune complex dissociation. Anti-HIV antibodies were detected in lysates from 16/259 subjects without immunoreactivity in paired sera. Four subjects, one of whom had a positive viral load initially, subsequently seroconverted. Six subjects showed transient anti-HIV-1 antibodies in the lysates and tested negative for all markers at the follow-up. Five subjects without follow-up data initially had lysate-positive/serum-negative s les, and these cases were classified as inconclusive. One subject had lysate antibodies and a detectable viral load but was seronegative at follow-up. In conclusion, lysate-derived anti-HIV-1 B-cell antibodies can be detected prior to seroconversion and earlier than or contemporary with HIV-1 RNA detection.
Opportunistic screening for Chlamydia: Microbiological input is essential in Chlamydia screening programmes.
Publisher: BMJ
Date: 31-07-2003
The Etiology of Male Urethral Discharge in Zimbabwe: Results from the Zimbabwe STI Etiology Study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2018
Mycoplasma genitalium coinfection in men with symptomatic gonococcal urethritis
Publisher: BMJ
Date: 10-09-2021
DOI: 10.1136/SEXTRANS-2020-054529
Abstract: International guidelines recommend Mycoplasma genitalium testing, preferably using an assay to detect macrolide resistance-associated mutations, for men presenting with non-gonococcal urethritis, but there is no specific guidance on such testing for men with gonococcal urethritis. This study aimed to estimate the proportion of men with gonococcal urethritis who have coinfection with M. genitalium through a retrospective analysis of cases of symptomatic urethral gonorrhoea at Western Sydney Sexual Health Centre in 2017 and 2018. Fourteen of 184 (7.6%, 95% CI 3.7 to 11.5) men with gonococcal urethritis had M. genitalium detected in the urine at the time of presentation. No demographic or behavioural factors predicted M. genitalium coinfection. Coinfection with urethral Chlamydia trachomatis was detected in 29 of 184 (15.8%, 95% CI 10.5 to 21.1). All five men with macrolide-resistant M. genitalium detected returned for treatment with moxifloxacin at a median of 8 days (range 5–16 days) after presentation and treatment of gonorrhoea three of five were documented to remain symptomatic at this visit. Although M. genitalium coinfection is less common than chlamydia among men with symptomatic gonococcal urethritis, M. genitalium testing, using an assay to detect macrolide resistance, will potentially reduce symptom duration particularly for men with macrolide-resistant infections, but may not be justifiable on cost-benefit analysis.
Syphilitic lymphadenitis clinically and histologically mimicking lymphogranuloma venereum
Publisher: South African Medical Association NPC
Date: 19-04-2016
Disentangling the tangled web of Neisseria gonorrhoeae transmission: how important are oropharyngeal infections?
Publisher: BMJ
Date: 09-07-2019
On-demand HIV pre-exposure prophylaxis: what are the healthcare workers’ barriers to delivery in a culturally and linguistically diverse population?
Publisher: BMJ
Date: 07-01-2020
Risk factors for oropharyngeal gonorrhoea in men who have sex with men: An age-matched case-control study
Publisher: BMJ
Date: 22-01-2018
DOI: 10.1136/SEXTRANS-2017-053381
Abstract: Oropharyngeal gonorrhoea is common among men who have sex with men (MSM). We aimed to clarify which oral sex practices were independent risk factors for oropharyngeal gonorrhoea: tongue kissing, receptive oro-penile sex (fellatio) or insertive oro-anal sex (rimming), and whether daily use of mouthwash and recent antibiotic use was protective. In 2015, we conducted an age-matched case–control study of MSM who attended the Melbourne Sexual Health Centre. Cases had tested positive for oropharyngeal gonorrhoea by nucleic acid lification testing, and controls had tested negative. Questionnaire items included tongue kissing, oral sex practices, condom use, recent antibiotic use, mouthwash use and alcohol consumption. We identified 177 cases, age matched to 354 controls. In univariable analyses, cases were 1.90 times (95% CI 1.13 to 3.20) more likely than controls to have had casual sexual partners (CSP) in the preceding 3 months, were 2.17 times (95% CI 1.31 to 3.59) more likely to have kissed CSP and were 2.04 times (95% CI 1.26 to 3.30) more likely to have had receptive oro-penile sex with CSP. Oropharyngeal gonorrhoea was not associated with insertive oro-anal sex or mouthwash use. The number of CSP for tongue kissing and receptive oral sex and total CSP were highly correlated, and in multivariable analysis neither kissing nor receptive oro-penile sex was significantly associated with having oropharyngeal gonorrhoea, after adjusting for total number of CSP. The finding that oropharyngeal gonorrhoea was associated with a higher number of sexual partners but not specific sexual practices highlights the need for further research in the area of gonorrhoea transmission to define the probability of transmission from specific sex acts.
Comparison of an in-house real-time duplex PCR assay with commercial HOLOGIC® APTIMA assays for the detection of Neisseria gonorrhoeae and Chlamydia trachomatis in urine and extra-genital specimens
Publisher: Springer Science and Business Media LLC
Date: 03-01-2019
Characterization of Haemophilus ducreyi cdtA, cdtB, and cdtC Mutants in In Vitro and In Vivo Systems
Publisher: American Society for Microbiology
Date: 09-2001
DOI: 10.1128/IAI.69.9.5626-5634.2001
Abstract: Haemophilus ducreyi expresses a soluble cytolethal distending toxin (CDT) that is encoded by the cdtABC gene cluster and can be detected in culture supernatant fluid by its ability to kill HeLa cells. The cdtA, cdtB , and cdtC genes of H. ducreyi were cloned independently into plasmid vectors, and their encoded proteins expressed singly or in various combinations in an Escherichia coli background. All three gene products had to be expressed in order for E. coli -derived culture supernatant fluids to demonstrate cytotoxicity for HeLa cells. Isogenic H. ducreyi cdtA and cdtB mutants were constructed and used in combination with the wild-type parent strain and a previously described H. ducreyi cdtC mutant (M. K. Stevens, J. L. Latimer, S. R. Lumbley, C. K. Ward, L. D. Cope, T. Lagergard, and E. J. Hansen, Infect. Immun. 67:3900–3908, 1999) to determine the relative contributions of the CdtA, CdtB, and CdtC proteins to CDT activity. Expression of CdtA, CdtB, and CdtC appeared necessary for H. ducreyi -derived culture supernatant fluid to exhibit cytotoxicity for HeLa cells. Whole-cell sonicates and periplasmic extracts from the cdtB and cdtC mutants had no effect on HeLa cells, whereas these same fractions from a cdtA mutant had a very modest cytotoxic effect on these same human cells. CdtA appeared to be primarily associated with the H. ducreyi cell envelope, whereas both CdtB and CdtC were present primarily in the soluble fraction from sonicated cells. Both the cdtA mutant and the cdtB mutant were found to be fully virulent in the temperature-dependent rabbit model for experimental chancroid.
HIV/STI risk-reduction intervention efficacy with South African adolescents over 54 months.
Publisher: American Psychological Association (APA)
Date: 2015
DOI: 10.1037/HEA0000140
Surveillance systems to monitor antimicrobial resistance in Neisseria gonorrhoeae: a global, systematic review, 1 January 2012 to 27 September 2020
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 05-05-2022
DOI: 10.2807/1560-7917.ES.2022.27.18.2100917
Abstract: Effective surveillance of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is required for the early detection of resistant strains and to ensure that treatment guidelines are appropriate for the setting in which they are implemented. AMR in N. gonorrhoeae has been identified as a global health threat. We performed a systematic review to identify and describe surveillance systems targeting AMR in N. gonorrhoeae . We searched Medline, PubMed, Global Health, EMBASE, CINAHL, Web of Science and ProQuest databases and grey literature between 1 January 2012 and 27 September 2020. Surveillance systems were defined as the continuous, systematic collection, analysis and interpretation of N. gonorrhoeae resistance data. The key components of surveillance systems were extracted, categorised, described and summarised. We found 40 publications reporting on N. gonorrhoeae AMR surveillance systems in 27 countries and 10 multi-country or global surveillance reports. The proportion of countries with surveillance systems in each of the WHO's six regions ranged from one of 22 countries in the Eastern Mediterranean and five of 54 in Africa, to three of 11 countries in South East Asia. Only four countries report systems which are both comprehensive and national. We found no evidence of a current surveillance system in at least 148 countries. Coverage, representativeness, volume, clinical specimen source, type and epidemiological information vary substantially and limit interpretability and comparability of surveillance data for public health action. Globally, surveillance for N. gonorrhoeae AMR is inadequate and leaves large populations vulnerable to a major public health threat.
Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV
Publisher: SAGE Publications
Date: 04-12-2017
Abstract: Adolescents in Africa are at high risk for HIV infection, other sexually transmitted infections (STIs) and bacterial vaginosis (BV). Since behavior and burden of STIs/BV may influence HIV risk, behavioral risk factors and prevalence of STIs/BV were compared in HIV-seronegative adolescent females (n = 298 16–22 years) from two South African communities (Soweto and Cape Town). STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1, HSV-2, Treponema pallidum, and Haemophilus ducreyi) were detected by multiplex polymerase chain reaction, human papillomavirus (HPV) by Roche Linear Array, and BV by Nugent scoring. Rates of BV (Nugent ≥7 46.6%) and HPV (66.8%) were high in both communities. Prevalence of C. trachomatis and N. gonorrhoeae were -fold higher in Cape Town than Soweto (Chlamydia: 42% [62/149] versus 18% [26/148], p 0.0001 gonorrhoea 11% [17/149] versus 5% [7/148], p = 0.05). Only 24% of adolescents with vaginal discharge-causing STIs or BV were symptomatic. In South African adolescents, clinical symptoms compatible with vaginal discharge syndrome had a sensitivity of 23% and specificity of 85% for the diagnosis of discharge-causing STI or BV. In a region with high HIV prevalence and incidence, % of young women with treatable conditions that could enhance HIV risk would have been missed because they lacked symptoms associated with syndromic management.
Multidrug-resistant gonorrhea: A research and development roadmap to discover new medicines
Publisher: Public Library of Science (PLoS)
Date: 26-07-2017
Erythema multiforme as a presentation of human immunodeficiency virus seroconversion illness.
Publisher: SAGE Publications
Date: 1992
Managing vaginal trichomoniasis resistant to high-dose metronidazole therapy.
Publisher: SAGE Publications
Date: 12-1997
Investigation of the interaction among the components of the cytolethal distending toxin of Haemophilus ducreyi.
Publisher: Elsevier BV
Date: 07-2001
Professor Cathy Ison: her contribution to the science and practice of STI control.
Publisher: BMJ
Date: 15-11-2013
Phenotypic and genetic characterization of the first two cases of extended-spectrum-cephalosporin-resistant Neisseria gonorrhoeae infection in South Africa and association with cefixime treatment failure
Publisher: Oxford University Press (OUP)
Date: 14-02-2013
DOI: 10.1093/JAC/DKT034
Abstract: To describe the phenotypic and genetic characteristics of the first two cases of extended-spectrum cephalosporin (ESC)-resistant Neisseria gonorrhoeae in South Africa, one of which was associated with verified cefixime treatment failure. Two ESC-resistant N. gonorrhoeae isolates were cultured from the urethral discharge of two men who have sex with men (MSM). One man reported a persistent urethral discharge that had failed to respond to previous therapy with oral cefixime. Agar dilution MICs were determined for eight antibiotics. β-Lactam-associated resistance mutations were identified through PCR-based lification and sequencing for several key genes: penA, mtrR and its promoter, porB1b (penB), ponA and pilQ. For molecular epidemiological characterization, full-length porB gene sequencing, N. gonorrhoeae multiantigen sequence typing (NG-MAST) and multilocus sequence typing (MLST) were performed. Both isolates were resistant to cefixime, ciprofloxacin, penicillin and tetracycline and intermediate/resistant to azithromycin, but susceptible to ceftriaxone, gentamicin and spectinomycin. Both isolates had the type XXXIV penA mosaic allele in addition to previously described resistance mutations in the mtrR promoter (A deletion), porB1b (penB) (G101K and A102N) and ponA1 (L421P). Both isolates had an identical NG-MAST sequence type (ST4822) and MLST sequence type (ST1901). Both isolates were resistant to cefixime and possessed a number of identical mutations in key genes contributing to ESC resistance in N. gonorrhoeae. The two isolates contained the type XXXIV penA mosaic allele and belonged to a successful international MSM-linked multidrug-resistant gonococcal clone (MLST ST1901) associated with several cefixime treatment failures in Europe and North America.
INTERPRETATION OF BLOOD FILMS IN DIAGNOSIS OF MALARIA
Publisher: Elsevier BV
Date: 09-1989
DOI: 10.1016/S0140-6736(89)90738-1
Abstract: Despite the ubiquity of ammonium in geothermal environments and the thermodynamic favorability of aerobic ammonia oxidation, thermophilic ammonia-oxidizing microorganisms belonging to the crenarchaeota kingdom have only recently been described. In this study, we analyzed microbial mats and surface sediments from 21 hot spring s les (pH 3.4 to 9.0 temperature, 41 to 86 degrees C) from the United States, China, and Russia and obtained 846 putative archaeal ammonia monooxygenase large-subunit (amoA) gene and transcript sequences, representing a total of 41 amoA operational taxonomic units (OTUs) at 2% identity. The amoA gene sequences were highly erse, yet they clustered within two major clades of archaeal amoA sequences known from water columns, sediments, and soils: clusters A and B. Eighty-four percent (711/846) of the sequences belonged to cluster A, which is typically found in water columns and sediments, whereas 16% (135/846) belonged to cluster B, which is typically found in soils and sediments. Although a few amoA OTUs were present in several geothermal regions, most were specific to a single region. In addition, cluster A amoA genes formed geographic groups, while cluster B sequences did not group geographically. With the exception of only one hot spring, principal-component analysis and UPGMA (unweighted-pair group method using average linkages) based on the UniFrac metric derived from cluster A grouped the springs by location, regardless of temperature or bulk water pH, suggesting that geography may play a role in structuring communities of putative ammonia-oxidizing archaea (AOA). The amoA genes were distinct from those of low-temperature environments in particular, pair-wise comparisons between hot spring amoA genes and those from sympatric soils showed less than 85% sequence identity, underscoring the distinctness of hot spring archaeal communities from those of the surrounding soil system. Reverse transcription-PCR showed that amoA genes were transcribed in situ in one spring and the transcripts were closely related to the amoA genes lified from the same spring. Our study demonstrates the global occurrence of putative archaeal amoA genes in a wide variety of terrestrial hot springs and suggests that geography may play an important role in selecting different assemblages of AOA.
Cephalosporin resistantNeisseria gonorrhoeae: time to consider gentamicin?
Publisher: BMJ
Date: 15-01-2012
Epidemiology, clinical features, diagnosis and treatment ofHaemophilus ducreyi– a disappearing pathogen?
Publisher: Informa UK Limited
Date: 06-03-2014
DOI: 10.1586/14787210.2014.892414
Abstract: Chancroid, caused by Haemophilus ducreyi, has declined in importance as a sexually transmitted pathogen in most countries where it was previously endemic. The global prevalence of chancroid is unknown as most countries lack the required laboratory diagnostic capacity and surveillance systems to determine this. H. ducreyi has recently emerged as a cause of chronic skin ulceration in some South Pacific islands. Although no antimicrobial susceptibility data for H. ducreyi have been published for two decades, it is still assumed that the infection will respond successfully to treatment with recommended cephalosporin, macrolide or fluoroquinolone-based regimens. HIV-1-infected patients require careful follow-up due to reports of treatment failure with single dose regimens. Buboes may need additional treatment with either aspiration or excision and drainage.
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Industrial Transformation Research Hubs - Grant ID: IH190100021
Start Date: 02-2021
End Date: 02-2026
Amount: $4,999,540.00
Funder: Australian Research Council
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