Gonorrhea Still Treatable But Last Effective Antibiotic Remains Vulnerable to Resistance

Dr. Bob Kirkcaldy MD, MPH Epidemiologist, Division of STD Prevention CDCMedicalResearch.com Interview with:
Dr. Bob Kirkcaldy MD, MPH
Epidemiologist, Division of STD Prevention

Medical Research: What is the background for this study? What are the main findings?

Dr. Kirkcaldy: Gonorrhea is a common sexually transmitted disease that, if untreated, can cause severe reproductive health complications. While gonorrhea is very common, it is often symptomless and many may not realize they have it. 333,004 cases were diagnosed in 2013, but more than 820,000 are estimated to occur annually. Because antibiotic resistance has jeopardized treatment for gonorrhea, CDC’s Gonoccocal Isolate Surveillance Project (GISP) monitors antimicrobial susceptibility and tracks patterns of resistance among antibiotics currently used to treat gonorrhea. From 2006-2009, susceptibility to the oral cephalosporin antibiotic cefixime declined in GISP, threatening the effectiveness of this drug. Continued use of cefixime in the face of declining susceptibility could theoretically foster broad resistance to the cephalosporin class (including ceftriaxone, the last treatment option). So in 2012,  CDC changed its treatment recommendations to recommend only dual gonorrhea treatment with injectable ceftriaxone plus oral azithromycin.

The most recent data from GISP analyzed urethral gonorrhea samples of men from STD clinics in 34 cities from 2006-2014 and found resistance to cefixime increased in 2014 after two years of dramatic decreases. While CDC’s STD Treatment Guidelines suggest cefixime should only be considered as an alternative treatment for gonorrhea when ceftriaxone is not available, trends of cefixime susceptibility have historically been a precursor to trends in ceftriaxone so it’s important to continue monitoring cefixime to be able to anticipate what might happen with other drugs in the future. GISP data also found that resistance remained stable for ceftriaxone and resistance levels remain highest among men who have sex with men (MSM).

We’re concerned about the increase in resistance for cefixime; however, more years of data are needed to know if the 2014 increase is the beginning of a new trend.

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Oral Sex Can Lead To Oral HPV Infection

Eduardo L. Franco DrPH, FRSC, FCAHS James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology Minda de Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology McGill University Montreal, Quebec, CanadaMedicalResearch.com Interview with;
Eduardo L. Franco DrPH, FRSC, FCAHS
James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology, Minda de Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology
McGill University, Montreal, Quebec, Canada

Medical Research: What should clinicians and patients take away from your report?

Dr. Franco: Our findings of oral transmission of human papillomavirus (HPV) infection in men are part of a larger molecular epidemiologic study called ‘HPV Infection and Transmission among Couples through Heterosexual Activity’ (HITCH) cohort study. The focus of the HITCH study is to understand how HPV is transmitted within couples via sexual contact and other behaviors. We measure the presence of this virus using highly-sensitive molecular assays for HPV DNA in the genital surfaces (vagina and penis), oral cavity, and hands. We also take a blood sample to look for the presence of antibodies against HPV. We take multiple samples over a period of two years at pre-scheduled visits. We have previously published results focused exclusively on genital transmission. The present report is the first in the HITCH study to look at what happens in terms of characteristics that place male participants to be at risk of oral HPV infection.

To our knowledge, this is the first study to show a high risk of oral HPV infection among men whose female partners had a genital or oral HPV infection, suggesting that transmission may occur through oral or genital routes. We looked at transmission for 36 individual HPV genotypes, which improved our ability to study risk determinants. Risk was also significantly higher among men who had ever smoked, had a high number of lifetime sex partners, or were in non-monogamous relationships. Our results are largely consistent with previous studies that have found male sex practices and smoking to be the most significant risk factors for oral HPV infection.
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Bacterial STD Linked to Increased Risk of HIV

Newswise — 3/9/2012  — A common sexually transmitted bacterial infection more than doubles the risk of HIV infection in African women, according to a study by researchers at RTI International.

The study, published in the March 13 issue of AIDS, found that women with the “emerging” sexually transmitted disease Mycoplasma genitalium are more likely to acquire HIV infection.

“Further research will be required to confirm a causal relationship and to identify risk factors for M. genitaliuminfection in African populations,” said Sue Napierala Mavedzenge, Ph.D., a research investigator with theWomen’s Global Health Imperative at RTI International and the study’s lead author. “If findings from this research are confirmed, M. genitalium screening and treatment among women at high risk for HIV-1 infection may be warranted as part of an HIV-1 prevention strategy.”

First discovered in 1980, M. genitalium is a bacterial STD that causes inflammatory conditions of the genitals and reproductive tract (urethritis, cervicitis and pelvic inflammatory disease). The infection, which may be present for years without causing any symptoms, can be eliminated with appropriate antibiotics.

This study used data from a larger study of HIV acquisition among young women in Zimbabwe and Uganda to assess the effects of M. genitalium on HIV risk. In the study, 190 women who became infected with HIV during follow-up were matched to women of similar age and risk who did not acquire HIV. Both groups were tested for the presence of M. genitalium, which was evaluated as a risk factor for HIV infection.

In initial samples, when all women were HIV free, infection with M. genitalium was present in about 15 percent of women who later developed HIV versus 6.5 percent in women who remained HIV free. Mycoplasma genitalium was more frequent than other bacterial STDs, including gonorrhea and chlamydia.

The researchers found that after adjustment for other factors, women who initially had M. genitalium were more than twice as likely to become infected with HIV. Certain other STDs were also risk factors for HIV.

The researchers estimated that about 9 percent of all HIV infections occurring in the study were attributable to M. genitalium. However, other factors were more strongly associated with HIV risk, especially the presence of herpes simplex virus 2 (the virus that causes genital herpes) and having a partner with HIV risk factors.