An evaluation of gentamicin susceptibility of Neisseria gonorrhoeae isolates in Europe.

OBJECTIVES: The emergence of decreased susceptibility to third-generation, extended-spectrum cephalosporins in Neisseria gonorrhoeae and associated treatment failures highlights the need to consider alternatives for future therapeutic use, such as gentamicin. METHODS: The three laboratories surveying gonococcal antimicrobial susceptibility as part of the European Network for Sexually Transmitted Infections Surveillance compared agar dilution and Etest to determine gentamicin MICs and performed the first survey of gentamicin susceptibility on 1366 gonococcal isolates from 17 European Union/European Economic Area (EU/EAA) countries in 2009. RESULTS: Sentinel surveillance of gentamicin susceptibility showed that 95% of European isolates were within a narrow MIC range (4-8 mg/L), with 79% showing an MIC of 8 mg/L. Most countries showed little variation, but wider MIC ranges were observed in Greece (1-16 mg/L) and France, Norway and Sweden (2-16 mg/L). While MICs for both methods generally differed by just one doubling dilution, they were lower by Etest. CONCLUSIONS: This is the first reported evidence that the European gonococcal population susceptibility to gentamicin is similar to that reported in other world regions. Clinical trials to evaluate the therapeutic efficacy of gentamicin may be warranted.

HIV and sexual risk behavior among commercial sex workers in the Netherlands.

In 2002-2005, a cross-sectional study to assess the potential for HIV transmission was carried out among 557 female and male-to-female transgender commercial sex workers (CSW) in three cities in the Netherlands. Female CSW (F-CSW), drug-using female CSW (DU), and transgender sex workers were recruited in street-based and establishment-based sites. An anonymous questionnaire was administrated by interviewers and a saliva sample was collected for HIV antibody testing. The overall HIV prevalence was 5.7% (31/547; 10 samples were excluded because of "intermediate" test results). HIV was more prevalent among transgender (18.8%, 13/69) and DU (13.6%, 12/88) sex workers than among F-CSW (1.5%, 6/390). Of the HIV positive CSW, 74% were unaware of their infection. Consistent condom use with clients was 81%. Regular condom failure with clients was reported by 39%. In multivariate analyses, transgender sex workers (OR = 22.9), drug-using CSW who ever injected drugs (OR = 31.1), African (OR = 19.0), and South European ethnicity (OR = 7.2) were independently associated with HIV. Condom failure (PRR = 2.0), anal sex (PRR = 2.1), and drug use (PRR = 3.8) were associated with inconsistent condom use with clients. There is a potential risk for further spread of HIV, through clients and (private) partners of sex workers, to the general population. Targeted health promotion activities are indicated for transgender sex workers and drug-using female CSW; active HIV testing must be continued.

Control measures used during lymphogranuloma venereum outbreak, Europe.

To assess the response to the reemergence of lymphogranuloma venereum, we conducted a cross-sectional survey by administering a structured questionnaire to representatives from 26 European countries. Responses were received from 18 countries. The ability to respond quickly and the measures used for outbreak detection and control varied. Evidence-based criteria were not consistently used to develop recommendations. We did not develop criteria to determine the effectiveness of the recommendations. The degree of preparedness for an unexpected outbreak, as well as the ability of countries to respond quickly to alerts, varied, which indicates weaknesses in the ability to control an outbreak. More guidance is needed to implement and evaluate control measures used during international outbreaks.