Publications by authors named "Lao-Tzu Allan-Blitz"

31 Publications

Multifactorial Correlates of Incident Bacterial Sexually Transmitted Infections Among Black Men Who have Sex with Men Recruited in 6 US Cities (HPTN 061).

Sex Transm Dis 2021 Mar 12. Epub 2021 Mar 12.

1Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, MA 2Department of Medicine, Boston Children's Hospital, Boston, MA 3Department of Medicine, Division of Infectious Diseases, Oregon Health and Science University, Portland, OR 4Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD 5Department of Medicine, Johns Hopkins University, Baltimore, MD 6Department of Human Development, State University of New York at Binghamton, Binghamton, NY 7Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa 8The Fenway Institute of Fenway Health, Boston, MA 9Division of Infectious Diseases: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 10Department of Medicine, Harvard Medical School, Boston, MA.

Background: Black men who have sex with men are at disproportionate risk for sexually transmitted infections (STI). Understanding the drivers of those disparities can lead to culturally-tailored interventions. We aimed to characterize the incidence and correlates of STI among Black individuals from HPTN 061, a multi-city cohort study conducted from 2009-2011 in the US.

Methods: We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHR) accounting for within participant correlation over multiple follow-up visits (enrollment, 6- and 12-month). We examined correlates of incident rectal and urethral STI as well as incident syphilis.

Results: Among 1522 individuals, the incidence of urethral and rectal Neisseria gonorrhoeae infection was 1.0 (95%CI: 0.6, 1.8) and 4.6 (95%CI: 3.5, 6.3) cases per 100 person-years, respectively. The incidence of urethral and rectal Chlamydia trachomatis infection was 2.5 (95%CI: 1.7, 3.6) and 2.5 (95%CI: 1.7, 3.7) cases per 100 person-years, respectively. The incidence of syphilis was 3.6 (95% CI 2.7-4.9) cases per 100 person-years. Younger age was associated with increased odds of incident urethral (aHR=5.1; 95% CI 2.3-11.1) and rectal (aHR=2.6; 95% CI 1.6-4.3) STI. Diagnosis of a rectal STI at baseline (aHR=2.3; 95% CI 1.1-4.0), use of saliva as lubricant (aHR=1.7; 95% CI 1.1-2.8) were associated with incident rectal STI. Diagnosis of syphilis at baseline was associated with incident syphilis during follow-up (aHR 5.6; 95% CI 2.5-12.2).

Conclusions: Younger participants had the highest STI incidence. Use of saliva as lubricant may be a driver of rectal infection, which deserves further study.
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http://dx.doi.org/10.1097/OLQ.0000000000001414DOI Listing
March 2021

Association of Lower Socioeconomic Status and SARS-CoV-2 Positivity in Los Angeles, California.

J Prev Med Public Health 2021 May 13;54(3):161-165. Epub 2021 Apr 13.

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood.

Methods: We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code.

Results: We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income
Conclusions: Residence in zip codes with lower average annual household income, lower rates of employment, or lower rates of health insurance was associated with SARS-CoV-2 positivity. Further research is needed into how those factors increase the spread of SARS-CoV-2 infection among populations of lower socioeconomic status in order to develop targeted public health interventions.
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http://dx.doi.org/10.3961/jpmph.21.126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190552PMC
May 2021

Heterogeneity in SARS-CoV-2 Positivity by Ethnicity in Los Angeles.

J Racial Ethn Health Disparities 2021 May 24. Epub 2021 May 24.

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.

Recent studies have identified notable disparities in SARS-CoV-2 infection risk among ethnic minorities. We evaluated SARS-CoV-2 test results from individuals presenting for testing in Los Angeles between June and December, 2020. We calculated prevalence ratios for various employment categories. Among 518,914 test results, of which 295,295 (56.9%) were from individuals reporting Hispanic ethnicity, SARS-CoV-2 positivity was 16.5% among Hispanic individuals compared to 5.0% among non-Hispanic individuals (p-value <0.01). The prevalence ratios comparing Hispanic and non-Hispanic individuals were highest for members of the media (PR = 6.7; 95% CI 4.3-10.4), government employees (PR = 4.0; 95% CI 3.3-4.9), and agricultural workers (PR = 4.0; 95% CI 3.2-5.0). Such heterogeneity warrants further investigation in order to develop targeted public health interventions towards specific drivers of SARS-CoV-2 transmission.
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http://dx.doi.org/10.1007/s40615-021-01062-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142866PMC
May 2021

Response to: Seroprevalence of SARS-CoV-2 following the largest initial epidemic wave in the United States: Findings from New York City, May 13-July 21, 2020.

J Infect Dis 2021 May 8. Epub 2021 May 8.

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.

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http://dx.doi.org/10.1093/infdis/jiab245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135970PMC
May 2021

The ongoing HIV epidemic in American youth: challenges and opportunities.

Mhealth 2021 20;7:33. Epub 2021 Apr 20.

Fenway Health, Boston, MA, USA.

The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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http://dx.doi.org/10.21037/mhealth-20-42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063015PMC
April 2021

SARS-CoV-2 Seroprevalence Data to Guide Local Public Health Interventions.

JAMA Intern Med 2021 07;181(7):1014

Division of Disease Prevention, Policy and Global Health, Department of Preventive Medicine, University of Southern California Keck School of Medicine.

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http://dx.doi.org/10.1001/jamainternmed.2021.0074DOI Listing
July 2021

The Rising Prevalence of SARS-CoV-2 Infection May Not be Due to Young Adults.

Pediatr Infect Dis J 2021 05;40(5):e213-e214

Professor of Preventative Medicine, Department of Preventative Medicine, Keck School of Medicine, University of Southern California.

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http://dx.doi.org/10.1097/INF.0000000000003097DOI Listing
May 2021

Prevalence of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Youth.

Pediatr Infect Dis J 2021 03;40(3):e132-e133

Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California.

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http://dx.doi.org/10.1097/INF.0000000000003023DOI Listing
March 2021

Zebra Hunting: How Caring Is Lost When We Chase Diseases.

J Gen Intern Med 2020 Oct 1. Epub 2020 Oct 1.

Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.

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http://dx.doi.org/10.1007/s11606-020-06268-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528709PMC
October 2020

PrEP 1.0 and Beyond: Optimizing a Biobehavioral Intervention.

J Acquir Immune Defic Syndr 2019 12;82 Suppl 2:S113-S117

Harvard Medical School, Boston, MA.

Background: Tenofovir disoproxil fumarate coformulated with emtricitabine (TDF/FTC) was shown to be effective in preventing HIV acquisition when used for pre-exposure prophylaxis (PrEP), but questions have arisen regarding optimal PrEP implementation strategies.

Methods: A narrative review of literature since 2010 regarding PrEP effectiveness, implementation, and new prevention modalities was undertaken to summarize lessons learned, and to review potential benefits and challenges.

Results: Although daily TDF/FTC is safe, well tolerated, and highly effective in preventing HIV transmission, it has been initiated by only 200,000 Americans, and a comparable number of individuals in other countries, meaning that 80%-90% of those at greatest risk globally have not benefitted yet. Barriers to PrEP uptake have included medication and care costs, anticipated side effects, stigma, and unsupportive health care systems. Innovations to increase PrEP uptake and adherence have included engaging nonmedical staff (eg, pharmacists, social workers, and peer navigators), economic assistance programs, and new technologies (eg, text messaging support and dedicated apps). Pericoital PrEP dosing seems to be effective in preventing HIV transmission among men who have sex with men, but has not been evaluated in women. Investigational PrEP approaches include antiretrovirals delivered by injection, implant, vaginal rings, rectal douches, and immunoprophylaxis. Some of these approaches may allow for infrequent dosing, whereas others may be more congruent with patterns of sexual behavior.

Conclusions: PrEP has been shown to be safe and effective when used consistently, but new approaches to enhance uptake, adherence, and convenience with less-frequent dosing are under study, suggesting that new models and modalities will evolve to optimize impact.
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http://dx.doi.org/10.1097/QAI.0000000000002169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830954PMC
December 2019

Improved determination of Neisseria gonorrhoeae gyrase A genotype results in clinical specimens.

J Antimicrob Chemother 2019 10;74(10):2913-2915

Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Background: The emergence of drug-resistant Neisseria gonorrhoeae has prompted the development of rapid molecular assays designed to determine antimicrobial susceptibility. One common assay uses high-resolution melt analysis to target codon 91 of the gyrase A gene (gyrA) to predict N. gonorrhoeae susceptibility to ciprofloxacin.

Methods: We extracted DNA from remnant clinical specimens that had previously tested positive for N. gonorrhoeae using the Aptima Combo 2 for CT/NG assay (Hologic, San Diego, CA, USA). We selected DNA extracts from specimens with indeterminate, WT and mutant gyrA genotype results from a previous study using high-resolution melt analysis to detect the gyrA codon 91 mutation. We re-tested those specimens using the recently CE-marked ResistancePlus GC (beta) assay (SpeeDx, Sydney, Australia).

Results: Of 86 specimens with indeterminate gyrA genotypes on high-resolution melt analysis, the ResistancePlus GC (beta) assay (SpeeDx) identified 30 (35%) WT, 22 (26%) mutant and 34 (40%) indeterminate gyrA genotypes.

Conclusions: The ResistancePlus GC (beta) assay showed improved N. gonorrhoeae gyrA genotype determination compared with a prior gyrA genotypic high-resolution melt assay.
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http://dx.doi.org/10.1093/jac/dkz292DOI Listing
October 2019

Using the genetic characteristics of Neisseria gonorrhoeae strains with decreased susceptibility to cefixime to develop a molecular assay to predict cefixime susceptibility.

Sex Health 2019 09;16(5):488-499

David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; and Division of Infectious Disease, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Center for Health Sciences, 37-121, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; and Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E. Young Drive S., Los Angeles, CA 90095, USA.

Background: In the last two decades, gonococcal strains with decreased cefixime susceptibility and cases of clinical treatment failure have been reported worldwide. Gonococcal strains with a cefixime minimum inhibitory concentration (MIC) ≥0.12 µg mL-1 are significantly more likely to fail cefixime treatment than strains with an MIC <0.12 µg mL-1. Various researchers have described the molecular characteristics of gonococcal strains with reduced cefixime susceptibility, and many have proposed critical molecular alterations that contribute to this decreased susceptibility.

Methods: A systematic review of all published articles in PubMed through 1 November 2018 was conducted that report findings on the molecular characteristics and potential mechanisms of resistance for gonococcal strains with decreased cefixime susceptibility. The findings were summarised and suggestions were made for the development of a molecular-based cefixime susceptibility assay.

Results: The penicillin-binding protein 2 (PBP2) encoded by the penA gene is the primary target of cefixime antimicrobial activity. Decreased cefixime susceptibility is conferred by altered penA genes with mosaic substitute sequences from other Neisseria (N.) species (identifiable by alterations at amino acid position 375-377) or by non-mosaic penA genes with at least one of the critical amino acid substitutions at positions 501, 542 and 551. Based on this review of 415 international cefixime decreased susceptible N. gonorrhoeae isolates, the estimated sensitivity for an assay detecting the aforementioned amino acid alterations would be 99.5% (413/415).

Conclusions: Targeting mosaic penA and critical amino acid substitutions in non-mosaic penA are necessary and may be sufficient to produce a robust, universal molecular assay to predict cefixime susceptibility.
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http://dx.doi.org/10.1071/SH18227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386398PMC
September 2019

Venue-Based HIV-Testing: An Effective Screening Strategy for High-Risk Populations in Lima, Peru.

AIDS Behav 2019 Apr;23(4):813-819

Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.

Venue-based testing may improve screening efforts for HIV and syphilis, thereby reducing transmission. We offered onsite rapid dual HIV and syphilis testing at venues popular among MSM and/or transgender women in Lima, Peru. We used Poisson regression to calculate adjusted prevalence ratios (aPRs) for factors associated with each infection. Most (90.4%) of the 303 participants would test more frequently if testing was available at alternative venues. New cases of HIV (69) and syphilis infection (84) were identified. HIV was associated with recent sex work (aPR 1.11; 95% CI 1.02-1.22), sex with a partner of unknown serostatus (aPR 1.18; 95% CI 1.09-1.27), exclusively receptive anal sex role (aPR 1.16; 95% CI 1.03-1.30) or versatile sex role (aPR 1.17; 95% CI 1.06-1.30) compared to insertive. Syphilis was associated with reporting role versatility (aPR = 2.69; 95% CI 1.52-5.74). Sex work venues had higher syphilis prevalence 47% versus 28% in other venues, p value = 0.012. Venue-based testing may improve case finding.
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http://dx.doi.org/10.1007/s10461-018-2342-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459703PMC
April 2019

A Case of Asymptomatic Syphilitic Proctitis.

Sex Transm Dis 2019 06;46(6):e68-e69

Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Gastroentrology, and.

The incidence of syphilis is increasing. Syphilitic proctitis involving the rectal mucosa often presents with pain on defecation, rectal bleeding, or ulceration. We present a case of asymptomatic syphilitic proctitis diagnosed upon a routine screening colonoscopy.
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http://dx.doi.org/10.1097/OLQ.0000000000000955DOI Listing
June 2019

The Frequency of Discordant Gyrase A Genotypes Among Cases of Multiple Neisseria gonorrhoeae Infections at Different Anatomic Sites.

Sex Transm Dis 2019 01;46(1):e3-e4

AIDS Healthcare Foundation.

Gyrase A genotyping reliably predicts Neisseria gonorrhoeae susceptibility to ciprofloxacin. It is unknown whether concurrent infections at different anatomic sites harbor different susceptibility profiles. We found a 3.2% frequency of discordant gyrase A genotypes among concurrent but anatomically separate N. gonorrhoeae infections diagnosed at 2 laboratories in Los Angeles.
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http://dx.doi.org/10.1097/OLQ.0000000000000912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289622PMC
January 2019

Field evaluation of a smartphone-based electronic reader of rapid dual HIV and syphilis point-of-care immunoassays.

Sex Transm Infect 2018 12 20;94(8):589-593. Epub 2018 Aug 20.

Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.

Objective: Electronic (E) devices read and quantify lateral flow-based rapid tests, providing a novel approach to assay interpretation. We evaluated the performance of one E-reader for two dual HIV and syphilis immunoassays.

Methods: We enrolled men who have sex with men and transgender women >18 years of age seeking medical services at an STD clinic in Lima, Peru, between October 2016 and April 2017. Venous blood was tested using two dual HIV and syphilis antibody immunoassays (SD BIOLINE HIV/Syphilis Duo, Republic of Korea, and First Response HIV 1+2/Syphilis Combo, India). Reference testing included a fourth-generation ELISA for HIV antibodies and use of the particle agglutination assay for syphilis antibodies. Trained clinic staff visually inspected the immunoassay results, after which the immunoassays were read by the HRDR-200 E-reader (Cellmic, USA), an optomechanical smartphone attachment. We calculated the concordance of the E-reader with visual inspection, as well as the sensitivity of both rapid immunoassays, in detecting HIV and antibodies.

Results: On reference testing of 283 participant specimens, 34% had HIV antibodies and 46% had antibodies. Using First Response, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for and 97% (95% CI 95% to 99%) for HIV antibodies. Using SD BIOLINE, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for and 99% (95% CI 98% to 99%) for HIV antibodies. For both immunoassays, the sensitivity for HIV antibodies was 98% (95% CI 93% to 100%) and the sensitivity for antibodies was 81% (95% CI 73% to 87%).

Conclusions: E-reader results correlated well with visual inspection. The sensitivities of both rapid assays were comparable with past reports. Further evaluation of the E-reader is warranted to investigate its utility in data collection, monitoring and documentation of immunoassay results.
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http://dx.doi.org/10.1136/sextrans-2017-053511DOI Listing
December 2018

The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru.

Sex Health 2018 06;15(3):261-268

Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA.

Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis.

Methods: Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed.

Results: Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3-24.3). HIV infection (RR 2.22; 95% CI 1.54-3.21) and history of syphilis infection (RR 2.23; 95% 1.62-3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net.

Conclusions: Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.
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http://dx.doi.org/10.1071/SH17118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446470PMC
June 2018

Coxiella burnetii Endocarditis and Meningitis, California, USA, 2017.

Emerg Infect Dis 2018 08;24(8)

The epidemiology of Coxiella burnetii infection in the United States is not well characterized. We report a case-patient with C. burnetii endocarditis and meningitis. Infection was diagnosed by detecting high serologic titers for C. burnetii and confirmed by sequencing of C. burnetii 16S rRNA isolated from resected valvular tissue and PCR of cerebrospinal fluid.
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http://dx.doi.org/10.3201/eid2408.180249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056110PMC
August 2018

Prevalence of Mycoplasma genitalium and Azithromycin-resistant Infections Among Remnant Clinical Specimens, Los Angeles.

Sex Transm Dis 2018 09;45(9):632-635

SpeeDx Pty Ltd., Sydney, Australia.

Background: Mycoplasma genitalium is an important cause of bacterial sexually transmitted diseases. Diagnosis and susceptibility testing of M. genitalium are limited by the fastidious nature of the organism. Therefore, the prevalence of infection and azithromycin resistance are poorly studied.

Methods: We conducted an exploratory study on remnant clinical specimens. We collected remnant DNA from consecutive urine samples and clinical swabs (cervical/vaginal, rectal, and pharyngeal) previously tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the Cobas 4800 CT/NG assay (Roche Molecular Systems, Pleasanton, CA) between March-April 2017 from across the University of California, Los Angeles Health System. We then retrospectively tested all specimens with the ResistancePlus MG (550) kit, a molecular assay for the detection of M. genitalium and genetic mutations associated with azithromycin resistance.

Results: Among 500 specimens, the prevalence of M. genitalium was 1.1% (95% confidence interval [CI], 0.04%-3.0%) in urine samples (n = 362), 17.4% (95% CI, 5.7%-39.6%) in rectal swabs (n = 23), and 1.9% (95% CI, 0.3%-7.3%) in cervical/vaginal swabs (n = 106). The prevalence of N. gonorrhoeae was 0.6% in urine samples and 4.3% in rectal swabs, whereas the prevalence of C. trachomatis was 2.2% in urine samples, 4.3% in rectal swabs and 3.8% in cervical/vaginal swabs. Of the 10 M. genitalium positive specimens, 8 (80.0%) had a mutation associated with azithromycin resistance.

Conclusions: The prevalence of M. genitalium infection in our population varied by anatomic site of infection. Most M. genitalium infections had at least 1 mutation associated with azithromycin resistance.
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http://dx.doi.org/10.1097/OLQ.0000000000000829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086743PMC
September 2018

Ciprofloxacin May be Efficacious in Treating Wild-Type Gyrase A Genotype Neisseria gonorrhoeae Infections.

Sex Transm Dis 2018 04;45(4):e18

David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA. Department of Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA Arthur Ashe Student Health & Wellness Center, University of California, Los Angeles, Los Angeles, CA Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA.

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http://dx.doi.org/10.1097/OLQ.0000000000000758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847432PMC
April 2018

A Cost Analysis of Gyrase A Testing and Targeted Ciprofloxacin Therapy Versus Recommended 2-Drug Therapy for Neisseria gonorrhoeae Infection.

Sex Transm Dis 2018 02;45(2):87-91

Background: Novel approaches to combating drug-resistant Neisseria gonorrhoeae infections are urgently needed. Targeted therapy with ciprofloxacin has been made possible by a rapid assay for genotyping the gyrase A (gyrA) gene; a nonmutated gene reliably predicts susceptibility to ciprofloxacin.

Methods: We determined the costs of running the gyrA assay, 500 mg of ciprofloxacin, 250 mg of ceftriaxone injection, and 1000 mg of azithromycin. Cost estimates for gyrA testing included assay reagents and labor. Cost estimates for ceftriaxone included medication, injection, administration, supplies, and equipment. We measured the cost of using the gyrA assay and treatment based on genotype using previously collected data over a 13-month period between November 2015 and November 2016 for all N. gonorrhoeae cases diagnosed at UCLA. We subsequently developed 3 cost models, varying the frequency of testing and prevalence of N. gonorrhoeae infections with ciprofloxacin-resistant or genotype-indeterminate results. We compared those estimates with the cost of recommended 2-drug therapy (ceftriaxone and azithromycin).

Results: Based on a 65.3% prevalence of cases with ciprofloxacin-resistant or genotype indeterminate N. gonorrhoeae infections when running an average of 1.7 tests per day, the per-case cost of gyrA genotyping and targeted therapy was US $197.19. The per-case cost was US $155.16 assuming a 52.6% prevalence of ciprofloxacin-resistant or genotype-indeterminate infections when running an average of 17 tests per day. The per-case cost of 2-drug therapy was US $142.75.

Conclusions: Direct costs of gyrA genotyping and targeted ciprofloxacin therapy depend on the prevalence of ciprofloxacin-resistant or genotype-indeterminate infections and testing frequency.
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http://dx.doi.org/10.1097/OLQ.0000000000000698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879096PMC
February 2018

High incidence of extra-genital gonorrheal and chlamydial infections among high-risk men who have sex with men and transgender women in Peru.

Int J STD AIDS 2018 05 29;29(6):568-576. Epub 2017 Nov 29.

1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.

Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.
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http://dx.doi.org/10.1177/0956462417744098DOI Listing
May 2018

Epidemiology of Neisseria gonorrhoeae Gyrase A Genotype, Los Angeles, California, USA.

Emerg Infect Dis 2017 09;23(9):1581-1584

We investigated the epidemiology of the mutant gyrase A gene, a reliable predictor of ciprofloxacin resistance, in Neisseria gonorrhoeae infections at UCLA Health in Los Angeles, California, USA, during November 1, 2015-August 31, 2016. Among 110 patients with N. gonorrhoeae infections, 48 (44%) had the mutant gyrase A gene.
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http://dx.doi.org/10.3201/eid2309.170215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572865PMC
September 2017

The Need for Outcome Studies Prior to Large-Scale Implementation of Screening for Anal Cancer.

Clin Infect Dis 2017 07;65(1):179-180

Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine.

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http://dx.doi.org/10.1093/cid/cix328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850527PMC
July 2017

Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis.

Sex Transm Dis 2017 05;44(5):261-265

From the *David Geffen School of Medicine, †Department of General Internal Medicine and Health Services Research, ‡Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine and §Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA.

Multidrug-resistant Neisseria gonorrhoeae infections have been declared 1 of the top 3 urgent threats to public health. Approaches to combat resistance include targeted therapy with antibiotics previously thought to be ineffective, made possible by rapid molecular assays to predict susceptibility. Previous studies have associated the gyrase A (gyrA) gene of N. gonorrhoeae with in vitro resistance to ciprofloxacin. We conducted a systematic review of studies comparing N. gonorrhoeae gyrA genotype results with conventional antimicrobial susceptibility testing results. We identified 31 studies meeting inclusion criteria, among which 7 different loci for mutations in the gyrA gene were identified, from 16 countries between the years of 1996 and 2016. We then performed a meta-analysis among those studies stratifying by use of real-time polymerase chain reaction (PCR) or non-real-time PCR technique, and compared the summary receiver operating characteristic curves between the 2 PCR methods. Among studies using real-time PCR, the pooled estimate of sensitivity and specificity of gyrA genotype results for the prediction of N. gonorrhoeae susceptibility to ciprofloxacin were 98.2% (95% confidence interval [CI], 96.5-99.1%) and 98.6% (95% CI, 97.0-99.3%), respectively. The summary operating characteristic curves for studies using real-time PCR techniques were well separated from those using non-real-time PCR techniques, with only slight overlap in the CIs, suggesting that real-time PCR techniques were a more accurate approach. GyrA genotype testing is a novel approach to combating the emergence of multidrug-resistant N. gonorrhoeae and is a sensitive and specific method to predict in vitro ciprofloxacin susceptibility.
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http://dx.doi.org/10.1097/OLQ.0000000000000591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407314PMC
May 2017

Implementation of a Rapid Genotypic Assay to Promote Targeted Ciprofloxacin Therapy of Neisseria gonorrhoeae in a Large Health System.

Clin Infect Dis 2017 05;64(9):1268-1270

Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.

Multidrug-resistant Neisseria gonorrhoeae is a top threat to public health. In November 2015, UCLA Health introduced a rapid gyrase A (gyrA) genotypic assay for prediction of Neisseria gonorrhoeae susceptibility to ciprofloxacin. We found a significant reduction in ceftriaxone use with a concomitant increase in targeted therapy.
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http://dx.doi.org/10.1093/cid/ciw864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399946PMC
May 2017

Codon 91 Gyrase A Testing Is Necessary and Sufficient to Predict Ciprofloxacin Susceptibility in Neisseria gonorrhoeae.

J Infect Dis 2017 02;215(3):491

Division of Infectious Diseases, Department of Medicine and Fielding School of Public Health, University of California, Los Angeles.

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http://dx.doi.org/10.1093/infdis/jiw551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993095PMC
February 2017

Neisseria gonorrhoeae susceptibility to ciprofloxacin.

MLO Med Lab Obs 2016 Dec;48(12):30

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December 2016

Long-Term Survival of a Patient With Late-Stage Non-Small Cell Lung Cancer.

Fed Pract 2016 Aug;33(Suppl 5):63S-65S

is a medical student and is an assistant professor of clinical medicine at the David Geffen School of Medicine, University of California Los Angeles. Dr. Hashemi is also a physician at the VA Greater Los Angeles Healthcare System in California.

After not responding to chemotherapy and monoclonal antibody therapy, a patient with late-stage non-small cell lung cancer benefited from treatment with erlotinib.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375520PMC
August 2016