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1.
Biology (Basel) ; 11(9)2022 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-36138842

RESUMO

Prospective cohort studies of sexually transmitted infections (STIs) are logistically impractical owing to time and expenses. In schools, students are readily available for school-related follow-ups and monitoring. Capitalizing on the logistics that society already commits to ensure regular attendance of adolescents in school, a school-based STI screening in New Orleans made it possible to naturally observe the occurrence of chlamydia and to determine its incidence among 14-19-year-old adolescents. Among participants screened repeatedly, we calculated incidence rates, cumulative incidence, and incidence times. Male (n = 3820) and female (n = 3501) students were observed for 6251 and 5143 person-years, respectively, during which 415 boys and 610 girls acquired chlamydia. Incidence rates per 100 person-years were 6.6 cases for boys and 11.9 cases for girls. In multivariable analysis, the adjusted hazard ratio was 5.34 for boys and 3.68 for girls if the student tested positive for gonorrhea during follow-up, and 2.76 for boys and 1.59 for girls if at first participation the student tested positive for chlamydia, and it increased with age among boys but not among girls. In joinpoint trend analysis, the annual percentage change in the incidence rate was 6.6% for boys (95% CI: -1.2%, 15.1%) and 0.1% for girls (95% CI: -5.3%, 5.7%). Annual cumulative incidence was 5.5% among boys and 8.6% among girls. Median incidence time was 9.7 months for boys and 6.9 months for girls. Our findings can be used to refine assumptions in mathematical modeling and in cost analysis studies of C. trachomatis infection, and provide strong evidence in support of annual chlamydia screening for adolescent boys.

4.
Clin Infect Dis ; 69(3): 459-465, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-30351348

RESUMO

BACKGROUND: Mycoplasma genitalium has been significantly and nonsignificantly associated with cervicitis, urethritis, or vaginal discharge. This study examined the associations of M. genitalium with selected sexually transmitted infections (STIs) and demographic, behavioral, and clinical factors among women attending a sexually transmitted disease (STD) clinic in New Orleans. METHODS: Women aged ≥18 years who presented to the New Orleans STD clinic provided sociodemographic data and sexual behavior; STI, obstetric, and gynecologic history; and urine, vaginal, endocervical, and rectal specimens. Specimens were tested for M. genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma species, and yeast. Bacterial vaginosis (BV) was diagnosed by Nugent score, and cervicitis was defined as ≥30 polymorphonuclear leukocytes per high-power microscopic field on a cervical Gram stain or yellow mucopus on an endocervical swab. RESULTS: Among 400 women studied, M. genitalium was independently significantly associated with age <25 years (P < .03) and with ≥2 sexual partners in the last 12 months (P < .003). Neisseria gonorrhoeae (adjusted odds ratio [AOR], 1.75; P = .103), C. trachomatis (AOR, 1.43; P = .247), and T. vaginalis (AOR, 1.60; P = .120) independently increased the odds of infection with M. genitalium. Controlling for other STIs and BV, there was a positive trend for M. genitalium to predict cervicitis (AOR, 3.18 [95% confidence interval, .99-10.2]; P = .05). CONCLUSIONS: Mycoplasma genitalium in our study displayed the clinical features of C. trachomatis and N. gonorrhoeae, the 2 organisms that drive research agendas in diagnosis, treatment, and prevention of bacterial STIs.


Assuntos
Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Adolescente , Adulto , Fatores Etários , Colo do Útero/microbiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Mycoplasma genitalium , Nova Orleans/epidemiologia , Prevalência , Estudos Prospectivos , Parceiros Sexuais , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Vagina/microbiologia , Vaginose Bacteriana/epidemiologia , Adulto Jovem
6.
Microbiome ; 4: 16, 2016 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-27090518

RESUMO

BACKGROUND: The epidemiology of bacterial vaginosis (BV) suggests it is sexually transmissible, yet no transmissible agent has been identified. It is probable that BV-associated bacterial communities are transferred from male to female partners during intercourse; however, the microbiota of sexual partners has not been well-studied. RESULTS: Pyrosequencing analysis of PCR-amplified 16S rDNA was used to examine BV-associated bacteria in monogamous couples with and without BV using vaginal, male urethral, and penile skin specimens. The penile skin and urethral microbiota of male partners of women with BV was significantly more similar to the vaginal microbiota of their female partner compared to the vaginal microbiota of non-partner women with BV. This was not the case for male partners of women with normal vaginal microbiota. Specific BV-associated species were concordant in women with BV and their male partners. CONCLUSIONS: In monogamous heterosexual couples in which the woman has BV, the significantly higher similarity between the vaginal microbiota and the penile skin and urethral microbiota of the male partner, supports the hypothesis that sexual exchange of BV-associated bacterial taxa is common.


Assuntos
Metagenoma/genética , Microbiota/genética , Pênis/microbiologia , Uretra/microbiologia , Vagina/microbiologia , Vaginose Bacteriana/microbiologia , Adulto , DNA Bacteriano/genética , Feminino , Prepúcio do Pênis/microbiologia , Heterossexualidade , Humanos , Masculino , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Comportamento Sexual , Parceiros Sexuais , Vaginose Bacteriana/patologia
7.
Sex Transm Dis ; 43(2 Suppl 1): S18-27, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26779684

RESUMO

School-based sexually transmitted disease (STD) screening (SBSS) was designed to provide chlamydia and gonorrhea testing, treatment, and counseling to adolescents in a school setting to overcome some of the difficulties of screening in this population. To inform STD control programs and other entities on decision making about potentially implementing this intervention, we reviewed existing published and gray literature on SBSS from 1998 to 2014. Although they are work-intensive to establish, school-based STD screening programs are a feasible and cost-effective way of testing large numbers of male and female adolescents for chlamydia and gonorrhea, and to provide counseling and treatment to almost all those who are found infected. School-based STD screening programs do not seem to reduce prevalence in either the school or the general adolescent population, although there are currently relatively few studies on large-scale SBSS. More research in this field is needed.


Assuntos
Controle de Infecções , Programas de Rastreamento/organização & administração , Serviços de Saúde Escolar , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Criança , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Guias como Assunto , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Controle de Infecções/tendências , Masculino , Programas de Rastreamento/economia , Prevalência , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Escolar/organização & administração , Serviços de Saúde Escolar/normas , Serviços de Saúde Escolar/tendências , Infecções Sexualmente Transmissíveis/economia , Infecções Sexualmente Transmissíveis/epidemiologia , Estados Unidos/epidemiologia
9.
Acad Pediatr ; 13(4): 308-15, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23685203

RESUMO

OBJECTIVE: To describe the trends in chlamydia positivity among New Orleans high school students tested in a schoolwide screening between 1996 and 2005, and to determine factors associated with chlamydia positivity among students during the 10-year period. METHODS: Between school years 1995-1996 and 2004-2005, students in New Orleans public high schools were tested for chlamydia using nucleic acid amplification tests (NAAT) in urine specimens (LCx assay until 1999-2000; BD assay from 2000-2001 to 2004-2005). For each year, we calculated chlamydia positivity by dividing the number of students testing positive by the total number of students tested. Data were analyzed separately by gender. Logistic regressions were performed to determine independent predictors of chlamydia positivity during the 10-year period. RESULTS: Between 1996 and 2005, the average chlamydia positivity was 7.0% (95% confidence interval 6.6-7.4) in boys and 13.1% (95% confidence interval 12.6-13.7) in girls (P < .001). Chlamydia detection increased with the switch from LCx to BD assay. In multivariate analyses, chlamydia positivity among boys and girls was significantly associated with age, black race, and gonorrhea coinfection. Additionally, positivity was significantly different by school year among boys (P = .03) and by NAAT used among girls (P = .008). CONCLUSIONS: The trends in chlamydia positivity observed between 1996 and 2005 more likely reflected a high and stable prevalence of chlamydia in the New Orleans school-age adolescent population. Any benefit of screening on individuals tested was likely to be mitigated by participants' uninterrupted social interactions with the dynamic forces that sustain the sexual transmission of chlamydia in the population.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Distribuição por Idade , Infecções por Chlamydia/etnologia , Infecções por Chlamydia/urina , Coinfecção , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Análise Multivariada , Nova Orleans/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Estudantes/estatística & dados numéricos
10.
J Infect Dis ; 207(12): 1922-31, 2013 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-23482642

RESUMO

BACKGROUND: The prevalence of Trichomonas vaginalis infection is highest in women with intermediate Nugent scores. We hypothesized that the vaginal microbiota in T. vaginalis-infected women differs from that in T. vaginalis-uninfected women. METHODS: Vaginal samples from 30 T. vaginalis-infected women were matched by Nugent score to those from 30 T. vaginalis-uninfected women. Equal numbers of women with Nugent scores categorized as normal, intermediate, and bacterial vaginosis were included. The vaginal microbiota was assessed using 454 pyrosequencing analysis of polymerase chain reaction-amplified 16S ribosomal RNA gene sequences. The 16S ribosomal RNA gene sequence of an unknown organism was obtained by universal bacterial polymerase chain reaction amplification, cloning, and sequencing. RESULTS: Principal coordinates analysis of the pyrosequencing data showed divergence of the vaginal microbiota in T. vaginalis-infected and T. vaginalis-uninfected patients among women with normal and those with intermediate Nugent scores but not among women with bacterial vaginosis. Cluster analysis revealed 2 unique groups of T. vaginalis-infected women. One had high abundance of Mycoplasma hominis and other had high abundance of an unknown Mycoplasma species. Women in the former group had clinical evidence of enhanced vaginal inflammation. CONCLUSIONS: T. vaginalis may alter the vaginal microbiota in a manner that is favorable to its survival and/or transmissibility. An unknown Mycoplasma species plays a role in some of these transformations. In other cases, these changes may result in a heightened host inflammatory response.


Assuntos
Mycoplasma/classificação , Vaginite por Trichomonas/microbiologia , Trichomonas vaginalis/isolamento & purificação , Vagina/microbiologia , Vaginose Bacteriana/microbiologia , Adulto , Sequência de Bases , Análise por Conglomerados , Estudos de Coortes , Estudos Transversais , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Demografia , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Metagenoma/genética , Dados de Sequência Molecular , Mycoplasma/genética , Mycoplasma/isolamento & purificação , Mycoplasma hominis/genética , Mycoplasma hominis/isolamento & purificação , Nova Orleans/epidemiologia , Filogenia , Prevalência , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Vaginite por Trichomonas/complicações , Vaginite por Trichomonas/epidemiologia , Trichomonas vaginalis/genética , Vaginose Bacteriana/complicações , Vaginose Bacteriana/epidemiologia
11.
Sex Transm Infect ; 89(1): 20-4, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22773326

RESUMO

OBJECTIVES: To describe uptake of chlamydia screening, determine rates of repeated yearly screening and investigate determinants of repeated participation in an organised school-based screening programme. METHODS: The authors analysed data from 1995 to 2005 from female and male students in up to 13 schools in New Orleans, Louisiana, USA. The authors calculated proportions of students tested among all enrolled students and among those with parental consent and the percentage of positive chlamydia tests in each school year. The authors used random effects logistic regression to examine the effect of past screening history on subsequent participation. RESULTS: 35 041 students were registered for at least one school year. Overall coverage was >30% in all school years. Among all students registered for 4 years, 10.6% (95% CI 9.3% to 12.0%) of women and 12.7% (95% CI 11.2% to 14.2%) of men had a test every year. Among students with parental consent for 4 years, 49.3% (95% CI 44.6% to 54.1%) of women and 59.3% (95% CI 54.5% to 64.0%) of men had a test every year. Among students registered for 2 or more years, those with a previous positive chlamydia test were less likely to have a subsequent test (female adjusted OR 0.77, 95% CI 0.67 to 0.88 and male adjusted OR 0.84, 95% CI 0.69 to 1.02). Chlamydia positivity increased over time. CONCLUSIONS: High levels of uptake can be achieved in school-based chlamydia screening programmes, but repeated yearly screening is difficult to sustain over time.


Assuntos
Linfogranuloma Venéreo/diagnóstico , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Estudos de Coortes , Feminino , Humanos , Masculino , Nova Orleans , Instituições Acadêmicas
13.
J Clin Microbiol ; 49(5): 1990-2, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21411587

RESUMO

This study assessed the utility of urine, vaginal, cervical, and rectal specimens for the detection of Mycoplasma genitalium in women by using our laboratory-developed PCR assay. The relative sensitivity was 85.7% for the vaginal swab specimen, 74.3% for the endocervical swab specimen, 61.4% for the urine specimen, and 24.3% for the rectal swab specimen.


Assuntos
Técnicas Bacteriológicas/métodos , Colo do Útero/microbiologia , Infecções por Mycoplasma/diagnóstico , Mycoplasma genitalium/isolamento & purificação , Reto/microbiologia , Urina/microbiologia , Vagina/microbiologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase/métodos , Sensibilidade e Especificidade , Adulto Jovem
15.
Sex Transm Infect ; 87(2): 149-51, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21076139

RESUMO

OBJECTIVES: To meet the need for services at sexually transmitted infection (STI) clinics, self-obtained vaginal (SOV) swabs or first-catch urine (FCU) samples collected at a clinic visit have been proposed as an alternative approach for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) screening. The purpose of this clinic-based survey was to determine if non-invasive clinic-based SOV swabs and FCU samples for CT and GC screening are acceptable replacements for a traditional provider visit. METHODS: Patients seen at STI clinics in three US cities completed a self-administered survey of preferences for methods of CT and GC screening under hypothetical circumstances. RESULTS: A total of 2887 participants completed a self-administered questionnaire that contained multiple-choice questions about their preference. If there was a hypothetical long clinic wait, 58% of the survey participants preferred to wait to see a doctor. If the clinic had to turn patients away, 41% of patients preferred to come back the next business day and 46% preferred to self-collect a sample. The percentages were similar across site, demographic and clinical groups. CONCLUSIONS: Clinic-based self-collected specimens for CT and GC screening were not preferred by most patients who participated in this survey. The findings indicate that more detailed information about self-collection practices must be provided for patients to adopt this new approach.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Preferência do Paciente , Manejo de Espécimes/psicologia , Adolescente , Adulto , Idoso , Assistência Ambulatorial , Infecções por Chlamydia/psicologia , Diagnóstico Precoce , Feminino , Gonorreia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
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