1. Management of sexually transmissible infections in the era of multiplexed molecular diagnostics: a primary care survey
- Author
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Nathan Keller, Sharon Amit, Ron Kedem, Omri Shental, Tal Brosh-Nissimov, and Nimrod Ophir
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,030106 microbiology ,Population ,Sexually Transmitted Diseases ,Chlamydia trachomatis ,Mycoplasma genitalium ,Mycoplasma hominis ,urologic and male genital diseases ,medicine.disease_cause ,Young Adult ,03 medical and health sciences ,Ureaplasma ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Trichomonas vaginalis ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,education ,education.field_of_study ,Chlamydia ,Primary Health Care ,biology ,business.industry ,Public Health, Environmental and Occupational Health ,medicine.disease ,biology.organism_classification ,Neisseria gonorrhoeae ,female genital diseases and pregnancy complications ,Infectious Diseases ,Coinfection ,Female ,business ,Ureaplasma urealyticum ,Empiric therapy - Abstract
Background Data regarding sexually transmissible infections (STI) often originate from STI clinics, screening programs or laboratory-based studies, thus are biased for specific risk groups or lack clinical details. This real-life observational study presents sample data of most young adult Israeli population by exploiting the centralised diagnostic and documentation platforms resulting from a mandatory military service at the age of 18 years for both genders. Methods: All STI diagnoses of Israeli Defence Forces soldiers during a 6-month period were reviewed. Patients with Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) (major-STI) and Ureaplasma urealyticum (UU), Ureaplasma parvum (UP) and Mycoplasma hominis (MH) (equivocal STI) were compared with STI-negative controls. Results: Sexually transmissible infection positivity rates (n = 2816) were as follows: CT 6.6%; MG 1.9%; NG 0.7%; TV 0.5%; UU 15.7%; UP 28.2%; and MH 6.2%. The CT+MG coinfection rate was 4.1%, yet CT+NG coinfections were rare (≈0.5%). More than half of the patients with ureaplasmas and/or MH were treated; 40% of them were recommended partner treatment. Most antibiotics were prescribed to patients with equivocal infections. Classic STI symptoms in males were linked to major-STI and UU, while females were asymptomatic or presented non-specific symptoms. Conclusions: The judicious use of antibiotics in the era of antimicrobial resistance necessitates re-evaluating the significance of equivocal pathogen detection and reporting (MH, UU, UP). Likewise, universal empiric treatment for NG should be reconsidered in light of its low rates in non-high-risk groups. Conversely, a high MG rate, a pathogen with potential resistance to common STI protocols, requires evaluation of guidelines adequacy.
- Published
- 2018
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