Carol E. Farshy

Multiple Drug-Resistant Chlamydia trachomatis Associated with Clinical Treatment Failure

In vitro susceptibility testing and genotyping were done on urogenital isolates of Chlamydia trachomatis from 3 patients, 2 of whom showed evidence of clinical treatment failure with azithromycin and one of whom was the wife of a patient. All 3 isolates demonstrated multidrug resistance to doxycycline, azithromycin, and ofloxacin at concentrations >4.0 microg/mL. Recurrent disease due to relapsing infection with the same resistant isolate was documented on the basis of identical genotypes of both organisms. This first report of clinically significant multidrug-resistant C. trachomatis causing relapsing or persistent infection may portend an emerging problem to clinicians and public health officials.

High Prevalence and Incidence of Sexually Transmitted Diseases in Urban Adolescent Females Despite Moderate Risk Behaviors

To better understand the prevalence, incidence, and risk factors for sexually transmitted diseases (STDs) among female adolescents, a prospective 6-month cohort study was conducted at four teen clinics in a southeastern city. At enrollment, 260 (40%) of 650 sexually active females ages 14-19 years had an STD: chlamydia, 27%; herpes simplex virus type 2 (HSV-2), 14%; gonorrhea, 6%; trichomoniasis, 3%; and hepatitis B, 2%. At follow-up, 112 (23%) of 501 participants had an incident infection: chlamydia, 18%; HSV-2, 4%; gonorrhea, 4%; and trichomoniasis, 3%. At either enrollment or follow-up, 53% had >/=1 STD; of those with 1 lifetime partner, 30% had an STD. Having a new partner (odds ratio [OR], 2.2; 95% confidence interval [CI], 1. 1-4.2) or friends who sell cocaine (OR, 1.6; CI, 1.0-2.6) was independently associated with incident infection. STD incidence and prevalence were extremely high in this population, even in teenagers with only 1 lifetime partner. Individual risk behaviors appeared less important for STD risk than population factors.

Risk Behaviors, Medical Care, and Chlamydial Infection Among Young Men in the United States

OBJECTIVES This study assessed factors related to chlamydial infection among young men in the United States. METHODS Data were from interviews of nationally representative samples of 470 men aged 18 to 19 years (teenagers) and 995 men aged 22 to 26 years (young adults) and from urine specimens tested by means of polymerase chain reaction. RESULTS Although a majority of the men reported occasional unprotected intercourse, only a minority perceived themselves to be at risk for contracting a sexually transmitted disease (STD). Chlamydial infection was detected in 3.1% of the teenagers and 4.5% of the young adults. A minority of those infected had symptoms or had been tested for STDs; very few had been diagnosed with STDs. CONCLUSIONS Chlamydial infection is common but usually asymptomatic and undiagnosed. Primary and secondary prevention efforts should be increased, particularly among young adult men.

Screening High-Risk Adolescent Males for Chlamydia trachomatis Infection: Obtaining Urine Specimens in the Field

Background and Objectives: Reported case data suggest that few men are being tested for Chlamydia trachomatis (CT) infection (female:male reported case ratio is >5:1) partially because men seek preventive health services less frequently than women and, until recently, obtaining a CT specimen from men required a urethral swab, which has low patient acceptability. A study was conducted in San Diego, CA, to determine whether urine specimens could be obtained from high‐risk teen males in the field using a peer teen outreach approach. Goals: Identify teen males infected with CT and provide treatment and partner management services. Study Design: Prevalence survey of 261 teen males and a program cost evaluation. Results: During the 6.5‐month study period (Dec 15, 1995 to June 30, 1996) an estimated 1,860 teen males were approached and 261 submitted a urine specimen; 16 (6.1%) were positive by polymerase chain reaction. All positive males were treated with azithromycin, 1 gm, in the field, and 9 female sex partners were treated, 7 of whom were CT positive. The cost per specimen obtained and per CT infection identified was

Prevalence incidence and correlates of chlamydia and gonorrhea among young adult injection drug users.

103 and

Evaluation of sera from patients with Lyme disease in the fluorescent treponemal antibody-absorption test for syphilis

1,677, respectively. The annual cost for adding a peer teen outreach service to an existing STD program using existing staff and adding 1.2 full‐time equivalents of outreach time is approximately

Detection of Chlamydia trachomatis cervical infection by urine tests among adolescents clinics

25,000. Conclusion: Peer teen outreach and in‐field collection of urine specimens appear to be an acceptable alternative for screening teen males for CT and should be further evaluated in other communities.

HIV-1 RNA Rectal Shedding Is Reduced in Men With Low Plasma HIV-1 RNA Viral Loads and Is Not Enhanced by Sexually Transmitted Bacterial Infections of the Rectum

PURPOSE To measure prevalence, incidence, and correlates of chlamydia and gonorrhea among injection drug users (IDUs). METHODS Participants (n = 2129; 63% male, 52% white, ages 18-30 years) in five US cities were tested for chlamydia and gonorrhea by urine LCR assay and completed a standardized questionnaire about demographics and recent sexual behavior. Logistic regression identified correlates of prevalent infection; incidence rates were calculated from 6-month follow-up data. RESULTS Chlamydia prevalence was 5.2% and did not differ by gender. Gonorrhea prevalence was 0.2% among men and 2.0% among women, P < .001. Among men, younger age [OR (95% CI): 0.89 (0.83-0.96)], age at sexual debut [0.91 (0.83-0.99)], and African American race [2.92 (1.53-5.59)] were associated with chlamydia. Among women, age at sexual debut [1.16 (1.02-1.31)] and commercial sex [1.96 (1.03-3.74)] were associated with chlamydia, and with gonorrhea [1.27 (1.04-1.56)] and [5.17 (1.66-16.11)], respectively. At 6 months, the cumulative incidence of chlamydia was 1.7% among men and 4.4% among women, P = .03; no men and 1.3% of women tested positive for gonorrhea, P = .01. IMPLICATIONS Prevalence and correlates of chlamydia and gonorrhea were similar to other samples, suggesting that screening criteria need not be modified for IDU populations. The number of behavioral correlates identified was limited; perhaps unmeasured sexual-network-level factors play a role in determining sexually transmitted disease (STD) prevalence.

Detection of Neisseria gonorrhoeae Infection by Ligase Chain Reaction Testing of Urine Among Adolescent Women With and Without Chlamydia trachomatis Infection

To determine whether the cross-reactivity between Treponema pallidum and Borrelia burgdorferi affects the specificity of the fluorescent treponemal antibody-absorption (FTA-Abs) test for syphilis, sera from patients with Lyme disease or syphilis were examined in a quantitative FTA-Abs test. Sera were diluted serially in phosphate-buffered saline, then in sorbent, and were tested with T. pallidum and B. burgdorferi antigens. Nine of 40 sera from patients with known Lyme disease were reactive at the 1:5 dilution with antigen from T. pallidum; only one serum was reactive at the 1:10 dilution. When both antigens were tested, the titer against B. burgdorferi was always higher than that against T. pallidum. Similarly, sera from patients with syphilis showed cross-reactivity with B. burgdorferi. Although reactivity could be absorbed with Treponemal phagedenis (Reiter strain), simultaneous titration with both antigens was easily performed and designated the etiologic agent.

Increased Susceptibility to Vaginal Simian/Human Immunodeficiency Virus Transmission in Pig-tailed Macaques Coinfected With Chlamydia trachomatis and Trichomonas vaginalis

PURPOSE To compare urine ligase and polymerase chain reaction (LCR, PCR) tests for diagnosis of Chlamydia trachomatis cervical infection with PCR and nucleic acid probe (GPA) on cervical specimens in adolescents, as well as risk factors for C. trachomatis infection and prevalence of infection at enrollment. METHODS Urine and cervical specimens were collected from women aged 13-20 years attending adolescent clinics, and interviews were administered. Urine specimens were tested by PCR and LCR, and cervical specimens by GPA and PCR. Prevalence rates of C. trachomatis infection and gonorrhea were compared by demographic, behavioral, and clinical risk factors. RESULTS Of 415 women tested, 86 (20.7%) were infected with C. trachomatis as indicated by positive cervical PCR results. A higher prevalence of C. trachomatis infection was seen among adolescents who douched monthly or more frequently, or had gonorrhea; prevalence declined from 25.8% in the first 7 months to 16.3% in the last 14 months of the study (p = .017). A statistically significant protective effect for reported condom use was not observed. Sensitivity of urine PCR was 89.5% and specificity was 100% relative to cervical PCR, compared to 84.9% and 99.4% (urine LCR) and 65.4% and 98.0% (cervical GPA). Sensitivity of urine PCR was higher in women with discharge; urine LCR sensitivity was higher in women < 19 years of age. CONCLUSIONS Polymerase chain reaction and LCR assays on urine specimens were sensitive, specific, and noninvasive tests in this population of adolescents with high C. trachomatis infection prevalence. Chlamydia trachomatis infection was associated with douching monthly or more frequently. Prevalence of infection declined over the period during which the study was conducted.