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1.
Int J STD AIDS ; 33(4): 404-415, 2022 03.
Article in English | MEDLINE | ID: covidwho-1883424

ABSTRACT

A large number of countries are being confronted with twin epidemics of increasing STI incidence and antimicrobial resistance (AMR). This has led to calls to intensify STI screening of high STI prevalence populations. The available evidence suggests that this will have little impact on STI prevalence but a significant deleterious effect on AMR. We suggest that this call to intensify STI screening is one of the several errors that stem from the way that the STI-field has been dominated by a biomedical individualistic conceptual framework. This framework views STIs as obligate pathogens that can and should be eradicated by intensive seek-and-destroy activities. We evaluate five types of evidence that suggest that a multi-level, socio-ecological framework would provide a more accurate portrayal of the important determinants of STI prevalence and AMR spread. By incorporating concepts such as limiting STI screening to scenarios with clear evidence of net-benefit and considering 'antimicrobial footprint' thresholds, this framework would be more likely to result in a better balance between targeting STI prevalence whilst minimizing the risk of AMR emerging.


Subject(s)
Gonorrhea , Sexually Transmitted Diseases , Anti-Bacterial Agents/therapeutic use , Gonorrhea/epidemiology , Humans , Mass Screening , Prevalence , Sexually Transmitted Diseases/diagnosis
2.
BMC Infect Dis ; 22(1): 519, 2022 Jun 04.
Article in English | MEDLINE | ID: covidwho-1879225

ABSTRACT

BACKGROUND: COVID-19 and Sexually Transmitted Diseases (STDs) are two very important diseases. However, relevant researches about how COVID-19 pandemic has impacted on the epidemiological trend of STDs are limited in China. This study aimed to analyze the impact of COVID-19 on STDs in China and proposed relevant recommendations to be used in bettering health. METHODS: The incidence of HIV infection, syphilis and gonorrhea in China from 2008 to 2020 were collected. Grey Model (1,1) were established to predict the incidence of STDs with the incidence data of these three STDs from 2013 to 2018 considering the impact of policies in China, respectively. We then calculated the predictive incidence of each STD in 2019, 2020 and 2021 by the established Model. And we estimated the extent of the impact of COVID-19 on the epidemiological changes of STDs by analyzing the difference between the absolute percentage error (APE) of the predictive incidence and actual rate in 2019 and 2020. RESULTS: The incidence of HIV infection and syphilis showed a trend of increase from 2008 to 2019 in China, but that for gonorrhea was fluctuant. Of note, the incidence of these three STDs decreased significantly in 2020 compared with that in 2019. The APE of HIV infection, syphilis and gonorrhea in 2020 (20.54%, 15.45% and 60.88%) were about 7 times, 4 times and 2 times of that in 2019 (2.94%, 4.07% and 30.41%). The incidence of HIV infection, syphilis and gonorrhea would be 5.77/100,000, 39.64/100,000 and 13.19/100,000 in 2021 based on our model. CONCLUSIONS: The epidemiological trend of STDs in China was significant influenced by COVID-19 pandemic. It is important to balance the control of COVID-19 and timely management of STDs during the COVID-19 epidemic to prevent or reduce the poor outcome among COVID-19 patients with STDs. New management strategies on STDs, such as leveraging social media, online medical care, rapid self-testing, timely diagnosis and treatment guarantee and balance of medical resources for STDs management should be adapted in the context of the long-term effects of COVID-19.


Subject(s)
COVID-19 , Gonorrhea , HIV Infections , Sexually Transmitted Diseases , Syphilis , COVID-19/epidemiology , China/epidemiology , Gonorrhea/epidemiology , Gonorrhea/prevention & control , HIV Infections/epidemiology , Humans , Pandemics , Sexually Transmitted Diseases/epidemiology , Syphilis/epidemiology , Syphilis/prevention & control
3.
Am J Public Health ; 112(7): 985-989, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1865380

ABSTRACT

The Baltimore City Health Department (Baltimore, MD) promoted IWantTheKit for chlamydia, gonorrhea, and HIV testing to city residents and clinic patients when COVID-19 restricted in-person clinic services. From April to October 2020, monthly online IWantTheKit orders increased by 645%. A high prevalence of chlamydia and gonorrhea was detected, and 96% of users who tested positive for chlamydia and gonorrhea were successfully contacted for treatment. Uptake by Baltimore City Health Department priority populations and excellent treatment linkage demonstrated how a public health-academic partnership successfully addressed a service gap during the pandemic. (Am J Public Health. 2022;112(7):985-989. https://doi.org/10.2105/AJPH.2022.306835).


Subject(s)
COVID-19 , Chlamydia Infections , Chlamydia , Gonorrhea , HIV Infections , COVID-19/diagnosis , COVID-19/epidemiology , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Gonorrhea/diagnosis , Gonorrhea/epidemiology , HIV Infections/diagnosis , HIV Infections/epidemiology , Humans
4.
Int J Infect Dis ; 118: 183-193, 2022 May.
Article in English | MEDLINE | ID: covidwho-1838865

ABSTRACT

OBJECTIVES: Molecular testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is costly. Therefore, we appraised the evidence regarding pooling samples from multiple individuals to test for CT/NG. METHODS: In this systematic review, we searched 5 databases (2000-2021). Studies were included if they contained primary data describing pooled testing. We calculated the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. RESULTS: We included 22 studies: most were conducted in high-income countries (81.8%, 18 of 22), among women (73.3%, 17 of 22), and pooled urine samples (63.6%, 14 of 22). Eighteen studies provided 25 estimates for the meta-analysis of diagnostic accuracy, with data from 6,913 pooled specimens. The pooled sensitivity for CT was 98.4% (95% confidence intervals [CI]: 96.8-99.2%, I2=77.5, p<0.001), and pooled specificity was 99.9% (95% CI: 99.6-100.0%, I2=62.6, p<0.001). Only 2 studies reported pooled testing for NG, and both reported similarly high sensitivity and specificity as for CT. Sixteen studies provided data on the cost of pooling, reporting cost-savings ranging from 39%-90%. CONCLUSIONS: Pooled testing from multiple individuals for CT is highly sensitive and specific compared with individual testing. This approach has the potential to reduce the cost of screening in populations for which single anatomic site screening is recommended.


Subject(s)
Chlamydia Infections , Gonorrhea , Chlamydia Infections/diagnosis , Chlamydia trachomatis , Female , Gonorrhea/diagnosis , Humans , Male , Mass Screening , Neisseria gonorrhoeae/genetics , Sensitivity and Specificity
5.
AIDS ; 36(6): 829-838, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1831560

ABSTRACT

OBJECTIVE: To assess the impact of coronavirus disease 2019 (COVID-19) epidemics on the prevention and care for HIV and other sexually transmitted infections at a major reference centre providing preventive and clinical services in Catalonia, Spain. DESIGN: We retrospectively compared anonymized clinical and laboratory data from March to December 2020 vs. 2019. METHODS: Monthly clinical data on HIV preexposure and postexposure prophylaxis users and on adults with HIV infection were retrieved from the administrative hospital database. Monthly tests for HIV, hepatitis B and C, Treponema pallidum, Neisseria gonorrhoeae,and Chlamydia trachomatis, and plasma lipids and glucose were recovered from the laboratory database. RESULTS: There were less (↓28%, P  = 0.003) but more advanced (mean CD4+ cells/µl 305 vs. 370, P  < 0.001) HIV infections and more gonorrhoea (↑39%, P  < 0.001) and chlamydia (↑37%, P  < 0.001) infections in 2020 vs. 2019. In people with HIV, rates of HIV RNA less than 50 copies/ml remained stable (11 vs. 11%, P  = 0.147) despite less scheduled visits (↓25%, P  < 0.001). However, they had less antiretroviral prescription changes (↓10%, P  = 0.018), worse plasma lipids [mean total cholesterol 190 vs. 185 mg/dl, P  < 0.001;mean low-density lipoprotein (LDL) cholesterol 114 vs. 110 mg/dl, P  < 0.001; mean triglycerides 136 vs. 125 mg/dl, P  < 0.001; mean high-density lipoprotein (HDL) cholesterol 47 vs. 48 mg/dl, P  = 006], and an excess of mortality (↑264%, P  = 0.006) due in great part not only to COVID-19 but also to other causes. CONCLUSION: In our setting, COVID-19 epidemics was associated with an increase in some prevalent sexually transmitted infections, with less but more advanced HIV infections, and with worse nonvirologic healthcare outcomes and higher mortality in people living with HIV.


Subject(s)
COVID-19 , Chlamydia Infections , Epidemics , Gonorrhea , HIV Infections , Sexually Transmitted Diseases , Adult , COVID-19/epidemiology , Chlamydia Infections/epidemiology , Cholesterol , Gonorrhea/epidemiology , Gonorrhea/prevention & control , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Lipids , Retrospective Studies , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control
6.
Sex Transm Dis ; 49(7): 490-496, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1806731

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, disruptions were anticipated in the US health care system for routine preventive and other nonemergency care, including sexually transmitted infection care. METHODS: Using a large national laboratory data set, we assessed the impact of the COVID-19 pandemic on the weekly numbers and percent positivity of chlamydia and gonorrhea tests ordered from the 5th week of 2019 to the 52nd week of 2020 in the United States. We compared weekly 2020 values for test volume, percent positive, and number of positives with the same week in 2019. We also examined the potential impact of stay-at-home orders for the month of April 2020. RESULTS: Immediately after the declaration of a national emergency for COVID-19 (week 11, 2020), the weekly number of gonorrhea and chlamydia tests steeply decreased. Tests then rebounded toward the 2019 pre-COVID-19 level beginning the 15th week of 2020. The weekly percent positive of chlamydia and gonorrhea remained consistently higher in 2020. In April 2020, the overall number of chlamydia tests was reduced by 53.0% (54.1% in states with stay-at-home orders vs. 45.5% in states without stay-at-home orders), whereas the percent positive of chlamydia and gonorrhea tests increased by 23.5% and 79.1%, respectively. CONCLUSIONS: To limit the impact of the pandemic on control of chlamydia and gonorrhea, public health officials and health care providers can assess measures put in place during the pandemic and develop new interventions to enable care for sexually transmitted infections to be delivered under pandemic and other emergency conditions. The assessment like this study is continuously needed.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexually Transmitted Diseases , COVID-19/diagnosis , COVID-19/epidemiology , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia Infections/prevention & control , Chlamydia trachomatis , Gonorrhea/diagnosis , Gonorrhea/epidemiology , Gonorrhea/prevention & control , Humans , Pandemics/prevention & control , Sexually Transmitted Diseases/epidemiology , United States/epidemiology
8.
Sex Transm Dis ; 49(2): 145-153, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1621710

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the disruption in care for sexually transmitted infections (STIs) and the social distancing measures have led to reductions in STI testing and sexual behavior. We assessed the impact of these COVID-19-related changes on transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among men who have sex with men (MSM) in The Netherlands. METHODS: We developed a mathematical model for CT and NG transmission among MSM, accounting for COVID-19-related changes in sexual behavior and testing in 2020 to 2021. Changes in 2020 were estimated from data from the Dutch COVID-19, Sex, and Intimacy Survey among MSM and the National Database of STI Clinics. Because of the lack of data for 2021, we examined several scenarios covering a range of changes. RESULTS: A reduction of 10% and 40% in STI testing of symptomatic and asymptomatic, respectively, individuals with a 10% to 20% reduction in numbers of casual partners (according to partner status and activity level) during the second lockdown, resulted in a 2.4% increase in CT prevalence, but a 2.8% decline in NG prevalence in 2021. A 5% and 30% reduction in STI testing of symptomatic and asymptomatic, respectively, individuals with the same reduction in casual partners resulted in a 0.6% increase in CT prevalence and a 4.9% decrease in NG prevalence in 2021. CONCLUSIONS: The disruption in STI care due to COVID-19 might have resulted in a small increase in CT prevalence, but a decrease in NG prevalence. Scaling up STI care is imperative to prevent increases in STI transmission.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , HIV Infections , Sexual and Gender Minorities , Sexually Transmitted Diseases , Chlamydia Infections/epidemiology , Communicable Disease Control , Gonorrhea/epidemiology , HIV Infections/epidemiology , Homosexuality, Male , Humans , Male , Models, Theoretical , Netherlands/epidemiology , Pandemics , Prevalence , SARS-CoV-2 , Sexual Behavior , Sexually Transmitted Diseases/epidemiology
10.
BMJ Case Rep ; 15(1)2022 Jan 04.
Article in English | MEDLINE | ID: covidwho-1607862

ABSTRACT

We describe an unusual case of a male patient presenting with penile and testicular swelling following an unprotected and traumatic sexual encounter. It was suspected that an isolated penile injury occurred during intercourse; however, ultrasound imaging identified an intact tunical layer and right-sided epididymo-orchitis. Following screening for sexually transmitted infections (STIs), he was discharged with antibiotics and advice to attend the Sexual Health Centre for contact tracing. He represented with a periurethral abscess and an antimicrobial-resistant (AMR) strain of Neisseria gonorrhoea was identified. Appropriate antibiotic treatment was initiated. Examination-under-anaesthesia, following abscess drainage, revealed a contained collection with no urethral fistula; however, a flat urethral lesion was seen during urethroscopy. Repeat urethroscopy and biopsy of the lesion indicated polypoid urethritis. Periurethral abscess secondary to gonococcal urethritis is a rare complication, but one that we should be suspicious of, especially with the growing incidence of AMR-STIs.


Subject(s)
Gonorrhea , Urethral Diseases , Urethritis , Abscess/etiology , Gonorrhea/complications , Gonorrhea/diagnosis , Gonorrhea/drug therapy , Humans , Male , Neisseria gonorrhoeae , Urethral Diseases/diagnosis , Urethral Diseases/etiology , Urethritis/diagnosis , Urethritis/drug therapy
11.
Sex Transm Dis ; 48(12): 939-944, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1605252

ABSTRACT

BACKGROUND: Reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are increasing among Canadian men. Estimates of community-based CT/NG prevalence are lacking among gay, bisexual, and other men who have sex with men (GBM). METHODS: Respondent driven sampling was used to recruit GBM in Montréal, Canada between February 2017 and June 2018. Specimens provided from urogenital, rectal, and pharyngeal sites were analyzed using nucleic acid amplification test to detect CT/NG. Prevalence estimates of CT/NG, overall and by anatomical site were calculated. All estimates are respondent-driven sampling-adjusted. RESULTS: Among 1177 GBM, the prevalence of rectal, urogenital, pharyngeal and overall were respectively 2.4%, 0.4%, 0.4%, and 2.8% for CT infections, and 3.1%, 0.4%, 3.5%, and 5.6% for NG infections. If testing had been limited to the urogenital site, 80% and 94% of CT and NG infections, respectively, would have been missed. CONCLUSIONS: This community-based study among GBM shows that the CT prevalence was about half of that observed for NG. A large part of CT/NG infections involves only the extragenital sites, highlighting the need for systematic multisite screening regardless of symptoms. In the mist of the COVID-19 pandemic and the limited CT/NG screening capacity due to test kits shortage, it might be considered to prioritize rectal and pharyngeal CT/NG testing over urogenital testing in asymptomatic GBM.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexual and Gender Minorities , Canada/epidemiology , Chlamydia Infections/epidemiology , Chlamydia trachomatis/genetics , Gonorrhea/epidemiology , Homosexuality, Male , Humans , Male , Neisseria gonorrhoeae/genetics , Pandemics , Prevalence , SARS-CoV-2
16.
APMIS ; 130(1): 34-42, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1511283

ABSTRACT

The COVID-19 pandemic has challenged the societies and health care systems globally, and resulted in many social and physical distancing restrictions to limit the spread of SARS-CoV-2. These restrictions have also likely affected the frequency of intimate contacts and the spread of sexually transmitted infections (STIs). Compared to most other countries, Sweden especially in Spring-Autumn 2020 pursued mainly milder voluntary, that is, not mandatory enforced by laws, recommended restrictions and the impacts of these on society and spread of STIs remain largely unknown. We describe the potential impact of the COVID-19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden in 2020. Compared to 2019, we found a significant decrease in incidence of chlamydia (-4.5%) and gonorrhoea (-17.5%), and in diagnostic testing (-10.5% for chlamydia, -9.4% for gonorrhoea) in 2020. However, the decrease in chlamydia incidence, which has mainly been decreasing in the last 10 years, was not significant when compared with the average incidence in 2017-2019. The largest decrease in national incidence of both infections was observed among young and heterosexual patients, however, some Swedish regions showed an increased incidence, particularly of chlamydia. Increased "internet-based self-sampling" testing approach partly compensated for a decreased attendance at STI clinics. Studies, including sexual behaviour, prevention, reasons for attending STI health care, STIs in different anatomical sites and management of STIs, are required to elucidate the impact of COVID-19-associated social and physical distancing restrictions on sexual activity and the incidence and epidemiology of chlamydia and gonorrhoea in Sweden.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Gonorrhea/diagnosis , Gonorrhea/epidemiology , COVID-19 , Chlamydia , Chlamydia trachomatis , Diagnostic Tests, Routine , Humans , Incidence , Neisseria gonorrhoeae , Pandemics , Physical Distancing , SARS-CoV-2 , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sweden/epidemiology
17.
J AAPOS ; 25(4): 230-231, 2021 08.
Article in English | MEDLINE | ID: covidwho-1486297

ABSTRACT

The most common ocular manifestation of SARS-CoV-2 in adults and children is acute conjunctivitis. We report the case of a 4-day-old infant who presented with acute-onset mucopurulent discharge of the left eye as well as subconjunctival hemorrhage and palpebral injection, without corneal findings. A diagnosis of ophthalmia neonatorum was established, for which ocular cultures and Gram staining were performed. No bacterial growth was noted, and polymerase chain reaction (PCR) testing for Chlamydia trachomatis, Neisseria gonorrhea, and herpes simplex were negative. Nasopharyngeal and conjunctival SARS-CoV-2 PCR were positive. Given the identification of SARS-CoV-2 illness, lack of other underlying bacterial or viral etiology on testing, and the well-documented ability for SARS-CoV-2 to cause conjunctivitis, the clinical picture was supportive of ophthalmia neonatorum secondary to SARS-CoV-2. The infant was treated with ceftriaxone and azithromycin prior to culture results. During admission, no systemic findings of Covid-19 illness were observed.


Subject(s)
COVID-19 , Conjunctivitis , Gonorrhea , Ophthalmia Neonatorum , Adult , Child , Conjunctiva , Humans , Infant , Infant, Newborn , Ophthalmia Neonatorum/diagnosis , Ophthalmia Neonatorum/drug therapy , SARS-CoV-2
18.
Przegl Epidemiol ; 75(2): 151-158, 2021.
Article in English | MEDLINE | ID: covidwho-1485744

ABSTRACT

INTRODUCTION: COVID-19 pandemic had a big impact on the health services organisation, including that of sexually transmitted infections (STIs). AIM: To analyse and evaluate the influence of COVID-19 epidemic on the detection of STIs and healthcare services in a group of these patients on the base of the experience of the Department of Dermatology and Venereology and University Outpatient Clinic in Bialystok, Poland. MATERIAL AND METHODS: Analysis of the number of consultations for suspicion of STIs, number of newly diagnosed cases of syphilis, gonorrhoea, Chlamydia trachomatis infections and genital herpes in two periods: January 2019 - February 2020 (before the epidemic state was introduced) and March 2020 - April 2021 (during pandemic). STIs cases hospitalised in the same periods were also analysed. RESULTS: The number of hospitalisations and outpatient consultations decreased during pandemic as compared to the period before it (by 83.3% and 41.9%, respectively). Patients with syphilis constituted the majority in both periods, remaining STIs were few. During pandemic, the proportion of detected cases of syphilis was higher as compared to the time before it, despite the diminished number of consultations (39.4% and 28%, respectively). Majority of patients with syphilis were men (92.3% and 93.3%), among them men-who-have-sex-with-men constituted at least 50%. Early syphilis was diagnosed more frequently during pandemic than before it (92.3% and 78.6%, respectively), early symptomatic syphilis in particular (46.2% and 35.7%, respectively). HIV coinfection in syphilis patients was more frequent during pandemic (15.8% and 7.1%, respectively). More than half of these patients (53.8%) did not come for follow-up visits after treatment during pandemic. CONCLUSIONS: The pandemic caused the decrease in number of outpatient STIs consultations and hospitalisations. The proportion of newly diagnosed cases of syphilis per number of consultations increased. The percentage of early syphilis cases, especially early symptomatic syphilis increased. Adherence to after treatment follow up was suboptimal.


Subject(s)
COVID-19 , Gonorrhea , HIV Infections , Sexual and Gender Minorities , Sexually Transmitted Diseases , Syphilis , Female , Gonorrhea/diagnosis , Gonorrhea/epidemiology , HIV Infections/epidemiology , Homosexuality, Male , Humans , Male , Pandemics , Poland/epidemiology , SARS-CoV-2 , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Syphilis/diagnosis , Syphilis/epidemiology
19.
J Clin Microbiol ; 59(11): e0264620, 2021 10 19.
Article in English | MEDLINE | ID: covidwho-1480240

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic reduced the sexually transmitted infection (STI) testing volume due to social-distancing and stay-at-home orders, among other reasons. These events highlighted previously known benefits of at-home STI self-testing or specimen self-collection and accelerated testing demand via telemedicine. We review testing outside traditional clinical settings. We focus on three curable bacterial STIs among the top 10 U.S. nationally notifiable conditions with screening recommendations: syphilis, gonorrhea (Neisseria gonorrhoeae, also known as the gonococcus [GC]), and chlamydia (Chlamydia trachomatis). At least 19 million GC/C. trachomatis (GC/CT) screening or diagnostic tests are performed annually, presenting a considerable challenge during the pandemic. Unlike for HIV, STI at-home tests are currently not commercially available. However, innovative telemedicine providers currently offer services where specimen self-collection kits are mailed to patients at home who then ship them to laboratories for processing. We discuss technical and regulatory aspects of modifications for home-based specimen self-collection. The telemedicine provider typically manages and communicates results, provides linkage to care, and is responsible for billing and case reporting. We also describe rapid testing devices in development that may present an opportunity for future self-testing. In summary, COVID-19 has accelerated the evaluation and development of STI self-tests and specimen self-collection. The remaining obstacles are high price, regulatory approval, support for laboratories offering the service, and uncertainty regarding whether target populations with the greatest need are reached effectively. However, increased testing, convenience, and privacy are potential benefits that may enhance uptake and outlast the pandemic.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexually Transmitted Diseases , Chlamydia Infections/epidemiology , Chlamydia trachomatis , Gonorrhea/epidemiology , Humans , Laboratories , Mass Screening , Neisseria gonorrhoeae , Pandemics , SARS-CoV-2 , Self-Testing , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology
20.
BMJ Open ; 11(10): e052823, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1462970

ABSTRACT

OBJECTIVES: The incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea. DESIGN: We developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx; (3) mouthwash reduced the transmissibility from the oropharynx; (4) the combined effect of mouthwash from scenarios 2 and 3. SETTING: We used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses. PARTICIPANTS: Published available data on MSM with multisite infections of gonorrhoea. PRIMARY AND SECONDARY OUTCOME MEASURES: Incidence of gonorrhoea. RESULTS: The overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%-80% mouthwash coverage), the total incidence increased (47-60/100 PY) and at all three anatomical sites by between 7.4% (5.9%-60.8%) and 136.6% (108.1%-177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20-39/100 PY) and at all anatomical sites by between 11.6% (10.2%-13.5%) and 99.8% (99.2%-100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22-55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%. CONCLUSIONS: The effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.


Subject(s)
Anti-Infective Agents, Local , Gonorrhea , Sexual and Gender Minorities , Gonorrhea/epidemiology , Gonorrhea/prevention & control , Homosexuality, Male , Humans , Incidence , Male , Models, Theoretical , Mouthwashes , Neisseria gonorrhoeae
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