RESUMO
Objectives: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns globally. Enhanced AMR surveillance for gonococci is essential worldwide; however, recent quality-assured gonococcal AMR surveillance in Latin America, including Brazil, has been limited. Our aims were to (i) establish the first nationwide gonococcal AMR surveillance, quality assured according to WHO standards, in Brazil, and (ii) describe the antimicrobial susceptibility of clinical gonococcal isolates collected from 2015 to 2016 in all five main regions (seven sentinel sites) of Brazil. Methods: Gonococcal isolates from 550 men with urethral discharge were examined for susceptibility to ceftriaxone, cefixime, azithromycin, ciprofloxacin, benzylpenicillin and tetracycline using the agar dilution method, according to CLSI recommendations and quality assured according to WHO standards. Results: The levels of resistance (intermediate susceptibility) to tetracycline, ciprofloxacin, benzylpenicillin and azithromycin were 61.6% (34.2%), 55.6% (0.5%), 37.1% (60.4%) and 6.9% (8.9%), respectively. All isolates were susceptible to ceftriaxone and cefixime using the US CLSI breakpoints. However, according to the European EUCAST cefixime breakpoints, 0.2% (n = 1) of isolates were cefixime resistant and 6.9% (n = 38) of isolates had a cefixime MIC bordering on resistance. Conclusions: This study describes the first national surveillance of gonococcal AMR in Brazil, which was quality assured according to WHO standards. The high resistance to ciprofloxacin (which promptly informed a revision of the Brazilian sexually transmitted infection treatment guideline), emerging resistance to azithromycin and decreasing susceptibility to extended-spectrum cephalosporins necessitate continuous surveillance of gonococcal AMR and ideally treatment failures, and increased awareness when prescribing treatment in Brazil.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Gonorreia/epidemiologia , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/efeitos dos fármacos , Vigilância de Evento Sentinela , Adulto , Azitromicina/farmacologia , Brasil/epidemiologia , Ceftriaxona/farmacologia , Ciprofloxacina/farmacologia , Gonorreia/urina , Humanos , Masculino , Neisseria gonorrhoeae/isolamento & purificação , Adulto JovemRESUMO
Resource-limited countries have limited laboratory capability and rely on syndromic management to diagnose sexually transmitted infections (STIs). We aimed to estimate the sensitivity, specificity and positive predictive value (PPV) of STI syndromic management when used as a screening method within a study setting. Men who have sex with men (MSM), female sex workers (FSWs) and people living with HIV/AIDS (PLWHA) participated in a behavioural surveillance study. Data were obtained on demographics, sexual behaviours, STI history and service utilisation. Biological specimens were tested for genital inflammatory infections (Neisseria gonorrhoeae [GC], Chlamydia trachomatis [CT], Mycoplasma genitalium [MG], Trichomonas vaginalis [TV]) and genital ulcerative infection (syphilis and Herpes simplex virus-2). There was a high prevalence of Herpes simplex virus-2 (MSM 48.1%, FSW 82.0% and PLWHA 84.4%). Most participants reported no ulcerative symptoms and the majority of men reported no inflammatory symptoms. Sensitivity and PPV were poor for inflammatory infections among PLWHA and MSM. Sensitivity in FSWs for inflammatory infections was 75%. For ulcerative infections, sensitivity was poor, but specificity and PPV were high. Reliance on self-reported symptoms may not be an effective screening strategy for these populations. STI prevention studies should focus on symptom recognition and consider routine screening and referral for high-risk populations.
Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina , Trabalho Sexual , Profissionais do Sexo , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Canal Anal/microbiologia , Canal Anal/parasitologia , Sangue/microbiologia , Sangue/virologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/urina , El Salvador/epidemiologia , Feminino , Gonorreia/epidemiologia , Gonorreia/urina , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Autorrelato , Comportamento Sexual , Fatores Socioeconômicos , Inquéritos e Questionários , Sífilis/sangue , Sífilis/epidemiologia , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/epidemiologia , Urina/microbiologia , Urina/parasitologia , Adulto JovemRESUMO
BACKGROUND: We assessed prevalences of seven sexually transmitted infections (STIs) in Peru, stratified by risk behaviours, to help to define care and prevention priorities. METHODS: In a 2002 household-based survey of the general population, we enrolled randomly selected 18-29-year-old residents of 24 cities with populations greater than 50 000 people. We then surveyed female sex workers (FSWs) in these cities. We gathered data for sexual behaviour; vaginal specimens or urine for nucleic acid amplification tests for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; and blood for serological tests for syphilis, HIV, and (in subsamples) herpes simplex virus 2 (HSV2) and human T-lymphotropic virus. This study is a registered component of the PREVEN trial, number ISRCTN43722548. FINDINGS: 15 261 individuals from the general population and 4485 FSWs agreed to participate in our survey. Overall prevalence of infection with HSV2, weighted for city size, was 13·5% in men, 13·6% in women, and 60·6% in FSWs (all values in FSWs standardised to age composition of women in the general population). The prevalence of C trachomatis infection was 4·2% in men, 6·5% in women, and 16·4% in FSWs; of T vaginalis infection was 0·3% in men, 4·9% in women, and 7·9% in FSWs; and of syphilis was 0·5% in men, 0·4% in women, and 0·8% in FSWs. N gonorrhoeae infection had a prevalence of 0·1% in men and women, and of 1·6% in FSWs. Prevalence of HIV infection was 0·5% in men and FSWs, and 0·1% in women. Four (0·3%) of 1535 specimens were positive for human T-lymphotropic virus 1. In men, 65·0% of infections with HIV, 71·5% of N gonorrhoeae, and 41·4% of HSV2 and 60·9% of cases of syphilis were in the 13·3% who had sex with men or unprotected sex with FSWs in the past year. In women from the general population, 66·7% of infections with HIV and 16·7% of cases of syphilis were accounted for by the 4·4% who had been paid for sex by any of their past three partners. INTERPRETATION: Defining of high-risk groups could guide targeting of interventions for communicable diseases-including STIs-in the general Peruvian population. FUNDING: Wellcome Trust-Burroughs Wellcome Fund Infectious Disease Initiative and US National Institutes of Health.
Assuntos
Trabalho Sexual/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Anticorpos Antivirais/sangue , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/urina , Feminino , Gonorreia/epidemiologia , Gonorreia/urina , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Inquéritos Epidemiológicos , Herpes Simples/sangue , Herpes Simples/epidemiologia , Herpes Simples/virologia , Herpesvirus Humano 2 , Humanos , Masculino , Peru/epidemiologia , Prevalência , Infecções Sexualmente Transmissíveis/sangue , Infecções Sexualmente Transmissíveis/urina , Inquéritos e Questionários , Sífilis/sangue , Sífilis/epidemiologia , Vaginite por Trichomonas/epidemiologia , Vagina/microbiologia , Vagina/parasitologia , Adulto JovemRESUMO
BACKGROUND: Chlamydia trachomatis (CT) is a sexually transmitted infection having repercussions on reproductive health and impact on the foetus. Our goal was to estimate the prevalence of and risk factors for CT in young parturient women in Brazil. METHODS: A national cross-sectional study of parturient women, aged 15 to 24 years, attending Brazilian public hospitals was performed in 2009. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT and Neisseria gonorrhoeae (NG), using polymerase chain reaction COBAS Amplicor CT/NG (Roche Molecular Systems, Branchburg, NJ). RESULTS: A total of 2400 women were selected and 2071 (86.3%) participated in the study. Mean age was 20.2 years (standard deviation = 2.7). Prevalence rates of CT and NG were 9.8% (95% confidence interval [CI]: 8.5-11.1) and 1.0% (95% CI: 0.6%-1.4%), respectively. Four percent of women infected with CT also had NG infection. CT associated factors were: being younger (15-19 years old) (odds ratio [OR] = 1.6 [95% CI: 1.15-2.17]); first sexual intercourse before 15 years of age (OR = 1.4 [95% CI: 1.04-6.24]); having more than 1 sexual partner in lifetime (OR = 1.6 [95% CI: 1.13-2.26]); Pap smear screening more than 1 year (OR = 1.5 [95% CI: 1.08-2.05]); and NG infection (OR = 7.6 [95% CI: 3.05-19.08]). CONCLUSIONS: This study shows a high prevalence of CT infection among young pregnant women in Brazil. We suggest that CT screening should be included as part of antenatal care routine in this group in Brazil.