G. La Ruche

High-level azithromycin-resistant Neisseria gonorrhoeae clinical isolate in France, March 2014.

We report the first case in France of a high-level azithromycin-resistant Neisseria gonorrhoeae (minimum inhibitory concentration (MIC) = 96 mg/L) assigned to MLST7363 (NG-MAST ST6360), also resistant to ciprofloxacin and tetracycline but susceptible to ceftriaxone. The patient was a 51 year-old heterosexual man who returned following 1g azithromycin monotherapy. Mechanisms of azithromycin resistance were a C2599T mutation in the four copies of the rrl gene and a novel mutation in the promoter of the mtrR gene.

Gonococcal infections and emergence of gonococcal decreased susceptibility to cephalosporins in France, 2001 to 2012.

Resistance to cephalosporins may lead to untreatable gonococcal infections. We describe the results of the sentinel surveillance of gonococcal infections and the evolution of the resistance of Neisseria gonorrhoeae to antibiotics in France from 2001 to 2012. We also analyse the factors associated with decreased susceptibility to third generation cephalosporins. In France, surveillance of gonococcal infections is conducted through a network of voluntarily participating laboratories. Strains are sent to the national reference laboratory to determine the minimum inhibitory concentration (MIC) for six antibiotics. During the study period, the number of gonococcal infections increased steadily. The susceptibility of 8,649 strains was studied for this period. The proportion of strains with decreased susceptibility to cefixime (MIC>0.125 mg/L) quadrupled between 2011 (0.7%:10/1,521) and 2012 (3.0%: 33/1,093; p 0.125 mg/L for ceftriaxone. Decreased susceptibility to cephalosporins increased with older age and was more common in pharyngeal strains. Decreased susceptibility to cefixime may indicate that the national recommendation to use ceftriaxone as a first line treatment for cases of urethritis and cervicitis has not been fully implemented. Enhanced surveillance of pharyngeal strains is strongly suggested.

Incidence of gonococcal and chlamydial infections and coverage of two laboratory surveillance networks, France, 2012

Surveillance of sexually transmitted diseases in France is based on voluntary networks of laboratories and clinicians. Despite the importance of incidence data in improving knowledge about the national context and in international comparisons, such data were not previously available. During nationwide quality control of laboratories, mandatory for all laboratories, we conducted a survey in June 2013 to estimate the incidence rates of gonococcal and chlamydial infections for 2012 and to estimate the proportion of diagnoses performed (coverage) by the countrys two laboratory-based sentinel networks for these diseases. Estimated incidence rates for 2012 were 39 per 100,000 persons aged 15 to 59 years for gonorrhoea and 257 per 100,000 persons aged 15 to 49 years for chlamydia. These rates were consistent with the average levels for a group of other Western countries. However, different estimates between countries may reflect disparate sources of surveillance data and diverse screening strategies. Better comparability between countries requires harmonising data sources and the presentation of results. Estimated coverage rates of the gonococcal and chlamydial infection surveillance networks in France in 2012 were 23% and 18%, respectively, with substantial regional variations. These variations justify improving the representativeness of these networks by adding laboratories in insufficiently covered areas.

Autorisation de séjour pour soins des malades étrangers en France : enquête sur les avis des médecins inspecteurs de santé publique

Position du probleme Les medecins inspecteurs de sante publique des directions departementales des affaires sanitaires et sociales sont charges de donner au prefet les avis d’autorisation de sejour pour soins des malades etrangers. Le medecin inspecteur, avec l’appui d’un rapport medical, precise si l’etat de sante de l’etranger necessite une prise en charge medicale, si le defaut de soins peut entrainer des consequences d’une exceptionnelle gravite et si l’interesse peut beneficier d’un traitement approprie dans son pays d’origine. Face a la forte croissance des demandes de sejour pour soins et au caractere potentiellement subjectif des avis rendus, une enquete a ete realisee aupres des medecins inspecteurs pour evaluer leurs pratiques. Methodes Un questionnaire a ete adresse par messagerie electronique en mars 2002 dans les departements de metropole. Les medecins inspecteurs devaient donner leur avis sur deux demandes fictives de sejour pour soins, proches de cas reels et soulevant des difficultes frequemment rencontrees. Il s’agissait d’un patient comorien de 57 ans traite pour hypertension arterielle et diabete non insulino-dependant (cas 1) et d’une patiente ivoirienne de 33 ans suivie apres traitement anti-tuberculeux (cas 2). Resultats Sur les 94 departements sollicites, il y a eu 42 reponses (45 %). Respectivement 88 % (cas 1) et 67 % (cas 2) des medecins inspecteurs ont considere que l’etranger necessitait des soins dont le defaut serait gravement prejudiciable, mais pour 26 % (cas 1 et 2), les soins pouvaient etre realises dans le pays d’origine. Au total, les avis divergeaient : pour 33 % (cas 1) et 53 % (cas 2) des medecins inspecteurs, le sejour pour soins en France n’etait pas justifie. Conclusions En depit d’un faible taux de reponse, cette enquete montre la subjectivite des avis, ce qui souleve un probleme d’egalite de traitement face aux demandes de sejour pour raison medicale. Notre etude suggere que cette subjectivite est liee a l’imprecision des notions sur lesquelles les medecins inspecteurs doivent se positionner et au manque de referentiels pour fonder leurs avis.

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.