Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Barbee L [original query] |
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Should we be testing for Mycoplasma genitalium on initial presentation? Trends in persistent/recurrent urethritis among men presenting for care in STD clinics, 2015-2019, STD Surveillance Network (SSuN)
Llata E , Tromble E , Schumacher C , Huspeni D , Asbel L , Pathela P , Kohn R , Kerani RP , Barbee L , Bachman L . Sex Transm Dis 2024 BACKGROUND: Mycoplasma genitalium is a major contributor to persistent/recurrent urethritis cases. However, there are limited published studies on recent trends of persistent/recurrent urethritis. METHODS: A retrospective analysis was conducted of men presenting with symptomatic urethritis in 16 STD clinics from 2015-2019. Poisson regression was used to assess trends in the annual proportions of urethritis episodes with follow-up (FU) characterized with persistent/recurrent urethritis symptoms. Results were also stratified by results of chlamydia (CT) and gonorrhea (NG) testing and treatment prescribed. RESULTS: There were 99,897 urethritis episodes, from 67,546 unique men. The proportion of episodes with persistent/recurrent symptomatic FU visits increased 50.8% over a 4-year period (annual percentage change (APC) 11.3%, 95% CI, 6.5-16.3). Similar trends were observed in non-chlamydial non-gonococcal urethritis episodes(APC, 12.7%; 95% CI, 6.8-18.9) but increases among those positive for NG (APC, 12.1%; 95% CI, -2.3 -28.5) or for CT (APC, 7.3%; 95% CI, -6.7-23.5) were not statistically significant. Among episodes who received azithromycin as first-line treatment, increases in the proportion of persistent/recurrent FU visits were observed (APC, 12.6%; 95% CI, 8.6-16.7). For episodes where first-line treatment was doxycycline, no significant increases were detected (APC, 4.3%; 95% CI, -0.3-9.2). CONCLUSION: We found an increase in the proportion of urethritis episodes with persistent or recurrent symptoms over time. Given these observed trends in episodes negative for NG or CT, an etiology not detectable by routine diagnostics was a likely factor in increased persistence, suggesting patients with urethritis may benefit from diagnostic testing for M. genitalium during an initial symptomatic presentation. |
The management of gonorrhea in the era of emerging antimicrobial resistance: What primary care clinicians should know
Quilter LAS , St Cyr SB , Barbee LA . Med Clin North Am 2024 108 (2) 279-296 Gonorrhea rates continue to rise in the United States and Neisseria gonorrhoeae's propensity to develop resistance to all therapies used for treatment has complicated the management of gonorrhea. Ceftriaxone is the only remaining highly effective recommended regimen for gonococcal treatment and few new anti-gonococcal antimicrobials are being developed. The 2021 CDC STI Treatment Guidelines increased the dose of ceftriaxone to 500 mg (1 g if ≥ 150 kg) for uncomplicated infections. It is recommended that all clinicians should be aware of antimicrobial resistant gonorrhea and be able to appropriately manage any suspected gonorrhea treatment failure case. |
Novel strain of multidrug non-susceptible Neisseria gonorrhoeae in the USA
Reimche JL , Pham CD , Joseph SJ , Hutton S , Cartee JC , Ruan Y , Breaux M , Ivanof C , Joshi A , DeMartino M , Kirby JE , Barbee LA , Kersh EN , Roosevelt KA , Hsu KK . Lancet Infect Dis 2024 Unsuccessful treatment of gonorrhoea has not yet occurred in the USA, and cases of gonorrhoea that are non-susceptible to cephalosporins have been rare. In 2019, non-susceptibility to ceftriaxone conferred by the mosaic penA 60.001 allele was found in a Neisseria gonorrhoeae multilocus sequence type (MLST) 1901 isolate from Nevada.1 In this Correspondence, we present two additional US cases of the penA 60.001 allele identified in MLST 8123, an emerging international multidrug non-susceptible N gonorrhoeae lineage. Although these cases responded to ceftriaxone treatment, N gonorrhoeae isolates from the first known patient (case 1) demonstrated in-vitro non-susceptibility to ceftriaxone as well as non-susceptibility or resistance to drugs previously recommended for front-line treatment. | | In August, 2022, N gonorrhoeae grown from urine culture from a patient with urethritis in primary care in Massachusetts displayed non-susceptibility to cephalosporins (the minimum inhibitory concentrations were 1·0 μg/mL for ceftriaxone and >1·0 μg/mL for cefixime by agar dilution; the minimum inhibitory concentration for cefixime was 1·5 μg/mL by gradient strip) and azithromycin and resistance to ciprofloxacin, penicillin, and tetracycline (appendix pp 6–7). Antimicrobial susceptibility testing was done with gradient strips at the state public health laboratory Massachusetts and then confirmed via agar dilution at the US Centers for Disease Control and Prevention (CDC). The patient (case 1) had already been successfully diagnosed on nucleic acid amplification test (NAAT) with gonorrhoea and was given 500 mg ceftriaxone intramuscularly and asked to return to primary care where, 9 days after treatment, he was asymptomatic, had normal results during examination, and tested negative by urine culture and pharyngeal and rectal NAAT recommended by the Massachusetts sexually transmitted diseases programme to document N gonorrhoeae clearance from any site of infection. The patient reported that he had not travelled outside USA in the 60 days before onset of symptoms. He disclosed female sex worker contacts, but insufficient information was provided to trace the contacts. |
Use of doxycycline to prevent sexually transmitted infections according to provider characteristics
Pearson WS , Emerson B , Hogben M , Barbee L . Emerg Infect Dis 2024 30 (1) 197-199 Use of doxycycline to prevent sexually transmitted infections (STIs) may lead to antimicrobial resistance. We analyzed attitudes toward this practice between US providers who commonly and less commonly treat STIs. Providers who more commonly treat STIs are more likely to prescribe prophylactic doxycycline and believe that benefits outweigh potential for increased antimicrobial resistance. |
Vital signs: Missed opportunities for preventing congenital syphilis - United States, 2022
McDonald R , O'Callaghan K , Torrone E , Barbee L , Grey J , Jackson D , Woodworth K , Olsen E , Ludovic J , Mayes N , Chen S , Wingard R , Johnson Jones M , Drame F , Bachmann L , Romaguera R , Mena L . MMWR Morb Mortal Wkly Rep 2023 72 (46) 1269-1274 INTRODUCTION: Congenital syphilis cases in the United States increased 755% during 2012-2021. Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death, and maternal and infant morbidity; these outcomes can be prevented through appropriate screening and treatment. METHODS: A cascading framework was used to identify and classify missed opportunities to prevent congenital syphilis among cases reported to CDC in 2022 through the National Notifiable Diseases Surveillance System. Data on testing and treatment during pregnancy and clinical manifestations present in the newborn were used to identify missed opportunities to prevent congenital syphilis. RESULTS: In 2022, a total of 3,761 cases of congenital syphilis in the United States were reported to CDC, including 231 (6%) stillbirths and 51 (1%) infant deaths. Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis. Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Addressing missed opportunities for prevention, primarily timely testing and appropriate treatment of syphilis during pregnancy, is important for reversing congenital syphilis trends in the United States. Implementing tailored strategies addressing missed opportunities at the local and national levels could substantially reduce congenital syphilis. |
Safety of longer-term doxycycline use: A systematic review and meta-analysis with implications for bacterial STI chemoprophylaxis
Chan PA , Le Brazidec DL , Becasen JS , Martin H , Kapadia J , Reno H , Bachmann L , Barbee LA . Sex Transm Dis 2023 50 (11) 701-712 BACKGROUND: Sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia have significantly increased over the past decade in the United States. Doxycycline as chemoprophylaxis (i.e., post-exposure prophylaxis [PEP]) offers promise for addressing bacterial STIs. The goal of the current study was to evaluate the safety of longer-term doxycycline use (defined as eight or more weeks) in the context of potential use as STI chemoprophylaxis through a systematic literature review and meta-analysis. METHODS: This review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search MEDLINE/PubMed for clinical studies published from August 2003 through January 2023 that reported on adverse events with doxycycline use with a focus on side-effects and metabolic effects of long-term use. RESULTS: A total of 67 studies were included in the systematic review. Overall, studies on longer-term doxycycline use reported 0% to over 50% adverse events ranging from mild to severe. Most common adverse events included gastrointestinal symptoms (i.e., nausea, vomiting, and abdominal pain), dermatologic (i.e., rash), and neurological (i.e., headache and dizziness) symptoms. Discontinuation of doxycycline due to adverse events was relatively uncommon in most studies. A meta-analysis of placebo controlled clinical trials (N = 18) revealed gastrointestinal and dermatological adverse events were more likely to occur in the doxycycline group. CONCLUSION: Longer-term (8+ weeks) doxycycline use is generally safe and may be associated with minor side-effects. Further research is needed on the potential metabolic impact of longer-term doxycycline use. |
Kiss around and find out: Kissing as a risk factor for pharyngeal gonorrhea
Chesson HW , Bernstein KT , Barbee LA . Sex Transm Dis 2023 Publish Ahead of Print (7) 402-403 What do we know about the role of kissing in gonorrhea transmission? Evidence suggests that gonorrheatransmission via kissing is possible, but we do not know if it is a relatively rare event or if it is one of the main drivers of gonorrhea transmission.1-3In this issue, Charlesonand colleagues provide a systematic review of studies of kissing as a risk factor for pharyngeal gonorrhea and chlamydia.4This important systematic review serves to summarize and highlight some of the available evidence of kissing as a possible route of gonorrhea and chlamydia transmission. The authors of the review are at the forefront ofthis field of investigation, and many wereco-authors on four5-8of the six studies included |
Management of Neisseria gonorrhoeae in the United States: Summary of evidence from the development of the 2020 gonorrhea treatment recommendations and the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Treatment Guidelines
Barbee LA , St Cyr SB . Clin Infect Dis 2022 74 S95-s111 INTRODUCTION: Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern given limited antibiotic options currently and an even smaller antimicrobial development pipeline. Since the release of the Centers for Disease Control and Prevention (CDC) 2015 STD Treatment Guidelines, azithromycin, part of the 2015 dual-drug treatment regimen, has had a rapid rise in resistance. The 2020 CDC Gonorrhea Treatment Recommendations and the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were developed weighing the priorities of treating the individual, protecting the population, and preventing antimicrobial resistance. METHODS: Gonorrhea subject matter experts (SME) generated 8 key questions and conducted a literature review of updated data from 2013 to 2019 on gonorrhea antimicrobial resistance, treatment failures, clinical trials, and other key topics. More than 2200 abstracts were assessed, and 248 clinically relevant articles were thoroughly reviewed. SMEs also evaluated N gonorrhoeae antimicrobial resistance data from the Gonococcal Isolate Surveillance Project (GISP). EVIDENCE: Although there have been reports of ceftriaxone treatment failures internationally, GISP data suggest that ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, with < 0.1% exhibiting an "alert value" MIC (> 0.25 mcg/mL). However, GISP documented a rapid rise in the proportion of isolates with an elevated MIC (≥ 2.0 mcg/mL) to azithromycin-nearly 5% in 2018. At the same time, new pharmacokinetic/pharmacodynamic data are available, and there is greater recognition of the need for antimicrobial stewardship. SUMMARY: The 2021 CDC STI Treatment Guidelines now recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites. If coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added. Few alternative therapies exist for persons with cephalosporin allergies; there are no recommended alternative therapies for N gonorrhoeae infection of the throat. |
Demographic and epidemiological characteristics associated with reduced antimicrobial susceptibility to Neisseria gonorrhoeae in the United States, Strengthening the U.S. Response to Resistant Gonorrhea (SURRG), 2018-2019
Gieseker K , Learner ER , Mauk K , Barbee LA , McNeil CJ , Hasty GL , Black JM , Johnson K , Quyen Nguyen T , Shrestha D , Pham CD , St Cyr S , Schlanger K , Kirkcaldy RD . Sex Transm Dis 2021 48 S118-S123 BACKGROUND: Jurisdictions participating in Strengthening the United States Response to Resistant Gonorrhea (SURRG) implemented specimen collection for culture and antimicrobial susceptibility testing (AST) from a sample of persons of all genders (at multiple anatomic sites) attending STD clinics and community clinics. We describe the percentage and characteristics of patients whose isolates demonstrated reduced susceptibility (RS) to azithromycin, ceftriaxone, or cefixime. METHODS: We included patients from clinics that participated in SURRG whose isolates underwent AST by Etest. We defined RS as azithromycin minimum inhibitory concentrations (MICs) ≥2 μg/ml (AZM-RS), ceftriaxone MICs ≥0.125 μg/ml (CRO-RS), or cefixime MICs ≥0.25 μg/ml (CFX-RS). Patients with repeated infections appeared >1 time in the data. We calculated the frequency and percentage of patients with an isolate demonstrating RS by epidemiological characteristics. RESULTS: During 2018-2019, 10,013 patients from eight jurisdictions provided 10,735 isolates. Among 10,013 patients, 11.0% (n = 1,099) had ≥1 isolate with AZM-RS (range by jurisdiction 2.5%-18.0%). Approximately 11.3% of 8,771 of patients visiting STD clinics and approximately 8.8% of 1,242 patients visiting community clinics had an AZM-RS isolate. Nearly 6% of 1,013 females had an AZM-RS isolate; among males, the percent of patients with an AZM-RS isolate was 17.7% among 4,177 men who have sex only with men and 6.1% among 3,581 men who have sex only with women. Few (0.4%) patients had isolates with CFX-RS (n = 40) or CRO-RS (n = 43). CONCLUSIONS: Although infections with reduced cephalosporin susceptibility were rare, AZM-RS infections were prevalent in this sample of patients in multiple jurisdictions and across gender and gender of sex partner categories. |
Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020
St Cyr S , Barbee L , Workowski KA , Bachmann LH , Pham C , Schlanger K , Torrone E , Weinstock H , Kersh EN , Thorpe P . MMWR Morb Mortal Wkly Rep 2020 69 (50) 1911-1916 Sexually transmitted infections (STIs) caused by the bacteria Neisseria gonorrhoeae (gonococcal infections) have increased 63% since 2014 and are a cause of sequelae including pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate transmission of human immunodeficiency virus (HIV) (1,2). Effective treatment can prevent complications and transmission, but N. gonorrhoeae's ability to acquire antimicrobial resistance influences treatment recommendations and complicates control (3). In 2010, CDC recommended a single 250 mg intramuscular (IM) dose of ceftriaxone and a single 1 g oral dose of azithromycin for treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum as a strategy for preventing ceftriaxone resistance and treating possible coinfection with Chlamydia trachomatis (4). Increasing concern for antimicrobial stewardship and the potential impact of dual therapy on commensal organisms and concurrent pathogens (3), in conjunction with the continued low incidence of ceftriaxone resistance and the increased incidence of azithromycin resistance, has led to reevaluation of this recommendation. This report, which updates previous guidelines (5), recommends a single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea. If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended. Continuing to monitor for emergence of ceftriaxone resistance through surveillance and health care providers' reporting of treatment failures is essential to ensuring continued efficacy of recommended regimens. |
Systems approaches to improving rates of extragenital chlamydia and gonorrhea screening among men who have sex with men engaged in human immunodeficiency virus care
Bernstein KT . Sex Transm Dis 2015 42 (10) 599-600 In 2011, there were an estimated 1.2 million persons living with human immunodeficiency virus (HIV) in the United States, of which approximately 478,000 (40%) were engaged in HIV care.1 Among gay, bisexual, and other men who have sex with men (collectively referred to as MSM), who account for the majority of new HIV diagnoses in the United States,2 38% of 245,545 were routinely accessing HIV care.1 Although the Centers for Disease Control and Prevention recommends that all sexually active persons with HIV infection get screened for curable sexually transmitted diseases (STDs; such as chlamydia, gonorrhea, and syphilis) at least annually as part of HIV care,3 STD screening rates are suboptimal, especially extragenital chlamydia and gonorrhea screening among MSM. In a review of 8 large HIV care clinics, less than 20% of patients had at least 1 annual extragenital chlamydia or gonorrhea screening test.4 Among MSM captured in the Medical Monitoring Project surveillance platform, approximately 20% of MSM engaged in HIV care had a documented chlamydia or gonorrhea test in the prior 12 months.5 In a large cohort of HIV-infected patients engaged in regular HIV care, chlamydia and gonorrhea screening rates increased over time between 2004 and 2010, yet still remained low (39% in 2010).6 | Men who have sex with men who are engaged in HIV care are actively seeking primary care services with some regularity. Why has it been so challenging to improve STD screening rates among this population of motivated men who are routinely engaging with a provider and health care system? Two articles published in this month’s volume of Sexually Transmitted Diseases further help us to better understand this challenge. Barbee and colleagues7 evaluate current bacterial STD screening practices in a large HIV care setting in Seattle, Washington. While nearly 75% of MSM engaged in care at the Madison Clinic had a syphilis serologic test in the prior year, less than one third had either a rectal or pharyngeal chlamydia or gonorrhea screening test,7 although the majority reported some level of sexual risk that would warrant screening at exposed sites. Furthermore, while a sizable minority reported seeking STD services from the local municipal STD clinic, nearly three fourths reported that the Madison Clinic was their primary source of STD care. Surveyed Madison Clinic providers overwhelmingly believed that their patients were getting STD care elsewhere, and many were not aware of current Centers for Disease Control and Prevention recommendations for STD screening or that nucleic acid amplification test-based screening was available in their clinic. |
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