C. Le Roy

First case of Chlamydia trachomatis L2b proctitis in a woman

Since 2003, outbreaks of lymphogranuloma venereum (LGV) have been reported in European countries, North America, and Australia. Current LGV cases have been caused by Chlamydia trachomatis serovar L2. This sexually transmitted infection is predominantly found among men who have sex with men, specifically men who are seropositive for human immunodeficiency virus and have clinical signs of proctitis. The current outbreak has been almost exclusively attributed to a new variant, designated L2b. Although urogenital cases of LGV have been described in the heterosexual population, we report the first case of C. trachomatis L2b proctitis in a woman.

P3.025 Internet Testing For Chlamydia Trachomatis in France in 2012

Chlamydia trachomatis (CT) infection spreads in Europe and in USA, and tendencies analysis shows an increase in the epidemic since last 10 years. In France, in 2006, a national survey carried out by phone and using a home-based sampling showed that CT prevalence was the highest in young people, with 3.6% for women and 2.4% in men aged 18–24 yo. To face this problem, several countries have developed new strategies, mixing newer technologies and home-based self-sampling test. Inspired by evaluation of those dispositives, the French National Institute of Health Prevention and Education (INPES) decided to experiment the proposition of a free home-based self-sampling to screen this infection via internet in young people 18–24 yo. This study, named Chlamyweb, aims to compare CT screening rate from this intervention with traditional information system and screening centre. Study design was a random control trial, with a 1:2 randomization. Recruitment took place on an Internet information website on sexually transmitted infections, and support by web campaign from September 3 to October 14 2012. Home-based kits were composed by uriswab 3 sponges for men and dry vaginal swabs for women (Copan diagnostics). All samples were analysed by using the fully automated cobas 4800 (Roche diagnostics). Self-sampling was proposed to 5 531 people. Out of them, 47.3% accepted, with a higher rate in women (53.0%). A total of 1616 kits provided [1002 from women (63.8%) and 614 from men (58.8%)] was return to the French National Reference Center for chlamydial infections. The global prevalence was 6.8% (8.3% in women, 4.4% in men). Sexual behaviour and sociodemographic patient’s characteristics were collected and their analysis is under investigation. These preliminary results show that Internet testing reaches a population with a high prevalence of CT infection and appears to be acceptable to young people.

P2.053 Chlamydia Trachomatis/Neisseria Gonorrhoeae Screening in Duplex: Should We Verify N. Gonorrhoeae Positive Results?

The objective of this study was to assess the utility of a supplementary PCR test following a positive Abbott m2000 PCR test result for Neisseria gonorrhoeae (NG) issued from urogenital specimens tested in the Department of Bacteriology at the Bordeaux University Hospital, France in 2011–2013. All NG-positive PCR specimens either negative with NG culture or without culture result, were retrieved and tested with two CT/NG PCR tests: Cepheid GeneXpert CT/NG and Roche cobas 4800 CT/NG (both targeting two genes). Analytical sensitivity of the three tests, Abbott, Cepheid and Roche for NG detection, was tested on serial dilutions (10–1 to 10–9) from one colony of NG suspended in cobas® PCR medium (Roche). Of 11.010 specimens tested on Abbott m2000, the global prevalence of NG was 2.5% (277/11.010) and varied with the origin of the patient, from 0.8% at a free and anonymous STI screening centre (CDAG) to 6% at STI clinics (CIDDIST). Out of 215 specimens analysed, 112 were confirmed by culture or with a second PCR-positive sample, and 103 were tested with the two other PCR assays. A total of 197/215 NG-positive Abbott PCR results were confirmed. The overall positive predictive value (PPV) of the CT/NG Abbott test was 91.6%, ranging from 73.5% for asymptomatic patients consulting at CDAG to 95.8% for symptomatic patients consulting at CIDDIST. Concerning the analytical sensitivity, the Cepheid test was 10 and 100 times more sensitive than the Abbott and the Roche tests, respectively. In populations where the prevalence was < 1%, the Abbott CT/NG test had a PPV < 90% and therefore required confirmation testing. When NG screening is associated with that of CT in populations with variable prevalence, it should be recommended to either use a NG PCR test with two targets or confirm a positive result by another PCR test with a different target.

P2.048 Evaluation of Two Commercial Real-Time PCR Assays For Detection of Mycoplasma Genitalium in Urogenital Specimens

Objectives Mycoplama genitalium is a sexually transmitted organism associated with non-gonococcal urethritis in men and several inflammatory reproductive tract syndromes in women. Nucleic acid amplification tests are currently the only available methods for detection. The first commercially available real-time (RT-) PCR kits have been recently developed. We compared the TIB MOLBIOL LightMix® Kit Mycoplasma genitalium and the Diagenode Mycoplasma genitalium real-time PCR kit to the in-house TaqMan RT-PCR used routinely for the M. genitalium diagnostic. Methods DNA extracts from 50 M. genitalium-negative and 53 M. genitalium-positive urogenital specimens collected between January 2010 and May 2011 at the Bordeaux University hospital, France, were retrospectively and systematically selected and thawed. DNA had been extracted using the MagNA Pure DNA isolation kit I (Roche Diagnostics). DNA extracts were evaluated by the TIBMOLBIOL LightMix® Kit Mycoplasma genitalium and the Diagenode Mycoplasma genitalium real-time PCR kit (DIA-MG-050 vs2) in comparison with a M. genitalium in-house RT-PCR targeting the MgPa adhesin gene using the cobas z480 analyser (Roche Diagnostics). Results The in-house PCR was first evaluated using two thermal cyclers, LC480 and cobas z480 (Roche Diagnostics). As no significant difference was noted, the cobas z480 was used in the rest of the study. The clinical sensitivity was 98%, 92% and 100% for the LightMix® Kit Mycoplasma genitalium, the Diagenode Mycoplasma genitalium real-time PCR kit and the in house RT-PCR, respectively. The clinical specificity was 100% for both kits and 94% for the in house RT-PCR. There was no statistically significant difference between the clinical sensitivity and specificity of these 3 methods. Moreover, there was no statistically significant difference between the cycle threshold mean of the in-house assay and those of both commercial kits. Conclusion Both commercial kits allowed prompt and specific results, validated by the use of an internal amplification control.

Observational study of anorectal Chlamydia trachomatis infections in France through the lymphogranuloma venereum surveillance network, 2010–2015

The objective of this article is to describe the epidemiology of lymphogranuloma venereum (LGV) and non-LGV Chlamydia trachomatis anorectal infections in France and to examine the characteristics of the affected populations via a voluntary sentinel surveillance system for LGV between 2010 and 2015. Anorectal samples positive for C. trachomatis (CT) were sent by the participating laboratories to the National Reference Center for CT for LGV identification. Biological and clinical data were collected by biologists and clinicians. There were 1740 LGV episodes and 2248 non-LGV episodes. Continuous monitoring highlighted a sharp increase in the number of LGV and non-LGV anorectal infections, which were 2.3-fold and 6.5-fold, respectively. Most of the infections occurred in men who have sex with men. LGV patients were older than non-LGV patients and were more frequently human immunodeficiency virus (HIV)-positive compared to non-LGV patients. Anorectal LGV was significantly associated with residence in Paris, HIV co-infection, concurrent syphilis and bloody anal discharge. Undocumented patient characteristics were strongly associated with anorectal LGV. The anorectal LGV epidemic is poorly controlled in France. Early detection and prompt treatment of patients and their sexual partners are required to prevent transmission in the context of pre-exposure prophylaxis (PrEP) for HIV infection.

TO59 La teneur en polyamines de l’alimentation influence la sensibilité à la douleur chez le rat

Introduction Les nutriments presents dans l’alimentation sont capables de moduler les systemes physiologiques. Les polyamines (spermine, spermidine et putrescine), issues majoritairement de l’alimentation, sont des polycations capables de moduler positivement le fonctionnement des recepteurs NMDA. Il est clairement etabli que les recepteurs NMDA jouent un role critique dans le developpement de l’hypersensibilite a la douleur. Une hypothese est que les polyamines pourraient faciliter la sensibilisation a la douleur via les recepteurs NMDA. Nous avons donc examine s’il existait une relation entre la teneur en polyamines de l’alimentation et le niveau de sensibilite a la douleur. Materiels et methode Les rats ont ete nourris avec 4 regimes alimentaires differents : 1) standard (RS ; polyamines = 30 mg/kg), 2) appauvri (RAP ; polyamines Resultats La teneur en polyamines dans l’alimentation ne modifie pas le seuil nociceptif de base. L’hyperalgesie inflammatoire ainsi que la sensibilisation a la douleur induite par une histoire de stress ou de douleur inflammatoire sont augmentees de maniere importante chez les rats nourris avec le REP alors qu’elles sont reduites chez les rats nourris avec le RAP ou le RIP versus le RS. Conclusion La teneur en polyamines de l’alimentation influence la sensibilite a la douleur. Moins les rats consomment de polyamines, moins ils developpent d’hypersensibilite a la douleur. La therapie nutritionnelle apparait comme une approche therapeutique innovante et efficace pour le traitement de la douleur notamment des douleurs chroniques.

TO57 Sensibilisation latente à la douleur chez des rats ayant eu une expérience douloureuse traitée par du fentanyl

Introduction Le stress induit de l’analgesie via une liberation endogene d’opioides. Cependant, des evenements stressants peuvent aussi jouer un role dans l’apparition d’episodes douloureux. De plus, il a ete montre qu’une seule exposition aux opioides activait les systemes pronociceptifs NMDA-dependants conduisant a une vulnerabilite a long terme a la douleur. Nous avons donc etudie si une experience de douleur inflammatoire traitee par du fentanyl pouvait favoriser : i) le developpement d’une vulnerabilite a long terme a la douleur apres un stress environnemental non nociceptif (SENN) et ii) la resistance aux effets antalgiques des opioides. Materiel et methode A J 0 , la carragenine, un agent pro-inflammatoire, a ete injectee dans une patte posterieure chez des rats traites par du fentanyl (4 x 100 μg/kg ; s.c.). Deux semaines apres, les rats ont ete exposes soit a : i) des SENN repetes, ii) une « ultra-low » dose de fentanyl (ULDf, 50 ng/kg) ou iii) une dose analgesique de fentanyl (25 μg/kg). La sensibilite a la douleur est evaluee quotidiennement par la determination du seuil nociceptif (SN) par le test de Randall-Selitto. Resultats Une ULDf induit une analgesie identique a celle observee apres un SENN chez les rats naifs mais provoque plusieurs heures d’hyperalgesie chez les rats ayant eu une experience douloureuse traitee par du fentanyl. Une resistance a l’effet analgesique du fentanyl 25 μg/kg est observee chez les rats ayant eu une histoire douloureuse et d’opioides. La repetition du SENN induit une importante augmentation (18 a 22 fois) de l’hyperalgesie. L’hyperalgesie induite par le SENN est toujours visible 4 mois apres l’experience douloureuse traitee par du fentanyl. Ce phenomene a ete denomme « sensibilisation latente a la douleur ». Discussion La sensibilisation latente a la douleur induite par une seule exposition aux opioides chez les rats avec une experience douloureuse pourrait jouer un role critique dans la transition de la douleur aigue a la douleur chronique apres une lesion tissulaire.

TO58 La répétition de stress environnementaux non nociceptifs induit une sensibilisation à la douleur – prévention par un régime appauvri en polyamines

Introduction Il est bien admis que le stress induit de l’analgesie via une liberation d’opioides endogenes. Cependant une seule administration d’opioides est capable d’induire a long terme, une hypersensibilite a la douleur via des systemes pronociceptifs NMDA dependants. Nous avons donc etudie si les opioides endogenes liberes lors de stress environnementaux non nociceptifs (SENN) pourraient favoriser le developpement d’une hypersensibilite a la douleur. D’un point de vue therapeutique, les agents anti-NMDA sont efficaces pour reduire l’hypersensibilite a la douleur mais leur utilisation prolongee n’est pas envisageable en clinique en raison d’effets secondaires. La modulation negative des recepteurs NMDA pourrait representer une meilleure strategie therapeutique. Dans cette perspective, puisque les polyamines, issues majoritairement de l’alimentation, sont des modulateurs positifs des recepteurs NMDA, nous avons evalue les effets « anti-sensibilisants » d’un regime alimentaire appauvri en polyamines (RAP). Materiel et methode Des rats ont ete exposes a un SENN a J0, J2 et J7. A J14, un agent pro-inflammatoire, la carragenine, est injecte dans une patte posterieure de rats traites ou non par du fentanyl (4x100 μg/kg, s.c.). La sensibilite a la douleur a ete evaluee quotidiennement par la determination du seuil nociceptif par le test Randall Selitto. L’effet preventif d’un RAP (polyamines Resultats Les SENN sont capables d’amplifier de maniere tres importante et durable (3-4 fois) l’hyperalgesie induite par une douleur inflammatoire chez des animaux traites ou non par du fentanyl. Un traitement par un regime appauvri en polyamines est capable de reduire totalement l’hypersensibilite a la douleur des animaux ayant ete stresses. Conclusion Puisque depourvu d’effets secondaires, un regime appauvri en polyamines peut etre considere comme une nouvelle strategie therapeutique efficace pour reduire l’hypersensibilite a la douleur.