Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Bolan GA[original query] |
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CDC laboratory recommendations for syphilis testing, United States, 2024
Papp JR , Park IU , Fakile Y , Pereira L , Pillay A , Bolan GA . MMWR Recomm Rep 2024 73 (1) 1-32 This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Newer serologic tests allow for laboratory automation but must be used in an algorithm, which also can involve older manual serologic tests. Direct detection of T. pallidum continues to evolve from microscopic examination of material from lesions for visualization of T. pallidum to molecular detection of the organism. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science. |
Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski KA , Bachmann LH , Chan PA , Johnston CM , Muzny CA , Park I , Reno H , Zenilman JM , Bolan GA . MMWR Recomm Rep 2021 70 (4) 1-187 These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. |
Recommendations for providing quality sexually transmitted diseases clinical services, 2020
Barrow RY , Ahmed F , Bolan GA , Workowski KA . MMWR Recomm Rep 2020 68 (5) 1-20 This report (hereafter referred to as STD QCS) provides CDC recommendations to U.S. health care providers regarding quality clinical services for sexually transmitted diseases (STDs) for primary care and STD specialty care settings. These recommendations complement CDC's Sexually Transmitted Diseases Treatment Guidelines, 2015 (hereafter referred to as the STD Guidelines), a comprehensive, evidence-based reference for prevention, diagnosis, and treatment of STDs. STD QCS differs from the STD Guidelines by specifying operational determinants of quality services in different types of clinical settings, describing on-site treatment and partner services, and indicating when STD-related conditions should be managed through consultation with or referral to a specialist. These recommendations might also help in the development of clinic-level policies (e.g., standing orders, express visits, specimen panels, and reflex testing) that can facilitate implementation of the STD Guidelines. CDC organized the recommendations for STD QCS into eight sections: 1) sexual history and physical examination, 2) prevention, 3) screening, 4) partner services, 5) evaluation of STD-related conditions, 6) laboratory, 7) treatment, and 8) referral to a specialist for complex STD or STD-related conditions.CDC developed the recommendations by synthesizing relevant, evidence-based guidelines and recommendations issued by other experts; reviewing current practice in the United States; soliciting Delphi ratings by subject matter experts on STD care in primary care and STD specialty care settings; discussing the scientific evidence supporting the proposed recommendations at a consultation meeting of experts and institutional stakeholders held November 20, 2015, in Atlanta, Georgia; conducting peer reviews of draft recommendations and supporting evidence; and discussing draft recommendations and supporting evidence during meetings of the CDC/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment STD Work Group. These recommendations are intended to help health care providers in primary care or STD specialty care settings offer STD services at their clinical settings and to help the persons seeking care live safer, healthier lives by preventing and treating STDs and related complications. |
Syphilis elimination: Lessons learned again
Valentine JA , Bolan GA . Sex Transm Dis 2018 45 S80-S85 It is estimated that approximately 20 million new sexually transmitted infections (STIs) occur each year in the United States. The federally-funded STD prevention program implemented by CDC is primarily focused on the prevention and control of the three most common bacterial STIs: syphilis, gonorrhea, and chlamydia. A range of factors facilitate the transmission and acquisition of sexually transmitted infections, including syphilis. In 1999 CDC launched the National Campaign to Eliminate Syphilis from the United States. The strategies were familiar to public health in general and to STD control in particular: 1) enhanced surveillance, 2) expanded clinical and laboratory services, 3) enhanced health promotion, 4) strengthened community involvement and partnerships, and 5) rapid outbreak response. This national commitment to syphilis elimination was not the first effort, and like others before it too did not succeed. However, the lessons learned from this most recent campaign can inform the way forward to a more comprehensive approach to the prevention and control of STIs and improvement in the nation's health. |
Sexually transmitted diseases treatment guidelines, 2015
Workowski KA , Bolan GA . MMWR Recomm Rep 2015 64 1-137 These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs. |
Trends in antimicrobial resistance in Neisseria gonorrhoeae in the USA: the Gonococcal Isolate Surveillance Project (GISP), January 2006-June 2012
Kirkcaldy RD , Kidd S , Weinstock HS , Papp JR , Bolan GA . Sex Transm Infect 2013 89 Suppl 4 iv5-iv10 BACKGROUND: Neisseria gonorrhoeae has progressively developed resistance to sulfonamides, penicillin, tetracycline and fluoroquinolones, and gonococcal susceptibility to cephalosporins has been declining worldwide. METHODS: We described trends in gonococcal antimicrobial susceptibility in the USA from January 2006 through June 2012. Susceptibility data for cefixime, ceftriaxone, azithromycin, penicillin, tetracycline and ciprofloxacin were obtained from the Gonococcal Isolate Surveillance Project (GISP), a sentinel surveillance system that monitors antimicrobial susceptibility in urethral gonococcal isolates collected from symptomatic men at 25-30 sexually transmitted disease clinics throughout the USA. RESULTS: The percentage of isolates with elevated cefixime minimum inhibitory concentrations (MICs) (≥0.25 microg/mL) increased from 0.1% in 2006 to 1.4% in 2010-2011 and was 1.1% in the first 6 months of 2012. The percentage with elevated ceftriaxone MICs (≥0.125 microg/mL) increased from 0.1% in 2006 to 0.3%-0.4% during 2009 through the first 6 months of 2012. There were no temporal trends in the prevalence of elevated azithromycin MICs (≥2 microg/mL) (0.2%-0.5%). The prevalence of resistance remained high for penicillin (11.2%-13.2%), tetracycline (16.7%-22.8%) and ciprofloxacin (9.6%-14.8%). CONCLUSIONS: The proportion of gonococcal isolates with elevated cephalosporin MICs increased from 2006 to 2010, but plateaued during 2011 and the first 6 months of 2012. Resistance to previously recommended antimicrobials has persisted. As the number of antimicrobials available for gonorrhoea treatment dwindles, surveillance systems such as GISP will be critical to detect emerging resistance trends and guide treatment decisions. |
Cephalosporin-resistant gonorrhea in North America
Kirkcaldy RD , Bolan GA , Wasserheit JN . JAMA 2013 309 (2) 185-7 Gonorrhea has affected humans for centuries and remains common. Worldwide, an estimated 106.1 million cases occur annually.1 In 2011, gonorrhea again was the second most commonly reported notifiable infection in the United States with 321 849 cases reported.2 Because gonorrhea often can be asymptomatic, the true disease burden may be closer to 700 000.3 Gonorrhea disproportionately affects racial, ethnic, and sexual minorities. Untreated gonococcal infection can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility in women and can facilitate transmission of human immunodeficiency virus.4 Childhood blindness still affects infants born to mothers infected with gonorrhea, particularly in resource-limited countries. | For years, gonorrhea has been easily treated with a single oral dose of antibiotics. However, Neisseria gonorrhoeae has progressively acquired resistance to each new agent: sulfonamides in the 1940s, penicillins and tetracyclines in the 1970s and 1980s, and fluoroquinolones by 2007 in the United States. Since then, cephalosporins have been the only antibiotics recommended for gonorrhea treatment.5 However, gonococcal susceptibility to oral cephalosporins is declining, and the effectiveness of these drugs is threatened. | Increasing cephalosporin minimum inhibitory concentrations (MICs), an early warning of impending resistance, and treatment failures with cephalosporins have been reported from east Asia since the early 2000s and recently have been reported from Europe.6,7 In the United States, the Gonococcal Isolate Surveillance Project (GISP), a national surveillance system that monitors trends in antibiotic susceptibility, has documented increasing cefixime MICs since 2009.8 The steepest cefixime MIC increases have been reported in the western United States and among individuals who have had male-to-male sexual contact, the region and population in which fluoroquinolone resistance initially emerged. However, data are lacking on the cefixime MICs at which clinical effectiveness wanes. |
A trich-y question: should Trichomonas vaginalis infection be reportable?
Hoots BE , Peterman TA , Torrone EA , Weinstock H , Meites E , Bolan GA . Sex Transm Dis 2013 40 (2) 113-6 Trichomonas vaginalis (TV) infection is the most common curable sexually transmitted infection (STI).1 In the United States, a population-based survey of females aged 14 to 49 years in 2001 to 2004 estimated that there were 2.3 million women with prevalent TV infections.2 Most infections are asymptomatic.3 In those with symptoms of disease, or trichomoniasis, the most common symptoms are vaginitis in women and urethritis in men.3 T. vaginalis infection is not currently reportable in any US state. | Recently, interest in making TV infection reportable has increased.4 Potential reasons for doing so include monitoring epidemiologic trends and stimulating public health research. The introduction of highly sensitive and specific nucleic acid amplification tests offers new options for making the diagnosis. In addition, researchers have cited associations of TV infection with adverse health events such as HIV acquisition, as reasons to make it reportable. | In the United States, the Council of State and Territorial Epidemiologists (CSTE) determines which conditions should be nationally notifiable by states to the Centers for Disease Control and Prevention. However, the authority to require reporting of cases of certain conditions resides in the states. Neither CSTE nor individual states have a published set of criteria to determine whether a condition should be reportable, although there are public health surveillance principles that are used by states and CSTE. |
Neisseria gonorrhoeae with high-level resistance to azithromycin: case report of the first isolate identified in the United States
Katz AR , Komeya AY , Soge OO , Kiaha MI , Lee MV , Wasserman GM , Maningas EV , Whelen AC , Kirkcaldy RD , Shapiro SJ , Bolan GA , Holmes KK . Clin Infect Dis 2012 54 (6) 841-3 We report on the first Neisseria gonorrhoeae isolate in the United States identified with high-level resistance to azithromycin. This report discusses the epidemiologic case investigation, the molecular studies of resistance-associated mutations and N. gonorrhoeae multiantigen sequence typing, and challenges posed by emerging gonococcal antimicrobial resistance. |
The emerging threat of untreatable gonococcal infection
Bolan GA , Sparling PF , Wasserheit JN . N Engl J Med 2012 366 (6) 485-7 It is time to sound the alarm. During the past 3 years, the wily gonococcus has become less susceptible to our last line of antimicrobial defense, threatening our ability to cure gonorrhea and prevent severe sequelae. | Gonorrhea is the second most commonly reported communicable disease in the United States, with an estimated incidence of more than 600,000 cases annually. It disproportionately affects vulnerable populations such as minorities who are marginalized because of race, ethnic group, or sexual orientation. Unfortunately, Neisseria gonorrhoeae has always readily developed resistance to antimicrobial agents: it became resistant to sulfanilamide in the 1940s, penicillins and tetracyclines in the 1980s, and fluoroquinolones by 2007.1 When the prevalence of antimicrobial resistance in the Gonococcal Isolate Surveillance Project (GISP) exceeds 5%, national treatment recommendations are changed to focus on other effective drugs. However, the treatment options recommended by the Centers for Disease Control and Prevention (CDC) are now limited to third-generation cephalosporins.2 |
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- Page last updated:May 06, 2024
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