Origin of Repeat Bacterial STIS Among Heterosexual Men

异性恋男性重复细菌性 STIS 的起源

• 批准号: 8485312
• 负责人: Patricia J Kissinger
• 金额: $ 41.83万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8485312
• 关键词: Adherence; Algorithms; Azithromycin; Centers for Disease Control and Prevention (U.S.); Chlamydia trachomatis; Classification; Clinic; Computer Assisted; Counseling; Data; Development; Dose; Ectopic Pregnancy; Electronics; Epidemic; Evaluation; Exposure to; Female; Funding; Gender; Genotype; Goals; Grant; Guidelines; Heterosexuals; Infection; Intervention; Interview; Lead; Measurement; Medical; Methods; Morbidity - disease rate; Mycoplasma genitalium; National Institute of Allergy and Infectious Disease; Organism; Outcome; Patient Self-Report; Pelvic Inflammatory Disease; Persons; Pharmaceutical Preparations; Provider; Public Health; Qualitative Methods; Recommendation; Recording of previous events; Reporting; Reproductive Health; Research; Risk Behaviors; Screening procedure; Sexual Partners; Source; Specimen; Surveys; Testing; Treatment Failure; Woman; Women' s Health; Work; base; chronic pelvic pain; clinical infrastructure; diaries; effective therapy; electronic data; follow-up; health disparity; indexing; men; prevent; protective behavior; reproductive; treatment strategy

DESCRIPTION (provided by applicant): Recent reports of an increase in possible treatment failure of azithromycin for Chlamydia trachomatis (Ct) and Mycoplasma genitalium (Mg) call for a better understanding of the origin of these repeat infections, so that providers can more efficiently target their treatment approach. For example if treatment failure is the origin, better medications are needed; if re-exposure to an untreated partner, better partner treatment strategies are needed; if exposure to a new partner, rescreening is indicated. Our preliminary data showed that the likely source of repeat infections among heterosexual men with Ct is multi-causal and treatment failure was substantial. These classifications, however, were based on self-reported sexual histories which may have over- estimated treatment failure. Genotyping data could provide a more objective method for classifying, but methodological issues with genotype-informed studies have made the origins of repeat infections difficult to interpret. We focus on heterosexual men, not just because their repeat infection rates are high, but because of their influence on women's health. Several decades of female-targeted interventions have failed to reduce the Ct epidemic. Clearly, interventions must also target men, particularly those with repeated infections, who may be core transmitters. We will also examine Mg, since there is mounting evidence that it is an important source of reproductive health morbidity and high rates of repeat infection have been documented. The goal of the study is to reduce early repeat infections with Ct and/or Mg among heterosexual men. Aim 1: To quantify the likely origins of early repeat infections with Ct and/or Mg among heterosexual men - We will combine data from electronic sexual diaries, test of cure computer assisted interviews and state-of-the-art genotyping of Ct and/or Mg to calculate the most likely source of repeat infection at test-of-cure. We hypothesize that there are multiple origins of repeat infection and that treatment failure is substantial (i.e. > 6%), which requires a re-evaluation of the present treatment guidelines. Aim 2: To conduct in-depth exploration of the origins of repeat Ct and/or Mg infections and explore adaptations of EPT and/or rescreening among heterosexual men. In-depth interviews will be conducted with men who do (n=30) and do not (n=30) have repeat Ct and/or Mg infections to enhance our understanding of the subtle, nuanced aspects of risk behaviors and contexts that lead or do not lead to repeat infections. These data will allow for the development of more gender appropriate counseling and interventions to reduce repeat infections among heterosexual men. To achieve these aims, we extend work started in our R56. Men attending two urban STD clinics (n=4777) will be screened for Ct/ Mg. Men with either organisms (~2327), will complete a weekly electronic sexual diaries, and return for a test of cure screening and interview 4 weeks post baseline. Specimens from men with repeat Ct and/or Mg infections (200 for each) will be genotyped. This research fits well within NIAID's goals of reducing health disparities/providing more effective STD treatment.

描述(由申请人提供)：最近关于阿奇霉素治疗沙眼衣原体(Ct)和生殖支原体(Mg)失败的报道呼吁更好地了解这些重复感染的来源，以便提供者能够更有效地针对他们的治疗方法。例如，如果治疗失败是起因，更好 需要药物治疗；如果再次接触未经治疗的伴侣，需要更好的伴侣治疗策略；如果接触新的伴侣，则需要重新筛查。我们的初步数据显示，在患有CT的异性恋男性中，重复感染的可能来源是多原因的，治疗失败是相当严重的。然而，这些分类是基于自我报告的性史，这些病史可能高估了治疗失败。基因分型数据可以提供一种更客观的分类方法，但基因信息研究的方法学问题使得重复感染的起源很难解释。我们关注异性恋男性，不仅因为他们的重复感染率很高，还因为他们对女性健康的影响。几十年来，针对女性的干预措施未能减少CT的流行。显然，干预措施也必须针对男性，特别是那些反复感染的人，他们可能是核心传播者。我们还将检查镁，因为有越来越多的证据表明，它是生殖健康发病率的重要来源，而且有记录表明重复感染率很高。这项研究的目标是减少异性恋男性中Ct和/或MG的早期重复感染。目的1：为了量化异性恋男性中Ct和/或MG早期重复感染的可能来源-我们将结合电子性日记、治愈测试计算机辅助访谈和最新的Ct和/或MG基因分型数据来计算治疗测试时最可能的重复感染来源。 我们假设重复感染有多个来源，治疗失败率很高(即&gt；6%)，这需要重新评估目前的治疗指南。目的2：深入探讨重复CT和/或MG感染的来源，探讨异性恋男性对EPT和/或重新筛查的适应情况。将对有(n=30)和没有(n=30)重复感染CT和/或MG的男性进行深入访谈，以加强我们对导致或不导致重复感染的危险行为和背景的微妙、细微差别的理解。这些数据将允许开发更多适合性别的咨询和干预措施，以减少异性恋男子的重复感染。为了实现这些目标，我们延长了在R56中开始的工作。前往两家城市性病诊所就诊的男性(n=4777)将接受CT/mg筛查。患有任何一种有机体(约2327)的男性将完成每周一次的电子性日记，并在基线4周后返回进行治愈筛查和面谈测试。来自重复感染CT和/或MG的男子的样本(每个200人)将进行基因分型。这项研究很好地符合NIAID减少健康差距/提供更有效的性病治疗的目标。