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BMC Infectious Diseases Feb 2024Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections have increased globally. Asymptomatic infections represent a significant risk of long-term...
Clinic-based evaluation of the dual Xpert CT/NG assay on the GeneXpert System for screening for extragenital chlamydial and gonococcal infections amongst men who have sex with men.
BACKGROUND
Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections have increased globally. Asymptomatic infections represent a significant risk of long-term complications. Men who have sex with men (MSM) are disproportionally affected, underscoring the need to offer screening programmes to this population. CT/NG Point of Care Testing (POCT) constitutes a strategic tool to improve the continuum of STI care, however extensive real-life evaluations amongst at risk populations are lacking. The aim of this study is to estimate the GeneXpert CT/NG assay performance and usability for CT and NG at genital and extragenital sites for screening amongst MSM.
METHODS
This study was a multi-site sexual health clinic-based evaluation (Italy, Malta and Peru) with consecutive enrolment. A first void urine sample (divided in two aliquots), two oropharyngeal and two anorectal swabs were collected for each study participant. One specimen set (one for each anatomical site) was tested with the dual index test (Cepheid) at the clinics by the healthcare staff, the other set with FDA/CE approved Nucleic Acid Amplification Tests (NAATs) at the laboratory. Clinical sites and reference laboratories participated in an internal and external quality control programme. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values for each anatomical site were estimated using a meta-analytic approach.
RESULTS
One thousand seven hundred two MSM were recruited across all clinical sites for a total of 5049 biological specimens. NG and CT were respectively detected in 274 and 287 of samples. Overall, the NG POCT sensitivity and specificity was 91.43% and 99.75% in urine (LR + 372.80, LR- 0.09), 89.68% and 99.55% in rectal specimens (LR + 197.30, LR- 0.10) and 75.87% and 98.77% at the pharynx respectively (LR + 61.94, LR- 0.24). The CT component of the POCT sensitivity was 84.82% and specificity 99.63% in urine (LR + 228.68, LR- 0.15), 78.07% and 99.19% respectively on rectal site (LR + 96.23, LR-0.22), 67.79% and 99.88% respectively at pharyngeal site (LR + 554.89, LR- 0.32). 95.95% of MSM reported to be willing to wait for POCT results and no provider reported difficulties in terms of performance or interpretation of the results of the Xpert CT/NG.
CONCLUSION
Rapid turnaround time, ease of use and high acceptability make the Xpert CT/NG testing system a strategic tool for increasing testing frequency, reaching those not yet tested and offering the possibility of immediate treatment if needed. The assay showed good negative likelihood ratios and confirms its use to rule out CT/NG infections. Sensitivity varied across sites and pathogens. Periodic staff training at the testing sites should be mandatory.
Topics: Male; Humans; Homosexuality, Male; Neisseria gonorrhoeae; Chlamydia Infections; Sexual and Gender Minorities; Gonorrhea; Chlamydia trachomatis; Nucleic Acid Amplification Techniques; Tomography, X-Ray Computed
PubMed: 38418963
DOI: 10.1186/s12879-024-09042-4 -
Asian Journal of Surgery Dec 2023
Topics: Humans; Abscess; Anus Diseases; Rectal Fistula; Patients
PubMed: 37783623
DOI: 10.1016/j.asjsur.2023.09.073 -
The Journal of Infection Apr 2024Many sexual health services are overwhelmed and cannot cater for all the individuals who present with sexually transmitted infections (STIs). Digital health software...
INTRODUCTION
Many sexual health services are overwhelmed and cannot cater for all the individuals who present with sexually transmitted infections (STIs). Digital health software that separates STIs from non-STIs could improve the efficiency of clinical services. We developed and evaluated a machine learning model that predicts whether patients have an STI based on their clinical features.
METHODS
We manually extracted 25 demographic features and clinical features from 1315 clinical records in the electronic health record system at Melbourne Sexual Health Center. We examined 16 machine learning models to predict a binary outcome of an STI or a non-STI diagnosis. We evaluated the models' performance with the area under the ROC curve (AUC), accuracy and F1-scores.
RESULTS
Our study included 1315 consultations, of which 36.8% (484/1315) were diagnosed with STIs and 63.2% (831/1315) had non-STI conditions. The study population predominantly consisted of heterosexual men (49.5%, 651/1315), followed by gay, bisexual and other men who have sex with men (GBMSM) (25.7%), women (21.6%) and unknown gender (3.2%). The median age was 31 years (intra-quartile range (IQR) 26-39). The top 5 performing models were CatBoost (AUC 0.912), Random Forest (AUC 0.917), LightGBM (AUC 0.907), Gradient Boosting (AUC 0.905) and XGBoost (AUC 0.900). The best model, CatBoost, achieved an accuracy of 0.837, sensitivity of 0.776, specificity of 0.831, precision of 0.782 and F1-score of 0.778. The key important features were lesion duration, type of skin lesions, age, gender, history of skin disorders, number of lesions, dysuria duration, anorectal pain and itchiness.
CONCLUSIONS
Our best model demonstrates a reasonable performance in distinguishing STIs from non-STIs. However, to be clinically useful, more detailed information such as clinical images, may be required to reach sufficient accuracy.
Topics: Male; Humans; Female; Adult; Homosexuality, Male; Sexual and Gender Minorities; Sexually Transmitted Diseases; Sexual Behavior; Heterosexuality; HIV Infections
PubMed: 38452934
DOI: 10.1016/j.jinf.2024.106128 -
International Journal of Surgery Case... Aug 2023Haemophilia A (HA) is a hereditary X-linked recessive hemorrhagic disorder that results from a deficiency or dysfunction of coagulation factor VIII (FVIII) caused by...
INTRODUCTION AND IMPORTANCE
Haemophilia A (HA) is a hereditary X-linked recessive hemorrhagic disorder that results from a deficiency or dysfunction of coagulation factor VIII (FVIII) caused by gene mutations.
CASE PRESENTATION
This case report presents the challenging management of a 37-year-old man who developed perianal necrotizing fasciitis accompanied by severe infection, necrosis, and septic shock. The patient underwent emergency surgery. However, significant bleeding occurred during and after the surgery.
CLINICAL DISCUSSION
Despite initial treatment with fresh frozen blood plasma infusion satisfactory efficacy was not achieved. Investigation into the patient's family history revealed a haemophiliac niece, prompting further testing for haemophilia. Ultimately, the patient was diagnosed with haemophilia A. Hemorrhage controlled was obtained through coagulation factor VIII infusion. With subsequent treatment, the patient experienced significant recovery, and normal anal function was restored.
CONCLUSION
In summary, routine coagulation examination may not effectively evaluate coagulation dysfunction in patients with severe infectious diseases. Comprehensive preoperative evaluations are necessary for acute anorectal surgeries, with emphasis on screening for haemophilia.
PubMed: 37441981
DOI: 10.1016/j.ijscr.2023.108470 -
Forensic Science International Jul 2024Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are the most common bacterial sexually transmitted infections (STIs) worldwide. These STIs are...
BACKGROUND
Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are the most common bacterial sexually transmitted infections (STIs) worldwide. These STIs are frequently asymptomatic, which often delays diagnosis and treatment with the risk of serious long-term complications. Current French recommendations call for targeted screening of populations considered to be at risk, including victims of sexual assault. However, no recent data on the prevalence of these STIs in this population are available in France. The aim of this study was therefore to determine the prevalence of CT/NG infections among victims of sexual assault attending three Clinical Forensic Units (CFUs).
METHODS
We retrospectively reviewed the forensic records of patients aged over 12 years reporting a sexual assault and referred between January 1, 2020 and December 31, 2021 to the CFU of Montpellier, Angers or Saint-Denis de La Réunion. Patients who had been screened for CT and NG infections were included.
RESULTS
341 alleged victims of sexual assault (324 women, 17 men, median age = 23 years) were screened for CT/NG STIs during the inclusion period (Montpellier, n=196; Angers, n=63; Saint-Denis, n=82). The median time between the sexual assault and the examination was 1 day. CT and NG were detected in 28 patients (8.2 %) and 8 patients (2.3 %) respectively, with no men tested positive. Positive results concerned genital samples, except for two CT-positive anorectal samples and one NG-positive oropharyngeal sample. Two patients (0.6 %) were co-infected with CT/NG. The overall prevalence of CT/NG STIs was 10.0 % and was higher in the 18-24 age group, reaching 13.2 % for CT.
CONCLUSIONS
This multicenter study confirms the high prevalence of CT/NG STIs in victims of sexual assault, and the vulnerability of the youngest age groups to these infections. Systematic screening for CT/NG STIs at the time of the forensic examination is the key to early diagnosis and effective treatment to prevent transmission and subsequent complications in these patients.
Topics: Humans; Female; France; Male; Gonorrhea; Chlamydia Infections; Retrospective Studies; Adult; Prevalence; Crime Victims; Young Adult; Chlamydia trachomatis; Adolescent; Neisseria gonorrhoeae; Sex Offenses; Middle Aged; Child; Forensic Medicine
PubMed: 38810590
DOI: 10.1016/j.forsciint.2024.112070 -
Cureus Aug 2023Fournier's gangrene (FG) is a rare form of necrotizing fasciitis that is characterized by fascial necrosis of the genitalia or perineum. FG typically results as a...
Fournier's gangrene (FG) is a rare form of necrotizing fasciitis that is characterized by fascial necrosis of the genitalia or perineum. FG typically results as a complication of genital or anorectal abscess, pressure sore, or surgical site infections. Many patients present with no symptoms, whereas other patients may present with non-specific symptoms such as pain or erythema in the genital or perianal regions. We present a case of FG in a 76-year-old male. Our patient presented initially with only complaints of perianal and groin pain. Upon imaging and skin examination, a diagnosis of Fournier's gangrene was made. However, due to the late recognition and treatment of FG, the patient developed a sequence of fatal complications that ultimately resulted in his passing. This case demonstrates the importance of a rapid diagnosis of this rare disease to prevent fatal complications. We hope to inform dermatologists, internists, and urologists of the varying presentations of Fournier's gangrene to allow for prompt initiation of treatment.
PubMed: 37779791
DOI: 10.7759/cureus.44383 -
Cureus Dec 2023Anorectal syphilis is relatively uncommon and diagnostically challenging given the wide differential diagnosis for anal lesions. Risk factors, such as men who have sex...
Anorectal syphilis is relatively uncommon and diagnostically challenging given the wide differential diagnosis for anal lesions. Risk factors, such as men who have sex with men or HIV-positive status, are especially important to elicit from patients during the clinical history. In this report, we present a rare case of painful anal syphilis diagnosed in an HIV-negative woman by tissue biopsy
PubMed: 38222243
DOI: 10.7759/cureus.50575 -
Cureus Oct 2023Anorectal malformations (ARMs) comprise a broad spectrum of congenital anomalies involving both anorectal and urogenital tracts. After diagnosis, urological problems...
Anorectal malformations (ARMs) comprise a broad spectrum of congenital anomalies involving both anorectal and urogenital tracts. After diagnosis, urological problems should be evaluated in addition to surgical correction of ARMs. Commonly encountered urological problems in patients with ARMs are recurrent urinary tract infections, vesicoureteral reflux, and chronic kidney disease. Therefore, the proper timing of urination and appropriate defecation habits are essential for preserving renal function in patients with ARMs. Here, we report a case of acute hydronephrosis by severe stool impaction in a patient with a history of congenital ARMs and neurogenic bladder. In this case, the physicians should consider properly managing chronic constipation and urination in patients with ARMs despite successful surgical corrections.
PubMed: 37965387
DOI: 10.7759/cureus.47036 -
Journal of Indian Association of... 2024To study the safety and feasibility of enhanced recovery after surgery (ERAS) protocol in pediatric colostomy closure.
AIMS
To study the safety and feasibility of enhanced recovery after surgery (ERAS) protocol in pediatric colostomy closure.
MATERIALS AND METHODS
Retrospective observational study of children who underwent colostomy closure. Data were collected from the electronic medical records and telephonic follow-up calls of patients from October 2013 to October 2023, in the Department of Pediatric Surgery of a Tertiary level Medical College. The parameters obtained were age, gender, type of stoma, primary diagnosis, discrepancy in luminal diameters, time to reach full feeds, postoperative hospital stay, and complications. The protocol followed for colostomy closure included the following-no bowel preparation or nasogastric tube, no overnight fasting, single dose of antibiotic prophylaxis, avoiding opioids, packing proximal stoma till mobilization and starting early oral feeds postoperatively. The continuous parameters were expressed as mean ± standard deviation or median (range) while the descriptive parameters were expressed as number and percentage.
RESULTS
A total of 90 patients were included in the study. Most of the patients had colostomy for anorectal malformation. Five of them had significant luminal discrepancy of 4 or more times. Full feeds were reached within 2 days in 79 patients. Postoperative hospital stay was 2-3 days in 62 patients. Six patients stayed for more than 5 days, due to complications requiring further management. We noted surgical site infection in 6 patients all of whom were managed with regular wound dressings and fecal fistula in 4 cases, two of which resolved spontaneously.
CONCLUSION
ERAS protocol in colostomy closure reduces the hospital stay and is cost effective, with early recovery and no added complications.
PubMed: 38912032
DOI: 10.4103/jiaps.jiaps_245_23 -
Medicine Nov 2023Perianal abscess is a common disease of the anus and intestine. Surgery is an important treatment option for perianal abscess. However, some patients have a long healing...
RATIONALE
Perianal abscess is a common disease of the anus and intestine. Surgery is an important treatment option for perianal abscess. However, some patients have a long healing time, poor healing effect after surgery, or even pseudo-healing. Platelet-rich plasma (PRP) is rich in platelets that can release a large number of factors when activated and promote wound healing. Moreover, there are few reports on the use of PRP for wounds that are difficult to heal after perianal abscess surgery.
PATIENT CONCERNS
The patient had reported a complaint of perianal swelling and discomfort associated with anal pain, which was considered a perianal abscess. Ceftriaxone, fumigation, and sitz bath were administered after mixed hemorrhoid and perianal abscess surgeries were performed; however, the wound remained unhealed for more than 3 months, and there was a fistula under the skin.
DIAGNOSIS
Perianal color ultrasonography revealed perianal abscess.
INTERVENTIONS
Autologous PRP treatment was performed 5 times for each patient.
OUTCOMES
The postoperative wound healed within 15 days after 5 times PRP treatments.
LESSONS
PRP is a novel treatment option for pseudo-healing.
Topics: Humans; Abscess; Rectal Fistula; Anus Diseases; Skin; Platelet-Rich Plasma; Skin Diseases; Treatment Outcome
PubMed: 37986293
DOI: 10.1097/MD.0000000000035996