Saliva Use as a Lubricant for Anal Sex Is a Risk Factor for Rectal Gonorrhoea among Men Who Have Sex with Men, A New Public Health Message

BACKGROUND:

Apart from penile-anal intercourse, other anal sexual practices (rimming, fingering and saliva use as a lubricant for anal sex) are common among men who have sex with men (MSM). The aim of this study is to evaluate whether these anal sexual practices are risk factors for rectal gonorrhoea in MSM.

METHOD:

A cross-sectional survey was conducted among MSM attending Melbourne Sexual Health Centre between 31 July 2014 and 30 June 2015. Rectal gonorrhoea cases were identified by culture.

RESULTS:

Among 1312 MSM, 4.3% (n=56) had rectal gonorrhoea. Other anal sexual practices were common among MSM: receptive rimming (70.5%), receptive fingering or penis dipping (84.3%) and using partner's saliva as a lubricant for anal sex (68.5%). Saliva as a lubricant was significantly associated with rectal gonorrhoea after adjusting for potential confounding factors. Receptive rimming and fingering or penis dipping were not statistically associated with rectal gonorrhoea. The crude population-attributable fraction of rectal gonorrhoea associated with use of partner's saliva as a lubricant for anal sex was 48.9% (7.9% to 71.7%).

CONCLUSIONS:

Saliva use as a lubricant for anal sex is a common sexual practice in MSM, and it may play an important role in gonorrhoea transmission. Almost half of rectal gonorrhoea cases may be eliminated if MSM stopped using partner's saliva for anal sex.

Purchase full article at:   http://goo.gl/65Oefu

By:  Chow EP1, Cornelisse VJ1, Read TR1, Lee D2, Walker S1, Hocking JS3, Chen MY1, Bradshaw CS1, Fairley CK1.

• 1Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
• 2Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
• 3Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

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The Prevalence & Epidemiology of Plasmid-Mediated Penicillin & Tetracycline Resistance among Neisseria Gonorrhoeae Isolates in Guangzhou, China, 2002–2012

Gonococcal antimicrobial resistance is a global problem. Different resistance plasmids have emerged and spread among the isolates of Neisseria gonorrhoeae worldwide and in China. We conducted this study to monitor the plasmid-mediated penicillin and tetracycline resistance amongN. gonorrhoeae isolates in Guangzhou from 2002 to 2012.

Consecutive isolates of N. gonorrhoeae were collected from outpatients with gonorrhea attending the STD clinic in Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention. Penicillinase-producing N. gonorrhoeae (PPNG) isolates were analyzed by the paper acidometric method. Plasmid-mediated resistance to tetracycline in N. gonorrhoeae (TRNG) isolates was screened by the agar plate dilution method. Plasmid types were determined for TRNG and PPNG isolates using polymerase chain reaction (PCR). Minimum inhibitory concentrations (MICs) to penicillin and tetracycline were detected by the agar plate dilution.

Of 1378 consecutive N. gonorrhoeae isolates, 429 PPNG and 639 TRNG isolates were identified. The prevalence of PPNG, TRNG, and PPNG/TRNG increased from 18.3 to 47.1 %, from 29.4 to 52.1 % and from 10.0 to 26.2 % between 2002 and 2012, respectively. Genotyping of plasmids among PPNGs showed that the majority (93.7 %) of the isolates were the Asian type plasmids, while the African type plasmid emerged in 2008 and rapidly increased to 14.0 % in 2012. For TRNGs, all 639 isolates carried the Dutch type plasmid. MICs of penicillin G and tetracycline persisted at high levels and the MIC _90s were 32-fold higher than the resistant cutoff point over 11 years. The prevalence rates of penicillin- and tetracycline-resistant N. gonorrhoeae varied from 90.9 to 91.1 % and from 88.3 to 89.3 % during 2002 to 2012, respectively.

Resistance to penicillin and tetracycline among N. gonorrhoeae isolates remained at high levels in Guangzhou. The Asian type PPNG continued to spread and Dutch type TRNG was still the dominant strain. The African type PPNG has emerged and is spreading rapidly.

Full article at: http://goo.gl/E3IQl7

By: Heping Zheng^*, Xingzhong Wu, Jinmei Huang, Xiaolin Qin, Yaohua Xue, Weiying Zeng,Yinyuan Lan, Jiangli Ou, Sanmei Tang and Mingheng Fang

Guangdong Provincial Centre for Skin Diseases and STIs Control and Prevention, Guangzhou 510091, China

  

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Gonococcal Susceptibility to Cephalosporins—Hawaii, 2003 to 2011

Among gonococcal isolates examined at the Hawaii State Laboratory Division from 2003 to 2011, the prevalence of elevated cefixime minimum inhibitory concentrations (MICs; ≥0.064 μg/mL) and elevated cefpodoxime MICs (≥0.19 μg/mL) increased over time. In contrast, few isolates exhibited elevated ceftriaxone MICs (≥0.094 μg/mL), and the prevalence of elevated ceftriaxone MICs did not change.

Below:  Proportion of gonococcal isolates with an elevated cefixime MIC (MIC ≥0.064 μg/mL) and elevated cefpodoxime MIC (MIC ≥0.19 μg/mL)—HGCSP, 2003 to 2011. *There was no cefixime testing, July 2004 to December 2009; testing for cefpodoxime started in April 2004.

TABLE 1

Prevalence of Elevated Cefixime MICs (MIC ≥0.064 μg/mL) in Patients With N. Gonorrhoeae Infection and Cefixime MIC Results—HGCSP, 2003 to 2004* and 2010 to 2011

	2003–2004*			2010–2011
	Prevalence	PR (95% CI)	P	Prevalence	PR (95% CI)	P
Sex
Male	6/320 (1.9%)	0.8 (0.3–2.4)	0.71	69/293 (23.6%)	4.1 (1.7–9.8)	<0.01
Female	7/304 (2.3%)	Reference	—	5/87 (5.8%)	Reference
Age, y
≤19	1/87 (1.2%)	0.4 (0.05–3.0)	0.34	8/40 (20.0%)	1.0 (0.5–2.0)	0.99
20–29	8/267 (3.0%)	Reference	—	41/206 (19.9%)	Reference	—
30–39	3/161 (1.9%)	0.6 (0.2–2.3)	0.47	14/75 (18.7%)	0.9 (0.5–1.6)	0.82
≥40	1/109 (0.9%)	0.3 (0.04–2.4)	0.23	11/59 (18.6%)	0.9 (0.5–1.7)	0.83
Race/Ethnicity
Asian	6/253 (2.4%)	1.0 (0.3–4.0)	0.99	19/83 (22.9%)	1.0 (0.6–1.8)	0.90
Black	2/46 (4.4%)	1.9 (0.3–10.8)	0.49	8/21 (38.1%)	1.7 (0.9–3.3)	0.13
HI/PI	0/10 (0%)	0 (—)	0.63	6/52 (9.6%)	0.4 (0.2–1.1)	0.06
Hispanic	0/43 (0%)	0 (—)	0.31	6/33 (18.2%)	0.8 (0.4–1.9)	0.64
White	3/128 (2.3%)	Reference	—	21/95 (22.1%)	Reference	—
Multiple/Other	0/21 (0%)	0 (—)	0.48	7/48 (14.6%)	0.7 (0.3–1.4)	0.29
District of residence
Oahu, Hawaii	11/596 (1.9%)	Reference	—	70/356 (19.7%)	Reference	—
Other island, Hawaii	0/25 (0%)	0 (—)	0.49	3/20 (15.0%)	0.8 (0.3–2.2)	0.61
Out of state	2/3 (66.7%)	36.1 (13.4–97.4)	<0.01	1/4 (25.0%)	1.3 (0.2–7.0)	0.79
Provider type
STD clinic	4/241 (1.7%)	Reference	—	44/225 (19.6%)	Reference	—
Private/HMO	7/292 (2.4%)	1.4 (0.4–4.9)	0.55	24/91 (26.4%)	1.3 (0.9–2.1)	0.18
Other	2/91 (2.2%)	1.3 (0.2–7.1)	0.74	6/64 (9.4%)	0.5 (0.2–1.1)	0.06
Interviewed patients from STD clinic Sex, sex of sex partner†
MSM	1/62 (1.6%)	1.8 (0.1–27.9)	0.68	33/127 (26.0%)	2.1 (1.0–4.3)	0.03
MSW	1/110 (0.9%)	Reference	—	8/65 (12.3%)	Reference	—
Women	2/69 (2.9%)	0.3 (0.03–0.4)	0.34	2/27 (7.4%)	1.7 (0.4–7.3)	0.50
Recent travel (patient or partner)†
Yes	2/95 (2.1%)	—	0.13	16/83 (19.3%)	0.9 (0.5–1.6)	0.78
No	0/110 (0%)	Reference	—	23/110 (20.9%)	Reference	—
Recent antimicrobial use†
Yes	1/29 (3.5%)	2.4 (0.3–22.1)	0.44	3/11 (27.3%)	1.3 (0.5–3.7)	0.57
No	3/207 (1.5%)	Reference	—	39/193 (20.2%)	Reference	—
Sex worker (patient or partner)†
Yes	1/21 (4.8%)	4.9 (0.5–52.1)	0.15	0/10 (0%)	0 (—)	0.10
No	2/207 (1.0%)	Reference	—	41/192 (21.4%)	Reference	—
Military (patient or partner)†
Yes	1/54 (1.9%)	1.6 (0.2–17.7)	0.68	11/39 (28.2%)	1.5 (0.8–2.6)	0.22
No	2/177 (1.1%)	Reference	—	31/161 (19.3%)	Reference	—
Total	13/624 (2.1%)			74/380 (19.5%)

Data presented are number of cases with elevated cefixime MIC/number of patients for whom data were available.

*There was no cefixime testing, July 2004 to December 2009.

†Analysis restricted to interviewed patients from the STD clinic (n = 241 [172 male patients] for 2003–2004, n = 225 [198 male patients] for 2010–2011).

HI/PI indicates Hawaiian/Pacific Islander; HMO, Health Maintenance Organization.

Full article at: http://ht.ly/SOQYs

By: Sarah Kidd, MD, MPH,* Maria V.C. Lee, MS,† Eloisa Maningas, BSMT,† Alan Komeya, MPH,† Gail Kunimoto, BS,†Norman O’Connor, MA,† Alan R. Katz, MD, MPH,†‡ Glenn M. Wasserman, MD, MPH,† Robert D. Kirkcaldy, MD, MPH,* and A. Christian Whelen, PhD†‡

^†Hawaii State Department of Health, Honolulu, HI

^‡

*Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

†Hawaii State Department of Health, Honolulu, HI

‡University of Hawaii-Manoa, Honolulu, HI

*Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

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Emergence and Evolution of Internationally Disseminated Cephalosporin-Resistant Neisseria gonorrhoeae Clones from 1995 to 2005 in Japan

Neisseria gonorrhoeae strains with resistance to extended-spectrum cephalosporins (ESCs), last options for first-line monotherapy of gonorrhoea, likely emerged and initially disseminated in Japan, followed by international transmission. In recent years, multi-locus sequence typing (MLST) ST1901 and N. gonorrhoeae multiantigen sequence typing (NG-MAST) ST1407 isolates with the mosaic penicillin-binding protein (PBP) 2 XXXIV have accounted for most ESC resistance globally. Our aim was to elucidate the initial emergence and transmission of ESC-resistant strains by detailed examination of N. gonorrhoeae isolates from 1995 to 2005 in Kanagawa, Japan.

Already in 1995, one cefixime-resistant (CFM-R) isolate was found, which is the first CFM-R isolate described globally. After 1996, the prevalence of CFM-R and CFM-decreased susceptibility (CFM-DS) isolates significantly increased, with the peak resistance level in 2002 (57.1 % CFM-R). In 1997–2002, the CFM-R MLST ST7363 strain type with the mosaic PBP 2 X was predominant among CFM-R/DS isolates. The first CFM-R/DS MLST ST1901 clone(s), which became the predominant CFM-R/DS strain type(s) already in 2003–2005, possessed the mosaic PBP 2 X, which was possibly originally transferred from the MLST ST7363 strains, and subsequently acquired the mosaic PBP 2 XXXIV. The first MLST ST1901 and NG-MAST ST1407 isolate was identified in Kanagawa already in 2003.

The two main internationally spread cefixime-resistant gonococcal clones, MLST ST7363 and ST1901 (NG-MAST ST1407 most frequent internationally) that also have shown their capacity to develop high-level ceftriaxone resistance (superbugs H041 and F89), likely emerged, evolved and started to disseminate in the metropolitan area, including Kanagawa, in Japan, which was followed by global transmission.

Below:  Molecular epidemiological relatedness of Neisseria gonorrhoeae isolates from 1998 to 2005 in the Kanagawa area, Japan. Minimal spanning tree of 48 MLST STs shows genetic distance of STs derived from 370 isolates. Circle sizes denote the number of isolates sharing the same ST. Black indicates N. gonorrhoeae isolates with resistance or decreased susceptibility to cefixime

Read more at:  http://ht.ly/SmGvU 

By:

Ken Shimuta¹, Yuko Watanabe², Shu-ichi Nakayama¹, Tomoko Morita-Ishihara¹, Toshiro Kuroki², Magnus Unemo³ and Makoto Ohnishi^14*

Is The Tide Turning Again for Cephalosporin Resistance in Gonorrhoeae in Europe? Results From The 2013 European Surveillance

Below:  Azithromycin, cefixime and ciprofloxacin gonococcal resistance trends in the EU/EEA, 2009–2013

Below:  Ceftriaxone MIC distributions for Neisseria gonorrhoeae isolates in EU/EEA during 2009–2013

In total, 93 (4.7 %) of 1994 isolates displayed resistance to cefixime, representing an increase compared to the 3.9 % detected in 2012 (p = 0.23). Cefixime resistance was detected in 13 (61.9 %) of the 21 countries. Cefixime resistance among men who have sex with men was only 1.2 %, compared to 5.6 % and 6.1 % in females and male heterosexuals, respectively. The univariate analysis confirmed that isolates resistant to cefixime were more likely to be from females (OR 4.87, p < 0.01) or male heterosexuals (OR 5.32, p < 0.01). Seven (0.4 %) isolates displayed ceftriaxone resistance (in addition to cefixime resistance) compared to three and 10 isolates in 2012 and 2011, respectively. All 93 isolates with cefixime resistance were additionally resistant to ciprofloxacin and 16 (17.2 %) were also resistant to azithromycin. Among all tested isolates (n = 1994), the ciprofloxacin resistance level (52.9 %) was higher than in 2012 (50.1 %; p = 0.08), and azithromycin resistance (5.4 %) increased since 2012 (4.5 %; p = 0.16).

In 2013, the ESC resistance was again slightly increasing in Europe. This emphasises the importance of implementing the actions outlined in the European and additional response plans, particularly activities strengthening the surveillance of antimicrobial resistance. Ceftriaxone combined with azithromycin remains a satisfactory option for the first-line treatment of gonorrhoea. However novel antimicrobials (new derivatives of previously developed antimicrobials or newly developed antimicrobials) for effective monotherapy or at least inclusion in new dual antimicrobial therapy regimens (combined with previously developed antimicrobials or novel antimicrobials) will likely be required.

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