Estimating the Burden of Illness Related to Genital Warts in Russia: A Cross-Sectional Study.

BACKGROUND: Human papillomavirus (HPV) infections are the etiologic agents of genital warts (GW). HPV is one of the most frequent sexually transmitted viral infections, and nearly 65% of individuals with partners who have GW also develop GW. In Russia, as in many other countries, overall GW prevalence data are scarce. Given the lack of Russian data, our study estimated GW prevalence in physician practices and GW-related health care resource use in Russia among male and female patients aged 18-60 years. METHODS: Russian physicians recorded daily patient logs for a two-week period and conducted a 30-minute survey to estimate GW prevalence and related resource use between January and June 2012. Age, gender, and GW diagnosis status was recorded. Prevalence was obtained for each physician and calculated into a single estimate across all physician types. Overall prevalence estimate and 95% confidence interval were weighted by the estimated number of physicians in each specialty and the proportion of total patients visiting each specialist type. Health care resource use was reported and compared among different physician specialties. RESULTS: The overall GW prevalence estimate was 9162 cases per 100 000 for male and female patients aged 18-60 years, with 9917 for obstetrician/gynecologists (OB/GYN), 8298 for urologists (URO), and 7833 for dermatologists (DERM). For males, GW prevalence was 8769 cases per 100 000, with the highest prevalence in the 30-34 age group. In females, GW prevalence was 9304 cases per 100 000, with the highest prevalence in the 18-24 age group. Among overall existing GW cases, 63.1% were recurrent and 34.2% were resistant. For all patients in our study, GW prevalence was higher in females. Male patients had the highest prevalence for those aged 30-34 years, and female patients for those aged 18-24 years. These results are consistent with data reported in other countries. Study limitations include estimates and results representative of the urban population of Russia. Despite its limitations, this study provides a GW prevalence estimate in Russia not previously available. CONCLUSIONS: GW is a significant public health concern in Russia, and the GW prevalence was higher in female patients compared to male patients.

2017 European guidelines for the management of genital herpes.

Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.

Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin.

BACKGROUND: Azithromycin has been widely used for Mycoplasma genitalium treatment internationally. However, the eradication efficacy has substantially declined recent decade. In Russia, josamycin (another macrolide) is the recommended first-line treatment for M. genitalium infections, however, no data regarding treatment efficacy with josamycin and resistance in M. genitalium infections have been internationally published. We examined the M. genitalium prevalence in males attending an STI clinic in Moscow, Russia from December 2006 to January 2008, investigated treatment efficacy with josamycin in male urethritis, and monitored the M. genitalium DNA eradication dynamics and selection of macrolide resistance in M. genitalium during this treatment. METHODS: Microscopy and real-time PCRs were used to diagnose urethritis and non-viral STIs, respectively, in males (n = 320). M. genitalium positive patients were treated with recommended josamycin regimen and treatment efficacy was monitored using quantitative real-time PCR. Macrolide resistance mutations were identified using sequencing of the 23S rRNA gene. RESULTS: Forty-seven (14.7%) males were positive for M. genitalium only and most (85.1%) of these had symptoms and signs of urethritis. Forty-six (97.9%) males agreed to participate in the treatment efficacy monitoring. All the pre-treatment M. genitalium specimens had wild-type 23S rRNA. The elimination of M. genitalium DNA was substantially faster in patients with lower pre-treatment M. genitalium load, and the total eradication rate was 43/46 (93.5%). Of the six patients with high pre-treatment M. genitalium load, three (50%) remained positive post-treatment and these positive specimens contained macrolide resistance mutations in the 23S rRNA gene, i.e., A2059G (n = 2) and A2062G (n = 1). CONCLUSIONS: M. genitalium was a frequent cause of male urethritis in Moscow, Russia. The pre-treatment M. genitalium load might be an effective predictor of eradication efficacy with macrolides (and possibly additional antimicrobials) and selection of macrolide resistance. Additional in vivo and in vitro data are crucial to support the recommendation of using josamycin as first-line treatment for M. genitalium infections in Russia. It would be valuable to develop international M. genitalium management guidelines, and quantitative diagnostic PCRs determining also M. genitalium load and resistance mutations (for macrolides and ideally also moxifloxacin) should ideally be recommended.