SCREENING FOR ASYMPTOMATIC STDS AND STAPHYLOCOCCUS CARRIAGE IN HIV INFECTED MEN

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。性传播疾病（std）已被证明在增加，特别是在男男性行为者（MSM）中。性传播疾病的存在与社区中不安全的性行为有关，并可能助长艾滋病毒的传播。此外，淋病和衣原体无症状感染的频率也在增加。因此，最近疾病控制和预防中心（CDC）的性病指南建议对高危男男性接触者进行性风险评估、以客户为中心的预防和性病筛查，包括对尿道、咽和直肠部位进行检测。建议至少每年进行一次筛查，对那些被认为处于最高风险的人进行更频繁的筛查。由于关于如何确定筛查的最佳频率以及哪些人群构成最高风险的数据很少，因此该指南主要基于专家意见。我们的研究将通过长期研究感染艾滋病毒的男男性接触者来探讨这些问题，以确定无症状感染的新病例被发现的频率，以及是否有选择的群体，其行为预示着他们患性病的风险最高。为了评估无症状性传播疾病的HIV传播风险，我们将测量无症状性传播疾病患者治疗前后生殖器分泌物中的HIV载量。研究的第二部分将重点关注耐甲氧西林金黄色葡萄球菌（MRSA）在鼻腔中的无症状定植。最近，在地方和全国范围内，男男性行为者中耐抗生素（甲氧西林）金黄色葡萄球菌（MRSA）感染有所增加。这些MRSA感染似乎比典型的金黄色葡萄球菌感染更严重和更具传染性。此外，有数据表明，男男性行为者之间的人际传播与性传播疾病的传播方式相似。怀疑金黄色葡萄球菌（金黄色葡萄球菌）和MRSA感染发生在金黄色葡萄球菌鼻腔定植后。然而，人们对金黄色葡萄球菌在鼻腔内的持久性所知甚少。为了更好地了解金黄色葡萄球菌和MRSA鼻腔定植在男男性接触者中的流行情况、其获得性和持久性，我们将对患者鼻腔中金黄色葡萄球菌的定植进行纵向调查。在每次研究访问中，参与者将接受双鼻孔鼻拭子，这些拭子将被用于检测金黄色葡萄球菌和耐药金黄色葡萄球菌/MRSA的存在。此外，将对这些金黄色葡萄球菌分离株进行菌株类型测试，以确定在同一患者体内定殖的菌株是否持续存在，还是被其他金黄色葡萄球菌菌株所取代，并了解不同人群中金黄色葡萄球菌本地菌株的相关性。此外，我们将要求参与者捐献血液和血清样本以供将来的检测。感染领域正在迅速发展。新认识的病原体有可能被发现，而已知的病原体在未来也将具有临床意义。这项纵向研究的参与者储存的血液和血清样本将在未来回答有关潜在新感染的患病率和发病率的问题时非常有价值。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Sexually transmitted diseases (STDs) have been shown to be increasing, particularly in men who have sex with men (MSM). The presence of STDs correlates with unsafe sexual practices in the community and can contribute to HIV transmission. Moreover, there is an increasing frequency of asymptomatic infections with gonorrhea and Chlamydia. Consequently, recent Centers of Disease Control and Prevention (CDC) STD guidelines recommend assessment of sexual risk, client centered prevention, and STD screening to include testing of urethral, pharyngeal and rectal sites in at-risk MSM. It is suggested that screening be performed at least annually, and more frequently in those considered to be at the highest risk. Since there are few data regarding how to define the optimal frequency for screening and what group constitutes those at the highest risk, the guidelines are primarily on expert opinion. Our study will explore these issues by studying HIV-infected MSM over time to determine how often new cases of asymptomatic infection are identified and whether there are select groups whose behaviors predict that they are at the greatest risk for STDs. To assess the risk for HIV transmission in asymptomatic STDs, we will measure the HIV load in genital secretion in patients with asymptomatic STD before and after therapy. The second part of the study will focus on asymptomatic colonization of Methicillin resistant Staphylococcus aureaus (MRSA) colonization in the nasal cavity. Recently there have been increases locally and nationally of antibiotic (methicillin)-resistant Staphylococcus aureus (MRSA) infections among men who have sex with men. These MRSA infections appear to be possibly more serious and contagious than typical S. aureus infections. Additionally, there ar edata suggesting that transmission from person to person among MSM occurs in a similar fashion to sexually transmitted diseases. It is suspected that Staphylococcus aureus (S. aureus) and MRSA infections occur after nasal colonization with S. aureus established. However, little is known about the persistence of S. aureus colonization in the nose. To better understand the prevalence of S. aureus and MRSA nasal colonization among MSM, its acquisition and its persistence, we will perform a longitudinal survey of nasal colonization with S. aureus in noses of patients. At each study visit, participants will undergo nasal swabbing of both nostrils and these swabs will be tested for the presence of S. aureus bacteria and the presence of drug-resistant S. aureus/MRSA. Additionally, these S. aureus isolates will be tested for strain type to see if the strains colonizing a patient persist in the same patient or are replaced with other S. aureus strains and to understand the relatedness of the local strains of S. aureus among different persons. Additionally, we will ask the participants to donate blood and serum samples for future testing. The field of infections is developing rapidly. Newly recognized pathogens are likely to be discovered as well as known pathogen will become clinically significant in the future. Stored blood and serum sample from participants of this longitudinal study will be very valuable in the future to answer questions regarding prevalence and incidence of potential new infections.