126 results on '"Ghanem, Khalil G"'
Search Results
2. Comparison of shipping versus immediate freezer storage of vaginal samples for vaginal microbiota assessment.
- Author
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Tuddenham S, Gajer P, Holm JB, Brown SE, Forney L, Ravel J, Ghanem KG, and Brotman RM
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- Humans, Female, Adult, Bacteria isolation & purification, Bacteria genetics, Bacteria classification, Young Adult, Freezing, DNA, Bacterial, Vagina microbiology, Specimen Handling methods, RNA, Ribosomal, 16S genetics, Microbiota genetics
- Abstract
ObjectivesWe evaluated how storing vaginal samples at room temperature in stabilising solutions versus immediate freezing affects 16S rRNA gene amplicon sequencing-based microbiota studies, aiming to simplify home and field collection., Methods: Twenty participants self-collected six mid-vaginal swabs that were stored in two nucleic acid preservatives (three in modified Solution C2 (Qiagen) and three in Amies/RNALater (Sigma)) in January-February 2016. From each set, two were immediately frozen (-80°C) and one was shipped to the University of Idaho (Moscow, Idaho) with return shipping to the Institute for Genome Sciences (Baltimore, Maryland). Amplicon sequencing of the 16S rRNA gene was used to characterise the vaginal microbiota, VALENCIA was used to assign community state types (CSTs), and quantitative PCR (qPCR) of 16S rRNA genes was used to estimate bacterial abundance. Cohen's Kappa statistic was used to assess within-participant agreement. Bayesian difference of means models assessed within-participant comparisons between shipped and immediately frozen samples., Results: There were 115 samples available for analysis. Average duration of transit for shipped samples was 8 days (SD: 1.60, range: 6-11). Within-participant comparisons of CSTs between shipped and immediately frozen samples revealed complete concordance (kappa: 1.0) for both preservative solutions. No significant differences comparing shipped and immediately frozen samples were found with taxon-level comparisons or bacterial abundances based on pan-bacterial qPCR., Conclusions: Short-term room temperature shipping of vaginal swabs placed in stabilising solutions did not affect vaginal microbiota composition. Home collection with mail-in of vaginal samples may be a reasonable approach for research and clinical purposes to assess the vaginal microbiota., Competing Interests: Competing interests: JR is co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutics drugs. ST has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics and Luca Biologics, receives royalties from UPTODATE and has received speaker honoraria from Roche Molecular Diagnostics and Medscape/WebMD. ST, KG, RB and JR participate in research supported by in-kind donation of test kits by Hologic. JH has been a consultant for Intralytix Inc. LJF consults with Psomagen, Inc. to evaluate factors that influence the outcome of in vitro fertilisation., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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3. Syphilis positivity among men who have sex with men (MSM) with direct, indirect, and no linkage to female sex partners: Exploring the potential for sex network bridging in Baltimore City, MD.
- Author
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Schumacher CM, Thornton N, Craig T, Tilchin C, Fields E, Ghanem KG, Hamill MM, Latkin C, Rompalo A, Ruhs S, and Jennings JM
- Abstract
Background: Syphilis epidemics among women and men-who-have-sex-with-men (MSM) may be connected, but these connections are poorly understood. Using egocentric network data from a U.S. urban MSM cohort, we examined socio-demographics, behaviors, and syphilis positivity among MSM with (1) direct (MSM who report sex with women, MSMW); (2) indirect (MSM who only report male partners, some of whom are MSMW, MSMO/W); and (3) no (MSM who only report male partners and whose partners only have sex with men, MSMO/O) connection to women., Methods: Sexually-active MSM aged 18-45 years were administered behavioral and network interviews (recall period: three months) and syphilis/HIV testing. Syphilis positivity was defined as RPR titer >1:8. Modified Poisson regression was used to test for differences across groups., Results: Among 385 MSM, 14.5% were MSMW and 22.3% were MSMO/W. MSMW and MSMO/W were significantly more likely than MSMO/O to report sex behaviors associated with increased syphilis acquisition/transmission risk, including: > 2 sex partners [MSMW aPR:1.28 (0.98-1.68); MSMO/W aPR:1.35 (1.09-1.69)], concurrent sex partners [MSMW aPR:1.50 (1.17-1.92); MSMO/W aPR:1.39 (1.11-1.74)], and for MSMW only, transactional sex [aPR:2.07 (1.11-3.88)]. Syphilis positivity was 16.4% and was lower among MSMW (9.4%) and MSMO/W (14.1%) than MSMO/O (18.5%), but differences were not significant., Conclusions: There may be considerable connectivity between MSM and female sex partners that could facilitate syphilis transmission, and behaviors that increase acquisition/transmission risk among MSMW and MSMO/W may be distinct from MSMO/O. Future work should focus on examining the context and temporal patterns of sex partnerships among MSMW and MSMO/W., Competing Interests: Conflicts of Interest and Sources of Support: This work was supported by the Centers for Disease Control and Prevention [1U01PS005171-01], and the Johns Hopkins University Center for AIDS Research [P30AI094189]., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2024
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4. Executive Summary: State-of-the-Art Review: Neurosyphilis.
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Hamill MM, Ghanem KG, and Tuddenham S
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- Humans, Anti-Bacterial Agents therapeutic use, Treponema pallidum, Neurosyphilis diagnosis, Neurosyphilis drug therapy
- Abstract
Competing Interests: Potential conflicts of interest. M. M. H. reports royalties from UpToDate, consulting fees from GSK, and writing fees from DynaMed. K. G. G. reports royalties from UpToDate. S. T. reports serving as a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; royalties from UpToDate; speaker honoraria from Roche Molecular Diagnostics and Medscape/WebMD; an unpaid role as a board member for the American Sexually Transmitted Diseases Association; and receipt of donated test kits to institution from Hologic. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
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- 2024
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5. Reply to: Cortés-Penfield and Musher.
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Hamill M, Ghanem KG, and Tuddenham S
- Abstract
Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
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- 2024
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6. State-of-the-Art Review: Neurosyphilis.
- Author
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Hamill MM, Ghanem KG, and Tuddenham S
- Subjects
- Humans, Treponema pallidum, United States epidemiology, Penicillin G Benzathine therapeutic use, Penicillin G Benzathine administration & dosage, Neurosyphilis diagnosis, Neurosyphilis drug therapy, Neurosyphilis cerebrospinal fluid, Neurosyphilis epidemiology, Anti-Bacterial Agents therapeutic use
- Abstract
We review key concepts in the diagnosis, treatment, and follow-up of individuals with neurosyphilis. We describe the epidemiology of syphilis in the United States, highlight populations that are markedly affected by this infection, and attempt to estimate the burden of neurosyphilis. We describe the cardinal clinical features of early and late (tertiary) neurosyphilis and characterize the clinical significance of asymptomatic neurosyphilis in the antibiotic era. We review the indications for cerebrospinal fluid (CSF) examination and the performance characteristics of different CSF assays including treponemal and lipoidal antibodies, white cell count, and protein concentration. Future biomarkers and the role of imaging are briefly considered. We review preferred and alternative treatments for neurosyphilis and evidence for their use, including evidence for the use of enhanced intramuscular benzathine penicillin G to supplement intravenous penicillin., Competing Interests: Potential conflicts of interest. M. M. H. reports royalties from UpToDate, consulting fees from GSK, and writing fees from DynaMed. K. G. G. reports royalties from UpToDate. S. T. reports serving as a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; royalties from UpToDate; speaker honoraria from Roche Molecular Diagnostics and Medscape/WebMD; an unpaid role as a board member for the American Sexually Transmitted Diseases Association; and receipt of donated test kits to institution from Hologic. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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7. A Narrative Review on Spontaneous Clearance of Urogenital Chlamydia trachomatis: Host, Microbiome, and Pathogen-Related Factors.
- Author
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Klasner C, Macintyre AN, Brown SE, Bavoil P, Ghanem KG, Nylander E, Ravel J, Tuddenham S, and Brotman RM
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- Humans, Female, Chlamydia trachomatis, Vagina microbiology, Sexually Transmitted Diseases microbiology, Chlamydia Infections epidemiology, Microbiota
- Abstract
Abstract: Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection in the United States. Untreated urogenital infection in women can result in adverse sequelae such as pelvic inflammatory disease and infertility. Despite national screening and treatment guidelines, rates continue to rise; because most infections are asymptomatic, the actual prevalence of CT infection is likely significantly higher than reported. Spontaneous clearance of CT in women (in the absence of antibiotic treatment) has been described in multiple epidemiologic studies. Given the serious consequences and high prevalence of CT infection, there is growing interest in understanding this phenomenon and factors that may promote CT clearance in women. Spontaneous CT clearance is likely the result of complex interactions between CT, the host immune system, and the vaginal microbiota (i.e., the communities of bacteria inhabiting the vagina), which has been implicated in CT acquisition. Herein, we briefly review current literature regarding the role of each of these factors in spontaneous CT clearance, identify knowledge gaps, and discuss future directions and possible implications for the development of novel interventions that may protect against CT infection, facilitate clearance, and prevent reproductive sequelae., Competing Interests: Conflict of interest and Sources of Funding: J.R. is co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutics drugs for women's health. S.T. has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; receives royalties from UPTODATE; and has received speaker honoraria from Roche Molecular Diagnostics and Medscape/WebMD., (Copyright © 2023 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2024
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8. A patient with secondary syphilis following incomplete treatment of primary infection.
- Author
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Lorenz Z, Rybolt L, Ghanem KG, and Shiroky-Kochavi J
- Subjects
- Male, Pregnancy, Female, Humans, Adult, Treponema pallidum, Doxycycline therapeutic use, Treatment Outcome, Syphilis diagnosis, Syphilis drug therapy
- Abstract
Syphilis is a bacterial infection caused by Treponema pallidum and is primarily transmitted via skin-to-skin or mucosal contact during sexual encounters, or through vertical transmission during pregnancy. Cases continue to rise globally across various demographic groups despite effective treatment and prevention interventions. We discuss the case of a 28-year-old cisgender man who presented with secondary syphilis 1 month after being inadequately treated for primary syphilis. Individuals can present with symptoms and signs of syphilis to clinicians of various subspecialties due to diverse clinical presentation. All health-care providers should be able to identify the common and less common manifestations of this infection, and adequate treatment and follow-up are crucial to preventing serious sequelae. Novel biomedical prevention interventions, such as doxycycline post-exposure prophylaxis, are on the horizon., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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9. Testing for Mycoplasma genitalium in Women With Vaginal Symptoms Should Not Be Performed Routinely.
- Author
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Yazdy GM, Van Gerwen OT, Ghanem KG, Sobel JD, Tuddenham S, and Muzny CA
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- Humans, Female, Vagina, Prevalence, Mycoplasma genitalium, Mycoplasma Infections diagnosis, Mycoplasma Infections epidemiology
- Abstract
Competing Interests: Conflicts of Interest and Sources of Funding: S.T. has been a consultant for BioFire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; receives royalties from UpToDate; and has received speaker honoraria from Roche Molecular Diagnostics and Medscape/WebMD. K.G.G. receives royalties from UpToDate. G.M.Y. has received honorarium from Elsevier. J.D.S. has been a consultant to Scynexis Pharmaceuticals and Mycovia Pharmaceuticals and receives royalties from UpToDate. O.T.V.G. has received research grant support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases, Abbott Molecular, and Gilead Sciences, Inc. She has also served on the scientific advisory board for Scynexis, for which she has received honoraria. C.A.M. has received grants to her institution from the National Institute of Allergy and Infectious Diseases, Lupin, Abbott Molecular, Visby, and Gilead. She also has received honorarium and/or consulting fees from Scynexis, Cepheid, BioNTech, Visby, Elsevier, UpToDate, Abbott Molecular, and Roche.
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- 2023
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10. Bacterial Vaginosis and Spontaneous Clearance of Chlamydia trachomatis in the Longitudinal Study of Vaginal Flora.
- Author
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Brown SE, Tuddenham S, Shardell MD, Klebanoff MA, Ghanem KG, and Brotman RM
- Subjects
- Humans, Female, Chlamydia trachomatis, Longitudinal Studies, Vagina microbiology, Vaginosis, Bacterial complications, Chlamydia Infections epidemiology, Chlamydia Infections complications
- Abstract
Background: Up to 26% of urogenital Chlamydia trachomatis infections spontaneously resolve between detection and treatment. Mechanisms governing natural resolution are unknown. We examined whether bacterial vaginosis (BV) was associated with greater chlamydia persistence versus spontaneous clearance in a large, longitudinal study., Methods: Between 1999 and 2003, the Longitudinal Study of Vaginal Flora followed reproductive-age women quarterly for 1 year. Baseline chlamydia screening and treatment were initiated after ligase chain reaction testing became available midstudy, and unscreened endocervical samples were tested after study completion. Chlamydia clearance and persistence were defined between consecutive visits without chlamydia-active antibiotics (n = 320 persistence/n = 310 clearance). Associations between Nugent score (0-3, no BV; 4-10, intermediate/BV), Amsel-BV, and chlamydia persistence versus clearance were modeled with alternating and conditional logistic regression., Results: Of chlamydia cases, 48% spontaneously cleared by the next visit (310/630). Nugent-intermediate/BV was associated with higher odds of chlamydia persistence (adjusted odds ratio [aOR] = 1.89; 95% confidence interval [CI], 1.30-2.74), and the findings were similar for Amsel-BV (aOR 1.39; 95% CI, .99-1.96). The association between Nugent-intermediate/BV and chlamydia persistence was stronger in a within-participant analysis of 67 participants with both clearance/persistence intervals (aOR = 4.77; 95% CI, 1.39-16.35). BV symptoms did not affect any results., Conclusions: BV is associated with greater chlamydia persistence. Optimizing the vaginal microbiome may promote chlamydia clearance., Competing Interests: Potential conflicts of interest. S. T. has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; receives royalties from UPTODATE; and has received speaker honoraria from Roche Molecular Diagnostics and Medscape. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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11. Association of Pregnancy and HIV Status With Molecular-Bacterial Vaginosis in Indian Women.
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Tuddenham S, Shafiq M, Mathad JS, Alexander M, Naik S, Kulkarni V, Deshpande P, Humphrys MS, Holm JB, Khan N, Yadana S, Cheedalla A, Bhosale R, Ghanem KG, Wang T, Wang S, Ma B, Ravel J, Gupta A, and Shivakoti R
- Subjects
- Female, Humans, Pregnancy, RNA, Ribosomal, 16S genetics, India epidemiology, Vagina microbiology, Vaginosis, Bacterial complications, Vaginosis, Bacterial epidemiology, HIV Infections complications, HIV Infections epidemiology
- Abstract
Background: Bacterial vaginosis (BV) is a highly prevalent disorder of the cervicovaginal microbiota. Molecular-BV may put women at increased risk for adverse reproductive and obstetric outcomes. We investigated the association of HIV and pregnancy on the vaginal microbiota and associations with molecular-BV in women of reproductive age from Pune, India., Setting: We studied vaginal samples from N = 170 women, including N = 44 nonpregnant HIV seronegative, N = 56 pregnant seronegative, N = 47 nonpregnant women with HIV (WWH), and N = 23 pregnant WWH, and collected data on clinical, behavioral, and demographic factors., Methods: We used 16S rRNA gene amplicon sequencing to characterize the composition of the vaginal microbiota. We classified the vaginal microbiota of these women into community state types based on bacterial composition and relative abundance and further categorized them into molecular-BV versus Lactobacillus -dominated states. To determine associations between pregnancy and HIV status with outcome of molecular-BV, logistic regression models were used., Results: There was a high prevalence of molecular-BV (30%) in this cohort. We found that pregnancy was associated with decreased odds of molecular-BV (adjusted OR = 0.35, 95% CI: 0.14 to 0.87), while HIV was associated with increased odds of molecular-BV (adjusted OR = 2.76, 95% CI: 1.33 to 5.73), even when controlling for multiple relevant factors such as age, number of sexual partners, condom use, and douching., Conclusion: Larger and longitudinal studies are needed to further characterize molecular-BV and the vaginal microbiota in pregnant women and WWH and relate these factors to infectious, reproductive, and obstetric outcomes. In the long term, these studies may lead to novel microbiota-based therapeutics to improve women's reproductive and obstetric health., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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12. The Utility of Biomarkers in the Clinical Management of Syphilis: A Systematic Review.
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Lorenz ZW, Nijhar S, Caufield-Noll C, Ghanem KG, and Hamill MM
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- Humans, Prospective Studies, Treponema pallidum, Biomarkers, Syphilis diagnosis, Syphilis drug therapy, Neurosyphilis diagnosis
- Abstract
Background: Routinely available laboratory tests for Treponema pallidum remain suboptimal for diagnostic, prognostic, predictive, and monitoring purposes. Biomarkers with enhanced performance characteristics can improve diagnostic confidence and facilitate management. We conducted a systematic review to examine the utility of biomarkers in the diagnosis and management of syphilis., Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify articles for inclusion and independently reviewed them for eligibility and study quality using a 3-stage procedure. The search, conducted by a senior library informationist, used PubMed, Embase, Cochrane Library, and Scopus and included any study published before May 2022., Results: Of the 111 studies identified, 31 (27.9%) were included in our review. Most studies were cross-sectional or prospective. The data were strikingly heterogeneous examining a variety of biomarkers across different syphilis stages, using different methodologies and definitions of treatment success. Available publications chiefly focused on diagnosing various syphilis stages, neurosyphilis and congenital syphilis, serological cure, the serofast state, and reinfection., Conclusions: Despite increasing attempts to identify novel biomarkers, we found limited evidence to support the use of any biomarker in clinical decision making at this time; the syphilis biomarker literature is heterogenous and lacks measurement of clinically meaningful end points. We recommend the formation of a working group to set priorities for syphilis biomarker research and to guide future study of clinically meaningful biomarkers., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2023 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2023
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13. Douching cessation and molecular bacterial vaginosis: a reanalysis of archived specimens.
- Author
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Brown SE, He X, Shardell MD, Ravel J, Ghanem KG, Zenilman JM, and Brotman RM
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- Humans, Female, Therapeutic Irrigation, Pilot Projects, RNA, Ribosomal, 16S genetics, Vagina microbiology, Lactobacillus genetics, Bacteria genetics, Vaginosis, Bacterial microbiology
- Abstract
Objectives: Observational studies demonstrate an association between vaginal douching and bacterial vaginosis (BV) characterised by Gram stain. We sought to describe the effect of a douching cessation intervention on the composition and structure of the vaginal microbiota and molecular-BV, a state defined by low levels of Lactobacillus spp evaluated by molecular tools., Methods: 33 women self-collected mid-vaginal swabs twice weekly (982 samples) during a douching observation phase (4 weeks) followed by a douching cessation phase (12 weeks) in a 2005 single crossover pilot study conducted in Baltimore, Maryland. Vaginal microbiota were characterised by 16S rRNA gene amplicon sequencing (V3-V4) and clustered into community state types (CSTs). Conditional logistic regression modelling allowed each participant to serve as their own control. Wilcoxon signed-rank tests were used to evaluate changes in microbiota between phases. Broad-range qPCR assays provided estimates of bacterial absolute abundance per swab in a subsample of seven participants before and after douching. A piecewise linear mixed effects model was used to assess rates of change in bacterial absolute abundance before and after douching., Results: There was no statistically significant change in the odds of molecular-BV versus Lactobacillus- dominated CSTs comparing the douching cessation interval to douching observation (adjusted OR 1.77, 95% CI 0.89 to 3.55). Removal of L. iners -dominated CST III from the outcome did not affect the results. There were no significant changes in the relative abundance of four Lactobacillus spp and no meaningful changes in other taxa investigated. There was no significant change in bacterial absolute abundance between a participant's sample collected 3 days prior to and following douching (p=0.46)., Conclusions: In this pilot study, douching cessation was not associated with major changes in vaginal microbiota. Douching cessation alone may not durably shift the vaginal microbiota and additional interventions may be needed to restore optimal vaginal microbiota among those who douche., Competing Interests: Competing interests: JR is a co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutic drugs for women’s health. All other authors have no competing interests to declare., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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14. Vaginal Candida albicans: High Frequency of in Vitro Fluconazole Resistance in a Select Population-A Brief Note.
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Agrawal P, Yazdy G, Ghanem KG, Handa VL, Schumacher CM, Sobel JD, Zhang SX, and Tuddenham S
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- Female, Humans, Candida albicans, Vagina, Antifungal Agents pharmacology, Antifungal Agents therapeutic use, Microbial Sensitivity Tests, Fluconazole pharmacology, Candidiasis, Vulvovaginal drug therapy
- Abstract
Competing Interests: Conflict of Interest and Sources of Funding: S.T. has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; receives royalties from UPTODATE; and has received speaker honoraria from Roche Molecular Diagnostics and Medscape/WebMD. S.X.Z. has received research funding from Vela Diagnostics and Scanogen Diagnostics and is on the Scientific Advisory Board to T2 Biosystems and Karius. J.D.S. has been a consultant to Scynexis Pharmaceuticals and Mycovia Pharmaceuticals and receives royalties from UPTODATE. K.G.G. receives royalties from UPTODATE. There was no specific funding for this study. However, S.T. is supported by K23AI125715.
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- 2023
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15. Enacted Sexual Minority Stigma, Psychological Distress, and Sexual and Drug Risk Behaviors Among Urban Men Who Have Sex with Men (MSM).
- Author
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Silvestri F, Tilchin C, Wagner J, Hamill MM, Rompalo A, Ghanem KG, Schumacher C, Ruhs S, Greenbaum A, Latkin C, and Jennings JM
- Subjects
- Male, Humans, Homosexuality, Male psychology, Prospective Studies, Sexual Behavior, Social Stigma, Risk-Taking, Sexual and Gender Minorities, HIV Infections epidemiology, HIV Infections psychology, Syphilis, Sexually Transmitted Diseases, Psychological Distress
- Abstract
Urban Black men who have sex with men (MSM) bear a disproportionate burden of HIV and syphilis in the U.S. Experiences of enacted sexual minority stigma and psychological distress among these men may be associated with HIV/STI sexual and drug risk behaviors. The objective was to determine the associations between enacted sexual minority stigma, psychological distress, and sexual and drug risk behaviors. In an urban prospective cohort study, survey measures assessed past 3-month exposure to enacted sexual minority stigma, psychological distress, and sexual and drug risk behaviors. Multivariable logistic regression models were utilized for hypothesis testing. The Black MSM (N = 140) reported the following: 22.1% experiences of enacted sexual minority stigma, 39% high levels of psychological distress, 48.6% > 1 sex partner, 8.6% transactional sex, and 6% injection drug use (IDU). In models adjusted for age and education, enacted sexual minority stigma significantly increased the odds of reporting > 1 sex partner, transactional sex, and IDU. Adjusting additionally for homelessness, the association between enacted sexual minority stigma and transactional sex remained significant. Adding psychological distress to this model showed a significant association between psychological distress and transactional sex, while the association was no longer significant for transactional sex. These findings highlight some of the complex psycho-social relationships that may be associated with sexual and drug risk behaviors among Black MSM placing them at increased risk for HIV and syphilis., (© 2022. The Author(s).)
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- 2023
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16. Lactobacillus-dominance and rapid stabilization of vaginal microbiota in combined oral contraceptive pill users examined through a longitudinal cohort study with frequent vaginal sampling over two years.
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Tuddenham S, Gajer P, Burke AE, Murphy C, Klein SL, Stennett CA, Wilgus B, Ravel J, Ghanem KG, and Brotman RM
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- Pregnancy, Humans, Female, Contraceptives, Oral, Combined, Lactobacillus genetics, Longitudinal Studies, Prospective Studies, RNA, Ribosomal, 16S genetics, Vagina microbiology, Vaginosis, Bacterial microbiology, Microbiota
- Abstract
Background: Bacterial vaginosis (BV), a condition in which vaginal Lactobacillus spp. are in low abundance, is associated with vulvovaginal symptoms, obstetric outcomes and urogenital infections. Recurrent BV is difficult to manage, and emerging data indicate a reduced risk of BV with the use of hormonal contraception (HC). Despite widespread use, little longitudinal data is available on whether, and in what timeframe, combined oral contraceptive pills (COCs) may act to affect vaginal microbiota stability and Lactobacillus dominance., Methods: We compared the vaginal microbiota of reproductive-age cisgender women during intervals on combined estrogen and progestin COCs with non-use intervals in a 2-year observational study. Vaginal microbiota were characterized by 16S rRNA gene amplicon sequencing., Findings: COC users were more likely to have Lactobacillus-dominated microbiota and more stable microbiota over time. Stability increased and then plateaued four weeks after COC initiation. The associations between COCs and Lactobacillus spp. dominance, and microbiota stability, were statistically significant for White, but not African American women; however sample size was limited for African American participants. Findings were similar for other forms of HC and when excluding samples collected during menses., Interpretation: Our study provides a methodologic framework to evaluate observational longitudinal microbiota data with exposure crossovers. We found COCs are associated with vaginal microbiota stability and a Lactobacillus-dominated state. COCs appear to impact stability within a month of initiation. Our findings have clinical implications for how soon benefits can be expected in (at least White) patients initiating COCs, and support the need for larger prospective trials to verify our results in ethnically diverse populations., Funding: R01-AI089878., Competing Interests: Declaration of interests J.R. is co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutics drugs for women's health. ST has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics and Luca Biologics, receives royalties from UPTODATE and has received speaker honoraria from Roche Molecular Diagnostics and Medscape. AEB receives university-mediated research funding from Merck and Scope/CHEMO. The remaining authors have not made any declarations., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2023
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17. Psychological distress and adherence to anti-retroviral therapy or pre-exposure prophylaxis regimens among Urban Black gay and bisexual men (MSM).
- Author
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Jimenez V, Thornton N, Tilchin C, Ghanem KG, Ruhs S, Hamill MM, Rompalo A, and Jennings JM
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- Homosexuality, Male psychology, Humans, Male, Medication Adherence, Prospective Studies, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections prevention & control, Pre-Exposure Prophylaxis, Psychological Distress, Sexual and Gender Minorities
- Abstract
Background: Urban Black gay, and bisexual men (MSM) bear a disproportionate burden of HIV in the U.S. Mental health is a barrier to adherence to both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). The objective was to determine the association between psychological distress and ART or PrEP adherence among urban Black MSM., Methods: Using data from a four-year prospective cohort study, adherence to ART was defined as > 95% and PrEP was defined as > 80% of doses taken in the past 30 days. Psychological distress measures included difficulty sleeping; feeling anxious; suicidality; feeling sad or depressed; feeling sick, ill, or not well in the past 3 months; high (vs. low) overall psychological distress was classified as above the median value. Associations were examined using Chi-square, Fisher's exact tests, and logistic regression., Results: Among 165 Black MSM, 44.2% (73) reported high psychological distress. 65.3% (47/72) of participants living with HIV and 39.8% (37/93) of HIV negative participants were ART or PrEP adherent, respectively. Education was significantly associated with PrEP adherence ( p = 0.038). Non-injection drug use in the past 3 months ( p = 0.008), difficulty sleeping ( p = 0.010), feeling anxious ( p = 0.003), and feeling sad or depressed ( p < 0.001), and overall psychological distress ( p < 0.001) were significantly associated with ART adherence. High psychological distress was significantly associated with a reduced odds of ART adherence (aOR 0.23; 95% CI = 0.08-0.70) adjusting for age and non-injection drug use., Conclusions: Increased psychological distress was significantly associated with ART nonadherence and may represent an important barrier to viral suppression.
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- 2022
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18. The Critical Need to Modernize Syphilis Screening.
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Tuddenham S and Ghanem KG
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- Female, Humans, Pregnancy, Pregnancy Complications, Infectious diagnosis, Social Change, Syphilis Serodiagnosis, Syphilis, Congenital diagnosis, Syphilis, Congenital prevention & control, Health Services Needs and Demand standards, Health Services Needs and Demand trends, Mass Screening methods, Mass Screening standards, Mass Screening trends, Syphilis diagnosis
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- 2022
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19. Sexually Transmitted Infection Transmission Dynamics During the Coronavirus Disease 2019 (COVID-19) Pandemic Among Urban Gay, Bisexual, and Other Men Who Have Sex With Men.
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Schumacher CM, Thornton N, Wagner J, Tilchin C, Ghanem KG, Hamill MM, Latkin C, Rompalo A, Ruhs S, Greenbaum A, and Jennings JM
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- Homosexuality, Male, Humans, Male, Pandemics, Sexual Behavior, COVID-19 epidemiology, HIV Infections epidemiology, Sexual and Gender Minorities, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases prevention & control
- Abstract
Background: The impact of coronavirus disease 2019 (COVID-19) mitigation measures on sexually transmitted infection (STI) transmission and racial disparities remains unknown. Our objectives were to compare sex and drug risk behaviors, access to sexual health services, and STI positivity overall and by race during the COVID-19 pandemic compared with pre-pandemic among urban sexual minority men (MSM)., Methods: Sexually active MSM aged 18-45 years were administered a behavioral survey and STI testing every 3-months. Participants who completed at least 1 during-pandemic (April 2020-December 2020) and 1 pre-pandemic study visit (before 13 March 2020) that occurred less than 6 months apart were included. Regression models were used to compare during- and pre-pandemic visit outcomes., Results: Overall, among 231 MSM, reports of more than 3 sex partners declined(pandemic-1: adjusted prevalence ratio 0.68; 95% confidence interval: .54-.86; pandemic-2: 0.65, .51-.84; pandemic-3: 0.57, .43-.75), substance use decreased (pandemic-1: 0.75, .61-.75; pandemic-2: 0.62, .50-.78; pandemic-3: 0.61, .47-.80), and human immunodeficiency virus/preexposure prophylaxis care engagement (pandemic-1: 1.20, 1.07-1.34; pandemic-2: 1.24, 1.11-1.39; pandemic-3: 1.30, 1.16-1.47) increased. STI testing decreased (pandemic-1: 0.68, .57-.81; pandemic-2: 0.78, .67-.92), then rebounded (pandemic-3: 1.01, .87-1.18). Nei-ther Chlamydia (pandemic-2: 1.62, .75-3.46; pandemic-3: 1.13, .24-1.27) nor gonorrhea (pandemic-2: 0.87, .46 1.62; pandemic-3: 0.56, .24-1.27) positivity significantly changed during vs pre-pandemic. Trends were mostly similar among Black vs. non-Black MSM., Conclusions: We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared with pre-pandemic. Our findings underscore the need for novel STI prevention strategies that can be delivered without in-person interactions., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America.)
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- 2022
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20. Summary of the Fourth Annual American Sexually Transmitted Diseases Association Workshop on Improving Sexually Transmitted Infection Control Efforts Through Cross-Sector Collaboration.
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Van Gerwen O, Griner S, Davis A, Footman A, Pinto CN, Melendez JH, Tuddenham S, Exten C, Soge OO, Chakraborty P, Nenninger A, Marlowe EM, Joseph AM, McGowin CL, Seña AC, Fortenberry JD, Ghanem KG, and Van Der Pol B
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- Humans, United States epidemiology, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases prevention & control
- Abstract
Abstract: The American Sexually Transmitted Diseases Association has, for several years, been conducting a cross-sector workshop to bring together a variety of stakeholders to develop ideas for collaboratively improving the sexually transmitted infection control efforts in the United States. In this summary, we share the content of discussions and ideas of the fourth annual workshop for future research and potential changes to practice with a focus on diagnostic capacity., Competing Interests: Conflict of Interest and Sources of Funding: Funding support for the workshop was received by ASTDA from Abbott Molecular, BD Diagnostics, BioFire Diagnostics, Hologic, Quest Diagnostics Nichols Institute, Roche Molecular, and SpeeDx. Authors from several of those entities contributed to the preparation of this manuscript. All other authors declare no conflict of interests., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.)
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- 2022
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21. Management of Adult Syphilis: Key Questions to Inform the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines.
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Tuddenham S and Ghanem KG
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- Adult, Anti-Bacterial Agents therapeutic use, Centers for Disease Control and Prevention, U.S., Humans, Penicillin G Benzathine therapeutic use, United States, HIV Infections complications, HIV Infections drug therapy, Neurosyphilis diagnosis, Syphilis diagnosis, Syphilis drug therapy, Syphilis prevention & control
- Abstract
A panel of experts generated 5 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these questions. Available data suggest no clinical benefit to >1 dose of benzathine penicillin G for early syphilis in human immunodeficiency virus (HIV)-infected patients. While penicillin remains the drug of choice to treat syphilis, doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There are very limited data regarding the impact of additional antibiotic doses on serologic responses in serofast patients and no data on the impact of additional antibiotic courses on long-term clinical outcomes. In patients with isolated ocular or otic signs and symptoms, reactive syphilis serologic results, and confirmed ocular/otic abnormalities at examination, a diagnostic cerebrospinal fluid (CSF) examination is not necessary, because up to 40% and 90% of patients, respectively, would have no CSF abnormalities. Based on the results of 2 studies, repeated CSF examinations are not necessary for HIV-uninfected patients or HIV-infected patients on antiretroviral therapy who exhibit appropriate serologic and clinical responses after treatment for neurosyphilis. Finally, several important gaps were identified and should be a priority for future research., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2022
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22. Reporting of Infectious Diseases in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic.
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Crane MA, Popovic A, Panaparambil R, Stolbach AI, Romley JA, and Ghanem KG
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- Humans, Incidence, Pandemics, SARS-CoV-2, United States epidemiology, COVID-19 epidemiology, Communicable Diseases
- Abstract
Reporting of infectious diseases other than COVID-19 has been greatly decreased throughout the COVID-19 pandemic. We find this decrease varies by routes of transmission, reporting state, and COVID-19 incidence at the time of reporting. These results underscore the need for continual investment in routine surveillance efforts despite pandemic conditions., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2022
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23. HIV Transmission Potential and Sex Partner Concurrency: Evidence for Racial Disparities in HIV Risk Among Gay and Bisexual Men (MSM).
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Tilchin C, Wagner J, Schumacher CM, Ghanem KG, Hamill MM, Rompalo A, Fields E, Latkin CA, Greenbaum A, and Jennings JM
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- Bisexuality, Homosexuality, Male, Humans, Male, Sexual Behavior, Sexual Partners, HIV Infections epidemiology, Sexual and Gender Minorities
- Abstract
We determined whether racial disparities in HIV infection among gay and bisexual men (MSM) may be partially explained by racial differences in the HIV transmission potential (i.e. mixing of people living with HIV and people not living with HIV or of unknown HIV serostatus) and density (i.e. sex partner concurrency) of sexual networks. Data included a behavioral survey, testing for HIV, and an egocentric sexual network survey. Mixed effects logistic regressions were used for hypothesis testing. Black (vs. non-Black) MSM were more likely to not know their partner's HIV serostatus (21.8% vs. 9.6%). Similar proportions reported sex partner concurrency (67.1% vs. 68.0%). In adjusted analyses, among Black MSM, sex partner concurrency significantly increased the odds of an HIV transmission potential partnership (TPP), and this association was not significant among non-Black indexes. The association between an HIV TPP and sex partner concurrency may help explain persistent racial disparities in HIV prevalence., (© 2021. The Author(s).)
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- 2022
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24. Diagnosis and Treatment of Sexually Transmitted Infections: A Review.
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Tuddenham S, Hamill MM, and Ghanem KG
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- Asymptomatic Infections epidemiology, Asymptomatic Infections therapy, Chlamydia Infections diagnosis, Chlamydia Infections drug therapy, Chlamydia Infections epidemiology, Chlamydia Infections ethnology, Contact Tracing, Drug Resistance, Microbial, Ethnic and Racial Minorities statistics & numerical data, Female, Gonorrhea diagnosis, Gonorrhea drug therapy, Gonorrhea epidemiology, Gonorrhea ethnology, HIV Infections complications, HIV Infections transmission, Herpes Genitalis diagnosis, Herpes Genitalis drug therapy, Herpes Genitalis epidemiology, Herpes Genitalis ethnology, Herpes Simplex diagnosis, Herpes Simplex drug therapy, Herpes Simplex epidemiology, Herpes Simplex ethnology, Humans, Male, Mass Screening, Mycoplasma Infections diagnosis, Mycoplasma Infections drug therapy, Mycoplasma Infections epidemiology, Mycoplasma Infections ethnology, Mycoplasma genitalium, Nucleic Acid Amplification Techniques, Sex Distribution, Sexual and Gender Minorities statistics & numerical data, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases ethnology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis ethnology, Syphilis Serodiagnosis methods, Trichomonas Vaginitis diagnosis, Trichomonas Vaginitis drug therapy, Trichomonas Vaginitis epidemiology, Trichomonas Vaginitis ethnology, United States epidemiology, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases drug therapy
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Importance: Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes., Observations: From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception., Conclusions and Relevance: Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles are effective treatments for gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral therapies for gonorrhea and Mycoplasma genitalium, and no cure is available for genital herpes.
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- 2022
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25. Bacterial Vaginosis and Alcohol Consumption: A Cross-Sectional Retrospective Study in Baltimore, Maryland.
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Froehle L, Ghanem KG, Page K, Hutton HE, Chander G, Hamill MM, Gilliams E, and Tuddenham S
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- Alcohol Drinking adverse effects, Alcohol Drinking epidemiology, Baltimore epidemiology, Cross-Sectional Studies, Female, Humans, Prevalence, Retrospective Studies, Risk Factors, Vaginosis, Bacterial epidemiology
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Background: Bacterial vaginosis (BV) is the most cited cause of vaginal complaints among women of reproductive age. Its etiology and associated risk factors are not entirely understood. Here we examined the association between BV and at-risk alcohol consumption in women attending 2 sexually transmitted infection (STI) clinics in Baltimore, MD., Methods: This was a retrospective cross-sectional analysis using data from first clinic visits from 2011-2016. At-risk alcohol use was defined as heavy episodic ("binge") drinking within the last 30 days or a self-report of having had vaginal or anal sex in the context of alcohol consumption. Pearson χ2 test and Student t test were used to assess baseline associations. Log binomial models were used to estimate prevalence ratios (PRs) before and after adjustments for potential confounding factors., Results: Of the 10,991 women included in the analysis, 2173 (19.7%) met the clinical diagnostic criteria for BV. Having had vaginal or anal sex in the context of alcohol consumption was associated with an increased risk of BV (PR, 1.25; 95% confidence interval, 1.13-1.37), as was binge drinking (PR, 1.15; 95% confidence interval, 1.04-1.27) after adjustment for confounders., Conclusions: In this population, at-risk alcohol consumption was associated with an increased risk of BV. The mechanisms remain uncertain. Future prospective studies are needed to verify and evaluate causality in these associations., Competing Interests: Conflict of Interest and Sources of Funding: S.T. has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics, and has received speaker honoraria from Roche Molecular Diagnostics and Medscape, as well as royalties from UPTODATE. S.T. is supported by the National Institutes of Health (grant no. K23AI125715). The remaining authors declare no conflict of interest., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2021
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26. Data on Safety of Intravaginal Boric Acid Use in Pregnant and Nonpregnant Women: A Narrative Review.
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Mittelstaedt R, Kretz A, Levine M, Handa VL, Ghanem KG, Sobel JD, Powell A, and Tuddenham S
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- Administration, Intravaginal, Adult, Boric Acids therapeutic use, Female, Humans, Pregnancy, Candidiasis, Vulvovaginal drug therapy, Vaginosis, Bacterial drug therapy
- Abstract
Abstract: Intravaginal boric acid (IBA) represents one of the only options available to treat azole-resistant vulvovaginal candidiasis (VVC) and is included as part of multiple national guidelines (including the United Kingdom and the United States) for the treatment of VVC or recurrent bacterial vaginosis. Novel products using IBA are under development for treatment and suppression of VVC and bacterial vaginosis. Use of over-the-counter or clinician-prescribed IBA in reproductive-aged women is already widespread and may increase further if drug resistance in VVC rises. However, IBA is not a Food and Drug Administration-approved drug, and safety data are sparse. Given these factors, it is important to understand the currently available data on the safety of IBA use. Herein, we set out to synthesize human and animal data (converting, where appropriate, dose and serum values to standard units to facilitate comparison) to answer 2 key questions: (1) What are the data on the safety of IBA use for women? and (2) What are the data on the safety of IBA use in pregnancy? We find that, despite gaps, available data suggest IBA use is safe, at least when used in doses commonly described in the literature as being prescribed by clinicians. Information on harms in pregnancy is limited, and data remain insufficient to change current guidelines, which recommend IBA avoidance in pregnancy., Competing Interests: Conflict of Interest and Sources of Funding: S.T. has been a consultant for Biofire Diagnostics, Roche Molecular Diagnostics, and Luca Biologics; receives royalties from UPTODATE; and has received speaker honoraria from Roche Molecular Diagnostics and Medscape. S.T. is supported by the National Institutes of Health (grant K23AI125715). A.P. receives royalties from UPTODATE. J.D.S. has served as a consultant to Scynexis Pharma and Mycovia Pharmaceuticals., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2021
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27. Plasma virome and the risk of blood-borne infection in persons with substance use disorder.
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Kandathil AJ, Cox AL, Page K, Mohr D, Razaghi R, Ghanem KG, Tuddenham SA, Hsieh YH, Evans JL, Coller KE, Timp W, Celentano DD, Ray SC, and Thomas DL
- Subjects
- Adult, Amino Acid Sequence, Anelloviridae, Blood-Borne Pathogens, Female, Hepatitis C epidemiology, Humans, Knowledge, Male, Metagenomics, Phylogeny, Public Health, Young Adult, Blood-Borne Infections, Plasma, Substance-Related Disorders, Virome
- Abstract
There is an urgent need for innovative methods to reduce transmission of bloodborne pathogens like HIV and HCV among people who inject drugs (PWID). We investigate if PWID who acquire non-pathogenic bloodborne viruses like anelloviruses and pegiviruses might be at greater risk of acquiring a bloodborne pathogen. PWID who later acquire HCV accumulate more non-pathogenic viruses in plasma than matched controls who do not acquire HCV infection. Additionally, phylogenetic analysis of those non-pathogenic virus sequences reveals drug use networks. Here we find first in Baltimore and confirm in San Francisco that the accumulation of non-pathogenic viruses in PWID is a harbinger for subsequent acquisition of pathogenic viruses, knowledge that may guide the prioritization of the public health resources to combat HIV and HCV., (© 2021. The Author(s).)
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- 2021
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28. Vaginal cytokine profile and microbiota before and after lubricant use compared with condomless vaginal sex: a preliminary observational study.
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Tuddenham S, Stennett CA, Cone RA, Ravel J, Macintyre AN, Ghanem KG, He X, and Brotman RM
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- Adult, Cytokines, Female, Humans, RNA, Ribosomal, 16S genetics, Vagina, Lubricants, Microbiota
- Abstract
Background: Limited data suggest that personal lubricants may damage the vaginal mucosal epithelium, alter the vaginal microbiota, and increase inflammation. We compared vaginal cytokine profiles and microbiota before and after vaginal lubricant use and condomless vaginal sex., Methods: Reproductive-age women were recruited to a 10-week observational cohort study and were asked to self-collect vaginal samples and behavioral diaries daily. This nested case-control analysis utilized samples collected before and after self-reported condomless sexual activity with lubricants (22 case participants) and without lubricants (22 control participants). Controls were matched to cases on race/ethnicity. Microbiota composition was characterized by sequencing amplicons of the 16S rRNA gene V3-V4 regions. Cytokine concentrations were quantified using a magnetic bead 41-plex panel assay and read using a Bio-Plex 200 array reader. Wilcoxon signed-rank tests were used to assess baseline differences in vaginal cytokines between cases and controls as well as differences pre- and post-exposure. Linear mixed effects models were used to examine differences in relative post-to-pre change in each individual cytokine between matched cases and controls. Similar analyses were conducted for the microbiota data., Results: Mean age was 29.8 years (SD 6.8), and 63.6% were African American. There were few statistically significant changes in cytokines or microbiota before and after exposure in cases or controls. In mixed-effects modeling, the mean relative post-to-pre change of cytokines was higher in cases vs. controls for macrophage derived chemokine (MDC) (p = 0.03). The microbiota data revealed no significant changes when measured by similarity scores, diversity indexes and descriptive community state types (CST) transition analyses. However, post sexual activity, the mean relative abundance of L. crispatus decreased for those who used lubricants (particularly those who were L. iners-dominated prior to exposure)., Conclusions: Although there were overall few differences in the vaginal microbiota and cytokine profiles of lubricant users and controls before and after condomless vaginal sex, there was a trend toward decreases in relative abundance of L. crispatus following use of lubricant. Future larger studies that take into account osmolarity and composition of lubricants may provide additional insights., (© 2021. The Author(s).)
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- 2021
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29. Factors associated with sexually transmitted infection diagnosis in women who have sex with women, women who have sex with men and women who have sex with both.
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Rahman N, Ghanem KG, Gilliams E, Page KR, and Tuddenham S
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- Adolescent, Adult, Ambulatory Care Facilities statistics & numerical data, Baltimore epidemiology, Female, Humans, Male, Retrospective Studies, Risk Factors, Sexual Partners, Sexually Transmitted Diseases microbiology, Sexually Transmitted Diseases parasitology, Young Adult, Bisexuality statistics & numerical data, Heterosexuality statistics & numerical data, Homosexuality, Female statistics & numerical data, Sexual Behavior statistics & numerical data, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology
- Abstract
Introduction: Many US women report same sex behaviour, yet data on risk factors and STIs in women who have sex with women (WSW), women who have sex with both men and women (WSB) and how these compare to women who have sex with men only (WSM) remain limited. Here we compared self-identified WSW, WSB and WSM attending two STI clinics in Baltimore, Maryland., Methods: This was a retrospective analysis using a database of first clinic visits 2005-2016. WSW and WSB were compared with an age-matched random sample of WSM. Proportions were compared using the χ
2 test. Acute STI (aSTI) was defined as gonorrhoea (Neisseria gonorrhoeae, GC), chlamydia ( Chlamydia trachomatis , CT), trichomonas ( Trichomonas vaginalis, TV) or early syphilis. Logistic regression was used to assess aSTI predictors. CT testing was not uniformly done, so a sensitivity analysis removing CT from the aSTI definition was conducted., Results: Visits from 1095 WSW, 1678 WSB and 2773 WSM were analysed. WSB had equal or higher test positivity for all STIs except urogenital chlamydia, had more sexual partners, were more likely to engage in transactional sex and were more likely to report drug use and binge drinking than WSM (p≤0.01). WSW had lower test positivity for urogenital GC and CT than WSM or WSB, but comparable test positivity for TV, higher reported binge drinking and comparable reported substance use as WSM. Younger age and cocaine use predicted STI diagnosis only in WSM., Conclusions: WSB in these clinics bear an equal or higher burden of most STIs, have more partners and report more substance use than WSM. WSW carry a lower, but still substantial burden of STIs, and many report substance use. Factors predicting STI diagnosis differ between WSW, WSB and WSM suggesting that tailored STI prevention and testing approaches are needed in these groups., Competing Interests: Competing interests: ST reports she has been a consultant for Luca Biologics, BioFire Diagnostics and Roche Molecular Diagnostics and has received a speaker honorarium from Roche Molecular Diagnostics., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2021
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30. Bacterial Vaginosis and Behavioral Factors Associated With Incident Pelvic Inflammatory Disease in the Longitudinal Study of Vaginal Flora.
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Turpin R, Tuddenham S, He X, Klebanoff MA, Ghanem KG, and Brotman RM
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- Adolescent, Adult, Alabama epidemiology, Female, Humans, Longitudinal Studies, Pelvic Inflammatory Disease microbiology, Prospective Studies, Sexual Partners, Sociodemographic Factors, Vaginosis, Bacterial complications, Young Adult, Pelvic Inflammatory Disease epidemiology, Sexual Behavior, Vagina microbiology, Vaginosis, Bacterial epidemiology
- Abstract
Background: Pelvic inflammatory disease (PID) leads to long-term reproductive consequences for cisgender women. Bacterial vaginosis (BV) and behavioral factors may play a role in PID pathogenesis. We assessed associations between BV, behavioral factors, and incident PID., Methods: We analyzed participants (N = 2956) enrolled in the National Institutes of Health Longitudinal Study of Vaginal Flora, a cohort of nonpregnant cisgender women followed quarterly for 12 months. PID was defined by at least 1 of the following: cervical motion tenderness, uterine tenderness, or adnexal tenderness (160 cases). We tested associations between BV (measured using Nugent and Amsel criteria) and PID at the subsequent visit. Sociodemographic factors, sexual behaviors, and Chlamydia trachomatis (CT), untreated at baseline and concurrent with BV, were covariates in Cox proportional hazards models. Adjusting for the few Neisseria gonorrhoeae and Trichomonas vaginalis cases did not alter results., Results: In multivariable modeling, Nugent-BV (adjusted hazard ratio [aHR], 1.53 [95% confidence interval {CI}, 1.05-2.21]), symptomatic Amsel-BV (aHR, 2.15 [95% CI, 1.23-3.75]), and vaginal douching (aHR, 1.47 [95% CI, 1.03-2.09]) were associated with incident PID., Conclusions: BV was associated with incident PID in a large prospective cohort, controlling for behavioral factors and sexually transmitted infections (STIs). Larger studies on how BV, STIs, behaviors, and host responses interactively affect PID risk are needed., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2021
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31. Methamphetamine Use, Syphilis, and Specific Online Sex Partner Meeting Venues Are Associated With HIV Status Among Urban Black Gay and Bisexual Men Who Have Sex Men.
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Jennings JM, Wagner J, Tilchin C, Schumacher CM, Thornton N, Hamill MM, Rompalo A, Ruhs S, Rives S, Ghanem KG, and Latkin C
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- Black or African American, Homosexuality, Male, Humans, Longitudinal Studies, Male, Sexual Behavior, Sexual Partners, HIV Infections epidemiology, Methamphetamine, Sexual and Gender Minorities, Sexually Transmitted Diseases epidemiology, Syphilis epidemiology
- Abstract
Background: In the context of increasing syphilis rates, particularly among Black men who have sex men (MSM), the objectives were to determine the associations between methamphetamine (meth) use and syphilis and HIV positivity, and to identify sex partner meeting venues as potential intervention access points among Black MSM in a mid-Atlantic US city., Methods: This study is an ongoing longitudinal cohort study. Participants were recruited from clinical and nonclinical settings and included sexually active MSM aged 18 to 45 years. The baseline visit included a behavioral survey and testing for syphilis, HIV, gonorrhea, and chlamydia. Logistic regression analyses were used for hypothesis testing., Results: Among 359 MSM completing baseline, 74.4% (268) Black MSM were included; 31% (84) were aged 24 to 29 years, 43.7% (117) reported unprotected anal intercourse at last sex, and 15.3% (41) reported meth use in the past 3 months. Sixteen percent (43) had syphilis, 46.6% (125) were living with HIV, and 19.0% (51) had gonorrhea and/or chlamydia. Meth use was associated with sexual and drug risk behaviors and HIV, but not syphilis. In adjusted analyses, meth use increased the odds of HIV positivity by 6.43 (95% confidence interval, 2.30-17.98) and syphilis positivity by 2.57 (95% confidence interval, 1.23-5.37). Four online sex partner meeting venues were associated with meth use and HIV, whereas syphilis was associated with one., Conclusions: Among Black MSM, meth use and syphilis positivity were associated with more than 6-fold and almost 3-fold increased adjusted odds of HIV positivity, respectively. Four specific sex partner meeting venues may be important access points for HIV/sexually transmitted infection and substance use prevention., Competing Interests: Conflict of Interest and Sources of Funding: The authors report no conflicts of interest. This study was supported by Centers for Disease Control and Prevention grants entitled Network Epidemiology of Syphilis Transmission (1U01PS005171-01)., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.)
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- 2021
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32. Assessing the Concordance Between Urogenital and Vaginal Microbiota: Can Urine Specimens Be Used as a Proxy for Vaginal Samples?
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Brown SE, Robinson CK, Shardell MD, Holm JB, Ravel J, Ghanem KG, and Brotman RM
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- Bacteria genetics, Female, Humans, Lactobacillus genetics, RNA, Ribosomal, 16S genetics, Vagina, Microbiota
- Abstract
Background: The vaginal microbiota play a key role in defense against reproductive tract infections; however, many population-based women's health studies do not collect vaginal samples. Molecular examinations of urine samples have revealed common vaginal bacteria. We sought to assess the extent that community state type assignments of archived random-catch and clean-catch urine samples agreed with the paired vaginal samples in both reproductive-age and peri/post-menopausal women., Results: Using archived samples, we evaluated the microbiota concordance among women in three studies: two with paired mid-vaginal/random-catch urine (N=91 reproductive-age participants and N=13 peri/post-menopausal participants), and one with paired mid-vaginal/clean-catch urine (N=99 reproductive-age participants). Microbiota composition was characterized by sequencing amplicons of the 16S rRNA gene V3-V4 regions and assigned to community state types. Similarity of paired samples was gauged using agreement of community state types and Yue-Clayton θ indices. Analysis of Composition of Microbiomes II indicated which taxa were differently relatively abundant in paired vaginal and urine samples. In reproductive-age women, random-catch and clean-catch urines were 89.0% and 86.9% concordant on five community state types with paired mid-vaginal swabs, and Kappa statistics indicated almost perfect agreement (κ
random-catch =.85, κclean-catch =.81, p<0.0001). A small number of pairs of samples were discordant (23/190, 12%), and discordant pairs tended to be between samples classified to L. iners -dominated and/or low- Lactobacillus states. Concordance and agreement remained similar when dichotomizing the microbiota to Lactobacillus- dominated versus low- Lactobacillus microbiota, as well as when evaluating separately the three subtypes of the low- Lactobacillus community state type IV. Median similarity of paired urine/vaginal samples was high (θrandom-catch =.85, θclean-catch =.88), and a comparison of the random-catch and clean-catch similarity scores showed no significant difference (p=.80). Concordance and similarity were lower for peri/post-menopausal women, but agreement remained substantial (76.9% concordant, κrandom-catch = 0.64, θrandom-catch =.62). Taxonomic-level analysis confirmed these findings., Conclusions: Random-catch and clean-catch urine samples showed substantial agreement on bacterial composition to paired mid-vaginal samples, indicating that the genitourinary microbiota may be a reliable proxy for assessing the overall composition of the vaginal microbiota via community state types. This data suggests that urine samples can, with proper interpretation, be utilized as a surrogate for developing preliminary data and hypothesis-generating studies., Competing Interests: JR is a co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutic drugs for women’s health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Brown, Robinson, Shardell, Holm, Ravel, Ghanem and Brotman.)- Published
- 2021
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33. The Terms "Serofast" and "Serological Nonresponse" in the Modern Syphilis Era.
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Ghanem KG and Hook EW 3rd
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- Humans, Syphilis Serodiagnosis, Treponema pallidum, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology
- Abstract
Competing Interests: Conflict of Interest and Sources of Funding: None declared.
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- 2021
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34. Reporting of sexually transmitted infections during the COVID-19 pandemic.
- Author
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Crane MA, Popovic A, Stolbach AI, and Ghanem KG
- Subjects
- Centers for Disease Control and Prevention, U.S., Chlamydia Infections epidemiology, Gonorrhea epidemiology, Humans, SARS-CoV-2, Syphilis epidemiology, United States epidemiology, COVID-19 epidemiology, Disease Notification, Sexually Transmitted Diseases epidemiology
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2021
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35. Licensing Nucleic Acid Amplification Tests for Extragenital Gonorrhea and Chlamydia: Innovative Science and a Call to Arms.
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Berry SA and Ghanem KG
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- Chlamydia trachomatis genetics, Humans, Neisseria gonorrhoeae genetics, Nucleic Acid Amplification Techniques, Chlamydia Infections diagnosis, Gonorrhea diagnosis
- Published
- 2020
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36. Dietary macronutrient intake and molecular-bacterial vaginosis: Role of fiber.
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Shivakoti R, Tuddenham S, Caulfield LE, Murphy C, Robinson C, Ravel J, Ghanem KG, and Brotman RM
- Subjects
- Adult, Cross-Sectional Studies, Female, Humans, Nutritional Status, Nutritive Value, Protective Factors, Ribotyping, Risk Assessment, Risk Factors, Vaginosis, Bacterial diagnosis, Vaginosis, Bacterial microbiology, Young Adult, Dietary Fiber administration & dosage, Lactobacillus genetics, Vagina microbiology, Vaginosis, Bacterial prevention & control
- Abstract
Background & Aims: Women with bacterial vaginosis (BV) have increased risk of sexually transmitted infections and other adverse health outcomes. Based on the composition of their vaginal microbiota, women can broadly be classified into low-Lactobacillus (termed molecular-BV) and Lactobacillus-dominated profiles. Our objective was to determine the association between dietary macronutrient intake and molecular-BV., Methods: In a cross-sectional study of 104 reproductive-age women, dietary intake data were obtained using the Block Brief 2000 food frequency questionnaire. Vaginal microbiota composition was characterized by sequencing amplicons of the 16S rRNA gene V3-V4 regions and clustering into community state types (CST). Logistic regression was used to determine the association of macronutrient intake with molecular-BV (low-Lactobacillus vs. Lactobacillus-dominated CSTs combined)., Results: Participants had a median age of 25.9 (interquartile range: 21.9-29.6), 58% were white (30% black), 51% overweight/obese and 52% on hormonal contraception. In multivariable models, diets richer in fiber were inversely associated with molecular-BV (adjusted odds ratio: 0.49 per standard deviation increase in energy-adjusted fiber intake, 95% confidence interval: 0.24-0.99; p = 0.049)., Conclusions: Our results indicate that diets richer in fiber were associated with lower odds of molecular-BV. Further studies are needed to confirm these findings and to test whether increasing fiber intake can modulate the microbiota towards a more optimal Lactobacillus-dominant profile., Competing Interests: Conflict of interest None declared. ST is a consultant for Biofire Diagnostics and Roche Molecular Diagnostics. JR is co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutics drugs for women's health., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)
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- 2020
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37. Overlapping Transmission Networks of Early Syphilis and/or Newly HIV Diagnosed Gay, Bisexual and Other Men Who Have Sex with Men (MSM): Opportunities for Optimizing Public Health Interventions.
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Jennings JM, Tilchin C, Meza B, Schumacher C, Fields E, Latkin C, Rompalo A, Greenbaum A, and Ghanem KG
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- HIV Infections epidemiology, HIV Infections transmission, Humans, Male, Public Facilities, Public Health, Risk Factors, Sexual Behavior, Social Environment, Syphilis epidemiology, Syphilis transmission, Bisexuality, HIV Infections diagnosis, Homosexuality, Male, Sexual Partners, Sexual and Gender Minorities psychology, Social Networking, Syphilis diagnosis
- Abstract
Syphilis and HIV among gay, bisexual and other men who have sex with men (MSM) are syndemic suggesting current prevention strategies are not effective. Sex partner meeting places and their networks may yield effective and optimal interventions. From 2009 to 2017, 57 unique venues were reported by > 1 MSM and 7.0% (n = 4), 21.1% (n = 12) and 71.9% (n = 41) were classified as syphilis, HIV or co-diagnosed venues, respectively. Forty-nine venues were connected in one main network component with four online, co-diagnosis venues representing 51.6% of reports and the highest degree and eigenvector centralities. In a sub-analysis during a local syphilis epidemic, the proportion of venues connected in the main component increased 38.7% (61.5% to 86.4%); suggesting increasing overlap in syphilis and HIV transmission and density of the venue network structure over time. This network analysis may identify the optimal set of venues for tailored interventions. It also suggests increasing difficulty of interrupting network transmission through fragmentation.
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- 2020
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38. Cerebrospinal fluid treponemal antibody titres: a breakthrough in the diagnosis of neurosyphilis.
- Author
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Ghanem KG
- Subjects
- Humans, Syphilis Serodiagnosis, Neurosyphilis
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2020
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39. Syphilis Laboratory Guidelines: Performance Characteristics of Nontreponemal Antibody Tests.
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Tuddenham S, Katz SS, and Ghanem KG
- Subjects
- Humans, Laboratories, Syphilis Serodiagnosis, Treponema pallidum, Neurosyphilis, Syphilis diagnosis
- Abstract
We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960-2017, and for data related to the venereal disease research laboratory test from 1940-1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Overall, many studies were limited by their sample size, lack of clearly documented clinical staging, and lack of well-defined gold standards. There is a need to better define the performance characteristics of nontreponemal tests, particularly in the late stages of syphilis, with clinically well-characterized samples. Published data are needed on automated nontreponemal tests. Evidence-based guidelines are needed for optimal prozone titrations. Finally, improved criteria and diagnostics for neurosyphilis (as well as ocular and otic syphilis) are needed., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.)
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- 2020
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40. The Modern Epidemic of Syphilis. Reply.
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Ghanem KG, Ram S, and Rice PA
- Subjects
- Humans, Sexual Behavior, Epidemics, Syphilis
- Published
- 2020
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- View/download PDF
41. Bacterial vaginosis diagnosis and treatment in postmenopausal women: a survey of clinician practices.
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Mark KS, Tenorio B, Stennett CA, Ghanem KG, and Brotman RM
- Subjects
- Female, Humans, Lactobacillus, Middle Aged, Postmenopause, Surveys and Questionnaires, Vagina, Vaginosis, Bacterial diagnosis, Vaginosis, Bacterial drug therapy
- Abstract
Objective: Some diagnostic features of the genitourinary syndrome of menopause (GSM) and bacterial vaginosis (BV) overlap, such as low levels of vaginal Lactobacillus and pH > 5. We sought to determine clinicians' diagnostic and treatment practices for postmenopausal women presenting with BV and GSM scenarios and how commercial molecular screening tests are utilized., Methods: Anonymous surveys were sent to practicing women's health clinicians to evaluate assessment and treatment strategies for postmenopausal women presenting with BV and GSM scenarios., Results: When given a scenario of a postmenopausal woman with symptoms overtly positive for BV, a majority of providers (73%) would conduct a wet mount, though only 35% would evaluate full Amsel's criteria. A majority (89%) recommended treatment with antibiotics, 28.2% recommended vaginal estrogen in addition to antibiotics, and 11.8% recommended vaginal estrogen alone. Of providers who would use a molecular swab, 30% would wait for results before treating the patient's symptoms. When given a scenario of a postmenopausal woman presenting with GSM, a majority (80%) recommended vaginal estrogen, and only 4.6% recommended antibiotics. Few (16%) responders would evaluate with a molecular swab, half of whom would wait for results before prescribing treatment. Clinicians in practice for less than 10 years were more likely to rely on molecular swabs than those who had been practicing longer (P < 0.0003)., Conclusions: Methods used to evaluate postmenopausal women with vaginal symptoms vary. Future studies of postmenopausal women that differentiate diagnostic criteria between BV and GSM, and validate commercial molecular testing for BV in women over age 50 are needed.
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- 2020
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42. A cross-sectional pilot study of birth mode and vaginal microbiota in reproductive-age women.
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Stennett CA, Dyer TV, He X, Robinson CK, Ravel J, Ghanem KG, and Brotman RM
- Subjects
- Adolescent, Adult, Cesarean Section, Cross-Sectional Studies, Female, Humans, Lactobacillus isolation & purification, Pilot Projects, Pregnancy, United States, Vaginosis, Bacterial epidemiology, Young Adult, Delivery, Obstetric, Microbiota, Parturition, Vagina microbiology
- Abstract
Recent studies suggest that birth mode (Cesarean section [C-section] or vaginal delivery) is an important event in the initial colonization of the human microbiome and may be associated with long-term health outcomes. We sought to determine the association between a woman's birth mode and her vaginal microbiota in adulthood. We re-contacted 144 adult women from two U.S. studies and administered a brief survey. Vaginal microbiota was characterized on a single sample by amplicon sequencing of the V3-V4 hypervariable regions of the 16S rRNA gene and clustered into community state types (CSTs). We evaluated the association between birth mode and a CST with low relative abundance of Lactobacillus spp. ("molecular bacterial vaginosis" [Molecular-BV]) compared to Lactobacillus-dominated CSTs in logistic regression modeling which adjusted for body mass index, a confounder in this analysis. Twenty-seven women (19%) reported C-section. Overall, C-section showed a non-significant trend towards increased odds of Molecular-BV (aOR = 1.22, 95% CI: 0.45, 3.32), and Prevotella bivia was the strongest single taxa associated with C-section. However, because the two archived studies had different inclusion criteria (interaction p = 0.048), we stratified the analysis by study site. In the study with a larger sample size (n = 88), women born by C-section had 3-fold higher odds of Molecular-BV compared to vaginally-delivered women (aOR = 3.55, p = 0.06, 95% CI: 0.97-13.02). No association was found in the smaller study (n = 56, aOR = 0.19, p = 0.14, 95% CI: 0.02-1.71). This pilot cross-sectional study suggests a possible association between C-section and Molecular-BV in adulthood. However, the analysis is limited by small sample size and lack of comparability in participant age and other characteristics between the study sites. Future longitudinal studies could recruit larger samples of women, address the temporal dynamics of vaginal microbiota, and explore other confounders, including maternal factors, breastfeeding history, and socioeconomic status, which may affect the relationship between birth mode and vaginal microbiota., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
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43. The Modern Epidemic of Syphilis.
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Ghanem KG, Ram S, and Rice PA
- Subjects
- Algorithms, Cerebrospinal Fluid microbiology, Epidemics, Female, Humans, Male, Neurosyphilis diagnosis, Pregnancy, Treponema pallidum isolation & purification, United States epidemiology, Anti-Bacterial Agents therapeutic use, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis physiopathology, Syphilis Serodiagnosis methods
- Published
- 2020
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44. The association of Chlamydia trachomatis and Mycoplasma genitalium infection with the vaginal metabolome.
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Borgogna JC, Shardell MD, Yeoman CJ, Ghanem KG, Kadriu H, Ulanov AV, Gaydos CA, Hardick J, Robinson CK, Bavoil PM, Ravel J, Brotman RM, and Tuddenham S
- Subjects
- Adult, Female, Humans, Lymphogranuloma Venereum pathology, Mycoplasma Infections pathology, Vagina microbiology, Vaginosis, Bacterial microbiology, Vaginosis, Bacterial pathology, Chlamydia trachomatis metabolism, Lymphogranuloma Venereum metabolism, Metabolome, Mycoplasma Infections metabolism, Mycoplasma genitalium metabolism, Vagina metabolism, Vaginosis, Bacterial metabolism
- Abstract
Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are two highly prevalent bacterial sexually transmitted infections (STIs) with a significant rate of co-infection in some populations. Vaginal metabolites are influenced by resident vaginal microbiota, affect susceptibility to sexually transmitted infections (STIs), and may impact local inflammation and patient symptoms. Examining the vaginal metabolome in the context of CT mono (CT+) and CT/MG co-infection (CT+/MG+) may identify biomarkers for infection or provide new insights into disease etiology and pathogenesis. Yet, the vaginal metabolome in the setting of CT infection is understudied and the composition of the vaginal metabolome in CT/MG co-infected women is unknown. Therefore, in this analysis, we used an untargeted metabolomic approach combined with 16S rRNA gene amplicon sequencing to characterize the vaginal microbiota and metabolomes of CT+, CT+/MG+, and uninfected women. We found that CT+ and CT+/MG+ women had distinct vaginal metabolomic profiles as compared to uninfected women both before and after adjustment for the vaginal microbiota. This study provides important foundational data documenting differences in the vaginal metabolome between CT+, CT+/MG+ and uninfected women. These data may guide future mechanistic studies that seek to provide insight into the pathogenesis of CT and CT/MG infections.
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- 2020
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45. The Impact of Human Immunodeficiency Virus Infection on Gut Microbiota α-Diversity: An Individual-level Meta-analysis.
- Author
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Tuddenham SA, Koay WLA, Zhao N, White JR, Ghanem KG, and Sears CL
- Subjects
- Female, Homosexuality, Male, Humans, Male, RNA, Ribosomal, 16S genetics, Gastrointestinal Microbiome, HIV Infections complications, HIV Infections epidemiology, Sexual and Gender Minorities
- Abstract
Background: Whether human immunodeficiency virus (HIV) infection impacts gut microbial α-diversity is controversial. We reanalyzed raw 16S ribosomal RNA (rRNA) gene sequences and metadata from published studies to examine α-diversity measures between HIV-uninfected (HIV-) and HIV-infected (HIV+) individuals., Methods: We conducted a systematic review and individual level meta-analysis by searching Embase, Medline, and Scopus for original research studies (inception to 31 December 2017). Included studies reported 16S rRNA gene sequences of fecal samples from HIV+ patients. Raw sequence reads and metadata were obtained from public databases or from study authors. Raw reads were processed through standardized pipelines with use of a high-resolution taxonomic classifier. The χ2 test, paired t tests, and generalized linear mixed models were used to relate α-diversity measures and clinical metadata., Results: Twenty-two studies were identified with 17 datasets available for analysis, yielding 1032 samples (311 HIV-, 721 HIV+). HIV status was associated with a decrease in measures of α-diversity (P < .001). However, in stratified analysis, HIV status was associated with decreased α-diversity only in women and in men who have sex with women (MSW) but not in men who have sex with men (MSM). In analyses limited to women and MSW, controlling for HIV status, women displayed increased α-diversity compared with MSW., Conclusions: Our study suggests that HIV status, sexual risk category, and gender impact gut microbial community α-diversity. Future studies should consider MSM status in gut microbiome analyses., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Published
- 2020
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46. Risk factors predictive of sexually transmitted infection diagnosis in young compared to older patients attending sexually transmitted diseases clinics.
- Author
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Tao X, Ghanem KG, Page KR, Gilliams E, and Tuddenham S
- Subjects
- Adolescent, Adult, Age Distribution, Age Factors, Alcohol Drinking epidemiology, Ambulatory Care Facilities, Baltimore epidemiology, Condoms statistics & numerical data, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Sex Distribution, Sex Factors, Sexual Partners, Sexually Transmitted Diseases epidemiology, Substance Abuse, Intravenous epidemiology, Young Adult, Ambulatory Care statistics & numerical data, Sexual Behavior, Sexually Transmitted Diseases diagnosis
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- 2020
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47. Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis.
- Author
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Powell A, Ghanem KG, Rogers L, Zinalabedini A, Brotman RM, Zenilman J, and Tuddenham S
- Subjects
- Administration, Intravaginal, Adult, Drug Administration Schedule, Female, Humans, Middle Aged, Patient Satisfaction, Recurrence, Retrospective Studies, Treatment Outcome, Anti-Infective Agents, Local administration & dosage, Boric Acids administration & dosage, Candidiasis, Vulvovaginal drug therapy, Vaginosis, Bacterial drug therapy
- Abstract
A retrospective chart review characterized clinicians' use of maintenance intravaginal boric acid for women with recurrent vulvovaginal candidiasis or bacterial vaginosis. Average length of use was 13 months with high patient satisfaction and few adverse events. Prospective studies are needed to evaluate the efficacy of maintenance boric acid for these conditions.
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- 2019
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48. Associations between dietary micronutrient intake and molecular-Bacterial Vaginosis.
- Author
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Tuddenham S, Ghanem KG, Caulfield LE, Rovner AJ, Robinson C, Shivakoti R, Miller R, Burke A, Murphy C, Ravel J, and Brotman RM
- Subjects
- Adult, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Microbiota, Nutritional Status, Diet adverse effects, Micronutrients adverse effects, Vagina microbiology, Vaginosis, Bacterial etiology
- Abstract
Objectives: Bacterial vaginosis (BV), a clinical condition characterized by decreased vaginal Lactobacillus spp., is difficult to treat. We examined associations between micronutrient intake and a low-Lactobacillus vaginal microbiota as assessed by molecular methods (termed "molecular-BV")., Methods: This cross-sectional analysis utilized data collected at the baseline visit of the Hormonal Contraception Longitudinal Study, a cohort of reproductive-aged women followed over 2 years while initiating or ceasing hormonal contraception (HC). The Block Brief 2000 Food Frequency Questionnaire was administered and micronutrient intakes were ranked. Vaginal microbiota composition was assessed using 16S rRNA gene amplicon sequencing and clustered into community state types (CSTs) based on the types and relative abundance of bacteria detected. Associations between the lowest estimated quartile intake of nutrients and having a low-Lactobacillus CST (molecular-BV) were evaluated by logistic regression. Separate models were built for each nutrient controlling for age, body mass index, behavioral factors, HC use and total energy intake. We also conducted a literature review of existing data on associations between micronutrient intakes and BV., Results: Samples from 104 women were included in this analysis. Their mean age was 25.8 years (SD 4.3), 29.8% were African American, 48.1% were using HC, and 25% had molecular-BV. In adjusted multivariable analyses, the lowest quartile of betaine intake was associated with an increased odds of molecular-BV (aOR 9.2, p value < 0.01, [CI 2.4-35.0])., Conclusions: This is the first study to assess the association between estimated micronutrient intake and molecular-BV. Lower energy-adjusted intake of betaine was associated with an increased risk of molecular-BV. Betaine might have direct effects on the vaginal microenvironment or may be mediated through the gut microbiota. Additional research is needed to determine reproducibility of this finding and whether improved intake of select micronutrients such as betaine decreases the risk of BV and its sequelae.
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- 2019
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49. Gonorrhoea and chlamydia in persons with HIV: number needed to screen.
- Author
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Tuddenham S, Ghanem KG, Gebo KA, Moore RD, Mathews WC, Agwu A, Mayer K, Schumacher C, Raifman J, and Berry SA
- Subjects
- Adolescent, Adult, Aged, Chlamydia Infections etiology, Chlamydia Infections microbiology, Chlamydia trachomatis genetics, Chlamydia trachomatis isolation & purification, Chlamydia trachomatis physiology, Coinfection, Female, Gonorrhea etiology, Gonorrhea microbiology, HIV Infections virology, Homosexuality, Male statistics & numerical data, Humans, Male, Mass Screening, Middle Aged, Neisseria gonorrhoeae genetics, Neisseria gonorrhoeae isolation & purification, Neisseria gonorrhoeae physiology, Risk Factors, Sexual Partners, Young Adult, Chlamydia Infections diagnosis, Gonorrhea diagnosis, HIV Infections complications
- Abstract
Objectives: Current guidelines recommend screening sexually active persons with HIV (PWH) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) at least annually. Yet, screening rates in many HIV clinics remain low. In this study, we estimated the number needed to screen (NNS) to detect a NG and/or CT infection at each anatomic site among different subpopulations of PWH. NNS provides a concrete, practical measure to aid in assessing the practical impact of screening. METHODS : We included adults in care at three HIV Research Network sites in 2011-2014. Restricting to first tests within each year, annual NNS was defined as number of persons tested divided by number positive. We computed urogenital and extragenital NNS by age and risk group (women, men who have sex with women (MSW) and men who have sex with men (MSM)). RESULTS : A total of 16 864 NG/CT tests were included. Among patients aged ≤25 years, urogenital NNS was similar among women (15 (95% CI 6 to 71)), MSW (21 (95% CI 6 to 167)) and MSM (20 (95% CI 12 to 36)). Over 25, urogenital NNS increased to a greater extent for women (363 (95% CI 167 to 1000)) and MSW (160 (95% CI 100 to 333)) than MSM (46 (95% CI 38 to 56)). The increase for women versus MSM >25 remained significant (p<0.01) in multivariable analysis. Among MSM, rectal NNS was 5 (95% CI 3 to 7) and 10 (95% CI 9 to 12) for ≤25 and for >25 years and pharyngeal NNS values were 8 (95% CI 5 to 13) and 20 (95% CI 16 to 24)., Conclusions: These findings suggest the importance of regular, at least annual NG/CT screening, particularly extragenital, of HIV positive MSM of all ages. They provide some support for age-based cutoffs for women and MSW (eg, universal screening for those aged ≤25 and targeted screening for those aged >25 years)., Competing Interests: Competing interests: Richard Moore was a consultant for Medscape, LLC until 2018, Susan Tuddenham is a consultant for Biofire Diagnostics., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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50. Evaluating congenital syphilis in a reverse sequence testing environment.
- Author
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Chen MW, Akinboyo IC, Sue PK, Donohue PK, Ghanem KG, Detrick B, Witter FR, Page KR, Arav-Boger R, and Golden WC
- Subjects
- Academic Medical Centers, Female, Fluorescent Treponemal Antibody-Absorption Test, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Luminescent Measurements, Male, Retrospective Studies, Syphilis diagnosis, Syphilis transmission, Syphilis, Congenital microbiology, Syphilis Serodiagnosis methods, Syphilis, Congenital diagnosis, Treponema pallidum isolation & purification
- Abstract
Objectives: To examine the effect of maternal reverse-sequence (RS) syphilis screening on management of infants at risk for congenital syphilis (CS) using a standardized approach., Study Design: A retrospective study from 2011 to 2014 at an academic medical center using RS testing, involving chemiluminescent immunoassay (CIA), rapid plasma reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS) assays for syphilis. Clinical management and outcomes of infants born to mothers with discordant (CIA+/RPR-/FTA+) serology were compared with national or internal guidelines., Results: Sixty-three infants were classified as discordant (n = 21), presumed false positive (CIA+/RPR-/FTA-; n = 16), or true positive (CIA+/RPR+; n = 26) based on maternal serology. Only 24% of cases in the discordant group underwent recommended full evaluation. None of the evaluated infants in the discordant group (n = 8) were diagnosed with CS., Conclusions: Management of infants with discordant maternal RS serology remained reliant on clinical judgment. In our high-risk population, RS testing did not identify additional cases of CS.
- Published
- 2019
- Full Text
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