Management of sexually transmissible infections in the era of multiplexed molecular diagnostics: a primary care survey
Tal Brosh-Nissimov A B E , Ron Kedem B , Nimrod Ophir B , Omri Shental B , Nathan Keller C and Sharon Amit C DA The Infectious Disease Unit, Assuta Ashdod University Hospital, Harefua 7, Ashdod 7747629, Israel.
B Israel Defense Forces Medical Corps, Tel Hashomer, MilPOB 02149, Israel.
C The Department of Clinical Microbiology, Sheba Medical Center, Emek Haela 1, Ramat-Gan 5265601, Israel.
D The Department of Clinical Microbiology and Infectious Diseases, Hadassah University Hospital, Jerusalem 91120, Israel.
E Corresponding author. Email: tbrosh@gmail.com
Sexual Health 15(4) 298-303 https://doi.org/10.1071/SH17190
Submitted: 11 October 2017 Accepted: 16 January 2018 Published: 30 April 2018
Abstract
Background: Data regarding sexually transmissible infections (STI) often originate from STI clinics, screening programs or laboratory-based studies, thus are biased for specific risk groups or lack clinical details. This real-life observational study presents sample data of most young adult Israeli population by exploiting the centralised diagnostic and documentation platforms resulting from a mandatory military service at the age of 18 years for both genders. Methods: All STI diagnoses of Israeli Defence Forces soldiers during a 6-month period were reviewed. Patients with Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) (major-STI) and Ureaplasma urealyticum (UU), Ureaplasma parvum (UP) and Mycoplasma hominis (MH) (equivocal STI) were compared with STI-negative controls. Results: Sexually transmissible infection positivity rates (n = 2816) were as follows: CT 6.6%; MG 1.9%; NG 0.7%; TV 0.5%; UU 15.7%; UP 28.2%; and MH 6.2%. The CT+MG coinfection rate was 4.1%, yet CT+NG coinfections were rare (≈0.5%). More than half of the patients with ureaplasmas and/or MH were treated; 40% of them were recommended partner treatment. Most antibiotics were prescribed to patients with equivocal infections. Classic STI symptoms in males were linked to major-STI and UU, while females were asymptomatic or presented non-specific symptoms. Conclusions: The judicious use of antibiotics in the era of antimicrobial resistance necessitates re-evaluating the significance of equivocal pathogen detection and reporting (MH, UU, UP). Likewise, universal empiric treatment for NG should be reconsidered in light of its low rates in non-high-risk groups. Conversely, a high MG rate, a pathogen with potential resistance to common STI protocols, requires evaluation of guidelines adequacy.
Additional keywords: empiric therapy, epidemiology, ureaplasma, Mycoplasma, Chlamydia.
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