The Natural History of <i>Mycoplasma genitalium</i> in the Pharynx and Rectum in a Cohort of Men Who Have Sex With Men: Prevalence, Incidence, Duration, and Symptoms

The Journal of Infectious Diseases · 2026-03-18 · 1 citations

BACKGROUND: Little is known about Mycoplasma genitalium's (MG) natural history in the throat and the rectum. Methods: Men who have sex with men (MSM) enrolled in a longitudinal cohort study on the natural history of extragenital gonorrhea and chlamydia. Men self-collected pharyngeal and rectal specimens weekly and completed electronic symptom and sexual behavior diaries for 48 weeks. Prevalent infections were detected on the first week of testing; incident infections were ≥2 consecutive weeks of positive specimens after a negative test. We calculated duration using Kaplan-Meier analysis. RESULTS: Of 140 enrolled MSM, 112 participated and 108 submitted samples on week one. Ten (9.3%) had prevalent rectal MG; there were fifteen incident rectal MG infections (incidence 19.8 per 100 person years (py), 95% CI:11.5-34.1 per 100 py). Rectal MG had a median duration of 42 weeks (95% CI: 7.3 weeks - undefined); most infections (60%) were entirely asymptomatic. Four (3.7%) participants had prevalent pharyngeal infections. Fourteen incident pharyngeal infections arose (incidence 17.5 per 100 person years, 95% CI: 9.9-30.8 per 100 py). Pharyngeal MG had a median duration of 12 weeks (95% CI: 6.3 weeks - undefined); symptoms were rare (6%). CONCLUSIONS: Rectal and pharyngeal MG was common in this cohort. Half of the rectal MG infections persisted for nearly a year; many remained positive on week 48 suggesting persistence beyond one year. Pharyngeal infection persisted three months. The absence of symptoms or other morbidity in most infections suggests testing for MG at these sites would have uncertain individual benefit.

‘Self-testing’ versus ‘self-collection’: the critical role of consistent language in the field of STI diagnostics

Sexually Transmitted Infections · 2025-10-30

Stability of Spiked <i>Chlamydia Trachomatis</i> and <i>Neisseria Gonorrhea</i> in Urine and Swab Specimens After Prolonged Storage at Room and Freezer Temperatures Using Aptima Combo-2 Test

Open Forum Infectious Diseases · 2025-06-30

Abstract We evaluated whether prolonged storage at room and freezer temperatures affects detection of Chlamydia trachomatis and Neisseria gonorrhoeae (CT/GC) using Aptima Combo-2 assay for research studies. Three hundred specimens were spiked with CT/GC; half were stored at room temperature and half at −80°C. All specimens remained CT/GC positive for 36 months.

Doxycycline to prevent bacterial sexually transmitted infections in the USA: final results from the DoxyPEP multicentre, open-label, randomised controlled trial and open-label extension

The Lancet Infectious Diseases · 2025-03-25 · 31 citations

Case Report: Treatment of Gonorrhea in Setting of Ceftriaxone Allergy

Sexually Transmitted Diseases · 2025-02-20 · 3 citations

ABSTRACT: Treating Neiserria gonorrhoeae infection in patients with cephalosporin allergy represents a significant challenge and highlights urgent need for alternative therapies. This patient case details use of alternative antimicrobials to cure urogenital and pharyngeal gonorrhea in a patient with a severe ceftriaxone allergy in the outpatient clinical setting.

Potential Impact of Doxycycline Post-Exposure Prophylaxis on Tetracycline Resistance in <i>Neisseria gonorrhoeae</i> and Colonization With Tetracycline-Resistant <i>Staphylococcus aureus</i> and Group A <i>Streptococcus</i>

Clinical Infectious Diseases · 2025-02-27 · 38 citations

BACKGROUND: Doxycycline post-exposure prophylaxis (doxy PEP) is increasingly used among men who have sex with men (MSM). Its impact on antimicrobial resistance and the microbiome is uncertain. METHODS: We used Neisseria gonorrhoeae (NG) surveillance data from King County, Washington, USA, and joinpoint regression to investigate trends in NG-tetracycline resistance (tetR), 2017-2024 and, among sexual health clinic (SHC) patients, evaluated the association of NG-tetR with doxy PEP use. We evaluated nasopharyngeal colonization with Staphylococcus aureus and Group A Streptococcus (GAS) in 703 MSM SHC patients, August 2023-July 2024. RESULTS: Among 2312 MSM with NG, tetR was stable 2017 to quarter 1 (Q1) 2023 (mean = 27%) and thereafter rose to 70% in Q2 2024 (P < .0001). (King County released doxy PEP guidelines in Q2 2023.) NG with high-level (HL) tetR increased Q1 2021 to Q2 2024 (2% to 65%) (P < .0001). Taking >3 doses of doxy PEP/month was associated with both tetR and HL tetR (P ≤ .01 for both), though any use of doxy PEP was not associated with tetR or HL tetR. S. aureus colonization was less common among doxy PEP users than non-users (27% vs 36%, P = .02), but colonization with both tetracycline-resistant S. aureus and GAS were more common among doxy PEP users than non-users (18% vs 8%, P < .0001% and 9% vs 4%, P = .008, respectively). CONCLUSIONS: TetR in NG rapidly increased from 2021 to 2024, and most NG among King County MSM now have HL tetR. Doxy PEP use is associated with colonization with GAS and tetracycline-resistant S. aureus, suggesting that doxy PEP impacts off-target bacteria.

Near-Universal Resistance to Macrolides of <i>Treponema pallidum</i> in North America

New England Journal of Medicine · 2024-06-12 · 13 citations

In the Shadow of Gonococcus: A Tale of Love and Admiration for the STI Field

Sexually Transmitted Diseases · 2024-08-16

Sexually transmitted diseases (STDs), previously known as venereal diseases, are as old as humanity. Do you call it STD or STI (sexually transmitted infection)1? Why not call it SSM (sexually shared microbiota)2? Regardless of what you call it, it is not every day you meet someone who admires STI and fell in love with the gonococcus (GC). The title of my reflection may not be surprising to those who know me well and are familiar with my passion and enthusiasm for the work I do. As a microbiologist, I have had the privilege of working with many clinically important bacteria and thought that my research would focus mostly on antimicrobial resistance (AMR) of bacteria causing community- and hospital-acquired infections. As serendipity would have it, I got involved in STI research while I was working on my doctoral research on multidrug-resistant Klebsiella pneumoniae isolated from urinary tract infections. Not everyone believes in love at first sight. When I first saw gonococcus in its fluorescent glory (Fig. 1), I had to get to know it better. My first project when I joined the University of Washington Neisseria Reference Laboratory in early 2000s was full of intrigue and beauty as I spent long hours making DNA agarose plugs, performing restriction enzyme digest, and running pulsed field gel electrophoresis to reveal the gorgeous gonococcus fingerprints of a cluster of isolates from an outbreak of fluoroquinolone resistance and gonorrhea treatment failure in Seattle.Figure 1: Immunofluorescence antibody staining of gonococcus, an endocervical Neisseria gonorrhoeae strain.Dare to love the gonococcus! It is insane, or is it? Neisseria gonorrhoeae is a strict human pathogen discovered by Albert Ludwig Sigesmund Neisser in 1879.3 I love the gonococcus because of its fascinating biology, pathogenesis including immune evasion, and importantly, its recalcitrant plasticity and remarkable resilient ability to sequentially develop resistance to all antimicrobials recommended for gonorrhea treatment. Since the 1940s, GC has serially developed resistance to changing first-line therapies, including sulfonamides, penicillins, tetracyclines, fluoroquinolones, and most recently extended-spectrum cephalosporins. Disturbingly, several countries have identified gonococci exhibiting high-level resistance to ceftriaxone, the last remaining highly effective treatment option for gonorrhea. The long-standing Gonococcal Isolate Surveillance Project was instrumental to the Centers for Disease Control and Prevention (CDC) recognizing GC as 1 of the 5 urgent antibiotic resistance threats in the United States in 2013 and 2019. I am thrilled by the progress in the US GC AMR surveillance, which was expanded in 2016 to build local capacity to perform timely and actionable antimicrobial susceptibility testing by the gradient strip method and established the Antibiotic Resistance Laboratory Network for surveillance of GC AMR through agar dilution antimicrobial susceptibility testing and whole genome sequencing.4 Data generated from the Gonococcal Isolate Surveillance Project/Antimicrobial Resistance Laboratory Network laboratories have been used to inform and guide revisions to the gonorrhea treatment guidelines. In 2022, CDC made a huge investment that involved more than 24 partners implementing collaborations in more than 42 countries to launch the Global Antibiotic Resistance Laboratory and Response Network including the expansion of the World Health Organization–CDC Enhanced Gonococcal Antimicrobial Surveillance Programme to resource-limited countries such as Zimbabwe, Malawi, and Côte d'Ivoire. Data from Enhanced Gonococcal Antimicrobial Surveillance Programme sites will improve our understanding of dissemination of GC AMR in geographically diverse areas where there is currently limited or no GC AMR data and inform national and international gonorrhea treatment guidelines. Although this is a commendable step in the right direction, there are still many countries that still rely on syndromic STI management and do not have the laboratory infrastructure for GC AMR surveillance. Although it is imperative to continue expanding and enhancing surveillance of GC AMR and gonorrhea treatment failures globally, our reliance on nucleic acid amplification tests for gonorrhea diagnosis, rather than isolation of GC by culture, will continue to make it impossible to conduct population-level surveillance of GC AMR until we can implement rigorous molecular AMR assays for detection of genetic determinants of GC AMR. Culture-independent genome sequencing of remnant nucleic acid amplification test specimens for molecular surveillance of GC AMR will significantly enhance the culture-based surveillance of GC AMR. Containment of ever more resistant, untreatable gonorrhea necessitates global cooperation in tracking national and international emergence of GC AMR and its transmission globally. As we look to the future, a holistic and comprehensive approach to combating GC AMR requires a better understanding of how GC AMR develops and is transmitted within the human microbiota. This is particularly important for pharyngeal gonorrhea, which often is asymptomatic, considered to be difficult to treat and associated with cephalosporin resistance. Moreover, drug levels in the oropharynx are often lower than at other sites of N. gonorrhoeae infection, and it is a reasonable hypothesis that the oropharynx often harbors diverse microbiota that facilitates horizontal genetic exchange of AMR determinants. Ongoing studies in my laboratory will contribute to our understanding of the dynamics of AMR among GC and the other bacteria that inhabit the human oropharynx. This knowledge will provide important insights into how AMR-GC develops, critically valuable information in developing strategies to contain the threat of AMR-GC and for development of novel antimicrobials. As we celebrate the 50th anniversary of our beloved and esteemed journal, I reflect on my admiration for the field of STI that I cherish so much. We owe a big shout-out to all the giants and leaders of STI who worked tirelessly to give STI the visibility and recognition it deserves. To the next generation of STI leaders, I salute your courage to keep moving the field of STI to greater heights. In STI, I have found not just mentors but friends, champions, and “sponsors” who want the best for the field and everyone working in it. I owe a great deal of admiration to the field of STI that supported me and continue to nurture my career development. Only in this amazing field of STI do I feel at home and feel connected to STI colleagues all over the world. To my beloved STD journal, I remember the nervous anticipation of submitting my first article for consideration,5 I now regularly coauthor articles in STD6,7 and feel honored to be on the journal's Editorial Board. As I reflect on my admiration for the STI field, I must convey my heartfelt appreciation to the American Sexually Transmitted Diseases Association (ASTDA) that has played a significant role in my scientific leadership development through participation in the Annual ASTDA Workshop8 and serving on the ASTDA Board of Directors. Reflecting on the impactful value that our field of STI brings to the world, I must acknowledge everyone working on STIs for all your amazing studies that have significantly contributed to advancing our understanding of the diagnosis, epidemiology, pathogenesis, treatment, surveillance, control, and prevention of STIs in the United States and globally. Looking at an STI through the magnifying lens of a microbiologist, STI pathogens, especially the gonococcus, have always held a special place in my heart, and I am grateful to have trained and continue to work as a faculty at the University of Washington. In closing, I am indebted to the field of STI and to my favorite bug, gonococcus. I am grateful to have had the serendipitous opportunity to join the University of Washington Neisseria Reference Laboratory over 2 decades ago, and I have since then loved working with GC and I look forward to more years of productive GC research till retirement do us part.

Asymptomatic and Subclinical Mpox: An Association With Modified Vaccinia Ankara Vaccine

Sexually Transmitted Diseases · 2024-01-26 · 4 citations

BACKGROUND: How often mpox causes asymptomatic infections, particularly among persons who have received the Modified Vaccinia Ankara (MVA) vaccine, is unknown. METHODS: We performed mpox polymerase chain reaction testing on rectal and pharyngeal specimens collected from symptomatic and asymptomatic patients at a sexual health clinic in Seattle, WA, between May 2022 and May 2023. Analyses evaluated the prevalence of asymptomatic or subclinical infection and, among persons with polymerase chain reaction-positive tests, the association of MVA vaccination status with the symptomatic infection. RESULTS: The study population included 1663 persons tested for mpox during 2353 clinic visits. Ninety-three percent of study participants were cisgender men and 96% were men who have sex with men. A total of 198 symptomatic patients (30%) had a first mpox-positive test during 664 visits. Eighteen patients (1.1%) tested during 1689 visits had asymptomatic or subclinical mpox based on a positive rectal or pharyngeal test done in the absence of testing done because of clinical suspicion for mpox. Fourteen (78%) of 18 persons with asymptomatic/subclinical mpox and 53 (26%) of 198 persons with symptomatic mpox had received at least 1 dose of the MVA vaccine ( P < 0.0001). Controlling for calendar month, study subjects who received 1 and 2 doses of MVA vaccine were 4.4 (95% confidence interval, 1.3-15) and 11.9 (3.6-40) times more likely to have asymptomatic versus symptomatic mpox, respectively, than persons who were unvaccinated. CONCLUSIONS: Asymptomatic mpox is uncommon. Modified Vaccinia Ankara vaccination is associated with an asymptomatic/subclinical infection among persons with mpox.

Characterizing the role of informal payments in the delivery of pathology and clinical laboratory services

American Journal of Clinical Pathology · 2024-02-12

OBJECTIVES: Informal payments (IPs) are unofficial cash or in-kind payments for goods or services that should be covered by the health care system. They are a common but regressive method of financing health care in low- and lower-middle-income countries (LMICs). This study aims to characterize the prevalence and impact of IPs on pathology and laboratory medicine (PALM) services. METHODS: From September 2021 to September 2022, PALM staff were surveyed about the frequency, determinants, and impacts of IPs in their respective workplaces. RESULTS: In total, 268 responses were received, and 46.6% (125/268) reported experience with IPs. These 125 participants were more likely to work in the public sector and in LMICs. Approximately 65% reported accepting IPs to perform tests or release results. Obtaining faster results was the most commonly perceived reason for patients offering IPs. Overall, participants reported that IPs had more negative than positive impacts on their workplace. CONCLUSIONS: This represents a first step in characterizing IPs within PALM and how this practice may affect access to these services in LMICs. Specifically, the fact that faster turnaround time was the most frequently perceived reason for offering IPs uncovers a potential barrier to improving PALM capacity in these regions.