Abdomen agudo quirúrgico por Neisseria gonorrhoeae / Acute surgical abdomen due to Neisseria gonorrhoeae / Abdome agudo cirúrgico por Neisseria gonorrhoeae

Resumen El diagnóstico diferencial de enfermedad inflamatoria pélvica (EIP) representa un desafío, porque tiene un gran polimorfismo en su forma de presentación y, de ser sintomática, se confunde con numerosas patologías que ocasionan dolor abdominal agudo. Neisseria gonorrhoeae es uno de sus agentes etiológicos más frecuentes. Se presenta el caso de una paciente de sexo femenino con síndrome de abdomen agudo asociado a vómitos. Los estudios de imágenes (ecografía y tomografía axial computada) revelaron la presencia de líquido interasas y apéndice aumentado de tamaño. Se decidió conducta quirúrgica. Durante la misma se tomó muestra de líquido abdominal de cuyo análisis microbiológico se recuperó N. gonorrhoeae, sensible a ceftriaxona y a azitromicina. La paciente fue tratada con estos antibióticos en dosis de 1 g/día/endovenoso, con buena evolución clínica. Frente a una paciente en edad fértil con abdomen agudo es útil recordar, por sus implicancias, la posibilidad de una EIP por N. gonorrhoeae.

Abstract Differential diagnosis of pelvic inflammatory disease (PID) represents a challenge because it has a great polymorphism in its presentations and, if symptomatic, there are numerous pathologies that cause acute abdominal pain. Neisseria gonorrhoeae is one of the most frequent etiological agents. The case of a female patient with acute abdominal syndrome associated with vomiting is presented. Imaging studies (ultrasound and computed tomography) revealed the presence of fluid between the intestinal loops and an enlarged appendix. Surgical management was decided, during which a sample of abdominal liquid was taken and N. gonorrhoeae, susceptible to ceftriaxone and azithromycin, was recovered from its microbiological analysis. The patient was treated with these antibiotics at doses of 1 g/day/iv, with good clinical evolution. In the case of a patient of childbearing age suffering from acute abdomen, it is useful to remember, because of its implications, the possibility of PID due to N. gonorrhoeae.

Resumo O diagnóstico diferencial de doença inflamatória pélvica (DIP), representa um desafio, porque tem um amplo polimorfismo em sua forma de apresentação e, caso seja sintomática, confunde-se com numerosas patologias que causam dor abdominal aguda. Neisseria gonorrhoeae é um dos seus agentes etiológicos mais frequentes. É apresentado o caso de uma paciente de sexo feminino com síndrome de abdome agudo associado com vômitos. Os estudos das imagens (ultrassonografia e tomografía axial computadorizada) revelaram a existência de líquido ascítico e apêndice aumentado de tamanho. Decidiu-se o tratamento cirúrgico. Durante a prática cirúrgica foi obtida amostra do líquido abdominal de cuja análise microbiológica foi recuperada N. gonorrhoeae, sensível à ceftriaxona e à azitromicina. A paciente recebeu o tratamento com esses antibióticos em dose de 1 g/dia/intravenosa, obtendo boa evolução clínica. Diante de uma paciente em idade fértil com abdome agudo, é útil lembrar, pelas suas consequências, a possibilidade de uma DIP por N. gonorrhoeae.

Etiología de las infecciones de transmisión sexual (ITS) diagnosticadas por la técnica de PCR múltiple-hibridación en población colombiana de la ciudad de Medellín atendida en el Laboratorio Clínico VID / Etiology of sexually transmitted infections (STIs) diagnosed by multiplex PCR-hibridization assay technique in a Colombian population attending the VID Clinical Laboratory in Medellin

Introducción. Las infecciones de transmisión sexual (ITS) son y seguirán siendo un serio problema de salud pública en todo el mundo según los datos de la OMS, con el agravante que la mayoría de los casos son asintomáticos y, además, no existe otro reservorio distinto al humano. El diagnóstico se puede realizar con pruebas tradicionales y moleculares, estas últimas incluyen la reacción en cadena de la polimerasa (PCR), de las cuales existen varios tipos, entre ellas, la PCR múltiple que tiene la capacidad de detectar ITS polimicrobianas a partir de una sola muestra. El objetivo de este estudio fue establecer cuáles fueron las infecciones de transmisión sexual más frecuentes en diferentes grupos de pacientes, así como determinar la utilidad del uso de la técnica de PCR múltiple en el diagnóstico de las ITS. Metodología. Se trata de un estudio observacional de corte transversal realizado entre los años 2021 y 2022 con pacientes que acudieron al servicio de diagnóstico del Laboratorio Clínico VID por sospecha de ITS. Las muestras recolectadas fueron evaluadas utilizando una prueba comercial basada en la técnica de PCR múltiple e hibridación. Las muestras procesadas fueron: orina e hisopados de endocérvix, uretra, recto, faringe y úlceras. Resultados. Se estudiaron 1.027 pacientes, de estos, 228 (22,2 %) fueron positivos para diferentes agentes de trasmisión sexual, distribuidos así: 50 (21,9 %) mujeres, 129 (56,6 %) hombres heterosexuales y 49 (21,5 %) hombres que tenían sexo con hombres (HSH). La edad promedio de las mujeres fue 30 años, y la de ambos grupos de hombres fue 36 años. Los microorganismos más frecuentemente identificados en mujeres fueron: C. trachomatis (A-K) en 28,6 %, seguido de virus herpes simplex tipo 2 (VHS-2) en 26,8 % y N. gonorrhoeae en 17,9 %. En hombres heterosexuales fueron C. trachomatis (A-K) en 37,5 %, N. gonorrhoeae en 21,5 % y VHS-2 en 18,7 %. En HSH fueron C. trachomatis (L1-L3) en 32,7 %, seguido de N. gonorrhoeae en 27,6 %, y de C. trachomatis (A-K) y VHS-2, ambos en 13,8 %. En 11 hombres heterosexuales, 8 HSH y en 6 mujeres, se identificó infección polimicrobiana. Conclusiones. C. trachomatis (A-K) fue el microorganismo más prevalente causante de ITS, seguido de N. gonorrhoeae en ambos grupos de hombres, y de VHS-2 en las mujeres, muy similar a lo reportado a nivel mundial. La prueba de PCR múltiple permite la detección de infecciones polimicrobianas comúnmente asociadas a ITS y el diagnóstico es preciso y confiable, incluso en pacientes asintomáticos

Sexually transmitted infections (STIs) are and will continue to be a serious public health problem throughout the world according to WHO data, with the aggravating factor that most cases are asymptomatic and, furthermore, there is no other reservoir other than humans. The diagnosis can be made with traditional and molecular tests, the latter include the polymerase chain reaction (PCR), of which there are several types, among them, multiplex PCR that has the capacity to detect polymicrobial STIs from a single sample. The objective of this study was to establish which were the most frequent sexually transmitted infections in different groups of patients, as well as to determine the usefulness of the multiplex PCR technique in the diagnosis of STIs. Methodology. This is an observational, cross-sectional study carried out between 2021 and 2022 with patients who attended the VID Clinical Laboratory for suspected STIs. The collected samples were evaluated using a commercial test based on the multiplex PCR technique and hybridization. The samples processed were: urine and swabs from endocervix, urethra, rectum, pharynx, and ulcers. Results. The study included 1,027 patients, of these, 228 (22.2%) were positive for different sexually transmitted agents, distributed as follows: 50 (21.9%) women, 129 (56.6%) heterosexual men and 49 (21.5%) men who had sex with men (MSM). The average age of the women was 30 years, and that of both groups of men was 36 years. The microorganisms most frequently identified in women were: C. trachomatis (A-K) in 28.6%, followed by herpes simplex virus type 2 (HSV-2) in 26.8% and N. gonorrhoeae in 17.9%. In heterosexual men they were C. trachomatis (A-K) in 37.5%, N. gonorrhoeae in 21.5% and HSV-2 in 18.7%. In MSM they were C. trachomatis (L1-L3) in 32.7%, followed by N. gonorrhoeae in 27.6%, and C. trachomatis (A-K) and HSV-2, both in 13.8%. Polymicrobial infection was identified in 11 heterosexual men, 8 MSM, and 6 women. Conclusions. C. trachomatis (A-K) was the most prevalent STI-causing microorganism, followed by N. gonorrhoeae in both groups of men, and HSV-2 in women, very similar to that reported worldwide. The multiplex PCR test allows the detection of polymicrobial infections commonly associated with STIs and the diagnosis is accurate and reliable, even in asymptomatic patients

Expression and purification of a peptide fragment of 660 - 1468 amino acids in Neisseria gonorrhoeae NGO2105 protein as well as preparation and identification of its polyclonal antibody / 中华皮肤科杂志

Objective:To prokaryotically express a peptide fragment of 660 - 1468 amino acids in Neisseria gonorrhoeae NGO2105 protein, and to prepare and identify its polyclonal antibody. Methods:The pCold TF-NGO2105 660-1468 aa recombinant plasmid was transformed into the bacterium Escherichia coli BL21 (DE3) for protein expression. After the inclusion body protein was denatured and renatured, the target protein was purified. Then, BALB/c mice were immunized with the target protein to prepare a polyclonal antiserum; the antibody potency was evaluated by enzyme-linked immunosorbent assay, the specificity of the antibody against NGO2105 protein in Neisseria gonorrhoeae was analyzed by Western blot analysis, the affinity of the antiserum with Neisseria gonorrhoeae was analyzed by flow cytometry, and adhesion inhibition assay was performed to evaluate the inhibitory effect of anti-NGO2105 660-1468 aa antibody on the adhesion of Neisseria gonorrhoeae to human cervical epithelial ME-180 cells. Comparisons between different groups were performed by using t test. Results:The NGO2105 660-1468 aa protein was expressed as the inclusion body, and the soluble target protein was obtained by denaturation, renaturation, and purification. After immunization of mice with the target protein, the antiserum titer was 5.12 × 10 6, and flow cytometry showed that the antibody bound well to the Neisseria gonorrhoeae NGO2105 660-1468 aa. Adhesion inhibition assay showed that the anti-NGO2105 660-1468 aa antibody significantly inhibited the adhesion of Neisseria gonorrhoeae to ME-180 cells, and the inhibitory effect was concentration-dependent to some extent, with the adhesion rates of Neisseria gonorrhoeae treated with 20- and 40-fold dilutions of the anti-NGO2105 660-1468 aa antibody being 52.9% and 79.2% respectively, significantly lower than the adhesion rate in the untreated group (100%, t = 8.40, 5.29, P < 0.001, = 0.006, respectively) . Conclusion:The NGO2105 660-1468 aa protein was successfully expressed and purified, and a highly potent polyclonal antibody was prepared, which had a good affinity with Neisseria gonorrhoeae and an adhesion inhibition ability.

Gonococcal arthritis in a healthy adult. Is it that possible?

A case report is presented of a 50-year-old woman who was seen in Accident and Emergency because of pain in the lumbar area. She was subsequently diagnosed with septic arthritis of the left hip due to being Neisseria gonorrhoeae positive for beta-lactamase. She responded to treatment with ceftriaxone, but later required a total hip replacement.

Presentamos el caso de una mujer de 50 arios, sin antecedentes de importancia, a quien se le diagnosticó inicialmente lumbago e infección de vías urinarias. Por persistencia del dolor y limitación de la movilidad en la cadera izquierda se inicia el estudio de artritis séptica, que fue provocada por Neisseria gonorrhoeae betalactamasa positiva, sensible a tratamiento con ceftriaxona, con posterior deterioro articular, el cual requirió reemplazo total de cadera.

Pelviperitonitis gonocócica. A propósito de un caso

Neisseria gonorrhoeae se considera uno de los agentes causales más importantes de la enfermedad pélvica inflamatoria (EPI) produciendo síntomas leves e inespecíficos, lo cual la convierte en un desafío diagnóstico. Se presenta un caso de una pelviperitonitis gonocócica aguda con dolor difuso, distensión abdominal, fiebre. El único hallazgo destacable fue un líquido peritoneal y endocervical purulento con reactantes de fase aguda elevados. El cultivo del líquido endocervical y peritoneal fue positivo para N. gonorrhoeae. En mujeres sexualmente activas y con sospecha de EPI es importante descartar enfermedades de transmisión sexual.

Neisseria gonorrhoeae is considered one of the most important causal agents of pelvic inflammatory disease, producing mild and nonspecific symptoms, which makes it a diagnostic challenge. A case of acute gonococcal pelviperitonitis with abdominal distension, fever and diffuse pain is presented. The only noteworthy finding was purulent peritoneal and endocervical fluid with elevated acute-phase reactants. Endocervical and peritoneal fluid culture showed infection with N. gonorrhoeae. Therefore, in sexually active women with suspected PID, it is important to rule out sexually transmitted diseases.

A pilot study to determine Neisseria gonorrhoeae–Chlamydia trachomatis coinfection rates in symptomatic patients attending STI Clinics, New Delhi, India

Background: Neisseria gonorrhoeae and Chlamydia trachomatis are the two most prevalent bacterial sexually transmitted infections. For over two decades, treatment guidelines have recommended empirical co-treatment for N.gonorrhoeae and C.trachomatis as symptoms overlap and co-infection is common. Studies from India estimating the same are limited and mostly based on conventional techniques. Aim and Objective: The aim of this study was to determine the frequency of N.gonorrhoeae and C.trachomatis coinfection using nucleic acid amplification tests. Further, we assessed the utility of pus cell estimation in Gram stained smears as a screening tool for inclusion of samples for molecular diagnosis. Methods: This was a prospective study conducted at two tertiary care hospitals; 100 patients (55 females and 45 males) with genitourinary discharge attending STI clinics were recruited, and endocervical or urethral swabs were collected. PCRs for N.gonorrhoeae and C.trachomatis were put up. In addition, microscopy and culture for gonococcus was performed followed by antimicrobial susceptibility testing. Statistical analysis was performed using the SPSS 16 software. Results: N.gonorrhoeae infection was more common than C.trachomatis. A total of 14 patients were positive by PCR (9 males and 5 females) for gonococcus. However, culture was positive only in 8 male patients. PCR for C.trachomatis was positive in 9 (4 males and 5 females) and the co-infection rate was 5%. The sensitivity and negative predictive value of pus cell estimation was 100% for males and 64% and 94.6% respectively for females. All isolates were susceptible to extended spectrum cephalosporins and azithromycin. Limitation: The sample size of the study was small. Conclusion: Frequency of N.gonorrhoeae/C.trachomatis coinfection in symptomatic STI patients is low. Coinfection is considerably overestimated and necessary confirmation of etiological diagnosis could reduce widespread empirical administration of broad-spectrum antibiotics.

Bilateral Gonococcal Conjunctivitis in An Adult: A Case Report

Gonococcal conjunctivitis is a condition characterized by copious mucopurulent discharge associated with chemosis and eyelid edema. It could potentially lead to blindness due to the ability of Neisseria gonorrhoeae, the causative organism of this condition to cause cornea injury. Herein, we present an unusual case of bilateral gonococcal conjunctivitis in a sexually active adult that developed following the use of his own urine to treat symptom of red eye. The need for health education on safe eye care practices that include avoidance of the use of urine (a potential source of gonococcal infection) as traditional eye medicine is hereby emphasized.

Prevalence and antimicrobial resistance profiles of Neisseria gonorrhea and Chlamydia trachomatis isolated from individuals attending STD clinics in Kampala, Uganda

Background: Sexually transmitted diseases (STDs) management in sub-Saharan Africa is syndromic but molecular diagnostics provide quicker, sensitive diagnosis and treatment. Effective STD control hinges on identification and treatment of infected persons and sexual partner contact tracing. Objectives: This study assessed feasibility of using the Xpert CT/NG test to identify prevalent Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) infections among STD clinic attendees and their sexual partners and tested for antimicrobial resistance for N. gonorrhea. Methods: A cross-sectional study was conducted at 4 outpatient STD clinics in Kampala, Uganda from February 2019 to October 2019. Participants received a syndromic diagnosis, were tested for NG and CT, as well as their sexual partners. Urine (men) and high vaginal swabs (women) were collected, examined using Xpert CT/NG assay. A total of 79 participants were enrolled at baseline of whom 25 had CT/NG. 21 partners of infected baseline participants and 7 partners of the 21 primary partners were enrolled. Results: The mean age of the reported sexual partners was 26 (18-43) years. The prevalence of NG was 25% at baseline and 18 % for CT. Nine (11.4%) people were dually infected. Men were more likely to have NG (p<0.001) at multivariable level. Two participants tested HIV-1 positive. On microbiological culture, 8 samples (2.5%) grew NG, and all were resistant to penicillin, ciprofloxacin. For CT, we found a preponderance of the F-serovar in this population. Conclusion: The most prevalent organism was Neisseria gonorrhea. Generally, the prevalence of CT and NG was high. Infection proportions increased among primary partners, particularly women. Etiologic testing without partner tracing and treatment may underestimate burden of CT/NG in this population and contribute to re-infection

A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America / Revisión sistemática de la prevalencia de determinadas infecciones de transmisión sexual en la población joven en América Latina / Revisão sistemática da prevalência de determinadas infecções sexualmente transmissíveis em jovens na América Latina

ABSTRACT Objective. To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean. Methods. The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle-Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported. Results. Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants). Conclusions. Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.

RESUMEN Objetivo. Calcular la carga de infecciones por Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (PT) y el virus del papiloma humano (VPH) en personas de edades comprendidas entre los 10 y los 25 años en América Latina y el Caribe. Métodos. Se realizaron búsquedas en las bases de datos MEDLINE, EMBASE y LILACS, así como en documentos de organizaciones regionales o instituciones nacionales de salud. Se incluyeron estudios poblacionales que notificaron la prevalencia o la incidencia de CT, NG, TP y VPH, detectados mediante pruebas confirmatorias en adolescentes y jóvenes. Dos revisores seleccionaron de forma independiente los estudios y extrajeron los datos. La calidad de los estudios se evaluó mediante la escala de Newcastle-Ottawa. Se hicieron estimaciones combinadas en los casos en que la heterogeneidad era <70 %; cuando no era posible, se presentaron los rangos de prevalencia. Resultados. De un total de 3 583 referencias, 15 estudios de prevalencia cumplieron los criterios de inclusión. Debido a una significativa heterogeneidad (>70%), no fue posible agrupar las estimaciones de frecuencia. En la población general, la prevalencia de infección por CT fluctuó entre 2,1 % y 30,1 % (9 estudios y 5 670 participantes); en el caso de NG, la prevalencia fluctuó entre 0 % y 2,9 % (8 estudios y 5 855 participantes); en el caso de PT, la prevalencia varió entre 0 % y 0,7 % (3 estudios y 11 208 participantes) y en el caso de infección por VPH, la prevalencia fluctuó entre 25,1 % y 55,6 % (8 estudios y 3 831 participantes). Conclusiones. Los datos poblacionales fiables sobre las infecciones de transmisión sexual (ITS) en adolescentes y jóvenes en América Latina y el Caribe son limitados. Es necesario hacer estudios adicionales para comprender mejor la carga de las ITS en este grupo poblacional. Sin embargo, dada la significativa prevalencia de ITS detectada, los países requieren políticas de salud pública para la prevención, el diagnóstico temprano y el tratamiento de las ITS en la población joven.

RESUMO Objetivo. Estimar a carga de infecção por Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP) e papilomavírus humano (HPV) na população entre 10 e 25 anos de idade na América Latina e no Caribe. Métodos. Foi realizada uma pesquisa nas bases de dados MEDLINE, EMBASE e LILACS, assim como da documentação de entidades regionais ou nacionais que atuam na área da saúde. Foram incluídos na revisão estudos populacionais que registraram a incidência ou a prevalência de infecção por CT, NG, TP e HPV, verificada por meio de exames confirmatórios realizados em adolescentes e jovens. Dois revisores trabalharam de modo independente na seleção dos estudos e extração dos dados. A qualidade dos estudos foi avaliada utilizando a Escala de Newcastle-Ottawa. Foi feito o cálculo dos estimadores combinados quando a heterogeneidade era <70% e apresentada a variação da prevalência nos outros casos quando essa estimativa não foi possível. Resultados. Das 3 583 referências levantadas, 15 eram estudos de prevalência que satisfizeram os critérios de inclusão. Devido à heterogeneidade considerável entre os estudos (>70%), não foi possível combinar os estimadores de frequência. Na população geral, a prevalência de infecção por CT variou entre 2,1% e 30,1% (9 estudos, 5 670 participantes); a de NG, entre 0 e 2,9% (8 estudos, 5 855 participantes); a de TP, entre 0 e 0,7% (3 estudos, 11 208 participantes); e a de infecção por HPV, entre 25,1% e 55,6% (8 estudos, 3 831 participantes). Conclusões. Faltam dados populacionais confiáveis relativos a infecções sexualmente transmissíveis (ISTs) em adolescentes e jovens na América Latina e no Caribe. Outros estudos devem ser realizados para um entendimento melhor da carga dessas infecções na população. Diante da elevada prevalência verificada, os países precisam dispor de políticas de saúde pública para prevenção, diagnóstico precoce e tratamento de ISTs na população jovem.'

Acceptability of self-sampling for etiological diagnosis of mucosal sexually transmitted infections (STIs) among transgender women in a longitudinal cohort study in São Paulo, Brazil

ABSTRACT This study conducted among transgender women in São Paulo, Brazil assessed the acceptability and suitability of screening sexually transmitted infections (STIs), such as Chlamydia trachomatis and Neisseria gonorrhoeae, by sampling multiple anatomical sites (i.e. urethral, anorectal, oropharyngeal, and neovaginal), and utilizing self- or provider-collection methods. First, a convenience sample of 23 cohort participants were recruited during a scheduled study visit between October and November 2018. Data collection was through a short investigator-led quantitative survey in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams to guide self-sampling. Three supplemental focus group discussions (FGDs) with a total of 30 participants guided by semi-structured script were conducted in Portuguese between September and October 2019. All participants reported being assigned male sex at birth and self-identified with a feminine gender identity at time of study. All survey respondents (100%; n = 23) indicated willingness to provide samples for STI screening during a future study visit. Preference was for self-collection of urine samples (83%; n = 19), urethral swabs (82%; n = 18), and anorectal swabs (77%; n = 17). A lower preference for self-collection of oropharyngeal swabs (48%; n = 11) was observed. Most respondents (78%; n = 18) indicated that they would not prefer specimens to be collected by a health professional, mainly due to 'more privacy' (72%; n = 13). All respondents indicated that they would feel comfortable to provide a self-collected sample based on instructional diagrams shown. In FGDs, although the collection by a health professional was described as a technically safer option for some participants, there was a preference for self-collection to avoid discomfort and embarrassment in exposing the body. Overall, this sub-study suggested acceptability among transgender women of introducing self-sampling for etiological diagnosis of STIs from potential infection sites. Uptake and usability will be explored further in a cross-sectional STI prevalence study of transgender women in Brazil.

Research progress in Neisseria gonorrhoeae lipooligosaccharides vaccine / 中华微生物学和免疫学杂志

Gonorrhea, caused by Neisseria gonorrhoeae, is one of the most frequently reported infectious diseases. With the increasing antibiotic resistance in Neisseria gonorrhoeae, gonorrhea has become a major public health problem worldwide, making it imperative to develop a safe and effective vaccine. Lipooligosaccharides (LOS), which exist on the outer surface of gram-negative bacteria, contain many important antigenic determinants. In recent years, a large number of studies have shown that LOS may become the most potential target of Neisseria gonorrhoeae vaccine and immunotherapy. This article reviewed the structure of LOS, its role in Neisseria gonorrhoeae infection, research progress in LOS vaccine and the challenges faced in vaccine development, aiming to provide reference for further study.

Gonococcal infections of the penile skin and accessory glands in men: high-frequency ultrasound features and their clinical significance / 中华皮肤科杂志

Objective:To investigate ultrasonographic manifestations of gonococcal infections of the penile skin and accessory glands in men, and to assess their clinical significance.Methods:From January 2014 to January 2021, male patients with gonococcal infections of the penile skin and accessory glands were collected from Department of Dermatology, Changshu No.1 People′s Hospital. The diagnosis had been confirmed by laboratory examinations, and these patients had not received relevant treatment. The real-time ultrasound imaging system SIEMENS ACUSON X300 was used to examine the penile skin and accessory gland lesions infected with Neisseria gonorrhoeae, with the probe frequency ranging from 7.5 to 15 MHz. Patients with tubular anechoic fluid-filled areas on the high-frequency ultrasound images received a single dose of intramuscular ceftriaxone (1 g) ; those with oval-shaped anechoic fluid-filled areas on the high-frequency ultrasound images received incision and drainage followed by intramuscular injection of ceftriaxone at a dose of 1 g once a day for 5 consecutive days; those with hypoechoic or mixed echoic areas on the high-frequency ultrasound images received intramuscular injection of ceftriaxone at a dose of 1 g once a day for 5 consecutive days, and if the nodules did not regress after 1-month treatment, local resection would be performed. One month after the treatment, the patients were followed up, and the efficacy was evaluated. Results:A total of 32 male patients with gonococcal infections of the penile skin and accessory glands were collected. They were aged 28.54 ± 3.27 years, all had a history of non-marital sexual contact, and the duration from non-marital sexual contact to the onset of symptoms was 4.45 ± 1.03 days. The disease course was 8.64 ± 1.87 days. Lesions were all solitary, and located at the external urethral meatus in 16 cases (50.00%) , at the glans penis in 7 cases (21.88%) , beside the foreskin frenulum in 5 cases (15.62%) , and at the penile raphe in 4 cases (12.50%) . Sixteen patients (50.00%) presented with sinus-like lesions, 9 (28.13%) with abscesses, 7 (21.87%) with nodules, and all had tenderness on palpation. High-frequency ultrasound examination showed tubular anechoic fluid-filled areas in 16 cases (50.00%) , oval-shaped anechoic fluid-filled areas in 7 cases (21.88%) , hypoechoic areas in 5 cases (15.62%) , and mixed echoic areas in 4 cases (12.50%) . Gonococcal infections involved the cavernous body of the urethra in 16 cases (50.00%) , cavernous body of the penis in 5 cases (15.62%) , and subcutaneous tissue of the penis in 11 cases (34.38%) . After the treatment, all the patients were cured.Conclusion:High-frequency ultrasound can be used in the assessment of skin lesions and selection of treatment regimens for male patients with gonococcal infections of the penile skin and accessory glands.

Ceftriaxone-resistant Neisseria gonorrhoeae strain FC428: prevalence, resistance mechanisms and control strategies / 中华皮肤科杂志

Antimicrobial resistance of Neisseria gonorrhoeae has become a big challenge in the control and prevention of sexually transmitted diseases. Recently, a ceftriaxone-resistant Neisseria gonorrhoeae strain FC428 has spread across the world including China, which has worsened the antimicrobial resistance problem. This strain is highly resistant to ceftriaxone due to a novel mosaic penA gene. In order to better understand the characteristics of FC428 and control its further spread, this review summarizes its origin, spread, main molecular characteristics, resistance mechanisms, detection methods, and strategies for clinical treatment and antimicrobial resistance surveillance.

Endocarditis infecciosa por Neisseria gonorroheae / Infectious endocarditis due to Neisseria gonorrhoeae

Resumen Se presenta un caso de endocarditis infecciosa por Neisseria gonorrhoeae, en un paciente masculino de 38 años, sin factores de riesgo cardiovascular ni otros antecedentes previos. La sospecha diagnóstica comienza por síndrome febril prolongado, astenia y pérdida de peso, confirmada con rescate de gonococo en los hemocultivos. Cumplió tratamiento antibiótico con ceftriaxona por 29 días. Evoluciona con insu ficiencia aórtica grave por lo cual se realiza cirugía de reemplazo valvular por prótesis mecánica bidisco exitosa, con una evolución favorable.

Abstract We report a case of infectious endocarditis due to Neisseria gonorrhoeae in a 38-year-old male patient with no cardiovascular risk factors or past medical history who presented with prolonged febrile illness, asthenia and weight loss. The blood cultures were positive for gonococcus. He received antibiotic treatment with ceftriaxone for 29 days. The patient developed severe aortic regurgitation and underwent surgical aortic valve replacement with a bileaflet mechanical prosthesis, with favorable outcome.

Neisseria gonorrhoeae: un patógeno díscolo: conceptos microbiológicos, resistencia a antimicrobianos y su vigilancia epidemiológica en Chile / Neisseria gonorrhoeae: a wayward pathogen: microbiological concepts, antimicrobial resistance and its epidemiological surveillance in Chile

Resumen Neisseria gonorrhoeae es un diplococo gramnegativo, no móvil, esporulado, aerobio o anaerobio facultativo, catalasa y oxidasa positivas. Las infecciones de transmisión sexual causadas por este microorganismo son un problema de salud pública definido como tal desde el siglo XIX, representando una gran amenaza para la salud humana debido a la su alta prevalencia y multirresistencia a antimicrobianos. En las últimas décadas han aumentado los reportes de cepas resistentes a penicilina, fluoroquinolonas, sulfonamidas, tetraciclina, macrólidos, y más recientemente a cefalosporinas y azitromicina. Tal panorama ha generado preocupación a nivel mundial, debido al aumento de casos de gonorrea asociados a cepas multirresistentes. En Chile se desarrolló desde el 2010 hasta el 2018 el Programa de Vigilancia de N. gonorrhoeae a nivel nacional con el objeto de caracterizar esta infección en las regiones y registrar la resistencia a los antimicrobianos. Esta revisión presenta un análisis sistemático bibliográfico, actualizado, de los principales aspectos de este microorganismo, su respuesta a antimicrobianos, y entrega pautas de diagnóstico y tratamiento, a la espera de avanzar en la comprensión del mecanismo molecular y las interacciones metabólicas e inmunológicas que determinan la infección, con miras a diseñar una vacuna efectiva.

Abstract Neisseria gonorrhoeae is a nonmotile, sporulated, aerobic or facultative anaerobic gram-negative diplococcus, catalase and oxidase positive. Sexually transmitted infections caused by this microorganism were established as public health problem since the 19th century, representing a great threat to human health due to its high prevalence and multi-resistance to antimicrobials. In recent decades, reports of strains resistant to penicillin, fluoroquinolones, sulfonamides, tetracycline, macrolides, and more recently to cephalosporins and azithromycin have increased. Such a panorama has generated concern worldwide, due to the increase in cases of gonorrhea associated with multi-resistant strains. In Chile, from 2010 to 2018, the National Surveillance Program for N. gonorrhoeae was developed in order to characterize this infection in the regions and record antimicrobial resistance. This review presents an updated, systematic bibliographic analysis of the main aspects of this microorganism, its response to antimicrobials, and provides diagnostic and treatment guidelines, while waiting to advance in the understanding of the molecular mechanism and the metabolic and immunological interactions that determine infection, with a view to designing an effective vaccine.

Main etiological agents identified in 170 men with urethritis attended at the Fundação Alfredo da Matta, Manaus, Amazonas, Brazil,

Abstract Background: Sexually transmitted infections (STI) are a global public health problem. Urethritis are among the most common STIs, and can cause several complications and facilitate the transmission of the HIV virus. Objectives: To investigate the main etiologic agents of urethritis in 170 men treated at Fundação Alfredo da Matta. Methods: To identify the agents, urethral exudate and urine were collected. Gram and culture tests were performed in Thayer-Martin medium for Neisseria gonorrhoeae and polymerase chain reaction for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, Mycoplasma genitalium, and herpes simplex types 1 and 2. Results: N. gonorrhoeae were identified in 102 (60.0%) patients, C. trachomatis in 50 (29.4%), U. urealyticum in 29 (17.0%), M. genitalium in 11 (6.5 %), U. parvum in ten (5.9%), and M. hominis in seven (4.1%). Herpes simplex type 2 was diagnosed in 24 (21.6%) of the 111 patients who underwent PCR for this pathogen. In 69 cases there was co-infection; the most frequent were: N. gonorrhoeae and C. trachomatis in 21 (14.7%) patients; N. gonorrhoeae and C. trachomatis in 21 (12.4%) patients; N. gonorrhoeae and herpes simplex type 2 in 11 (6.5%), and N. gonorrhoeae and U. urealyticum in nine (5.3%). Study limitations: Not relevant. Conclusion: N. gonorrhoeae, C. trachomatis, U. urealyticum, and herpes simplex type 2 were the pathogens most frequently identified in the present study. The main coinfection found was N. gonorrhoeae and C. trachomatis. T. vaginalis and herpes simplex type 1 were not identified in any of the patients.

Brazilian protocol for sexually transmitted infections, 2020: pelvic inflammatory disease

Abstract Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy.

Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause urethral discharge

Abstract This article approaches infections that cause urethral discharge. This theme is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. Urethritis can cause severe and even irreversible health damage when not properly treated, or when the microorganism develops antimicrobial resistance. It is noteworthy that the high levels of antimicrobial resistance grown by pathogens that cause urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention, and control actions for infections that cause urethral discharge, to contribute to managers' and health professionals' care qualification.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam corrimento uretral / Brazilian Protocol for Sexually Transmitted Infections 2020: infections that cause urethral discharge / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan secreción uretral

Este artigo aborda as infecções que causam corrimento uretral, tema que compõe o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. As uretrites, quando não tratadas de maneira correta, ou quando o microrganismo desenvolve resistência ao tratamento empregado, podem causar danos graves e até irreversíveis à saúde. Os níveis de resistência antimicrobiana que esses agentes têm desenvolvido são considerados uma emergência global em saúde pública. Neste artigo, são apresentados aspectos epidemiológicos e clínicos, recomendações sobre diagnóstico e tratamento e estratégias para as ações de vigilância, prevenção e controle das infecções que causam corrimento uretral, com a finalidade de contribuir com gestores e profissionais de saúde para a qualificação da assistência.

This article approach infections that cause urethral discharge, theme which is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020. These guidelines were prepared based on scientific evidence and validated in discussions with experts. When urethritis is not treated correctly, or when the microorganism develops antimicrobial resistance, it can cause serious and even irreversible health damage. It is noteworthy that the high levels of antimicrobial resistance developed by pathogens that causes urethritis comprises a global emergency in public health. This article presents epidemiological and clinical aspects, recommendations on diagnostic and treatment, and strategies for surveillance, prevention and control actions of infections that cause urethral discharge, with the purpose of contributing with managers and health professionals to care qualification.

El artículo trata de las infecciones que causan secreción uretral, tema que hace parte del Protocolo Clínico y Directrices Terapéuticas para Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Dicho documento se elaboró con base en evidencias científicas y se validó en discusiones con expertos. Las uretritis, cuando no tratadas correctamente o cuando el microorganismo desarrolla resistencia al tratamiento, puede ocasionar daños graves a la salud. Los niveles de resistencia antimicrobiana que estos agentes desarrollan son considerados una emergencia de salud pública. En este artículo, se presentan aspectos epidemiológicos y clínicos, recomendaciones para el diagnóstico y tratamiento y estrategias para acciones de monitoreo epidemiológico, prevención y control de las infecciones que causan secreción uretral, a fin de contribuir con gestores y personal de salud para la cualificación de la asistencia.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: doença inflamatória pélvica / Brazilian Protocol for Sexually Transmitted Infections 2020: pelvic inflammatory disease / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: enfermedad inflamatoria pélvica

O tema doença inflamatória pélvica está contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. A doença inflamatória pélvica é a infecção aguda do trato genital superior feminino decorrente da ascensão canalicular de microrganismos cervicovaginais endógenos e, principalmente, os de transmissão sexual. Entre os agentes etiológicos envolvidos, destacam-se Chlamydia trachomatis e Neisseria gonorrhoeae. As sequelas mais importantes são dor pélvica crônica, infertilidade e gravidez ectópica. O diagnóstico clínico apresenta-se como a abordagem prática mais importante. O tratamento com antibióticos deve ser iniciado imediatamente diante da suspeição clínica. Descrevem-se orientações para gestores e profissionais de saúde sobre testes diagnósticos, tratamento preconizado, seguimento, aconselhamento, notificação, manejo de parcerias sexuais e de populações especiais. Com a maior disponibilidade da técnica de biologia molecular no Brasil, recomenda-se o rastreio de C. trachomatis e N. gonorrhoeae como estratégia preventiva da doença.

Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.

El tema de la enfermedad inflamatoria pélvica está incluido en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral para Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. La enfermedad inflamatoria pélvica es una infección aguda del tracto genital superior femenino resultante del ascenso canalicular de microorganismos cervicovaginales endógenos y, principalmente, los de transmisión sexual. Entre los agentes etiológicos involucrados, se destacan Chlamydia trachomatis y Neisseria gonorrhoeae. Las secuelas más importantes son: dolor pélvico crónico, infertilidad y embarazo ectópico. El diagnóstico clínico es el enfoque práctico más importante. El tratamiento con antibiótico debe iniciarse inmediatamente ante la sospecha clínica. Se describen pautas para gestores y profesionales de la salud sobre pruebas de diagnóstico, tratamiento, seguimiento, asesoramiento, notificación, manejo de parejas sexuales y poblaciones especiales. Con la mayor disponibilidad de la técnica de biología molecular, se recomienda el cribado de C. trachomatis y N. gonorrhoeae como estrategia preventiva para la enfermedad.