Sandbox:Prince

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Prince	Tarek	Aysha
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Prince	Tarek	Aysha
Hello	Hi	Goodbye

The uterine cervix is the most common site of mucosal infection with N. gonorrhoeae in women (picture 1). Most women with cervical gonococcal infection, up to 70 percent in some series, are asymptomatic

   At least 86 (31%) of the 278 infections were in women who had pelvic inflammatory disease. These data indicate that the clinical spectrum of gonococcal infection varies according to where the patients are seen and that the widely held concept that most gonococcal infections in women are asymptomatic may be erroneous. 

AD

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SYMPTOMS:

Among 6230 women, prevalence of C trachomatis and N gonorrhoeae was 6.9% and 2.1%, respectively; 520 women (8.3%) had either organism detected. Age, cervical signs (mucopus, induced bleeding), and inflammation on endocervical GS were independently associated with infection. However, the positive predictive value (PPV) of any cervical finding for infection was less than 19% in women 25 years and older. Inflammation on endocervical GS was the sole indicator of infection in 79 of 520 (15%) infections, but was insensitive in the absence of mucopurulent cervicitis (sensitivity, 26%; PPV, 21%)

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When present, genital symptoms develop in most women within 10 days of exposure

Infection was more common among women with more than one exposure (13/14) than among those with one exposure (6/12). Gonococcal infection was significantly associated with the presence of findings on physical examination suggestive of upper genital tract inflammation.
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EPIDEMIOL

In about 30% of patients gonococci could be found in only one of the sites tested (cervix 18%, urethra 6%, rectum 4.8%, and throat 1.5%) 76760
In about 30% of patients gonococci could be found in only one of the sites tested (cervix 18%, urethra 6%, rectum 4.8%, and throat 1.5%)

COMPLICATION These infections are likely to be particularly important in promoting the sexual transmission and mother-to-child intrapartum transmission of HIV-1, and should therefore be the focus of HIV prevention strategies. 18685546

it may cause pregnancy and/or neonatal complications as a result of infection of the fetus, placenta, amniotic fluid, decidua, or membranes. In addition, cervicitis appears to be associated with a significant increase in risk of HIV-1 acquisition and shedding

There is no evidence that human papillomavirus infection (HPV) induces cervical inflammation, but it can cause other histologic changes (eg, cervical intraepithelial neoplasia). ?? SOURCE

prevalence The prevalence of M genitalium was 2.1% and of Chlamydia trachomatis was 2.8% among 5519 tested women

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These findings implicate M. genitalium as an etiologic agent of cervicitis in HIV-infected women, providing a potential mechanism for enhanced HIV transmission to an uninfected partner. Screening and treatment of M. genitalium among HIV-infected individuals may be warranted to further understand this coinfection scenario, improve cervical health, and reduce the spread of HIV 26783349

treatment The conclusion was that empiric azithromycin treatment of cervicitis reduces cervicitis at follow-up in populations with high prevalence of Chlamydia trachomatis and/or Mycoplasma genitalium. There are no benefits of empiric azithromycin for non-specific cervicitis or empiric partner treatment. 26792283

Minimum inhibitory concentrations (MICs) from some contemporary isolates exhibited high-level susceptibility to most macrolides and quinolones, and moderate susceptibility to most tetracyclines, whereas other contemporary isolates had high MICs to the same antibiotics. Randomized trials demonstrated poor efficacy of doxycycline and better, but declining, efficacy of single-dose azithromycin therapy. Treatment failures after extended doses of azithromycin similarly increased, and circulating macrolide resistance was present in high levels in several areas. Moxifloxacin remains the most effective therapy, but treatment failures and quinolone resistance are emerging. Surveillance of M. genitalium prevalence and antimicrobial resistance patterns is urgently needed. 26602619

signs/lab Although the prevalence of M. genitalium was high at 8.4%, the overall lack of any association between the findings of cervicitis and the detection of M. genitalium support the conclusion that cervicitis has poor clinical utility as an indicator for the presence of M. genitalium infection. 23702105

treatment, invest, screening of m. geni

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Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics.

   23658265 azi as first line moxi 2nd but high resi to azi than moxi

screening

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The prevalence of C. trachomatis is high in pregnant women seen at the Genital Infection Unit Care, UNESP, and is related to many risk factors. Therefore, its screening is extremely important in reducing obstetrical and neonatal complications The presence of chlamydial infection was associated with smoking

prevalence 26783349 21071566 MG was significantly associated with women being HIV positive (p=0.03), but not with age, vaginal discharge, commercial sex work, being of culturally and linguistically diverse background, or concurrent CT infection.

Overall prevalence of infection with C. trachomatis, N. gonorrhoeae, T. vaginalis, and M. genitalium was found to be 11.1%, 4.6%, 15.3%, and 19.2%, respectively. Prevalence in women with cervicitis was 15.8%, 6%, 18.9%, and 28.6% for C. trachomatis, N. gonorrhoeae, T. vaginalis, and M. genitalium, respectively. Percentages of coinfections were high. C. trachomatis and M. genitalium were significantly associated with cervicitis in univariate analysis, but only M. genitalium was significantly associated with cervicitis (AOR: 2.5) in multiple logistic regression models. 19704398

complication 19828674 In the literature, the generally assumed risk of developing PID after lower genital tract chlamydia infection varies considerably, and is up to 30%. For developing tubal infertility after PID the risks are 10-20%. This implies that the risk of test-positive women of developing tubal infertility would range between 0.1 and 6%. We included chlamydia IgG antibody testing in a model and estimated a risk of tubal infertility up to 4.6%. this is for clamydia

screening, treatment

24555561 Trichomonas vaginalis (TV) is a common sexually transmitted infection that can cause vaginitis, cervicitis and urethritis. Persistent and recurrent TV infections are frequent in women, potentially due to the lack of routine screening recommendations for this pathogen, the chronic nature of some infections, and drug resistance. Metronidazole and tinidazole are two oral drugs that are effective against trichomoniasis. There are few alternative treatment options for persons with a metronidazole allergy or treatment failure. Most TV isolates from women with treatment failures that have been analyzed for susceptibility testing in the United States have exhibited low-level metronidazole resistance, supporting the initial use of tinidazole for patients who fail metronidazole therapy. Several non-nitroimidazole drugs and other agents have demonstrated acceptable in vitro activity or cure rates in case reports for metronidazole-resistant trichomoniasis; however, clinical trials are imperative to evaluate their efficacy as alternative therapeutic regimens for this highly prevalent infection.

Sexually transmitted diseases (STDs) and their associated syndromes are extremely common in clinical practice. Early diagnosis, appropriate treatment, and partner management are important to ensure sexual, physical, and reproductive health in our patients 24493491

Concurrently, there has been a rapid emergence of antibiotic resistance in M. genitalium, with macrolide resistance now appearing to be endemic in some centres, and quinolone resistance is beginning to emerge.In the absence of specific M. genitalium diagnostic and antimicrobial resistance testing, azithromycin 1 g should not be used for the management of patients with symptomatic disease potentially caused by M. genitalium. This review offers an alternative evidence-based approach to managing such patients that should, theoretically, reduce the risk of the development of antimicrobial resistance.    24322592 

Diagnosis

of M. genitalium infections is performed exclusively using nucleic acid amplification tests (NAATs), owing to poor or slow growth of bacterium in culture

Among 64,463 patients, 33.9% had an initial STD and 7.0% had a subsequent STD. Patients with an initial STD had significantly higher probability of a subsequent STD than patients without (12.0% vs. 4.4%). A subsequent STD was significantly more likely for both sexes for those with an initial STD, who were symptomatic at initial visit, reporting exchange of sex, or under age 20 as well as for men reporting sex with men.

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treatment and diag

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Diagnosis is usually made from wet mount microscopy and direct visualisation, which are insensitive. DNA amplification techniques perform with good sensitivity, but are not yet approved for diagnostic purposes. In areas where diagnostic methods are limited, management of trichomoniasis is usually as part of a clinical syndrome; vaginal discharge for women and urethral discharge for men. A single dose of metronidazole is effective in the majority of cases. Outside of the United States, other nitroimidazoles may be used and are as effective as metronidazole. Metronidazole resistance is an emerging problem, but its clinical importance is not yet clear. Concomitant treatment of sexual partners is recommended.