64 results on '"Gratrix J"'
Search Results
2. P438 Incidence and outcomes of Jarisch-Herxheimer reactions following treatment for infectious syphilis in late pregnancy in Alberta, Canada, 2015–2020
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Macumber, S, primary, Singh, A, additional, Robinson, J, additional, Smyczek, P, additional, Sklar, C, additional, Gratrix, J, additional, and Rathjen, L, additional
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- 2021
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3. O1-S04.03 Co-infection with sexually transmitted infections among Canadian street-involved youth 2001–2006
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Atwood, C V, Fang, L, Demers, A, Gratrix, J, Rossi, M, Taylor, D, Wright, J, Wong, T, and jayaraman, G
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- 2011
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4. Engineering Spectral Control Using Front Surface Filters for Maximum TPV Energy Conversion System Performance
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E. Brown, D. DePoy, P Fourspring, Thomas D. Rahmlow, E Gratrix J Lazo-Wasem, D Eno, B Wernsman, R. G. Mahorter, J. Azarkevich, and J Parrington
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Engineering ,Fabrication ,Interference (communication) ,Tandem ,Thermophotovoltaic ,business.industry ,Electronic engineering ,Optoelectronics ,Energy transformation ,Systems design ,Filter (signal processing) ,business ,Energy (signal processing) - Abstract
Energy conversion efficiencies of better than 23% have been demonstrated for small scale tests of a few thermophotovoltaic (TPV) cells using front surface, tandem filters [1, 2]. The engineering challenge is to build this level of efficiency into arrays of cells that provide useful levels of energy. Variations in cell and filter performance will degrade TPV array performance. Repeated fabrication runs of several filters each provide an initial quantification of the fabrication variation for front surface, tandem filters for TPV spectral control. For three performance statistics, within-run variation was measured to be 0.7-1.4 percent, and run-to-run variation was measured to be 0.5-3.2 percent. Fabrication runs using a mask have been shown to reduce variation across interference filters from as high as 8-10 percent to less than 1.5 percent. Finally, several system design and assembly approaches are described to further reduce variation.
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- 2004
5. Evidence for Increased Chlamydia Case Finding After the Introduction of Rectal Screening Among Women Attending 2 Canadian Sexually Transmitted Infection Clinics
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Gratrix, J., primary, Singh, A. E., additional, Bergman, J., additional, Egan, C., additional, Plitt, S. S., additional, McGinnis, J., additional, Bell, C. A., additional, Drews, S. J., additional, and Read, R., additional
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- 2014
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6. P3.250 Early Diagnosis of Acute HIV Infection in STI Clinic Patients and Patients with Positive Syphilis Serology
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Singh, A E, primary, Fenton, J, additional, Plitt, S, additional, Preiksaitis, J, additional, Gratrix, J, additional, Archibald, C, additional, Wong, T, additional, and Lee, B E, additional
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- 2013
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7. P3.016 Prevalence and Correlates of Rectal-Only Chlamydia Infection at Two Canadian STI Clinics
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Gratrix, J, primary, Bergman, J, additional, Egan, C, additional, Singh, A E, additional, Drews, S, additional, and Read, R R, additional
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- 2013
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8. P5-S4.05 The use of financial compensation as an incentive for infectious syphilis case finding among vulnerable populations in Edmonton, Canada
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Gratrix, J., primary, Fan, S., additional, Anderson, B., additional, Conroy, P., additional, Hewitt, S., additional, Parnell, T., additional, Jaipual, J., additional, Parker, P., additional, Singh, A. E., additional, and Talbot, J., additional
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- 2011
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9. LBP-1.10 Misclassification of syphilis cases using a reactive enzyme immunoassay and reactive RPR algorithm alone for diagnosis
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Singh, A., primary, Fonseca, K., additional, Mukhi, S., additional, Gratrix, J., additional, Plitt, S., additional, Read, R., additional, Sutherland, K., additional, Zahariadis, G., additional, Tyrrell, G., additional, and Lee, B., additional
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- 2011
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10. P5-S5.02 Outcomes following the introduction of HIV partner notification guidelines in Edmonton, Canada
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Bergman, J., primary, Brandley, J., additional, Gratrix, J., additional, Ross, K., additional, Paradis, K., additional, Parker, P., additional, Anderson, B., additional, Houston, S., additional, and Singh, A., additional
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- 2011
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11. P3-S6.03 Seroreversion of treponemal tests in cases meeting Canadian surveillance criteria for confirmed congenital syphilis
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Ameeta, S., primary, Guenette, T., additional, Bergman, J., additional, Gratrix, J., additional, Parker, P., additional, Anderson, B., additional, Plitt, S., additional, Lee, B., additional, and Robinson, J., additional
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- 2011
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12. LBP-1.08 Preliminary report on experience with point of care syphilis and HIV testing in hard-to-reach populations in outreach settings in Edmonton, Canada
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Bergman, J., primary, Plitt, S., additional, Gratrix, J., additional, Conroy, P., additional, Li, J., additional, Rocco, K., additional, Fenton, J., additional, Archibald, C., additional, Wong, T., additional, and Singh, A., additional
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- 2011
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13. Retrospective Review of Prenatal Gonorrhea and Chlamydia screening in Alberta: 2018-2022
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McCullough, E., Gratrix, J., Smyzcek, P., Charlton, C., and Plitt, S.
- Abstract
A retrospective five-year province-wide evaluation of prenatal Neisseria gonorrhoeae(GC) and Chlamydia trachomatis(CT) screening for Alberta, Canada, was carried out to assess compliance with the provincial recommendations for universal prenatal screening as a prevention for neonatal ophthalmia. Screening generally improved across the province each year; 82.1% in 2018 and reaching 87.3% in 2022. Women in the age group under 25 years were the most likely to not have the recommended first trimester screening and demonstrated the highest prevalence of GC and CT infections. The results of this investigation demonstrate that continued improvements are needed to achieve universal prenatal GC/CT screening in Alberta.
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- 2023
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14. The functions of a planning department.
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Young, James G. and Gratrix, J.
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- 1934
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15. Discussion on “Standardisation in relation to production engineering” at the Yorkshire Section of the Institution.
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Cooke, Le Maistre, Gratrix, J., Scaife, J.D., Hill, and Newell
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- 1933
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16. Impact of reverse sequence syphilis screening on new diagnoses of late latent syphilis in edmonton, Canada.
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Gratrix J, Plitt S, Lee BE, Ferron L, Anderson B, Verity B, Prasad E, Bunyan R, Zahariadis G, and Singh AE
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- 2012
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17. Retrospective Cohort Study of Financial Incentives for STI Testing and Treatment in an Outreach Population in Edmonton, Canada, 2018-2019.
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Krahn J, Gratrix J, Khan MN, Meyer G, Smyczek P, and Singh AE
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Background: The incidence of sexually transmitted infections (STI) continues to increase worldwide. Patient incentives are one proposed intervention to increase STI testing and treatment., Methods: We conducted a retrospective cohort study comparing incentivized versus routine care for STI outreach test and treat services between October 2018-June 2019. Incentivized care included a $10 gift card for testing visits and an additional $10 gift card for results and/or treatment visits. Incentivized visits were offered to clients with a lack of housing, who were difficult to locate, or had a history of being lost to follow-up. All test and treatment visits included chlamydia, gonorrhea, syphilis, and HIV testing and/or treatment by Registered Nurses and outreach workers from an STI Clinic. Outreach visits were offered at subsidized housing locations, community-based organizations, and street outreach., Results: From October 2018 to June 2019, 2384 outreach clients were reached: 453 (19.0%) receivedincentives and 1931 (81.0%) received routine care. There were no significant differences in case-finding rates for chlamydia (4.8%), gonorrhea (2.9%), and HIV (0.1%); however, there was for syphilis (3.8% for incentivized vs. 1.9% for routine visits; p = 0.02). All newly diagnosed infections identified in the incentivized group received treatment compared with routine visits (chlamydia 100% vs. 79.1%, p = 0.008, gonorrhea 100% vs. 59.7%, p = 0.002, and syphilis 100% vs. 86.7%, p = 0.08)., Conclusions: Incentives were associated with increased case-finding rates of syphilis and were associated with 100% treatment rates. Incentives are a promising approach to decreasing the burden of STI among outreach populations., Competing Interests: Conflict of Interest declaration: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2024
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18. Summary of the National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) Statement: Recommendations on Screening for Syphilis in Non-Pregnant Adults and Adolescents.
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Begum H, Gadient S, Bullard J, Gratrix J, Grennan T, Hatchette T, and Fleurant-Ceelen A
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Background: Sustained and significant increases in Canadian rates of infectious syphilis prompted the National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) to update the existing screening recommendation for non-pregnant adults and adolescents., Methods: These guidelines were developed following the 2014 World Health Organization Handbook. The research question was: "What is the clinical utility of syphilis screening using risk-based versus population-wide approaches for adolescents and adults?" The evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach., Results: The environmental scan included 11 guidelines on syphilis screening published between 2014 and January 2023. Two systematic reviews were identified and included. In the updated literature search from November 6, 2019, to January 17, 2023, there were no published systematic reviews on the effectiveness of risk-based screening or the comparison of risk-based and interval screening; however, one recent randomized control trial in Canada was published. Evidence for outcomes, patient values and preferences, resources, acceptability, equity, cost and cost effectiveness and feasibility were reviewed., Conclusion: This statement provides two screening recommendations for adults and adolescents. Recommendation 1: NAC-STBBI recommends syphilis screening in all sexually active persons with a new or multiple partners and/or upon request of the individual. They also recommend screening every three to six months in individuals with multiple partners. Recommendation 2: NAC-STBBI recommends that targeted "opt-out" screening programs should be considered as frequently as every three months when serving population groups and/or communities experiencing a high prevalence of syphilis (and other STBBI). Both are strong recommendations with moderate certainty of evidence., Competing Interests: Competing interests None.
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- 2024
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19. Retrospective Review of Prenatal Gonorrhea and Chlamydia Screening in Alberta: 2018-2022.
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McCullough E, Gratrix J, Smyzcek P, Charlton C, and Plitt SS
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- Pregnancy, Infant, Newborn, Female, Humans, Adult, Retrospective Studies, Alberta epidemiology, Neisseria gonorrhoeae, Chlamydia trachomatis, Prevalence, Mass Screening methods, Gonorrhea diagnosis, Gonorrhea epidemiology, Chlamydia Infections diagnosis, Chlamydia Infections epidemiology
- Abstract
A retrospective 5-year province-wide evaluation of prenatal Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) screening in Alberta, Canada, was carried out to assess compliance with the provincial recommendations for universal prenatal screening as a prevention for neonatal ophthalmia. Screening generally improved across the province each year, 82.1% in 2018 and reaching 87.3% in 2022. Women in the age group under 25 years were the most likely to not have the recommended first-trimester screening and demonstrated the highest prevalence of GC and CT infections. The results of this investigation demonstrate that continued improvements are needed to achieve universal prenatal GC/CT screening in Alberta., (Copyright © 2023 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. All rights reserved.)
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- 2024
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20. Use of genome sequencing to resolve differences in gradient diffusion and agar dilution antimicrobial susceptibility testing performance of Neisseria gonorrhoeae isolates in Alberta, Canada.
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Ma A, Ferrato C, Martin I, Smyczek P, Gratrix J, and Dingle TC
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- Humans, Azithromycin, Ceftriaxone, Agar, Cefixime pharmacology, Alberta, Retrospective Studies, Microbial Sensitivity Tests, Anti-Bacterial Agents pharmacology, Tetracycline pharmacology, Ciprofloxacin, Penicillins pharmacology, Neisseria gonorrhoeae genetics, Gonorrhea diagnosis
- Abstract
Agar dilution is the gold standard method for phenotypic antimicrobial susceptibility testing (AST) for Neisseria gonorrhoeae . However, this method is laborious and requires expertise, so laboratories that perform N. gonorrhoeae AST may choose alternative methods such as disk diffusion and gradient diffusion. In this study, we retrospectively compare the performance of gradient diffusion to agar dilution for 2,394 unique N. gonorrhoeae isolates identified in Alberta from 2017 to 2020 against azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, and tetracycline. Genome sequencing was utilized to resolve discrepancies between AST methods, detect antimicrobial resistance markers, and identify trends between error rates and sequence types (STs) of isolates. Over 90% of N. gonorrhoeae isolates were susceptible to azithromycin, cefixime, and ceftriaxone, whereas decreased susceptibility was observed for ciprofloxacin, penicillin, and tetracycline. Categorical (CA) and essential agreement (EA) was poorest between the two methods for penicillin (CA: 86.02%; EA: 77.69%) and tetracycline (CA: 47.22%; EA: 55.96%); however, the low CA was primarily attributed to minor errors. Antimicrobial agents with errors outside of acceptable limits included azithromycin (very major error: 18.42%; major error: 7.73%) and tetracycline (very major error: 6.17%). Genome sequencing on a subset of isolates resolved 30.3% of the azithromycin major errors and confirmed the azithromycin or tetracycline very major errors. Significant associations between certain STs and error types for azithromycin and tetracycline were also identified. Overall, gradient diffusion compared well to agar dilution for cefixime, ceftriaxone, and ciprofloxacin, and genome sequencing was identified as a useful tool to arbitrate discrepant susceptibility testing results between gradient diffusion and agar dilution for N. gonorrhoeae ., Competing Interests: Tanis C. Dingle is a voting member on the CLSI Antimicrobial Susceptibility Testing subcommittee. Tanis C. Dingle has received speaker honoraria from BioMerieux.
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- 2023
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21. Case Series of Stillbirths Due to Syphilis in Edmonton, Alberta, Canada.
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Robinson JL, Donovan A, Gratrix J, Smyczek P, and Tse-Chang A
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- Female, Humans, Infant, Pregnancy, Alberta epidemiology, Penicillin G Benzathine therapeutic use, Pregnancy Complications, Infectious diagnosis, Stillbirth epidemiology, Syphilis complications, Syphilis diagnosis, Syphilis drug therapy, Syphilis, Congenital epidemiology, Syphilis, Congenital prevention & control, Syphilis, Congenital drug therapy
- Abstract
Background: Data on the incidence and characteristics of stillbirths attributed to congenital syphilis were collected., Methods: We extracted data on stillbirths in the Edmonton Zone on January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery., Results: Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths were diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (1 of whom was treated early in pregnancy and presumably reinfected), and 1 had a stillbirth in the week after one dose of benzathine penicillin G., Conclusions: Stillbirths due to congenital syphilis were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy., 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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22. Sensitivity and specificity of two investigational Point of care tests for Syphilis and HIV (PoSH Study) for the diagnosis and treatment of infectious syphilis in Canada: a cross-sectional study.
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Singh AE, Ives N, Gratrix J, Vetland C, Ferron L, Crawford M, Hale-Balla L, Dong K, Meyer G, Smyczek P, Galli R, Rourke SB, and Fonseca K
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- Humans, Cross-Sectional Studies, Treponema pallidum, Syphilis Serodiagnosis methods, Point-of-Care Testing, Sensitivity and Specificity, Syphilis diagnosis, Syphilis drug therapy, HIV Infections complications, HIV Infections diagnosis
- Abstract
Objectives: Single-visit testing and treatment for syphilis can reduce follow-up visits. The objectives of this study were to evaluate the performance and treatment outcomes of two dual syphilis/HIV point-of-care tests (POCTs)., Methods: Participants aged 16 years and older were offered concurrent syphilis/HIV POCTs with fingerstick blood sampling using two extremely rapid (<5 minutes) devices (MedMira Multiplo Rapid TP/HIV test and INSTI Multiplex HIV-1/HIV-2/Syphilis Antibody Test). Those with positive POCT results were offered same-day syphilis treatment and linkage to HIV care. Nurses performed testing at two emergency departments, a First Nations community, a correctional facility, and a sexually transmitted infection clinic. POCT results were compared with those of standard serological testing. Sensitivity and specificity were calculated., Results: Between August 2020 and February 2022, 1526 visits were completed. Both POCTs accurately identified participants with HIV (sensitivity, 100% [24 of 24]; 95% CI, 86.2-100%; specificity, 99.6% [1319 of 1324]; 95% CI, 99.1-99.8%), linking 24 HIV cases to care. Both tests were most sensitive with a rapid plasma reagin (RPR) of ≥1:8 dilutions (Multiplo: sensitivity, 98.3% [231 of 235]; 95% CI, 95.7-99.3%; specificity, 99.5% [871 of 875]; 95% CI, 98.8-99.8%; INSTI Multiplex: sensitivity, 97.9% [230 of 235]; 95% CI, 95.1-99.1%; specificity, 99.8% [873 of 875]; 95% CI, 99.2-99.9%) and least sensitive with non-reactive RPR (Multiplo: sensitivity, 54.1% [59 of 109]; 95% CI, 44.8-63.2%; specificity, 99.5% [871 of 875]; 95% CI, 98.8-99.8%; INSTI Multiplex: sensitivity, 28.4% [31 of 109]; 95% CI, 20.8-37.5%; specificity, 99.8% [873 of 875]; 95% CI, 99.2-99.9%). Eighty-five percent of participants with infectious syphilis were treated on the same day as the positive POCT result., Discussion: Two extremely rapid (<5 minutes) dual syphilis/HIV POCTs showed excellent sensitivity and specificity for the diagnosis of active syphilis (RPR, ≥1:8 dilutions) and HIV and confirmed the ability to offer single-visit testing and treatment for syphilis and linkage to HIV care in diverse clinical settings., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)
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- 2023
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23. Retrospective testing for the presence of monkeypox virus in a high-risk population from February-June 2022 in Alberta, Canada.
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Kanji JN, Dieu P, Wong A, Pabbaraju K, Shokoples S, Smyczek P, Gratrix J, Singh AE, Charlton CL, Zhou HY, Zelyas N, Hinshaw D, and Tipples G
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Background: A multi-country outbreak of monkeypox virus (MPXV) infections was identified by the World Health Organization in May 2022. The western Canadian province of Alberta identified its first case of MPXV in a returning traveller on June 2, 2022. We undertook a retrospective testing exercise to evaluate whether MPXV may have been circulating in the province earlier., Methods: Skin (genital and non-genital) and mucosal lesion swabs submitted for herpes simplex virus (HSV)/varicella zoster virus (VZV)/syphilis testing from male patients attending sexually-transmitted infection clinics across the province of Alberta from January 28 to May 30, 2022 were retrieved from storage. The population tested was selected based on the epidemiology of the current 2022 multi-country MPXV outbreak. Samples underwent viral nucleic acid extraction and testing for the presence of Orthopoxvirus DNA using a commercial real-time polymerase chain reaction (PCR) kit., Results: A total of 392 samples (representing 341 unique individuals of median age 31 years) were retrieved. Of them, 349 (89.0%) samples were submitted for HSV/VZV/syphilis testing, 13 (3.3%) for HSV/VZV only, and 30 (7.7%) for syphilis PCR only. None of the 392 samples tested were found to be positive for Orthopoxvirus DNA., Conclusions: The results of this study indicate that circulation of MPXV in a higher-risk population in Alberta, prior to the first case, was less likely. We recommend that other provinces/territories review their local epidemiology, context and resources prior to conducting similar studies., (© Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada), 2022.)
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- 2023
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24. Prevalence of syphilis coinfection in hepatitis C virus positive prenatal patients from Alberta during a pilot routine screening program.
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Thompson LA, Plitt SS, Gratrix J, and Charlton CL
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BACKGROUND: Alberta routinely screens pregnant patients for select communicable diseases. Hepatitis C virus (HCV) was added to the prenatal screening panel as part of a provincial pilot program in February 2020. This retrospective cross-sectional study aimed to characterize the prevalence of syphilis coinfections in prenatal patients infected with HCV following implementation of the pilot program. METHODS: Routine prenatal HCV and syphilis testing data were extracted from the Public Health Laboratory Information System over a 21-month period. HCV positivity was defined as HCV enzyme immunoassay (EIA) reactive with detected HCV ribonucleic acid (RNA) following molecular confirmation, and positive results were examined for syphilis coinfections. All patients reactive on a syphilis EIA and confirmatory Treponema pallidum particle agglutination (TPPA) or follow-up rapid plasma reagin (RPR) test were considered positive for syphilis. Descriptive statistics for coinfected patients were analyzed. RESULTS: Eighty-seven prenatal patients were identified to be positive for HCV. Of those, 19 (21.8%) were reactive on the syphilis EIA and 17 (19.5%) had confirmed infections with the TPPA or RPR tests. For HCV/syphilis coinfected patients, the majority resided in metropolitan regions (64.6%), were from the lowest income quintile neighbourhoods (47.1%) and had previously tested positive for HCV (82.4%) and syphilis (64.6%) at the public health laboratory. CONCLUSIONS: The prevalence of syphilis coinfections in prenatal patients infected with HCV is high in Alberta. HCV/syphilis coinfection prevalence should be further investigated in other jurisdictions and prenatal cohorts to better understand testing and treatment options for prevention of congenital transmission., (© Canadian Association for the Study of the Liver, 2023.)
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- 2023
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25. Serologic follow-up of solid organ transplant recipients who received organs from donors with reactive syphilis tests: A retrospective cohort study.
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Fernández García OA, Singh AE, Gratrix J, Smyczek P, and Doucette K
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- Humans, Retrospective Studies, Follow-Up Studies, Treponema pallidum, Tissue Donors, Transplant Recipients, Antibodies, Syphilis diagnosis, Syphilis epidemiology, Organ Transplantation adverse effects, Organ Transplantation methods
- Abstract
The increased procurement of organs from donors with risk factors for blood-borne diseases and the expanding syphilis epidemic have resulted in a growing number of organs transplanted from donors with reactive syphilis serology in our center. Based on guidelines, recipients typically receive therapy shortly after the transplant, but data on outcomes are limited. The primary objective of this study was to determine syphilis seroconversion rates at three months post-transplant in recipients of solid organs procured from donors with reactive syphilis serology. Organ donors and recipients were tested for syphilis antibody; positive results were confirmed with Treponema pallidum Particle Agglutination (TPPA). Eleven donors with reactive syphilis antibody donated organs to 25 syphilis negative recipients. Three recipients seroconverted at post-transplant month 3. All of them had received therapy shortly after transplant. TPPA was negative in all 3. Despite post-transplant treatment, 3 of 25 (12%) syphilis negative recipients of organs from syphilis positive donors seroconverted at 3 months. All remained TPPA negative possibly reflecting passive antibody transfer or differing test sensitivity to low level treponemal antibodies. Further studies are needed to assess optimal syphilis transmission prevention strategies and follow up recipient testing in organ transplantation., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2023
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26. Population-Level Provider Compliance With Provincial Treatment Guidelines for the Management of Gonorrhea in Adolescents and Adults in Alberta, Canada; 2000 to 2019.
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Ugarte-Torres A, Diaz Pallares C, Niruban JS, Smyczek P, Gratrix J, Strong D, and Singh AE
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- Humans, Adolescent, Alberta epidemiology, Gonorrhea drug therapy, Gonorrhea epidemiology
- Abstract
Competing Interests: Conflict of Interest and Sources of Funding: All authors declared no conflict of interest.
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- 2023
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27. A Cross-Sectional, Retrospective Evaluation of Opt-Out Sexually Transmitted Infection Screening at Admission in a Short-Term Correctional Facility in Alberta, Canada.
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Reekie A, Gratrix J, Smyczek P, Woods D, Poshtar K, Courtney K, and Ahmed R
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- Humans, Retrospective Studies, Cross-Sectional Studies, Alberta epidemiology, Mass Screening methods, Correctional Facilities, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases prevention & control, Gonorrhea diagnosis, Gonorrhea epidemiology, Gonorrhea prevention & control, Syphilis diagnosis, Syphilis epidemiology, Syphilis prevention & control, HIV Infections diagnosis, HIV Infections epidemiology, Chlamydia Infections diagnosis, Chlamydia Infections epidemiology, Chlamydia Infections prevention & control
- Abstract
Incarcerated populations experience higher rates of sexually transmitted infections (STIs) than the general population, alongside inconsistent testing strategies. In response, universal opt-out STIs (chlamydia, gonorrhea, syphilis, and HIV) screening was implemented at admission in a short-term correctional facility in Alberta, Canada, for individuals ≤35 years. A cross-sectional, retrospective evaluation of testing outcomes between March 2018 and February 2020 was completed. Descriptive statistics were used to stratify STIs by gender, age group, and date for univariate analysis. Despite low uptake (31.2%), opt-out screening resulted in high positivity rates (14.9%, 10.8%, 29.5%, and 0.3%, respectively) and treatment completion (93.7%) while capturing a high proportion (52.6%) of asymptomatic cases. Opt-out screening at admission is feasible and can improve STI testing in high-risk individuals experiencing incarceration in Canada.
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- 2022
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28. Retrospective audit of a convenience cohort of individuals on HIV pre-exposure prophylaxis in Alberta, Canada.
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Candler E, Naeem Khan M, Gratrix J, Plitt S, Stadnyk M, Smyczek P, Anderson N, Carter J, Sayers S, Smith D, Ugarte-Torres A, Shukalek C, and Singh AE
- Abstract
Background: We undertook an audit of a province-wide HIV pre-exposure prophylaxis (PrEP) program in Alberta (Canada)., Methods: A retrospective record review of individuals accessing PrEP in Alberta included demographics, PrEP indication(s), and reported non-prescription drug and alcohol use from March 2016 to June 2019. Hepatitis A, B, C, HIV and syphilis serology, serum creatinine, and nucleic acid amplification tests testing for chlamydia and gonorrhea were collected. Descriptive statistics, incidence, and prevalence were calculated., Results: A total of 511 participants were seen at STI, sexual, and reproductive health clinics and private family practitioner (FP) offices; 98.4% (503) were men, median age was 34 years (IQR 28-43 years), and 89.8% (459) were gay or bisexual men who have sex with men. Non-prescription drug use was reported by 39.3% (201) and alcohol use by 55.4% (283). 94.3% (482) reported condomless anal sex in the past 6 months. Testing rates were high (>95%) for all tests except for chlamydia and gonorrhea at the first follow-up visit 89.6%; (3-4 months). There was one HIV seroconversion. The incidence of new bacterial STIs was high: chlamydia 17 cases per 100 person-years (95% CI 13.5% to 21.4%), gonorrhea 11.14 cases per 100 person-years (95% CI 8.3% to 15.0%), and syphilis 1.94 cases per 100 person-years (95% CI 0.73% to 5.12%)., Conclusions: Following implementation of a provincial program for PrEP in Alberta, PrEP initiation and continuation was feasible in a range of settings and by both specialists and FPs., Competing Interests: AE Singh received consulting fees from Gilead; C Shukalek received grants or contracts from CIHR and the Royal College of Physicians and Surgeons, consulting fees and payment for speaking engagements from Gilead and Merck Canada, stock options from Purpose Med, and is a board member of The SHARP Foundation. The other authors have nothing to disclose., (Copyright © 2022, Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada).)
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- 2022
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29. Retrospective Cohort Study of the Incidence and Outcomes of Jarisch-Herxheimer Reactions After Treatment of Infectious Syphilis in Late Pregnancy.
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Macumber S, Singh AE, Gratrix J, Robinson JL, Smyczek P, Rathjen L, and Sklar C
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- Female, Humans, Incidence, Penicillin G Benzathine therapeutic use, Pregnancy, Retrospective Studies, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis drug therapy, Syphilis epidemiology
- Abstract
Abstract: Of 39 pregnant women at ≥20 weeks' gestation treated with benzathine penicillin G for infectious syphilis, we identified only 2 mild Jarisch-Herxheimer reactions. There were no immediate fetal sequelae. Data from our study do not support the recommendation for routine admission for the treatment of infectious syphilis in late pregnancy., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (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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30. Retrospective Cohort Study Examining the Correlates of Reported Lifetime Stimulant Use in Persons Diagnosed With Infectious Syphilis in Alberta, Canada, 2018 to 2019.
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Raval M, Gratrix J, Plitt S, Niruban J, Smyczek P, Dong K, and Singh AE
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- Alberta epidemiology, Female, Homosexuality, Male, Humans, Male, Retrospective Studies, HIV Infections epidemiology, Sexual and Gender Minorities, Syphilis epidemiology
- Abstract
Background: We sought to examine the correlates for stimulant use in persons diagnosed with infectious syphilis during an outbreak in Alberta to help guide public health interventions., Methods: Infectious syphilis data were extracted from the Communicable Disease and Outbreak Management database from January 1, 2018, to December 31, 2019. Behavioral, demographic, and lifetime reported stimulant use data were obtained. Descriptive analyses and logistic regression were performed for 3 subpopulations (gay, bisexual, and other men who have sex with men; men who have sex with women; and women)., Results: Of 3627 individuals diagnosed with infectious syphilis, 23.9% (n = 867) cases were not interviewed for substance use and were removed from further analysis. Of the remaining 2759 people, 41.8% (n = 1153) self-reported lifetime stimulant use. Gay, bisexual, and other men who have sex with men reported stimulant use less often than women (24.6% vs. 44.1%; P < 0.0001) and men who have sex with women (24.6% vs. 46.2%; P < 0.0001). Multivariable analyses demonstrated that stimulant use was associated with persons who injected drugs, had correctional involvement, or reported multiple sex partners. Men who have sex with women were more likely to self-report First Nations ethnicity (adjusted odds ratio, 1.76 [95% confidence interval, 1.25-2.49]), and women were more likely to have a concurrent gonorrhea infection (adjusted odds ratio, 1.62 [95% confidence interval, 1.15-2.28])., Conclusions: Nearly half of infectious syphilis cases in Alberta reported lifetime nonprescription stimulant use. Infectious syphilis cases with stimulant use were associated with injection drug use, multiple sex partners, and correctional involvement. Our observations highlight the need for integration of sexual health services into programs for people who use substances and those in corrections custody., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (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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31. Examination of Care Milestones for Preventing Congenital Syphilis Transmission Among Syphilis-Infected Pregnant Women in Alberta, Canada: 2017-2019.
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Round JM, Plitt SS, Eisenbeis L, Smyczek P, Gratrix J, Charlton C, Fathima S, and O'Brien A
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- Alberta epidemiology, Female, Humans, Infant, Infant, Newborn, Pregnancy, Pregnant Women, Prenatal Care, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious prevention & control, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital diagnosis, Syphilis, Congenital epidemiology, Syphilis, Congenital prevention & control
- Abstract
Background: An infectious syphilis outbreak in Alberta has resulted in increased congenital syphilis (CS) cases. To shed light on potential risk factors, we used administrative data sets to examine care milestones for the prevention of CS among pregnant women diagnosed with syphilis, as well as correlates of women giving birth to infants with CS., Methods: Provincial administrative databases were used to identify and describe pregnant women diagnosed with any stage of infectious or noninfectious syphilis who gave birth in Alberta between January 1, 2017, and December 31, 2019. Data on prenatal care, syphilis screening, and syphilis medication dispensation were used to evaluate the care milestones. Clinical care and maternal demographics were assessed using logistic and linear regression analyses to determine correlates for missed care milestones or a newborn outcome of CS., Results: Of 182 syphilis-infected pregnant women, 63 (34.6%) delivered a newborn with CS. Overall, in the first trimester, 136 (75.1%) women had a health care visit, 72 (39.6%) had a prenatal care visit, 71 (39.0%) were screened for syphilis, and 44 (24.2%) were treated. Gestational time to treatment initiation (adjusted odds ratio, 1.04; 95% confidence interval, 1.02-1.06) and older maternal age at diagnosis (adjusted odds ratio: 1.28, 95% confidence interval, 1.08-1.50) were independently associated with CS outcomes. No variables were found to be independently associated with a health care visit, prenatal screening, or initiation of treatment., Conclusions: Although nearly two-thirds of CS cases were prevented, there remained missed opportunities in the prevention of CS. Early treatment, which relies on timely access to prenatal care and screening, was the most important for the prevention of CS., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2022 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2022
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32. Molecular Surveillance and Prediction of Antimicrobial Resistance of Neisseria gonorrhoeae in Northern Alberta, Canada, 2015 to 2018.
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Pilkie D, Gratrix J, Sawatzky P, Martin I, Singh A, Prasad E, Naidu P, Mulvey M, Wong T, and Smyczek PA
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- Alberta epidemiology, Anti-Bacterial Agents pharmacology, Azithromycin pharmacology, Cephalosporins pharmacology, Ciprofloxacin pharmacology, Drug Resistance, Bacterial genetics, Humans, Microbial Sensitivity Tests, Gonorrhea drug therapy, Gonorrhea epidemiology, Neisseria gonorrhoeae genetics
- Abstract
Background: The aims of this study was to describe molecular surveillance of Neisseria gonorrhoeae in the North Zone of Alberta (NZ) and to determine its value in predicting antimicrobial resistance., Methods: Sequence types (STs) and single-nucleotide polymorphism (SNP) assays were performed on nucleic acid amplification testing (NAAT) samples. Sequence types of NAATs were matched to ST of cultures from across Alberta. Antimicrobial resistance prediction of NAATs for cephalosporins, azithromycin, and ciprofloxacin using SNP was compared with matching ST culture results using agar dilution and whole-genome sequencing., Results: Of 2755 eligible specimens (2492 cases), 61.9% (1646 specimens) were sent for sequence typing, identifying 196 unique ST. Antimicrobial resistance data for 1307 additional cases were available using matching cultures. Decreased susceptibility (DS) to antimicrobials used for gonorrhea treatment was rare in the NZ; according to the SNP assay, none of the specimens had predicted DS to cephalosporins or azithromycin resistance. However, of the NZ NAAT samples tested in this study, 10.7% (131 of 1220) were predicted to have intermediate cephalosporin minimum inhibitory concentrations and 9.6% (115 of 1204) were resistant to ciprofloxacin. Based on cultures, the proportions of resistance in all of Alberta were as follows: DS to cephalosporins, 0.6% (20 of 3373); DS to intermediate cephalosporin, 16.9% (570 of 3373); azithromycin resistance, 1.2% (41 of 3373); and ciprofloxacin resistance, 32.2% (1087 of 3373)., Conclusions: Our results highlight our ability to use culture-independent methods to predict antimicrobial resistance in N. gonorrhoeae., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2022 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2022
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33. Outcomes of infectious syphilis in pregnant patients and maternal factors associated with congenital syphilis diagnosis, Alberta, 2017-2020.
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Gratrix J, Karwacki J, Eagle L, Rathjen L, Singh A, Chu A, and Smyczek P
- Abstract
Background: Congenital syphilis (CS) is a significant public health challenge, requiring early diagnosis and treatment to improve infant outcomes. The aim of this study is to describe public health outcomes of infectious syphilis cases among pregnant patients and factors associated with a CS diagnosis for their infant., Methods: We conducted a retrospective review of demographic and clinical characteristics of infectious syphilis cases diagnosed during pregnancy and resulting infant outcomes in Alberta from 2017 to 2020 from the provincial communicable disease database. Adequate maternal treatment was defined as receiving at least one dose of Benzathine penicillin G-LA 2.4 million units IM at least 28 days before delivery. Univariate and multivariate analysis was performed to determine factors associated with CS diagnosis using SPSS version 25., Results: A total of 374 cases of infectious syphilis were diagnosed in pregnancy, with two patients being diagnosed twice in a single pregnancy. The majority (79.1%; n=296) of women had a live birth, followed by therapeutic abortion (9.4%; n=35), stillbirth (7.5%; n=28) and spontaneous abortion (4.0%; n=15). Infant records (n=265) were available for review (n=117 CS cases and 148 non-cases). Correlates associated with CS were screening time in third trimester (adjusted odds ratio [AOR] 8.4, 95% confidence interval [CI], 2.9-24.6) and fewer than 28 days before delivery (AOR 8.1, 1.4-47.8 [vs. first and second trimester] and inadequate treatment (AOR 86.1, CI, 15.9-466.5). Among the CS cases, 23.1% (n=27) were stillborn compared with one (0.7%) stillbirth in the non-CS infants ( p <0.001)., Conclusion: The early identification and treatment of syphilis in pregnancy is crucial to preventing poor infant outcomes., Competing Interests: Competing interests: None.
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- 2022
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34. Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018.
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Berenger BM, Demczuk W, Gratrix J, Pabbaraju K, Smyczek P, and Martin I
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- Alberta epidemiology, Gonorrhea microbiology, Humans, Microbial Sensitivity Tests, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae genetics, Phylogeny, Polymerase Chain Reaction, Population Surveillance, Anti-Bacterial Agents pharmacology, Cephalosporin Resistance genetics, Gonorrhea epidemiology, Neisseria gonorrhoeae isolation & purification
- Abstract
In July 2018, a case of Neisseria gonorrhoeae associated with ceftriaxone treatment failure was identified in Alberta, Canada. We identified the isolate and nucleic acid amplification testing (NAAT) specimen as the ceftriaxone-resistant strain multilocus sequence type 1903/NG-MAST 3435/NG-STAR 233, originally identified in Japan (FC428), with the same penA 60.001 mosaic allele and genetic resistance determinants. Core single-nucleotide variant (SNV) analysis identified 13 SNVs between this isolate and FC428. Culture-independent surveillance by PCR for the A311V mutation in the penA allele and N. gonorrhoeae multiantigen sequence typing directly from NAAT transport media positive for N. gonorrhoeae by NAAT did not detect spread of the strain. We identified multiple sequence types not previously detected in Alberta by routine surveillance. This case demonstrates the benefit of using culture-independent methods to enhance detection, public health investigations, and surveillance to address this global threat.
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- 2019
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35. A cross-sectional evaluation of opt-in testing for sexually transmitted and blood-borne infections in three Canadian provincial correctional facilities: a missed opportunity for public health?
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Gratrix J, Smyczek P, Bertholet L, Lee MC, Pyne D, Woods D, Courtney K, and Ahmed R
- Subjects
- Adolescent, Adult, Age Factors, Blood-Borne Pathogens, Canada epidemiology, Cross-Sectional Studies, Female, HIV Infections diagnosis, HIV Infections epidemiology, Hepatitis diagnosis, Hepatitis epidemiology, Humans, Male, Middle Aged, Public Health, Retrospective Studies, Sex Factors, Young Adult, Mass Screening organization & administration, Prisons organization & administration, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology
- Abstract
Purpose: Incarceration provides an opportunity for screening and treatment of sexually transmitted and blood-borne infections (STBBIs) in high-risk groups. The purpose of this paper is to determine positivity rates of STBBI screening within correctional facilities using opt-in strategies and estimate the proportion of admissions tested., Design/methodology/approach: A cross-sectional, retrospective review of testing data from January 2012 to August 2015 from three provincial correctional facilities located in Alberta, Canada was completed. Analysis variables included STBBI, gender, facility, collection year and age. STBBI-stratified analysis was performed to identify correlates for positivity using univariate and logistic regressions., Findings: Overall prevalence of chlamydia was 11.2 percent and gonorrhea was 3.5 percent; correlates for both were younger age and facility type. The syphilis prevalence rate was 3.2 percent; correlates included being female, older age, adult facilities, with later years being protective. In total, 14 (0.3 percent) newly diagnosed HIV cases were found, prevalence increased with age. HBV prevalence was 1.7 percent with no significant correlations. Nearly one-tenth ( n =422) of those screened for HCV antibody were positive; all variables were significantly correlated. Overall estimates of the proportion of admissions tested by STBBI were low and ranged from 4.8 to 16.1 percent., Originality/value: This study found high rates of STBBI in correctional facilities and showed that only a small proportion of the population was tested using an opt-in strategy. Shifting to an "opt-out" strategy may be warranted.
- Published
- 2019
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36. Retrospective review of tertiary and neurosyphilis cases in Alberta, 1973-2017.
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Landry T, Smyczek P, Cooper R, Gratrix J, Bertholet L, Read R, Romanowski B, and Singh AE
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- Adult, Aged, Alberta epidemiology, Female, HIV Seropositivity epidemiology, Humans, Male, Middle Aged, Retrospective Studies, Neurosyphilis epidemiology, Syphilis epidemiology, Syphilis, Cardiovascular epidemiology
- Abstract
Objectives: To review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era., Methods: A retrospective review of all neurosyphilis and tertiary syphilis cases reported in Alberta from 1973 to March 2017 was undertaken and cases classified into early neurosyphilis, late neurosyphilis and cardiovascular (CV) syphilis. Variables collected included demographics, sexual partners, HIV status, clinical parameters, symptoms and treatment and distributions were compared between early versus late neurosyphilis and asymptomatic versus symptomatic cases (stratified by early versus late stage). Data were analysed using IBM SPSS Statistics V.19.0., Results: 254 cases were identified; 251 were neurosyphilis and 3 were CV. No cases of gummatous syphilis were reported. Early neurosyphilis accounted for 52.4% (n=133) and 46.1% (n=117) were late neurosyphilis cases; one (0.4%) case with unknown duration. Three outbreaks of infectious syphilis were identified during the study period and a concurrent rise in both early and late neurosyphilis was observed during the outbreak periods. The most common manifestation of symptomatic neurosyphilis was ocular involvement which was more likely in early neurosyphilis. Relative to late neurosyphilis cases, early neurosyphilis cases were more likely to be younger, Caucasian, born in Canada, HIV positive and reporting same sex partners., Conclusions: Our review of tertiary and neurosyphilis cases found that early and late neurosyphilis cases continue to occur in the context of cycling syphilis outbreaks. CV syphilis cases were extremely rare. Ongoing identification of new cases of syphilis and clinical evaluation of cases for complications continues to be important in the context of global resurgence of syphilis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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37. Gonococcal Conjunctivitis in Adults: Case Report and Retrospective Review of Cases in Alberta, Canada, 2000-2016.
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Belga S, Gratrix J, Smyczek P, Bertholet L, Read R, Roelofs K, and Singh AE
- Subjects
- Adolescent, Adult, Alberta, Female, Genotyping Techniques, Humans, Male, Neisseria gonorrhoeae drug effects, Neisseria gonorrhoeae genetics, Retrospective Studies, Young Adult, Anti-Bacterial Agents therapeutic use, Ophthalmia Neonatorum diagnosis, Ophthalmia Neonatorum drug therapy
- Abstract
Background: A case of gonococcal conjunctivitis (GC) prompted us to review the reported cases and treatment regimens of GC in Alberta, Canada., Methods: Gonococcal cases reported from 2000 to 2016 were extracted from the provincial sexually transmitted infection reporting database. The diagnosis of GC was based on a positive culture and/or nucleic acid amplification test from the eye., Results: A total of 45 cases of GC were reported in adults. Three quarters (75.6%; n = 34) of the cases were diagnosed using culture, 57.8% (n = 26) of cases were among men, and 55.5% (n = 25) were diagnosed since 2014. Very few (13.3%; n = 6) of the cases were treated according to current Canadian Guidelines on Sexually Transmitted Infections, using 2 g of ceftriaxone in combination with azithromycin or doxycycline. Results of test of cures were available for 15.6% (n = 7) of the cases and occurred within 10 to 79 days (median = 26 days) after treatment; all were negative., Conclusions: Gonococcal conjunctivitis was relatively uncommon in our region, but given its potential for severe manifestations and sequelae coupled with the rising rates of gonorrhea; it remains important to consider this diagnosis in sexually active individuals presenting with purulent conjunctivitis. Additional studies are needed to inform treatment recommendations and to evaluate outcomes of infection.
- Published
- 2019
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38. Surveillance for Antimicrobial Resistance in Gonorrhea: The Alberta Model, 2012⁻2016.
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Gratrix J, Kamruzzaman A, Martin I, Smyczek P, Read R, Bertholet L, Naidu P, and Singh AE
- Abstract
Alberta established a surveillance system in 2001 to monitor resistance to antibiotics used for the treatment of gonorrhea. A retrospective review of gonorrhea cases during the last five years was conducted. All cases of gonorrhea were reportable to public health by testing laboratories and clinicians. Specimens were primarily submitted for nucleic acid amplification testing (NAAT); three sentinel sites obtained specimens for culture and NAAT. The Provincial Laboratory for Public Health conducted E-tests on isolates for multiple antibiotics. A proportion of isolates and NAAT specimens were submitted to the National Microbiology Laboratory for sequence typing (ST). Data were combined and analyzed using SAS version 9.4. Between 2012 and 2016, 13,132 gonorrhea cases were reported; 22.0% ( n = 2891) had isolates available for susceptibility testing. All culture positive isolates were susceptible to ceftriaxone. Decreased susceptibility (0.5 ug/mL) to cefixime was reported in four cases in 2014. Resistance to azithromycin (≥2 ug/mL) ranged between 0.4% and 1.8%. Many ( n = 509) unique STs were identified; the most prevalent sequence groups (SG) were SG-7638 ( n = 367), SG-5985 ( n = 145), and SG-11299 ( n = 127). The Alberta model for maintaining surveillance for antimicrobial resistance in gonorrhea employs culture and NAAT specimens, providing information crucial to informing provincial treatment guidelines.
- Published
- 2018
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39. Early Childhood Neurodevelopmental Outcomes in Infants Exposed to Infectious Syphilis In Utero.
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Verghese VP, Hendson L, Singh A, Guenette T, Gratrix J, and Robinson JL
- Subjects
- Adolescent, Adult, Anti-Bacterial Agents therapeutic use, Canada, Cohort Studies, Female, Humans, Infant, Newborn, Mothers, Neurodevelopmental Disorders microbiology, Outcome and Process Assessment, Health Care, Parturition, Pregnancy, Risk Factors, Syphilis Serodiagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital mortality, Treponema pallidum, Young Adult, Neurodevelopmental Disorders etiology, Pregnancy Complications, Infectious microbiology, Syphilis, Congenital complications
- Abstract
Background: There are minimal neurodevelopmental follow-up data for infants exposed to syphilis in utero., Methods: This is an inception cohort study of infants exposed to syphilis in utero. We reviewed women with reactive syphilis serology in pregnancy or at delivery in Edmonton (Canada), 2002 through 2010 and describe the neurodevelopmental outcomes of children with and without congenital syphilis., Results: There were 39 births to women with reactive syphilis serology, 9 of whom had late latent syphilis (n = 4), stillbirths (n = 2) or early neonatal deaths (n = 3), leaving 30 survivors of which 11 with and 7 without congenital syphilis had neurodevelopmental assessment. Those with congenital syphilis were all born to women with inadequate syphilis treatment before delivery. Neurodevelopmental impairment was documented in 3 of 11 (27%) infants with congenital syphilis and one of 7 (14%) without congenital syphilis with speech language delays in 4 of 11 (36%) with congenital syphilis and 3 of 7 (42%) without congenital syphilis., Conclusions: Infants born to mothers with reactive syphilis serology during pregnancy are at high risk for neurodevelopmental impairment, whether or not they have congenital syphilis, so should all be offered neurodevelopmental assessments and early referral for services as required.
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- 2018
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40. Gonococcal and Chlamydial Cases of Pelvic Inflammatory Disease at 2 Canadian Sexually Transmitted Infection Clinics, 2004 to 2014: A Retrospective Cross-sectional Review.
- Author
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Chen JZ, Gratrix J, Smyczek P, Parker P, Read R, and Singh AE
- Subjects
- Adolescent, Adult, Ambulatory Care Facilities, Anti-Bacterial Agents therapeutic use, Canada epidemiology, Chlamydia Infections diagnosis, Chlamydia Infections drug therapy, Cross-Sectional Studies, Female, Gonorrhea diagnosis, Gonorrhea drug therapy, Humans, Metronidazole therapeutic use, Ofloxacin therapeutic use, Pelvic Inflammatory Disease drug therapy, Retrospective Studies, Treatment Failure, Young Adult, Chlamydia Infections epidemiology, Gonorrhea epidemiology, Pelvic Inflammatory Disease epidemiology, Pelvic Inflammatory Disease microbiology
- Abstract
One hundred thirteen patients with gonococcal and chlamydial pelvic inflammatory disease were reviewed at 2 Canadian sexually transmitted infection clinics. Most patients (81%) with pelvic inflammatory disease were diagnosed as having chlamydia alone. Three treatment failures were seen in patients treated with ofloxacin.
- Published
- 2018
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41. Increasing incidence of syphilis among patients engaged in HIV care in Alberta, Canada: a retrospective clinic-based cohort study.
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Lang R, Read R, Krentz HB, Ramazani S, Peng M, Gratrix J, and Gill MJ
- Subjects
- Adult, Aged, Alberta, Alcoholism complications, Ambulatory Care Facilities, Canada epidemiology, Female, HIV genetics, HIV isolation & purification, HIV Infections complications, HIV Infections epidemiology, Homosexuality, Male, Humans, Incidence, Male, Middle Aged, RNA, Viral blood, Retrospective Studies, Risk Factors, Syphilis complications, Syphilis epidemiology, Viral Load, Young Adult, HIV Infections diagnosis, Syphilis diagnosis
- Abstract
Background: Syphilis is a global health concern disproportionately affecting HIV-infected populations. In Alberta, Canada, the incidence of syphilis in the general population has recently doubled with 25% of these infections occurring in HIV-infected patients. The Southern Alberta HIV Clinic (SAC) and Calgary STI Program (CSTI) analyzed the epidemiologic characteristics of incident syphilis infections in our well-defined, HIV-infected population over 11 years., Methods: Since 2006, as routine practice of both the Southern Alberta Clinic (SAC) and Calgary STI Programs (CSTI), syphilis screening has accompanied HIV viral load measures every four months. All records of patients who, while in HIV care, either converted from being syphilis seronegative to a confirmed seropositive or were re-infected as evidenced by a four-fold increase in rapid plasma reagin (RPR) after past successful treatment, were reviewed., Results: Incident syphilis was identified 249 times in 194 HIV-infected individuals. There were 36 individuals with repeated infections (28.5% of episodes). Following a prior decline in annual incident syphilis rates, the rates have tripled from 8.08/1000 patient-years (95% confidence interval (CI): 4.14-14.75) in 2011, to 27.04 per 1000 person-years (95% CI: 19.45-36.76) in 2016. Half of the syphilis episodes were asymptomatic. Patients diagnosed with syphilis were twice as likely not to be taking ART and had a higher likelihood of having plasma HIV RNA viral loads > 1000 copies/mL (19%). Incident syphilis was seen predominantly in Caucasians (72%, P < 0.001), males (94%, P < 0.001) and men who have sex with men (MSM) as their HIV risk activity (75%, P < 0.001)., Conclusions: We have highlighted the importance of a regular syphilis screening program in HIV-infected individuals demonstrated by increasing rates of incident syphilis in our region. Targeted preventative strategies should be directed towards HIV-infected populations identified at highest risk, including; MSM, prior alcohol abuse, prior recreational drug use and those with prior syphilis diagnoses.
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- 2018
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42. Benefit of adjunct universal rectal screening for Chlamydia genital infections in women attending Canadian sexually transmitted infection clinics.
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Thanh NX, Akpinar I, Gratrix J, Plitt S, Smyczek P, Read R, Jacobs P, Wong T, and Singh AE
- Subjects
- Adult, Canada epidemiology, Chlamydia Infections economics, Chlamydia Infections epidemiology, Cost-Benefit Analysis, Female, Health Care Costs, Humans, Incidence, Markov Chains, Rectal Diseases epidemiology, Chlamydia Infections prevention & control, Chlamydia trachomatis isolation & purification, Mass Screening economics, Rectum microbiology
- Abstract
Adding universal rectal screening to urogenital screening should positively impact rectal Chlamydia trachomatis (CT) incidence in affected populations. A dynamic Markov model was used to evaluate costs and outcomes of three rectal CT screening strategies among women attending sexually transmitted infection clinics in Alberta, Canada: universal urogenital-only screening (UG-only), additional selected (exposure-based) rectal screening (UG+SR), and additional universal rectal screening (UG+UR). The model included two mutually exclusive health states: infected and susceptible. Additionally, the model included two rounds of transmission: male sex partners of women infected with rectal-only CT and female sex partners of those men. CT complications impacting patients' quality of life (QALY) were considered. Alberta and Canadian data were used to estimate model inputs. We used a health care perspective, a time period of 10 years, and a discount rate of 3% for analyses. Compared to UG-only screening, the incremental cost effectiveness ratios (ICERs) were CA$34,000 and CA$49,000 per QALY gained for UG+SR and UG+UR screening strategies, respectively. Compared to UG+SR, the ICER was CA$62,000 per QALY gained for the UG+UR strategy. Both adjunct selected and universal rectal screening strategies are cost effective compared to UG-only screening, and UG+UR screening is cost effective when compared to UG+SR screening.
- Published
- 2017
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43. Trichomonas vaginalis Prevalence and Correlates in Women and Men Attending STI Clinics in Western Canada.
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Gratrix J, Plitt S, Turnbull L, Smyczek P, Brandley J, Scarrott R, Naidu P, Bertholet L, Chernesky M, Read R, and Singh AE
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- Adult, Alberta epidemiology, Demography, Female, Humans, Male, Prevalence, Prospective Studies, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases parasitology, Trichomonas Vaginitis diagnosis, Trichomonas Vaginitis parasitology, Young Adult, Sexually Transmitted Diseases epidemiology, Trichomonas Vaginitis epidemiology, Trichomonas vaginalis isolation & purification
- Abstract
Trichomonas vaginalis prevalence (2.8%) in female sexually transmitted infection clinic attendees was within the prevalence of chlamydia (5.8%) and gonorrhea (1.8%), while being very low for male attendees (0.2%). Correlates among women were indigenous ethnicity, other ethnicity, and being symptomatic.
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- 2017
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44. Prevalence and antibiotic resistance of Mycoplasma genitalium among STI clinic attendees in Western Canada: a cross-sectional analysis.
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Gratrix J, Plitt S, Turnbull L, Smyczek P, Brandley J, Scarrott R, Naidu P, Parker P, Blore B, Bull A, Shokoples S, Bertholet L, Martin I, Chernesky M, Read R, and Singh A
- Subjects
- Adult, Alberta epidemiology, Cervix Uteri microbiology, Chlamydia Infections drug therapy, Chlamydia Infections epidemiology, Chlamydia trachomatis drug effects, Cross-Sectional Studies, Female, Fluoroquinolones therapeutic use, Gonorrhea drug therapy, Gonorrhea epidemiology, Humans, Logistic Models, Macrolides therapeutic use, Male, Moxifloxacin, Multivariate Analysis, Neisseria gonorrhoeae drug effects, Sex Factors, Urine microbiology, Young Adult, Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial, Mycoplasma Infections drug therapy, Mycoplasma Infections epidemiology, Mycoplasma genitalium drug effects
- Abstract
Objectives: To determine the prevalence and correlates of M ycoplasma genitalium (MG) infection among men and women, determine the prevalence of gene mutations conferring resistance and compare test performance of female specimen types., Methods: A cross-sectional study was conducted on specimens collected for gonorrhoea (NG, Neisseria gonorrhoeae ) and chlamydia (CT, Chlamydia trachomatis ) among male and female Alberta STI clinic attendees using the M. genitalium transcription-mediated amplification-research use only test. Positive specimens were sequenced for 23SrRNA, parC and gyrA genes. Gender-stratified analysis compared test results using χ
2 or Fisher's exact test, Mann-Whitney U test and logistic regression. Female endocervical and urine specimens were compared., Results: A total of 2254 individuals were tested; 53.8% (n=1212) were male. Male prevalence of MG was 5.3%; CT was 5.9% and NG was 1.8%. Correlates of male infection were a non-gonococcal urethritis diagnosis and NG coinfection. MG prevalence for women was 7.2%; CT was 5.8% and NG was 1.8%. Correlates of female infection were younger age, Indigenous/Other ethnicity and CT/NG coinfection. Nearly two-thirds of eligible specimens had mutations associated with macrolide resistance and 12.2% of specimens had a parC mutation signifying possible moxifloxacin resistance. There was high concordance (98.1%) of results between urine and endocervical swabs., Conclusions: The high prevalence of MG relative to CT and NG supports the incorporation of MG testing into routine sexually transmissible infection screening. The high rate of resistance to macrolides and moxifloxacin raises concerns about treatment options. The good concordance of results between urine and endocervical swabs supports the use of female urine specimens for testing., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)- Published
- 2017
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45. Retrospective Review of Gonococcal and Chlamydial Cases of Epididymitis at 2 Canadian Sexually Transmitted Infection Clinics, 2004-2014.
- Author
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Chen JZ, Gratrix J, Brandley J, Smyczek P, Parker P, Read R, and Singh AE
- Subjects
- Adult, Alberta epidemiology, Anti-Bacterial Agents therapeutic use, Chlamydia Infections microbiology, Chlamydia Infections physiopathology, Epididymitis drug therapy, Epididymitis physiopathology, Gonorrhea microbiology, Gonorrhea physiopathology, Humans, Male, Medication Adherence statistics & numerical data, Middle Aged, Practice Guidelines as Topic, Retrospective Studies, Treatment Outcome, Young Adult, Chlamydia Infections epidemiology, Epididymitis epidemiology, Epididymitis microbiology, Gonorrhea epidemiology
- Abstract
Fifty-seven cases of gonococcal and chlamydial infections complicated by acute epididymitis seen at 2 Alberta STI clinics from 2004 to 2014 were reviewed. The majority responded to treatment recommended by national guidelines. Three of 6 treatment failures were not treated according to guidelines.
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- 2017
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46. Use of the APTIMA Combo 2 Assay and a Secondary Algorithm to Detect and Confirm Chlamydia trachomatis in Rectal-Only Infections.
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Pabbaraju K, Wong S, Gill K, Severini A, Roy F, Gratrix J, Singh AE, Naidu P, Read R, and Drews SJ
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- Algorithms, Chlamydia Infections microbiology, Chlamydia trachomatis genetics, Female, Humans, Male, Chlamydia Infections diagnosis, Chlamydia trachomatis isolation & purification, Rectum microbiology
- Abstract
We sought to confirm the results of 81 rectal specimens positive for Chlamydia trachomatis by the APTIMA Combo 2 assay among patients with concurrently collected negative genitourinary specimens. A total of 79 (97.5%) samples were confirmed by the APTIMA single target assay and/or sequencing of the C. trachomatis ompA gene.
- Published
- 2017
- Full Text
- View/download PDF
47. A Retrospective Review of Treatment Failures Using Azithromycin and Doxycycline in the Treatment of Rectal Chlamydia Infections in Women and Men Who Have Sex With Men.
- Author
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Gratrix J, Brandley J, Dane M, Plitt SS, Smyczek P, Read R, and Singh AE
- Subjects
- Adult, Alberta, Female, Homosexuality, Male, Humans, Male, Retrospective Studies, Treatment Failure, Young Adult, Anti-Bacterial Agents pharmacology, Azithromycin pharmacology, Chlamydia Infections drug therapy, Chlamydia trachomatis drug effects, Doxycycline pharmacology, Rectal Diseases drug therapy
- Abstract
We examined the prevalence of rectal chlamydia treatment failures in men who have sex with men and women attending Alberta sexually transmitted infection clinics. Among those completing a test of cure, there was no significant difference among patients treated initially with azithromycin (treatment failure, 39/460 [8.5%]; 95% confidence interval, 5.9%-11.0%) compared with patients treated with doxycycline (0/16; 95% confidence interval, 0%-0.2%; P = 0.63).
- Published
- 2016
- Full Text
- View/download PDF
48. Impact of Introducing Triage Criteria for Express Testing at a Canadian Sexually Transmitted Infection Clinic.
- Author
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Gratrix J, Bergman J, Brandley J, Parker P, Smyczek P, and Singh AE
- Subjects
- Ambulatory Care Facilities statistics & numerical data, Canada epidemiology, Female, Humans, Male, Prevalence, Sexual Behavior, Time Factors, Chlamydia Infections diagnosis, Gonorrhea diagnosis, Nucleic Acid Amplification Techniques statistics & numerical data, Office Visits statistics & numerical data, Syphilis diagnosis, Triage statistics & numerical data
- Abstract
The implementation of express testing in an sexually transmitted infection (STI) clinic reduced the length of visit time compared with other visit types and increased the proportion of STIs diagnosed at clinic visits. Express testing did not impact the time to treatment for asymptomatic patients diagnosed as having an STI.
- Published
- 2015
- Full Text
- View/download PDF
49. Intensive HIV Partner Notification Is Effective in Identifying New and Previously Diagnosed HIV Infections in Edmonton, Canada.
- Author
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Bergman J, Gratrix J, Pillay T, Houston S, Cooper R, Charlton CL, Lemire S, Paradis K, Birse T, and Singh AE
- Subjects
- Adult, Canada, Female, HIV Infections prevention & control, Health Surveys, Humans, Male, Contact Tracing statistics & numerical data, HIV Infections diagnosis, Outcome and Process Assessment, Health Care, Sexual Partners
- Published
- 2015
- Full Text
- View/download PDF
50. Gonorrhea Treatment Failures With Oral and Injectable Expanded Spectrum Cephalosporin Monotherapy vs Dual Therapy at 4 Canadian Sexually Transmitted Infection Clinics, 2010-2013.
- Author
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Singh AE, Gratrix J, Martin I, Friedman DS, Hoang L, Lester R, Metz G, Ogilvie G, Read R, and Wong T
- Subjects
- Administration, Intravenous, Administration, Oral, Canada epidemiology, Drug Therapy, Combination, Female, Humans, Male, Microbial Sensitivity Tests, Practice Guidelines as Topic, Retrospective Studies, Treatment Failure, Anti-Bacterial Agents administration & dosage, Azithromycin administration & dosage, Cephalosporins administration & dosage, Gonorrhea drug therapy, Neisseria gonorrhoeae drug effects
- Abstract
Background: Antimicrobial resistance has developed to all antibiotics used to treat gonorrhea (GC), and trends in GC antimicrobial resistance have prompted changes in treatment guidelines. We examined treatment failures in sexually transmitted infection clinics., Methods: Four Canadian sexually transmitted infection clinics reviewed treatment regimens, minimum inhibitory concentrations for cephalosporins and azithromycin, anatomical infection sites, and treatment outcomes for GC infections between January 2010 and September 2013, in individuals who returned for test of cure within 30 days of treatment. Treatment failure was defined as the absence of reported sexual contact during the posttreatment period and (i) positive for Neisseria gonorrhoeae on culture of specimens taken at least 72 hours after treatment or (ii) positive nucleic acid amplification test specimens taken at least 2 to 3 weeks after treatment, and matching sequence type pretreatment and posttreatment. χ Test and Fisher exact test were used to assess association of categorical variables., Results: Of 389 specimens reviewed, GC treatment failures occurred in 13 specimens treated with cefixime 400-mg single dose (17.8% treatment failure rate regardless of anatomical site) and in 1 oropharyngeal specimen treated with cefixime 800-mg single dose. No treatment failures occurred using either ceftriaxone monotherapy or cefixime/ceftriaxone combined with azithromycin or doxycycline., Conclusions: In contrast to oral cefixime monotherapy, no treatment failures were identified with injectable ceftriaxone monotherapy or combination GC treatment. Our data support the use of combination treatment of GC with an extended spectrum cephalosporin (including oral cefixime) with azithromycin or doxycycline as well as ceftriaxone monotherapy.
- Published
- 2015
- Full Text
- View/download PDF
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